Meds



Medication

Purpose


Action of medication


Side effects


Drug level/ therapeutic level


Nursing Intervention

Diuretics

  • Will have an electrolyte imbalance

  • Dehydration is a risk 

  • Measure the intake and output 

  • PLACE ON FALL PRECAUTIONS 

  • Give fluid to patients 

  • Change positions slowly

Hydrochlorothiazide (HCTZ)

Purpose

  • Gets rid of extra salt and water

  1. Increase urinary output

  2. Decreases fluid volume

  3. Decreases blood pressure

Side effects

  • Low potassium (hypokalemia)

  • Dizziness

  • Dehydration

  • Low sodium

  • High blood sugar

Contraindications

  • Severe kidney failure

  • Low portassium

  • dialyisis

Things to expect

  • Decrease BP

  • Decrease weight 

  • Decrease sodium levels 

  • Decrease potassium levels 

  • Expected edema 

Nursing Interventions

  • Take in the morning (it makes you pee a lot)

  • Take 2x a day 

  • Have a low sodium diet 

  • Monitor potassium levels

  • Eat more potassium 

Drug interactions 

  • Digoxin (increase toxicity risks)

  • NSAIDS (decreases effectiveness)


Key

  • Monitor potassium levels, sodium levels, and I&O

  • Fall precautions 

Furosemide (lasix)

Purpose

  • Heart failure

  • Edema (swelling)

  • High blood pressure

Action of medication

  • Increase urine output 

  • Decrease fluid and BP

Side effects

  • Low potassium (hypokalemia)

  • Low BP

  • Otoxicity

Things to expect

  • Decrease amount of fluid in their leg

Nursing Interventions

  • Monitor kidney function 

  • Monitor mg,k, Na

  • Monitor intake and output 

  • Monitor daily weights

  • Check BP before giving it 

  • Give first thing in the morning 

Acetozolamide

(Carbonic anhydrase inhibitor)

Purpose

  • Glaucoma

  • Altitude sickness

  • Metabolic alkilosis

  • Seizures

Action of medication

  • Makes the body get ride of bicarbonate, sodium and water

  • Urinate a lot, decrease fluid, decrease eyepressure and cranial prssure

Side effects

  • Hypokalemia

  • Monitor ABG

Contraindications

  • Sulfa allergy

  • Severe kidney disease 

  • Liver disease

  • Low potassium 

Nursing interventions

  • Monitor potassium levels (super important)

  • Give in the morning 

  • May be given IV or PO

  • Encourage potassium foods

  • Check Bp and daily weights

Client education 

  • Can get prasthysia 

  • Can get metallic taste

  • Can cause increased lithium levels and digoxin toxicity

Drug interactions

  • Digoxin 

  • Lithium 

  • Other diuretics

Spironolactone

Purpose

  • Heart failure 

  • Hypertension

  • Edema

Action of medication

  • Sodium and water comes out while allowing potassium to stay in

Side effects

  • Hyperkalemia

  • Gynecomastia

  • Irregular periors

  • dizziness

Things to expect

  • Weight to be down

  • Potassium to be high

  • Edema to be low

  • Bp to be low

Nursing considerations

  • Avoid potassium foods

  • Can cause urine to turn bluish



Key

  • Spironolactone saves potassium

Mannitol

(osmotic diuretic that is used short term)

Purpose

  • Reduce intracranial pressure

  • Treat acute kidney failure

  • Lower eye pressure (glaucoma)

Action of medication

  • Type of sugar alcohol used as an osmotic diuretic

  • Helps increase urine production and reduce swelling in the brain

Side effects

  • Dehydration

  • Electrolyte imbalance

  • Headache

  • Nausea

Contraindicaitions 

  • Renal failure 

  • Anuria (no urine output)

  • Intracranial bleeding 

  • Heart failure 

  • Dehydration 

  • pregnant

Nursing Interventions 

  • Monitor lung sounds 

  1. Can cause pulmonary edema

  • Do assemsemnts in morning 

  • Should be urinating at least 30mL per hour

Phenazopridine

Purpose

  • UTI

  • Urinary analgesic (pain reliever)

