NCLEX pharmacology facts

ACE Inhibitor Drugs

Captopril (Capoten), Enalapril (Vasotec), Enalaprilat (Vasotec IV), Fosinopril (Monopril), Lisinopril (Prinivil)

ACE Inhibitors/ARBs Use

Uses: Hypertension, HF, MI, diabetic neuropathy. Precautions/interactions: caution with diuretic therapy, monitor potassium levels.

Side effects of ACE inhibitor/ARBs

Persistent non-productive cough with ACE. Angioedema (administer epinephrine), hypotension, should not be used in second and third trimester of pregnancy

Captopril time to take

1 hour before meals

Calcium channel blocker drugs

Nifedipine (Adalat, Procardia), verapamil (Calan), Diltiazem (Cardizem), Amlodipine (Norvasc)

Ca++ channel blocker Use

Angina, hypertension. Verapamil and diltiazem used for a fib, atrial flutter, or SVT.
Use cautiously with digoxin and beta blockers, contraindicated for those with HF, heart block, bradycardia. NO GRAPEFRUIT JUICE. IV injection over 2-3 minutes. Slowly taper if discontinuing

Side effects of calcium channel blockers

Constipation, reflex tachycardia, peripheral edema, toxicity

Alpha Adrenergic Blockers (Sympatholytics)

Selectively inhibit alpha, adrenergic receptors, resulting in peripheral arterial and venous dilation that lowers BP. Side effects: dizziness, fainting. Take at bed time to minimize effects of hypotension.

Alpha Adrenergic Blockers Drugs

Prazosin (Minipress), Doxazosin mesylate (Cardura)

Centrally Acting Alpha2 Agonists

Stimulate alpha-adrenergic receptors in the brain to reduce peripheral vascular resistance, heart rate, and systolic and diastolic blood pressure. Used for HTN, hypertensive crisis, severe cancer pain.

Centrally Acting Alpha2 Agonist Drugs

Clonidine (Catapres), Guanfacine HCl (Tenex), Methyldopa (Aldomet)

Centrally Acting Alpha2 Agonist Drug Precautions

Contraindicated with anticoagulant therapy, hepatic failure. Do not administer to clients taking MAOIs. Do not administer methyldopa through IV line with barbiturates or sulfonamides. Use cautiously in CVA, MI, DM, depression, or chronic renal failure. Do not use during lactation

Centrally Acting Alpha2 Agonist Drug Side Effects

Dry mouth, drowsiness, sedation, rebound HTN, black or sore tongue, leukopenia

Beta Adrenergic Blockers (Sympatholytics)

Inhibit stimulation of receptor sites, resulting in decreased cardiac excitability, cardiac output, myocardial oxygen demand, lower BP by decreasing release of renin by kidney. Hypertension, angina, tachydysrhythmias, HF, MI.

Beta Adrenergic Blocker Medications (Cardioselective Beta1 meds)

Metoprolol (Lopressor), atenolol (Tenormin), Metoprolol succinate (Toprol XL)

Beta Adrenergic Blocker Medications (Nonselective beta1 and 2 meds)

Propranolol (Inderal), Nadolol (Corgard), Labetalol (Normodyne)

Beta Adrenergic Blocker Precautions

Contraindicated in clients who have AV block and sinus bradycardia, do not administer nonselective beta blockers to clients who have asthma, bronchospasm, HF, propranolol may mask effects of hypoglycemia in DM, do not administer labetalol in same IV line with furosemide. Do not administer if systolic less than 100 and pulse less than 60.

Beta adrenergic blocker side effects

Bradycardia, nasal stuffiness, AV block, rebound myocardium excitation if stopped abruptly, bronchospasm

Vasodilators

Direct vasodilation of arteries and veins resulting in rapid reduction of BP (decreased preload and afterload). Used for hypertensive emergencies. Precautions: clients who have hepatic or renal disease, older adults, electrolyte imbalances

Vasodilator medications

Nitroglycerin (Nitrostat IV): Enalaprilat (Vasotec IV), Nitroprusside (Nipride), Hydralazine (Apresoline).

