Standard Lab Values:
-
Sodium (NA): 135-145 [“odd numbers are 1-3-5”]
- WBC’s: 5,000-10,000 [“Wanna Buy a Car for 5,000 to 10,000”]
Potassium (K+): 3.5-5 [“3-5 bananas in a bunch”]
- Liver function tests (LFT):
BUN: 10-20 [“10-20$ for a hamburger BUN”]
 AST: 5-40 units/L
Creatinine: 0.5-1.5 [“0.5-1.5 is the rating for an ugly creature”]
 ALT 8-20 units/L
Glucose: 70-105 [“Glucose is energy & energy is low at 70-105
 ALP 30-120 units/L
years old”] (HbA1C: 4-6%)
What are these drugs used for?
ACE inhibitors: Hypertension, HF, and acute MI
ARB blockers: Block vasoconstriction and the secretion of aldosterone
Calcium channel Blockers (CCBs): Reduce the workload of the heart and
decreased myocardial oxygen demand; (Treatment of HTN, Angina,
dysrhythmias, migraines)
Beta Blockers: Reduce the workload of the heart; Mainstay in the treatment
of several cardiovascular diseases (Angina, MI, Hypertension,
Dysrhythmias)
Centrally Acting Adrenergic Blockers: Decrease norepinephrine
production, decrease blood pressure
Peripherally Acting Adrenergic Blockers: Reduces peripheral vascular
resistance and BP by dilating both arterial and venous blood vessels
Anti-dysrhythmic drugs: Alpha vs Beta receptors; Dysthymias
Vasodilators: Decrease BP; Directly relax arteriolar or venous smooth
muscle (or both)
Diuretics: First line antihypertensives; Decrease plasma and extracellular
fluid volumes
Anticholinergic drugs: Decrease in bronchospasms; Binds with ACH
receptor to prevent bronchoconstriction [adverse effects: Dry mouth,
cough, Nasal congestion, Palpitations, GI distress]
Know the steps for administering an inhaler with or without a spacer.
What teaching is involved for patients with inhalers? The adverse
effects commonly caused by inhaled medications
How are corticosteroids used in treatment for respiratory diseases: For
Anti-inflammatory/decrease airway mucus; Turns off immune system and decrease
inflammation
What are the adverse effects and what do we monitor for when these
drugs are inhaled?
What is the standard rescue drug for Asthma? Albuterol: for acute
asthma attacks
The purpose of Iron Supplements: Treatment of iron deficiency anemia
Why would a patient need iron: Loss of blood during heavy menstruation,
pregnancy, blood donation, bleeding ulcers, chronic heart failure, and
surgery (before and after)
How to administer and what to monitor for with Epoetin Alpha: Oral
forms taken between meals with orange juice; Assess CBC, iron levels,
B12, Folic acid; Obtain nutritional assessment: signs for bleeding and
malnutrition
The use of statins for management of high cholesterol: Decrease
cholesterol/plaque in arteries; For Hypercholesterolemia, protect against
MI, CVA What are the adverse effects? Liver toxicity, Myopathy,
Rhabdomyolysis What are the nursing considerations for this class of
drugs? Pregnancy Cat X, Monitor ALT/AST @ 12wks then q6 months,
Monitor CK levels, Avoid alcohol, Monitor for
anorexia/N/V/jaundice/muscle pain
Antihypertensive Drugs- CH. 22
Drug class
Alpha2 receptor
agonists (central)
Drugs
Clonidine and
methyldopa
Action and use
Decrease norepinephrine production,
decrease blood pressure
Adverse effects
orthostatic hypotension, fatigue,
and dizziness
Nursing implications
Watch for HYPOTENSION
Alpha1 receptor
blockers (peripheral)
Doxazosin, prazosin, and
terazosin