  • Treat symptoms not the infection

Action of medication

  • Numbs the lining of the urinary tract 

  1. Decrease burning 

  2. Decrease pain

  3. Decrease urgency

Side effects

  • Pee is bright orange (this is expected)

  • Can change glucose urine levels

Contraindications 

  • Severe kidney disease

  • Severe liver disease

Nursing Interventions 

  • Teach urine will turn orange

  • Give with food to prevent stomach upset

  • Short term use only (2-3 days)

  • Must use with an antibiotic

oxybutin

Purpose

  • Overreactive bladder

  • Anticholinergic drug

Action of medication

  • Relaxes the bladder muscle, decreasing the urge and frequency

Side effects

  • Dry mouth 

  • Constipation 

  • Blurry vision

  • Urinary retention

Contraindication 

  • Glycoma

  • Bowel disfunction 

  • Urinary retention

Nursing Intervention

  • Monitor output

  • Hydration biotin for dry mouth 

  • Encourage fluid and fiber 

Tamsulosin 

Purpose

  • Benign porstatic hyperplasia

Action of medication

  • Relaxes muscle in prostate and bladder neck making it easier to urinate

Side effects

  • Vasodilation and hypotension

  • Dizzyness

  • Hypotension 

  • Ejaculation problems (do not take with erectile dysfunction meds)

Nursing Interventions 

  • Hydration is important

  • Take whol pill (do not crush)

  • Asses vitals (ortho is a possobility)

  • ASses urinary improvement

  • Monitor intake and output 

  • Monitor BUN and creatine 

Patient Education 

  • Avoid alcohol

  • Take with full glass of water 

  • Take whole medicatcation




Medication

Purpose


Action of medication


Side effects


Contraindications


Nursing Intervention



Antihypertensive Meds

Nuursing Interventions 


P- Monitor BP

R- Rise slowly due to orthostatic

E- Eat a low sodium diet

S- Stay on medication, do not skip

S- Safety monitoring due to falls

U- Unreliable respomse

R- Remind to stop alcohol and exercise more

E- Eliminate smoking- smoking sensation; constricts the arteries

Captopril

(Ace Inhibitor)

Purpose

  • Lower blood pressures

Action of medication

  • Inhibits the angiotensin-converting enzyme; vasoconstrictor where BV will be small decreasing the amount of blood

Side effects

  • Dizziness

  • Cough

  • Angioedema

  • Potassium (Hyperkalemia)

Contraindications

  • Pregnant

  • Angioede ma

  • Kidney problems

  • Hyperkalemia history

Nursing Interventions 

  • Check Bp before givine med

  • Monitor BUN and creatine 

  • Monitor for hyperkalemia 

  • Report difficulty breathing and inflammation 

  • No salt substitutes

Meds that are contraindications

  • Potassium sparing diuretics

  • NSAIDS

  • Lithium

  • Other antihypertensive

Losartin

Angiotensin II Receptor Blocker

Purpose

  • Antihypertensive

Action of medication


Side effects


Contraindications

????

DIltiazem

(Calcium Channel Blocker)

Purpose

  • Decreases Bp

Action of medication

  • Blocks calcium channels

  1. Decrease HR

  2. Decreases Contractility

  3. Vasodilation occurs

Side effects

  • Bradycardia

  • Hypotension

  • Dizziness

  • Fatigue 

  • Peripheral edema

Contraindications

  • Severe hypotension

  • Severe heart failure

  • Sick sinus syndrome

Nursing Interventions

  • Monitor BP and HR

  1. Let providor know of systolic less than 90, and HR less than 60

  • Swallow whole (no crushing)

