NURS 572A Nursing Pharmacology
Medication Table
Generic Drug
Name (Brand
Name)
Classifications
General Mechanism
of Action
Indication for Use
Warfarin
(Coumadin)
Therapeutic:
anticoagulants
Interferes with hepatic
synthesis of vitamin Kdependent clotting
factors (II, VII, IX, and
X).
Therapeutic Effects:
Prevention of
thromboembolic
events.
Prophylaxis and
treatment of: Venous
thrombosis, Pulmonary
embolism, Atrial
fibrillation with
embolization.
Management of
myocardial infarction:
Decreases risk of death,
Decreases risk of
subsequent MI,
Decreases risk of future
thromboembolic events.
Prevention of thrombus
formation and
embolization after
prosthetic valve
placement.
Prophylaxis and
treatment of various
thromboembolic
disorders including:
Venous
thromboembolism,
Pulmonary emboli, Atrial
fibrillation with
embolization, Acute and
chronic consumptive
Pharmacologic:
coumarins
(Vallerand &
Sanoski, 2021)
Heparin
(unfractionated)
Therapeutic:
anticoagulants
Pharmacologic:
antithrombotics
Potentiates the
inhibitory effect of
antithrombin on factor
Xa and thrombin. In
low doses, prevents the
conversion of
prothrombin to
thrombin by its effects
on factor Xa. Higher
doses neutralize
Identify 2
severe/lifethreatening side
effects/adverse
reactions-Include any
Black Box
Warnings
1) Bleeding
2) Calciphylaxis
For each identified
severe/life-threatening
side effect/adverse
reaction, give 1 nursing
implication (What can
you do about it?)
1) Assess for signs of
bleeding and hemorrhage
(bleeding gums; nosebleed;
unusual bruising; tarry,
black stools; hematuria; fall
in hematocrit or BP;
guaiac-positive stools,
urine, or nasogastric
aspirate). Monitor PT, INR
and other clotting factors
frequently during therapy.
2) Evaluate the patient’s
skin frequently, checking
for abnormalities, necrosis,
and wounds.
1) Bleeding
2) Heparininduced
thrombocytopenia
(HIT) (with or
without
thrombosis)
1) Assess for signs of
bleeding and hemorrhage
(bleeding gums; nosebleed;
unusual bruising; black,
tarry stools; hematuria; fall
in hematocrit or BP;
guaiac-positive stools).
Notify health care
professional if these occur.
(Vallerand &
Sanoski, 2021)
Clopidogrel
(Plavix)
Therapeutic:
antiplatelet agents
Pharmacologic:
platelet aggregation
inhibitors
thrombin, preventing
the conversion of
fibrinogen to fibrin.
Therapeutic Effects:
Prevention of thrombus
formation. Prevention
of extension of existing
thrombi (full dose).
coagulopathies,
Peripheral arterial
thromboembolism. Used
in very low doses (10–
100 units) to maintain
patency of IV catheters
(heparin flush).
Inhibits platelet
aggregation by
irreversibly inhibiting
the binding of ATP to
platelet receptors.
Therapeutic Effects:
Reduction in risk of MI
and stroke.
Acute coronary
syndrome (ST-segment
elevation MI, non-STsegment elevation MI, or
unstable angina). Patients
with established
peripheral arterial
disease, recent MI, or
recent stroke.
1) Thrombotic
thrombocytopenic
purpura
2) Toxic
epidermal
necrolysis
2) Monitor platelet count
every 2–3 days during
therapy. May cause mild
thrombocytopenia, which
appears on 4th day and
resolves despite continued
heparin therapy. Heparininduced thrombocytopenia
(HIT), a more severe form
which necessitates
discontinuing medication,
may develop on 8th day of
therapy; may reduce
platelet count to as low as
5000/mm3 and lead to
increased resistance to
heparin therapy. HIT may
progress to development of
venous and arterial
thrombosis (HITT) and
may occur up to several wk
after discontinuation.
Patients who have received
a previous course of
heparin may be at higher
risk for severe
thrombocytopenia for
several mo after the initial
course.
1) Monitor patient for signs
of thrombotic thrombocytic
purpura
(thrombocytopenia,
microangiopathic
hemolytic anemia,
neurologic findings, renal
dysfunction, fever). May
rarely occur, even after
short exposure (<2 wk).
