pharm

Diuretics

Thiazides

Uses:

  • Treats hypertension.

  • Treats heart failure.

  • Treats cirrhosis of the liver.

Side Effects (SE):

  • Hypokalemia (low potassium levels).

  • Hypercalcemia (elevated calcium can cause muscle weakness).

  • Dehydration (increased urination leads to dehydration).

  • Hyperglycemia (risk for diabetics).

  • Gout (monitor uric acid levels).

Patient Education (PT ED):

  • Eat potassium-rich foods (banana, spinach, orange juice, potato).

  • Stay hydrated.

  • Elders: Avoid taking at night (frequent urination).

  • Report pain or swelling in joints (potential gout flare-up).

  • Monitor weight daily (for fluid retention/loss).

Nursing Interventions:

  • Monitor blood pressure (BP) and heart rate (HR).

  • Check electrolytes (potassium and calcium levels).

  • Watch for signs of dehydration (dry mouth, urine output).

Loop Diuretics (Most Powerful)

Uses:

  • Treats hypertension.

  • Treats pulmonary edema.

Side Effects (SE):

  • Hypokalemia.

  • Dehydration.

  • Hyperglycemia.

  • Ototoxicity (risk of hearing loss if IV pushed too fast).

Patient Education (PT ED):

  • Eat potassium-rich foods.

  • Stay hydrated.

  • Elders: Avoid taking at night.

  • Report any hearing changes.

  • Report swelling in legs/feet and dark urine.

  • Report dizziness.

Nursing Interventions:

  • Monitor BP and HR.

  • Monitor kidney function (BUN and creatinine levels).

  • Check electrolytes (potassium).

  • Monitor weight daily.

Potassium-Sparing Diuretics

Uses:

  • Treats hypertension.

  • Treats heart failure.

  • Treats cirrhosis of the liver.

Side Effects (SE):

  • Deepens voice.

  • Hyperkalemia (high potassium levels).

  • Irregular menstrual cycles in women.

  • Gynecomastia in men.

  • Dehydration.

  • Postural hypotension.

Patient Education (PT ED):

  • Avoid potassium-rich foods.

  • Report hormonal changes.

  • Elders: Avoid taking at night.

  • Stay hydrated.

  • Move slowly when changing positions.

  • Report signs of muscle weakness and palpitations.

Nursing Interventions:

  • Monitor electrolytes (potassium).

  • Watch for menstrual changes in women and gynecomastia in men.

  • Monitor signs of dehydration.

  • Monitor BP and HR.

BPH Meds - ACE Inhibitors (Prils)

Uses:

  • Treats hypertension.

  • Treats heart failure.

  • Treats diabetic neuropathy.

Side Effects (SE):

  • Dry cough.

  • Severe hypotension after first dose.

  • Metallic taste.

  • Angioedema (swelling of face, eyes, throat, skin).

  • Hyperkalemia.

  • Not safe for pregnancy.

  • Avoid alcohol.

Patient Education (PT ED):

  • Report dry cough to healthcare provider (HCP).

  • Monitor blood pressure.

  • Watch for hyperkalemia symptoms.

ARBs - Sartans (Losartan)

Uses:

  • Prevents stroke.

  • Manages diabetic neuropathy (Valsartan).

Side Effects (SE):

  • Can cause hyperkalemia.

  • Angioedema.

  • Headache and dizziness.

Patient Education (PT ED):

  • Avoid high potassium foods.

  • Monitor BP.

  • Report sudden position changes and swelling.

  • Not pregnancy safe.

Aldosterone Antagonists – Eplerenone

Uses:

  • Treats hypertension.

  • Manages manifestations of heart failure following myocardial infarction (MI).

Side Effects (SE):

  • Hyperkalemia.

Patient Education (PT ED):

  • Avoid potassium high foods and supplements.

  • Report muscle pain.

Direct Renin Inhibitors – Aliskiren

Uses:

  • Treats hypertension.