  • Take with milk or food

  • Increase fiber and exercise

  • Monitor BUN and creatine, LFT

  • Assess ECG

Hydralazine

Purpose

  • Decreases BP and afterload

Action of medication

  • Direct vasodilator

  • Relaxes arteries

Side effects

  • Reflex tachycardia (High HR)

  • Hypotension

  • Headache 

  • Flushing 

  • Dizzines 

  • Lupus like syndrome (Butterfly rash in face, fever, joint and muscle ache

Contraindications

  • Coronary artery disease

  • Severe hypotension

  • tachycardia

Nursing Interventions

  • Monitor Temp

  • Monitor CBC and creatine 

  • Daily weights 

  • Med is take 3x a day (8 hr apart)

Antihypotensive Meds

Medicine for orthostatic hypotension, given throughout the day

Nursing Interventions for all meds 

  • Fall precautions 

  • Nurses should help and not the CNAS

Midodrine

Purpose

  • Orthostatic hypotension 

  • Symptomatic low BP

Action of medication

  • Causes vasocontriction 

  • Increases BP

Side effects

  • Supine hypertension

  1. Headache

  2. Blurry vision 

  3. Dizzyness 

  • Piloerection (goosbumps)

  • Urinary retention 

  • Parasthesia

  • Headache

Contraindications

  • Severe heart Disease

  • Acute renal disease

  • Urinary retention 

  • Persistent hypertension

Nursing Intervention

  • Monitor BP 

  1. Laying 

  2. Sitting 

  3. Standing 

  • Hold if Bp is elevated

  • Monitor for hypertension 

  • Asses for urinary retention

Education 

  • They should sit up for atleast 30 minutes after taking med 

  • Take it in the morning 

Heart failure 

Med is given to strengthen hearts 


Ejection Fracture

  • Less than 40% indicates heart failure 

  • Less than 10% indicate high probabiility of death 

  • Greater than 75% means heart is working too hard

Digoxin

Purpose

Slow HR

  • Heart failure 

  • Atrial fibrillation 

  • Atrial flutter

Action of medication

  • Increase contractillity

  • Decreases heart rate

Improves stroke value and cardiac output to ensure we are getting enough pxygen

Side effects

  • Electrolyte imbalance 

  1. Hopkalemia

  2. Hypomangemia

  3. hypercalcemia

Drug Level

0.5-2 ng/mL

Toxicity is anything over 2 

  • Digibind is the antidote

Nursing Interventions

  • Check pulse for 1 minute before giving 

  • Daily weight 

  • Strict intake and output

  • Eat potassium rish foods 

  • Take medicine same time daily 

  • Do not take medicine with food

Milrinone

Purpose

  • Short term med; waiting for heart transplant

Action of medication

  • Blocks enzyme PDE-3 inhibitor in heart

  • vasodilator

Side effects

  • Arrhythmias

  • Hypotension 

  • Hypokalemia

  • Dysrythmia 

Therapeutic range

  • ??


Nursing Interventioons

  • Continuous cardiac monitoring 

  • Monitor BP and HR

  • Water for decrease in bp and 

  1. Increase in urine 

  2. Increase in angina 

  • Protect med from light

  • Daily weights

Ivabradine

Purpose

  • Heart failure 

  • Chronic stable angina

Action of medication

  • Reduces heart rate

Side effects

  • Bradycardia 

  • Hypotension 

  • Visual distrubences

Contraindications

  • HR less than 60

  • Sick sinus syndrome 

  • Patients with pace makers

Nursing interventions

  • Check pulse before giving med

  • ECG 

  • Check for arrhythmia symptoms 

Patient Education 

  • Take with meals

  • Teach how to check pulse

  • No grapefruit juice

  • No st.johns worth, rifropamin, dijoxin, phenytoin

Sacubitril/ Valsartan

Purpose

  • Increase ejection fraction

Action of medication

  • Relaxes blood vessels, decreases pressure. Increase supply in the heart

Side effects

  • Hypertension

  • Hyperkalemia

  • Dizziness

  • Renal failure

Contraindications

  • Pregnancy

  • Angioedema

  • Ace inhibitors

Nursing interventions

  • Monitor BP

  • Monitor daily weight

  • Monior electrolytes

  • Monitor renal function 

  • Regular blood test

Pateint education 

  • Get up slowly 

  • Avoid potassium supplements and salt substitutes

  • Avoid NSAIDS

Antiarrhythmic Meds

Medications used to treat abnormal heart rhythms (a-fibs) by regulating the heart's electrical activity.

