Pharm meds

Morphine Sulfate Expected Pharmacological Action

Opioid analgesic that binds to mu receptors in the CNS (brain/spinal cord) which produces analgesia and euphoria

Morphine Sulfate Therapeutic Use

○ Analgesia for moderate to severs pain

○ Preoperative sedation

○ Reduce anxiety

Morphine Sulfate Complications

○ Respiratory depression

○ Sedation

○ Dizziness

○ Lightheadedness

○ Drowsiness

○ Constipation

○ Nausea

○ Vomiting

○ Urinary retention

○ Cough suppression

○ Potential misuse

Morphine Sulfate Contraindications/Precautions

acute OR severe asthma, hypersensitivity, GI obstruction, and caution in renal impairment

Pregnancy: Drug can cause fetal harm, and prolonged use can result in neonatal opioid withdrawal. Risks outweigh the benefits

○ Pregnancy (long-term)

○ Kidney failure

○ Preterm labor

○ Biliary colic

○ Increased intracranial pressure

○ Older adults

○ Hypotension

○ Prostatic enlargement

○ Hepatic or kidney disease

○ Inflammatory bowel disease

Morphine Sulfate Interactions

5HT3 receptor antagonists: increased risk of serotonin syndrome (includes St. Johns wort, & tryptophan)

Anticholinergics: severe constipation, urine retention

Other CNS depressants, opioids, gen. anesthetics: Increased additive effects, which increases risk of coma/sedation

Diuretics: decreased diuretic efficacy

MAO inhibitors: increased risk of opioid toxicity

Agon-Antag/ partial agon analgesics: withdrawal symptom, reduced effect

Morphine Sulfate Medication Administration

○ Measure VS before giving med

○ Oral

■ Do not crush or chew

○ IV

■ Give over 4-5 min

○ IM

○ SC

○ Rectally

○ Epidural

Morphine Sulfate Evaluation of Effectiveness

Reduction in pain level for patients with moderate-severe pain.

Morphine Sulfate Nursing Interventions

Monitor pain level, respiratory status (esp. during initiation or increase), sighs of sedation, circulatory status (hypotension), adrenal insufficiency, and for signs of serotonin syndrome (agitation, muscle twitching, vomiting)

Morphine Sulfate Client Education

○ Take only when needed

○ Short term use

○ Do not operate vehicles or heavy machinery

○ Change positions slowly

○ Take with food and milk if taken orally

○ Report

■ Inability to urinate

○ Cough regularly

Lovastatin Expected Pharmacological Action

HMG-CoA reductase inhibitor; reduces cholesterol synthesis

Lovastatin Therapeutic Use

Hyperlipidemia and cardiovascular disease prevention

Lovastatin Complications

Muscle pain, liver enzyme elevations (cirrhosis/liver failure), and gastrointestinal symptoms

Lovastatin Contraindications/Precautions

○ (L)iver disease

○ Children under 8 yo

○ Elevated AST or ALT

○ Alcohol use

○ Renal disorders

Lovastatin Interactions

○ Fibrate increases the risk of myopathy or liver toxicity

○ Erythromycin

○ Grapefruit juice

○ Warfarin

■ Can increase PT and INR levels

Lovastatin Medication Administration

Oral; take with the evening meal for better absorption

Lovastatin Evaluation of Effectiveness

Lower LDL levels and overall cholesterol reduction (L)

Lovastatin Nursing Interventions

Monitor lipid levels and liver function tests

Lovastatin Client Education

○ Report

■ Muscle pain

■ Abdominal pain

■ Jaundice

■ Fatigue

○ Comply with periodic liver function testing

ACE Inhibitors Expected Pharmacological Action

• Inhibits ACE from conversing Angio I to Angio II

• Decreases Angiotensin II levels

• Increases Bradykinin (since ACE breaks down bradykinin, an inhibitor would increase) only ACE inhibitors leads to increased bradykinin!!!!

