A&C

Here is the requested comprehensive breakdown for every medication listed in your sources, categorized by drug class and detailed across all clinical and nursing parameters.

ADRENERGIC AGONISTS

1. Phenylephrine

  • Therapeutic Indication: Relief of nasal congestion associated with allergic rhinitis, treatment of vascular shock, and dilation of pupils (mydriasis) for eye examinations.

  • Contraindications or Precautions: Contraindicated in patients with known cardiac disease, hypertension (HTN), and generalized anxiety disorder (GAD) or panic/anxiety disorders.

  • Cautions: Use with caution in patients with cardiac disease, hypertension, or anxiety.

  • Nursing Considerations:

    • Assess vital signs (BP and HR) and evaluate clinical presentation for nasal congestion or cold symptoms.

    • Screen health history for drug contraindications (cardiac disease, HTN, GAD/panic disorder).

    • Monitor BP, HR, and patient anxiety levels during administration.

    • Onset of Action: IV route acts within minutes (for shock); Intranasal acts in 10–15 minutes; Oral (PO) acts within 60 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Headache (HA), tachycardia, nervousness, trouble sleeping, and anxiety.

    • Adverse Effects: Severe hypertension and reflex bradycardia.

  • Route of Administration: Oral (PO), Nasal, and Ophthalmic.

  • Nursing Education: Educate patient on the medication's therapeutic purpose (congestion relief, blood pressure management, or pupil dilation).

2. Albuterol

  • Therapeutic Indication: Management, prevention, and treatment of acute bronchospasm, asthma, and obstructive pulmonary conditions.

  • Contraindications or Precautions: Contraindicated in patients with current extreme tachycardia (>120 bpm).

  • Cautions: Cardiac disease, tachycardia, hypertension, diabetes mellitus (DM), hyperthyroidism, and excessive dosing (which can cause receptor desensitization and loss of efficacy).

  • Nursing Considerations:

    • Assess respiratory rate, oxygenation, heart rate, respiratory status, and anxiety levels.

    • Auscultate lung sounds before and after administration.

    • Note that while albuterol is Beta-2 selective, high doses can stimulate Beta-1 receptors and induce tachycardia.

    • Onset of Action: Within 3–5 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Tachycardia, tremors, nervousness, headache, and insomnia.

    • Adverse Effects: Cardiac dysrhythmias, chest pain, and paradoxical bronchospasm.

  • Route of Administration: Respiratory Inhaler or Nebulizer.

  • Nursing Education: Demonstrate proper inhaler usage technique; instruct patient to keep rescue inhaler accessible at all times; advise taking 30–60 minutes prior to exercise; warn that overuse can paradoxically worsen symptoms.

3. Epinephrine (Adrenalin)

  • Therapeutic Indication: Treatment of severe hypotensive states, vascular shock, CPR/cardiac arrest, and acute anaphylaxis.

  • Contraindications or Precautions: Contraindicated in patients with known cardiac dysrhythmias, narrow-angle glaucoma, or cardiogenic shock.

  • Cautions: Cardiac disease, hypertension, and hypovolemia (fluid resuscitation must be performed prior to administration).

  • Nursing Considerations:

    • Monitor vital signs, IV site integrity, tissue perfusion, and continuous ECG.

    • Continuously monitor HR and BP.

    • Differentiate minor side effects (which do not require stopping infusion) from severe cardiac adverse effects or IV infiltration/necrosis (which require immediate intervention/cessation).

    • Onset of Action: Within minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Restlessness, hyperglycemia, and anxiety.

    • Adverse Effects: Cardiac dysrhythmias, sinus tachycardia (ST), palpitations, severe hypertension, and tissue necrosis following IV infiltration.

  • Route of Administration: Continuous IV infusion (mcg/kg/min), Subcutaneous, or Intramuscular (IM auto-injectors / EpiPens).

  • Nursing Education: Instruct patient to administer EpiPen immediately at the first sign of an allergic/anaphylactic reaction, seek immediate emergency care after injection, and remember administration technique ("orange to thigh, blue to sky").

4. Clonidine (Catapres)

  • Therapeutic Indication: Treatment of hypertension (HTN), pain, ADHD, and substance withdrawal.

