Prototype Drugs EXAM 2

Heparin

Anticoagulants

MOA: Activates antithrombin III → inhibits thrombin (factor IIa) and factor Xa → slows clotting.

Therapeutic Effect: Prevents formation of new clots; used in DVT, PE, MI, a-fib, stroke.

Side Effects: Bleeding, bruising, injection site pain.

Adverse Effects: Heparin-induced thrombocytopenia (HIT), severe bleeding, hypersensitivity.

Contraindications: Active bleeding, recent surgery, low platelets, history of HIT.

Nursing Considerations: Given IV or SC, IV most preferred i believe

Monitor aPTT (therapeutic range: 1.5–2.5x control).

Use infusion pump for IV route.

Antidote: Protamine sulfate.

Check platelet count frequently.

SubQ route used for prophylaxis.

Route: IV (acute treatment), SubQ (prophylaxis).

Note: Fast-acting, does not cross placenta (safe in pregnancy).

Warfarin

Anticoagulants

MOA: Inhibits vitamin K–dependent clotting factors (II, VII, IX, X).

Therapeutic Effect: Prevents thrombosis/embolism (DVT, PE, stroke prevention in a-fib or prosthetic valves).

Side Effects: Bleeding, bruising, GI discomfort.

Adverse Effects: Hemorrhage, necrosis (rare), purple toe syndrome.

Contraindications: Pregnancy (Category X), active bleeding, uncontrolled hypertension, recent surgery.

Nursing Considerations:

Monitor INR (goal 2–3).

Teach patients to keep vitamin K intake consistent.

Avoid NSAIDs, alcohol, and aspirin.

Antidote: Vitamin K (phytonadione).

Takes 2–5 days to reach full effect → often overlapped with heparin.

Route: PO (only).

Note: Requires frequent lab monitoring and patient teaching.

Clopidogrel

Anti-platelet

MOA: Inhibits ADP receptor on platelets, preventing aggregation.

Therapeutic Effect: Reduces risk of stroke, MI, and clotting with stents or atherosclerosis.

Side Effects: Bleeding, bruising, diarrhea, rash.

Adverse Effects: Thrombotic thrombocytopenic purpura (TTP), severe bleeding.

Contraindications: Active bleeding, peptic ulcer, liver disease.

Nursing Considerations:

Monitor for signs of bleeding (gums, stool).

Discontinue 5–7 days before surgery.

No antidote; platelet transfusion in severe bleeding.

Interacts with proton pump inhibitors (PPIs).

Route: PO.

Note: Often combined with aspirin in dual antiplatelet therapy (DAPT).

Alteplase

Thrombolytics

MOA: Converts plasminogen to plasmin, which digests fibrin clots (fibrinolysis).

Therapeutic Effect: Dissolves clots in stroke, MI, or PE (time-sensitive).

Side Effects: Nausea, hypotension.

Adverse Effects: Severe bleeding, intracranial hemorrhage, anaphylaxis.

Contraindications: History of hemorrhagic stroke, recent surgery, trauma, or active bleeding.

Nursing Considerations:

Must be given within 3–4.5 hours of symptom onset for stroke.

Monitor for bleeding closely (neuro checks, VS, CBC).

Avoid IM injections and invasive procedures.

Antidote: Aminocaproic acid.

Route: IV.

Note: High risk drug. Requires informed consent and strict protocol.

Epoetin alfa

Biologic Response Modifiers

CSF Erythropoietin-stimulating agent

MOA: Stimulates bone marrow to produce RBCs by acting like erythropoietin.

Therapeutic Effect: Treats anemia in CKD, chemotherapy, or HIV.

Side Effects: Headache, body aches, hypertension.

Adverse Effects: Thromboembolism, stroke, MI if Hgb rises too fast.

Contraindications: Uncontrolled hypertension, Hgb > 11 in CKD

Nursing Considerations: given through IV

Monitor Hgb (goal: 10-11 g/dL) and BP.

Do not shake vial.

Hold dose if Hgb rises too quickly.

May require iron supplementation.

Route: IV or SubQ.

Note: Black Box Warning: Cardiovascular events if overused.

Filgrastim

Biologic Response Modifiers

Granulocyte colony-stimulating factor

MOA: Stimulates neutrophil production in bone marrow (G-CSF).

Therapeutic Effect: Prevents infection in neutropenic patients (e.g., chemotherapy).

Side Effects: Bone pain, fatigue, nausea.

Adverse Effects: Spleen rupture (rare), ARDS.

Contraindications: Hypersensitivity to E. coli–derived proteins.

Nursing Considerations: Given IV but SC is most common and preferred

Monitor ANC (absolute neutrophil count).

