DRUG CLASS

What is a therapeutic drug class?

The classification that tells you what the drug is for — its indication (e.g. pain control; hypertension; infection). This is the primary focus in Nursing 1.

What is a pharmacological drug class?

A classification based on the drug's mechanism of action; physiological effect; and chemical structure. Found in the PDR (Physician's Desk Reference).

What is an indication for a medication?

The reason the medication is being given to the patient.

What does contraindication mean?

A reason the medication should NOT be given — could be food interactions; other medications; herbal supplements; NPO status; or a patient condition.

What is the difference between a side effect and an adverse reaction?

A side effect is an expected known outcome of the medication. An adverse reaction is unexpected and potentially harmful.

In drug notation how do you identify a generic name vs. a brand name?

Generic names are written in all lowercase letters. Brand names begin with a capital letter.

On what are nursing students tested — generic or brand names?

Generic names are used for testing. Both generic and brand names should be known for patient care.

What is the average number of medications a hospitalized patient takes per day?

Approximately 15 medications per day.

What are some other considerations that go along with giving out medications?

• Assessments

• Interventions

• Evaluations

• Pt/family education

Thought Process Applied to Practice

1. What is the medication?

2. How is it classified?

3. What does it do, or what is it

used for?

4. What is the dose?

5. Is the dose appropriate for the

patient?

6. Are there any contraindications?

7. Is an assessment needed before

or after administration?

8. Are there any nursing

interventions needed?

9. Is patient teaching needed?

Lisinopril (Anti-Hypertensive)

An ACE inhibitor commonly used to treat high blood pressure and heart failure by relaxing blood vessels.

Assessment:Full set of Vital signs before and after administration

Teaching: Monitor BP at home and take it at the same time of the day. Sit up for a 1-2minute before standing up

Side Effects: Syncope, Dizziness,

What is the nurse's responsibility if they don't know why a patient is on a medication?

"They must find out — look it up in the drug handbook; ask the pharmacist; or consult available hospital resources before administration."

What is the generic name and brand name of the most common non-opioid analgesic?

Generic: acetaminophen. Brand name: Tylenol.

What are the two therapeutic uses of acetaminophen?

Pain relief (mild to moderate) and antipyretic (fever reduction).

What pain scale range do non-opioid analgesics control?

Mild to moderate pain — pain scale of 0 to 6.

What pain scale range do opioid analgesics control?

Moderate to severe pain — pain scale of 6 to 10.

What is the maximum dose of acetaminophen in a 24-hour period?

2 to 3 grams per 24 hours.

What is the major adverse effect of large doses or regular use of acetaminophen?

Liver toxicity (hepatotoxicity).

What are the signs of acetaminophen liver toxicity?

"Nausea; vomiting; diarrhea; right upper quadrant tenderness; and elevated liver function tests (LFTs)."

Why must the patient's age be considered when dosing acetaminophen?

As patients age kidney and liver function declines — giving maximum doses to elderly patients couldcincrease the risk of toxicity.

What lab values should be monitored for patients on acetaminophen?

Liver function tests (LFTs) especially if the patient has overdosed or is on regular or high doses.

What tablet strengths does acetaminophen come in?

325 mg (regular strength); 500 mg (extra strength); and 650 mg (suppository form).

How long is acetaminophen recommended for short-term use before consulting a healthcare provider?

Less than three days and then consult their HCP.

What patient education is essential for acetaminophen?

"Know the 2–3 gram per 24-hour maximum; identify the strength of tablets at home; count total doses carefully; and consult HCP if needed beyond 3 days."

What does NSAID stand for?

Non-Steroidal Anti-Inflammatory Drug.

Name four NSAIDs mentioned in the lecture.

"Ketorolac (Toradol); ibuprofen (Advil); naproxen (Aleve); and Salicylates-aspirin (Bayer)."

What are the four therapeutic uses of anti-inflammatory medications?

"Anti-inflammatory; antipyretic (fever); analgesic (pain); and low-dose anticoagulant (Aspirin)."

What dose of aspirin is used as a low-dose anticoagulant?

81 mg (formerly called baby aspirin). If a patient is on 81 mg aspirin it is NOT for fever — it indicates a cardiac or anticoagulant purpose.

How do NSAIDs differ from acetaminophen?

NSAIDs are anti-inflammatory — they reduce swelling and inflammation at the injury site. Acetaminophen only controls pain and has no anti-inflammatory effect.

What is the most common side effect of NSAIDs?

"GI distress — nausea; vomiting; stomach pain; and diarrhea." Dizziness, Tinnitus, and Occult Blood loss

What does occult blood loss mean in relation to NSAIDs?

Hidden blood loss — blood in the stool or urine not visible to the naked eye; caused by overuse of NSAIDs.

What is tinnitus and when does it occur with aspirin?

Tinnitus is ringing in the ears. When it occurs with aspirin it generally indicates aspirin toxicity.

What lab is specific to monitoring aspirin toxicity?