ACE Inhibitors Therapeutic Use

○ Hypertension 

○ Heart failure 

○ Diabetic nephropathy 

○ Left ventricle dysfunction 

ACE Inhibitors Complications

○ Hypotension following the first dose

○ Dry, nonproductive cough

■ Due to the increase in bradykinin

○ Rash

○ Metallic taste in the mouth

○ Angioedema

○ Hyperkalemia

○ Neutropenia

ACE Inhibitors Contraindications/Precautions

○ Pregnancy (can be teratogenic to baby)

○ Breastfeeding

○ Hypotension

○ Liver disease

○ Decreased renal function

○ HF

○ Hyperkalemia

○ Hyponatremia

○ Older adults

○ Cardiovascular disease

ACE Inhibitors Interactions

NSAIDs may reduce effectiveness; increased risk of hyperkalemia with potassium supplements

○ Potassium-sparing diuretics, potassium supplements, and use of salt substitutes.

All increase risk for hyperkalemia

○ Antihypertensive increases risk for hypotension

○ Foods rich in potassium

ACE Inhibitors Medication Administration

Oral; can be taken with or without food 2x-3x a day

ACE Inhibitors Evaluation of Effectiveness

Lower blood pressure and improved heart function (A)

ACE Inhibitors Nursing Interventions

○ Start w/ low dose then gradually increase

○ Monitor

■ BP

■ Dry cough

■ Potassium levels

■ White blood cell count

○ If any of the reactions occur discontinue

ACE Inhibitors Client Education

○ Lie supine if lightheadedness

○ Report dry cough, rash, metallic taste, minor swelling of mouth/throat.

○ Decreased intake and weight loss

○ Report any palpitations, muscle twitching, weakness

HMG-CoA Reductase Inhibitors (Statins) Expected Pharmacological Action

HMG-CoA reductase inhibitors, also known as statins, lower cholesterol in the blood by blocking the enzyme HMG-CoA reductase in the liver.

HMG-CoA Reductase Inhibitors (Statins) Therapeutic Use

○ Reduce LDL levels

○ Increase HDL levels

○ Reduce the risk of cardiovascular disease

HMG-CoA Reductase Inhibitors (Statins) Complications

Myopathy, liver enzyme abnormalities, and digestive issues

HMG-CoA Reductase Inhibitors (Statins) Contraindications/Precautions

○ Liver disease

○ Children under 8 yo

○ Elevated AST or ALT

○ Alcohol use

○ Renal disorders

pregnancy

HMG-CoA Reductase Inhibitors (Statins) Interactions

○ Fibrate increases the risk of myopathy or liver toxicity

○ Erythromycin

○ Grapefruit juice

○ Warfarin

■ Can increase PT and INR levels

HMG-CoA Reductase Inhibitors (Statins) Medication Administration

Oral; taken at night (h)

HMG-CoA Reductase Inhibitors (Statins) Evaluation of Effectiveness

Decreased LDL cholesterol levels

HMG-CoA Reductase Inhibitors (Statins) Nursing Interventions

○ Monitor

■ Myopathy

■ Liver function test

○ Measure creatine kinase levels if muscle pain occurs

HMG-CoA Reductase Inhibitors (Statins) Client Education

○ Report

■ Muscle pain

■ Abdominal pain

■ Jaundice

■ Fatigue

○ Comply with periodic liver function testing

Angiotensin II Receptor Blockers (ARBs) Expected Pharmacological Action

○ Lowers blood pressure by blocking angiotensin 2 receptors.

○ It blocks angiotensin 2 receptors and causes vasodilation in the urinary excretion

of sodium and water. Reduces afterload.