  • Contraindications or Precautions: Contraindicated in patients with baseline bradycardia, hypotension, or severe renal/hepatic impairment.

  • Cautions: Bradycardia, hypotension, and renal/hepatic disease. Exercise extreme caution when co-administering with CNS depressants due to risks of profound hypotension, bradycardia, and respiratory depression.

  • Nursing Considerations:

    • Measure blood pressure and heart rate prior to each administration.

    • Monitor BP, HR, level of consciousness (LOC), and sedation level.

    • Gradually taper off medication when discontinuing; never stop abruptly.

    • Onset of Action: PO onset within 60 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Sedation, dizziness, dry mouth, and fatigue.

    • Adverse Effects: Severe hypotension, bradycardia, syncope, and rebound hypertension (secondary to abrupt cessation).

  • Route of Administration: Oral (PO).

  • Nursing Education: Teach patient to check BP prior to taking; advise that medication causes drowsiness and dizziness; emphasize never stopping medication suddenly to prevent life-threatening rebound HTN; warn regarding interactions with beta blockers like Metoprolol.

ADRENERGIC ANTAGONISTS

5. Phentolamine

  • Therapeutic Indication: Treatment and prevention of dermal necrosis following norepinephrine extravasation, and management of hypertensive crises.

  • Contraindications or Precautions: Contraindicated with concurrent antihypertensive therapy.

  • Cautions: Cardiac disease, baseline hypotension, and volume depletion / fluid volume deficit (FVD).

  • Nursing Considerations:

    • Assess orthostatic blood pressure and inspect IV site patency/integrity (evaluating for extravasation leakage requiring phentolamine antidote).

    • Implement strict fall precautions due to orthostatic risk.

    • Onset of Action: IV onset within minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Orthostatic hypotension, dizziness, reflex tachycardia, nasal congestion, and GI upset.

    • Adverse Effects: Severe hypotension, syncope, and reflexive tachyarrhythmias.

  • Route of Administration: Intravenous (IV), Intramuscular (IM), Subcutaneous, and Topical.

  • Nursing Education: Instruct patient to change positions slowly, report dizziness or fainting immediately, and maintain adequate fluid intake.

6. Metoprolol

  • Therapeutic Indication: Treatment of hypertension (HTN), angina, heart failure (HF), and cardiac arrhythmias (including urgent/emergent IV control of Atrial Fibrillation with Rapid Ventricular Response [Afib RVR]).

  • Contraindications or Precautions: Contraindicated in patients with bradycardia (e.g., HR < 48 bpm), hypotension, heart block, or uncompensated heart failure.

  • Cautions: Bradycardia, heart block, and heart failure. (Note: Does not act on respiratory receptors).

  • Nursing Considerations:

    • Measure blood pressure and heart rate prior to administration; hold dose if parameters fall outside clinical limits.

    • Monitor continuous ECG for signs of heart block.

    • Onset of Action: IV route acts within minutes; PO route acts within 30–90 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Bradycardia, fatigue, hypotension, and dizziness.

    • Adverse Effects: Heart block, worsening heart failure, severe bradycardia, and severe hypotension.

  • Route of Administration: Oral (PO) and Intravenous (IV).

  • Nursing Education: Instruct patient never to stop medication abruptly; teach patient how to monitor BP and HR at home and recognize symptoms of hypotension and bradycardia.

7. Propranolol

  • Therapeutic Indication: Management of hypertension (HTN), heart failure (HF), post-myocardial infarction (post-MI), dysrhythmias, and anxiety.

  • Contraindications or Precautions: Contraindicated in patients with a history of asthma, COPD, severe bradycardia, hypotension, heart block, or heart failure.

  • Cautions: Asthma, COPD, bradycardia, and heart block.

  • Nursing Considerations:

    • Check BP and HR prior to administration.

    • Monitor ECG for heart block and monitor respiratory status closely due to risk of nonselective Beta-2 blockade / bronchospasm.

    • Onset of Action: PO onset within 30–90 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Bradycardia, fatigue, hypotension, and dizziness.

    • Adverse Effects: Heart block, severe bradycardia, severe hypotension, and bronchospasm.

  • Route of Administration: Oral (PO).

  • Nursing Education: Advise patient against abrupt discontinuation; instruct on home BP/HR monitoring and signs of symptomatic bradycardia and hypotension.