Report bone pain, left upper quadrant pain (spleen).

Use cautiously in sickle cell anemia.

Route: SubQ or IV.

Note: Given daily until ANC is normalized.

Sagramostism

Biologic Response Modifiers

Granulocyte-macrophage colony-stimulating factor

Sargramostim (Leukine)

MOA: Stimulates production of granulocytes, monocytes, and macrophages (GM-CSF).

Therapeutic Effect: Enhances immune recovery after bone marrow transplant or for neutropenia.

Side Effects: Diarrhea, weakness, malaise.

Adverse Effects: First-dose effect (dyspnea, hypotension), capillary leak syndrome.

Contraindications: Yeast hypersensitivity.

Nursing Considerations: Given SC or IV

Monitor CBC, weight, and fluid status.

Premedicate for fever or chills if needed.

Stop if signs of capillary leak or respiratory distress.

Route: IV or SubQ.

Note: May be used after chemo or bone marrow suppression to reboot the immune system.

Diphenhydramine

(Antihistamine), concept: gas exchange

has anticholinergic properties

Mechanism of Action: Diphenhydramine blocks histamine (H1) receptors, preventing the release of histamine that causes allergic symptoms.

TE: Allergic rhinitis • Pruritus • Urticaria • Common cold • Sneezing • Cough • Motion sickness prevention

• Is used for histamine reactions • Common in OTC Sleep Aids

Side Effects: First gen: Drowsiness, dizziness, fatigue, dry mouth, constipation, disturbed coordination, urine retention, and blurred vision are common. Ex. benadrayl

Second gen: Usually have less drowsiness • Usually have less anticholinergic symptoms. EX. Clartin

Adverse Effects: Urinary retention, tachycardia, and paradoxical excitation (especially in children) may occur.

Contraindications: Avoid in patients with closed-angle glaucoma, urinary retention, or severe liver disease.

Interaction: Increases CNS depression with alcohol & other CNS depressants

Client Teaching and Nursing Considerations: Advise patients to avoid driving, alcohol, and other CNS depressants. Take with food to minimize gastric irritation. Suggest sugar-free gum or ice chips for dry mouth. Monitor for urinary difficulty, especially in older adults.

Clinical Judgment: Diphenhydramine

Recognize cues • Hx of environmental exposures; Evidence of urinary dysfunction; Cardiac and respiratory status

Generate solutions: • decreased nasal congestion, mucosal secretions, and cough

Take action • Give oral form of diphenhydramine with food to decrease gastric distress • Warn to avoid driving a motor vehicle and performing dangerous activities until stabilized on the drug • Advise the patient to avoid alcohol and other CNS depressants • Suggest use of sugarless candy, gum, or ice chips for mouth dryness

Dextromethorphan Hydrobromide

(Antitussive)

Mechanism of Action: Dextromethorphan acts on the cough center in the medulla to suppress the cough reflex. It is a non-opioid cough suppressant.

TE: suppress the cough reflex in the medulla, decreasing the frequency and intensity of dry, nonproductive coughs. This promotes comfort and rest for patients with respiratory irritation.

Side Effects: Drowsiness, dizziness, fatigue, nausea, and GI distress are common.

Adverse Effects: In large doses or misuse, it may cause hallucinations, serotonin syndrome (if taken with SSRIs), or respiratory depression

.Contraindications: Contraindicated in patients with asthma, COPD, or concurrent MAOI use.

Client Teaching and Nursing Considerations: Avoid alcohol and other sedatives. Monitor for excessive sedation or confusion. Teach that this medication is intended for short-term relief of dry, nonproductive cough. Warn against overuse or recreational misuse.

Fluticasone

Glucocorticoid

Mechanism of Action: Fluticasone is a corticosteroid that suppresses airway inflammation and the immune response, decreasing edema, mucus, and irritation in the airways.

Anti-inflammatory • Decrease rhinorrhea, sneezing, and congestion

TE: allergic rhinitis

Side Effects: Hoarseness, nausea, vomiting, sore throat, nasal irritation, cough, dry mouth, and headache. Headache • Blurred vision • Pharyngitis • Candidiasis • Insomnia • Irritated/dry nasal mucosa

Adverse Effects: Possible oropharyngeal candidiasis (thrush), adrenal suppression with long-term use, or osteoporosis after prolonged systemic exposure.

Contraindications: Avoid in untreated fungal infections, hypersensitivity, or significant immunosuppression.