Reduces peripheral vascular
resistance and BP by dilating both
arterial and venous blood vessels
Tachycardia, dizziness, N/V/D,
constipation, dry mouth, HA, chest
pain, depression
Also used for BPH
Beta receptor
blockers (peripheral)
Propranolol, metoprolol,
and atenolol
Cause reduced secretion of renin,
Combination alpha1
and beta receptor
blockers
AngiotensinConverting
Enzyme (ACE)
Inhibitors
Labetalol and carvedilol
Uses: hypertension and HF
Bradycardia
Drowsiness, Impotence
Constipation, dry mouth, Edema
hypoglycemia
hypotension
See above
captopril (Capoten)
enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Prinivil)
Inhibit ACE, decrease angiotensin II,
and decrease BP
Fatigue, Dizziness Headache
Mood changes
Impaired taste
hyperkalemia
Dry, nonproductive cough, which
reverses when therapy is stopped
Angioedema: rare
Pregnancy D
Angiotensin II
Receptor
Blockers(ARBs)
losartan (Cozaar)
eprosartan (Teveten)
valsartan (Diovan)
irbesartan (Avapro)
ARBs block vasoconstriction and the
secretion of aldosterone
Pregnancy D
Calcium Channel
Blockers
amlodipine (Norvasc)
Cause smooth muscle relaxation by
blocking the binding of calcium to its
receptors, preventing muscle
contraction
Chest pain
Fatigue Diarrhea
Hypoglycemia
Urinary tract infection
Anemia
Weakness
hypotension, palpitations,
tachycardia or bradycardia,
constipation, nausea, dyspnea,
-
Acute toxicity
 Monitor ECG for
dysthymias
Diuretics
Hydrochlorothiazide
First-line antihypertensives
Decrease plasma and extracellular fluid
volumes
Directly relax arteriolar or venous
smooth muscle (or both), Decrease BP
Fluid and electrolyte imbalance
Vasodilators
hydralazine
- Oral
- Injectable:
hypertensive
emergencies
- BiDil
Vasodilators
minoxidil
See above
T-wave electrocardiographic
changes, pericardial effusion or
tamponade, angina, breast
tenderness, rash, and
thrombocytopenia
Vasodilators
nitroprusside
(Nitropress)
See above
bradycardia, decreased platelet
aggregation, rash, hypothyroidism,
hypotension, methemoglobinemia,
and (rarely) cyanide toxicity
dizziness, headache, anxiety,
tachycardia, edema, dyspnea, N/V
hypotension, diarrhea, hepatitis
Monitor K, Na, hydration status
-
May cause
tachycardia, sodium
retention, arrhythmias,
angina
- Use caution with
MOIAs
- Monitor BP/ instruct
how to take BP
- NEVER double dose
- NEVER abruptly stop
taking, rebound
hypertensive crisis and
lead to stroke
- Take oral with meal
- If giving IV, use IV
pump for accuracy
- AVOID HOT TUBS/
SHOWERS/
WEATHER/
prolonged
sitting/standing/
alcohol = will
aggervate BP
Use in HTN crisis
Antianginal Drugs- CH. 23
Drug class
Nitrates and Nitrites
Drug
Action and use
- Nitroglycerin (both
rapid & long acting)
Cause vasodilation because of relaxation
of smooth muscles
- Isosorbide dinitrate
(both rapid & long
acting)
Potent dilating effect on coronary
arteries
Available forms:
- Isosorbide
mononitrate (only long
acting)
-
Beta Blockers
atenolol
metoprolol
propranolol
nadolol
Sublingual, translingual sprays,
IV, transdermal patches
(bypass liver & first-pass
effect)
Chewable tablets
Oral capsules/tablets
Ointments
Mainstay in the treatment of several
cardiovascular diseases
Angina
Adverse effect
-
Headaches
(Usually diminish in intensity
and frequency with continued
use)
-
Reflex tachycardia
Postural hypotension
Tolerance may develop.