Vasodilator Side Effects

Dizziness, headache, profound hypotension, cyanide toxicity, thiocyanate poisoning

Nitroprusside Interventions

Should not be mixed with any medication, apply protective cover to container, discard unused fluid after 24 hour, provide continuous ECG and blood pressure monitoring

Cardiac Glycosides

Used in the treatment of clients who have cardiac failure or ineffective pumping mechanism of the heart muscle. Increase the force and velocity of myocardial contractions to improve stroke volume and CO. Slow the conduction rate, allowing for increased ventricular filling. Used for HF, a fib

Cardiac Glycoside Medication

Digoxin (Lanoxin, Lanoxicaps, Digitek)

Digoxin Precautions/interactions

Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity. ACE and ARBs increase risk of hyperkalemia. Verapamil (Calan) increases risk of toxicity

Digoxin Toxicity

GI effects (anorexia, n/v, abdominal pain), CNS effects (fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects)

Digoxin interventions

Assess apical pulse for 1 min prior to administration. Notify HCP if HR less than 60 (adult), less than 70 (child), less than 90 (infant), monitor for signs of digoxin toxicity, hypokalemia, and hypomagnesemia, notify provider of any sudden increase in pulse rate that previously normal or low, maintain therapeutic level

Management of Digoxin Toxicity

Discontinue digoxin and potassium-wasting medications, treat dysrhythmias with phenytoin (Dilantin) or lidocaine, treat bradycardia with atropine, for excess overdose, administer Digibind to prevent absorption

Antianginal Medications

Organic nitrates, beta adrenergic-blocking agents, and calcium channel blockers to treat pain related to imbalances between myocardial oxygen supply and demand.

Organic Nitrates

Relax peripheral vascular smooth muscles, resulting in dilation of arteries and veins, thus reducing venous blood return (reduced preload) to the heart, which leads to decreased oxygen demands on the heart. Increase myocardial oxygen supply by dilating large coronary arteries and redistributing blood flow.

Organic Nitrates Meds

Nitrostat (sublingual), nitrolingual (translingual spray), nitro-bid (topical ointment), nitro-dur (transderm patch)

Organic Nitrate Precautions/interactions

Contraindicated in clients with head injury, hypotensive risk with antihypertensive meds, erectile dysfunction meds may increase life-threatening hypotension

Organic Nitrates side effects

Headache, orthostatic hypotension, reflex tachycardia, tolerance

Organic Nitrate Interventions

Sublingual: give, wait 5 mins, give again, if not relief call 911, may take up to three doses. May be used prophylactically before exercise.

Nitrobid (topical ointment) administration

Wear gloves, do not massage or rub area, apply to area without hair, cover area where patch is placed with clear plastic wrap and tape in place, gradually reduce over 4-6 weeks.

Nitro-Dur (transderm patch)

Skin irritation may alter medication absorption, optimal locations for patch are upper chest or side, pelvis, inner/upper arm, rotate skin sites daily

Antidysrhythmic Agents

Complex agents with multiple mechanisms of action. They are classified according to their effects on the electrical conduction system of the heart (class I, II, III, IV)

Antidysrhythmic Medications

Adenosine, amiodarone, atropine

Adenosine (Adenocard)

Antidysrhythmic agent. Slows conduction time through the AV node, interrupts AV node pathways to restore NSR. Converts supraventricular tachycardia (SVT) to sinus rhythm. Rapid IV (1-2 seconds) push, flush immediately with normal saline.

Amiodarone (Cordarone)

Antidysrhythmic agent. Prolongs repolarization, relaxes smooth muscles, decreases vascular resistance. For ventricular fibrillation and unstable ventricular tachycardia. Incompatible with heparin, may be given in PO maintenance dose, monitor for respiratory complications.

Atropine

Antidysrhythmic agent. Increases firing of the sinoatrial node (SA) and conduction through the atrioventricular node (AV) of the heart, opposes the action of the vagus nerve by blocking acetylcholine receptor sites. Used for bradycardia and known exposure to chemical nerve agent (AtroPEN).

Antidysrhythmic agents precautions/interactions

Toxicity is a major concern due to additive effects, caution is needed when used with an AV block, caution is needed when using anticholinergic medications.

