320: Exam 2 Medications

what are the nursing considerations for Metoprolol (Lopressor)?

• Monitor HR and BP before administration.

• Hold if HR <50 bpm or SBP <90 mmHg.

• Caution in patients with asthma or COPD.

• Monitor for fatigue, depression, and bradycardia.

• preferred for MI or HF history

• less effective in Black patients

what are the nursing considerations for lisinopril (Zestril)?

• monitor BP

• Watch for cough, angioedema, and orthostatic hypotension

• monitor creatinine, K+

• Avoid with NSAIDs or K-sparing diuretics

what are the nursing considerations for Losartan (Cozaar)?

• no cough

• full BP effect in 3-6 weeks

• do not combine with ACEIs in kidney disease

what are the nursing considerations for spironolactone?

• monitor for orthostatic hypotension & hyperkalemia

• avoid K+ supplements and other K+ sparing diuretics

• caution with ACE inhibitors or ARBs

what are the nursing considerations for furosemide (Lasix)?

• monitor for orthostatic hypotension & electrolyte imbalances

• effective in renal insufficiency

• shorter acting than thiazides

• less effective for HTN

what are the nursing considerations for hydrochlorothiazide?

• monitor for hypokalemia, alkalosis, and orthostatic hypotension

• can increase digoxin toxicity if hypokalemia develops

• NSAIDs may reduce effect

• encourage K+ rich foods

what are the nursing considerations for simvastatin?

• monitor liver enzymes and CK levels

• best effects when taken in the evening

What are the risks associated with taking Simvastatin (Zocor)?

• ↑ Risk of rhabdomyolysis with gemfibrozil, niacin, erythromycin

• ↑ Prothrombin time with warfarin

• Dose ≤ 40 mg/day

• Caution with amiodarone due to ↑ myopathy risk

what are the nursing considerations for valsartan?

• monitor BP and kidney function

• watch for hyperkalemia and dizziness

• avoid in pregnancy

• use cautiously in patients with renal artery stenosis

What are the nursing considerations for enoxaparin (Lovenox)?

• Monitor for bleeding and platelet count.

• Do not expel air bubble in prefilled syringe.

• Administer in abdomen, rotate sites.

• Use cautiously in renal impairment.

What are the nursing considerations for unfractionated heparin?

• Monitor aPTT or anti-Xa levels.

• Monitor for HIT.

• Antidote: Protamine sulfate.

• High alert drug—double-check dosage.

What are the nursing considerations for warfarin (Coumadin)?

• Monitor INR (goal: 2–3 for most indications).

• Avoid foods high in vitamin K.

• Many drug interactions (check before new meds).

• Antidote: Vitamin K.

What are the nursing considerations for aspirin and clopidogrel?

• Monitor for bleeding (e.g., gums, bruising).

• Take with food to reduce GI upset.

• Stop before surgery if ordered.

• Avoid in active bleeding, GI ulcers.

What are the nursing considerations for diltiazem?

• Monitor HR and BP.

• Watch for signs of heart block or bradycardia.

• May cause peripheral edema or constipation.

• Avoid grapefruit juice (especially with diltiazem).

What are the nursing considerations for nitroglycerin and long-acting nitrates?

• Monitor BP closely (risk for hypotension).

• Instruct patient to sit/lie when taking SL NTG.

• Rotate sites with patches/ointments.

• Tolerance can develop—provide nitrate-free interval.

What are the nursing considerations for metoprolol succinate?

• Monitor HR and BP before administration; hold if HR < 50 bpm or SBP < 90 mmHg unless otherwise directed.

• Do not crush or chew extended-release tablets.

• Use caution in patients with asthma/COPD—although cardioselective, β1-blockers can still affect β2 receptors at higher doses.

• Assess for signs of bradycardia, hypotension, dizziness, or fatigue.

• Can mask symptoms of hypoglycemia in diabetic patients.

• Educate patients not to stop abruptly—taper gradually to avoid rebound tachycardia or hypertension.

• May be used for heart failure, angina, hypertension, or post-MI management.

What are the nursing considerations for digoxin?

• Monitor apical pulse for 1 full minute before administration; hold if HR < 60 bpm (adults) or per provider’s order.

• Watch for signs of digoxin toxicity: anorexia, nausea, vomiting, visual disturbances (e.g., yellow/green halos), confusion, bradycardia.

• Monitor serum digoxin levels: therapeutic range = 0.5–2.0 ng/mL.

• Check potassium levels: hypokalemia increases risk of toxicity (especially with diuretics).

• Monitor renal function—digoxin is renally excreted.

• Teach patients to take it at the same time daily and to report irregular pulse or symptoms of toxicity.

• Use with caution in older adults due to increased sensitivity.

• Antidote for toxicity: Digoxin immune fab (Digibind)