pharmacology

Diuretics

Thiazides

Uses:

• Treats hypertension by reducing blood pressure through the diuretic effect.

• Treats heart failure by reducing fluid overload and improving symptoms.

• Treats cirrhosis of the liver by alleviating edema and ascites.

Side Effects (SE):

• Hypokalemia: Low potassium levels, which may cause muscle cramps and arrhythmias.

• Hypercalcemia: Elevated calcium levels that can lead to muscle weakness and confusion.

• Dehydration: Increased urination often leads to dehydration symptoms such as dry mouth and dizziness.

• Hyperglycemia: Monitoring is vital for diabetic patients, as these drugs can increase blood sugar levels.

• Gout: Monitor uric acid levels closely, since diuretics can precipitate gout attacks.

Patient Education (PT ED):

• Encourage intake of potassium-rich foods (e.g., bananas, spinach, orange juice, potatoes) to mitigate hypokalemia.

• Advise adequate hydration to prevent dehydration.

• For elderly patients, recommend taking the medication in the morning to avoid frequent urination at night.

• Instruct to report pain or swelling in joints as it could indicate gout flare-ups.

• Stress the importance of daily weight monitoring to track fluid retention or loss.

Nursing Interventions:

• Regularly monitor blood pressure (BP) and heart rate (HR) to assess the drug's effectiveness and side effects.

• Check electrolyte levels, particularly potassium and calcium, to avoid complications.

• Watch for signs of dehydration, such as reduced urine output and dry mouth.

Loop Diuretics (Most Powerful)

Uses:

• Effective in treating hypertension and managing pulmonary edema due to heart failure.

• Used in acute situations to rapidly reduce excess fluid in patients.

Side Effects (SE):

• Hypokalemia: Similar risk as thiazides but may occur more rapidly.

• Dehydration: Patients should be monitored for volume status frequently.

• Hyperglycemia: Risk for patients with diabetes.

• Ototoxicity: Risk of hearing loss, especially when IV pushed too quickly.

Patient Education (PT ED):

• As with thiazides, recommend potassium-rich foods and adequate hydration.

• Alert elders to avoid nighttime dosing to minimize urination disturbances.

• Advise to report any changes in hearing or symptoms of leg/feet swelling and dark urine.

• Instruct to report any episodes of dizziness, as it can indicate a fall risk.

Nursing Interventions:

• Continually monitor BP and HR to optimize dosages.

• Assess kidney function through BUN and creatinine levels.

• Regularly check electrolyte levels, especially potassium, to avoid complications.

• Daily weight monitoring is imperative to assess fluid retention effectively.

Potassium-Sparing Diuretics

Uses:

• Commonly prescribed for hypertension and heart failure management, particularly in patients who develop hypokalemia from other diuretics.

• Useful in cirrhosis of the liver as well to manage fluid overload.

Side Effects (SE):

• Deepened voice: Hormonal effects can alter vocal cords, especially in women.

• Hyperkalemia: Risk of high potassium levels leading to arrhythmias.

• Irregular menstrual cycles in women and gynecomastia in men due to hormonal imbalances.

• Dehydration: Patients should be aware of signs of dehydration.

• Postural hypotension: Care needed when standing up to avoid dizziness.

Patient Education (PT ED):

• Advise against potassium-rich foods and supplements to prevent hyperkalemia.

• Report any hormonal changes like breast enlargement in men or menstrual irregularities in women.

• Suggest hydration and slow position changes to mitigate postural hypotension.

Nursing Interventions:

• Regularly monitor potassium levels to prevent hyperkalemia.

• Assess menstrual changes in women and monitor for gynecomastia in men.

• Observe for signs of dehydration and check BP regularly.

BPH Medications

ACE Inhibitors (Prils)

Uses:

• Treats hypertension effectively by relaxing blood vessels.

• Helps in heart failure management, improving morbidity and mortality.

• Beneficial in treating diabetic neuropathy by slowing progression.

Side Effects (SE):

• Dry cough: Can be a cause for discontinuation of therapy.

• Severe hypotension: Particularly after the initial dose; monitoring is essential.

• Metallic taste: May affect adherence to therapy.

• Angioedema: Serious condition requiring immediate medical attention, manifested by swelling in the face, throat, and skin.

• Hyperkalemia: Second to renal impairment; monitor potassium levels.

• Contraindicated in pregnancy: Significant teratogenic effects.

Patient Education (PT ED):

• Report dry cough or any swelling to the healthcare provider immediately.

• Encourage regular BP monitoring at home.

• Be aware of signs and symptoms associated with hyperkalemia and when to contact a physician.

