Medical-Surgical II MKD Pharmacology List Flashcards

Vocabulary flashcards detailing class, mechanism of action, therapeutic uses, adverse effects, interactions, and nursing considerations for Medical-Surgical II MKD medications.

Digoxin (Lanoxin)

Class: Cardiac glycoside. Mechanism: Competes with $\text{K}^+$ in the cardiac Na-K pump; decreases HR, decreases conduction, increases contractility. Therapeutic uses: Heart failure, A. fib, A. flutter. Adverse effects: Bradycardia (early sign of toxicity), arrhythmias, anorexia, NVD (nausea, vomiting, diarrhea). Interactions: Anything that affects $\text{K}^+$ or heart rhythm. Nursing considerations: Apical HR, ECG, IV $\text{K}^+$, serum levels, fall precautions.

Diovan (Valsartan)

Class: Angiotensin II receptor blocker. Mechanism: Inhibits vasoconstriction, decreases vascular resistance and BP. Therapeutic uses: HTN, heart failure. Adverse effects: Palpitations, dyspnea, pruritus, dry mouth. Interactions: Lithium, Potassium. Nursing considerations: Contraindicated with pregnancy and breast feeding; monitor liver and renal functions.

Amlodipine (Norvasc)

Class: Calcium channel blocker. Mechanism: Prevents smooth muscle contraction (arterial only); causes vasodilation. Therapeutic uses: HTN, angina pectoris. Adverse effects: Headache, edema, flushing. Interactions: Other HTN medications, fentanyl, ETOH, lithium. Nursing considerations: Contraindicated with impaired renal or hepatic function, heart block, and in breast feeding patients.

Verapamil (Calan)

Class: Calcium channel blocker. Mechanism: Prevents smooth muscle contraction (CV, arterial); vasodilation, decreases contractility, decreases HR, decreases conduction. Therapeutic uses: HTN, angina, arrhythmia. Adverse effects: Arrhythmia, CHF, constipation, bradycardia, dizziness. Interactions: Other HTN medications, fentanyl, ETOH, lithium, other chronotropic/inotropic/dromotropic medications, grapefruit. Nursing considerations: Monitor BP, HR, CHF.

Diltiazem (Cardizem)

Class: Calcium channel blocker. Mechanism: Prevents smooth muscle contraction (CV, arterial); vasodilation, decreases contractility, decreases HR, decreases conduction. Therapeutic uses: HTN, angina, arrhythmia. Adverse effects: Arrhythmia, CHF, constipation, bradycardia, dizziness, edema. Interactions: Other HTN medications, fentanyl, ETOH, lithium, other chronotropic/inotropic/dromotropic medications, grapefruit. Nursing considerations: Monitor BP, HR, CHF.

Nitroglycerin (SL, paste, & IV)

Class: Organic nitrate. Mechanism: Venous and arterial dilation; reduces myocardial oxygen consumption. Therapeutic uses: Angina, MI, HF, HTN. Adverse effects: Headache, hypotension, dizziness, tachycardia, syncope, tolerance. Interactions: Viagra (life threatening), other anti-HTN, anticholinergics. Nursing considerations: SL: protect from light, replace after $6\text{ months}$, 1 tab SL every $5\text{ min} \times 3$, then call 911 if pain continues; store in glass bottle in cool dry place; requires MD order for nitrate-free period to prevent tolerance.

Amiodarone (Cordarone)

Class: Potassium channel blocker. Mechanism: Prolongs action potential, inhibits sympathetic nervous system, slows sinus, PR, QT, vasodilation. Therapeutic uses: Arrhythmias. Adverse effects: ARDS, CHF, arrhythmias, liver toxicity, bradycardia, hypotension, dizziness, fatigue, ataxia, paresthesia, neuropathy, tremor. Interactions: Digoxin, other anti-arrhythmics, grapefruit. Nursing considerations: Monitor EKG and liver function; cautious use with digoxin and warfarin as Amiodarone can decrease their levels.

