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Antihypertensives ✔✔These drugs affect both the blood pressure and the rhythm of the heart. Monitor patient blood pressure. Orthostatic hypotension is a common side effect.
- Betablockers
- Alpha 1 Blockers
- Calcium Channel blockers
- ACE Inhibitors
- ARB Inhibitors
- Diuretics Betablockers ✔✔Usually end in -olol. Propranolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor) What additional effects of betablockers should the nurse monitor? ✔✔The nurse should monitor for broncho constriction and bronchospasms due to beta- 2 adrenergic blocking mechanisms.
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In what population should betablockers be used cautiously in? ✔✔Betablockers should be used cautiously in patients who suffer from asthma. Beta blockers can mask tachycardia in patients suffering from hypovolemia and hypoglycemic symptoms seen in diabetic patients. What affects do betablockers cause? ✔✔Therapeutic effects include decreasing blood pressure and heart rate. Alpha 1 blocker ✔✔Clonidine (Catapres) What affects do alpha 1 blockers cause? ✔✔They cause systemic vasodilation by directly acting on smooth muscle of arteries. What adverse effects can alpha 1 blockers cause? ✔✔Hypotension, dizziness, sedation. In what form are alpha 1 blockers usually administered? ✔✔Alpha 1 blockers are generally administered as a patch and are changed once a week. Calcium Channel Blockers ✔✔Verapamil (Calan) Dilitiazem (Cardizem) Amlodipine (Norvasc)
What should the nurse monitor for in patients receiving ACE Inhibitors? ✔✔The nurse should monitor the patient's renal function. Angioedema ✔✔A hypersensitivity reaction of the dermis, mucosa, and submucosa tissues resulting in life threatening airway obstruction. Epinephrine is treatment of choice. ARB Inhibitor ✔✔Usually end in -artan. Losartan (Cozaar) Valsartan (Diovan) Irbesartan (Avapro) How do ARB Inhibitors work? ✔✔These work by blocking angiotensin II receptors in the angiotensin loop. What should the nurse monitor in a patient receiving ARB Inhibitors? ✔✔The nurse should monitor potassium levels and renal function. What adverse effect may occur from ARB Inhibitors? ✔✔Angioedema can occur.
Diuretics ✔✔These are used for both antihypertensive effects and to control edema. What should the nurse monitor in a patient receiving diuretics? ✔✔The nurse should monitor electrolytes, dehydration, orthostatic hypotension, digoxin and lithium toxicity, hyperglycemia. In what type of patient should diuretics be used cautiously? ✔✔Diuretics should be used with caution in patients with renal impairment. Thiazide Diuretics ✔✔Hydrochlorothiazide (HCTZ) Loop Diuretics ✔✔Furosemide (Lasix) Bumetanide (Bumex) What should the nurse monitor in patients receiving loop diuretics? ✔✔The nurse should monitor for signs of hypotension, ototoxicity, and potassium depletion. What allergy should the nurse check for in a patient receiving loop diuretics? ✔✔The nurse should ask the patient if they are allergic to sulfa based medications. Potassium-Sparing Diuretics ✔✔Spironolactone (Aldactone) What are potassium-sparing diuretics used for? ✔✔They are used to treat edema.
Digoxin (Lanoxin) is used to treat chronic heart failure, a-fib, and paroxysmal atrial tachycardia. What is the digoxin therapeutic level? ✔✔Therapeutic level of digoxin is 0.5 - 2 ng/mL. What are the signs and symptoms of digoxin toxicity? ✔✔Signs of toxicity include abdominal pain, anorexia, nausea, vomiting, visual disturbances, and bradycardia. What must the nurse do before administering digoxin? ✔✔The nurse must take the patient's apical heart rate. When would a nurse hold administering digoxin? ✔✔If the patient's apical HR is below 60 or above 100. What should the nurse monitor in a patient receiving digoxin? ✔✔The nurse should monitor the patient's potassium level. A decrease in potassium precipitates digoxin toxicity. What is given if the patient is suffering from digoxin toxicity? ✔✔The patient receives digoxin immune fab (Digibind) to bind to reduce circulating digoxin. What are nitrates used for? ✔✔They are used to decrease angina pain.
