Drugs Flashcards
1
Q
Paracetamol
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Analgesic
Generic names: Panadol, PanadolOsteo, Panamax, Dymadon
Indication:
- mild to moderate pain
- fever reduction
Key mechanism of action:
- inhibits prostaglandin synthesis in the CNS
Prostaglandins control inflammation, blood flow and blood clot formation
- antipyretic in the same way it reduces inflammation
- Prostaglandins inhibit endogenous pain control mechanisms by blocking transmission at spinal noradrenergic synapses.
2x adverse effects:
- dyspepsia (intergestion)
- renal disfunction
- liver failure
- nausea and vomiting
Major nursing considerations:
- as it is metabolised by the liver caution use in patient with chronic liver disease= can result in hepatotoxicity
- caution use in patient with alcohol dependance as as their livers are already compromised.
2
Q
Ibuprofen
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Analgesic
Generic names: Neurophen, Brufen
Indication:
- fever
- mild to moderate pain
Key mechanism of action:
- inhibit COX-1 (enzyme that produces prostaglandins) non-selectively and selectively binds to COX-2 decreasing signs and symptoms of inflammation and pain.
- it inhibits the speed of prostaglandin pain messengers
2x adverse effects: - rash - epigastric pain - diarrhoea - abdominal pain - heart burn - prolonged bleeding time GI bleeding/ulceration
Major nursing considerations:
- contraindicated with asprin or NSAIDS as it increases risk of GI side effects such as ulceration and pain
- caution with concurrent warfarin use → increases risk of bleeding
- caution use when patient is at any risk of bleeding
- use of antacids will decrease the absorption of ibuprofen
3
Q
Opioids
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Opioid analgesics are commonly used during the surgical journey
Intraoperatively → as an adjunct to inhalation anaesthesia, will also reduce the amount of anaesthetic agents required to produce anaesthesia
postoperatively → administered to counteract perioperative pain i.e. directly from the surgical procedure
Side effects are similar for all;
- resp depression
- constipation
- rash
- nausea
Schedule 8 drugs (2x nurse check)
4
Q
Morphine Sulfate
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Opoid Analgesic
Generic names: Morphine, Anamorph, Kapanol
Indication:
- moderate to sever pain
- supplementary analgesia during GA
Key mechanism of action:
- binds with specific opioid receptors (mu, delta, kappa) pre- and post-synaptically → decreasing pain transmission in the spinal cord, changes the pain pathway in the brain
- this prevents CNS smooth muscle pains from being noticed
- decreases respiratory centre, suppresses cough, stimulates vomiting centre, increases smooth muscle tone in the GIT, reduces peristalsis, reduces anxiety, can produce euphoria or dysphoria and drowsiness
2x adverse effects - dry mouth - blurred vision - constipation headache - resp Depression - urinary retention - drowsiness, raised intracranial pressure, hallucinations, delirium, slurred speech - bradycardia, orthostatic hypotension - tolerance, dependence
Major nursing considerations:
- monitor for resp depression
- provide stool softners or counsel on diet for constipation
- caution use in patients with confusion
- administer prior (15-20 mins) to a procedure
- closely monitor urinary output/bowel sounds
- be aware of withdrawal symptoms e.g. aggression, yawning, agitation, tremor, insomnia, nausea, vomiting, sweating, dilated pupils
5
Q
Fentanyl
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Opoid Analgesic
Generic names: Durogesic, Fenpatch, Denpax
Indication:
- moderate to sever pain
Key mechanism of action:
- binds with specific opioid receptors (mu, delta, kappa) pre- and post-synaptically → decreasing pain transmission in the spinal cord, changes the pain pathway in the brain
- acts on mu receptors of the brain and spinal cord
- more potent than morphine
2x adverse effects - muscle rigity - bleeding gums - dry mouth - blurred vision - constipation headache - resp Depression - urinary retention - drowsiness, raised intracranial pressure, hallucinations, delirium, slurred speech - bradycardia, orthostatic hypotension - tolerance, dependence
Major nursing considerations
- monitor for resp depression
- provide stool softners or counsel on diet for constipation
- caution use in patients with confusion
- administer prior (15-20 mins) to a procedure
- closely monitor urinary output/bowel sounds
- be aware of withdrawal symptoms e.g. aggression, yawning, agitation, tremor, insomnia, nausea, vomiting, sweating, dilated pupils
6
Q
Oxycodone
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Opoid Analgesic
Generic names: Endone, Oxycontin, Oxynorm
Indication: Moderate to sever pain
Key mechanism of action
- semi-synthetic opooid
- similar to morphine but shorter acting
- binds with specific opioid receptors (mu, delta, kappa) pre- and post-synaptically → decreasing pain transmission in the spinal cord, changes the pain pathway in the brain
- acts on mu receptors of the brain and spinal cord
- more potent than morphine