Side Effects (SE):

  • Hyperkalemia.

  • Cough or angioedema.

  • Diarrhea.

  • Abdominal pain.

Patient Education (PT ED):

  • Report persistent cough.

Calcium Channel Blockers

Uses:

  • Treats stable angina.

  • Treats moderate to severe hypertension.

Side Effects (SE):

  • Lowers BP and HR.

  • Facial flushing.

  • Peripheral edema.

  • Headache and dizziness.

  • Growth of mouth tissue and occasionally bleeding gums.

Patient Education (PT ED):

  • Monitor HR.

  • Report rapid HR and peripheral swelling.

  • Report dizziness.

  • Avoid grapefruit.

  • Move slowly to prevent rebound hypotension.

Sodium Channel Blockers – Flecainide

Uses:

  • Life-threatening supraventricular tachy dysrhythmias.

  • Long-term for patients with A-fib.

Adverse Reactions:

  • Worsening heart failure.

  • Fluid retention and edema.

  • Shortness of breath.

Patient Education (PT ED):

  • May be placed on Holter monitor for ECG monitoring.

  • Report visual changes.

Beta Blockers – OLOLS

Uses:

  • Treats hypertension.

  • Affects HR negatively.

Side Effects (SE):

  • Bradycardia.

  • Breathing issues (risk for asthmatic patients).

  • Negative effects on heart failure.

  • Affects blood sugar levels.

Patient Education (PT ED):

  • Report peripheral edema.

  • Check pulse.

  • Report shortness of breath.

  • Report new onset of chest pain.

  • Weigh daily to monitor fluid retention.

Class 2 Beta Blocker – Propranolol

Uses:

  • Treats tachydysrhythmias.

  • Helps reduce mortality after myocardial infarction.

Side Effects (SE):

  • Bradycardia.

Patient Education (PT ED):

  • Same as first beta blockers.

Alpha 1 Blockers – Doxazosin

Uses:

  • Treats hypertension and BPH.

Side Effects (SE):

  • Postural/orthostatic hypotension.

  • Headache and dizziness.

Patient Education (PT ED):

  • Move slowly.

  • Elders should take in the morning.

  • Watch for swelling.

Alpha 2 Agonists – Clonidine

Uses:

  • Treats hypertension.

Side Effects (SE):

  • Dizziness.

  • Dry mouth.

  • Rebound hypertensive crisis if discontinued abruptly.

Patient Education (PT ED):

  • Take at night.

  • No driving.

  • Hydrate/suck on hard candy.

Direct Acting Vasodilators – Hydralazine

Uses:

  • Treats hypertension; used with digitalis and other vasodilators for heart.

Side Effects (SE):

  • Headache, dizziness, fatigue.

  • Tachycardia.

  • Fluid retention/edema.

Patient Education (PT ED):

  • Monitor pulse.

  • Report swelling.

  • Do not stop medications abruptly (risk of heart failure).

Nitrates – Nitroglycerin, Minoxidil

Uses:

  • Treats angina pectoris (chest pain).

Side Effects (SE):

  • Headache.

  • Orthostatic hypotension.

  • Tachycardia.

  • Hot flashes.

Patient Education (PT ED):

  • Take OTC headache meds.

  • Change position slowly.

  • Avoid hazardous activities.

Anti-Anginal – Ranolazine

Uses:

  • Treats angina.

Side Effects (SE):

  • Allergic reactions (constipation, nausea, headache, blurred vision).

  • Syncope, dizziness.

Patient Education (PT ED):

  • Avoid grapefruit and alcohol.

  • Report allergic reactions.

Sodium Channel Blocker – Quinidine, Procainamide

Uses:

  • Antidysrhythmics; treats A-fib and tachycardia.

Side Effects (SE):

  • GI manifestations.

  • Hypotension.

  • Arterial embolism (dislodging blood clots).

Patient Education (PT ED):

  • Take with food.

