NURS 3000 PHARM - Med Charts for Exam 2, pharm Latest updated version with expert curated questions and answers (GUARANTEED SUCCESS)

Diphenhydramine (Benadryl)

Classifications:

1st Generation H1 Antagonist *inhibit/block*

Indications:

1.) Good for allergenic rhinitis

2.) Best as prophylaxis

Mechanism of Action (MOA):

1.) Competes with histamine to bind to H1 receptors

2.) Acting centrally (brain) and peripherally (airway)

3.) Cross blood brain barrier

Adverse Effects:

1.) More significant central adverse effects (drowsiness and sedation)

2.) Excessice anticholinerfic effects (dry mouth, urinary histancy)

Nursing Concerns/Miscellaneous:

1.) Tolerance develops after a few doses

2.) Used in some OTC sleep aids for insomnia

Loratidine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allergra)

Classifications:

2nd Generation of H1 Antagonists *inhibit/block*

Indications:

1.) Allergic rhinitis

2.) Vertigo and motion sickness [Promethazine (Phenergan) discussed in GI drugs]

3.) Parkinson's disease (central and anticholinergic effects, 1st generation)

4.) Insomnia (OTC sleep aids, 1st generation but tolerance, less than 2 weeks)

5.) Urticara and other skin rashes (1st and 2nd generation, oral and topical creams)

Mechanism of Action (MOA):

1.) Acting peripherally to bind to Histamine 1 receptors

2.) Does NOT cross blood brain barrier

Adverse Effects:

1.) Less significant central adverse effects (drowsiness and sedation)

2.) Less anticholinergic side effects (dry mouth, urinary histancy)

Nursing Concerns/Miscellaneous:

1.) Allergy history and renal impairment, pregnancy and lactation

2.) Avoid OTC cold, allergy unless approved

3.) No alcohol and other CNS drugs

4.) No grapefruit, apple or orange juice in 1 hr of taking drug (decreased absorption, especially 2nd generation)

5.) Stop taking at least 4 days before skin allergy test

Pseudoephedrine (Sudafed)

Classifications:

Decongestant (Oral or Intranasal Spray)

Indications:

Mechanism of Action (MOA):

1.) Activate alpha1 adrenergic receptors (vasoconstriction in nasal mucosa)

2.) Stimulate beta2 adrenergic receptors of the lower respiratory tract (bronchodilation)

Adverse Effects:

1.) Headache, nervousness, tremors (CNS side effects)

2.) Tachycardia, palpitations, hypertension (Cardiovascular)

Nursing Concerns/Miscellaneous:

*Rebound Effects*

1.) Use no longer than 3-5 days

2.) Patients with dependence need a gradual switch to intranasal corticosteriods (nasal spray directly to site)

3.) Oral drugs eliminate rebound effects but slower onset and less effective

Codeine

Classifications:

Antitussives - Opioid

Indications:

Mechanism of Action (MOA):

1.) Suppress cough reflex center in medulla.

2.) Binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain throughout the body and brain.

Adverse Effects:

Dizziness, sedation, abuse causing CNS toxicity (limit use to < a week)

Nursing Concerns/Miscellaneous:

1.) Centrally acting with alcohol and other CNS drugs.

2.) Precaution - fever and productive cough (do NOT inhibit) or pre-existing pulmonary disease.

Dextromethorphan

Classifications:

Antitussives - Non-opioid

Indications:

Inhibit cough reflex in the throat, trachea, or lungs.

Mechanism of Action (MOA):

Acts as a nonselective serotonin reuptake inhibitor and a sigma-1 receptor agonist.

Adverse Effects:

Dizziness, sedation, abuse causing CNS toxicity (limit use to < a week)

Nursing Concerns/Miscellaneous:

1.) Centrally acting with alcohol and other CNS drugs.

2.) Precaution - fever and productive cough (do NOT inhibit) or pre-existing pulmonary disease.

Guaifenesin (Robitussin, Musinex)

Classifications:

Expectorants

Indications:

Helps loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus, drain bronchial tubes and make coughs more productive.

Mechanism of Action (MOA):

Reduce thickness or viscosity of bronchial secretions.

Adverse Effects:

Nursing Concerns/Miscellaneous:

1.) Commonly used OTC drug

2.) Avoid cigarette smoking when taking (can worsen signs/symptoms)

Albuterol (Proventil)

Classifications:

Beta2 Adrenergic Agonists

Indications:

Mechanism of Action (MOA):

Activate selective beta2 adrenergic agonists in bronchus resulting in bronchodilation.

Adverse Effects:

Tachycardia, angina, tremors (act on alpha 1 in cardiovascular)

Nursing Concerns/Miscellaneous:

1.) Inhalation - short acting as rescuer

2.) Oral - long acting

3.) Levalbuterol (Xopenex) - expensive but less cardiac adverse effects (purified version)

Theophylline (Theolair), Aminophylline

Classifications:

Methylxanthines

Indications:

Treatment of the symptoms and reversible airflow obstruction associated with chronic asthma and other chronic lung diseases, e.g., emphysema and chronic bronchitis.

