Pharmacology Unit 3

Prils

ACE inhibitors

Sartans

Angiotensin receptor blockers

Triptans

Acute migraine treatment

Statins

Lower LDL cholesterol

Pines

Calcium channel blockers

tidines

H2 blockers (reduce nighttime acid)

Prazoles

proton pump inhibitors for GERD

Azoles

Antifungal

Olol

beta blocker

Gly/Glu/Glit

Antidiabetics

Cillins/Mycins

antibiotics

Analgesics

Can help with deep breathing and getting the client up & moving. Around the clock dosing can maintain steady levels of med

Analgesic routes

Oral, IM, IV, PCA

Non opioid analgesics

Acetaminophen

NSAIDs

Acetaminophen overdose stage 1

Abd pain, diaphoresis, nausea/vomiting, malaise,

pallor

Acetaminophen overdose stage 2

RUQ pain, elevated LFTs

Acetaminophen overdose stage 3

Hepatic failure, encephalopathy, coma

Acetaminophen overdose treatment

Mucomyst (acetylcysteine solution)

Antidiabetics (Biguanides)

Decreases liver's production of glucose, intestinal glucose

absorption, and improves insulin receptor sensitivity

Metformin (Glucophage)

Used for blood glucose control of patients with Type 2

Diabetes

Nursing Care for metformin

- Monitor kidney/liver function

- Take medication in AM if once daily

- Should NOT take if patient NPO

- Hold for procedures using radiologic dyes (CT, MRI, etc.) prior to scan and 48 hours after scan

Nursing considerations for antidiabetics

• Assess blood glucose

• Assess for/teach patient and family on signs of hypo &

hyperglycemia

• Patient should carry glucagon kit/sugar

• Carry diabetic emergency ID

• Comply with diet, meds, and exercise

• Teach how to perform BG check

• Give med with food

Antibiotics

Work by killing bacteria or inhibiting its reproduction, patients should complete entire prescription

Types of antibiotics

1. Penicillin: e.g. amoxicillin

2. Cephalosporins (5 generations)

3. Tetracyclines

4. Sulfonamides - common allergy for patients.

5. Aminoglycosides

Penicillin

• Treats gram + and gram - infections

• Ex: PCN-G, amoxicillin, amoxicillin-clavulanate

Nursing Care for Penicillin

• Take with a FULL glass of water

• Take complete course to prevent antibiotic resistance

• Administer at equal intervals around the clock

• Assess for allergies

Cephalosporins

• Treats gram + and gram - infections

• Ex: cefazolin (Ancef), cephalexin (Keflex), ceftriaxone (Rocephin), cefepime (Maxipime)

nursing care for cephalosporins

• Be cautious with administration if patient is allergic to penicillin

• May cause nausea, vomiting, diarrhea,

• Beware of candidiasis or vaginitis

• Increased risk for unintended pregnancy

Antibiotic Nursing Care

• Use a barrier birth control method if on oral contraceptives

• Teach patients to eat yogurt or take probiotics to maintain normal flora

• Do not stop antibiotics abruptly to prevent superinfection

Diuretics

Drugs that elevate the rate of bodily urine excretion

Three types of diuretics

- Thiazide

- Loop

- Potassium-sparing

Loop diuretics

- Rid the body of excess fluid and electrolytes

- Decreases edema

Loop diuretics examples

- furosemide

- bumetanide

- torsemide

Loop diuretics action

Blocks sodium and water reabsorption at proximal tubule sites and ascending loop of Henle

Loop diuretics adverse effects

orthostatic hypotension, hypokalemia, dry mouth, ototoxicity, loss of volume and hypotension, hyponatremia, hypochloremia, dehydration

Loop diuretics nursing care

- Daily weight

- Administer with food or milk

- Teach patient to change positions slowly

- Sun protection

- Increase potassium in diet

- Maintain usual fluid intake

- I&O

- BP

- Use hard, sugarless candy for dry mouth

When should you report weight loss or gain to the provider

Report weight loss or gain of 3lbs in 1 day to HCP

Normal sodium levels

135-145 mEq/L

Normal potassium levels

3.5-5.0 mEq/L

Normal Therapeutic INR levels

2.5-3

Anticoagulants

prevent blood clot formation

warfarin sodium (Coumadin)