ARBs - Sartans (Losartan)

Uses:

• Prevents stroke and manages hypertension effectively.

• Helps manage diabetic neuropathy, improving renal function.

Side Effects (SE):

• Hyperkalemia risk is present.

• Possibility of angioedema, though less frequent than with ACE inhibitors.

• Headaches and dizziness are commonly reported.

Patient Education (PT ED):

• Recommend avoiding high potassium foods and regular BP checks.

• Report any sudden position changes that lead to dizziness or swelling.

• Advise against use during pregnancy due to risks.

Aldosterone Antagonists – Eplerenone

Uses:

• Effective in treating hypertension and managing heart failure symptoms post-myocardial infarction.

Side Effects (SE):

• Risk of hyperkalemia necessitates frequent potassium monitoring.

Patient Education (PT ED):

• Advise against potassium-rich food intake and certain supplements.

• Report muscle pain or weakness immediately as these may indicate elevated potassium levels.

Direct Renin Inhibitors – Aliskiren

Uses:

• Treats hypertension effectively.

Side Effects (SE):

• Risk for hyperkalemia along with potential cough or angioedema.

• Possible gastrointestinal issues such as diarrhea and abdominal pain.

Patient Education (PT ED):

• Report any persistent cough that develops after starting this drug.

Calcium Channel Blockers

Uses:

• Treats stable angina and moderate to severe hypertension.

Side Effects (SE):

• Lowers BP and HR; patients should be monitored closely.

• Commonly reports facial flushing, peripheral edema, and headaches.

• Can lead to growth of gum tissue and potential for bleeding gums.

Patient Education (PT ED):

• Monitor heart rate and report any rapid increases or peripheral swelling.

• Advise gradual position changes to avoid hypotension.

• Recommend avoiding grapefruit, which can affect drug metabolism.

Sodium Channel Blockers – Flecainide

Uses:

• Indicated for life-threatening supraventricular tachy dysrhythmias and for long-term management in atrial fibrillation.

Adverse Reactions:

• May exacerbate heart failure, fluid retention, and edema.

• Shortness of breath should be monitored closely.

Patient Education (PT ED):

• Patients may require Holter monitoring for ECG assessment.

• Immediately report any visual changes to their healthcare provider.

Beta Blockers – OLOLS

Uses:

• Effectively treats hypertension and affects heart rate negatively.

Side Effects (SE):

• Bradycardia and breathing difficulties, especially in patients with asthma.

• Can negatively affect heart failure and glycemic control.

Patient Education (PT ED):

• Report peripheral edema and check pulse regularly.

• Advise reporting symptoms of shortness of breath and new onset chest pain.

• Emphasize daily weight monitoring for fluid retention assessment.

Class 2 Beta Blocker – Propranolol

Uses:

• Treats tachydysrhythmias and reduces mortality after myocardial infarction.

Side Effects (SE):

• Primarily bradycardia, necessitating pulse monitoring.

Patient Education (PT ED):

• The same as for first-generation beta blockers.

Alpha 1 Blockers – Doxazosin

Uses:

• Treats hypertension and benign prostatic hyperplasia (BPH).

Side Effects (SE):

• Risk for postural/orthostatic hypotension, headaches, and dizziness.

Patient Education (PT ED):

• Advise gradual position changes and recommend morning doses for elders to minimize nighttime issues.

Alpha 2 Agonists – Clonidine

Uses:

• Used primarily for hypertension.

Side Effects (SE):

• Can cause dizziness and dry mouth; potential for rebound hypertensive crisis if stopped abruptly.

Patient Education (PT ED):

• Recommend nightly dosing and to refrain from driving initially after starting the medication.

• Encourage hydration and sucking on hard candy for dry mouth relief.

Direct Acting Vasodilators – Hydralazine

Uses:

• Prescribed for hypertension; may be used with digitalis and other vasodilators for heart management.

Side Effects (SE):

• Common side effects include headache, dizziness, and fatigue.

• Risk of tachycardia, fluid retention, and edema.

Patient Education (PT ED):

• Monitor pulse regularly and report any notable swelling or changes in symptoms.

• Emphasize not stopping medications abruptly to avoid heart failure risks.

Nitrates

Uses:

• Primarily used for treating angina pectoris (chest pain).

Side Effects (SE):

• Typical side effects include headache, orthostatic hypotension, tachycardia, and hot flashes.

Patient Education (PT ED):

• Suggest taking over-the-counter medications for headaches and changing positions slowly.

• Advise against activities that can lead to accidents (e.g., driving) due to potential dizziness.

Anti-Anginal – Ranolazine

Uses:

• Treatment for chronic angina.