2x adverse effects - muscle rigity - bleeding gums - dry mouth - blurred vision - constipation headache - resp Depression - urinary retention - drowsiness, raised intracranial pressure, hallucinations, delirium, slurred speech - bradycardia, orthostatic hypotension - tolerance, dependence
Major nursing considerations
- may increase effects of warfarin → need to check INR regularly
- monitor for resp depression
- provide stool softners or counsel on diet for constipation
- caution use in patients with confusion
- administer prior (15-20 mins) to a procedure
- closely monitor urinary output/bowel sounds
- be aware of withdrawal symptoms e.g. aggression, yawning, agitation, tremor, insomnia, nausea, vomiting, sweating, dilated pupils
7
Q
Antiemetics
A
- act by blocking the neurotransmitters in the vomiting centre, the cerebral cortex and the CTZ
Nausea and vomiting is a complex process involving multiple nerve pathways and neurotransmitters
- results from impulses sent via efferent nerves from the emetic centre to the upper GIT, diaphragm and abdominal muscles
- strong contractions of the abdominal muscles forces the stomach contents past the oesophageal sphincter and into the mouth
- coordinated responses between sensory nerve cells (chemoreceptor trigger zone - CTZ) located in the brain and the vomit centre located in the medulla
- considered a protective mechanism to rid the body of a toxic substance
in severe cases however, it can result in fluid and electrolyte disturbances
8
Q
Ondansetron
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: 5HT3 Receptor Antagonist
Indication: control nausea and vomiting
Generic names: Zofran, Ondaz, Onsetron
Key mechanism of action
- preventing nausea and vomiting in children and adults related to chemotherapy use, radiation therapy, and the effects of postoperative anesthesia
2x adverse effects
- headache
- dizziness
- fatigue
- diarrhoea
- constipation
- extrapyramidal reactions → confusion, dyskinesia, tremors, muscle contractions = oculogyric crisis
Major nursing considerations
- wafers should be placed on the tongue, allowed to dissolve and then swallowed
- may decrease analgesic effects of tramadol
- given during most anesthetics
9
Q
Metoclopramide
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: antiemetic
Generic names: Maxolon, Pramin
Indication: controls nausea and vomiting
Key mechanism of action
- stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary or pancreatic secretions
- increases tone and amplitude of gastric contraction, relaxes the pyloric shincter and increases peristalsis of the duodenum and jejunum
- exact mode of action is unknown
- it sensitises tissues to the action of acetylcholine
2x adverse effects
- restlessness, drowsiness, headache, dizziness
- constipation
- tardive dyskinesia
- extrapyramidal reactions → confusion, dyskinesia, tremors, muscle contractions = oculogyric crisis
Major nursing considerations
- not recommended to use in pregnancy
- not safe for children under 15 (increased risk of acute dystonic reactions- a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements)
- contraindicated whenever gastric motility might be dangerous → GIT haemorrhage, bowel obstruction, perforation
- extrapyramidal reactions could occur up to 36 hours after administration
10
Q
Explain and describe PCAs
Advantages and disadvantages
A
Patient controlled analgesics
- will contain schedule 8 drugs e.g. morphine, fentanyl, tramadol
Advantages
- avoidance of analgesic peaks and troughs
- allows patient to recieve medication without delya = increased patient empowerment and control
- patients are able to anticipate activities such as coughing or movement associated with increased pain and provide themselves with an opioid bolus in advance
- enables increased patient mobility
11
Q
Explain the 3 PCA pump models
A
- PCA mode only → demand dose, the patient will only receive a dose of analgesia when they press the PCA button, there is a lock-out period after each bolus dose self-administered by the patient as a safety measure
- Continuous infusion → a background infusion where the patient will receive a continuous dose of analgesia, cannot be altered by the patient
- Continuous infusion with additional demand analgesia → the PCA is set for a continuous background infusion as per orders but the patient can self-administer an additional bolus of analgesia as required
12
Q
Explain the nursing management for a PCA pump
A
- Always review the medical order, including the section on reportable observations
- RN must have a thorough understanding of the medication being administered, including common adverse effects
- When caring for a patient on a PCA, the following reviews / assessments should be performed hourly, unless indicated by the medical orders or organisational clinical practice guidelines:
- vital signs= assess your patient for CNS effects of opioid overdose → respiratory depression, drowsiness, confusion
- pain assessment
- device review to ensure there are no problems such as leaking around connections / kinked tubing
- IVC assessment
- documentation
13
Q
What is a contraindication for a PCA?