Adenosine (Adenocard) side effects

Flushing, nausea, bronchospasm, prolonged asystole

Amiodarone side effects

Bradycardia, cardiogenic shock, pulmonary disorders

Atropine side efffects

When used for life-threatening emergency, has no contraindications. Monitor for dry mouth, blurred vision, photophobia, urinary retention, and constipation.

Antilipemic Medications

Aid in lowering low-density lipoprotein (LDL) levels and increase high-density lipoprotein (HDL) levels. Therapy includes diet, exercise, and weight control. Uses: primary hypercholesterolemia, prevention of coronary events, and protection against MI and stroke in clients with diabetes. Should not be used with pregnancy and used with caution in renal dysfunction.

Antilipemic Medication Side Effects

Muscle aches, hepatotoxicity, myopathy, rhabdomyolysis, peripheral neuropathy

Antilipemic Nursing Interventions

Take medication in the eventing (when cholesterol synthesis increases), monitor liver and renal function laboratory profiles, low-fat/high-fiber diet, note dietary precautions with specific classes

Antilipemic Drugs

Simvastatin (Zocor), Lovastatin (Mevacor), Pravastatin sodium (Pravachol), Rosuvastatin (Crestor), Fluvastatin (Lescol, Lescol XL)

Antilipemic Medication Precaustions and interactions

- Prolonged bleeding in certain clientes also taking warfarin (coumadin).
- Has multiple drug interactions: digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NSAIDs, tetracycline, beta-blocking agents, gemfibrozil, glipizide, glyburide, oral contraceptives, and phenytoin.
- DO NOT ADMINISTER WITH GRAPEFRUIT JUICE.

Cholesterol Absorption Inhibitor

Inhibits the absorption of cholesterol secreted in the bile and from food. Often used in combination with other antilipemic medications. Med: Ezetimibe (Zetia). Take 1 hour before or 4 hours after other antilipemics. Risk of liver damage increased when combined with statins.

Inhalation Guidelines

Take beta2 agonist before the inhaled glucocorticoid to increase steroid absorption, examine mouth for irritation, and perform frequent oral care.
1. Remove the mouthpiece cap.
2. If appropriate, shake the container.
3. Stand up or sit upright, exhale deeply.
4. Place the mouthpiece between teeth and close lips tightly around the inhaler.
5. While breathing in, press down on the inhaler to activate and release the medication; continue breathing in slowly for several more seconds (slow, long, steady inhalation is better than quick short breaths)
6. Hold breath for 5-10 seconds
7. Breathe in/out normally.

Beta2 adrenergic agonists

Promote bronchodilation by activating beta2 receptors in bronchial smooth muscle. Albuterol (proventil, ventolin); Formoterol (Foradil), salmeterol (Serevent); Terbutaline (Brethine)

Beta2 Adrenergic Agonist Precautions/Interactions

Contraindicated for clients with tachydysrhythmias; caution: DM, hyperthyroidism, heart disease, hypertension, angina; beta blockers will reduce effects; MAOIs will increase effects.

Beta2 Adrenergic Agonist Side Effects

Tachycardia, palpitations, tremors.

Albuterol (Proventil, Ventolin)

Inhaled (short-acting), few minutes for onset. Used for acute bronchospasm.

Formoterol (Foradil), salmeterol (Severent)

Inhaled (long-acting), onset is 15-20 minutes and lasts 12 hours. Caution against using salmeterol more frequently than every 12 hours.

Terbutaline (Brethine)

Oral (long-acting), long term control of asthma.

Methylxanthines

Relaxation of bronchial smooth muscle, resulting in bronchodilation. Relief of bronchospasm and long-term control of asthma.

Methylxanthines Drugs

Aminophylline (Truphylline), Theophylline (Theo-Dur, Theolair, Theo-42)

Methylxanthine Precautions/Interactions

Contraindicated with active peptic ulcer disease. Caution: DM, hyperthyroidism, heart disease, HTN, angina. Do not mix parenteral form with other medications. Phenobarbital and phenytoin decrease theophylline levels. Caffeine, furosemide, cimetidine, fluoroquinolones, acetaminophen, and phenylbutazone falsely elevate therapeutic levels.