Glipizide (Glucotrol)

Class: Sulfonylurea. Mechanism: Stimulates insulin secretion. Therapeutic uses: Type 2 DM with functioning Beta cells. Adverse effects: Hypoglycemia, GI upset, dizziness, weight gain, photosensitivity, aplastic anemia. Interactions: ETOH, diuretics, steroids, warfarin, beta blockers. Nursing considerations: Monitor glucose, teach s/s, medic alert bracelet, check CBC, give $30\text{ min}$ before breakfast. Divide dose and give before meals if taking more than $15\text{ mg/day}$.

Pradaxa

Class: Direct Thrombin Inhibitor. Mechanism: Inhibits thrombin as well as thrombin-induced platelet aggregation. Therapeutic uses: Prevent stroke and blood clots in atrial fibrillation, VTE, PE. Adverse effects: Reflux, bloody stool, nausea, uncontrolled bleeding, increased risk of MI. Interactions: Aspirin, NSAIDS, Mifepristone. Nursing considerations: No PT or INR monitoring needed; bleeding precautions; contraindicated with active bleeding or artificial heart valve; do not stop abruptly without starting another antithrombotic.

Thyroxine (Synthroid, Levothyroid)

Class: Thyroid hormone. Mechanism: Controls metabolic activity (gluconeogenesis, glycogenolysis, protein synthesis, cell growth, brain CNS development). Therapeutic uses: Hypothyroidism, prevent Cretinism. Adverse effects: Thyrotoxicosis (insomnia, tachycardia, angina pectoris, diaphoresis, weight loss, heat intolerance). Interactions: Warfarin, sympathomimetics, hypoglycemics. Nursing considerations: Take prior to breakfast on an empty stomach; check apical pulse prior to dose; educate on lifelong therapy; monitor blood levels.

Alendronate (Fosamax)

Class: Bisphosphonate. Mechanism: Incorporates into bone and inhibits osteoclasts; reduces bone loss. Therapeutic uses: Osteoporosis, Paget's disease. Adverse effects: Esophagitis, musculoskeletal pain. Interactions: Calcium, antacids, food. Nursing considerations: Take on an empty stomach with $8\text{ oz}$ of water; remain sitting upright for $30\text{ minutes}$ to avoid esophagitis; dosed weekly or daily.

Keppra (Levetiracetam)

Class: Antiepileptic (anticonvulsant). Mechanism: Inhibits the spread of seizure activity in the brain. Therapeutic uses: Seizures, bipolar disorder. Adverse effects: Somnolence, asthenia, headache, dizziness, suicidal thoughts when initiating therapy. Interactions: Fentanyl. Nursing considerations: Formulations include PO, IV, extended release, liquid; teach patient not to stop suddenly; wear Medic Alert bracelet; take at the same time daily.

Phenytoin (Dilantin)

Class: Antiepileptic. Mechanism: Inhibits sodium channels, slowing brain impulses that cause seizures. Therapeutic uses: Managing seizures in adults and children. Adverse effects: Ataxia, sedation, diplopia, hypotension, gingival hyperplasia, aplastic anemia, neutropenia. Interactions: Stomach acid reducers, hormones, antibiotics, antifungals, sedatives, antidepressants, other seizure medications. Nursing considerations: Oral hygiene, monitor CBC, calcium, albumin, wear Medic Alert bracelet; administer with or after meals; monitor serum levels aiming for $10\text{--}20\text{ mcg/mL}$; monitor continuous ECG during IV administration.

Ciprofloxacin (Cipro) & Levofloxacin (Levaquin)

Class: Fluoroquinolones. Mechanism: Inhibit bacterial DNA synthesis. Therapeutic uses: Bacterial infections of all kinds (especially respiratory, GU/UTI, GI, skin). Adverse effects: Seizures, liver toxicity, C. diff, tendinitis and rupture of Achilles tendon (especially in older adults and corticosteroid users). Interactions: Calcium and antacids. Nursing considerations: Perform Culture & Sensitivity (C&S) prior to first dose.

