5W Drugs – Flashcard

Classification: antidysrhythmic Action: Prolongs duration of action potential and effective refractory period; increases PR and QT intervals, decreases sinus rate, decrease peripheral vascular resistance What does that mean? : It reduces the heart muscle's excitability. And dilates peripheral arteries. Use: Severe ventricular tachycardia, supraventricular tachycardia, ventricular fibrillation not controlled by first line agents Dosage: -Ventricular dyshythmias: PO loading dose 800-1600 mg/day for 1-3 weeks; maintenance 400 mg/day -Perfusion tachycardia: IV 5 mg/kg loading dose given over 20-60 min -Supraventricular tachycardia: PO 600-800 mg/day x 7 days or until desire response, then 400 mg/day x 21 days, then 200-400 mg/day maintenance Side Effects: Headache, dizziness, hypotension, bradycardia, nausea, vomiting, blurred vision Nursing Implications: -Assess for pulmonary toxicity: dyspnea, fatigue, cough, fever, chest pain -Assess ECG continuously to determine product effectiveness -Assess I&O ratio, cardiac rate, respirations -Thyroid, liver toxicity - Amiodarone has a VERY LONG half life (50 days)

Classification: Antianginal, antihypertensive, calcium channel blocker Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle and peripheral vascular smooth muscle; dilates coronary vascular arteries; increases myocardial oxygen delivery in patients with vasospastic angina What does that mean??: There isn't one mechanism of action. There's several. It slows impulses from the SA node, making the heart beat more slowly. Then it relaxes blood vessels so they can expand. Bigger blood vessels + less contractions = lower blood pressure. Use: Chronic stable angina pectoris, hypertension, variant angina Dosage: -Angina: PO 5-10 mg daily -Hypertension: PO 2.5-5.5 mg daily, max 10 mg/day Side Effects: HA, fatigue, anxiety, dysrhythmia, peripheral edema, bradycardia, hypotension, gastric upset, N&V, polyuria, hair loss, weight gain Nursing Implications: -Assess cardiac status: BP, pulse, respirations, ECG, daily wt, edema, SOB, jugular vein distention, crackles, orthostatic hypotension. -Give without regards to meals -BP effects are greatest 6-9 hours after administration - "-pine" drugs are usually Ca channel blockers (but not clozapine, that's a psyche drug) - Patients react differently to different Ca channel blockers. Your patient may be on Amlodipine because nifedipine had too many side effects.

Classification: Nonopioid analgesic, NSAID, antipyretic, antiplatelet Action: Blocks pain impulses in CNS, reduces inflammation by prostaglandin synthesis; antipyretic action from vasodilation of peripheral vessels; decrease platelet aggregation What does that mean: you're patient will have less swelling, less pain, less fever, and bleed more. Use: Mild to moderate pain or fever including RA, osteoarthritis, thromboembolic disorders; TIA's, rheumatic fever, postmyocardial infarction, prophylaxis of MI, ischemic stroke, angina Dosage: -Arthritis: PO 2.6-5.2 g/day in divided doses q4-6hr -Acute rheumatic fever: PO 5-6 g/day initially -Pain/fever: PO/RECT 325-650 mg q4hr prn, not to exceed 4 g/day -MI, stroke prophylaxis, TIA's: PO 160-325 mg/day Side Effects: Seizures, HA, N&V, GI bleeding, rash Nursing Implications: -Assess pain or temperature prior to administration and 1 hr after -assess hepatic studies, renal studies, blood studies, edema in legs -watch for toxic effects - abd pain and TINNITUS.

Classification: antihypertensive, α/β adrenergic blocker Action: mixture of nonselective α/β adrenergic blocking activity; decreases CO, exercise-induced tach, reflux orthostatic tach; vauses vasodilation, reduction in peripheral vascular resistance What does that mean: think "beat blocker and decrease workload." It makes the heart work more efficiently. Use: essential HTN alone or in combo with other HTNives, CHF, LV dysfunction following MI, cardiomyopathy Dosage: -CHF PO 3.125 mg bid x 2 weeks -Essential HTN: PO 6.25 mg bid x 7-14 days -Cardiomyopathy: PO 6.25-25 mg bid -Angina (unlabeled use): PO 25-50 mg bid Side Effects: dizziness, fatigue, bradycardia, postural hypotension, weakness, hyperglycemia, diarrhea Nursing Implications:-assess renal studies, hepatic studies, BP, edema -If pulse <50, hold product, call prescriber