Mechanism of Action (MOA):

1.) Increase cyclic adenoside monophosphate (cAMP) to dilate bronchial smooth muscle

2.) Suppress airway responsiveness to stimuli that promote bronchospasm

Adverse Effects:

*increased cAMP*

1.) cerebral stimulation (restlessness, insomnia, dizziness)

2.) skeletal muscle stimulation (restlessness)

3.) pulmonary vasodilation

4.) cardiac stimulation (palpitation, tachycardia)

5.) diuretics (urinary frequency)

Nursing Concerns/Miscellaneous:

1.) NOT available for inhalation (long term management)

2.) WANT bronchodilation

3.) Risk of toxicity (drug level monitor) = narrow therapeutic drug window

4.) multiple drug-drug interactions and contraindications

5.) NOT commonly used

Ipratropium (Atrovent)

Classifications:

Anticholinergic (antagonist)

Indications:

1.) Bronchospasm associated with COPD

2.) used for allergen- or exercise-induces asthma

3.) pair with albuterol for emergency situations

Mechanism of Action (MOA):

1.) Block cholinergic receptors in bronchial smooth muscle

2.) Intranasal administration reduces nasal hypersecretion

Adverse Effects:

1.) Bladder pain, bloody or cloudy urine, cough producing mucus

2.) difficult, burning, or painful urination (frequent urge to urinate as well)

3.) difficulty with breathing, shortness of breath, tightness in the chest, wheezing

4.) lower back or side pain

Nursing Concerns/Miscellaneous:

1.) Available for inhalation and nasal spray

2.) Complete respiratory history

3.) Respiratory signs assessment including dyspnea, orthopnea, cyanosis, nasal flaring, wheezing (most common)

4.) Vital signs

5.) Pulse Oximetry - oxygen (2 O2) with hemoglobin

6.) Peak Flow (usually >/= 6 yr)

7.) Arterial blood gas (more severe/urgent situations)

8.) Pulmonary Function Test (PFT)

Fluticasone (Flovent)

Classifications:

Anti-inflammatory - Inhaled Corticosteroids as controller

Indications:

Mechanism of Action (MOA):

Reduces inflammation and immune response thus reducing frequency of asthma attacks.

Adverse Effects:

Nursing Concerns/Miscellaneous:

Cost effectiveness, most prescribed

Budesonide (Pulmicort)

Classifications:

Anti-inflammatory - Inhaled Corticosteroids as controller

Indications:

Mechanism of Action (MOA):

Reduces inflammation and immune response thus reducing frequency of asthma attacks.

Adverse Effects:

Nursing Concerns/Miscellaneous:

Expensive with nebulizer

Beclomethasone (Qvar)

Classifications:

Anti-inflammatory - Inhaled Corticosteroids as controller

Indications:

Mechanism of Action (MOA):

Reduces inflammation and immune response thus reducing frequency of asthma attacks.

Adverse Effects:

Nursing Concerns/Miscellaneous:

Cromolyn (Intal)

Classifications:

Anti-inflammatory - Mast Cell Stabilizer

Indications:

Mechanism of Action (MOA):

Stabilizes mast cells thus preventing inflammatory response (release histamine)

Adverse Effects:

Nursing Concerns/Miscellaneous:

Montelukast (Singulair)

Classifications:

Anti-inflammatory - Leukotriene Modifiers as controller

Indications:

Controller Medication

Mechanism of Action (MOA):

Blocks leukotriene receptors in airways thereby preventing airway edema and inflammation.

Adverse Effects:

Nursing Concerns/Miscellaneous:

Isoniazid (INH)

Classifications:

Anti-TB Agent

Indications:

Prophylaxis and active treatment

Mechanism of Action (MOA):

*Inhibits synthesis of mycolic acid on cell wall*

1.) Bacteriocidal for rapidly dividing organisms

2.) Bacteriostatic for dormant mycobacteria

Adverse Effects:

Hepatotoxic- Monitor liver function first 2 weeks

Nursing Concerns/Miscellaneous:

1.) Avoid alcohol and foods containing tyramine (Aged cheeses, smoked or pickled fish, beer, chocolate, red wine) to prevent flushing, palpitation, and BP elevation

2.) Most effective and safest (1st line for TB)

3.) Administer vitamin B6 supplement to prevent neurotoxic effects - peripheral neurophathy

Rifampin

Classifications:

Anti-TB Agent

Indications:

Bacteriocidal

Mechanism of Action (MOA):

Inhibits RNA synthesis

Adverse Effects:

Flu-like hypersensitivity

Nursing Concerns/Miscellaneous:

1.) Potent CYP450 inducer

2.) History including TB exposure, living conditions, HIV status, past medical history

3.) Meication compliance - long term use

4.) No alcohol

5.) Medication taking with food - reduce upset stomach

6.) Infection control with sneezing and coughing

7.) Routine liver function for adverse effects

Ethambutol (Myambutol)

Classifications:

Anti-TB Agent

Indications:

Good for TB resistance

Mechanism of Action (MOA):

Unclear but bacteriostatic by inhibiting cell wall and RNA synthesis

Adverse Effects:

Risk of optic neuritis for distinguishing red and green

Nursing Concerns/Miscellaneous:

1.) Short half-life (1 to 4 hr)

2.) History including TB exposure, living conditions, HIV status, past medical history