Client Teaching and Nursing Considerations: Instruct to rinse the mouth after inhalation to prevent oral thrush. Emphasize that fluticasone is not a rescue inhaler—it is for long-term control. Monitor for white patches in the mouth or throat and for signs of infection. Encourage daily use as prescribed to maintain airway stability

Albuterol

Beta-Adrenergic Agonist/ bronchodilator.

short-acting beta-agonist (SABA) used for quick relief.

Other medications may also end in "-buterol" (Mnemonic: "brutally asthma").

Concept: oxygenation

Mechanism: Stimulates β₂ receptors → bronchodilation → rapid airflow improvement. Rapid onset of action! • INHALE: 5-15 MIN • Longer duration of action • Few side effects

Use: Asthma attack, acute bronchospasm, bronchospasm prophylaxis, prevention before exercise.

Side Effects: Tremor, palpitations, excitability, headache, rhinitis.

AE: Tachycardia, paradoxical bronchospasm, angina, hypertension, dysrhythmia

Contraindications/ cautions: Cardiac disease, severe hypertension, hyperthyroidism

Nursing Considerations: Monitor HR & O₂ sat; use as rescue inhaler; avoid caffeine; assess for chest pain

Use as rescue inhaler for acute bronchospasm; monitor HR and O₂ sat; avoid caffeine; report chest pain or palpitations; teach proper inhaler technique

Tiotropium

Bronchodilator: Anticholinergic

Mechanism of Action: Tiotropium blocks muscarinic (M3) receptors in airway smooth muscle, preventing bronchoconstriction and promoting sustained airway dilation.

TE: maintain open airways by relaxing bronchial smooth muscles, making it easier to breathe in patients with COPD. It helps reduce bronchospasms, wheezing, and frequency of exacerbations.

Side Effects: dry mouth, constipation, headache, sinusitis, and insomnia.

Adverse Effects: urinary retention, tachyarrhythmias, and worsening of glaucoma.

Contraindications: Avoid in patients allergic to atropine or ipratropium and those with narrow-angle glaucoma.

Client Teaching and Nursing Considerations: Administer only via the HandiHaler device once daily for maintenance—not for acute attacks. Have the patient rinse their mouth after use to reduce dryness and infection risk. Monitor for urinary retention and encourage fluid intake.

Montelukast

Leukotriene Receptor Antagonist (lungs). concept: oxygenation

Mechanism of Action: decrease inflammation process, edema, mucus secretion, and bronchoconstriction

TE: Asthma • Prophylaxis of exercise-induced bronchospasm • Not recommended for acute asthmatic attacks

Side Effects: Headache, dizziness, fatigue, and GI distress, depression, weakness, infection.

Adverse Effects: suicidal ideation, mood changes, and hepatic toxicity.

Contraindications: Not for use in acute asthma attacks; use cautiously in patients with liver disease.

Client Teaching and Nursing Considerations: Take once daily in the evening, even if symptoms are absent. Monitor liver function tests. Educate patients and families to report mood changes, depression, or suicidal thoughts. Reinforce that this medication prevents symptoms but does not relieve acute bronchospasm.

Insulin

Antidiabetic

MOA: Promote use of glucose by body cells

TE: Reduce blood glucose, control diabetes mellitus

SE: insulin shock •Nervousness, trembling •Lack of coordination •Sweating, •Headache, confusion

•Response to excess insulin •Occurs in predawn hours •Rapid decrease in blood glucose during night stimulates hormonal release to increase blood glucose •Reduce HS insulin dose

Lipodystrophy

• Tissue atrophy from frequent injections Insulin Side Effects Dawn phenomenon

• Hyperglycemia upon awakening • Symptoms • Headache, night sweats, nightmares • Increase insulin dose at HS

Diabetic ketoacidosis

• Hyperglycemia - fruity breath, increased thirst, hunger, & urine output (3 P's) • Leads to fat catabolism - increase in ketones

AR: Hypokalemia, Somogyi effect (overnight thing). too much insulin can drop the blood pressure, tachycardia, insulin resistance, cataracts

Life threatening: Insulin shock, anaphylaxis, angioedema, bronchospasm

contraindications: hypoglyemia

Interactions: increase glucose with thiazides, glucocorticoids, estrogen, thyroid drugs

Decrease glucose with aspirin, oral anticoagulants Gastrointestinal secretions destroy insulin structure - therefore, no oral insulin

Nursing consideration/client teaching: IV or SC

Check for signs & symptoms of hypoglycemia and hyperglycemia.