Classification: Platelet aggregation inhibitor Action: Inhibits first and second phases of ADP-induced effects in platelet aggregation What does that mean: it alters platelets so that fibrin does not stick to them = less clot formation. Use: Reducing the risk of stroke, MI, peripheral arterial disease in high-risk patients, actue coronary syndrome, TIA, unstable angina Dosage: -Recent MI, stroke, peripheral arterial disease: PO 75 mg daily with or without Aspirin -Acute coronary syndrome: PO loading dose 300 mg then 75 mg daily Side Effects: HA, dizziness, edema, HTN, N&V, UTI, bleeding Nursing Implications: -Assess for thrombotic/thrombocytic purpura: fever, thrombocytopenia, neurolytic anemia -Assess for s/sx of stroke, MI during treatment - Stomach acid blockers reduce the effect of Plavix. Might want to switch them from PPI (protonix) to an H2 receptor blocker (pepcid).

Classification: cardiac glycoside, inotropic, antidysrhytmic Action: inhibit sodium-potassium ATPase, makes more calcium available for contractile proteins, resulting in increased CO; increases force of contraction; decreases HR What does that mean: Digoxin "slows and steadies the heart". It decreases heart rate, but makes each contraction more full and powerful. Use: Heart failure, A fib, atrial flutter, atrial tach, cardiogenic shock, paroxysmal atrial tach, rapid digitalization (i.e. - bringing Dig levels into the therapeutic range rapidly) Dosage: -IV digitalizing dose 0.6-1 mg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals -PO digitalizing dose 0.75-1.25 mg given as 50% of the dose initially, additional fractions given at 4-8hr intervals -Maintenance: 0.125-0.5 mg/day (tabs) or 0.350-0.5 mg/day (gelatin caps) Side Effects: HA, hypotension, N&V, drowsiness, fatigue, dysrhythmias Nursing Implications: -Check apical pulse for 1 min, if pulse <60 in adults or <90 in infants, take again in 1 hr; call prescriber -Assess electrolytes, I&O, daily weights, cardiac status - Digoxin competes with potassium for binding sites. So low potassium levels will increase digoxin effects. And high potassium levels will decrease digoxin effects. -"Digoxin toxicity" - look for confusion, anxiety, irregular pulse and palpitations. -Are they on a diuretic (lasix, spironolactone) too? That will affect potassium, which will affect Digoxin levels.

Classification: anticoagulant, antithrombotic Action: binds to antithrombin III inactivating factors Xa/IIa resulting in higher ratio of anti-factor Xa to IIa What that means: it binds to antithrombin making antithrombin more potent = less blood clots Use: prevention of DVT, pulmonary emboli in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non-Q-wave MI Dosage: -DVT prevention before hip/knee replacement: SUBCUT 30 mg bid given 12-24 hr postop for 7-10 days, until DVT risk is diminished -Prevention of ischemic complications in unstable angina/non-Q-wave MI: SUBCUT/IV 1 mg/kg q12h until stable with Aspirin 100-325 mg daily Side Effects: Fever, confusion, nausea, BLEEDING Nursing Implications: - Assess blood studies - PTT or APTT (not PT). -Assess for bleeding - bruising, petechiae -Assess for neurologic symptoms -Don't give the shot where their clothing's waistband will rub.

Classification: Laxative, emollient; stool softener Action: Increases water, fat penetration in intestine; allows for easier passage of stool What does that mean: it pulls water into the large intestine, making stools softer. Use: Prevention of dry, hard stools Dosage: PO 50-300 mg daily Side Effects: bitter taste, nausea, anorexia, cramps, diarrhea Nursing Implications: -assess cause of constipation -assess cramping, rectal bleeding, N&V= discontinue if these Sx occur - If you can't tell why your patient is on DSS, think "prophylactic". Have they had an MI, stroke, recent cardiac surgery? Patients are often given DSS because we don't want them to "bear down" while evacuating. Bearing down rapidly lowers the blood pressure to dangerous levels. You may hear this called "vagaling" or "Valsalva manuever". DSS makes it so that the patient does not have to bear down when evacuating.