Methylxanthine Side Effects

Irritability and restlessness, toxic effects (tachycardia, tachypnea, seizures

Methylxanthine Nursing Interventions

Monitor therapeutic levels for aminophylline and theophylline, avoid caffeine intake, monitor for signs of toxicity, smoking will decrease effects, alcohol abuse will increase effects.

Treatment of methylxanthine toxicity

Stop parenteral infusion, activated charcoal to decrease absorption in oral overdose, lidocaine for dysrhythmias, diazepam to control seizures.

Inhaled anticholinergics

Muscarinic receptor blocker resulting in bronchodilation. Used to prevent bronchospasm, manage allergen or exercise-induced asthma, or COPD. Maximum effects may take up to 2 weeks, shake inhaler well before administration, when using two different inhaled medications, wait 5 minutes between, if administered via nebulizer, use within 1 hour of reconstitution.

Inhaled anticholinergic drugs

Ipratropium (Atrovent) and Tiotropium (Spiriva)

Inhaled anticholinergic Precautions/Interactions

Contraindicated for clients with peanut allergy (contains soy lecithin), use extreme caution with narrow-angle glaucoma and BPH, do not use treatment of acute bronchospasms.

Inhaled anticholinergic side effects

Dry mouth and eyes, urinary retention.

Glucocorticoids

Prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function. Short term uses: IV agents for status asthmaticus, oral for treatment of symptoms following an acute asthma attack. Long term uses: inhaled for prophylaxis of asthma and oral for treatment of chronic asthma.

Glucocorticoids Oral Drugs

Prednisone (Deltasone), Prednisolone (Prelone), and betamethasone (Celestone).

Glucocorticoids Inhalation Drugs

Beclomethasone dipropionate (QVAR), budesonide (pulmicort, flexhaler), fluticasone propionate (Advair, Flovent), and Triamcinolone acetonide (Azmacort)

Glucocorticoid IV Drugs

Hydrocortisone sodium succinate (Solu-Cortef), Methylprednisolone sodium succinate (Solu-Medrol), Betamethasone sodium phosphate (Betnesol, Celestone Phosphate)

Glucocorticoid Precautions/Interactions

Clients who have DM may require higher doses, never stop medication abruptly

Glucocorticoid Side Effects

Euphoria, insomnia, psychotic behavior, hyperglycemia, peptic ulcer, fluid retention (increased appetite), withdrawal symptoms.

Glucocorticoid Nursing Interventions

Assess client activity and behavior, administer medication with meals, teach symptoms to report, do not take with NSAIDs, teach client about gradual reduction of dose to prevent Addisonian Crisis

Leukotriene Modifiers

Prevent effects of leukotriene resulting in decreased inflammation, bronchoconstriction, airway edema, and mucus production. Used for long-term management of asthma in adults and children over 15, prevention of exercised-induced bronchospasm. Never abruptly substitute corticosteroid therapy, teach client to take daily, do not decrease or stop taking other prescribed asthma drugs until instructed, if using oral granules, pour directly into mouth or mix with cold soft foods (never liquids), and use open packets within 15 minutes.

Leukotriene Modifiers Precautions/Interactions

Do not use for acute asthma attack and chewable tablets contain phenylalanine.

Zileuton (Zyflo)

Leukotriene modifier. High risk of liver disease, increased warfarin effects, theophylline toxicity. Elevated liver enzymes.

Zafirlukast (Accolate)

Leukotriene modifier. High risk of liver disease, increased warfarin effects, theophylline toxicity. Elevated liver enzymes.

Montelukast (Singulair)

Leukotriene modifier. Phenobarbital will decrease circulating levels of montelukast.

Antitussives

Hydrocodone and codeine. Suppress cough through action in the CNS. Used for chronic nonproductive cough. Opioid antitussives have potential for abuse.

Expectorants

Guaifenesin (Mucinex). Promote increased mucous secretion to increase cough production. Often combined with other agents to manage respiratory disorders.