• Analyze cues & prioritize hypothesis

• Reduced glucose regulation, hypoglycemia

• Generate solutions

• The patient will self-administer insulin correctly

Take action Clinical Judgment: Insulin • Determine blood glucose levels & report changes • Monitor patient's HbA1c • Teach patient to recognize & report • hypoglycemia & hyperglycemia • Teach patient how to administer insulin • Advise patient that hypoglycemic reactions are more likely to occur during peak action time • Carry MedicAlert tag, card or bracelet o Eva

Glipizide (pills)

Oral Antidiabetic Drug, Second-gen sulfonylurea

MOA: Directly stimulates beta cells in the pancreas to secrete insulin

o Indirectly alters sensitivity of peripheral insulin receptors,

allowing increased insulin binding

TE: Used to treat type 2 diabetes (hyperglycemia)

SE: Drowsiness, dizziness, headache, confusion

AR: Hypoglycemia, hyponatremia

Life-threatening: angioedema and Agranulocytosis

Contraindication: elderly patients, type I DM

Nursing considerations/client teaching: Concept

oGlucose regulation

o Recognize cues

Clinical Judgment:

Oral Antidiabetics

oDetermine patient's knowledge of DM & use of oral antidiabetics.

oNote v/s & blood glucose levels.

o Analyze cues and prioritize hypothesis

oReduced glucose regulation, hyperglycemia

o Generate solutions

oThe patient's blood glucose will be within normal serum levels.

Take action: Clinical Judgment: Oral Antidiabetics o Administer oral antidiabetics with food to minimize gastric upset. o Monitor blood glucose levels & report changes. o Teach patient to recognize symptoms of hypoglycemia & hyperglycemia. o Teach patient necessity of adherence to diet and drug regimen. o Avoid alcohol o Evaluate outcomes

Teach patients to recognize symptoms of a hypoglycemic reaction—headache, nervousness, sweating, tremors, and rapid pulse—and hyperglycemic reaction, which include thirst, increased urine output, and a sweet, fruity breath odor.

• Explain that insulin might be needed instead of an oral antidiabetic drug during stress, surgery, or serious infection. Blood glucose levels are usually elevated during stressful times.

• Tell patients about the necessity for compliance with a diet and drug regimen.

•  Advise patients to carry a MedicAlert card, tag, or bracelet that indicates their health problem and the antidiabetic dosage.

Metformin (pills)

Oral Antidiabetic Drug

MOA: Recommended as a first-line treatment.

Decreases glucose production in the liver by reducing gluconeogenesis

Improves tissue sensitivity to insulin.

Increases glucose transport to skeletal muscles and fatty tissues

Reduces glucose absorption from intestines o Improves tissue sensitivity to insulin

TE: Controls glucose in type 2 DM; promotes weight stability.

SE: Dizziness, headache, weakness, chills, metallic taste, nausea, diarrhea.

AR: o Palpitations, chest pain

o Life-threatening - lactic acidosis and acute renal failure

Contraindication: Renal/hepatic dysfunction, dehydration, alcohol use.

Nursing consideration/ client teaching: Hold med if patient is having IV contrast - 48 hours before and after administration due to risk 1) lactic acidosis 2) acute renal failure

Monitor renal function

o Usually stopped if moderate/severe kidney disease/GFR < 45.

oReduced glucose regulation, hyperglycemia

o Generate solutions

oThe patient's blood glucose will be within normal serum levels.

Take action: Clinical Judgment: Oral Antidiabetics o Administer oral antidiabetics with food to minimize gastric upset. o Monitor blood glucose levels & report changes. o Teach patient to recognize symptoms of hypoglycemia & hyperglycemia.

Teach patients to recognize symptoms of a hypoglycemic reaction—headache, nervousness, sweating, tremors, and rapid pulse—and hyperglycemic reaction, which include thirst, increased urine output, and a sweet, fruity breath odor.

• Explain that insulin might be needed instead of an oral antidiabetic drug during stress, surgery, or serious infection. Blood glucose levels are usually elevated during stressful times.

•  Advise patients to carry a MedicAlert card, tag, or bracelet that indicates their health problem and the antidiabetic dosage.

Hydrochlorothiazide (HCTZ)

Thiazide & Thiazide-Like Diuretic

MOA: Act on distal convoluted renal tubule • Promote sodium, chloride, water excretion

TE: increase urine output and to treat hypertension and peripheral edema due to HF

SE: Dizziness, headache, weakness, blurred vision, Fluid/electrolyte Imbalance:

AR: Orthostatic hypotension,

Life-threatening: Hypokalemia, renal failure, Stevens-Johnson syndrome

Contraindication: Renal failure o GFR <. 30

o Age related concerns - low Na+

anuria

caution: pregnancy, ESPECIALLY IN THE ELDERLY • Gout.