A
PCAs are only suitable for patients that have a clear understanding of the use → patient’s with a cognitive impairment will not understand the concepts of self-administering analgesia and they will not be able to comply with the instructions on how to use the device
14
Q
Explain bronchodilators as a whole and the 3 groups of them
A
Action: increase airway diameter to reduce airway resistance and improve gaseous exchange.
There are three groups of bronchodilators:
• β2 agonists
• Methylxanthines
• Anticholinergics
15
Q
B2 adrenoceptor agonists
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: B2 adrenoceptor agonists (Sympathomimetic Bronchodilators)
Generic names:
Short acting β2 agonists: Salbutamol (Ventolin) Terbutaline (Bricanyl)
Long acting β2 agonists: Salmetrol (Serevent) Eformoterol (Oxis, Foradile)
Indication:
Bronchial constriction
Key mechanism of action
- Relaxes bronchial smooth muscle causing bronchodilation by stimulating β2 receptors
(also relaxes uterine and blood vessel smooth muscles)
2x adverse effects
- fine skeletal muscle tremor
- palpitations
- tachycardia
- nervousness
Major nursing considerations
- contraindicated in pregnancy (unless benefits outweigh risks)
- check inhaler technique
- monitor vital signs as an elevated heart rate may be a side effect
- monitor and escalate any arrhythmias
- educate patients on possible side effects
16
Q
Xanthine Derivatives
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Methylaxnthines
Generic names:
Aminophylline (IV) Theophylline (Nuelin)
Indication:
Key mechanism of action:
- dilate bronchioles by relaxing smooth muscles
- Stimulant effect on myocardium, CNS and respiration
- relax smooth muscle in the blood vessels so result in a decrease in peripheral resistance
- Inhibit release of inflammatory mediators & histamine
- Promote diuresis
- Uses: Severe, acute asthma
- Maintenance therapy in severe asthma and COPD
2x adverse effects:
- anxiety
- headache
- nausea and vomiting
- bradycardia
Major nursing considerations:
- warn patient not to take excessive amounts of caffeine related beverages
- xanthines, diuretics and hypoxia may increase the risk of hypokalaemia if administered with beta2 adrenoreceptor agonists
17
Q
Anticholinergic (Antimuscarinic) Drugs
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Antimuscarinic
Generic names: Ipratropium bromide (Apoven, Atrovent, Ipravent), Tiotropium (Spiriva)
Indication
- Acute, severe asthma.
- Chronic asthma, bronchospasm, rhinorrhea
Key mechanism of action
- Produce bronchodilation by blocking vagal tone and those reflexes that induce bronchoconstriction. They may also reduce secretions.
Effective within 3-5 minutes, reaching peak at 11⁄2 - 2 hours, duration 4 - 6 hours
2x adverse effects
- dry mouth, cough, irritated throat
- headache, nervousness, insomnia
- urinary urgency, retention
- tachycardia, palpitations, arrhythmias
Major nursing considerations
- check inhaler technique
- educate patients regarding dry mouth and possible complications
- inform patient to seek medical advice if: difficulty passing urine, painful urination, eye pain/discomfort
- caution in those with unstable angina, AMI or arrythmias
- caution in those with symptomatic prostatic hyperplasia
- hypersensitivity to atropine
18
Q
Local corticosteroids (preventer medications )
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Local cortico steroids
Generic names: Beclomethasone (Becotide, Becloforte), Budesonide (Pulmicort), Fluticasone (Flixotide), Ciclesonide (Alvesco)
Indication: asthma prophylaxis, allergic rhinitis, laryngotracheobronchitis
Key mechanism of action:
Used in chronic asthma to decrease airway obstruction due to inflammation
Exact mechanism of action is unclear, but involves:
- Decreasing generation of prostaglandins and histamines
- Decreasing production of substances that lead to bronchospasm
- Decreasing production of immunoglobulins IgE and IgG
- Decreasing production of mast cells
- Decreasing mucus production
These drugs are usually used after bronchodilator in order to allow maximum tissue exposure within the lower respiratory tract
2x adverse effects:
- impaired wound healing
- abdominal pain
- diarrhoea
- hoarseness, sore throat, dry mouth
Major nursing considerations:
- bronchodilator should be taken first, several minutes beforehand
- caution if oral and inhaled steroid therapy
caution in those with - hypertension, diabetes mellitus, glaucoma
- avoid grapejuice
19
Q
Systemic corticosteroids (preventer medications)