Mucolytics

Acetylcysteine (Mucomyst, Acetadote) and hypertonic saline. Only saline solutions should be used in children younger than 2 years. Enhance the flow of secretions in the respiratory tract. Used for acute and chronic pulmonary disorders with copious secretions, cystic fibrosis, and an antidote for acetaminophen poisoning. Aspiration and bronchospasm risk.

Nursing Interventions for Antitussives, expectorants, and mucolytics

Caution with OTC meds, potentiate effects. Monitor cough frequency, effort and ability to expectorate, monitor character, tenacity of secretions, auscultate for adventitious lung sounds, teach client why multiple therapies are needed, and promote fluid intake.

Side effects for Antitussives, Expectorants, and Mucolytics

Drowsiness, dizziness, and constipation.

Decongestants

Stimulate alpha1 adrenergic receptors, causing reduced inflammation of nasal membranes. Used for allergic rhinitis, sinusitis, and common cold. Drugs: phenylephrine (Sudafed), ephedrine (Pretz-D), and naphazoline (Privine), phenylpropanolamine. Side effects: anticholinergic effects and drowsiness.

Antihistamines

Decreased allergic response by competing for histamine receptor sites. Used to relieve/prevent hypersensitivity reactions. Side effects: anticholinergic effects and drowsiness.

Decongestant/Antihistamine Precautions/Interactions

Use cautiously in clients with HTN, glaucoma, peptic ulcer disease, and urinary retention. Children may have symptoms of excitation, hallucinations, incoordination, and seizures.

Nursing Interventions for Antihistamines and Decongestants

Assess for hypokalemia, monitor BP, teach client to manage anticholinergic effects, advise to take at night.

Oral Hypoglycemics

Used in conjunction with diet and exercise to control glucose levels in clients who have type 2 diabetes. Precautions/interactions: caution in clients with renal, hepatic, or cardiac disorders. Generally avoided during pregnancy and lactation. Instruct client to discuss with prescriber.

Alpha-glucosidase inhibitors

Oral hypoglycemic. Acarbose (Precose) and miglitol (Glyset). Slows carbohydrate absorption and digestion. Contraindicated in clients with intestinal disease due to increased gas formation.

Biguanides

Oral hypoglycemic. Metformin (Glucophage). Reduces gluconeogenesis and increases uptake of glucose by muscles. Withhold 48 hours prior to and 48 hours after a test with contrast media. Contraindicated in clients with severe infection, shock, and hypoxic conditions.

Gliptins

Oral hypoglycemic. Sitagliptin (Januvia). Promotes release of insulin, lowers glucagon secretion and slows gastric emptying. Caution with impaired renal function- dose will be reduced.

Meglitinides

Oral hypoglycemic. Repaglinide (Prandin) and nateglinide (Starlix). Reduces production of glucose within the liver through suppression of gluconeogenesis. Increases muscle uptake and use of glucose. Should not be used with NPH insulin due to risk of angina.

Sulfonyleureas

Oral hypoglycemic. Glipizide (Glucotrol) and glyburide (DiaBeta, Micronase). Promotes release of insulin from the pancreas. Extreme high risk of hypoglycemia in clients with renal, hepatic, or adrenal disorders.

Thiazolidinediones

Oral hypoglycemic. Rosiglitazone (Avandia) and pioglitazone (Actos). Decreases insulin resistance. There is high risk of CHF due to fluid retention.

Oral Hypoglycemic Nursing Interventions

Teach signs and management of hypoglycemia, especially with sulfonylureas. Encourage diet and exercise to follow American Diabetes Association recommendations. Monitor glycosylated hemoglobin (HbA1C). Refer to diabetic nurse educator.

Lispro (Humalog)

Rapid-acting insulin. Onset: less than 15 minutes. Peak: 0.5-1 hour. Duration: 3-4 hours.

Regular (Humulin R)

Short-acting insulin. Onset: .5-1 hour. Peak: 2-3 hours. Duration: 5-7 hours.

NPH (Humulin N)

Intermediate-acting insulin. Onset: 1-2 hours. Peak: 4-12 hours. Duration: 18-24 hours.