Nursing implications
Contraindications:
-
Known drug allergy
Severe anemia
Closed-angle glaucoma
Hypotension
Severe head injury
Use of erectile dysfunction
drugs
Monitor vitals
-
Hypotension
Headache
Tolerance
Monitor vitals
-
Hypotension
Headache
Tolerance
Monitor vitals
MI
Hypertension
Dysrhythmias
Reduce the workload of the heart
Calcium Channel
Blockers
amlodipine
diltiazem
nicardipine
nifedipine
verapamil
*Reduce the workload of the heart
and decreased myocardial oxygen
demand
*Treatment of HTN, Angina,
dysrhythmias, migraines
Heart Failure Drugs- CH. 24
Drug class
ACE inhibitors
Drug
lisinopril, enalapril,
captopril
Action & Use
Uses: hypertension, HF, and
acute MI
Adverse effects
Nursing implication
Hypotension, dry cough,
hyperkalemia, others
Decrease workload on heart
ARBs
valsartan, candesartan,
losartan
Uses: hypertension, HF,
Hypotension, others
Decrease workload on heart
beta blockers
Metoprolol, carvedilol
prevent catecholamine-mediated
actions on the heart by blocking
sympathetic nervous system
stimulation
Bradycardia, hypotension, bronci
constriction (NO ASTHMA/COPD
PTS), Blood sugar masking
-
Assess BP/pulse
Hyponatremia, hypokalemia,
hypotension, others
-
Monitor potassium levels
Hyperkalemia, others
-
Monitor potassium levels
Narrow therapeutic window: 0.5- 2
ng/mg
-
Cardiac: dysthymias, bradycardia,
tachycardia
-
Look for hypokalemia, hepatic dysfunction,
hypercalcemia, hypothyroidism, renal or
respiratory disease, use of cardiac pacemaker
Assess: apical pulse 1 full minute, weight, I&O,
ECG, Labs: electrolytes & liver function tests
Apical pulse: less than 60 or greater than 100: hold
med and call doc
AVOID HIGH FIBER FOODS
Decrease workload on heart
Loop diuretics
furosemide
Inhibits reabsorption of fluids
causing fluid excretion
Decrease workload on heart
Aldosterone
inhibitors
spironolactone
Vasodilators
hydralazine/isosorbide
dinitrate (BiDil)
Cardiac Glycoside
Digoxin
(2nd choice b/c dangerous)
Inhibits aldosterone causing sodium
and fluid excretion
Hypotension, others
Increases myocardial contractility
-
Increase stroke volume
Decrease venous BP
Blood supply increased
Decrease workload on heart
CNS: headaches, fatigue, malaise,
confusion, convulsions
Eyes: colored vision (seeing green,
yellow, purple), halo vision, flicking
lights
GI: anorexia, nausea, vomiting, diarrhea
-
Anticoagulation Drugs- CH. 26
Drug class
Anticoagulants
Drugs
Action and use
Adverse effects
Heparin
Inhibit clotting factors II, IX, X, XI, XII
Bleeding
(LMWH:
Enoxaparin)
Prevent clot formation
Heparin-induced
thrombocytopenia (HIT)
Therapeutic value
Routes:
Nausea, vomiting, abdominal
cramps.
Nursing implications
ANTIDOTE: Protamine sulfate
-
Double check doses
Assess for bleeding (CBC & clotting studies)
NEVER give heparin & enoxapin together
Assess allergy to benzyl alcohol
Subcute: DVT
prophylaxis
Anticoagulants
Warfarin
Inhibits production of vitamin K–
Bleeding
Prevent clot formation
Skin necrosis
ANTIDOTE: Vit. K
-
Purple toe syndrome
Antiplatelets
Aspirin (also
antipyretic)
Prevent platelet adhesion or start of a blood clot
-
Reduce risk of stroke & MI; after stents
Aspirin: GI bleed,
nausea/gastritis; low platelets,
anemia
Clopidogrel
Clopidogrel: Bleeding,
abdominal pain/nausea, flul-like
symptoms
Antiplatelet
Pentophylline
Decrease blood viscosity
bleeding
Thrombolytic
Alteplase
break down, or lyse, preformed clots
Bleeding
Routes: IV
Indications: Acute MI, DVT, occulted shunts or
catheters, pulmonary embolism, acute ischemic strokes
Nausea, vomiting, hypotension
Cardiac dysrhythmias
Antifibrinolytics
Desmopressin
Promote clot formation: > Prevent lysis of fibrin
Aminocaproic acid