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: corticosteroids
Generic names: Betamethasone, Hydrocortisone, Prednisolone, Methylprednisolone
Indication: suppresses undesirable inflammatory or immune responses and used for this reason in respiratory conditions
Key mechanism of action:
- suppresses inflammatory response including inhibiting inflammatory mediators
- increase gluconeogenesis and decrease peripheral glucose utilisation
- inhibit protein synthesis
- affects mood and behaviour, neuronal excitability
- may be used for a short period to assist with control of an acute respiratory condition
- these can have severe and toxic effects given this way musculoskeletal, fluid and electrolyte imbalances, adrenal suppression, growth retardation, fat deposits, impaired healing
2x adverse effects:
- sodium and fluid retention; potassium and calcium depletion
- hypertension, congestive cardiac failure, arrhythmias
- muscle wasting weakness, osteoporosis
- nausea, vomiting, abdominal distention
- headache, depression, modd swings, insomnia
- delayed wound healing, easy bruising
- acute adrenal insufficiency if ceased abruptly
Major nursing considerations
- monitor electrolytes. Ensure salt restricted diet, consider potassium supplements
- patient should be monitored for changes in mood
- monitor blood sugar levels (especially in patients diabetes mellitus)
- fluid balance chart/daily weigh
- monitor adrenal functioning in long term use
20
Q
Mast cell stabilisers (preventer medications)
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Mast cell stabilisers
Generic names: Sodium cromoglycate (Intal) & Nedocromilsodium (Tilade)
Indication: mild to moderate asthma prophylaxis, prevention of bronchospasm
Key mechanism of action
- Anti-inflammatory drugs that inhibit release of histamine, leukotriene, and other mediators of inflammation from mast cells
- Administered via inhalation to reduce incidence of acute asthma episodes
2x adverse effects
- headache
- nausea, vomiting, abdominal pain
- cough, pharyngitis, bronchospasm
Major nursing considerations
- inhaler to be used with a spacer
- do not stop medication abruptly as asthma may deteriorate
21
Q
Leukotriene receptor antagonists
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Leukotriene receptor antagonists (i think thats de class?????)
Generic names
Indication: prophylaxis and treatment of chronic asthma, seasonal allergic rhinitis
Key mechanism of action:
- a newer category of drug that block leukotriene receptors to reduce inflammation, mucous secretion and bronchoconstriction
- selective leukotriene receptor antagonists that inhibits LTC4, LTD4 and LTE4 that are pro-asthmatic mediators
2x adverse effects:
- fever
- headache, dizziness, fatigue
- sleep disturbance,
- depression
Major nursing considerations:
- not used as a reliever during acute asthma
- don’t operate machinery if symptomatic with dizziness and/or fatigue
22
Q
Anti-histamines
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class
Generic names: Promethazine (Avomine, Phenergan), Cetirizine
Indication: • Seasonal allergic rhinitis (hay fever) • Allergic skin reactions • Motion sickness • Anaphylactic shock
Key mechanism of action:
- Histamine is a naturally occurring substance stored in mast cells that causes smooth muscle contraction, inflammation and itching. They are also responsible for capillary permeability and dilatation, erythema and oedema.
- H2 receptors are involved in the regulation of gastric acid secretion.
- H1 receptor antagonists are often referred to as antihistamines and block the action of histamines to treat allergic reactions.
- Has antiemetic, sedative, antimuscarinic, local anaesthetic and antitussive effects
2x adverse effects - sedation, decreased motor skills and coordination - fatigue, dizziness - dry eyes, nose and mouth nausea, vomiting and diarrhoea
Major nursing considerations
- advise against driving if symptomaic with drowsiness
- reduced tolerance to alcohol
23
Q
Mucolytics
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class
Generic names: Bromhexine (Bisolvon), Acetylcysteine sodium (Mucomyst), Dornasealpha (Pulmozyme) – most often used in cystic fibrosis
Indication:
- breakdown mucous in those with cold, influenza or other bronchial condition with excessive mucous production
Key mechanism of action:
- Mucolytics encourage the removal of respiratory tract secretions by thinning them so that ciliary action can allow them to move.