Lidocaine

(only for emergency)

Purpose

  • Only for emergency, help stabilize heart rhythm and increase HR

  1. Ventricular tachycardiar

  2. Ventricular fibrillation 

  3. PVC 

Action of medication

  • Sodium channel blocker 

  • Decreases abnormal ventricular rhythms

Side effects

  • CNS (confusion, seizures, drowsiness)

  • Hypotension 

  • Bradycardia


Nursing Intervention 

  • ECG monitoring 

  • Asses CNS status

  • Check BP and HR

Propranolol

(Betablocker)

Purpose

  • High blood pressure

  • Heart arrhythmias

  • Migraine prevention

Action of medication

  • Decrease HR
    Reduces BP

  • Blocks stress hormone

  • (lower HR and tightens airway)

Side effects

  • Dizziness

  • Fatigue

  • Cold hands and feet

  • Sleep disturbance

Contraindication 

  • Asthma and COPD patients 

  • Diabetecs (can get hyperglycemia)

Nursing interventions

  • Take in morning 

  • Do not stop abruptly

  • Report chest pains, angiedeme 

  • Monitor BP and HR before giving it 

Amiodarone

Purpose

  • Severe arrhythmias

  • Atrial fibrillation 

  • Ventricular tachycardia

Action of medication

  • Stabalizes heart electrical signal 

  • Restores normal heart rhythm 

  • Revents abnormal heartbeats

Side effects

  • Thyroid problems 

  • Liver toxicity

  • Vision changes

  • Lung damae (fibrosis; lung tissue scars)

Nursing Interventions

  • Asses for 

  1. Bradycardia

  2. Hypotension

  3. phototherapy

  • Monitor lung sounds 

  • Monitor AST,LST,TSH

  • Monitor HR and BP

  1. Systolic less than 90 (hold)

Diltiazem

(calcium channel blocker)

Purpose

  • A-fib patient

  • manages angina (chest pain)

  • Treats High BP

Action of medication

  • Relaxes blood vessels

  • Resduces HR

  • Decrease cardiac workload

Side effects

  • Dizzyness

  • Headache

  • Swelling in legs

  • fatigue

Contraindications

  • Severe Heart Failure pt

Nursing Interventions

  • Monitor for prthostaic hypotension 

  • Check BP

  • Monior KFT, LFT

  • Do not chew or crush

  • Can develop constipation

Antianginal agents

Used for patients who have chest pain caused by reduce bloof flow in heart

  1. Stable: Expect it to happen 

  2. Unstable: Emergency if it lasts more than 5 minutes

Nitroglycerin

Purpose

  • Angina pt

  • Relives chest pain 

  • Lowers BP

Action of medication

  • Vasodilator that helps widen blood vessels and improves blood flow

Side effects

  • Headache

  • Dizzines

  • Hypotension

  • Flushing

Routes

  • Sublingual 

  • Spray

  • Patches

  • IV

Nursing Interventions

  • Keep sublingual med in dark place 

  • No vasodilators 

  • Check BP (hold for systolic less than 90)

  • Check HR

  • Wear gloves when giving this 

  • No erectile meds

Isosorbide

Purpose

  • Reduce chest pain 

  • Heart failure

Action of medication

  • Nitrate med that helps dilate blood vessels and improves blood flow

Side effects

  • Headache

  • Dizzyness

  • Hypotension

  • flushing

Nursing Interventions

  • Monitor BP 

  • Asses chest pain 

  • Educate pt

  • Instruct proper use 

  • Take early in the morning 

  • Long term med

Lipid Lowering Meds 

High LDL: Cardiac Problem

Low LDL: No med, change diet

—-------------------------------------

Ttl chol: Less than 200

LDL: Less than 100

HDL: Greater than 40

Triglycerides: Under 150

Cholestyramine

Purpose

  • Improve LDL

Action of medication

  • Bile acid helps lower cholesterol levels

Traps cholesterol in intestine and attaches to bowel and excretes through poop.

