Pharmacology: Medication Uses and Actions
Ibuprofen/Naproxen
Use:
Indicated for mild to moderate pain and antipyretic (fever reduction).
Action:
Provides non-selective reversible inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes, which are vital in the production of prostaglandins involved in pain and inflammation.
Route:
Administered orally (PO) and intravenously (IV).
Adverse Effects (AEs):
Gastrointestinal (GI) issues, ulcerations, nephrotoxicity (elevated blood urea nitrogen [BUN]/creatinine).
Contraindications (Con):
Presence of allergies to non-steroidal anti-inflammatory drugs (NSAIDs) and salicylates.
Nursing Interventions (NI):
Do not exceed 3200 mg daily and advise to take with food to minimize GI discomfort.
Morphine
Use:
Effective for relief of moderate to severe pain.
Action:
Binds to opioid receptors in the central nervous system (CNS) and peripheral nervous system (PNS) to inhibit pain signals.
Route:
Administered orally (PO), intramuscularly (IM), subcutaneously (SC), or via transdermal patches (noting to give IV opioids slowly over 5 minutes).
Adverse Effects (AEs):
Respiratory depression leading to sedation, autonomic nervous system (ANS) effects on GI and bladder function, CNS side effects, and itching reactions.
Contraindications (Con):
Respiratory depression confirmed with a respiratory rate (RR) of less than 12 breaths per minute.
Nursing Interventions (NI):
Stop administration if RR is below 12 and have naloxone available as a resuscitation medication.
Aspirin
Use:
Utilized in anti-platelet therapy and for mild to moderate pain relief.
Action:
Irreversibly inhibits COX-1 and COX-2 enzymes, lowering the production of inflammatory prostaglandins.
Route:
Administered orally (PO), intravenously (IV), or rectally.
Adverse Effects (AEs):
Gastrointestinal complications, hematologic implications, possible hearing loss, toxicity, and rash. Special concern for children due to the risk of Reye Syndrome.
Contraindications (Con):
Known hypersensitivity, history of bleeding disorders, and a maximum daily dosage of 8000 mg.
Nursing Interventions (NI):
Assess pain on a scale, avoid crushing the tablet, advise to take with food, and assess for prior allergies.
Digoxin
Use:
Second-line therapy for mild to moderate heart failure (HF) and in managing arterial fibrillation.
Action:
Enhances cardiac contractility, thereby improving cardiac output and increasing the force of contraction.
Adverse Effects (AEs):
Toxicity characterized by serum levels exceeding 2.0 mg/mL causing anorexia, nausea, and vision changes (yellow/green halos).
Contraindications (Con):
Dysrhythmias and noted on the BEERS list for caution in older adults.
Nursing Interventions (NI):
Avoid giving with dairy or antacids, be cautious with furosemide, administer IV over 5 minutes, and monitor potassium levels due to heightened toxicity danger with low potassium (K+). The antidote for toxicity is digoxin immune fab.
Furosemide (Lasix)
Use:
Treatment of severe heart failure; acts as a diuretic to promote sodium and fluid loss.
Action:
Inhibits sodium chloride (NaCl) reabsorption in the ascending loop of Henle in the kidneys.
Adverse Effects (AEs):
Electrolyte imbalance (notably decreased K+), hypotension, and potential ototoxicity.
Contraindications (Con):
Allergy to sulfa drugs, caution in older adults, and pregnancy category C.
Nursing Interventions (NI):
Monitor daily fasting weight and glucose levels, and infuse IV over 1-2 minutes. Note the interaction with digoxin can heighten the risk of toxicity.
Low-Dose Aspirin
Use:
To decrease the rate of vascular clotting.
Action:
Inhibits cyclooxygenase enzyme in thromboxane at low doses (91-325 mg/day).
Nursing Interventions (NI):
Report any signs of bleeding, advice to take with or after meals.
t-PA (Alteplase)
Use:
Employed for reperfusion therapy in cases of ischemic stroke.
Action:
Dissolves blood clots and stimulates the conversion of plasminogen (produced by the liver) to plasmin, a fibrinolytic protein.
Adverse Effects (AEs):
Risk of bleeding of any type and cardiac arrhythmias.
Contraindications (Con):
Active current anticoagulant therapy and bleeding tendencies.
Nursing Interventions (NI):
Ensure consent form is signed, avoid subcutaneous or intramuscular injections, monitor for bleeding, and administer at 0.9 mg/kg body weight.
Atorvastatin
Use:
First-line therapy as an HMG-CoA reductase inhibitor to manage cholesterol.
Action:
Inhibits the enzyme necessary for the hepatic synthesis of cholesterol, thus lowering LDL cholesterol levels.
Adverse Effects (AEs):
GI symptoms, muscle-related complaints, and hepatotoxicity.
Contraindications (Con):
Contraindicated in pregnancy and liver disease.
Nursing Interventions (NI):
Administer in the evening, cease use if muscle pain, tenderness, or weakness arises, and avoid grapefruit due to interaction.
Spironolactone (Aldactone)
Use:
Prescribed for hypertension (HBP) and heart failure, often used with other medications to reduce potassium loss.
Action:
Blocks aldosterone receptors in the kidneys, leading to potassium retention.
Adverse Effects (AEs):
Risk of hyperkalemia, low sodium (Na+), and potential for tumor growth.
Contraindications (Con):
Increased potassium levels, renal or liver disease.
Nursing Interventions (NI):
Monitor for hyperkalemia, sodium and potassium levels, avoid grapefruit, and typically used with furosemide.
Propranolol
Use:
Treatment for hypertension (HTN) and heart failure (HF).