For people with: Hemophilia, vonWilebrand’s disease &
post-surgery to prevent bleeding
Stroke, Heart attack, Clot formation
Same time all the time
Routine labs: Pt/INR: goal 2-3/ 2.5-3.5 for
mechanical heart valve
St. John’s wart: decreased warfarin effect
Avoid alcohol & cranberry juice
Soft Toothbrush/Electric Razor
aspirin w/ 6-8oz of water & sit up 30 min after taking
-
-
Take w/ food
Aspirin: not for kids/teens b/c risk of Reye’s
syndrome
NOT IN PREGNANCY
Held 5-7 days before surgery
Monitor CBC (H&H, platelets) & pt/INR
baseline
Monitor IV sites for bleeding, redness, pain
Aseptic technique in IV management
Monitor for bleeding in gums, nose, stool,
urine, emesis, injection sites, bruising
Drugs for Anemia- CH. 54
Iron
Ferric gluconate
Ferrous sulfate
Treatment of iron deficiency
anemia
Iron dextran (may cause
anaphylactic shock, give test
dose)
Folate
Drug for megaloblastic
anemia
Erythropoiesis-Stimulating
Agents
Food that promote
absorption_________
black, tarry stools
Food that impair
absoption____________
Liquid oral preparations may stain
teeth- use straw
Injectable forms cause pain upon
injection- use Z-Track
Iron sucrose
Water-soluble B-complex
vitamin
nausea, vomiting, diarrhea,
constipation, stomach cramps
Tx for overdose_______
Interactions:
Treatment of folic acid deficiency
anemia
-
Administer w/
food
Cyanocobalamin (Vitamin B12)
Treat pernicious anemia
-
Untreated
pernicious
anemia
Epoetin alfa
Stimulates the bone marrow to
produce red blood cell
-
Assess CBC,
iron levels, B12,
Folic acid
Obtain
nutritional
assessment: signs
for bleeding and
malnutrition
Oral forms taken
between meals
with orange juice
Folic acid
-
Biosynthetic form of the
natural hormone
erythropoietin
-
Used for: end-stage renal
disease, chemo-induced
anemia
hypertension, fever, headache,
pruritus, rash, nausea/vomiting,
arthralgia,
-
-
Antidysrhythmic Drugs- CH. 25
Drug class
Class Ia
Class Ib
Drug
procainamide, quinidine
Action/ use
Fast sodium channel blockers, Delay
repolarization
Uses: atrial fibrillation, premature
atrial contractions,
Increase APD
phenytoin, lidocaine
Block sodium channels
Lidocaine used for ventricular dysrhythmias
Both are used for
Adverse effects
Nursing implications
ventricular dysrhythmias, blood
disorders, SLE–like syndrome,
N,V,D, fever, leukopenia,
twitching, convulsions, confusion,
respiratory depression or arrest,
hypotension, bradycardia, and
dysrhythmias
dysrhythmias caused by digoxin toxicity
Class Ic
flecainide, propafenone
Block sodium channels
dizziness, visual disturbances, and
dyspnea
Used for severe ventricular dysrhythmias
First-line for atrial fibrillation
Class II beta
blockers
Atenolol (Tenormin)
block sympathetic nervous system stimulation,
thus reducing transmission of impulses in the
heart’s conduction system
Class III
Amiodarone
Increase APD
Used for dysrhythmias that are difficult to treat
-
Drug of choice for ventricular
dysthymias
-
-
corneal microdeposits
visual halos
photophobia
dry eyes
photosensitivity
pulmonary toxicity
Drug interactions:
-
Diltiazem
Unclassified Anti
Adenosine
Digoxin, warfarin,
grapefruit juice
Contraindications:
-
Calcium channel
blockers
Radial pulse for a
full minute: under
60= hold meds
Hypersensitity
Temporary control of rapid vent response
Dysrh
Contraindications:
-
KDA
Diuretics- CH
Drug class
Loop diuretics
Drug
bumetanide
ethacrynic acid
furosemide (Lasix)
Action/ use
Act directly on the
ascending limb of the
loop of Henle to inhibit
chloride and sodium
resorption
-
Potassium-sparing
diuretics
spironolactone
(Aldactone)
Treatment of
edema in HF,
nephrotic
syndrome,
ascites,
To control
hypertension
Work in collecting ducts
and distal convoluted
tubules