Atropine

Class: Anticholinergic (antimuscarinic). Mechanism: Blocks acetylcholine receptors. Therapeutic uses: Bradycardia, heart block, pre-op, eye dilation, cholinesterase inhibitor poisoning. Adverse effects: Tachycardia, dry mouth, dry eyes, constipation, urinary retention, mydriasis, anhidrosis, dementia. Interactions: Anticholinergics, antihistamines, tricyclic antidepressants, levodopa. Nursing considerations: Monitor for tachycardia, palpitations, urinary retention, dry mouth; use cautiously prior to surgery.

Celecoxib (Celebrex)

Class: NSAID, COX-2 inhibitor. Mechanism: Inhibits prostaglandin synthesis, reducing inflammation and pain. Therapeutic uses: Arthritis (all kinds), acute pain. Adverse effects: GI bleeding, Stevens-Johnson syndrome. Interactions: Warfarin, lithium. Nursing considerations: Assess for kidney/renal impairment; administer with food; note cross-reactivity with sulfa.

Clopidogrel (Plavix)

Class: ADP inhibitor. Mechanism: Inhibits platelet aggregation and degranulation; inhibits arterial clots. Therapeutic uses: MI, stroke, PAD reduction. Adverse effects: Bleeding, neutropenia, TTP. Interactions: Other antiplatelets, anticoagulants, several herbal/natural supplements. Nursing considerations: Monitor CBC, educate on signs of bleeding, drug compliance, GI bleeding, neutropenia.

Morphine, MS Contin

Class: Strong Opioid / Narcotic Analgesic. Mechanism: Stimulates opioid receptors. Therapeutic uses: Pain, MI. Adverse effects: Respiratory depression, confusion, sedation, euphoria, hypotension, constipation, urinary retention, itching, biliary colic, miosis, tolerance, withdrawal. Interactions: Other CNS depressants (benzos, ETOH, tricyclics), MAO inhibitors. Nursing considerations: Monitor respiratory rate and pain; fall precautions; manage constipation.

Piperacillin-tazobactam (Zosyn)

Class: Broad-spectrum anti-infective (Extended-spectrum penicillin). Mechanism: Interferes with cell wall replication; tazobactam is a $\beta$-lactamase inhibitor protecting piperacillin from degradation. Therapeutic uses: Moderate to severe piperacillin-resistant $\beta$-lactamase infections (respiratory, skin, UTI, bone, joint, gonorrhea, pneumonia). Adverse effects: Seizures, cardiac toxicity, pseudomembranous colitis, pancreatitis, oliguria, proteinuria, hematuria, Stevens-Johnson syndrome. Interactions: Aspirin, probenecid, methotrexate. Nursing considerations: Assess for allergic reactions, angioedema, decreased urine output (nephrotoxicity), BUN, creatinine, and pseudomembranous colitis.

Vancomycin (Vanco)

Class: Anti-infective. Mechanism: Inhibits bacterial cell wall synthesis; blocks glycopeptides. Therapeutic uses: Bactericidal for staph, strept, Corynebacterium, Clostridium; endocarditis prophylaxis for dental procedures; bacteremia, joint/bone infections, osteomyelitis, pneumonia, septicemia. Adverse effects: Nausea, pseudomembranous colitis, cardiac arrest, nephrotoxicity, anaphylaxis, superinfection. Interactions: Antifungals, antivirals, cholestyramine, colestipol, cidofovir, metformin. Nursing considerations: Watch for Red man syndrome; monitor I&O, BUN, creatinine; take in equal intervals around the clock for full $7\text{--}10\text{ day}$ course.

Ceftriaxone (Rocephin)

Class: Antibiotic (Beta-lactam, third-generation cephalosporin). Mechanism: Bactericidal activity against gram-negative bacteria; crosses blood-brain barrier to reach therapeutic concentrations in CNS. Therapeutic uses: Severe or life-threatening bacterial infections (e.g., meningitis), surgical infection prophylaxis. Adverse effects: Mild diarrhea, injection site warmth/lump, vaginal itching/discharge, rash, abnormal LFTs. Interactions: Contraindicated with severe allergic reactions to cephalosporins (Omnicef, Keflex). Nursing considerations: Monitor for seizures and signs of pseudomembranous colitis.