Nitrates ✔✔Nitroglycerin What route can nitroglycerin be given? ✔✔Nitro can be given in tablets, patches, paste, or IV. When would a patient take nitroglycerin? ✔✔A patient experiencing angina, MI (given IV), or suffering from chronic heart failure. How do nitrates work? ✔✔Nitrates lower blood pressure which improves blood flow to the myocardium. When a patient is having an angina episode, what is the protocol for taking sublingual nitroglycerin? ✔✔The patient should take one tab under the tongue every 5 minutes up to three times. If no relief is acquired, they should immediately call 911 and get transported to the ER. What should the nurse monitor in patients receiving nitrates? ✔✔The nurse should monitor for hypotension, headache, and rebound tachycardia due to vasodilation. What teaching should the nurse include in patients taking cardiac medications? ✔✔Education should include having the patients changing position slowly, reporting facial swelling, dyspnea, dizziness, signs of digoxin toxicity, weight loss or gain, and change in mental status.
What are the adverse effects of heparin? ✔✔Adverse effects include bleeding, anemia, and thrombocytopenia. What should the nurse monitor in patients receiving heparin? ✔✔The nurse should monitor the patients aPTT or PTT and hematocrit. What is the antidote of heparin? ✔✔The antidote of heparin is protamine sulfate. What is enoxaparin (Lovenox)? ✔✔Enoxaparin is a low molecular weight heparin. It is similar to heparin but has a longer half-life and causes less thrombocytopenia. What are the indications for warfarin? ✔✔Indications include venous thrombus, pulmonary embolism, MI, A-fib, and prosthetic valve replacement. What are the therapeutic levels of warfarin? ✔✔Therapeutic blood levels change depending on treatment. DVT: INR 1.5-2. A-Fib: INR 2.0-3. Valve: INR 2.5-3.
What are the adverse effects of warfarin? ✔✔Adverse effects of warfarin are excessive bleeding. What should the nurse monitor in patients receiving warfarin? ✔✔The nurse should monitor protime (PT) and INR. What is the antidote to warfarin? ✔✔The antidote for warfarin is vitamin K. Hyperlipidemics ✔✔Usually end in -statin. Atorvastatin (Lipitor) Simvastatin (Zocor) Lovastatin (Mevacor) These medications lower cholesterol levels. What food should patients receiving hyperlipidemics avoid? ✔✔Patients should avoid eating or drinking food or drinks with grapefruit as it can decrease metabolism. What should the nurse monitor in patients receiving hyperlipidemics? ✔✔The nurse should monitor for muscle pain (myalgia) and rhabdomyolysis. They should also check LFTs before and during therapy.
Regular Insulin ✔✔Humulin R How long does it take for humulin R to peak? ✔✔It takes about 2 to 4 hours for humulin R to peak. NPH Insulin ✔✔Humulin N How long does it take for humulin N to peak? ✔✔It takes about 6 to 12 hours for humulin N to peak. Long Acting Insulin ✔✔Glargine (Lantus) How often is glargine given? ✔✔Glargine is given once a day. This insulin lasts for 24 hours. What are the signs and symptoms of hypoglycemia? ✔✔Signs of hypoglycemia include cool, clammy, confused, weakness, palpitations, and hunger. What are the signs and symptoms of hyperglycemia? ✔✔Signs of hyperglycemia include dry, flushed skin, polyuria, and polydipsia.