Promote the excretion of
sodium and water
Adverse effects
Dizziness, headache, tinnitus, blurred vision
GI: Nausea, vomiting, diarrhea Agranulocytosis,
neutropenia,
thrombocytopenia
Blood: Hypokalemia, hyperglycemia,
hyperuricemia
Nursing implications
Interactions:
-
Neurotoxic
Nephrotoxic
Thiazide
NSAIDs
Cover up when going outside
Monitor intake & output
Teach about high potassium diet
(bananas, dates,
Dizziness, headache Cramps, nausea, vomiting,
diarrhea
Urinary frequency,
weakness, hyperkalemia Gynecomastia
Amenorrhea
Irregular menses
Postmenopausal bleeding
Thiazide and
thiazide-like
diuretics
Hydrochlorothiazide
1st line for HTN
Action primarily in the
distal convoluted tubule
Result: water, sodium, and
chloride are excreted
-
1st line for HTN,
CNS: Dizziness, headache, blurred vision
-
GI: Anorexia, nausea, vomiting, diarrhea,
Genitourinary Impotence
-
Hematologic: Jaundice, leukopenia Urticaria,
photosensitivity, Hypokalemia, hyperglycemia,
hyperuricemia, hyperchloremic alkalosis
Antilipemic Drugs- CH. 27
Monitor electrolytes
(potassium)!!
Assess vitals
Drug class
HMG–CoA reductase
inhibitors
Drugs
atorvastatin (Lipitor)
Action and use
Inhibit HMG-CoA reductase, which is used by the
liver to produce cholesterol
simvastatin (Zocor)
First-line for
hypercholesterolemia
Adverse effects
Nursing implications
(GI) disturbances
Interactions:
Rash, Headache
-
Oral anticoagulants
Reduces LDL, and triglycerides
lovostatin (Mevacor)
Myopathy (muscle pain), rhabdomyolysis
Contraindicated in active liver disease
pravastatin (Pravachol)
Elevations in liver enzymes or liver disease
Monitor serum cholesterol levels before
and 4 weeks after
rosuvastatin (Crestor)
Monitor for: Anorexia, vomiting, nausea,
jaundice
Increases HDL
Monitor LFT’s
Report muscle weakness
Pregnancy cat. X
Take @ NIGHT
Bile acid sequestrants
B vitamin niacin
cholestyramine (Questran)
Prevent resorption of bile acids from small intestine
Constipation
colestipol (Colestid)
Prevent absorption of cholesterol
Heartburn, nausea, belching, bloating
Niacin
Increases activity of lipase, which breaks down lipids
Flushing (caused by histamine release)
Also used in Treatment of loose bowel
movements
Pruritus
GI distress
Fibric acid derivatives
(fibrates).
gemfibrozil (Lopid)
activating lipase, which breaks down cholesterol
fenofibrate (Tricor)
Abdominal discomfort, diarrhea, nausea
Blurred vision, headache
Risk of gallstones
Contraindications:
-
KDA
Severe liver or kidney disease
Cirrhosis
Gallbladder disease
Longer prothrombin time
Interactions: Oral anticoagulants & Statins
cholesterol absorption
inhibitor
ezetimibe (Zetia):
Inhibits absorption of cholesterol and related sterols
from the small intestine
Herbal Product
Garlic
Used as an antispasmodic, antihypertensive,
antiplatelet, lipid reducer
dermatitis, vomiting, diarrhea, flatulence,
antiplatelet activity
Herbal Product
Flax
Uses: atherosclerosis, hypercholesterolemia, GI
distress, menopausal symptoms
diarrhea and allergic reactions
Week 4: Respiratory drugs
Drug class
Antihistamines
(Sedating)
Drugs
-
diphenhydramine(sedating)
loratadine (non- sedating)
cetirizine
fexofenadine
Action and use
For: Allergies, Insomnia
Adverse effects
Dry mouth, Difficulty urinating, Constipation,
Changes in vision, Drowsiness
Blocks histamine I receptor sites to stop
vasodilation and capillary permeability
Nursing implications
Contraindications:
-
liver disease
breastfeeding
Interactions:
Pregnancy B
Decongestants
Adrenergics
-
pseudoephedrine (Sudafed)- oral
ephedrine- topical
phenylephrine- topical
Constrict small blood vessels, shrinking
nasal tissue, and nasal secretions in the
swollen mucous membranes are better able
to drain.