Drug interactions:

o Antihypertensives; antidiabetic (hyperglycemia); herbal preparations may cause electrolyte imbalances, interactions

Nursing consideration/ client teaching: Concept • Elimination • Recognize cues • What will we assess? • What will we check? • Analyze cues and prioritize hypothesis • Fluid overload, hypokalemia, hyponatremia, fluid and electrolyte imbalances. • Generate solutions • Patient's edema will be decreased. • No fluid or electrolyte imbalance • Take in the morning

Take action

• Monitor v/s & serum electrolytes: potassium, glucose, uric acid, and cholesterol levels.

• Observe

• When should the drug be taken?

• What else should we teach the patient?

Monitor fluid and electrolytes

• Hypokalemia (uscle weakness, leg cramps, and cardiac dysrhythmias.), Hypomagnesemia, Hypochloremia

• Hypercalcemia, Hyperuricemia, Hyperglycemia

• Elevated lipids

and hyperglycemia

Report changes. If a patient is taking digoxin and hypokalemia occurs, digitalis toxicity frequently results.

• Monitor the patient's weight at the same time every day with the same type of clothing. A weight gain of 2.2 lb is equivalent to 1 L of body fluids.

• Note urine output to determine fluid loss or retention.

large doses of hydrochlorothiazide increase blood glucose levels.

Furosemide

loop diuretic

MOA: Act on ascending loop of Henle • Excrete sodium, water, K+, Ca+, Mg+ • Potent and dose dependent

TE: To treat edema due to HF, renal dysfunction, hepatic cirrhosis, and nephrotic syndrome, and to treat hypertension

SE: Electrolyte imbalances: NOTABLY POTASSIUM • Dizziness, headache, weakness • Muscle cramps

AR: Orthostatic hypotension

life threatening: anemia

Contraindication: Sulfa allergy, anuria, severe electrolyte depletion.

Nursing consideration/ client teaching: Concept • Elimination • Recognize cues • Assess Clinical Judgment: Loop Diuretics • Analyze cues and prioritize hypothesis • Fluid overload • Generate solutions • Patient’s edema & hypertension will be reduced. • Stable blood chemistry

Take action • Monitor I & O Clinical Judgment: Loop Diuretics • Monitor v/s - what should we note? • How do we administer IV furosemide? Slow or fast • What do we observe for? • Which medicine do we monitor? • Evaluate outcomes

Observe for signs and symptoms of hypokalemia (<3.5 mEq/L), such as muscle weakness, abdominal distension, leg cramps, and/or cardiac dysrhythmias.

• Monitor serum potassium levels, especially when a patient is taking digoxin. Hypokalemia enhances the action of digitalis, causing digitalis toxicity.

Spironolactone

Potassium-Sparing Diuretic

MOA: Block action of aldosterone • Promote sodium/water excretion & K+ retention

TE: Edema due to ? (aldosterone)

hypertension and heart failure

SE: Dizziness • Headache • Weakness • GI distress

AR: Hyperkalemia (potassium-sparing), bradycardia, and orthostatic hypotension

Contraindication: Renal failure, hyperkalemia, caution: pregnancy.

Nursing consideration/ client teaching: Concept • Elimination • Recognize cues • Assess Clinical Judgment: Potassium-Sparing Diuretics • Analyze cues and prioritize hypothesis • Fluid overload & hyperkalemia • Generate solutions • Patient's blood pressure will be decreased. • Patient's electrolytes will be within normal range.

Take action • Monitor urinary output: Clinical Judgment: Potassium-Sparing Diuretics • Urine output needs to be at least 600 mL/day. • Record V/S • Observe for ? (potassium sparing drug) • Administer: when is the best time? • Advise patients Evaluate outcomes

Observe for signs and symptoms of hyperkalemia (serum potassium >5.0 mEq/L). Nausea, diarrhea, abdominal cramps, numbness and tingling of the hands and feet, leg cramps, tachycardia and later bradycardia, peaked narrow T wave on electrocardiogram, or oliguria may signal hyperkalemia.

• Administer spironolactone in the morning and not in the evening to avoid nocturia.

Lispro

rapid acting

pharmacodynamics

Subcut: Onset: 15-30 min

Peak: 30-90 min

Duration: 3-5 h

regular

short acting

pharmacodynamics

Subcut: Onset: 30 min

Peak: 1.5-3.5 h

Duration: 5-7 h

NPH

intermediate acting

pharmacodynamics

Subcut: Onset: 1.5 h

Peak: 6-8 h

Duration: 14-24 h

Glargine

long acting

pharmacodynamics

Subcut: Onset: 1.5 h

Peak: None

Duration: 24 h