○ Prevent the activation of RAAS

○ Reduces secretions of aldosterone secretion

○ It makes it easier for the heart to pump

Angiotensin II Receptor Blockers (ARBs) Therapeutic Use

Hypertension and heart failure

Angiotensin II Receptor Blockers (ARBs) Complications

○ Hyperkalemia

○ Kidney failure

○ Hypotension

○ Cough

○ Dizziness

○ Angioedema

○ Oliguria

○ Increased creatine/BUN

○ Decreased hemoglobin/hematocrit

Angiotensin II Receptor Blockers (ARBs) Contraindications/Precautions

○ Pregnancy

○ Breastfeeding

○ Hypersensitivity

○ Kidney/liver impairment

Angiotensin II Receptor Blockers (ARBs) Interactions

○ Aliskiren

○ ACE inhibitors

○ ARBs

○ Potassium-sparing diuretics

○ NSAIDs

○ Lithium

Angiotensin II Receptor Blockers (ARBs) Medication Administration (A)

○ Oral

○ Twice a day

○ Give w/ food

Angiotensin II Receptor Blockers (ARBs) Evaluation of Effectiveness

Reduced blood pressure and improved heart function (not ACE)

Angiotensin II Receptor Blockers (ARBs) Nursing Interventions

○ Monitor

■ BP

■ Renal function

■ Potassium before the first dose

■ Urine output

■ Manifestations of heart failure

Angiotensin II Receptor Blockers (ARBs) Client Education

○ Notify the provider if you are pregnant or breastfeeding

○ Report if feeling dizzy, lightheadedness, or hypotension

○ Avoid potassium supplements and salt substitutes to prevent hyperkalemia

Beta-Adrenergic Blocking Agents Expected Pharmacological Action

Beta blockers bind to B1 and B2 receptors and inhibit the effects of epinephrine

Beta-Adrenergic Blocking Agents Therapeutic Use

Hypertension, anxiety, and migraine prophylaxis

Beta-Adrenergic Blocking Agents Complications

○ Bradycardia

○ Shortness of breath

○ Edema

○ Coughing at night

Beta-Adrenergic Blocking Agents Contraindications/Precautions

○ Sinus bradycardia

○ moderate/severe HF

○ Cardiogenic shock

○ Asthma

○ COPD

○ renal/liver disease

○ Diabetes

○ Major depression

○ Pheochromocytoma

Beta-Adrenergic Blocking Agents Interactions

○ Antihypertensives may increase effect

○ Antacids decrease absorption

○ Digoxin increase bradycardia

○ Beta-blockers

○ Antimuscarinic anticholinergic meds

Beta-Adrenergic Blocking Agents Medication Administration

○ Oral

○ IV

○ Do not crush

○ Take before meals or at bedtime

Beta-Adrenergic Blocking Agents Evaluation of Effectiveness

Decreased blood pressure and heart rate; reduced anxiety

Beta-Adrenergic Blocking Agents Nursing Interventions

Monitor heart rate (for signs of heart failure) and blood pressure

Beta-Adrenergic Blocking Agents Client Education

○ Check pulse daily

○ Report shortness of breath, extremity edema, night cough to provider

○ Do not stop talking abruptly

○ Report increase in angina or new onset of chest pain.

Calcium Channel Blockers Expected Pharmacological Action

○ Mild to moderate hypertension

○ Stable angina

○ Variant angina

Calcium Channel Blockers Therapeutic Use

Hypertension and angina

Calcium Channel Blockers Complications

• tachycardia

• headaches

• lightheadedness

• arrythmia

• peripheral edema

• dysrrhytmias

• constiption

• ortho. hypotension

• gingival hyperplasia

• facial flushing

Calcium Channel Blockers Contraindications/Precautions

○ Systolic less than 90mmhg

○ Sick sinus syndrome

○ Concurrent grapefruit juice, rifampin, rifabutin phenobarbital, St. John’s wort