- Alter the structure of mucous, breaking down the mucous chains to decrease viscosity and aid in removal
- Expectorants may increase the volume of secretions in the respiratory tract and aid removal by ciliary action and coughing
2x adverse effects
- nausea, vomiting, diarrhoea
- headache, dizziness
Major nursing considerations
- may contain fructose - avoid for those with fructose intolerance
- caution in those with gastiric ulcer or severe kidney/liver disease
24
Q
Penicillins
Class Generic names Indication Key mechanism of action 2x adverse effects Major nursing considerations
A
Class: Penicillins
Generic names:
Indication: resp infection
Key mechanism of action:
Bactericidal; interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death.
2x adverse effects
- diarrhoea
- nausea
- pain and inflammation at injection site
- superinfection (including candidiasis) especially during prolonged treatment with broad-spectrum penicillins, allergy
- black tongue
- electrolyte disturbances
Major nursing considerations
- monitor complete blood count and renal and hepatic function during prolonged high-dose treatment (>10 days)
25
Cephalosporins
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
```
Class: Cephalosporins (anti-infectives)
Generic names
Indication: Cephalosporins are rarely the drugs of first choice. Exceptions include ceftazidime for melioidosis, and cefotaxime or ceftriaxone for the empirical treatment of bacterial meningitis.
Key mechanism of action
- Interfere with bacterial cell wall peptidoglycan synthesis by binding to penicillin-binding proteins, eventually leading to cell lysis and death; bactericidal.
2x adverse effects
- rash
- dizziness
- allergy
- superinfection
- neuotoxicity (confusion, seizures, encephalopathy)
- nausea and vomiting
Major nursing considerations
- monitor renal function and complete blood count during prolonged (>10 days) and/or high-dose treatment
- unless using cefoxitin give an additional antibacterial if anaerobic cover required in surgical prophylaxis
26
Tetracyclines
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: Tetracyclines- anti infectives
Generic names
Indication: H. pylori eradication, with other agents
Key mechanism of action:
- Bacteriostatic; inhibit bacterial protein synthesis by reversibly binding to 30S subunit of the ribosome.
Effect in acne vulgaris and rosacea also involves mechanisms other than antimicrobial activity.
2x adverse effects
- epigastric burning
- tooth discolouration, enamel dysplasia
- photosensitivity (depends on tetracycline, dose and degree of sun exposure)
Major nursing considerations
- take with food or milk to reduce stomach upset.
- remain up right for an hour after taking the meds
27
Lipid-lowering agents
General info
- prevention and slowing of CAD with antihyperlipidemic agents
- have lifestyles factors been assessed and attempted to chnage before this?
28
Statins
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: HMG-CoA reductase inhibitors
```
Generic names:
Atorvastatin
Simvastatin
Pravastatin
Rosuvastatin
```
Indication: hypercholestrolmia, dyslipidemia
Key mechanism of action:
Reversibly inhibit HMG-CoA reductase reducing cholesterol synthesis and increasing the number of liver LDL (low-density lipoprote) receptors and reducing LDL concentration.
* reduces cholsterol systheisis
Also, may have an effect on endothelial function, the inflammatory response, modify thrombus formation, stabilise atherosclerotic plaques and increase fibrolytic action.
```
2x adverse effects:
- Gastronintestinal upset - constipation, nauseas and vomiting, cramping
- Central nervous system effects: headache, dizziness, blurred vision, insomnia, fatigue
- Cataract development
- Hyperglycaemia
- Rasied liver enzymes and
liver toxicity
- Elevated creatine kinase levels
- Myopathy, rhabdomyolysis
- Be aware of drug-drug interactions
```
Major nursing considerations:
- avoid grapefruit juice
- Avoid large amounts of alcohol - increased risk of liver impairment
- Seek medical advice with any signs of myopathy or liver damage
29
ACE inhibitors (angiotension-comverting enzyme inhibitors)
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: ACE inhibitors
Generic names:
Indication:
- hypertension
- heart failure
- diabetic nephropathy
- myocardial infarction
They are also used to prevent cardiovascular events in patients at high risk.
Key mechanism of action:
Prevents the conversion of angiotensin I to angiotensin II by inhibiting ACE. This results in reduced peripheral vascular resistence and decreased BP.
Decreases aldosterone production - reducing sodium and water reabsorption.