Requires prompt treatment.
(Vallerand &
Sanoski, 2021)
Aspirin
(ASA)
Therapeutic:
antipyretics,
nonopioid analgesics
Pharmacologic:
salicylates
(Vallerand &
Sanoski, 2021)
Produce analgesia and
reduce inflammation
and fever by inhibiting
the production of
prostaglandins.
Decreases platelet
aggregation.
Therapeutic Effects:
Analgesia. Reduction
of inflammation.
Reduction of fever.
Decreased incidence of
transient ischemic
attacks and MI.
Inflammatory disorders
1) GI bleeding
including: Rheumatoid
arthritis, Osteoarthritis.
2) Toxicity
Mild to moderate pain.
Fever. Prophylaxis of
transient ischemic attacks
and MI.
Unlabeled Use:
Adjunctive treatment of
Kawasaki disease.
2) Assess for rash
periodically during therapy.
Discontinue therapy if
severe or if accompanied
with fever, general malaise,
fatigue, muscle or joint
aches, blisters, oral lesions,
conjunctivitis, hepatitis,
and/or eosinophilia.
1) Assess for signs of GI
bleeding including unusual
bleeding of gums; bruising;
black, tarry stools. Monitor
hematocrit periodically in
prolonged high-dose
therapy to assess for GI
blood loss. Caution patient
to avoid concurrent use of
alcohol with this
medication to minimize
possible gastric irritation; 3
or more glasses of alcohol
per day may increase risk
of GI bleeding.
2) Monitor for the onset of
tinnitus, headache,
hyperventilation, agitation,
mental confusion, lethargy,
diarrhea, and sweating. If
these symptoms appear,
withhold medication and
notify health care
professional immediately.
Alteplase
(Activase, tPA)
Therapeutic:
thrombolytics
Pharmacologic:
plasminogen
activators
(Vallerand &
Sanoski, 2021)
Epoetin alfa
(Epogen)
Therapeutic:
antianemics
Pharmacologic:
hormones,
erythropoiesis
stimulating agents
(ESA)
Convert plasminogen
to plasmin, which is
then able to degrade
fibrin present in clots.
Alteplase directly
activate plasminogen.
Therapeutic Effects:
Lysis of thrombi in
coronary arteries, with
preservation of
ventricular function or
improvement of
ventricular function
(and ↓ risk of HF or
death). Lysis of
pulmonary emboli or
deep vein thrombosis.
Lysis of thrombi
causing ischemic
stroke, reducing risk of
neurologic sequelae.
Restoration of cannula
or catheter patency and
function.
Stimulates
erythropoiesis
(production of red
blood cells).
Therapeutic Effects:
Maintains and may
elevate RBCs,
decreasing the need for
transfusions.
Acute myocardial
infarction (MI). Acute
massive pulmonary
emboli. Acute ischemic
stroke. Occluded central
venous access devices.
1) Intracranial
hemorrhage
Anemia associated with
chronic kidney disease
(CKD). Anemia
secondary to zidovudine
(AZT) therapy in HIVinfected patients. Anemia
from chemotherapy in
patients with nonmyeloid
malignancies when there
is ≥2 additional mo of
planned chemotherapy.
Reduction of need for
allogeneic red blood cell
transfusions in patients
1) Cardiovascular
events (including
HF, myocardial
infarction, stroke,
thrombolytic
events)
1) Assess neurologic status
throughout therapy. Altered
sensorium or neurologic
changes may be indicative
of intracranial bleeding.
2)
Hypersensitivity
reaction (including
anaphylaxis)
2) Assess patient for
hypersensitivity reaction
(rash, dyspnea, fever,
changes in facial color,
swelling around the eyes,
wheezing). If these occur,
inform health care
professional promptly.
Keep epinephrine, an
antihistamine, and
resuscitation equipment
close by in the event of an
anaphylactic reaction.
2) Seizures
1) Assess patient for signs
and symptoms of
cardiovascular events
including chest pain,
shortness of breath,
weakness, slurring of
speech, edema, and weight
gain. Advise patient to
notify health care
professional immediately if
signs and symptoms of
blood clots (chest pain,
trouble breathing or
shortness of breath; pain in
undergoing elective,
noncardiac, nonvascular
surgery.