Carvedilol (Coreg)

Class: Beta blocker. Mechanism: Blocks epinephrine on heart and blood vessels, lowering HR, BP, and strain on heart. Therapeutic uses: HTN, heart failure, post-MI mortality reduction. Adverse effects: Chest pain/tightness, dizziness, fainting, generalized/peripheral edema, shortness of breath, bradycardia, weight gain. Interactions: Cimetidine, Clonidine, Cyclosporine, Digoxin, Diltiazem, Epinephrine. Nursing considerations: Monitor I&O, daily weight, fluid overload; note that symptoms may temporarily worsen during initiation for HF.

Losartan (Cozaar)

Class: Antihypertensive (Angiotensin II Receptor Blocker / ARB). Mechanism: Blocks substance causing blood vessels to tighten, relaxing vessels and increasing blood/oxygen supply to heart. Therapeutic uses: Stroke risk reduction in HTN and cardiomegaly; diabetic kidney problems in DM II with HTN history. Adverse effects: URIs/colds, dizziness, stuffy nose, back pain, diarrhea, fatigue, hypoglycemia, chest pain, hypo- or hypertension. Interactions: Aspirin, Ibuprofen, Naproxen, potassium-sparing diuretics, Fluconazole, Lithium, Phenobarbital, potassium supplements. Nursing considerations: Assess for orthostatic hypotension, pulse changes, and angioedema.

Sartans (ARBs) General Considerations

Class: Angiotensin II Receptor Blockers (ARBs). Mechanism: Effective initial antihypertensive therapy that lowers blood pressure and offers pleomorphic effects. Therapeutic uses: Diabetic kidney disease, stroke prevention, heart failure, HTN. Adverse effects: Dizziness, headache, drowsiness, nausea, vomiting, diarrhea, cough, elevated potassium levels.

Fondaparinux (Arixtra)

Class: Blood thinner, Factor Xa inhibitor. Mechanism: Indirect inhibitor of factor Xa; does not inhibit thrombin. Therapeutic uses: Treat and prevent blood clots after hip, knee, or abdominal surgery. Adverse effects: Injection site reactions, insomnia, dizziness, N/V, rash, headache, fever, peripheral swelling. Interactions: Increased bleeding risk with warfarin, aspirin, NSAIDs, some cephalosporins, valproic acid, Plavix. Nursing considerations: Assess for bleeding; monitor CBC and platelet count.

Rivaroxaban (Xarelto)

Class: Factor Xa inhibitor. Mechanism: Selective direct Factor Xa inhibitor (inhibits free and prothrombinase-bound Xa) with rapid onset. Therapeutic uses: Treat and prevent blood clots. Adverse effects: Back pain, bleeding gums, bloody stools, bowel/bladder dysfunction, paresthesia, coughing blood, dyspnea, increased menstrual flow. Interactions: Aspirin, long-term NSAIDs, Coumadin. Nursing considerations: No routine INR monitoring needed; no antidote for major bleeding; $10\text{ mg}$ can be taken without food, but $15\text{ mg}$ and $20\text{ mg}$ must be taken with food.

Carbamazepine (Tegretol)

Class: Anticonvulsant. Mechanism: Sodium channel blocker. Therapeutic uses: Control certain seizure types in epilepsy; treat trigeminal neuralgia. Adverse effects: Dizziness, abnormal thinking, speech difficulty, tremors, constipation, dry mouth. Interactions: Grapefruit juice, MAOIs, SSRIs (risk of hyperpyrexia, HTN, seizures within 2 weeks of use). Nursing considerations: Monitor skin for SJS/TEN (more common in Asian ancestry); monitor CBC, platelets, reticulocyte count, serum iron weekly for first $2\text{ months}$, then yearly.