2x adverse effects
- Cough
- angioedema
- hypotension (usually after the first dose)
- renal failure
- hyperkalemia
- Dizziness
- headache
- weakness
- fatigue
Major nursing considerations
- Patients should avoid driving or operating heavy machinary for 12 hours after the first dose
- NSAIDs can interact with ACE inhibitors diminishing effectiveness
- Avoid dehydration and excessive sweating
- Report any signs of swelling or yellowing of the skin and eyes
- Low salt diet can be beneficial in reducing BP
- Avoid in pregnancy
30
Anti-anginal agents
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: Anti-anginal agents
Generic names:
Indication:
Manage acute pain and prevent further attacks by improving perfusion and/or by reducing the metabolic demand on the heart
Key mechanism of action:
- (main ingredient= calcium channel blockers)
Relaxes the smooth muscle= vasodilation of the peripheral arteries and veins= decreasing arterial pressure and cardiac output= decreased myocardial oxygen demand.
- Also dilates coronary vessels increasing myocardial perfusion and oxygen delivery.
2x adverse effects
- Headache (nurses should also be careful when administering GTN that it does not touch their skin)
- Hypotension
- syncope
- tachycardia (reflex)
- nausea and vomiting
Major nursing considerations
- Warn the patient that lightheadedness, dizziness and fainting may occur
- Ensure patient understands the importance of reporting ongoing symptoms of angina despite taking medication as prescribed
- Tolerance can develop and therefore a medication-free period should be considered.
31
Calcium channel blockers
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: Calcium channel blockers
Generic names:
- Dihydropyridines act primarily on the arterioles
- phenylalkylamine and benzothiazepine act on arterioles and the heart.
Indication:
- Used to treat hypertension, angina pectoris and cardiac dysrhythmias.
Key mechanism of action
- Impedes the influx of calcium ions through the slow channels of cell membrane during depolarisation of cardiac and vascular smooth muscle.
- Dilates coronary arteries to improve oxygen supply to ischaemic areas and improves collateral blood flow.
- Dilates peripheral arteries reducing peripheral vascular resistance and therefore blood pressure.
- This improves myocardial oxygen supply, reduces myocardial work by reducing afterload resulting in improved cardiac output.
2x adverse effects
- Constipation, dizziness, headache, oedema, dry mouth
- Bradycardia, AV blocks
Major nursing considerations
- Grapefruit juice can inhibit the intestinal and hepatic metabolism of medications and can lead to toxicity.
- Interactions with digoxin and beta-adrenergic blocking agents - requires close monitoring.
- Caution must be taken to ensure the right dose is prescribed, taking into consideration immediate release, slow release or extended release.
- Not recommended in pregnancy
32
Beta blockers
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: beta blockers
Generic names:
Indication:
- angina pectoris
- hypertension
- cardiac dysrhythmias
- myocardial infarction
- heart failure
Key mechanism of action
- Inhibits beta-adrenoceptors (sympathetic nervous system) thereby reducing some response to adrenaline (epinephrine), noradrenaline and isoprenaline.
The blocking of beta 1 receptors in the heart results in reduced heart rate, reduced force of contraction and reduced velocity of impulse conduction through the AV node leading to reduced cardiac output and myocardial oxygen demand.
Also, inhibits the release of renin from the kidneys.
2x adverse effects
- Bradycardia
- reduced cardiac output
- hypotension, precipitation of heart failure
- AV heart block, decreased libido
- fatigue
Major nursing considerations
- Note patient's vital signs prior to administration; particularly bradycardia or hypotension
- Monitor closely patients with cogestive heart failure
- Advise not to stop the medication abruptly as this may lead to angina pectoris, acute myocardial infarction or cardiac arrhythmias
- Can be contraindicated in patient's with asthma, COPD, bronchconstriction disorders or allergic disorders
33
Hydrochlorothiazide
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: Thiazide diuretics
Generic names:
Indication:
- Heart failure
- Oedema associated with heart failure, cirrhosis and renal impairment.
- Acute pulmonary oedema
- Hypertension
Key mechanism of action
- aims to reduce blood volume and reduce arterial resistance with some vasodilator activity. Increases the excretion of sodium and chloride ions and water in the proximal segment of the distal tubule.
2x adverse effects
- Hypotension (particularly with loop diuretics)
- Hypokalemia (not potassium sparing diuretics) and other electrolytes and acid-base imbalances
- Dehydration, hypovolaemia
- Hyperglycaemia
- Hyperuricemia
- Increased serum cholesterol and triglyceride levels
- Impaired glucose tolerance
- Loop diuretics can cause hearing loss
Major nursing considerations:
- Fluid, electrolyte and acid-base imbalances need to be considered and treated
- Caution with the administration of IV furosemide, rapid administration can cause permanent hearing loss/deafness
- Monitor vital signs, fluid balance and urine output; particularly with IV administration
- Can increase risk of toxicity of other medications
- Advise patients to avoid vitamin C and calcium (thiazide & potassium sparing)
- Avoid foods high in potassium (potassium sparing)
34
Furosemide
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: Loop diuretics
Generic names
Indication
- Heart failure
- Oedema associated with heart failure, cirrhosis and renal impairment.