Side Effects (SE):

• Allergic reactions such as constipation, nausea, headache, and blurred vision might occur.

• Risk of syncope and dizziness, especially upon initiation or dosage changes.

Patient Education (PT ED):

• Avoid consuming grapefruit and alcohol, and instruct to report any allergic reactions.

Sodium Channel Blocker – Quinidine, Procainamide

Uses:

• Class of medications used as antidysrhythmics for A-fib and tachycardia treatment.

Side Effects (SE):

• GI manifestations such as nausea or diarrhea, hypotension, and risk of arterial embolism (dislodging blood clots).

Patient Education (PT ED):

• Instructions to take the medication with food to minimize GI upset and report any significant changes in pulse, BP, and HR.

Potassium Channel Blockers – Amiodarone

Uses:

• Critical for treating ventricular tachycardia and ventricular fibrillation that are resistant to other therapies; also used for atrial dysrhythmias (A-fib).

Side Effects (SE):

• GI manifestations such as loss of appetite, nausea, vomiting, or constipation.

• Serious adverse effects include acute respiratory distress syndrome (ARDS) and pulmonary toxicity.

Patient Education (PT ED):

• Instruction to take with food to decrease GI irritability.

• Report vision changes, fever, dry cough, or shortness of breath immediately as these may indicate serious toxicity.

Cardiac Glycosides – Digoxin

Uses:

• Typically used as a second-line medication for heart failure; also effective for treating cardiac dysrhythmias like atrial fibrillation.

Side Effects (SE):

• Monitor for cardiac dysrhythmias and assess pulse regularly.

• Patients may experience GI manifestations, including nausea and possible vision changes indicating digoxin toxicity.

Patient Education (PT ED):

• Required to report heart palpitations, GI symptoms, and vision changes as these can all indicate digotoxicity.

• Emphasize close monitoring of digoxin levels due to narrow therapeutic window to avoid toxicity (potassium levels should stay above 3.5).

Hypertensive Crisis Medications

Meds:

• Nitro, Nicardipine, Clevidipine, Analaprilat, Esmolol.

Monitoring:

• Patients must be put on cardiac monitors to observe any adverse effects and ensure quick intervention if necessary.

Adrenergic Agonist – Epinephrine

Uses:

• Primarily used in treating cardiac dysfunction and anaphylaxis.

Side Effects (SE):

• Severe side effects include chest pain, myocarditis, hypertensive crises, cardiac arrhythmias, and tissue necrosis at injection sites.

Patient Education (PT ED):

• Instruct patients about continuous monitoring requirements when administered and emphasize this treatment should only occur in a hospital setting for severe cardiovascular dysfunction.

• Report any chest pain immediately.

Ears

Antiserum – Debrox

Uses:

• Softens ear wax to facilitate easier removal.

Side Effects (SE):

• May cause redness, itchiness, or rash in some patients.

Patient Education (PT ED):

• Stress the importance of reporting any side effects and avoid administration if there is a known ear infection.

• Advise to tilt the head to the side when administering the solution for effective action.

Prostaglandin Analogs – Latanoprost

Uses:

• Effective at decreasing intraocular pressure (IOP) in conditions like glaucoma.

Side Effects (SE):

• Side effects can include pigmentation changes of the eyelid and eyelashes, as well as sensations of irritation in the eye.

Patient Education (PT ED):

• Caution against rubbing the eyes and advise using a different tissue for drops in each eye.

• If a dose is missed, resume with the next dose without doubling.

• Recommend removing contact lenses prior to administration and waiting 2-3 minutes between multiple drops if applicable.

Beta-Adrenergic Antagonists - Timolol

Uses:

• Primarily treats acute angle-closed glaucoma and decreases intraocular pressure.

Side Effects (SE):

• Similar sensations to other eye drops, including feeling something in the eye, irritation, and stinging.

Patient Education (PT ED):

• Educate on possible sensations of curtain-like visual obstructions; advise against driving until after effects are known.

Cholinergic Agonists – Isopto-Carpine

Uses:

• Decreases intraocular pressure in patients with glaucoma.

Side Effects (SE):

• Can cause urinary urgency, bradycardia, and constriction of bronchioles.

Patient Education (PT ED):

• Suggest wearing sunglasses in bright light conditions and prohibit driving due to potential side effects.

Cholinesterase Inhibitors - Echothiophate Ophthalmic Drops

Uses:

• Another option for decreasing IOP in glaucoma management.

Side Effects (SE):

• Side effects may include urinary urgency, bradycardia, constriction of bronchioles, and decreased visual acuity, particularly at night.

Patient Education (PT ED):

• Like other eye drops, teach clients not to rub their eyes, and report decreased vision promptly.