- Anticoagulant

-disrupts clotting cascade by slowing fibrin production

- PO same time daily usually at 1700.

warfarin sodium antidote

vitamin K

warfarin drug interactions

- Amiodarone (will increase INR)

- garlic and ginkgo will increase bleeding risk

- St. John's wort will decrease effects

warfarin nursing care

• Monitor PT (Prothrombin time) & INR (International normalized ratio)

• Use electric razor & soft toothbrush

• Wear medical alert bracelet

• Do not change intake of green, leafy vegetables-keep them consistent daily

• Report blood in urine, stool, bleeding gums

• Do not double doses if one is missed.

• Avoid aspirin and NSAIDs

enoxaparin (Lovenox)

enoxaparin (Lovenox)

enoxaparin action

Inhibits thrombus and clot formation by blocking factors Xa and IIa, deactivates thrombin, preventing conversion of

fibrinogen to fibrin

enoxaparin antidote/reversal

protamine sulfate

enoxaparin nursing care

• Do not expel air bubble in pre-filled syringe

• Give SQ, alternate sites, do not massage after injection

• Educate patients on bleeding precautions and to avoid aspirin and NSAIDs unless ordered by provider

Laxatives

medications or foods given to stimulate bowel movements

laxiatives indication for use

Short-term relief for constipation, prevent straining when clinically undesirable, evacuate bowel for diagnostic procedures, removal of ingested poisons

Types of laxatives

- Stimulant

- Bulk-forming

- Osmotic

- Emollients

stimulant laxatives

Works by simulating peristalsis, intestinal mucosa, and smooth muscles (ex. bisacodyl, Dulcolax)

Nursing care for stimulant laxatives

• Do not administer if patient c/o nausea, vomiting, or abdominal cramps

• Ensure easy access to bathroom

• Used for acute constipation and pre-op bowel prep (not for daily use)

Bulk forming laxatives

Works by increasing stool mass and water content, promotes peristalsis

• Ex: psyllium (Metamucil)

Nursing care for bulk forming laxatives

- Mix with min. 8oz cold water, drink immediately

- check for added sugar for diabetic patients

Osmotic laxatives

Works by pulling water in GI tract

• Ex: polyethylene glycol (MiraLAX)

Osmotic laxative nursing care

- Mix with 8 oz of water

- Monitor/assess GI status

Emollients

Works by lubricating stool and intestines; fecal softener

• Ex: docusate (Colace), mineral salts

Contraindications for emollients

- Nausea

- Vomiting

- Fecal impaction or obstruction

Antihypertensives

drugs used to lower blood pressure (ex. ACE inhibitors and beta blockers)

ACE Inhibitors "prils" action

Prevents conversion of angiotensin 1 to

angiotensin II, a vasoconstrictor

ACE inhibitor examples

- captopril (Capoten)

- lisinopril (Prinivil)

ACE inhibitor drug interactions

- Digoxin

- lithium

- potassium sparing diuretics

Adverse/Side effects of ACE inhibitors

• Dry, non-productive cough (reversible)

• Dizziness

• Headache

• Orthostatic Hypotension

Nursing care for ACE inhibitors

• Monitor BP

• If missed dose, do not double up doses

• Change positions slowly

Black box warning for ACE inhibitors

Fetal toxicity

beta blockers action

Blocks beta receptors in the heart causing:

• Decreased heart rate

• Decreased force of conduction

• Decreased rate of AV conduction

beta blockers examples

- metoprolol (Lopressor)

- propranolol (Inderal)

- atenolol (Tenormin)

- carvedilol (Coreg)

What are beta blockers used to treat?

SVT, tachycardia, A-fib, A-flutter

adverse/side effects of beta blockers

- drowsiness

- fatigue

- GI upset

nursing care for beta blockers

• Give with food

• Assess apical pulse & blood pressure before giving

• Report edema, weight gain

• Monitor heart rhythm

• Use with caution with asthma-it is usually not prescribed for an asthmatic

cephalosporins

cef-, ceph-

osmotic laxative example

polyethylene glycol (MiraLax)

emollient laxative example

docusate sodium (Colace)

can emollient laxatives be used long-term?

yes

potassium-sparing diuretic example

Spironolactone