Class 2: Drug Therapy

True or False: Antihypertensive medications frequently cause sexual dysfunction, making them the most unadhered to medication by men.

True or False: Antihypertensive medications frequently cause sexual dysfunction, making them the most unadhered to medication by men.

True

Analgesics (opoid)

Major Side Effects:

• Sedation

• Confusion

• Nausea and vomiting

• Agitation

• Decrease BP

• Decrease respiration

• Dependence

Nursing Actions:

• Check BP and resp. before giving

• Do not give if resp. below 12 or if BP below 100/60

• Give with food or antiemetic if causes nausea

Anticonvulsant

Major Side Effects:

• Toxicity

• GI distress

• Gingival hyperplasia

• Nystagmus

• Sedation

Nursing Actions:

• Check blood levels of the drug before giving

• Give good oral hygiene

• Give with food or milk to prevent GI distress

Coumadin (Anticoagulants) (Oral)

Major Side Effects:

• Bleeding

Nursing Actions:

• Check prothrombin time (PT) before giving

• Check INR

• Antidote is Vitamin K

Heparin (Anticoagulants) (IV or SQ)

Major Side Effects:

• Bleeding

Nursing Actions:

• Check partial thromboplastin time (PTT) before administering

• Antidote is protamine sulfate

Antihypertensives

Major Side Effects:

• Decrease BP and increase P

Nursing Actions:

• Check BP and P before giving

• Hold if BP is below 100/60 or P below 60

Anti-Infectives

Major Side Effects:

• Allergic hypersensitivity

• Direct toxicity

• Superinfection

Nursing Actions:

• Check allergies before giving

• Be alert to cross-over sensitivities (penicillin and cephalosporins)

• Culture blood or wound before giving drug

Tetracycline Class

Major Side Effects:

• Calcium and iron decrease in absorption

Nursing Actions:

• Do not administer within three hours of ingesting dairy food, iron, or antacids

Non-Steroidal Anti-Inflammatory (NSAID)

Major Side Effects:

• GI ulcers and bleeding

• Tinnitus

• HA

• Hematuria

• Rash

Nursing Actions:

• Give with food

• Watch for occult or frank bleeding

Steroids

Major Side Effects:

• Masking of infection

• Osteoporosis

• Depression of adrenal function

• GI ulcers

Nursing Actions:

• Do not stop drugs abruptly

• Taper dose down

• Watch for potential infection

Antiulcer Agents

Major Side Effects:

• Confusion

• Diarrhea

• Dizziness

Nursing Actions:

• Monitor elderly patients closely for confusion, especially at night.

Cardiac Glycosides

Major Side Effects:

• Toxicity symptoms

• Nausea

• Vomiting

• Diarrhea

• Halos around lights

• Bradycardia

Nursing Actions:

• Take an apical pulse for a full minute before giving.

• Hold if the pulse is less than 60 and notify the prescriber

• Check blood level (digoxin level) before giving

Diuretics Non-Potassium Sparing

Major Side Effects:

• Hypokalemia

• Hypotension

• Tachycardia

• Dehydration

Nursing Actions:

• Check K levels before giving

• Monitor BP and P

• Monitor I&O

• Teach high-potassium foods to eat

Potassium Sparing Diuretics

Major Side Effects:

• Hyperkalemia

• Dehydration

Nursing Actions:

• Teach the patient to avoid high-potassium foods

• Monitor K levels

• Monitor I&Os

Estrogens

Major Side Effects:

• Blood clots

• Increase BP

• Edema

• Migraine HA

Nursing Actions:

• Ask about leg pain every shift

• Monitor fluid balance

-alol

• BP medication

Major Side Effects:

• Orthostatic hypotension

Nursing Actions:

• Check BP before giving

• Check HR before giving

Example:

• Labetalol

-azepam

• Anti-Anxiety

Major Side Effects:

• Respiratory depression

Nursing Actions:

• Check RR and hold if low before administration

Example:

• Lorazepam

-barb

• CNS depressant

Major Side Effects:

• Respiratory depression

• Hypersensitivity

• Stevens-Johnson syndrome

Nursing Actions:

Example:

• phenobarbital

-cef/ceph-

• Infection

Major Side Effects:

• Cross sensitivity if allergic to penicillin

Nursing Actions:

• Assess for penicillin allergy before administration

• Monitor WBC count for effectiveness

Example:

• Cephalexin

-cillin

• Infection

Major Side Effects:

• GI upset

• Development of allergy

Nursing Actions:

• Monitor WBC count for effectiveness

Example:

• Amoxicillin

estr-

• Female HRT (estradioll)

Major Side Effects:

• Nausea

Nursing Actions:

• HRT is contraindicated for those with cardiac history or history of CVA

• Know your client’s history

Example:

• Conjugated Estrogen

-irudin

• tx DVTs, a thrombin inhibitor

Major Side Effects:

Nursing Actions:

• Monitor coagulation panel (H&H, platelets, CBC)

Example:

• Hirudin

-mab

• Cancer treatment and other treatments as needed for autoimmune disorders

Major Side Effects:

• Infusion/injection-related reactions

• Increased risk of infection

Nursing Actions:

• Use is contraindicated in active infection.

Example:

• Adalimumab

• Inflizimab

-mycin

• Infection

Major Side Effects:

• Prolonged use can lead to C. diff

Nursing Actions:

• Monitor for:

  • Dizziness

  • H/A

  • Rash

  • WBC count for effectiveness

Example:

• Erythromycin

-olol

• HTN

Major Side Effects:

• Orthostatic hypotension

Nursing Actions:

• Check BP/HR before administration

Example:

• metoprolol

-amide

• Fluid retention/HTN

Major Side Effects:

• Contraindicated in those with significant liver or kidney dysfunction

Nursing Actions:

• Check BP/HR before administration

Example:

• Acetazolamide

-parin

• Anticoagulation

Major Side Effects:

• Hemorrhaging

Nursing Actions:

• Monitor coagulation panel (H&H, platelets, CBC) per protocol

• Enoxaparin does not require coagulation panel monitoring-- only CBC.

Example:

• Heparin

-peridol

• Treatment of schizophrenia/psychosis

Major Side Effects:

• It can cause extrapyramidal symptoms (EPS) and tardive dyskinesia

Nursing Actions:

• Monitor for dizziness and sedation

Example:

• Haloperidol

-poetin

• Stimulate RBC production

Major Side Effects:

• Fever

• H/A

• HTN

• Injection site reaction

Nursing Actions:

• Monitor HCT and Hbg for effectiveness

Example:

• Epoetin alfa

True or False: All drugs with the same ending will be apart of the same family.

False

Medication Reconciliation

The process of comparing a patient's medication orders to all of the medications that the patient has been taking. Done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.

High Alert Medication

Drugs that bear a heightened risk of causing significant patient harm when they are used in error. The consequence of an error is greater, though med errors themselves may not be.

High Alert Medication Examples

• Insulin

• Heparin IV

• Morphine

• Potassium

Special Considerations for Administering High Alert Medications

• Standardize the order, storage preparation, and administration of these medications

• Limit access

• Improve access to information about these drugs

• Employing redundancies

• Using axillary labels and automatic alerts

• Two nurse administrations/cosign

Nursing Interventions to Prevent Med Errors

• Review six rights of medication/med checks

• Med alerts popping up on the medication distribution center

• Storing greater concentrations of a drug away from the lower ones

• Multi-nurse check

Why are nurses more likely to abuse controlled substances?

• They have a greater access to controlled substances

• They have incredibly stressful jobs

How can facilities prevent the abuse of controlled substances?

• Lenient admittance policies that allow nurses to keep their license and job as long as the get help.

• Drug testing

• Wasting

• Drug counts after retrieving medications

Dyslipidemic Agents

• Work by altering the production, absorption, and metabolism of lipids.

• Increase the removal of lipids from the blood.

• Patient Teaching:

  • Limit drinking grapefruit juice

  • Notify the physician of unexplained muscle pain, tenderness, or weakness

• Ex. Lovastatin, atorvastatin, simvastatin, pravastatin.

True or False: A patient on a dyslipidemic drug should increase their intake of grapefruit juice to promote drug effectiveness.

False

Antidiarrheal Agents

• May slow peristalsis

• May change adsorption of the GI contents

Laxatives

• Used for the treatment of constipation and work to increase the removal of feces from the body. This is done by either increasing the bulk of the stool or increasing the amount of fluid in the stool, which makes the stool easier to pass.

• Patient Teaching:

  • Teach the patient to learn personal bowel habits.

  • Urge patient to increase their fiber and fluid intake

  • Do not encourage long-term usage unless approved by a physician.