(Vallerand &
Sanoski, 2021)
Filgrastim
(Neupogen)
Therapeutic:
colony-stimulating
factors
Pharmacologic: Ø
A glycoprotein,
filgrastim binds to and
stimulates immature
neutrophils to divide
and differentiate. Also
activates mature
neutrophils.
Therapeutic Effects:
Decreased incidence of
infection in patients
who are neutropenic
Prevention of febrile
neutropenia and
associated infection in
patients who have
received bone marrow–
depressing
antineoplastics for the
treatment of nonmyeloid
malignancies. Reduction
of time for neutrophil
recovery and duration of
the legs, with or without
swelling; a cool or pale arm
or leg; sudden confusion;
trouble speaking or trouble
understanding others’
speech; sudden numbness
or weakness in the face,
arm, or leg, especially on
one side of the body;
sudden trouble seeing;
sudden trouble walking,
dizziness, loss of balance
or coordination; loss of
consciousness or fainting;
hemodialysis vascular
access stops working)
occur.
2) Institute seizure
precautions in patients who
experience greater than a 4point increase in hematocrit
in a 2-wk period or exhibit
any change in neurologic
status. Risk of seizures is
greatest during the first 90
days of therapy.
1) Acute
1) Assess for signs and
respiratory distress symptoms of acute
syndrome
respiratory distress
syndrome (fever, lung
2) Splenic rupture infiltrates, or respiratory
distress). If symptoms
occur, withhold filgrastim
until symptoms resolve or
discontinue.
from chemotherapy or
other causes. Improved
harvest of progenitor
cells for bone marrow
transplantation.
Improved survival in
patients exposed to
myelosuppressive
doses of radiation.
(Vallerand &
Sanoski, 2021)
Oprelvekin
(Interleukin-11)
Therapeutic:
colony-stimulating
factors
Pharmacologic:
interleukins,
thrombopoietic
growth factors
Stimulates production
of megakaryocytes and
platelets.
Therapeutic Effect:
Increased platelet
count.
fever in patients
undergoing induction and
consolidation
chemotherapy for acute
myelogenous leukemia.
Reduction of time to
neutrophil recovery and
sequelae of neutropenia
in patients with
nonmyeloid malignancies
undergoing
myeloablative
chemotherapy followed
by bone marrow
transplantation.
Mobilization of
hematopoietic progenitor
cells into peripheral
blood for collection by
leukapheresis.
Management of severe
chronic neutropenia.
Survival improvement in
patients acutely exposed
to myelosuppressive
doses of radiation.
Unlabeled Use:
Neutropenia associated
with HIV infection.
Neonatal neutropenia.
Prevention of severe
thrombocytopenia and
reduction of the need for
platelet transfusions
following
myelosuppressive
chemotherapy in patients
with nonmyeloid
2) Monitor for signs and
symptoms of splenic
enlargement or rupture (left
upper abdominal or
shoulder pain).
1) Fluid retention
2) Cardiac
dysrhythmias
(ventricular
arrythmias,
tachycardia, atrial
1) Assess patient for signs
of fluid retention (dyspnea
on exertion, peripheral
edema) during therapy.
Fluid retention is a
common side effect that
usually resolves within
several days following
malignancies at risk for
thrombocytopenia.
(Vallerand &
Sanoski, 2021)
fibrillation, and
atrial flutter),
discontinuation of
oprelvekin.
2) Monitor vital signs.
Monitor ECG periodically
during therapy. Assess
adequacy of cardiac output
and tissue perfusion, noting
significant variations in
BP/pulse rate equality,
respirations, changes in
skin color, temperature,
level of consciousness,
sensorium, and urine
output during episodes of
dysrhythmias. Advise
patient to notify health care
professional if symptoms
of abnormal heart rate or
rhythm (racing heartbeat,
shortness of breath,
dizziness, fainting) occur.
References
Vallerand, A. H., & Sanoski, C. A. (2021). Davis’s drug guide for nurses (17th ed.). F. A. Davis Company.
https://doi.org/https://bookshelf.vitalsource.com/reader/books/9781719642705/epubcfi/6/2%5B%3Bvnd.vst.idref%3DF00_cover%5D!/4/2/2/
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