Salicylate level — measures the amount of salicylate in the blood to guide treatment.

What labs should be monitored for patients on NSAIDs?

"CBC (especially platelets and hemoglobin/hematocrit); BMP (BUN and creatinine for renal function); and LFTs if available."

Why monitor platelets before giving NSAIDs?

NSAIDs can interfere with clotting — platelets are essential to clotting and must be at an appropriate level before administration.

What nursing precautions are needed for patients on NSAIDs who require procedures?

Hold pressure longer at IV sites and be extra careful with any invasive procedures due to increased bleeding risk.

What should patients be instructed to do when taking oral NSAIDs?

Take with a full glass of water and eat food to offset GI distress and nausea.

Why should patients avoid alcohol while on NSAIDs?

Alcohol potentiates GI irritation and the risk of bleeding with NSAIDs.

Why should NSAIDs not be taken with anticoagulants?

NSAIDs potentiate the anticoagulant effect significantly increasing the risk of bleeding. The HCP must be notified.

What is Reye syndrome?

A rare but serious condition causing swelling of the liver and brain in children associated with giving aspirin during viral illnesses (flu; chickenpox).

What are the signs and symptoms of Reye syndrome?

"Confusion; seizures; and loss of consciousness. It is a true emergency."

What is the age restriction for aspirin use in children?

Aspirin is not recommended for children under 12 years old due to the risk of Reye syndrome.

What medications are safe for fever and pain in children under 12?

Acetaminophen and ibuprofen. They can be alternated every four hours to avoid exceeding the maximum dose of either.

What abbreviation for aspirin might appear on a patient's allergy bracelet?

ASA.

What pain scale range do opioid analgesics control?

Moderate to severe pain — pain scale of 6 to 10.

Name four common opioids mentioned in the lecture.

"Morphine sulfate; hydrocodone; hydromorphone (Dilaudid); and oxycodone (OxyContin)."

How do opioids work?

They bind to opioid receptors in the CNS inhibiting ascending pain pathways — essentially blocking the pain signal.

What are expected (common) CNS side effects of opioids?

"Drowsiness; confusion (especially in elderly); impaired concentration; and sedation."

What GI and urinary side effects are common with opioids?

"Nausea; vomiting; constipation; and urinary retention."

What cardiovascular and respiratory side effects are associated with opioids?

"Decreased respirations; decreased blood pressure; diaphoresis; and bradycardia."

Narcotics affect the full body system so it requires a…

full body assessment to ensure patient safety and identify potential side effects. Before and After administration of narcotics.

What respiratory rate requires the nurse to hold an opioid and notify the HCP?

Respiratory rate less than 12 breaths per minute.

What safety measures must be in place for patients receiving opioids?

Fall precautions — call bell within reach; bed in lowest position; side rails up. As well as Alert and Oriented x 4

What herb interacts with opioids and increases sedation?

St. John's Wort — patients must be asked about herbal use during admission assessment.

What misconception do many elderly patients have about opioids?

That taking even one dose will cause addiction. Patient education is needed to explain appropriate therapeutic use.

What patient teaching is essential for patients going home on opioids?

"Change positions slowly due to dizziness; avoid driving or operating heavy machinery; and avoid alcohol and other CNS depressants."

What is the generic name and brand name of the opioid antagonist?

Generic: naloxone. Brand name: Narcan.

How does naloxone work?

It blocks opioid receptors and displaces the opioid — reversing its effects.

What are the known side effects of naloxone?

There are no known adverse side effects. The patient may wake up angry because their pain relief has been reversed.

What routes can naloxone be administered by?

"Nasal; oral; endotracheal; IV; and injectable."

What must the nurse assess frequently after administering naloxone?

"Respiratory status; vital signs; level of consciousness; and pain level (since pain relief has been reversed)."

Is there a maximum dose for naloxone?

Not that the instructor is aware of — multiple doses may be required depending on the amount of opioid to be reversed.

What lab value may naloxone affect?

PTT (partial thromboplastin time) — it may increase bleeding times though this would not delay administration in an emergency.

After administering naloxone what alternate pain management must the nurse address?

Reassess pain and plan for alternate pain control since the opioid effect has been reversed.

What is the therapeutic use of anxiolytics?

"Treatment of anxiety and insomnia; but also used for seizure control; alcohol withdrawal; skeletal muscle spasms; and preoperative sedation."

Name three common anxiolytics and their brand names.

"diazepam (Valium); alprazolam (Xanax); and lorazepam (Ativan)."

What suffix do most anxiolytics share?

They all end in -pam (the pams).

How do anxiolytics work?

They inhibit nerve impulse transmission — slowing everything down and reducing anxiety.

What are the common side effects of anxiolytics?

"Sedation (especially with first doses); dizziness; dry mouth; blurred vision; fatigue; constipation; ataxia; and lowered blood pressure."

Why is it critical to know the reason a patient is taking an anxiolytic before administration?