Stool-Softener

May be administered to decrease the surface tension of the stool, which increases the amount of fluid in the stool, thus making it easier to pass.

True or False: Laxatives increase the urge to have a bowel movement whereas stool softeners do not affect the urge to have a bowel movement--they simply make the stool easier to pass.

True

True or False: Laxatives and stool softeners are generally prescribed for long-term usage.

False

Adrenergic Agents

• Stimulate the beta2-adrenergic receptors in the smooth muscles of the airways.

• Ex. Albuterol, salmetrol

Albuterol

Given in inhaled form with MDIs and are used for acute attacks of bronchoconstriction.

Salmeterol

Used as prophylaxis and is not effective for acute attacks

Anticholinergic Agents

• Used for maintenance therapy of bronchoconstriction such as that seen in emphysema.

• Inhibit the cholinergic receptors in bronchial smooth muscle tissue, ultimately resulting in localized bronchodilators.

• Patient Teaching:

  • Contact the healthcare provider immediately if medication does not relieve shortness of breath.

  • Bronchodilators should be used before steroids.

  • Those who are prescribed theophylline should avoid caffeine, chargrilled meats, and large amounts of cruciferous veggies.

• Ex. Ipratropium

Corticosteroids

• Used to treat constrictive disorders by suppressing inflammation through the decrease of fluid & protein movement into the airways or other muscles in the body.

• Usually end in -asone, -isone, -ide, or -olone

• Prednisone is the most frequently used

• Patient Teaching:

  • These drugs are not for rescue use.

  • Take prescribed bronchodilators five minutes prior to using inhaled steroids.

  • The client may experience hyperglycemia while receiving steroids.

True or False: Corticosteroids are not for rescue use.

True

ACE Inhibitors

• Block the conversion of angiotensin I to angiotensin II, thus producing a vasodilating effect.

• Decrease the production of aldosterone, which works to increase the excretion of sodium and water.

• First-line medication to treat hypertension in diabetics.

• Patient Teaching:

  • Persistent dry cough develops that subsides after stopping medication

  • May cause drowsiness

• End in -pril

• Ex. Lisinopril, accupril, enalapril, captopril.

Calcium Channel Blockers

• Dilate peripheral arteries and decrease vascular resistance by relaxation of vascular smooth muscle.

• Results in inhibition of cardiac muscle excitation.

• Patient Teaching:

  • Report unrelieved chest pain or shortness of breath

  • Check pulse and blood pressure

• Ex. nifedipine, verapamil, diltiazem, amlodipine.

Betablockers

• Treat hypertension by blocking the stimulation of beta1 adrenergic receptors. (Act on the heart)

• Patient Teaching:

  • ALWAYS check the pulse and notify the physician if it is less than 60.

  • Nurses check apical HR.

• Usually end in -lol

• Ex. Metoprolol, atenolol, carvedilol, labetalol.

Angiotensin II Receptor Antagonist

• Work by disabling the renin-angiotensin-aldosterone system.

• Patient Teaching:

  • Report sore throat, extremity swelling, dry cough, facial swelling, nausea, vomiting, diarrhea, or metallic taste to a physician.

  • May cause drowsiness

• End in -sartan.

• Ex. Losartan, valsartan, candesartan, irbesartan.

Thiazide Diuretics

• Weakest and usually used in combination with another medication.

• Decrease the re-absorption of sodium, water, and chloride in the distal convoluted tubule.

• Be aware of allergies.

• This medication only works when the kidneys are functioning properly.

• Ex. Hydrochlorothiazide

Loop Diuretics

• Inhibit sodium and chloride reabsorption in the ascending Loop of Henle.

• Produce a significant diuresis which makes them the most effective and versatile.

• Ex. Furosemide

Potassium Sparing Diuretics

• Act at the distal tubule to decrease sodium reabsorption and to decrease the amount of potassium that is excreted.

• Weak when used alone.

• Ex. Spironolactone

Osmotic Diuretics

• Produce rapid diuresis by increasing the solute amount found in the glomerular filtrate. This causes water to be pulled back into the vascular space, thus increasing blood volume.

• Effective in reducing intracranial pressure and intraocular pressure.

• Ex. Mannitol

Opportunistic/Super Infection

When the organism is native to the host, but causes an infection.