8. Labetalol

  • Therapeutic Indication: Treatment of hypertension (HTN), heart failure (HF), post-MI, and cardiac arrhythmias.

  • Contraindications or Precautions: Contraindicated in severe hypotension (e.g., BP 84/48 mmHg), bradycardia, heart block, heart failure, asthma, and COPD.

  • Cautions: Asthma, COPD, bradycardia, and heart block.

  • Nursing Considerations:

    • Check BP and HR prior to drug administration.

    • Monitor ECG for heart block and evaluate respiratory status for nonselective beta-blocking effects.

    • Onset of Action: IV acts within minutes; PO acts within 30–90 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Bradycardia, fatigue, hypotension, and dizziness.

    • Adverse Effects: Heart block, severe bradycardia, severe hypotension, and bronchospasm.

  • Route of Administration: Intravenous (IV) and Oral (PO).

  • Nursing Education: Warn against abrupt drug withdrawal; instruct patient to monitor BP and HR regularly.

9. Tamsulosin (Flomax)

  • Therapeutic Indication: Treatment of Benign Prostatic Hyperplasia (BPH) symptoms and hypertension.

  • Contraindications or Precautions: Contraindicated in heart failure or in patients who are already edematous.

  • Cautions: Orthostatic hypotension and "first-dose effect" (severe hypotension following initial dose).

  • Nursing Considerations:

    • Monitor urine output (UOP), blood pressure, dizziness, and cardiovascular status.

    • Maintain fall precautions.

    • Onset of Action: Requires hours to weeks for therapeutic effect.

  • Side Effects and Adverse Effects:

    • Side Effects: Dizziness, headache, orthostatic hypotension, nasal congestion, and fatigue.

    • Adverse Effects: Drowsiness, cardiac arrhythmias, severe hypotension, edema, and heart failure.

  • Route of Administration: Oral (PO).

  • Nursing Education: Warn patient regarding risk of sudden drop in BP with first dose; instruct to change positions slowly; advise that improvement in urinary stream will take time and is not immediate.

10. Prazosin (Minipress)

  • Therapeutic Indication: Treatment of hypertension (HTN), Benign Prostatic Hyperplasia (BPH), and off-label management of PTSD-related nightmares.

  • Contraindications or Precautions: Contraindicated in patients with heart failure or baseline fluid retention/edema.

  • Cautions: Orthostatic hypotension and pronounced first-dose effect.

  • Nursing Considerations:

    • Monitor blood pressure (specifically orthostatic changes), dizziness, urine output, and cardiovascular status.

    • Enforce fall precautions.

    • Onset of Action: Requires hours to weeks.

  • Side Effects and Adverse Effects:

    • Side Effects: Dizziness, headache, orthostatic hypotension, nasal congestion, and fatigue.

    • Adverse Effects: Drowsiness, cardiac arrhythmias, severe hypotension, edema, and heart failure.

  • Route of Administration: Oral (PO).

  • Nursing Education: Educate patient to rise slowly from lying or seated positions to prevent syncopal episodes; instruct on monitoring BP.

MUSCARINICS / CHOLINERGICS / ANTICHOLINERGICS

11. Bethanechol

  • Therapeutic Indication: Treatment of non-obstructive urinary retention and post-operative bladder atony.

  • Contraindications or Precautions: Contraindicated in asthma, COPD, bradycardia, mechanical GI or urinary tract obstruction, and hypotension.

  • Cautions: Asthma, COPD, bradycardia, and GI/urinary tract obstruction.

  • Nursing Considerations:

    • Monitor intake and output (I&O), heart rate, blood pressure, and respiratory status.

    • Onset of Action: Within minutes to hours.

  • Side Effects and Adverse Effects:

    • Side Effects: Excessive sweating, hyper-salivation, nausea (N), and abdominal cramping.

    • Adverse Effects: Severe bronchospasm and severe bradycardia.

  • Route of Administration: Oral (PO).

  • Nursing Education: Inform patient to expect increased salivation and sweating; advise taking medication on an empty stomach; encourage adequate fluid intake.

12. Donepezil

  • Therapeutic Indication: Treatment of cognitive decline in Alzheimer's disease.