Classification: H2-histamine receptor antagnoist Action: competitively inhibits histamine at histamine H2-receptor site, decreasing gastric secretion while pepsin remains at a stable level What does that mean: GI histamine 2 receptors stimulate the GI parietal cells to produce more acid into the GI lumen. Less stimulation = less acid secretions. Use: Short-term Tx of active duodenal ulcer, maintenance therapy for duodenal ulcer; GERD, heartburn Dosage: -Active ulcer: PO 40 mg daily at bedtime x 4-8 wks, then 20 mg daily at bedtime if needed -Heartburn relief/prevention: PO 10 mg with water or 1 hr before eating Side Effects: headache, dizziness, constipation, N&V Nursing Implications: -assess for epigastric pain, abdominal pain, frank or occult blood in emesis, stools -assess for bleeding, hematuria, hematuresis, occult blood in stools; abdominal pain - Can reduce the effects of Digoxin

Classification: Hematinic Action: replaces iron stores needed for RBC development, energy and O2 transport, utilization; sulfate contains 20% Use: Iron deficiency anemia, prophylaxis for iron deficiency in pregnancy Dosage: PO 0.75-1.5 g/day in divided doses tid Side Effects: Nausea, constipation, epigastric pain, black and red tarry stools Nursing Implications: -Do not take antacids within 2 hours; may color stool black -Do not crush/chew -Do not give via feed tube -Assess elimination

Classification: Anticoagulant, antithrombotic Action: prevents conversion of fibrinogen to fibrin and prothrombin to thrombin Use: Prevent DVT, pulmonary emboli, MI, open heart surgery, a fib Dosage: -DVT/MI: IV BOL 5000-7000 unites q4hr then titrated to PTT or ACT level; IV INF after bolus dose, then 1000 units/hr titrated to PTT or ACT level -Anticoagulation: SUBCUT 5000 units IV then 10,000-20,000 units, then 8000-10,000 units q8hr or 15,000-20,000 units q12hr Side Effects: fever, chills, HA, rash, hematuria, hemorrhage, anemia Nursing Implications: -Assess blood studies - PTT, platelet count Assess for bleeding - bruising, petechiae

Classification: loop diuretic Action: inhibits reabsorption of sodium and chloride at proximal and distal tubule and in loop of henle Use: pulmonary edema; edema in CHF, hepatic disease. nephrotic syndrome, ascites, HTN Dosage: -Edema: PO 20-80 mg/day in AM; may give another dose in 6 hr up to 600mg/day; IM/IV 20-40 mg -Acute Pulmonary Edema: IV 40 mg given over several min, repeated in 1 hr; increase to 80mg if needed -Hypertensive crisis/ARF: IV 100-200 mg over 1-2 min Side Effects: headache, fatigue, weakness, orthostatic hypotension, chest pain, hypokalemia, hyperglycemia, nausea Nursing Implications: -assess signs of metabolic alkalosis: drowsiness, restlessness -assess signs of hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness - Check their last few K+ labs! Check renal function labs - BUN, creatinine -By pulling water (and the electrolytes that follow it) out of the blood stream, diuretics automatically increase the concentration (but not the amount) of blood cells. Check the H&H, -Are they also on an osmcotic diuretic too (Albumin, Mannitol)? 2 different MOA's - Osmotic diuretics pull water from the cells and into the bloodstream. Lasix is then used to pull that water out of the bloodstream and into the kidneys where it can be urinated out. If your patient is "third-spacing" you will see this.

Classification: Thiazide diuretic, antihypertensive Action:acts on distal tubule and ascending loop of Henle by increasing excretion of water, sodium, chloride, potassium What does that mean: it makes you urinate out water and electrolytes. Use: Edema, HTN, diuresis, CHF Dosage: PO 12.5-100 mg/day Side Effects: Dizziness, fatigue, weakness, hypokalemia Nursing Implications: -assess weight, I&O, respirations, BP, electrolytes -assess signs of hypokalemia -increase fluid intake to 2-3L/day unless contraindicated -Check labs for kidney function - BUN, creatinine -HCTZ is slower and longer acting than Lasix -Similar to Sulfa drugs. Check for Sulfa drug allergies

Classification: antidiabetic, pancreatic hormone Action: decreases blood glucose, transport glucose into cells and converts glucose to glycogen Use: type 1 DM, type 2 DM Dosage: SLIDING SCALE Side Effects: blurred vision, dry mouth, flushing, hypoglycemia Nursing Implications: Regular: Onset- 30 min; Peak- 2.5-5hr; Duration- up to 6 hrs -Assess fasting blood glucose -Assess for hypoglycemic reactions that can occur during peak time (sweating, weakness, dizziness, chills, confusion, HA, nausea, rapid weak pulse, fatigue, tachycardia, memory lapse) -Assess for hyperglycemia: acetone breath, polyuria, fatigue, polydipsia, dry skin, lethargy -"Hot and Dry, sugar high. Cold and clammy, need some candy."