Anti-Platelet – Clopidogrel (Aspirin)

Uses:

• Functions to thin platelets for preventing clot formation.

Side Effects (SE):

• Risk of notable GI manifestations and increased bleeding risk, particularly in individuals with peptic ulcers.

Patient Education (PT ED):

• Urge clients to take the medication with food and report any signs of bleeding, prolonged bleeding, or severe headache.

Heparin – Lovenox

Uses:

• Alters clotting time factors, typically given postoperatively, in hip replacements, and other interventions requiring anticoagulation.

Side Effects (SE):

• Significant risk of bleeding/hemorrhage and potential for low platelet count (thrombocytopenia).

Patient Education (PT ED):

• Advise avoiding NSAIDs that can induce bleeding and using soft toothbrushes and electric razors.

• Report any signs of black, tarry stools and calf pain/swelling, as they indicate deep vein thrombosis (DVT).

• Report any episodes of shortness of breath, which could signal a pulmonary embolism.

Non Vitamin K Antagonist Oral Anticoagulants - Dabigatran

Uses:

• Prevents cerebral vascular accidents (CVA) related to atrial fibrillation; an alternative to warfarin.

Side Effects (SE):

• Significant risk for bleeding complications.

Patient Education (PT ED):

• Educate on the importance of reporting bruising, hematomas, or black tarry stools.

• Stress the need to take prescribed doses regularly and inform healthcare providers before any surgical procedures.

Vitamin K Antagonists – Warfarin (Coumadin)

Uses:

• Prevents venous thrombosis, pulmonary embolism, recurrence of myocardial infarctions (MI), and thromboembolic prevention.

Side Effects (SE):

• Observe for signs of hemorrhage; potent anticoagulation can sometimes lead to life-threatening bleeding.

Patient Education (PT ED):

• Instruct to report any bleeding, bruising, or changes associated with black tarry stools.

• No use of NSAIDs, particularly aspirin, without consulting healthcare providers.

• Recommend electric razors, soft toothbrushes, and wearing a bracelet indicating they are on anticoagulants.

Nursing Intervention:

• Regular check of blood tests (PT/INR); target INR ranges from 2-3, with clotting times falling within 11-13.5 seconds.

Thrombolytics – Alteplase

Uses:

• Dissolves clot formations in DVT, pulmonary embolism, and acute ischemic CVAs.

Side Effects (SE):

• Major concern is bleeding complications.

Patient Education (PT ED):

• Instruct to report any prolonged bleeding immediately.

Erythropoietic Growth Factor – Epoetin Alfa

Uses:

• Supports red blood cell production in conditions such as chemotherapy-induced anemia or preoperative anemia.

Side Effects (SE):

• Potentially leads to hypertension and seizures, requiring close monitoring.

Patient Education (PT ED):

• Inform about the need for frequent blood pressure checks during therapy.

• Advise reporting symptoms like headaches or sudden chest pain.

Nursing Intervention:

• Baseline blood pressure should be recorded before initiation and monitored thereafter.

• Frequent monitoring of hemoglobin, CBC, BUN, and creatinine levels is essential; hold treatment if hemoglobin exceeds 12 or above 10 for cancer patients.

Iron Preparations – Ferrous Sulfate

Uses:

• Treats and prevents iron deficiency anemia.

Side Effects (SE):

• Gastrointestinal issues such as constipation, metallic taste in the mouth, potential staining of teeth in liquid form, and harmless dark green or black stool.

• Risk of fatal iron toxicity in children due to overdose.

Patient Education (PT ED):

• Recommend taking with food to mitigate GI symptoms, expect dark stools as harmless, and to increase fluid intake and dietary fiber to counter constipation.

• Suggest rinsing the mouth after taking to prevent staining.

Vitamin B12 – Cyanocobalamin

Uses:

• Treats pernicious anemia and vitamin B12 deficiency conditions such as malabsorption issues.

Side Effects (SE):

• May cause erythema, hypertension, and hypokalemia.

Patient Education (PT ED):

• Report any signs of muscle spasms, weakness, nausea, palpitations, or paresthesia to a healthcare provider promptly.

Folic Acid

Uses:

• Prevents megaloblastic anemia caused by folate deficiency and is critical in pregnancy for fetal neural development.

Side Effects (SE):

• Can lead to increased yellowing of urine, increased risk of developing colorectal or prostate cancer.

Patient Education (PT ED):

• Encourage clients to consume a diet high in folic acid, including dark leafy vegetables and fortified cereals.

• Monitoring reticulocyte count (RBC levels) is important to ensure treatment effectiveness.