Pathopharm II: Unit 2 medications

Glucagon

Uses: Prevents hypoglycemia when pt unconscious/unable to swallow oral glucose

Action: Maintains blood glucose levels (by stimulating liver to convert glycogen into glucose)

Route: 1 mg IM/SQ

SE: Nausea, vomiting, hyperglycemia,

Specific nursing considerations: Pt should eat complex carb after, monitor for hypokalemia

Sulfonylureas

Ex: Glipizide, Glyburide

Uses: T2DM

Action: stimulates pancreas to increase insulin production via B-cells

Route: PO

SE: Hypoglycemia, weight gain

Specific nursing considerations: Take 15-30 mins before meal and must not skip meal; decrease of effectiveness after prolong use

a-glucosidase inhibitors

Ex: Acarbose

Uses: T2DM, prediabetics

Action: blocks enzymes that break down carbs into glucose; starch blocker

Route: PO

SE: Diarrhea, flatulence, abdominal distention

Specific nursing considerations: Give with first bite of each meal; can be taken with insulin, metformin, or sulfonylurea

Biguanide

Ex: Metformin

Uses: T2DM

Action: decreases glucose production in liver, increase tissue response to insulin, and reduces glucose absorption in gut

Route: Oral

SE: N/V/D

Specific nursing considerations: Give with meals; Not useful for kidney, liver, or HF pts who drink excessive alcohol; discontinue and withhold before and after IV contrast w/ iodine

Meglitinides

Ex: Repaglinide, “-glinide”

Uses: T2DM

Action: stimulates release of insulin from beta cells

Route: PO

SE: Hypoglycemia, weight gain, headache, nausea

Specific nursing considerations: faster onset & shorter duration; give 30 mins before meals; do not take if missed meals

Thiazolidinediones (Glitizones/ TZDs)

Ex: Pioglitazone

Uses: T2DM, specifically w/ insulin resistance

Action: regulates genes involved in glucose and lipid metabolism by improving insulin sensitivity, transporting more glucose into cells, and liver makes less glucose and triglycerides

Route: PO

SE: Headaches, URT infection, sinusitis, mylagia

Specific nursing considerations: BBW HF; progressively slow

DDP-4 Inhibitors

Ex: Sitagliptin, end in “-gliptin”

Uses: T2DM

Action: delays the breakdown of GLP-1 & GIP (incretin hormones) by DPP-IV enzyme

Route: PO

SE: URT infection, sore throat, headache, hypersensitivity rxns, hypoglycemia

Specific nursing considerations: Monitor s/s of pancreatitis; monitor for hypoglycemia if taking w/ insulin or sulfonylureas; give with/without food

SGLT-2 Inhibitors

Ex: Empagliflozin, end in “-glifozin”

Uses: T2DM

Action: blocks glucose reabsorption in kidneys

Route: PO

SE: Genital yeast infection, UTIs, polyuria; older adults: postural hypotension, dizziness

Specific nursing considerations: With/without food before breakfast/AM; monitor risk of DKA, impaired kidney function

Amyline Mimetic (agonist)

Ex: Pramlintide

Use: T1/T2DM

Action: Mimics amylin hormone in the pancreas, which increases satiety, slows gastric emptying, and suppresses glucagon secretion

Route: SQ injection

SE: N/V, anorexia (loss of appetite), headache

Specific Nursing consideration: give big meals beforehand, never mix with insulin

GLP-1 Agonists

Ex: Exenatide, “-glutide/tide”

Use: T2DM

Action: Mimic incretin hormone, slow gastric emptying, increasing satiety

Route: SQ INJ

SE: N/V/D, possible weight loss

Specific nursing considerations: Monitor for pancreatitis and kidney issues

ACE Inhibitors

End in “-pril”

Action: Inhibit conversion of angiotensin I to angiotensin II

Used for: Hypertension, heart failure, PAD

SE: Dry cough, postural hypotension, elevated K+, angioedema

Specific nursing considerations: Monitor cough, angioedema, K+ levels , Assess BP after FIRST dose, preferred for diabetics, avoid NSAIDs, take 1 hr before meals

