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Analgesics (4)
  • acetaminophen (Tylenol)
  • hydrocodone & acetaminophen (Norco)
  • morphine sulfate (Morphine)
  • Ketorolac (Toradol)
Drugs for the cardiovascular system (9)
  • aspirin
  • heparin
  • warfarin (Coumadin)
  • hydralazine
  • lisinopril
  • metoprolol
  • enalapril
  • furosemide (Lasix)
  • hydrochlorothiazide
Drugs for glucose (5)
  • metformin
  • aspart
  • NPH
  • lantus
  • regular
Drugs for infection (4)
  • levofloxacin
  • vancomycin
  • metronidazole
  • ceftriaxone
Drugs for the GI tract (4)
  • protonix
  • pepcid
  • zofran
  • reglan
Drugs for the respiratory system (3)
  • albuterol
  • ipratropium
  • flucatisone and salmeterol
Immune modulating drugs (3)
  • prednisone
  • cellcept
  • rapamune
acetaminophen
  • drug class
  • MOA
  • 2nd gen NSAID - analgesic and antipyretic properties
  • inhibits COX in the CNS, which decreases prostaglandin synthesis in CNS
acetaminophen
  • expected main side effects
  • hematologic: hemolytic anemia, thrombocytopenia, neutropenia, leukopenia, pancytopenia
  • hepatic: jaundice, hepatotoxicity
  • skin: rash, urticaria
  • other: hypersensitivity rxn
acetaminophen
  • nursing considerations
  • alcohol use increases risk of hepatotoxicity
  • concurrent use with warfarin may increase risk of bleeding
  • s/s of acute toxicity and overdose are n/v, anorexia, malaise, diaphoresis, RUQ pain or tenderness, elevated bilirubin and hepatic enzyme levels
norco
  • drug class
  • MOA
  • opioid agonist/nonopioid analgesic combo
  • blocks release of inhibitory neurotransmitters, altering perception and emotional response to pain
norco
  • expected main side effects
  • CNS depression: bradycardia, drowsiness, sedation, repsiratory depression, orthostatic hypotension
norco
  • main nursing considerations
  • prolonged use may lead to physical dependence
  • since drug may cause drowsiness, pt should avoid driving and other hazardous activities until CNS effects are known
  • have pt move slowly when sitting or standing up to avoid syncope
morphine
  • drug class
  • MOA
  • opioid analgesic
  • interacts with opioid receptor sites, primarily in the limbic system, thalamus and spinal cord; this interaction alters neurotransmitter release, altering perception of and tolerance for pain
morphine
  • expected main side effects
  • respiratory depression
  • constipation
  • orthostatic hypotension
  • urinary retention
  • cough suppression
  • euphoria
morphine
  • nursing considerations
  • monitor VS - notify MD if RR<10/min
  • monitor I/O - stay alert for urinary retention
  • monitor bowel activity and intervene as appropriate
ketorolac (Toradol)
  • drug class
  • MOA
  • nonaspirin, 1st gen NSAID
  • reversibly inhibits COX and also acts as a potent inhibitor of platelet aggregation
ketorolac (Toradol)
  • expected main side effects
  • gastric ulceration and perforation
  • increased bleeding time
  • renal impairment
ketorolac (Toradol)
  • nursing considerations
  • drug is only meant for short term pain mgmt
  • pt should avoid aspirin products and herbs during therapy
  • monitor pt for adverse rxns, esp prolonged bleeding time and CNS rxns
aspirin
  • drug class
  • MOA
  • 1st gen NSAID
irreversibly inhibits COX-1 & 2, duration of action depends on how long it takes tissues to start synthesizing COX again
aspirin
  • expected main side effects
  • gastric ulceration
  • risk for bleeding
  • renal impairment
  • ototoxicity, tinnitus
aspirin
  • nursing considerations
  • elderly pts are at increased risk for toxocity
  • should NOT be used to treat fever in children due to Reye's syndrome
  • consider holding if pt is also on anticoagulant therapy
heparin
  • drug class
  • MOA
  • anticoagulant
  • activates antithrombin, which then inactivates thrombin and clotting factor Xa
  • anticoagulant effects develop within minutes of IV administration
heparin
  • expected main side effects
  • hemorrhage
  • thrombocytopenia (reduced platelet counts)
  • hypersensitivity rxns
heparin
  • nursing considerations
  • instruct pt to immediately report chest tightness, dizziness or fever
  • assess I/O to detect dehydration
  • aPTT should fall in range of 60-80 seconds
  • can only be given by injection
  • protamine is "antidote"
warfarin
  • drug class
  • MOA
  • anticoagulant
  • inhibits synthesis of vitamin K dependent clotting factors, including prothrombin and factor X
warfarin
  • expected main side effects
  • hemorrhage
  • teratogenic, so should NOT be given to pregnant women or while breastfeeding
warfarin
  • nursing considerations
  • food sources of vitamin K: mayo, soybean and canola oil, leafy green veggies
  • given orally, will take several days before reachingtherapeutic levels
  • PT ratio used to monitor levels
  • vitamin K is "antidote"
hydralazine
  • drug class
  • MOA
  • vasodilator