Side effects

  • Constipation 

  • Bloating

  • Gas

  • Upset stomach

Route

  • Powder mix with 8oz of water

Nursing interventions 

  • NI for constipation 

  • Other meds should be taken

  • 1 hour before this med

  • 4-6 hours after this med

  • Drink plenty of water

  • May decrease vitamin absorption 

  • Monitor…

  • Bowel movement

  • Lipid levels and LFT

Atorvastatin

Purpose

  • Lower cholesterol

  • Lower LDL

  • Lower tri

  • Raise HDL

Action of medication

  • Blocks cholesterol production and lowers LDL

Side effects

  • Myalgia (muscle pain and weakness)

  • Elevated liver enzymes

  • Digestive issues

Nursing Intervnetions

  • Check lipid panel 

  • Asses muscle pain and coke like urine (hold if pt has coke urine)

  • Teach lifestyle change

  1. Low sodium 

  2. Low fats

  3. Low red meat consumption

  • Monitor BUN and creatine 

  • Asses muscle pain with CK (high levels= +)

Education

  • Take in the evening 

  • No grapefruit juice

Ezetimible

Purpose

  • Cholesterol absorption inhibitor

Action of medication

  • Blocks the absorption of cholesterol in small intestine

Side effects

  • Headache 

  • Diarrhea

  • Abdominal pain 

  • Muscle pain

Nursing Interventions 

  • Monitor lipid panel and LFT

  • Asses for GI symptoms 

  • Low fat diet 

Anticoagulants

INR levels 

  • 2> = Clot risk 

  • 2-3= Therapeutic range

  • >3= Bleeding risk 

Warfrin

Purpose

  • Prevents blood clots

Action of medication

  • Blocks Vitamin K

Side effects

  • Bleeding gums

  • Bruising easily 

Therapeutic range

  • 0.8-1.1 normal with med

  • Less than 2= blood clot prone 

  • Greater than 3= blood is too thin

Antidote

  • Vitamin K

Nursing intervention

  • Avoid high vitamin K foods (spinach, broccoli)

  • Pt should use electric razors 

  • Pt should report excessive bleeding in urine, stoold

  • Check blood daily/weekly

Heparin

Purpose

  • DVT

  • Pulmonary embolism 

  • Heart attack adn stroke

Action of medication

  • Anticoagulant med

  • Prevents clots from getting bigger

Side effects

  • Bleeding 

  • Bruising

  • Heperain-induced thrombocytopenia

Nursing Intervention

  • Monitor aPTT levels 

  • Monitor Blood test

  • 2 nurse chech when admin 

  • PT will be on fall risk 

  • 3-5 days onset

Protamine sulfate is antidote


  • Iv or SQ

Alteplase 

(Clot-buster)

Purpose

  • Ischemic strokes

  • Acute myocardial infraction

  • Pulmonary embolism

Mechanism of action

  • Breaks down blood clots by converting plasminogen to plasmin which dissolves fibrin 

Side effects 

  • Bleeding

Route

  • IV infusion 

  1. Initial bolus dose over 1-2 min 

  2. Continous infusion over 60 minutes

Nursing Interventions 

  • Asses for signs of bleeding 

  • Monitor neuro status and vitals 

  • Avoud invasive procedures (injections unnecessary lines)

  • Use infusion pump and do not mix meds

  • Monitor labs

  1. aPTT

  2. Fibrinogen

  • High risk fo bleeding

  • Bleeding is a big SE and a contraindication