Rapid acting insulin

Ex: Lispro, Aspart, Glulisine

When: 0-15 mins before meal

Onset of action: 10-30 mins

Peak: 30 mins - 3hrs

Duration: 3-5hrs

Short acting insulin

Ex: Regular insulin

When: 30-45 mins before meal

Onset of action: 30-60 mins

Peak: 2-5hrs

Duration: 5-8 hrs

Intermediate acting insulin

Ex: NPH

When: Injected before meal

Appearance: cloudy

Onset: 1.5-4hrs

Peak: 4-12 hrs

Duration: 12-18hrs

Long acting insulin

Ex: Glargine, detemir

When: once a day at bedtime/morning

Onset: 1-4hrs

Peak: None

Duration: 16-24 hrs

DO NOT MIX W/ OTHER INSULINS

Octreotide

Use: Acromegaly

Action: Antagonizes (blocks) effect of GH

Route: SQ INJ 3x/wk

SE: Headache, muscle pain, altered blood glucose levels, D/N/V

Specific nursing considerations: GH levels measured 2x/wk, risk for gallstones

Somatropin

Ex: Ominitrope, Genotropin, humatrope; “-trope/tropin”

Use: Hypopituitarism (pituitary hypofunction)

Action: recombinant growth hormone promotes growth

Route: daily SQ INJ

SE: fluid retention, myalgia, joint pain, headache

Specific nursing consideration: monitor glucose, GH levels, and s/s of fluid retention/edema

Furosemide (lasix)

Class: Loop diuretic

Use: Pulmonary edema, edema w/ HR, liver disease, ascites, nephrotic syndrome, HTN w/ HF

Action: Inhibits Na+, Cl-, & H2O reabsorption

SE: Severe hypokalemia, orthostatic hypotension

Specific nursing considerations: FAST ACTING + most potent diuretic, Monitor BP, I&O, daily weights, hydration status, K+, give in AM

Desmopressin

Use: Central DI

Action: Synthetic polypeptide similar to ADH; holds onto more water, helps blood clot, and forms clots

Route: IV, nasal spray, PO

SE: Excessive water retention, drowsiness, headache, nausea, flushing

Specific nursing considerations: Monitor daily weights, I&O, urine specific gravity; IV stronger than PO

Vasopressin

Use: Central DI, hemorrhages, septic shock

Action: controls/prevents polydipsia, polyuria, and dehydration; vasoconstricts

Route: Nasal spray or IV

SE: vasoconstriction, fever, headache, hypertension, abdominal cramping, nausea

Specific nursing considerations: Monitor cardiovascular (HR/BP)

and thromboembolism (leg swelling, redness, warmth, pain, SOB, sudden chest pain)

Antithyroid agents

Ex: Propylthiouracil (PTU), Methimazole

Use: Hyperthyroidism, thyroid storm, pre-surgery, or RAI

Action: Inhibits production of thyroid hormone

Route: PO

SE: abdominal discomfort, nausea, vomiting, agranulocytosis, fever, rash/pruitis, dizziness, peripheral neuropathy, smokey urine, decrease UO

Specific nursing consideration: Monitor CBC, store in a light-sensitive container, may increase anticoagulant effect of heparin or oral anticoagulants

• PTU used for pregnancy & lactation

• DO NOT USE METHIMAZOLE IF PREGN/LACTATING

Corticosteroids

Ex: Prednisone, hydrocortisone “-one”

Use: Addison disease

Action: glucocorticoids; immune suppression, anti-inflammatory

Route: Parenteral, topical, PO

SE: Edema, peptic ulcers, delayed wound healing, osteoporosis, infections

Specific nursing considerations: give with food, never abruptly discontinue, rinse mouth after inhaled route, monitor risk for infection

• Give 2/3 dose AM, 1/3 dose PM (hydrocortisone)

• Action last 18-36hrs

Levothryoxine (synthroid)

