SKILLS ORAL MEDS

DILTIAZEM

Indications: Hypertension, angina, arrhythmias

MOA: Blocks calcium channels in the heart and blood vessels, leading to vasodilation, which lowers HR and BP.

Side Effects: Peripheral edema, hypotension, bradycardia, constipation.

NC: Monitor BP and HR. Hold per provider's order parameters (e.g., SBP < 90, HR < 60).

PT: Do not consume grapefruit juice. Change positions slowly.

DILTIAZEM Indications:

Indications: Hypertension, angina, arrhythmias

DILTIAZEM Does

Blocks calcium channels in the heart and blood vessels, leading to vasodilation, which lowers HR and BP.

DILTIAZEM Side Effects:

Peripheral edema, hypotension, bradycardia, constipation.

DILTIAZEM Monitor

Monitor BP and HR. Hold per provider's order parameters (e.g., SBP < 90, HR < 60)

DILTIAZEM Not to do

PT: Do not consume grapefruit juice. Change positions slowly.

Digoxin

Indications: Heart failure, atrial fibrillation, atrial flutter.

MOA: Positive inotropic effect (1 force and efficiency of heart contractions) and negative chronotropic effect (+ HR).

When you dig a hole, go slow and strong.

Side Effects: Arrhythmias, bradycardia, digoxin toxicity (S/S: GI upset, fatigue, weakness, vision changes).

NC: Check pulse before administration (do not administer if pulse < 60 bpm). Monitor digoxin levels during therapy (therapeutic range = 0.5 - 2 ng/mL). Treat bradycardia with atropine, toxicity with digoxin immune fab.

Hypokalemia increases the risk of digoxin toxicity.

Digoxin Indications (what 4?)

Indications: Heart failure, atrial fibrillation, atrial flutter.

Digoxin Does

Positive inotropic effect (1 force and efficiency of heart contractions)

and negative chronotropic effect ( low HR).

Digoxin Side Effects Signs and Symptoms

Arrhythmias, bradycardia, digoxin toxicity

(S/S: GI upset, fatigue, weakness, vision changes).

Digoxin Monitor

Check pulse before administration (do not administer if pulse < 60 bpm)

Monitor digoxin levels during therapy

Hypokalemia( low potassium) increases the risk of digoxin toxicity.

Treat bradycardia with atropine, toxicity with digoxin immune fab.

Potassium

3.5 to 5.0(mEq/L)

Therapeutic range for DIGOXIN

0.5 - 2 ng/mL

lisinopril

Indications: Hypertension, heart failure, myocardial infarction, diabetic nephropathy.

MOA: Blocks conversion of angiotensin I to angiotensin Il, causing vasodilation.

Contraindications: Pregnancy.

Side Effects: ACE: Angioedema, Cough, Elevated potassium, hypotension, dizziness.

Fetal toxicity.

NC: Monitor BP and potassium levels.

PT: Change positions slowly.

lisinopril Indications (what 4?)

Hypertension,

heart failure,

myocardial infarction,

diabetic nephropathy.

Lisinopril does

Ace inhibitor

Blocks conversion of angiotensin I to angiotensin Il, causing vasodilation.

lisinopril Side Effects:

ACE

• Angioedema,

• Cough,

• Elevated potassium,

hypotension, dizziness.

Fetal toxicity.

Lisinopril Monitor- Contraindications

Monitor BP

potassium levels.

Change positions slowly.

kidneys

Contraindications: Pregnancy.

warfarin

Indications: Prevention and treatment of thromboembolic disorders (e.g., DVT, PE, AFIB with thrombus). Prevention of complications following an MI.

MOA: Antagonizes vitamin K, preventing formation of several clotting factors.

Warfarin is going to war on vitamin K!

Side Effects: Gl upset, hepatitis.

Life-threatening bleeding.

NG: Closely monitor PT/INR levels. Therapeutic INR is 2 - 3 (takes 5 - 7 days to get to a therapeutic level). Antidote is vitamin K!

PT: Maintain a consistent dietary intake of vitamin K.

warfarin Indications: (what 4?)

Prevention and treatment of thromboembolic disorders

(e.g., DVT, PE, AFIB with thrombus).

Prevention of complications following an MI.

warfarin does

Antagonizes vitamin K,

preventing formation of several clotting factors.

WARFARIN Side Effects/ warning

Gl upset, hepatitis.

Life-threatening bleeding.

WARFARIN MONITOR

Closely monitor PT/INR levels.

Antidote is vitamin K!

PT: Maintain a consistent dietary intake of vitamin K.

what is the norm INR

2-3

Therapeutic INR is 2 - 3 (takes 5 - 7 days to get to a therapeutic level).

Guaifenesin

Indications: Cough associated with respiratory infections.

MOA: / Thickness of respiratory secretions, makes coughs more productive.

Guaifenesin helps you cough up all that gunk!

Side Effects: Gl upset, dizziness.

PT: To improve cough production and thin secretions, take with a full glass of water and fluid intake.

Guaifenesin Indications:

Cough associated with respiratory infections.

Guaifenesin DOES

LOWERS Thickness of respiratory secretions,

makes coughs more productive.

Guaifenesin Side Effects:

Gl upset, dizziness.

PT: To improve cough production and thin secretions, take with a full glass of water and HIGHER fluid intake.

Pantoprazole

Indications: Duodenal and gastric ulcers, GERD,

Zollinger-Ellison syndrome.

I'm going to take omeprazole and pray my ulcer pain goes away.

MOA: 1 Gastric acid secretion.

Side Effects: Gl upset, C. diff, bone fractures (with long-term use).

PT: Report diarrhea, abdominal pain, bloody stools.

Pantoprazole Indications:

Duodenal

gastric ulcers,

GERD,

Zollinger-Ellison syndrome.

Pantoprazole DOES…

Lower Gastric acid secretion.

Pantoprazole Side Effects:

Gl upset,

C. diff,

bone fractures (with long-term use).

pantoprazole MONITOR

Report diarrhea,

abdominal pain,

bloody stools.

Magnesium 1.5-2.5

Furosemide

Indications: Pulmonary edema, edema (related to heart failure, liver disease, kidney disease), hypertension.

MOA: Blocks reabsorption of Na, Cl, and water in the ascending loop of Henle, causing rapid diuresis.

Furosemide furiously gets rid of excess sodium and water.

Side Effects: Dehydration, electrolyte imbalances (e.g., hypokalemia, hyponatremia), hypotension, ototoxicity, hyperglycemia, rash.

NC: Administer several hours before bed if possible to prevent disruption of sleep, infuse at 20 mg/min, weigh patients daily, monitor 180s and electrolytes,

PT: Consume foods high in potassium (e.g., bananas, dark leafy greens, potatoes, cantaloupe, tomatoes).

Furosemide Indications:

Pulmonary edema,

edema (related to heart failure, liver disease, kidney disease),

hypertension.

Furosemide DOES

Blocks reabsorption of Na, Cl, and water in the ascending loop of Henle, causing rapid diuresis.

Furosemide Side Effects:

Dehydration,

electrolyte imbalances (e.g., hypokalemia POTASSIUM , hyponatremia SODIUM),

hypotension,

ototoxicity,

hyperglycemia,

rash.

Furosemide NURSE ACTION- MONITOR

Administer several hours before bed if possible to prevent disruption of sleep,

infuse at 20 mg/min,

weigh patients daily,

monitor INPUT AND OUTPUT

MONITOR electrolytes,

PT: Consume foods high in potassium (e.g., bananas, dark leafy greens, potatoes, cantaloupe, tomatoes).

sodium levels

135-145