Classification: antidiabetic (long acting) Action: transports glucose into the cell. Also transports potassium into cells. Use: to decrease blood glucose over the long term (24 hours). Lantus regulates the basal metabolism of glucose. However, since meals produce a spike in blood sugar, we use regular or rapid acting insulin on a sliding scale at meal time to stabilize the mealtime spikes in blood sugar. Dosage: depends on the patient's basal metabolism of glucose. Remember that Lantus works SLOWLY. It has no peak. but it will start acting about 2 hours after administration and stay in their system for around 24 hours. So it's unlikely that a patient will crash right after you give them Lantus. But giving them Lantus when their blood sugar is decreasing rapidly will exacerbate their problem and make it harder to bring them back should they crash. This is why you want to look at 3-4 previous blood sugar values before giving Lantus. Side Effects: Since insulin lowers blood sugar and moves potassium into the cells, watch out for S/S of hypoglycemia and hypokalemia. Hypoglycemia : Remember - "Hot and Dry - sugar high. Cold and clammy - need some candy". Hypokalemic symptoms: Since potassium affects neuromuscular discharge, low potassium inhibits the cells from firing repeatedly. Look for muscle weakness, muscle aches, and muscle cramps. Plus, always check their last Potassium lab value - someone will invariably ask you on 5W. Nursing Implications: -Never mix Lantus with another kind of Insulin. -Know their last 3-4 blood sugar values. Do they go high at night? Are their blood sugars low in the morning? Are they anxious? Are they eating? Are they dehydrated? Do they think hospital food is so bad they wouldn't feed it to their dog? Are they on potassium supplements, steroids, TPN, or diuretics? These will all affect blood sugar. And they are all clues that will tell you how well their blood sugar is managed.

Classification: antidiabetic (fast) Action: transports glucose (and K+) into cells Use: to decrease blood glucose from meals or sudden acute elevations. Unike Lantus or regular insulin, rapid acting insulins take effect almost immediately (10-30 mins), peak 1-3 hrs and are out of the system in 3-5 hrs. This is why it's used to control sudden spikes in blood glucose. Dosage: usually sliding scale according to pre-meal blood glucose level Side effects: watch out forsudden S/S of hypoglycemia and hypokalemia. Hypoglycemia - LOC changes, cold an clammy skin, tachycardia. Hypokalemic symptoms: Since potassium affects neuromuscular discharge, low potassium inhibits the cells from firing repeatedly. Look for muscle weakness, muscle aches, and muscle cramps. Plus, always check their last Potassium lab value - someone will invariably ask you on 5W. Nursing Implications: -Know their last 3-4 BSFS values. - If giving at mealtime, wait until they have food in front of them. What if you give the insulin and then breakfast is late? This is a problem you don't want to have. -If drawing up 2 different insulins into one syringe - draw the short acting insulin 1st! The idea is to keep the NPH out of the rapid acting insulin vial. "Draw clear before cloudy".

Classification: antianginal, vasodilator Action: relaxation of vascular smooth muscle, decreased preload and afterload, reduce cardiac O2 demand Use: Tx, prevention of chronic stable angina pectoris, diffuse esophageal spasm Dosage: PO initiate at 30-60 mg/day as a single dose, increase q3 days as needed, may increase to 120mg/day, max 240 mg/day Side Effects: vascular HA, flushing, weakness, dizziness, faintness, sweating, postural hypotension Nursing Implications: -assess pain -assess BP, pulse, respiration -assess tolerance if taken over long period

Classification: Thyroid hormone Action: Increases metabolic rate, controls protein synthesis, increases cardiac output, renal blood flow, O2 consumption, body temp, blood volume, growth, development at cellular level, exact mechanism unknown Use: Hypothyroidism, myxedema coma, thyroid hormone replacement, thyrotoxicosis, congenital hypothyroidism, some types of thyroid cancer Dosage: - Severe Hypothyroidism: PO 50 mcg/day, increase by 25 mcg/day every 6-8 wk, average dose 100-200 mcg/day; max 200 mcg/day; IM/IV: 50-100 mcg/day as a single dose of 50% or usual oral dosage -Myxedema coma: IV 200-500 mcg, may increase by 100-300 mcg after 24 hr, place on oral medication as soon as possible Side Effects: anxiety, insomnia, tremors, tachycardia, palpitations, angina, dysrhythmias Nursing Implications: -Assess BP, pulse periodically during treatment, daily weight -Assess cardiac status: angina, palpitation, chest pain, change in VS -Don't take at the same time as calcium supplements -May initially make blood glucose levels spike from shifting thyroid hormone levels.