Use: hypothyroidism

Action: replaces thyroid hormone

Route: PO, parenteral

SE: Too low — bradycardia, lethargy, constipation, excessive fatigue & sleep. Too high — irritability, hyperthermia, tachycardia, diarrhea, tremors, insomnia

Specific nursing considerations: Take in the morning on empty stomach, 30-45 mins before meals, monitor for angina and cardiac dysrythmias, also used for Dx TSH

Potassium Iodine / Lugol’s solution

Class: antithyroid agent

Use: Pre-op thyroidectomy, thyroid storm

Action: inhibits synthesis and release of thyroid hormones

Route: PO

SE: swelling of buccal mucosa and other mucous membranes, excess salivation, N/V, skin reactions

Specific nursing consideration: Monitor signs iodine toxicity, straw use, AVOID SEAFOOD

Naloxone (Narcan)

Use: Reverses respiratory depression and opioid OD

Action: opioid antagonist (reverse); binds to pain receptors (blocks) but does not reduce pain signals or respiratory depression

Route: IV, IM, SQ, Intranasal

SE: Increased BP, tremors, hyperventilation

Specific nursing considerations: Monitor vitals, no abuse potential, lasts 1hr

Codeine

Opioid antitussive

Use: mild to moderate pain, cough suppression

Action: binds to pain receptors and reduces pain sensation

Route: PO

SE: GI upset, constipation, respiratory depression, CNS depression

Specific nursing considerations: Moderate potential for abuse; contraindicated in peds and breastfeeding mothers, lasts 4-6hrs

Oxycontin

Use: Severe, chronic pain

Action: Binds to opioid receptors to produce strong pain relief up to 12 hrs

Route: PO

SE: Respiratory depression, constipation, N/V, urinary retention, sedation, itchy dizziness, confusion, hallucinations

Specific nursing considerations: DO NOT CRUSH!; high abuse potential, montior vital signs

Corticosteroid nasal spray

Exs: Fluticasone, mometasone

Use: Allergies

Action: Inhibits inflammatory response of allergic rhinitis, decreases mucosal inflammation, and facilitates drainage of sinuses

SE: Nasal mucosal irritation, dry mouth, pharyngeal irritation, oral fungal infections (thrush/candidiasis)

Specific nursing considerations: Teach pt use regularly, clear nasal passage before use, takes several days or 1-2wks for max effect

Leukotriene receptor antagonists (LTRA)

Ex: Montelukast

Use: Allergies; asthma attacks

Action: suppresses leukotriene activity (inflammatory response signal), inhibits airway edema, mucus production, bronchoconstriction, and inflammation

Route: PO

SE: Headaches, dizziness, rash, altered LF, GI changes

Specific nursing considerations: Do not use for acute attacks; Long-term asthma control

Oral decongestants

Exs: Pseudoephedrine, phenylephrine

Use: Allergies

Action: Stimulates adrenergic receptors (CNS) and promotes vasoconstriction of superficial vessels in nose

SE: insomnia, excitation, headache, irritability, increased BP and OP, dysuria, palpitations, tachycardia

Specific nursing considerations: pts w/ CVD, HTN, DM, glaucoma, benign prostatic hyperplasia, liver/kidney disease must tell HCP

First generation antihistamines

Ex: Diphenhydramine

Use: Allergies; relieves acute symptoms of allergic response (itching, sneezing, rhinorrhea)

Action: Bind w/ H1 receptors on target cells, blocking histamine release (act like anticholingeric)

SE: Sedation, somnolence, restlessness, nervousness, insomnia, palpitations, dry mouth, constipation, urinary hesitancy

Route: IV, IM, topical, PO

Specific nursing considerations: Do not use w/ alcohol and drugs; rapid onset

Anticholinergic nasal spray

Ex: Ipratropium bromide

Use: Allergies, common cold, nonallergic rhinitis

Action: Blocks nasal cholinergic receptors, reducing nasal secretions (anti-cholingeric)