3.) Meication compliance - long term use

4.) No alcohol

5.) Medication taking with food - reduce upset stomach

6.) Infection control with sneezing and coughing

7.) Routine liver function for adverse effects

Pyrazinamide (PZA)

Classifications:

Anti-TB Agent

Indications:

Mechanism of Action (MOA):

Inhibits synthesis of mycolic acid

Adverse Effects:

Gout or arthralgia

Nursing Concerns/Miscellaneous:

1.) Old drug, easily develop resistance when used alone

2.) History including TB exposure, living conditions, HIV status, past medical history

3.) Meication compliance - long term use

4.) No alcohol

5.) Medication taking with food - reduce upset stomach

6.) Infection control with sneezing and coughing

7.) Routine liver function for adverse effects

Epinepherine (Adrenaline), Ephedrine (Efedron)

Classifications:

Nonselective Adrenergic Agonists

Indications:

1.) Used to treat bronchospasm, cardiac arrest, and hypotension

2.) CPR, antishock, antianaphylaxis, bronchodilator

Mechanism of Action (MOA):

Activate both alpha and beta receptors

Adverse Effects:

Nursing Concerns/Miscellaneous:

Ephedrine (Efedron) - for OTC bronchodilator

Phenylephrine (Neo-Synephrine)

Classifications:

Alpha1 Adrenergic Agonists

Indications:

1.) Generally prescribed for nasal congestion and hypotension

2.) May be used to produce mydriasis during ophthalmic exams

Mechanism of Action (MOA):

Activate alpha adrenergic receptors

Adverse Effects:

Headache, restlessness, insomnia, euphoria, palpitations, dysrhythmias, tachycardia, hypertension, pulmonary edems, cardiac arrest

Nursing Concerns/Miscellaneous:

1.) Examine IV sites frequently

2.) Remove contact lenses and dark eye protection after ophthalmic use

3.) Use in limited 3-5 days for intranasal decongestion

Pseudoephedrine (Sudafed)

Classifications:

Alpha1 Adrenergic Agonists

Indications:

Nasal

Mechanism of Action (MOA):

Adverse Effects:

Headache, restlessness, insomnia, euphoria, palpitations, dysrhythmias, tachycardia, hypertension, pulmonary edems, cardiac arrest

Nursing Concerns/Miscellaneous:

1.) Assess for underlying problem and preexisting conditions.

2.) Establish baseline of vital signs.

3.) Monitor respiratory status.

4.) Use cardiac/resuscitation monitor including BP.

5.) Inform prescriber changes of I&O.

6.) Examine IV sites frequently.

7.) Remove contact lenses and dark eye protection after ophthalmic use.

8.) Use in limited 3-5 days for intranasal decongestion.

Tetrahydrozoline (Visine)

Classifications:

Alpha1 Adrenergic Agonists

Indications:

Ocular

Mechanism of Action (MOA):

Adverse Effects:

Headache, restlessness, insomnia, euphoria, palpitations, dysrhythmias, tachycardia, hypertension, pulmonary edems, cardiac arrest

Nursing Concerns/Miscellaneous:

1.) Assess for underlying problem and preexisting conditions.

2.) Establish baseline of vital signs.

3.) Monitor respiratory status.

4.) Use cardiac/resuscitation monitor including BP.

5.) Inform prescriber changes of I&O.

6.) Examine IV sites frequently.

7.) Remove contact lenses and dark eye protection after ophthalmic use.

8.) Use in limited 3-5 days for intranasal decongestion.

Dopamine (Intropin)

Classifications:

Beta1 Agonist

Indications:

1.) Critical care drug for heart attack, heart failure, shock

2.) Powerful effects on the heart

Mechanism of Action (MOA):

Activates Beta 1 receptors

Adverse Effects:

Headache, restlessness, insomnia, euphoria, palpitations, dysrhythmias, tachycardia, hypertension, pulmonary edems, cardiac arrest

Nursing Concerns/Miscellaneous:

1.) Assess for underlying problem and preexisting conditions.

2.) Establish baseline of vital signs.

3.) Monitor respiratory status.

4.) Use cardiac/resuscitation monitor including BP.

5.) Inform prescriber changes of I&O.

Albuterol (Proventil)

Classifications:

Beta2 agonist

Indications:

Used to treat Asthma

Mechanism of Action (MOA):

Adverse Effects:

Headache, restlessness, insomnia, euphoria, palpitations, dysrhythmias, tachycardia, hypertension, pulmonary edems, cardiac arrest

Nursing Concerns/Miscellaneous:

1.) Assess for underlying problem and preexisting conditions.

2.) Establish baseline of vital signs.

3.) Monitor respiratory status.

4.) Use cardiac/resuscitation monitor including BP.

5.) Inform prescriber changes of I&O.

Terbutaline (Brethine)

Classifications:

Beta2 agonist

Indications:

Reduced preterm labor contraction of uterus

Mechanism of Action (MOA):

Adverse Effects:

Headache, restlessness, insomnia, euphoria, palpitations, dysrhythmias, tachycardia, hypertension, pulmonary edems, cardiac arrest

Nursing Concerns/Miscellaneous:

1.) Assess for underlying problem and preexisting conditions.

2.) Establish baseline of vital signs.

3.) Monitor respiratory status.