○ Severe renal/liver disease

○ Caution w/geriatric pt

○ HF

Calcium Channel Blockers Interactions

○ Beta-blockers may in(c)rease risk for HF

○ Grapefruit juice

○ St. John’s wort decreases blood levels

Calcium Channel Blockers Medication Administration

○ Oral in capsules, sustained released tablets

○ It can be combined with beta-blocker

Calcium Channel Blockers Evaluation of Effectiveness

Reduced blood pressure and chest pain frequency

Calcium Channel Blockers Nursing Interventions

○ Monitor 

■ HR 

■ Edema 

■ BP 

○ Withhold med if BP is below 90 mmHg systolic

○ Advise regular dental care 

Calcium Channel Blockers Client Education

○ Report rapid Heartbeat increased angina

○ Report swelling of feet/legs

○ Report dizziness syncope

○ Report HR less than 50 bpm

○ Report bleeding gums

Hydralazine Expected Pharmacological Action

Direct vasodilator that relaxes vascular smooth muscle

Hydralazine Therapeutic Use

○ Moderate to severe hypertension

○ Used with Digitalis other vasodilators to treat heart failure on a short-term basis

Hydralazine Complications

○ Headache

○ Dizziness

○ Weakness

○ Fatigue

○ Reflex tachycardia

○ Fluid retention

○ Edema

○ Abrupt withdrawal can cause hypertensive crisis and heart failure

Hydralazine Contraindications/Precautions

○ Allergic

○ Cerebrovascular

○ Cardiovascular disease

○ Server hepatic/renal impairment

Hydralazine Interactions

○ Allergic

○ Cerebrovascular

○ Cardiovascular disease

○ Server hepatic/renal impairment

Hydralazine Medication Administration

○ Oral

■ Give with food

■ Begin slowly then gradually increase

○ IM

○ IV

Hydralazine Evaluation of Effectiveness

Lowered blood pressure (h)

Hydralazine Nursing Interventions

○ Advise clients that headaches/tachycardias can occur

○ Monitor

■ Pulse

■ Edema

■ Crackles in lungs

■ Signs of facial rash

■ Joint pain

■ Fatigue

○ Taper medication

Hydralazine Client Education

○ Begin with a slow dose to minimize side effects

○ Avoid strenuous activity

○ Reports any

■ Rash

■ Joint pain

■ Unexplained fever

■ Chest pain

■ Fatigue

■ Edema

■ Do not stop out of the blue

Lidocaine Expected Pharmacological Action

Local anesthetic that blocks sodium channels, stabilizing the neuronal membrane

Lidocaine Therapeutic Use

Local anesthesia and management of ventricular arrhythmias

Lidocaine Complications

CNS toxicity (seizures, confusion) and cardiovascular effects (bradycardia)

Lidocaine Contraindications/Precautions

Severe heart block and hypersensitivity

Lidocaine Interactions

Increased risk of toxicity with other CNS depressants

Lidocaine Medication Administration

IV for arrhythmias; topical for local anesthesia

Lidocaine Evaluation of Effectiveness

Resolution of arrhythmias or pain relief

Lidocaine Nursing Interventions

○ Monitor closely for CNS effects 

○ Monitor 

■ Vital signs 

■ Cardiac rhythm 

○ Administration 

■ IV 

■ IM (emergency only)

■ Insoluble with other meds antibiotics and phenytoin 

Lidocaine Client Education

○ Report 

■ Numbness of lips 

■ Unusual sensations 

○ Make client aware that cardiac monitoring is frequent and vital signs are monitor frequently 