Anxiolytics treat multiple conditions — incorrectly telling a patient they are receiving medication for a condition they don't have can cause significant distress and damage trust.

What is the danger of stopping anxiolytics abruptly after long-term use?

New onset seizures can occur — patients must be tapered (phased off) gradually; not stopped cold turkey.

What substances decrease the effectiveness of anxiolytics?

Tobacco and caffeine both decrease the effects of these medications.

What substances must be avoided while taking anxiolytics?

Alcohol and other CNS depressants — they increase sedation dangerously.

What patient teaching is essential for anxiolytics?

"No driving or operating heavy machinery; avoid alcohol; do not stop abruptly; reduce caffeine and tobacco; consider non-pharmacologic relaxation techniques."

What is the therapeutic use of diuretics?

Decrease edema and decrease blood pressure by increasing urine output and excretion of water; sodium; and electrolytes through the kidneys.

What conditions are diuretics commonly used for?

"Congestive heart failure; excessive lower extremity swelling/edema; and kidney impairment."

Name the three subcategories of diuretics covered in the lecture.

"Loop diuretics; thiazide diuretics; and potassium-sparing diuretics."

What is the generic and brand name of the most common loop diuretic?

Generic: furosemide. Brand name: Lasix.

What is the generic and brand name of the common thiazide diuretic?

Generic: hydrochlorothiazide (HCTZ). Brand name: Microzide.

What is the generic and brand name of the (K+) potassium-sparing diuretic?

Generic: spironolactone. Brand name: Aldactone.

How does furosemide (Lasix) affect potassium?

It flushes out potassium — patients on Lasix will have low potassium and typically need a potassium supplement.

How does a potassium-sparing diuretic (spironolactone) differ regarding potassium?

It does NOT wash out potassium — patients on spironolactone generally do NOT need a potassium supplement.

What are the signs and symptoms of hypokalemia (low potassium)?

"Bradycardia; cardiac dysrhythmias; muscle weakness; and leg cramps. Can lead to lethal cardiac rhythm and death if severe enough."

What electrolyte imbalances are common side effects of diuretics?

Hypokalemia (low potassium) and hypernatremia (high sodium) depending on the subcategory.

What labs must be monitored for patients on diuretics?

"BMP — specifically BUN; creatinine; sodium; potassium; and chloride; monitored daily."

What is the risk of long-term overuse of diuretics?

Can decrease kidney function and cause renal failure over time.

Why are patients on diuretics at high risk for dehydration?

Diuretics increase urine output making fluid volume deficit and dehydration a constant risk, so assessing the patient for hydration status is crucial.

Overuse of diuretics can actually decrease kidney function over a long period of time, so…

close monitoring of renal function is essential to prevent renal failure.

What daily monitoring is required for patients on diuretics?

Daily weights — same time; same scale; same clothing. Report a gain or loss of 1–2 pounds in 24 hours or 5 pounds in a week.

When should patients be taught to take their diuretics?

In the morning (or early in the day if multiple doses) — taking them at night causes frequent urination throughout the night and loss of sleep.

What fall precautions should be taught for patients on diuretics at home?

"Remove rugs; clear pathways to the bathroom; sit up slowly before standing; no loose cords on floors. because dizziness can occur from low volume, or BP, or Potassium”

What dietary instructions apply to patients on diuretics?

"Low-sodium diet; plenty of fluids to prevent dehydration; and potassium-rich foods (dark green leafy vegetables; fruits) if on Lasix."

Why is intake and output critical for patients on diuretics?

To monitor fluid balance — determine whether the patient is balanced; taking in too much; or losing too much.

What are the therapeutic uses of anticholinergics?

"Preoperative use (decrease salivation); antispasmodics for peptic ulcers/GI cramping; treatment of symptomatic bradycardia; and prevention of nausea/motion sickness."

Name the three anticholinergic drugs mentioned and their uses.

"Atropine — preoperative and symptomatic bradycardia. Dicyclomine (Bentyl) — GI spasms and cramping. hyoscine (Scopolamine)— patches for nausea and motion sickness."

How do anticholinergics work?

They inhibit the action of acetylcholine — slowing down all body secretions and motility.

What are the general side effects of anticholinergics?

"Dry mouth (cottonmouth); blurred vision; constipation; urinary stasis (retention); loss of appetite; and slowing of all body functions."

Why is atropine used in symptomatic bradycardia?

It increases the heart rate by blocking acetylcholine. It requires some electrical cardiac activity to work — it will not work if there is no heart rate at all.

What does symptomatic bradycardia mean?

Not just a low number — the patient is bradycardic AND hypotensive with decreased or absent peripheral pulses and very delayed capillary refill. The patient is in serious condition.

What critical assessment must be done post-operatively before giving oral intake after atropine?

Auscultate all four quadrants for bowel sounds. Bowel sounds must be present in all four quadrants before giving anything by mouth — no motility means risk of bowel obstruction.