4.) Use cardiac/resuscitation monitor including BP.

5.) Inform prescriber changes of I&O.

Prazosin (Minipress), Phentolamine (Regitine)

Classifications:

Alpha Adrenergic antagonists

Indications:

1.) Used for hypertension, benign prostatic hypertrophy (BPH), Raynaud's disease

2.) Reduce profound hypertension by pheochromocytoma *tumor* (excessive secretion of catecholamine by adrenal gland)

Mechanism of Action (MOA):

Block alpha1 adrenergic receptors selectively

Adverse Effects:

1.) First dose orthostatic hypotension

2.) GI upset, nausea, vomiting, abdominal cramps

3.) incontinence, depression, lethargy, vivid dreams

4.) Sexual dysfunction - inability to ejaculate

Nursing Concerns/Miscellaneous:

1.) Monitor BP, monitor urinary hesitancy and output, give with food, caution with first dose, avoid ETOH

2.) Relax urinary obstruction but NOT cure BPH (surgery needed)

3.) Diminish vasospasm to fingers and toes on Raynaud's disease

4.) Initial therapy with low doses and usually given at bed time

5.) Assess for syncope - first dose phenomenon

Proprandolol (Inderal)

Classifications:

Beta Adrenergenic Antagonists - nonselective

Indications:

Hypertension, angina, dysrhythmia, glaucoma

Mechanism of Action (MOA):

Block beta1 and beta2 receptors

Adverse Effects:

*MORE side effects*

Most likely on older patients and impaired renal function

Nursing Concerns/Miscellaneous:

1.) Caution for COPD and asthma

2.) Through medical history including allergies, asthma, and COPD

3.) Vital signs, labs (kidney, liver, hematologic, and cardiac functions), I&O ratio and daily weight

4.) interactions with alcohol and OTC antacids

5.) caution for diabetics

6.) watch for impending heart failure and depression

7.) discontinue drug slowly

Metoprolol (Lopressor, Toprol), Atenolol

Classifications:

Beta Adrenergenic Antagonists - selective

Indications:

Hypertension, angina, heart failure

Mechanism of Action (MOA):

Block beta1 receptor

Adverse Effects:

*LESS side effects*

Most likely on older patients and impaired renal function

Nursing Concerns/Miscellaneous:

1.) Safely given for COPD and asthma

2.) Through medical history including allergies, asthma, and COPD

3.) Vital signs, labs (kidney, liver, hematologic, and cardiac functions), I&O ratio and daily weight

4.) interactions with alcohol and OTC antacids

5.) caution for diabetics

6.) watch for impending heart failure and depression

7.) discontinue drug slowly

Bethanechol (Urecholine)

Classifications:

Cholinergic Agonists

Indications:

1.) Restore peristalsis or urinary retention

2.) Precaustion for obstructive GI and GU diseases

Mechanism of Action (MOA):

1.) Direct acting

2.) Increase tone of urinary bladder

3.) Relaxation of spincter

4.) Increase gastric mobility

Adverse Effects:

1.) CV - hypotension, syncope, bradycardia, complete heart block

2.) GI - abdominal cramps, increased salivation, sweating, nausea/vomiting

3.) Eye - moisis, blurred vision

4.) Resp - increase in bronchial secretions, acute bronchospasm

Nursing Concerns/Miscellaneous:

1.) Assess DR, RR, and BP for at least 1 hr following administration

2.) Monitor for early signs of overdose

3.) Ensure atropine available (for cholinergic crisis)

4.) No OTC preparation (drug interactions)

5.) Monitor I&O, urinary and bladder distention

6.) Instruct PT to be near toliet after taking and safety precaution for blurred vision

Neostigmine (Prostigmine)

Classifications:

Cholinergic Agonists

Indications:

1.) Protect against bioterrorist attack with nerve gases

2.) Precaution for cholinergic crisis (overdose)

Mechanism of Action (MOA):

1.) Indirect acting

2.) Myasthenia gravis, Alzheimer's disease, and glaucoma

Adverse Effects:

1.) CV - hypotension, syncope, bradycardia, complete heart block

2.) GI - abdominal cramps, increased salivation, sweating, nausea/vomiting

3.) Eye - moisis, blurred vision

4.) Resp - increase in bronchial secretions, acute bronchospasm

Nursing Concerns/Miscellaneous:

1.) Assess DR, RR, and BP for at least 1 hr following administration

2.) Monitor for early signs of overdose

3.) Ensure atropine available (for cholinergic crisis)

4.) No OTC preparation (drug interactions)

5.) Monitor I&O, urinary and bladder distention

6.) Instruct PT to be near toliet after taking and safety precaution for blurred vision

Digoxin (Lanoxin, Lanoxicaps)

Classifications:

Cardiac Glycosides

Indications:

Used for heart failure and dysrhythmia

Mechanism of Action (MOA):

1.) Increase heart contractility (positive inotropic)

2.) Slow down heart rate and electric conduction (negative dromotropic)

3.) Inhibit Na+-K+ ATPase (compete with potassium)

Adverse Effects:

1.) CV - AV block, dysrhythmias

2.) GI - Anorexia and N/V

3.) Vision - colored vision (yellow) and halo vision

4.) Precaution - Older adults and Renal impairment

Nursing Concerns/Miscellaneous:

1.) Complete health history and PE including SOB, Peripheral and pulmonary edema

2.) Monitor heart rate and potassium level

3.) narrow therapeutic index (therapeutic level at 0.5-2.5ng/mL)

4.) Monitor and treat arrhythmias

5.) Hold digoxin when HR<60

6.) I/O and daily weight

7.) Lab values (hypokalemia predisposes dig toxicity and digoxin level)

Nitroglycerin (Nitrostat)

Classifications:

Organic Nitrates

Indications:

Used for angina pectoris, chest pain

Mechanism of Action (MOA):

1.) Form nitric oxide to trigger the release of calcium ions

2.) Relax venous muscle → reduce preload

3.) Relax arterial muscle → increase blood flow

Adverse Effects:

1.) Hypotension → reflex tachycardia

2.) Headache, blurred vision, syncope

Tolerance

Nursing Concerns/Miscellaneous:

1.) Every 5 min administration x 3, then 911

2.) Unstable (heat, moisture, light etc)

Nifedipine (Adalat), Amlodipine (Norvasc), Nicardipine (Cardene)

Classifications:

Calcium Channel Block (CCB) - Dihydropyridines: bind reversibly to closed-type calcium channels

Indications:

Hypertension, Angina Pectoris

Mechanism of Action (MOA):

1.) Antagonize Calcium Channel

2.) Selectively block calcium channels in vascular smooth muscle

3.) Decrease amount of calcium available for muscle contraction

Adverse Effects:

Nursing Concerns/Miscellaneous:

1.) Assessment of complete history and examination

2.) Monitor VS and BP 30 to 60 min before administration, withhold drug if systolic BP<90 mmHg

3.) Watch for orthostatic hypotension and chest pain

4.) Check daily weight, I/O and edema (heart failure)

5.) Avoid grapefruit (interact with CYP450)

6.) Observe for constipation

7.) Discontinue gradually

8.) Report palpitation and nausea

9.) No smoking, alcohol, or breastfeeding

Verapamil (Calan), Diltiazem (Cardizem)

Classifications:

Calcium Channel Block (CCB) - Nondihydropyridines: bind to different subunits of L-type calcium channels

Indications:

Used for hypertension, angina pectoris, dysrhythmia, Coronary artery disease

Mechanism of Action (MOA):

1.) Block calcium channel

2.) Inhibit flow of calcium ions into cardiac muscle cells and vascular smooth muscle

3.) Cause vasodilation of peripheral arterioles and reduces contractility of myocardium

Adverse Effects:

Nursing Concerns/Miscellaneous:

1.) Assessment of complete history and examination

2.) Monitor VS and BP 30 to 60 min before administration, withhold drug if systolic BP<90 mmHg

3.) Watch for orthostatic hypotension and chest pain

4.) Check daily weight, I/O and edema (heart failure)

5.) Avoid grapefruit (interact with CYP450)

6.) Observe for constipation

7.) Discontinue gradually

8.) Report palpitation and nausea

9.) No smoking, alcohol, or breastfeeding

Enalapril, Lisinopril, Captorpil

Classifications:

ACE Inhibitors

Indications:

first line hypertensive drugs

Mechanism of Action (MOA):

Adverse Effects:

Nursing Concerns/Miscellaneous:

Losartan

Classifications:

ARBs (Angiotensin receptor blockers)

Indications:

Mechanism of Action (MOA):

Similar effects of ACE inhibitors

Adverse Effects:

Fewer adverse effects than ACE inhibitors include hypotension, angioedema (rare)

Nursing Concerns/Miscellaneous:

Clonidine (Catapres), Methyldopa (Aldomet)

Classifications:

Alpha2 Agonists

Indications:

1.) 2nd line drugs for hypertension

2.) Reduce sympathetic nerve impulses

Mechanism of Action (MOA):

Unknown centrally acting mechanism unrelated to alpha2 receptors

Adverse Effects:

1.) Drowsiness, depression, sedation

2.) Decreased libido/impotence

Hepatotoxicity

3.) Positive coombs test → anemia

Nursing Concerns/Miscellaneous:

Prazosin (Minipress), Doxazosin (Cardura)

Classifications:

Alpha1 Antagonists

Indications:

Mechanism of Action (MOA):

1.) Block alpha 1 receptors

2.) Relax arterial and venous smooth muscle

Adverse Effects:

1.) Similar effects of ACE inhibitors

2.) Fewer adverse effects than ACE inhibitors include hypotension, angioedema (rare)

Nursing Concerns/Miscellaneous:

Hydralazine (Apresoline)

Classifications:

Direct-acting Vasodilators

Indications:

2nd line hypertension drugs

Mechanism of Action (MOA):

Dilate arterial smooth muscle directly (Some also affect veins)

Adverse Effects:

1.) Reflex tachycardia

2.) Fluid retention

3.) Can be minimized with beta blockers and diuretics

Nursing Concerns/Miscellaneous:

Nitroprusside (Nipride)

Classifications:

Fastest directly-acting vasodilator

Indications:

Hypertensive

Mechanism of Action (MOA):

Given IV only

Adverse Effects:

Continuous cardiac and hemodynamic monitor needed

Nursing Concerns/Miscellaneous:

1.) Complete health history and PE

2.) BP and pulse before drug administration

3.) EKG and lab values including electrolytes

4.) Daily weight and I/O (fluid retention)

5.) No OTC and herbals

6.) Sedation and dizziness for patient safety

Furosemide (Lasix)

Classifications:

Loop Diuretics

Indications:

Hypertension, Heart failure, Renal failure, Liver failure/cirrhosis, Pulmonary edema

Mechanism of Action (MOA):

Block Na+ , K+ and Cl- reabsorption at ascending loop of Henle

Adverse Effects:

1.) ototoxicity and hypokalemia

2.) Drug interactions

3.) Electrolyte imbalances

4.) Dehydration

5.) Hypotension

Nursing Concerns/Miscellaneous:

Most effective

Hydrochlorothiazide (HydroDIURIL, HCTZ)

Classifications:

Thiazide Diuretics

Indications:

Hypertension, Heart failure, Renal failure, Liver failure/cirrhosis, Pulmonary edema

Mechanism of Action (MOA):

1.) Block Na+ reabsorption at distal tubule

2.) Result in less water reabsorption

Adverse Effects:

1.) hypokalemia

2.) gout attacks and blood dyscrasias

Nursing Concerns/Miscellaneous:

Most commonly prescribed

Spironolactone (Aldactone)

Classifications:

Potassium-sparing Diuretics

Indications:

Hypertension, Heart failure, Renal failure, Liver failure/cirrhosis, Pulmonary edema

Mechanism of Action (MOA):

1.) Inhibit action of aldosterone in distal tubule and collecting ducts of nephron

2.) Increase sodium, chloride and water excretion

3.) Potassium retained

Adverse Effects:

hyperkalemia → life-threatening cardiac dysrhythmias

Nursing Concerns/Miscellaneous:

Less effective

Mannitol (Osmitrol)

Classifications:

Osmotic Diuretics

Indications:

head injury or surgery (increased ICP) and renal failure

Mechanism of Action (MOA):

1.) Pull water from intracellular and interstitial space

2.) Decreased water and sodium through filtration by glomerulus but incapable of being reabsorbed by renal tubule

Adverse Effects:

Rebound increase in ICP and extravasation

Nursing Concerns/Miscellaneous:

Acetazolamide (Diamox)

Classifications:

Carbonic Anhydrate Inhibitors (Weak diuretics)

Indications:

glaucoma

Mechanism of Action (MOA):

1.) Inhibit carbonic anhydrate activity in proximal renal tubule

2.) Cause increased excretion of sodium and bicarbonate

Adverse Effects:

metabolic acidsis

Nursing Concerns/Miscellaneous:

1.) Complete health history

2.) Vital signs, BP and LOC frequently

3.) Baseline and period determination of electrolytes

4.) Safety precaution: hypotension and syncope

5.) Old patients observation

6.) Readiness to access to bathroom

7.) Given early in day (prevent nocturia)

8.) Daily weight, I/O and watch for cerebral, pulmonary edema and swelling

9.) No breastfeeding

Heparin

Classifications:

Anticoagulant

Indications:

DVT prophylaxis, SubQ, preferably into abdomen, rotate site, no aspiration of syringe

Mechanism of Action (MOA):

1.) Continuous infusion or subcutaneous injection

2.) Activate antithrombin III which inhibits thrombin and to lesser extent factor Xa (prevent new thrombi formation and growth of existing thrombi but not dissolve thrombus)

Adverse Effects:

Nursing Concerns/Miscellaneous:

1.) Lab - APTT checked every 6 hrs

2.) Antidote - Protamine sulfate

Warfarin (Coumadin)

Classifications:

Anticoagulant

Indications:

used with iv heparin until therapeutic PT achieved to Coumadin only

Mechanism of Action (MOA):

1.) Transition from heparin to coumadin

2.) Inhibit two enzymes involved in formation of activated vitamin K; Inhibit synthesis of new clotting factors (prevent new thrombus formation but not dissolve thrombus)

Adverse Effects:

Nursing Concerns/Miscellaneous:

1.) Orally given

2.) Lab - PT/INR PT/INR every day until discharge; weekly to biweekly afterwards

3.) Antidote: Vitamin K (Aqua-MEPHYTON)

Acetylsalicylic acid (ADA)

Classifications:

Antiplatelet Agents

Indications:

prevent of heart attack and stroke (low dose 81mg/day), acute MI (medium dose 162-325 mg/day)

Mechanism of Action (MOA):

Reducing platelet aggregation through irreversibly inhibiting platelet COX-1 (low dose) and COX-2 (high dose)

Adverse Effects:

1.) Subclinical bleeding such as Petechiae or Ecchymosis

2.) GI hemorrhage or irritation

Nursing Concerns/Miscellaneous:

Alteplase (Activase)

Classifications:

Thrombolytics

Indications:

severe clots within 48 hours window

Mechanism of Action (MOA):

converts plasminogen to plasmin which then dissolves fibrin clots; degrades procoagulant factors V and VIII and lowers circulating amount of fibrinogen and plasminogen

Adverse Effects:

1.) Excessive bleeding

2.) IV given in critical care units with close monitor of hemodynamics

Nursing Concerns/Miscellaneous:

1.) Intravenously given

2.) Lab - PT/INR, aPTT, Platelet and clotting factors monitored

Aminocaproic acid (Amicar)

Classifications:

Hemostatics (making clotting)

Indications:

aplastic anemia, postop cardiac surgery

Mechanism of Action (MOA):

occupies binding sites on plasminogen and plasmin; prevents digestion of fibrin clot by plasmin

Adverse Effects:

IV site of extravasation and thrombophlebitis

Nursing Concerns/Miscellaneous:

1.) Intravenously given

2.) Lab - PT/INR, aPTT, Platelet and clotting factors monitored

Lovastatin (Mevacor), Simvastatin (Zocor), Fluvastatin (Lescol)

Classifications:

STATIN

Indications:

High cholesterol, LDLs

Mechanism of Action (MOA):

Inhibit precursor of cholesterol thereby lowers cholesterol (HMG-CoA Reductase Inhibitors)

Adverse Effects:

constipation, diarrhea, rhabdomyolysis (kidney damage)

Nursing Concerns/Miscellaneous:

1.) Given at evening

2.) Interactions: digoxin, grapefruits

Cholestyramine (Questran)

Classifications:

Bile Sequestering Agents

Indications:

High cholesterol, LDLs

Mechanism of Action (MOA):

1.) Binds to bile acids

2.) Forms insoluble complex containing cholesterol and excreted in feces

3.) Lowers LDL cholesterol levels by increasing LDL receptors on hepatocytes

Adverse Effects:

constipation, bloating, belching, Steatorrhea (loose, greasy and foul stool)

Nursing Concerns/Miscellaneous:

1.) Given at evening

2.) Interaction: digoxin and warfarin

3.) Contraindication: complete biliary obstruction

4.) Exercise, water, fiber enriched food (constipation)

5.) Monitor for bruising and bleeding (low Vitamin K)

6.) Other meds taken 1 hr before or 4 hr after administration

7.) Teaching plan for nutrition of fat soluble vitamins (A, K, and E) supplement

Gemfibrozil (Lopid)

Classifications:

Fibric Acid Agents

Indications:

High cholesterol, LDLs

Mechanism of Action (MOA):

Inhibit breakdown of stored fat (HDL) and decrease production of cholesterol

Adverse Effects:

cholelithiasis (gall stones), abnormal liver function

Nursing Concerns/Miscellaneous:

1.) report abnormal cramping

2.) avoid breastfeeding

3.) follow low-cholesterol diet

4.) monitor blood glucose level

5.) if diabetic, consult other drugs

Enoxaparin (Lovenox)

Classifications:

Anticoagulant (Lower Molecular Weight Heparin)

Indications:

Commonly used for prophylaxis and treatment (home and post op)

Mechanism of Action (MOA):

1.) subcutaneous prophylactic injection

2.) Unfractioned heparin, Subcutaneously given

Adverse Effects:

Never given with heparin (potential death)

Nursing Concerns/Miscellaneous:

No Lab monitored

The nurse knows that vasopressin (Pitressin) may be prescribed for the following conditions

Diabetes Insipidus

Heart block

GI hemorrhage Nocturnal enuresis

Which of the following serum electrolytes levels would the nurse monitor to determine if vasopressin(Pitressin) is achieving a pharmacotherauptic effect?

sodium

Which of the following drugs is most likely to cause drug related hypoglycemia?

Metformin (Glucophage)

Which of the following assessments would be important for the nurse to monitor in a client that has received levothyroxine (synthroid)

Body weight

Anticholinergic drugs, such as atropine, produce which one of the following genitourinary side effects?

Urinary retention

The nurse knows that reflex tachycardia can occur after the administration of a vasodilator because:

The baroceptors in the carotid are stimulated

A client is receiving propylthiouracil (PTU/Propacil) for a thyroid condition. The nurse

recognizes that the primary mode of action for this medication is to

Inhibit the formation of thyroid hormones that convert iodine to tyrosine

The nurse knows that albuterol (Proventil) is used in the treatment of asthma to

Promote bronchodilation

Which of the following patients would the nurse refer to direct observation therapy?

A 32-year-old homeless woman with psychological problems diagnosed with tuberculosis

Which of the following vitamins is most likely to be prescribed with anti-tuberculosis drug therapy?

Vitamin B6

A client is being treated with Metronidazole (Flagyl) for an intestinal parasitic infection. When instructing the client about this drug, the nurse should caution about the possibility of which adverse reaction?

Metallic taste

The nurse is reviewing the concept of a drug's half-life for a student nurse, explaining that it is the time it takes for

One-half of the drug to be eliminated by the body.

The patient is prescribed Lactated Ringers (LR) intravenous infusion. The nurse knows that this solution

a balanced electrolyte solution

When administering digoxin (Lanoxin), a drug with a positive inotropic action, the nurse recognizes the following action will occur in the client

Digoxin increases preload by increasing the strength of contractions

Anticholinergic drugs, such as atropine, produce which one of the following genitourinary side effects?

urinary retention

The client diagnosed with high blood pressure is ordered captopril (Capoten). Which statements by the client indicate to the nurse the discharge teaching has been effective? Select all that apply.