  • Report GI symptoms and changes in pulse, BP, and HR.

Potassium Channel Blockers – Amiodarone

Uses:

  • Treats ventricular tachycardia and fibrillation resistant to other medications; atrial dysrhythmias (A-fib).

Side Effects (SE):

  • GI manifestations (anorexia, nausea, vomit, constipation).

  • ARDS (acute respiratory distress syndrome).

  • Pulmonary toxicity.

  • Dizziness, malaise, ataxia, paresthesia.

Patient Education (PT ED):

  • Take with food.

  • Report vision changes, fever, dry cough, shortness of breath.

Cardiac Glycosides – Digoxin

Uses:

  • Second-line medication for heart failure.

  • Treats cardiac dysrhythmias (A-fib).

Side Effects (SE):

  • Cardiac dysrhythmias (monitor pulse).

  • GI manifestations (anorexia, nausea).

  • Vision changes (indicating digotoxicity).

Patient Education (PT ED):

  • Report heart palpitations, GI symptoms, and vision changes.

Monitoring:

  • Frequent monitoring of digoxin levels to avoid toxicity (potassium levels under 3.5).

Hypertensive Crisis Meds

Meds:

  • Nitro, Nicardipine, Clevidipine, Analaprilat, Esmolol.

Monitoring:

  • Must be on cardiac monitors.

Adrenergic Agonist – Epinephrine

Uses:

  • Treats cardiac dysfunction and anaphylaxis.

Side Effects (SE):

  • Chest pain.

  • Myocardial infarction (MI).

  • Hypertensive crisis.

  • Cardiac arrhythmias.

  • Tissue necrosis.

  • Tachycardia, tremors, nervousness, seizures, cerebral hemorrhage, pulmonary edema.

Patient Education (PT ED):

  • Inform clients of continuous monitoring.

  • Only given in hospital for cardiovascular dysfunction.

  • Report chest pain immediately.

Ears – Antiserum – Debrox

Uses:

  • Softens ear wax for easier removal.

Side Effects (SE):

  • Redness, itchiness, rash.

Patient Education (PT ED):

  • Report side effects.

  • Don’t administer if there is an ear infection.

  • Tilt head to the side when giving solution.

Prostaglandin Analogs – Latanoprost

Uses:

  • Decreases intraocular pressure.

Side Effects (SE):

  • Changes pigmentation of eyelid and eyelashes.

  • Sensation of something in the eye, itching, burning, stinging.

Patient Education (PT ED):

  • No rubbing eyes.

  • Use a different tissue for each eye.

  • If a dose is missed, continue with next dose; do not double down.

  • Remove contacts before giving drops.

  • Wait 2-3 minutes between drops if administering multiple drops.

Beta-Adrenergic Antagonists - Timolol

Uses:

  • Treats acute angle-closed glaucoma; decreases intraocular pressure.

Side Effects (SE):

  • Sensation of something in the eye, itching, burning, stinging.

Patient Education (PT ED):

  • Can feel like there’s a curtain over eyes.

  • No driving; report manifestations of retinal detachment.

Cholinergic Agonists – Isopto-Carpine

Uses:

  • Decreases intraocular pressure in glaucoma.

Side Effects (SE):

  • Urinary urgency, bradycardia, constriction of bronchioles.

Patient Education (PT ED):

  • Wear sunglasses in bright lights.

  • No driving.

Cholinesterase Inhibitors - Echothiophate Ophthalmic Drops

Uses:

  • Decreases intraocular pressure in glaucoma.

Side Effects (SE):

  • Urinary urgency, bradycardia, constriction of bronchioles.

  • Decreased visual acuity.

  • Myopia (especially at night).

Patient Education (PT ED):

  • No rubbing eyes.

  • No driving.

  • Report decreased visual acuity.

Anti-Platelet – Clopidogrel (Aspirin)

Uses:

  • Thins platelets.

Side Effects (SE):

  • GI manifestations.