- Acute pulmonary oedema
- Hypertension
Key mechanism of action
- lowers blood pressure by reducing blood volume and promoting vasodilation.
- Can provide a profound diuresis (IV and oral) and therefore can be used in patients with low cardiac output and low GFR (thiazides are not as effective with low GFR). Inhibits the reabsorption of sodium, potassium and chloride primarily in the ascending limb of the Loop of Henle, resulting in increased water excretion.
2x adverse effects
- Hypotension (particularly with loop diuretics)
- Hypokalemia (not potassium sparing diuretics) and other electrolytes and acid-base imbalances
- Dehydration, hypovolaemia
- Hyperglycaemia
- Hyperuricemia
- Increased serum cholesterol and triglyceride levels
- Impaired glucose tolerance
- Loop diuretics can cause hearing loss
Major nursing considerations:
- Fluid, electrolyte and acid-base imbalances need to be considered and treated
- Caution with the administration of IV furosemide, rapid administration can cause permanent hearing loss/deafness
- Monitor vital signs, fluid balance and urine output; particularly with IV administration
- Can increase risk of toxicity of other medications
- Advise patients to avoid vitamin C and calcium (thiazide & potassium sparing)
- Avoid foods high in potassium (potassium sparing)
35
spironolactone or triamterene
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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ClassPotassium sparing diuretics
Generic names
Indication
- Heart failure
- Oedema associated with heart failure, cirrhosis and renal impairment.
- Acute pulmonary oedema
- Hypertension
Key mechanism of action:
- mild diuretic and antihypertensive effect and the degree of diuresis is much smaller. However because these diuretics conserve potassium, these medications play an important role. Increases the excretion of sodium in the distal convulted tubule and conserves potassium.
2x adverse effects
- Hypotension (particularly with loop diuretics)
- Hypokalemia (not potassium sparing diuretics) and other electrolytes and acid-base imbalances
- Dehydration, hypovolaemia
- Hyperglycaemia
- Hyperuricemia
- Increased serum cholesterol and triglyceride levels
- Impaired glucose tolerance
- Loop diuretics can cause hearing loss
Major nursing considerations:
- Fluid, electrolyte and acid-base imbalances need to be considered and treated
- Caution with the administration of IV furosemide, rapid administration can cause permanent hearing loss/deafness
- Monitor vital signs, fluid balance and urine output; particularly with IV administration
- Can increase risk of toxicity of other medications
- Advise patients to avoid vitamin C and calcium (thiazide & potassium sparing)
- Avoid foods high in potassium (potassium sparing)
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spironolactone or triamterene
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
```
ClassPotassium sparing diuretics
Generic names
Indication
- Heart failure
- Oedema associated with heart failure, cirrhosis and renal impairment.
- Acute pulmonary oedema
- Hypertension
Key mechanism of action:
- mild diuretic and antihypertensive effect and the degree of diuresis is much smaller. However because these diuretics conserve potassium, these medications play an important role. Increases the excretion of sodium in the distal convulted tubule and conserves potassium.
2x adverse effects
- Hypotension (particularly with loop diuretics)
- Hypokalemia (not potassium sparing diuretics) and other electrolytes and acid-base imbalances
- Dehydration, hypovolaemia
- Hyperglycaemia
- Hyperuricemia
- Increased serum cholesterol and triglyceride levels
- Impaired glucose tolerance
- Loop diuretics can cause hearing loss
Major nursing considerations:
- Fluid, electrolyte and acid-base imbalances need to be considered and treated
- Caution with the administration of IV furosemide, rapid administration can cause permanent hearing loss/deafness
- Monitor vital signs, fluid balance and urine output; particularly with IV administration
- Can increase risk of toxicity of other medications
- Advise patients to avoid vitamin C and calcium (thiazide & potassium sparing)
- Avoid foods high in potassium (potassium sparing)
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Angiotension 2 receptor antagonists (blockers)
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class
Generic names
- Irbesartan
- Candesartan (Atacand)
- Losartan (Cozaar)
- Valsartan (Diovan)
Indication
- Hypertension
- Often utilised for those patients who can not tolerate ACE inhibitors
Key mechanism of action
- Similar to ACE inhibitors
- Block the angiotensin II receptors on the vascular smooth muscle and adrenal cortex.