"I should get up slowly when I am getting out of my bed."

"I should check and record my blood pressure once a day."

The client, who is taking warfarin (Coumadin), says "I always take ibuprofen (Motrin) daily for my painful arthritis." The nurse's response would be based on which of the following physiologic concepts?

Many substances such as aspirin and ibuprofen will increase the risk of bleeding.

The client is prescribed a potassium sparing diuretic for treatment of heart failure. The nurse knows that _____________ is an example of one drug in this classification.

Spironolactone (Aldactone)

For moderate to severe asthma patients, what of the following medication most likely to prescribe for daily treatment?

Fluticasone (Flovent)

A patient with a wasp sting presents to the ER with a BP 58/40, HR 142, Resp 30, and severe wheezing. The nurse anticipates which drug to be ordered?

Epinephrine (adrenalin)

The nurse teaches the client that captopril (Capoten) reduce blood pressure by

Preventing angiotensin, I conversion to angiotensin II

The nurse is teaching the client diagnosed with angina about sublingual nitroglycerin (NTG). Which statement indicates the client needs more medication teaching?

"If my pain is not relieved with one tablet, I will get medical help."

The client is prescribed a cardiac glycoside for treatment of heart failure. The nurse recognizes that the major action of cardiac glycosides is to:

increase myocardial contractility

The nurse knows that drugs such as gemfibrozil (lopid)are intended to reduce the likelihood of which conditions?

coronary heart disease and strokes

The client receiving furosemide (Lasix) as an adjunct to treatment of hypertension returns for follow up. Which of the following objective data should the nurse consider when determining the effectiveness of the drug therapy?

Blood pressure ranging from 120/70 to 134/88 mm Hg.

A nurse in monitoring a client who is receiving Ibuprofen (Motrin) for arthritis four times daily. Which of the following adverse effects would prompt the nurse to notify the provider?

gastric bleeding

Prior to administering furosemide (Lasix) to client for treatment of heart failure, the nurse place priority on which of the following?

checking serum potassium levels

Which of the following objective symptoms would the nurse notice if a patient develops digoxin (Lanoxin) toxicity?

very slow pulse rate (objective)

When the nurse assesses the readiness of tuberculosis discharge teaching, what statement indicates SUCCESSFUL instruction completed?

A combination of drugs should be used for 6 months to 2 years

The nurse is teaching the patient to avoid tyramine containing foods. Which of the following foods contain tyramine? (select all that apply)

pickled fish

aged cheese

chocolate

beer and wine

In teaching clients on heparin therapy to avoid the risk of hemorrhage, it would be inappropriate for the nurse to instruct the client to:

Use a disposable razor

A client has been started on an antilipemic drug for the treatment of severely elevated triglyceride levels. When the client develops ecchymosis and petechiae, the nurse anticipated what laboratory value to be ordered?

International normalized ratio (INR)

Unless contraindicated by the client's condition, the appropriate site for a subcutaneous injection of sodium heparin (Heparin) is in the:

abdomen

A nurse is monitoring a client who is receiving a cholinergic antagonist. For which of the following drug related adverse effects would the nurse notify the provider?

tachycardia and dysrhythmias

A client takes a nitroglycerin (Nitrostat) tablet at the onset of anginal pain. The chest pain is relieved, but the client complains of a sudden pounding headache. The nurse is aware that the headache represents:

an expected adverse reaction

The nurse would administer prazosin (Minipress) to a client for the treatment of:

Hypertension

Which of the following medication is NOT applied to the patients with hypertension?

Lovastatin (Mevacor)

Which of the following goal statements would be appropriate for a myasthenia gravis patient receiving cholinergic agonists such as pyridostigmine (Mistinon)? The patient will exhibit

decreased in facial muscle weakness, ptosis, and diplopia

The 28-year-old female client with COPD is taking Montelukast (Singular).

I should not decrease the dose or suddenly stop taking this medication

Which of the following health promotion activities should be stressed to women taking oral contraception?

stop smoking

The patient has selected an over the counter cold medication that contains phenylephrine (Neosynephrine). The nurse knows that patients with _________ should be advised not to take this medication.

cardiovascular disease

Patients who are prescribed spironolactone (Aldactone) should be instructed to:

avoid orange juice and bananas

A client is receiving cholestyramine (Questran) for elevated LDL levels. Which of the following adverse effects would the nurse include in the care plan? Monitor for______

abdominal pain

The patient is admitted to the ER for an acute asthma attack. The physician has ordered albuterol (Proventil) aerosol treatments. As part of the treatment regimen, the nurse will monitor the procedure illustrated in the photo. What is the name of the procedure and what data does it provide to the healthcare providers?

Peak flow measure: a test, which measures the maximum speed that air is exhaled from the lungs

The nurse is administering mannitol (Osmitrol) to the client. Which of the following statements is correct concerning this drug therapy? (select all that apply)

-Mannitol (Osmitrol) pulls body water from the intercellular and interstitial space into the vascular system

- increased intracranial pressure due to traumatic head injury is one indication for this drug therapy

-Clients recvieiving this drug should avoid foods high in vitamin K

-This pharmacological agent causes potassium retention

-This drug is used to treat tuberculosis in homeless crisis

Corticosteroids

fluticasone (Flovent)