SE: Nasal dryness, irritation, nosebleeds, dry mouth

Second generation antihistamines

Exs: cetirizine, fexofenadine, loratidine

Use: Allergies; relieves acute symptoms

Action: Bind w/ H1 receptors on target cells, blocking histamine release

SE: minimal sedation, bladder function, and psychomotor activities

Nursing specific considerations: OTC, longer duration

Decongestant nasal spray

Ex: Oxymetazoline

Use: Nasal congestion

Action: Stimulates adrenergic receptors and promotes vasoconstriction of superficial vessels in the nose

SE: Rebound nasal congestion; vasodilation and congestion

Nursing specific considerations: Do not use more than >3 days; possible addiction

Cromolyn spray

Use: prevention and treatment of allergic rhinitis

Action: Mast cell stabilizer, preventing allergic inflammatory response before it starts

Route: intranasal spray

SE: Nasal irritation/stinging, sneezing afterward, unpleasant taste, headache, nosebleeds

Specific nursing considerations: Use before allergen exposure; takes several days to weeks

Mucomyst

Use: cystic fibrosis, chronic bronchitis, and Tylenol OD/toxicity

Action: breaks down and thins thick, viscous respiratory secretions

SE: Tastes like rotten eggs, vomitting

Route: PO and IV

Specific nursing consideration: repeat dose if vomiting occurs within 1 hr of dosing

Expectorants

Ex: Guaifenesin (Mucinex)

Use: Productive cough

Action: breaking down and thinning out respiratory secretions, making mucus easier to cough up

Route: PO

SE: Nausea, diarrhea, constipation, headache, dizziness

Specific nursing considerations: Encourage fluid intake

Azithromycin

Class: semisynthetic macrolide Abx

Use: URI, LRI, COPD exacerbation preventions/episodes; infections caused by step/haemophilus

Action: binds w/ ribosomal receptor sites in susceptible organisms to inhibit protein synthesis

Routes: IV or PO

SE: nausea, vomiting, diarrhea, abdominal pain, superinfections

Specific nursing considerations: 8oz water, take w/ food, avoid fruit juices; acts as anti-inflammatory effects when used daily

Inhaled corticosteroids (ICS)

Ex: Fluticasone, budesonide, mometasone

Use: Asthma/anti-inflammatory drug

Action: Reduces bronchial hyperresponsiveness, blocks late phase response, and inhibits inflammatory cells

Route: Inhalation, oral, or IV

SE: Easy bruising, decreased bone density, oropharyngeal candidiasis, hoarseness, dry cough

Specific nursing considerations: Use spacer or gargle after use to prevent infection; more effective in improving asthma control

Amoxicillin

Class: penicillin Abx

Use: bacterial infections

Action: PO

SE: diarrhea, nausea, vomiting; vaginal, oral, diaper candidiasis, rash

Specific nursing considerations: watch for penicillin allergy, do not take with acidic juices, 6oz water, monitor for Stevens-Johnson syndrome

Rifampin

Class: Antitubercular

Use: Abx for TB

Action: Broad-spectrum; inhibits RNA polymerase of tubercle bacillus

Route: PO

SE: Hepatotoxicity — hepatitis, hypersensitivity, GI upset, peripheral neuropathy, ORANGE SECRETIONS

Specific nursing considerations: Cancel out birth control and warfarin, orange body secretions, increases metabolism of digoxin and oral hypoglycemics

Isoniazid (INH)

Class: Antitubercular

Use: Abx for TB

Action: interferes w/ DNA of tubercle bacillus

Route: PO, IM

SE: N/V, ab pain; rare — neurotoxicity, optic neuritis, and hepatotoxicity (jaundice)

Specific nursing considerations: Give w/ B6 (prevents peripheral neuritis); no alcohol; monitor LFT

Pyrazinamide

Class: Antitubercular

Use: Abx for TB

Action: bactericidal effect

Route: PO

SE: Hepatotoxicity, increased uric acid levels, fever, skin rash, hyperuricemia, jaundice