Classification: Antihypertensive, angiotensin-converting enzyme Action: Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE, preventing conversion of angiotensin 1 to angiotensin II What does that mean: since the cycle stops at angiotensin2, aldosterone (ADH) never gets produced, water gets excreted, and BP decreases. Use: Mild - mod HTN, adjunctive therapy of systolic CHF, acute MI Dosage: HTN: adults PO 10-40 mg/day ; geriatric PO 2.5-5 mg/day CHF: adults PO 5 mg initially with diuretics/digoxin, range 5-40 mg Side Effects: vertigo, fatigue, N&V, depression Nursing Implications: -assess blood studies -assess pulss/apical/pedal -assess edema in feet, legs, daily; weight daily -assess skin turgor -Lisinopril is different from other ACE inhibitors in 3 ways - it's hydrophilic. It has a long half life. It's not metabolized by the liver. It's excreted unchanged, in the urine. Does your patient have liver failure? Electrolyte imbalances? Are they on diuretics (HCTZ)? Interesting Factoids: like other ACE inhibitors, Lisinopril comes from Brazilian Pit viper venom.

Classification: Antidiabetic, oral Action: inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin Use: Type 2 diabetes mellitus Dosage: PO 500 mg bid initially then increase to desired response 1-2 g Side Effects: Headache, weakness, hypoglycemia, n&v Nursing Implications: -Assess for hypoglycemic reactions -Assess CBC -Can hide certain cardiac conditions

Classification: Cholinergic, antiemetic Action:Enhances response to acetylcholine of tissue in upper GI tract, which causes contraction of gastric muscle; relaxes pyloric, duodenal segments; increases peristalsis without stimulating secretions, blocks dopamine in chemoreceptor trigger zone of CNS Use: Prevention of nausea, vomiting induced by chemotherapy, radiation, delayed gastric emptying, gastroesophageal reflux Dosage: -Gastroesophageal Reflux: PO 10-15mg qid 30 min before meals -N&V: IV 1-2mg/kg 30 min before administration of chemotherapy, then q2hr x 2 doses, then q3hr X 3 doses Side Effects: Sedation, fatigue, restlessness, HA, drowsiness, hypotension, constipation Nursing Implications: -assess mental status: depression, anxiety, irritability -Assess GI complaints: N&V, anorexia, constipation

Classification: antihypertensive, antianginal Action: lowers BP by β blocking effects; reduces elevated rennin plasma levels; blocks β 2 adrenergic receptors in bronchial, vascular smooth muscle only at high doses, negative chronotropic effect Use: Mild-mod HTN, acute MI to reduce cardiovascular morality, angina pectoris, NYHA class II, III heart failure Dosage: -HTN: PO 50 mg bid, or 100 mg/day, may give up to 200-450 mg in divided doses; ext rel give daily -MI: IV Bol 5 mg q2min x 3, then 50 mg PO 15 min after last dose and q6hr x 48 hr Side Effects: insomnia, dizziness, hypotension, N&V, headache Nursing Implications: -Assess ECG directly when giving IV during initial treatment -Assess I&O, daily weight, BP, apical/radial pulse

Classification: multiple vitamins Action: needed for adequate metabolism Use: prevention and treatment of vitamin deficiencies Dosage: PO/IV depends on brand Side Effects: none known at recommended dosage Nursing Implications: -assess vitamin deficiency

Classification: Proton Pump Inhibitor Action: suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks final step of acid production What does that mean: it keeps the gastric parietal cells from secreting H+ ions (protons) which then makes the GI secretions less acidic. Use: GERD, severe erosive esophagitis, maintenance, long-term pathologic hypersecretory conditions Dosage: -GERD: PO 40 mg/day x 8 weeks -Duodenal ulcer/gastric ulcer/ NSAID ulcer prophylaxis: PO 40 mg/day Side Effects: HA, diarrhea, abdomen pain, rash Nursing Implications: -assess GI system -assess hepatic studies