  • Bleeding (contraindicated in peptic ulcer).

  • Thrombotic thrombocytopenia.

Patient Education (PT ED):

  • Take with food.

  • Report signs of bleeding, prolonged bleeding, sudden severe headache, weakness, numbness, easy bruising, bleeding gums.

Heparin – Lovenox

Uses:

  • Changes clotting time factors; given post-op, hip replacement, etc.

  • Blood thinner (anticoagulation).

Side Effects (SE):

  • Bleeding/hemorrhage.

  • Low platelet count.

Patient Education (PT ED):

  • Avoid NSAIDs (induce bleeding).

  • Use soft toothbrushes and electric razors.

  • Report black tarry stools and calf pain/swelling (indicates DVT).

  • Report shortness of breath (could indicate pulmonary embolism).

Non Vitamin K Antagonist Oral Anticoagulants - Dabigatran

Uses:

  • Prevention of cerebral vascular accident (CVA) related to atrial fibrillation.

Side Effects (SE):

  • Bleeding.

Patient Education (PT ED):

  • Report bruising, hematomas, black tarry stools.

  • Do not skip doses.

  • Notify HCP before any surgical procedures.

Vitamin K Antagonists – Warfarin (Coumadin)

Uses:

  • Prevention of venous thrombosis (clots), pulmonary embolism, during atrial fibrillation, prevention of thromboembolism, prevention of recurrent MI.

Side Effects (SE):

  • Hemorrhage.

Patient Education (PT ED):

  • Report bleeding, bruising, black tarry stools.

  • No NSAIDs, especially aspirin.

  • Use electric razors and soft toothbrushes.

  • Limit activity to avoid fall.

  • Wear band that says "On Coumadin".

Nursing Intervention:

  • Check blood tests (PT/INR); target INR is 2-3, should clot within 11-13.5 seconds.

Thrombolytics – Alteplase

Uses:

  • Dissolves clots for DVT, pulmonary embolism, acute ischemic CVA.

Side Effects (SE):

  • Bleeding.

Patient Education (PT ED):

  • Report prolonged bleeding.

Erythropoietic Growth Factor – Epoetin Alfa

Uses:

  • Supports production of erythrocytes (red blood cells) in chemotherapy, preoperative anemia.

Side Effects (SE):

  • Hypertension.

  • Seizures.

Patient Education (PT ED):

  • Have frequent blood pressure checks.

  • Report headache, sudden chest pain, weakness, numbness.

Nursing Intervention:

  • Take baseline BP before and after, monitor hemoglobin, CBC, BUN, uric acid, creatinine. Hold if hemoglobin is above 12 or above 10 for cancer patients.

Iron Preparations – Ferrous Sulfate

Uses:

  • Treats iron deficiency anemia; prevention of iron deficiency anemia.

Side Effects (SE):

  • GI manifestations (constipation).

  • Metallic taste in mouth.

  • Can stain teeth if liquid form.

  • Dark green or black stool.

  • Fatal iron toxicity (overdose in kids).

Patient Education (PT ED):

  • Take with food.

  • Expect dark green or black stools (harmless).

  • Increase fluids and fiber for constipation.

  • Suck on candy for metallic taste.

  • Rinse mouth after taking.

Nursing Intervention:

  • Monitor bowel patterns.

Vitamin B12 – Cyanocobalamin

Uses:

  • Treats pernicious anemia and vitamin B12 deficiency.

Side Effects (SE):

  • Erythema.

  • Hypertension.

  • Hypokalemia.

Patient Education (PT ED):

  • Report muscle spasms, weakness, nausea, palpitations, or paresthesia.

Folic Acid

Uses:

  • Treats megaloblastic anemia; folate deficiency.

Side Effects (SE):

  • Increased yellowing of urine.

  • Increased risk of developing colorectal or prostate cancer.

Patient Education (PT ED):

  • Encourage clients to consume foods high in folic acid.

  • Monitor reticulocyte count (RBCs).