Amiodarone Expected Pharmacological Action

○ Class 3 medication that blocks potassium channels

○ Blocks Sodium channels

○ Blocks Calcium channels

○ Blocks beta-adrenergic receptors

○ Decreases automaticity

○ Decrease contractility

○ Dialites coronary and peripheral vessels

○ Widened QRS complex

○ Prolonged PR/QT intervals

Amiodarone Therapeutic Use

Ventricular and atrial arrhythmias

Amiodarone Complications

○ Anorexia

○ Nausea

○ Vomiting

○ Constipation

○ Adult respiratory distress syndrome

○ Pulmonary toxicity W/ pneumonitis

■ Fevers, cough and shortness of breath

○ Dizziness

○ Fatigue

○ Malaise

○ Ataxia

○ paresthesia/coronal microdeposits

○ Bradycuasria and tachycardia w/IV infusion

Amiodarone Contraindications/Precautions

○ Pregnancy

○ Breastfeeding

○ Allergy

○ Benzyl alcohol

○ Cardiogenic shock

○ Bradycardia

○ Heart block

○ Sinus node dysfunction

○ Severe hepatic disease

Amiodarone Interactions

○ CYP3-A4 inhibitors/inducers

○ Grapefruit juice

○ Azole antifungal

○ Erythromycin

○ St. Johns wort

○ Phenytoin

○ Diuretics

○ Beta-blockers

○ Calcium channel blockers

Amiodarone Medication Administration

○ Oral

○ IV

○ Make sure to correct low potassium or magnesium levels before beginning

therapy.

○ Electrolyte imbalance can cause dysrhythmias.

Amiodarone Evaluation of Effectiveness

Control of arrhythmias and improved cardiac function

Amiodarone Nursing Interventions

○ Monitor for

■ GI manifestations

■ Vision

■ Light sensitivity/photophobia (UV light)

■ Pulse

■ Blood pressure

■ Cardiac rhythm (IV infusion)

■ Weight changes

■ Edema

■ CNS manifestations

■ Heart failure

○ Test baseline chest x-ray and pulmonary function before starting

○ Auscultate breath sounds

Amiodarone Client Education

○ Take medication w/ milk and food

○ Avoid grapefruit juice

○ Report to your provider if you experience fever, dry cough, dizziness, light

sensitivity, syncope, or shortness of breath.

○ Have routine eye exams.

○ Report weight gain

■ Edema

○ Avoid if pregnant or breastfeeding

○ Vital to take at constant times

Nitroglycerin Expected Pharmacological Action

Vasodilator that relaxes smooth muscle and dilates coronary arteries

○ Works through a series of enzymes

○ Treats CAD by decreasing the oxygen demand of the heart. Variant angina causes

pain through spasms of the coronary arteries. Nitroglycerin increases oxygen

supply in variant angina by relaxing spasms in coronary arteries.

Nitroglycerin Therapeutic Use

Angina pectoris and acute heart failure

Nitroglycerin Contraindications/Precautions

○ Allery

○ pregnancy/lactation

○ Increased intracranial pressure

○ Server anemia

○ Pericardial tamponade

○ Uncorrected hypovolemia

○ Head trauma

○ Glaucoma

○ Server liver disease

○ Older adults

○ Early MI

Nitroglycerin Interactions

○ Antihypertensives

■ hypotension

○ Phosphodiesterase-5

■ Cause server hypotension

○ Anticholinergic

■ Decrease absorption of SL nitro

Nitroglycerin Complications

Headache, hypotension, and reflex tachycardia

Nitroglycerin Medication Administration

○ Sublingual

■ No more than 3 tablets before going to hospital

○ Sustained release capsules

○ Translingual spray

■ 1-2 sprays

■ No more than 3 doses

○ Transmucosal tablet

■ Should not swallow let dissolve in mouth

○ Transdermal ointment/patch

■ Apply areas w/no hair

○ IV

■ Use special tubing

○ Store tablets in dark place

○ Taper dose if used for a long time.

Nitroglycerin Evaluation of Effectiveness

Relief of angina symptoms

Nitroglycerin Nursing Interventions

Monitor blood pressure and angina frequency

Nitroglycerin Client Education

○ Take OTC analgesic for headache

○ Report

■ Dizziness

■ Syncope

○ Move slowly from lying down to standing up to prevent injury.

○ Remove patches every day

○ Take sublingual tabs PRN

Digoxin Expected Pharmacological Action

Cardiac glycoside that increases myocardial contractility and decreases heart rate