Nervousness
Insomnia
Palpitations
Tremors
Decongestants
-
ipratropium (Atrovent)- nasal
spray
Dry nasal secretion
Dry mucous membrane, hypertension,
tachycardia, urinary retention, constipation
Anticholinergics
(with systemic absorption)
Decongestants
-
fluticasone (Flonase)
beclometha
Decreased inflammation results in
decreased congestion
-
Narrow angle glaucoma
uncontrolled cardio disease, HTN
Diabetes / hyperthyroidism
BPH
Interactions:
-
Methyldopa
Urinary acidifiers & alkalinizes
& sympathomimetics
Local mucosal dryness
and irritation
Corticosteroids
Antitussives
Contraindications:
-
Codeine
Hydrocodone
Suppress the cough reflex
Sedation, N, V lightheadedness, constipation
Contraindications: Opioid dependency,
Resp. depression, Renal impairment
-
Dextromethorphan
Benzonatate (cause HA)
For: Cough
Dizziness, drowsiness, nausea
Interactions: CNS depressants, ETOH,
Tricyclic Antidepressants
Nausea, vomiting, GI irritation
Pregnancy C
Opioids
Antitussives
Suppress the cough reflex
Non opioids
Expectorants
-
guaifenesin (Musinex)
For: Resp. congestion, cough
Reduce the viscosity of secretions
loosening/thinning
Week 4 drug Template (Respiratory drugs)
Drug class
Bronchodilators: Short
acting Beta-Adrenergic
Agonists
Anticholinergics
Xanthine Derivatives
Drugs
Action and use
Adverse effects
Nursing implications
-
albuterol
levalbuterol
terbutaline
salmeterol
For: Acute asthma attacks
Hypotension or hypertension
Activates beta2 receptors
Vascular headache
relaxes smooth muscle in the airway
and results in bronchial dilation and
increased airflow.
Tremor
-
ipratropium
tiotropium
aclidinium
For: Decrease in bronchospasms
Dry mouth, cough, Nasal
congestion, Palpitations, GI
distress,
DO NOT give if narrow-angle glaucoma
or BPH (Will worsen)
-
theophylline
Synthetic xanthines:
aminophylline (IV)
For: long term COPD or asthma
Hyperglycemia tachycardia,
Nausea, vomiting, anorexia
Therapeutic range: 5-15 mcg/ml
Binds with ACH receptor to prevent
bronchoconstriction
Increase levels of energy-producing
cAMP
-
-
-
Avoid caffeine
Monitor for
tachycardia/tremors
Pregnancy C
Pregnancy B
Avoid caffeine
Pregnancy C
Cause bronchodilation
Leukotriene receptor
antagonists
-
Corticosteroids
-
Mast cell stabilizers
Montelukast
beclomethasone
dipropionate
budesonide
fluticasone
triamcinolone acetonide
methylprednisolone
cromolyn and nedocromil,
Blocks leukotriene and decrease
inflammation
Headache, nausea, diarrhea
For: Anti-inflammatory/decrease
airway mucus
Pharyngeal irritation
Turns off immune system and
decrease inflammation
Coughing, Dry mouth
Oral fungal infections
Systemic effects rare with low
doses for inhalation therapy.
Stabilize membranes of cells that
release harmful bronchoconstricting
substances
N,V,D headache
Suicide risk
-
Pregnancy B
-
Pregnancy C