  • causes selective dilation of arterioles with little effect on veins; inresponse, peripheral resistance and arterial BP fall...also increases heart rate and contractility
hydralazine
  • expected main side effects
  • hypotension, dizziness, headache, weakness
  • reflex tachycardia and increased O2 demand
  • increased blood volume due to sodium and water retention
  • SLE-like syndrome, s/s: muscle and joint pain, fever, antinuclear antibodies
hydralazine
  • nursing considerations
  • monitor BP, heart rate and regularity and daily weight
  • should be taken with food
  • pt should rise slowly to prevent diziiness
  • to avoid rapid BP drop, taper dosage before discontinuing
lisinopril
  • drug class
  • MOA
  • ACE inhibitor
  • inhibits ACE, therefore inhibiting angiotension II...also increases levels of bradykinin by inhibiting kinase II
  • primarily dilates arterioles and reduces blood volume
lisinopril
  • expected main side effects
  • first-dose hypotension - d/t widespread vasodilation from abrupt lowering of angiotension II levels
  • persistent, dry cough
  • hyperkalemia
  • renal failure
lisinopril
  • nursing considerations
  • concurrent use with diuretics may intensify 1st dose hypotension
  • increased risk for hypokalemia when used with K supplements and K-sparing diuretics (spironolactone)
metoprolol
  • drug class
  • MOA
  • 2nd gen beta blocker
  • selectively blocks beta-1 receptors in the heart (at therapeutic levels) - so should reduce heart rate, force of contraction, and reduces renin secretion by the kidneys
metoprolol
  • expected main side effects
  • bradycardia, reduced cardiac output, AV heart block and rebound tachycardia (following abrput withdrawal) - should be used with caution in pts with heart failure
  • safer for pts with asthma and diabetes
metoprolol
  • nursing considerations
  • monitor BP and pulse rate/rhythm
  • watch for orthostatic hypotension, esp in the elderly
  • drug may s/s of hypoglycemia, so monitor blood glucose levels in diabetic pts
  • may also mask s/s of hyperthyroidism
  • taper drug when discontinuing
  • monitor daily weight in pts in heart failure
enalapril
  • drug class
  • MOA
  • ACE inhibitor
  • inhibits conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; inactivates bradykinin and prostaglandins; increases plasma renin and K levels, reduces aldosterone levels - producing systemic vasodilation
enalapril
  • expected main side effects
  • 1st-dose hypotension
  • persistent, dry cough
  • hyperkalemia
  • renal failure
  • angioedema
enalapril
  • nursing considerations
  • assess BP prior to administration
  • monitor VS, I/O and daily weight
  • supervise pt during ambulation until effects are known
  • monitor BUN, LFTs, creatinine and electrolyte levels
  • tell pt to report persistent, dry cough with nasal congestion (signs of toxicity)
lasix
  • drug class
  • MOA
high-ceiling (loop) diuretic
acts in the thick segment of ascending limb of Henle's loop to block reabsorption of Na and Cl - which also passively blocks reabsorption of water
lasix
  • expected main side effects
  • hyponatremia, hypochloremia, dehydration
  • hypotension due to lowered blood volume
  • hypokalemia - which can result in fatal dysrythmias
  • ototxicity
lasix
  • nursing considerations
  • assess BP, pulse rate, I/O and daily weight prior to administration
  • monitor blood glucose levels in diabetic pts since effects of drug may increase glucose levels
  • pts can minimize risk of hypokalemia by eating K-rich foods (nuts, dried fruits, spinach, citrus fruits, potatoes, bananas)
  • risk of hearing loss increases when used with other ototoxic drugs (esp aminoglycosides)
HCTZ
  • drug class
  • MOA
  • thiazide diuretic
  • blocks reabsorption of Na and Cl in the early segment of the distal convoluted tubule
HCTZ
  • expected main side effects
  • hyponatremia, hypochloremia, dehydration
  • hypokalemia
  • contraindicated for pregnant women
HCTZ
  • nursing considerations
  • assess BP, I/O and daily weight prior to administration
  • use caution when administering with digoxin - have a higher risk of digoxin toxicity
  • nocturia can be minimized by avoiding dosing in the late afternoon
metformin
  • drug class
  • MOA
  • biguanide (oral antidiabetic)
inhibits glucose production in the liver, slightly reduces glucose absorption in the gut and sensitizes insulin receptors in fat and skeletal muscle (thereby priming those tissues to increase glucose uptake)
metformin
  • expected main side effects
  • decreased appetite and weight loss
  • lactic acidosisn(s/s: hyperventilation, myalgia, malaise)
metformin
  • nursing considerations
  • watch for s/s of hypoglycemia
  • may need to change dose in response to health status (infection or fever may increase metabolic demand and lower glucose levels)
levofloxacin
  • drug class
  • MOA
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