  • Contraindications or Precautions: Contraindicated in baseline bradycardia, asthma, COPD, active GI obstruction, and seizure disorders.

  • Cautions: Bradycardia, asthma/COPD, GI obstruction, and seizure disorders.

  • Nursing Considerations:

    • Monitor heart rate and assess for GI complications (cramping, diarrhea, nausea).

    • Monitor for signs of overdose / cholinergic crisis (Antidote: Atropine).

    • Onset of Action: Requires weeks to demonstrate cognitive effects.

  • Side Effects and Adverse Effects:

    • Side Effects: Nausea, vomiting, diarrhea (N/V/D), increased salivation, increased sweating, and bradycardia.

    • Adverse Effects: Cholinergic crisis (characterized by profound muscle weakness and bronchospasm) and severe bradycardia.

  • Route of Administration: Oral (PO).

  • Nursing Education: Instruct caregiver/patient to take medication strictly at scheduled times; report excessive salivation, sweating, or severe diarrhea; explain that cognitive benefits may take several weeks to manifest.

13. Atropine

  • Therapeutic Indication: Symptomatic bradycardia, antidote for cholinergic agonist toxicity/overdose (reverses cholinergic crisis), and induction of mydriasis for eye exams.

  • Contraindications or Precautions: Contraindicated in narrow-angle glaucoma, BPH, urinary retention, older adults (high risk for acute confusion), and dementia.

  • Cautions: Narrow-angle glaucoma, BPH, and urinary retention.

  • Nursing Considerations:

    • Monitor heart rate, fluid intake and output (I&O), and level of consciousness (LOC).

    • Implement fall precautions; manage dry mouth and constipation.

    • Onset of Action: IV route acts within minutes; PO route acts within 30–60 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Tachycardia, dry mouth, blurred vision, constipation, and drowsiness.

    • Adverse Effects: Acute confusion, delirium, and severe urinary retention.

  • Route of Administration: Intravenous (IV) and Oral (PO).

  • Nursing Education: Warn patient to avoid overheating (due to inhibition of sweating mechanism); suggest sugar-free hard candy for dry mouth relief; instruct to report confusion, severe urinary retention, or visual changes immediately.

14. Scopolamine

  • Therapeutic Indication: Prevention and treatment of motion sickness, vertigo, and excessive respiratory secretions.

  • Contraindications or Precautions: Contraindicated in narrow-angle glaucoma, BPH, urinary retention, older adults (confusion risk), and dementia.

  • Cautions: Narrow-angle glaucoma, BPH, and urinary retention.

  • Nursing Considerations:

    • Monitor heart rate, fluid balance (I&O), and LOC.

    • Apply fall precautions.

    • Onset of Action: Transdermal patch onset takes hours.

  • Side Effects and Adverse Effects:

    • Side Effects: Tachycardia, dry mouth, blurred vision, constipation, and drowsiness.

    • Adverse Effects: Acute confusion, delirium, and severe urinary retention.

  • Route of Administration: Transdermal (Patch).

  • Nursing Education: Advise patient to avoid high temperatures/overheating; use sugar-free candy for mouth dryness; report confusion, vision shifts, or inability to urinate.

15. Diphenhydramine

  • Therapeutic Indication: Treatment of allergic reactions and systemic allergic symptoms.

  • Contraindications or Precautions: Contraindicated in narrow-angle glaucoma, BPH, urinary retention, older adults (high confusion risk), and dementia.

  • Cautions: Narrow-angle glaucoma, BPH, and urinary retention.

  • Nursing Considerations:

    • Monitor heart rate, I&O, and level of consciousness.

    • Maintain fall precautions due to sedative properties.

    • Onset of Action: IV route acts within minutes; PO route acts within 30–60 minutes.

  • Side Effects and Adverse Effects:

    • Side Effects: Drowsiness, tachycardia, dry mouth, blurred vision, and constipation.

    • Adverse Effects: Acute confusion, delirium, and severe urinary retention.

  • Route of Administration: Oral (PO) and Intravenous (IV).

  • Nursing Education: Caution patient regarding severe drowsiness; advise against overheating; instruct on managing dry mouth and reporting sudden confusion or urinary hesitancy.

💡 Would you like to review practice NCLEX-style questions based on these specific drug classes to test your recall?