Specific nursing considerations: Take w/ food

Ethambutol

Class: Antitubercular

Use: Abx for TB

Action: Inhibits RNA synthesis and is bacteriostatic for tubercle bacillus

Route: PO

SE: Skin rash, GI disturbance, malaise, peripheral neuritis, optic neuritis

Specific nursing considerations: Give w/ food, observe for vision changes, do not for children under 7; red-green color discrimination is normal

Factor Xa Inhibitors

end in “-ban”

Ex: Rivaroxaban (Xarelto) & Apixaban (Eliquis)

Uses: PE, DVT, Atrial fib, stroke prevention

Specific nursing considerations: No monitoring blood level needed

Warfarin (Coumadin)

Use: PE

Anticoagulant

Specific nursing considerations: consistent intake of foods in vitamin K (low or high); monitor INR every 4 weeks

Antidote: Vitamin K

Heparin (LMWH) — Lovenox

Class: Anticoagulant

Action: Prevents clot from getting larger, but DOES NOT BREAK DOWN CLOT just prevents development of other clots

Uses: NSTEMI, MI, PE, DVT, Atrial fib

Route: IV or subcutaneous injection

SE: spontaneous bleeding at mucous membranes, hematuria

Specific nursing considerations: Monitor PTT (46-70), bleeding precautions, avoid aspirin

Antidote: Proamine sulfate

Alteplase (Activase)

Ex: Steptokinase Activase, Tenecteplaxe

Class: Thrombolytic agent, tPA

Use: PE, MI, arterial thrombosis, acute ischemic stroke, occlusion of shunts/caths, or flushing clogged IVs/arterial lines

Action: Clot busters; activates an enzyme that breaks down thrombus

Route: IV

SE: spontaneous bleeding, oozing from fresh wound site, allergic rxns

Specific nursing considerations: Monitor IV site, vitals, INR, PTT, platelets, finbrinogen level, report decreased Hg & Hct

Bronchodilator — LABAs

Ex: Formoterol, salmeterol (never first choice)

Use: Asthma maintenance; COPD

Action: Prevents release of mediators from inflammatory cells, but DO NOT inhibit late phase response or have anti-inflammatory effect

SE: tremors, anxiety, nausea, tachycardia, palpitations

Route: Oral, injectable, inhaled

Specific nursing considerations: Longer onset (12 hrs); must be used w/ controller meds (ICS); caution w/ heart problems

Bronchodilator — SABA

Ex: Albuterol

Use: For acute asthma attack; COPD; quick relief of bronchoconstriction

Action: Prevents release of mediators from inflammatory cells, but DO NOT inhibit late phase response or have anti-inflammatory effects

Route: Oral, injectable, inhaled

Side effects: tremors, anxiety, nausea, tachycardia, palpitations

Specific nursing considerations: should not be used alone; used too frequently causes reduced effectiveness; caution w/ heart problems

Bronchodilator — Methylxanthines

Ex: Theophylline

Use: Asthma

Action: Weak bronchodilator w/ mild anti-inflammatory effects

Route: PO

SE: Nausea, vomiting, palpitations

Specific nursing considerations: Alternative therapy to ICS first line, monitor BP, HR

Bronchodilator — LAMA (Anticholinergics)

Exs: Ipratropium & tiotropium; “-tropium”

Use: Severe asthma attacks, COPD, bronchospasm

Action: Prevents bronchial muscle tightening by reducing parasympathetic response

Route: MDI, inhalation

SE: headache, GI distress, urinary retention, increased intraocular pressure

Specific nursing considerations: Combo w/ ICS

Monoclonal Antibodies

Anti-immunoglobulin E — Omalizumab

Action: Decreases IgE levels, prevents release of chem mediators

Route: SQ

Anti-interleukin-5 — Mepolizumab, benralizumab

Action: Inhibits production and survival of eosinophils

Specific nursing considerations: Long term asthma control

Phosphodiesterase Inhibitor

Roflumilast (Daliresp)

Use: prevent COPD excerbations

Action: Anti-inflammatory

Route: PO

SE: Nausea, headache, diarrhea, insomina, dizziness, weight loss

Specific nursing considerations: FDA warning for psychiatric symptoms; maintenance med