Penicillin’s, Cephalosporins, and Vancomycin

Inhibition of cell wall synthesis or activation of enzymes that disrupt the cell wall

Inhibition of Protein Synthesis by Bacteria or Production of Abnormal Bacterial Proteins

Aminoglycosides, clindamycin, erythromycin, and tetracycline

Antifungal Medications

Disruption of cell membranes

Fluroquinolones and Rifampin

Inhibition of organism reproduction

Sulfonamides

Inhibition of cell metabolism

True or False: Penicillin is one of the most common medication allergies.

True

True or False: If a person is allergic to penicillin, they may be allergic to medications in the cephalosporin family too.

True

True or False: A patient should stop taking their antibiotic treatment once they feel better, even if they have pills left over.

False

Patient Teaching Regarding Antibiotics

• Take all medications are prescribed and do not stop taking the medications without speaking to a physician.

• Be aware of side effects such as fungal infections, pseudomembranous colitis.

• Women using birth control need to be counseled to use alternative birth control methods.

Beta-Lactamase Inhibitor

• Paired with antibiotics to prevent drug resistant bacteria from using beta-lactamase to destroy penicillin molecules.

• Although not always effective, it does make the drug more powerful.

• Ex. Clavulanic acid

True or False: Tetracyclines should not be administered with diary products.

True

Antiplatelet

• Prevent the clotting activity of platelets by inhibiting platelet aggregation and preventing the development of platelet plugs.

• Patient Teaching:

  • Notify the physician if a sore throat, fever, chills, or unusual bleeding occurs.

  • Avoid taking other medications or supplements without speaking to a healthcare provider first.

• Ex. Ticlidopine, clopidogrel, aspirin.

Thyroid Dysfunction Medications

• Levothyroxine

• Methimazole

• Saturated potassium iodine solution

Patient Education Regarding Thyroid Medications

• How to know if the medication is working

• How to know if the client is having any adverse effects

• The client understands the importance of not changing brands of medications as this can alter effectiveness

Monoclonal Antibody Medications

• Osteoporosis medication

• Work by recognizing and finding specific proteins on specific cells.

• Administered subcutaneously every 6 months

• Side Effects:

  • Skin irritation

  • Itchiness

  • Back pain

  • GI concerns

• Adverse Effects:

  • Unusual bleeding

  • Numbness/tingling around mouth/fingers/toes

  • Facial swelling

  • Difficulty breathing

  • Fever

  • Loose teeth

Bone Reabsorption Inhibitor

• Prevent bone loss by inhibiting osteoclast activity

• Prevent and treat osteoporosis

• Patient Teaching:

  • Importance of adequate calcium and vitamin D intake.

  • Medication needs to be taken 30 minutes before breakfast on an empty stomach, and the patient must remain upright to decrease reflux.

  • Importance of engaging in weight-bearing exercise to increase bone density.

  • Use sunscreens.

• Ex. alendronate, etidronate, risedronate, raloxifene, tamoxifen.

Romosozumab

• Works by promoting bone formation and inhibiting bone reabsorption.

• Administered subcutaneously once/month for a year.

• Effectiveness wanes after 12 doses.

• Patient Teaching:

  • Emphasize the importance of taking vitamin D and calcium.

  • Contraindications include hypersensitivity to the medication or hypocalcemia.

  • May cause osteonecrosis of the jaw, emphasize the importance of oral hygiene.

• May increase the risk of:

  • Heart attacks

  • Strokes

  • Death from cardiovascular disease

Iron Deficiency Anemia Medications

• Ferrous sulfate

• Iron sucrose

• Cyanocobalamin

• Folic acid

• Erythropoietin

Iron Deficiency Medication Patient Teaching

• Include side effects

• Dairy decreases absorption

• Vitamin C enhances absorption

Glucose Regulation Medications

• It is used to treat high blood sugar levels when either the pancreas cannot secrete insulin, or the patient is resistant to the insulin available in the body.

• Patient Teaching:

  • Include manifestations of hyperglycemia and hypoglycemia.

  • If using injected medications, teaching should include how to administer medications.

• Four categories:

  • Sulfonylureas

  • Biguanides

  • Thiazolidinediones

  • Insulin

Sulfonylureas

• Stimulate insulin release

• Decrease insulin resistance

• Ex. Glyburide, glipizide, glimepriride.

Biguanides

• Increase uptake of insulin by cells

• Decreases gluconeogenesis

• Decreases cellular intestinal reabsorption of glucose

• Ex. Glucophage

Thiazolidinediones

• Enhances glucose uptake by muscle and fatty tissue.