What should the nurse monitor and teach the patient about? ✔✔The nurse should monitor and teach the patient about blood glucose monitoring. What is the antidote to hypoglycemia? ✔✔The patient should take a CHO tab under the tongue or eat something sugary. The patient can also receive dextrose 50% IV or glucagon IM. Oral Hypoglycemics ✔✔Metformin (Glucophage) Glipizide (Glucotrol) Glyburide (Micronase) What are the adverse effects of oral hypoglycemics? ✔✔Common GI adverse effects include diarrhea and bloating. Other effects include liver dysfunction, photosensitivity, hypoglycemia, and aplastic anemia. What allergies should the nurse assess for prior to administering oral hypoglycemic? ✔✔The nurse should ask if the patient has any allergies to sulfonamides. What should the nurse monitor when administering oral hypoglycemic? ✔✔The nurse should monitor CBC and Hg A1C.
What are the adverse effects of glucocorticoids? ✔✔Adverse effects affect nearly every organ system. Glucocorticoids can cause hyperglycemia, poor wound healing, decreased immune function, increased risk of infection, osteoporosis, emotional labiality, and sodium and water retention. Can glucocorticoids be stopped abruptly? ✔✔No, glucocorticoid treatment needs to be tapered off prior to discontinuing. Inhaled Glucocorticoids ✔✔Albuterol (beta 2 agonist adrenergic) Proventil (Salbutamol) Ipratropium (Atrovent) What should the nurse teach the patient after taking inhaled glucocorticoids? ✔✔The nurse should teach the patient to rinse their mouth after each use to reduce risk for candidiasis. In addition, they should dry the chamber after each use. What should the nurse monitor in a patient receiving Proventil? ✔✔The nurse should monitor for increased heart rate and tremors. How does ipratropium work as a respiratory agent? ✔✔Ipratropium relaxes bronchial smooth muscle. It is slower acting than albuterol and does not produce tachycardia.
Antihistamines ✔✔Diphenhydramine (Benadryl) What is diphenhydramine used for? ✔✔It is used to treat anaphylaxis, seasonal allergies, and allergic skin rashes. It is also used as a mild sleep sedative and for motion sickness. What should the nurse monitor for in a patient taking diphenhydramine? ✔✔The nurse should monitor for drowsiness, anorexia, and dry mouth. It may cause paradoxical excitation in children and falls in the elderly from lingering central nervous system effects Cough and Cold Preparations ✔✔Dextromethorphan: antitussive Guafenesin: expectorant Pseudoephedrine: decongestant Antitussive ✔✔A type of medication used to relieve coughing. Expectorant ✔✔A type of medication used to help remove mucous from airways. Decongestant ✔✔Reduces nasal congestion and swelling.
How long are antituberculosis medications used for? ✔✔These medications are used in combination for 12 to 18 months. Bacteriostatic/Bactericidal Medications ✔✔Gentamycin (Garamycin) Vancomycin (Vancocin) Metronidazole (Flagyl) Ampicillin/clavulanate (Augmentin) Azithromycin (Zithromax) Cefazolin (Ancef) Cephalexin (Keflex) Erythromycin (E-Mycin) Levofloxacin (Levaquin) Penicillin V (Pen-Vee-K) Trimethorpim/sulfamethoxazole (Bactrim) Tetracycline (Tetracap) What are general adverse effects of antibiotics? ✔✔Antibiotic use can result in bacterial overgrowth resulting in yeast infections or GI disturbances. What can occur when antibiotics are administered too rapidly? ✔✔Rapid administration of antibiotics can increase risk of hypotension.
What adverse effects do gentamycin and vancomycin have? ✔✔They are nephrotoxic and ototoxic. The nurse should monitor for ringing of the ears. What adverse effects can metronidazole have? ✔✔Adverse effects include seizures. The patient should avoid alcohol. What adverse effects does tetracycline have? ✔✔Patients should avoid sun exposure due to increased photosensitivity. Antiseizure Medications ✔✔Divalproex (Depakote): Bipolar disorder Phenytoin (Dilantin) Gabapentin (Neurontin): neuropathic pain treatment Carbamazepine (Tegretol) Diazepam (Valium): status epilepticus What should the nurse monitor in patients taking antiseizure medications? ✔✔The nurse should monitor for confusion, drowsiness, and ataxia. The nurse should monitor carbamazepine and phenytoin levels and CBC for toxicity or aplastic anemia and agranulocytosis.