Classification: Electrolyte, mineral replacement Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance Use: Prevention and treatment of hypokalemia Dosage: PO 40-100 mEq in divided doses tid-qid; IV 20 mEq/hr when diluted as 40 mEq/1000ml, not to exceed 150 mEq/day Side Effects: Confusion, bradycardia, N&V, cramps, diarrhea, dysrhythmias Nursing Implications: -Assess ECG for peaking T waves, lowered R, depressed RST, prolonged P-R interval, widening QRS complex, hyperkalemia; product should be reduced or discontinued -Assess potassium level during treatment - S/S hypokalemia - hypotension, flaccid muscles, tachycardia -S/S hyperkalemia - N/V, tremors and twitches, bradycardia -Are they on drugs that effect K+? insulin? Diuretics? Steroids? -Remember K+ is absorbed in GI tract, stored in muscle cells and liver, and excreted in the urine. Any alteration to these systems can affect K+ values. - So if they're hypokalemic, it can be because 1. they aren't eating or 2. they're losing it - diuretics, N/V/D, burn injuries. -Just like glucose, insulin moves K+ into cells, too.

Classification: Potassium-sparing diuretic Action: Competes with aldosterone at receptor sites in distal tubule, resulting in excretion of sodium chloride, water, retention of potassium, phosphate Use: Edema of CHF, HTN, diuretic-induced hypokalemia, primary-hyperalodsteronism, edema of nephritic syndrome, cirrhosis of the liver with ascites Dosage: -Edema/HTN: PO 25-200 mg/day in 1-2 divided doses -CHF: PO 12.5-25 mg/day; max 50mg/day Side Effects: HA, confusion, drowsiness, diarrhea, cramps Nursing Implications: -assess electrolytes: Na, Cl, K, BUN, seruyn creatinine, ABGs, CNC, signs of hyperkalemia -S/S hyperkalemia - N/V, tremors and twitches, bradycardia - S/S hypokalemia - hypotension, flaccid muscles, tachycardia -Assess weight, I&O daily

Classification: Selective α1-peripheral adrenergic blocker Action: Binds preferentially to α1A-adrernoreceptor subtype located mainly in the prostate What does that mean: it relaxes the detrussor muscle (in men and women) enabling easier urination. Use: Symptoms of benign prostatic hyperplasia (BPH) Dosage: PO 0.4 mg/day, increasing up to 0.8 mg/day if required Side Effects: hot flashes, HA, light headedness, N&V, rash Nursing Implications: -Assess CBC, bleeding, effects of alopecia on body image -Assess for uterine malignancies -Assess for symptoms indicating severe allergic reactions - Can be prescribed in women too if there's an obstruction (like calculi)

Classification: Antihypertensive Action:Blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II What does that mean: It keep blood vessels from narrowing and lowers blood pressure. Use: HTN, alone or in combination, CHF Dosage: -HTN: PO 80-160 mg/day alone or in combination with other antihypertensives, may increase to 320 mg -CHF: PO 40 mg bid, up to 160 mg bid Side Effects: Dizziness, insomnia, diarrhea, dysrhythmias, anemia, cough Nursing Implications:-assess BP, pulse q4h, blood studies, electrolytes, edema in legs, skin turgor

Classification: osmotic diuretic Action: pulls water out of the cells and into the bloodstream via osmotic pressure gradient Use: edema. reduce ICP. Does your patient have edema, yet their vials signs suggest they're hypovolemic? (decreased BP and urine output). Why? They're hiding that water in their cells. That's why they're getting mannitol. Dosage: it's an IV med. As a student, you won't be giving, it. But it will affect the other drugs, labs, and make your patient ask for water incessantly. So know it. Side Effects: if fluid comes out of cells and into bloodstream, but then isn't excreted, what happens? Edema, hypertension, HA, LOC changes, electrolyte imbalances, dehydration. Nursing Implications:

Classification: "statin", antilipidemic Action: inhibits biosynthesis of VLDV, LDL, which are develop cholesterol by inhibiting the HMG-CoA reductase enzyme. Statins lower total cholesterol, LDL cholesterol, and triglycerides. They also raise HDL cholesterol. What does that mean: it inhibits an enzyme that makes cholesterol - hereby reducing cholesterol in the blood. Use: hyperlipidemia, atherosclerosis and prophylactically in lipid conditions exacerbated by diabetes. Dosage: po 40-80mg/day qhs Side Effects: HA, N/V/D, muscle pain, abnormal liver tests. Nursing Implications: -Check ALT - ALT gets released into blood when there's liver damage (norm 7-56u/L). -Check liver function tests - albumin, GGT, -Check C-reactive Protein test. A high value means an inflammatory response. Just like inflammation and secretions can block an airway, inflamed blood vessels and cholesterol deposits can block arteries, leading to an MI. -contraindicated in liver disease, severe infections. -Use cautiously with alcoholics