• Ex. Avandia

Insulin

• The goal is to have the correct amount in the blood when glucose is present.

• May be rapid acting (insulin lispro)

• May be short acting (regular insulin)

• May be long acting (insulin glargine)

Anticoagulants

• Prevent the formation of blood clots and prevent clots that already exist from growing larger.

• They DO NOT DISSOLVE CURRENT CLOTS

• Patient Teaching:

  • Report unexplained or excessive bruising or bleeding immediately

  • Do not take antiplatelet agents

  • Do not drink alcohol

  • Use soft-bristled toothbrush

  • Do not floss

  • Use electric razor

  • Wear a medical alert bracelet

  • Be aware of food/drug interactions and drug/durg interactions

Heparin

• Works by inactivation certain clotting factors and inhibiting the conversion of prothrombin to thrombin.

• Prevents thrombus formation

• Inhibits additional coagulation of thrombi that are present.

• High alert medication

Low Molecular Weight Heparin

• Contain the portion of heparin that has been found to be most active and have been found to be as effective as intravenous heparin in the treatment of thrombotic conditions.

• While similar to heparin, they are not interchangable.

• Ex. Dalteparin, enoxaparin.

Warfarin

• Most widely used oral anticoagulant

• Prevents the synthesis of certain clotting factors that are dependent upon vitamin K for synthesis.

Antiglaucoma Medications

• Work by decreasing intraocular pressure either by reducing any obstruction to the outflow of aqueous humor or by decreasing the formation of aqueous humor.

• Patient Teaching:

  • Compress the lacrimal duct for one minute.

  • Place medication in the conjunctival sac, not on the pupil.

  • Avoid doing activities that require visual acuity after administration.

• Ex. Acetazolamide, apraclonidine, pilocarpine, and carbachol.

Neuraminidase Enzymes

Enable budding virions to escape from infected cells and spread throughout the body.

Cholestyramine

• Bind with bile acids in the intestinal lumen.

• Causes the bile salts to be excreted in the feces which causes the liver to use more cholesterol from the blood to make more bile salts resulting in the removal of cholesterol.

• May cause constipation

• Take before meals

Antacids

• Used to neutralize gastric contents.

• Ex. Calcium carbonate, sodium bicarbonate, sodium sitratem and citric acid.

• Given as needed after meals when abdominal discomfort occurs.

• It may cause constipation and rebound stomach acidity

• Heartburn that persists for more than two weeks should be evaluated.

True or False: Magnesium and calcium containing antacids are contraindicated for those in renal failure.

True

Histamine Receptor Antagonists (H2RAS)

• Used to prevent and treat peptic ulcer disease, GERD, ulcers, and esophagitis.

• They have a longer lifespan than antacids and are frequently given on a daily basis for several weeks to allow the healing of tissues to occur.

• It may cause constipation and rebound stomach acidity

• Heartburn that persists for more than two weeks should be evaluated.

• End in -tidine.

• Ex. Cimetidine, ranitidine, famotidine.

Proton Pump Inhibitors (PPIs)

• Given to inhibit the secretion of gastric acid.

• Bind with the gastric proton pump to prevent the release of gastric acid from the parietal cells.

• Patient Teaching:

  • Should be taken for a full course of therapy

  • Notify the physician if swallowing difficulties occur

  • Avoid alcohol, NSAIDs, smoking, caffeine, and other foods that cause gastric irritation.

• End in -prazole.

• Ex. Esomeprazole, lansoprazole, omeprazole, pantoprazole.

Parkinson’s Medication Patient Teaching

• Commonly seen side effects:

  • Dry mouth (can be alleviated with good oral hygiene and the use of sugarless gum or hard candy)

• Make sure to take medication at the same time of day with food if instructed.

Dopamine Replacement Drugs

• Levodopa

• Carbidopa-levodopa

MAO-B Inhibitors

• Work as a selective MAO inhibitor.

• It helps to improve the effects of levodopa by preventing the body from breaking it down. MAO enzymes are distributed throughout the body.

• End in -giline

• Ex. Selegiline

COMT Inhibitors

• Help to preserve levodopa

• End in -pone

• Ex. Entacapone

Dopamine Agonists

• Mimic dopamine

• Bromocriptine, pramipexole, ropinirole

Medications for Tuberculosis

• Isoniazid

• Ethambutol

• Pyrazinamide

• Rifampin