Action:
Blocks beta-adrenergic receptors leading to decreased heart rate (HR), contractility, blood pressure (BP), and renin release, inducing vasodilation.
Adverse Effects (AEs):
Risk for bradycardia, bronchospasm (wheezing), and orthostatic hypotension. Black box warning against abrupt cessation, especially in patients with coronary artery disease (CAD).
Contraindications (Con):
Caution required in asthma and chronic obstructive pulmonary disease (COPD) patients as it may mask severe hypoglycemia.
Nursing Interventions (NI):
Measure apical pulse and blood pressure prior to administration; withhold if pulse is below 50-60 bpm.
Lisinopril
Action:
Blocks the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.
Adverse Effects (AEs):
May cause a dry persistent cough, hyperkalemia, and angioedema.
Contraindications (Con):
Pregnancy category D, renal artery stenosis, and historical angioedema.
Nursing Interventions (NI):
Monitor blood pressure, heart rate, BUN/creatinine, and potassium levels; discontinue if angioedema occurs.
Ciprofloxacin
Use:
Effective for treating sinusitis, pneumonia, lower respiratory infections, and urinary tract infections (UTI).
Route:
Administered orally (PO) or intravenously (IV).
Adverse Effects (AEs):
Gastrointestinal symptoms, headache, dizziness, photosensitivity, and a black box warning for potential Achilles tendon rupture.
Contraindications (Con):
Caution advised in renal disease; contraindicated in patients under 18 years of age.
Nursing Interventions (NI):
Instruct to stop and report any discomfort in the Achilles tendon area.
Clindamycin (Cleocin)
Use:
Topically used for treating acne and cocci infections.
Route:
Administered topically or orally (PO).
Adverse Effects (AEs):
Nausea/vomiting and a black box warning for potential colitis.
Contraindications (Con):
Caution in patients with liver impairment.
Nursing Interventions (NI):
Take with water and avoid refrigeration of the medication.
Cephalosporin (Cefazolin)
Use:
Utilized for surgical prophylaxis.
Action:
Inhibits the structural integrity of the bacterial cell wall, providing a broad-spectrum antibiotic activity.
Route:
Available in PO, IM, or IV forms.
Adverse Effects (AEs):
Hypersensitivity reactions, gastrointestinal (GI) side effects, genitourinary (GU) issues, renal insufficiency, and bleeding.
Contraindications (Con):
Patients with a history of penicillin allergy should use with caution.
Nursing Interventions (NI):
Monitor for diarrhea and stop due to the risk of Clostridium difficile infection; assess for possible cross-sensitivities due to structural similarities with penicillin.
Metronidazole
Use:
Treats Clostridium difficile infections and helps to prevent infections during abdominal surgeries.
Route:
Administered by PO, IV, or topical application.
Adverse Effects (AEs):
Risk of yeast infections and a metallic taste in the mouth.
Contraindications (Con):
Assess for hypersensitivity, use during pregnancy with caution, and caution in CNS, blood, or liver diseases.
Nursing Interventions (NI):
Advise against alcohol consumption as it may lead to adverse reactions, monitor for allergies, and be aware of numerous drug interactions; urine may appear dark reddish-brown.
1st Generation Antihistamines (Diphenhydramine)
Use:
Used for allergic reactions and as a cough suppressant.
Action:
Competes with histamine for receptor sites on effector cells, reducing allergic responses.
Route:
Administered orally (PO), IM, IV, or topically.
Adverse Effects (AEs):
Sedation, drowsiness, and anticholinergic effects such as urinary retention.
Contraindications (Con):
Use with caution during breastfeeding, in the elderly, and in patients with asthma/COPD.
Nursing Interventions (NI):
Monitor for allergy symptoms and advise to take with or without food, drinking milk to mitigate GI upset.
Vancomycin
Use:
Indicated for serious Gram-positive infections, for example, Methicillin-resistant Staphylococcus aureus (MRSA).
Action:
A bacterial agent effective only against Gram-positive bacteria, inhibiting cell wall synthesis.
Route:
Administered IV slowly (over 1-2 hours) and orally for Clostridium difficile infections.
Adverse Effects (AEs):
Nephrotoxicity, ototoxicity, and vancomycin infusion reactions.
Contraindications (Con):
Allergy to corn and renal impairments.
Nursing Interventions (NI):
Monitor renal function and hearing, check peak-trough levels, and assess for flushing, redness, or rash post-infusion.
Penicillin
Use:
Used to prevent infective endocarditis.
Action:
Bactericidal in nature, it inhibits bacterial cell wall synthesis and has a broad-spectrum effect.
Route:
Administered via IM or IV routes.
Adverse Effects (AEs):
Hypersensitivity reactions, rashes, GI discomfort, and a black box warning regarding decreased potassium levels.
Contraindications (Con):
Allergies to penicillin (noting that if allergic to one form, risks allergy to all are elevated), and increased caution in those with known cephalosporin sensitivity.
Nursing Interventions (NI):
Document and know patient allergies, monitor for side effects, and be aware of the risk of fatal anaphylaxis.
Gentamicin
Use:
Administered for serious systemic infections through IM or IV.
Action:
Binds to the 30s subunit of bacterial ribosomes, inhibiting protein synthesis in bacteria.
Adverse Effects (AEs):
Potential hearing loss, nephrotoxicity especially in patients taking muscle relaxants or anesthesia, and ototoxicity.
Contraindications (Con):
Hypersensitivity and caution required in older adults due to renal impairment risks.
Nursing Interventions (NI):
Monitoring is necessary due to its narrow therapeutic window, requiring peak-trough measurement, and should not be administered for more than 10 days.