Classification: aminoglycoside antibiotic Action: binds to the ribosome causing protein mis-synthesis and eventual cell death. What does that mean: it kills bacteria. Use: severe infections Dosage: IV - so as a student you won't be giving it. But you will most likely be giving drugs to minimize it's side effects. Side Effects: it is neurotoxic, hepatotoxic, nephrotoxic and hematotoxic Nursing Implications: -Ask patient about allergies to other antibiotics. Especially "-mycins" like streptomycin. -Your patient will probably be on drugs to minimize Gentamicin's side effects - protonix for GI distress, etc -Not effective against anaerobic bacteria -Monitor LFT for hepatotoxicity (i.e. -normal ALT=7-56u/L) -Monitor kidney function labs - BUN, creatinine, urine output. -Monitor CBC - H&H, WBCs, platelets, neutrophils, eosinophils

Classification: Lipid-lowering agent, Vitamin Action: Decrease lipoprotein and triglyceride synthesis by inhibiting release of free fatty acids from adipose tissue and decrease hepatic lipoprotein synthesis. (decrease blood lipids and lower cholesterol) What does it mean?: To lower cholesterol and blood lipids. Used in combination with a healthy diet to lower bad cholesterol and increase good cholesterol. This medicine is also used to decrease triglycerides. If triglycerides are too high, you may be at risk of developing pancreatitis. This is a painful condition that causes inflammation of the pancreas and can lead to serious health problems. This medicine can also be helpful in patients who have heart disease or who have had a heart attack. SE: Pruritus, orthostatic hypotension, GI upset and hepatotoxicity. Nursing Implications: Take with meal to prevent GI irritation. Check for AST, ALT.

Classification: Androgen inhibitor Action: 5-alpha-dihydrotestosterone is partially responsible for prostatic hyperplasia. Prophylactic use for prostate cancer. What does it mean?: Prophylatic use for prostate cancer or reduced prostate size. SE: decreased libido, decreased volume of ejaculate, erectile dysfunction. Nsg Imp: Assess for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, interruption of urinary stream)

Classification: Blood viscosity reducing agent Action: Increases the flexibility of RBCs & increases blood flow. What does it mean?: To increase blood flow and to thicken blood. This medicine helps to decrease pain, discomfort, or cramps from having poor circulation in legs. SE: agitation, chest pain (fast/irregular heartbeat), flushing, seizures, dizziness/drowsiness, HA, n/v, indigestion Nsg imp: Take w/ meals to prevent GI upset. Monitor BP periodically in pts on concurrent antihtn therapy.

Classification: Anti-infectives, anticuler agent Action: broad spectrum bactericidal action Tx: Skin and skin structure infections, Otitis media, Sinusitis, Respiratory infections, Genitourinary infections. Endocarditis prophylaxis. Prophylaxis for UTI. SE: seizure, n/v/d, renal impairement Nsg Imp: observe for s/s/ of anaphylaxis, obtain specimens for culture & sensitivity prior to therapy

Classificiation: Antihyperlipidemic Action: inhibit peripheral lipolysis & LDL What does it mean?: can help lower blood fats and cholesterol for people who are at risk of getting inflammation of the pancreas (pancreatitis) from having very high amounts of fats in their blood. This medicine is only for patients whose blood fats are not controlled by diet. SE: n/v, seizure, muscle pain, stomach pain, pain/difficulty passing urine Nsg Imp: take 30 min. before meals, instruct pt to report unusual bruises, bleeding or muscle pain.

Classification: Antiasthmatic, short-acting corticosteroid Action: Suppresses inflammation & normal immune response. Replacement therapy for adrenal insufficiency. What does it mean?: It is commonly used to treat inflammation of the skin, joints, lungs, and other organs. Common conditions treated include asthma, allergies, and arthritis. It is also used for other conditions, such as blood disorders and diseases of the adrenal glands. SE: peptic ulcer, htn, a/n, decrease wound healing Nsg Imp: monitor creatinine, I&O, daily weight, & BP.

Classification: mineral & electrolyte replacement/supplements Action: Essential for nervous, muscular, & skeletal systems. Maintains cell membrane & capillary premeability. Acts as an activator in trasnamission of nerve impules and contraction of ardiac, skeletal, & smooth muscle. Esential for bone formation & blood coagulation. Replacement of calcium in deficiency states. What does it mean?: It is used as an antacid to relieve the symptoms of indigestion and heartburn. It is also used to prevent osteoporosis, as a calcium supplement, and to treat high phosphate levels in patients with kidney disease. SE: confusion/irritability, constipation, flatus; a/n/v, unusally weak/tired. Nsg Imp: monitor Ca+ levels.

Classification: 3rd generation cephalosporin; anti-infective Action: binds to bacteria cell wall membrane, causing cell death. Spectrum is silimilar to that of 2nd generation, but activity against staph is less and activity against gram-neg pathogens is greater even for organisms resistant to 1st & 2nd generation agents. Addtl Txment: Txment for COPD. COPD incr risk of respiratory tract infections making it more difficult to breathe therefore producing further irreversible lung drainage. COPD incr HTN. SE: d/n/v, rash, pain, seizures, HA Nsg Imp: assess for infection, obtain hx of allergies, obtain specimens for culture & sensitivity before initiating therapy. monitor bowel fx.

Classification: Bronchodilator Action: Relaxes airway smooth muscle with subsequent bronchodilation. What does it mean?: It helps open up the airways in your lungs to make it easier to breathe. It's used to tx & prevent bronchospasm. SE: nervousness, restlessness, tremors, chest pain, palipitations Teaching: excess use can lead to paradoxical bronchospasm (wheezing) Nsg Imp: assess lung sounds, pulse, & bp before admin & during peak of meds. Note amt, color, & character of sputum produced.

Classification: Laxative Action: Active components of senna alter water & electrolyte transport in large intestine resulting in accumulation of water & increased peristalsis. What does it mean?: It relieves constipation. May be used to empty & prepare bowel for surgery or examination. SE: cramping, d/n, pink-red or brown-black discoloration of urine, F&E imbalance Nsg imp: admin at bedtime & on on empty stomach for more rapid results. Shake oral suspension before administer making sure granulates are fully dissolved.

Classification: antianginals, antihypertensive; calcium channel blocker Action: inhibits calcium transport into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction couping and subsequent contraction. Systemic vasodilation, resulting in decr BP. Coronary vasodilation, resulting in decr freq & severity of attacks of angina What does it mean?: It affects the amount of calcium found in your heart and muscle cells. This relaxes your blood vessels, which can reduce the amount of work the heart has to do. This medicine is used to treat chest pain caused by angina. SE: HA, abnml dreams, anxiety, peripheral edema, flushing Nsg Imp: assess fall risks; assess for dig tox if pt is taking concurrently w/ digoxin. monitor I&Os, asess for sings of CHF (edema, rales/crackles, dyspnea, JVD)

Classification: antihistamine Action: helps to relieve sneezing, runny nose, & itchy, watery eyes. Used to tx sxs of indoor/outdoor allergies. Used to tx itchy skin rash & hives SE: confusion, blurred vision,d ry mouth, GI upset, rash Nsg imp: assess allergy sxs (rhinitis, conjunctivitis, hives), assess lung sounds & character of bronchial secretions, maintain fluid intake 1500-2000 L/day

Classification: antigout agent, antihyperuricemics Action: reduces the amount of uric acid that body makes. Used to tx sxs of gout. Used to tx/prevent high uric acid levels that occur as a result of certain types of chemotherapy. Helps pt who frequently have kidney stones SE: rash, HF, renal failure Ngs: pt must be hydrated, monitor I&O, asses joint pain & swelling. May be taken w/ NSAID for acut attacks. Check labs for uric acid

Classification: fat-soluble vitamin Action: A man-made form of vitamin D. It helps the body have the right amt of calcium & phosphorus. It's needed for strong bones & teeth. Used in pts w/ chronic renal failure SE: dizziness, malaise, dyspnea Nsg imp: assess for bone pain & wekaness, asses for evidence of hypocalcemia (paresthesia, muscle twitching)

Classification: Anticoagulant Action: Prophylaxis & txment of venous thrombsis, pulmonary embolism, atrial fibrillation w/ embolization. Management of MI, decr risk of subsequent MI. Prevents thrombus formation and embolization. SE: cramps, n, dermal necrosis, bleeding

Classification: anticonvulsant, antiepileptic Action: decreases incidence & severity of seizures SE: suicidal thoughts, dizziness, coordination difficulties Nsg imp: assess location, duration, & characteristic of seizure activity, assess for CNS adverse effects Labs: may decr RBC & WBC & abnml liver fx tests