- Angiotensin II is responsible for vasoconstriction, stimulation of aldosterone, regulation of salt and water homeostasis and cell growth stimulation.
- Increases renal blood flow and maintains GFR whilst decreasing renal vascular resistance (to increase renal blood flow)
- Does not inhibit ACE, therefore bradykinin is not affected and less likely to have the adverse effect of a cough (like ACE inhibitors do)
- can improve the left ventricle ejection fraction, reduce heart failure symptoms and increase exercise intolerance, however, it has less effect on the ventrciular remodelling that occurs.
2x adverse effects
- Hypotension, chest pain, tachycardia
- Dizziness, headache, depression, fatigue
- Hypertriglyceridaemia, hyperkalemia
Major nursing considerations
- Consider the patient's fluid and electrolyte balance
Consider monitoring potassium and creatinine levels
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Digoxin
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: cardiac glycoside
Generic names: Digoxin
Indication:
- Heart failure
- Atrial fibrillation
- Paroxysmal atrial tachycardia
Key mechanism of action
- Positive inotropic action - increases myocardial contractile force and thereby increases cardiac output by inhibiting sodium-potassium pump exchange
- Alters electrical activity of the heart by slowing the conduction rate through the AV mode. It increases the vagal acitivity to prolong refractory period and decrease heart rate
- Reduces the symptoms of heart failure however not proven to prolong life.
2x adverse effects
- anorexia, nausea, vomiting
- arrhythmias, bradycardia, conduction disturbances
- digoxin toxicity
Major nursing considerations
- Causes bradycardia and therefore heart rate should be measured prior to administration
- Be aware of the signs and symptoms of digoxin toxicity
39
Heparin
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
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Class: Anti-coagulants/Anti-platelets
- Unfractionated Heparin
- Low-molecular Weight Heparin (LMWH) (Enoxaparin)
- Fonaparinux
Generic names: heparin
Indication:
- Prophylaxis and treatment of deep vein thrombosis, pulmonary embolism, or thrombophlebitis
- Prophylaxis of thromboembolic complications from heart/vascular surgery
- Patency of IV devices, extracorporeal circulation (heart/lung/kidney machines)
- LMWH: as above and used in cojunction with other therapies for the treatment of unstable angina, myocardial infarction and STEMI
Key mechanism of action
- Suppresses coagulation by helping antithrombin inactivate clotting factors (primarily thrombin and factor Xa) supressing the formation of fibrin. It also inhibits the activation of fibrin stabilising factor to prevent stable clot formation
- If a thrombus exists, heparin inhibits any further coagulation by inactivating thrombin however has no effect on the existing clot
- LMWH: (a smaller molecule of heparin) activates antithrombin inhibiting generation of thrombin, accelerates inhibition of factor Xa
- enhance the activity of antithrombin. Antithrombin is a protein that inactivates thrombin and factor Xa (clotting factors). This leads to a reduction in the production of fibrin and clotting is suppressed.
2x adverse effects
- haemorrhage
- local irritation, erythema, haematoma, ulceration may occur with sub-cutaneous injection
Major nursing considerations
- Sub cut injection
- rotate injection site
- do not rub site after injection
- at the site of injection - mild pain, erythema and haematoma formation can occur
- for some heparin therapy, laboratory monitoring may need to occur. This includes APTT, platelet count and haematocrit
40
Warfarin
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
```
Class: Anti-coagulants/Anti-platelets
Generic names:
Indication:
- Long-term prophylaxis of thrombosis
- Prevention of thrombosis in patients with atrial fibrillation
- Prevention of thromboembolism in patients with prosthetic heart valves
Key mechanism of action:
- suppresses coagulation by decreasing production of clotting factors (VII, IX, Interferes with vitamin K-dependent synthesis of prothrombin (factor II and factors VII, IX and X)
2x adverse effects
- Haemorrhage (medic alert advised)
Major nursing considerations
- the anti-coagulant effects can be serious and need to be monitored closely which is reported as the INR
- brands (Coumadin and Marevan) should NOT be interchanged
- loading doses are not recommended
bleeding can occur even within the therapeutic range - monitor for signs and symptoms
41
Aspirin
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Class
Generic names
Indication
Key mechanism of action
2x adverse effects
Major nursing considerations
```
Class: Anti-coagulants/Anti-platelets
Generic names
Indication:
- Ischemic stroke
- TIA's
- Chronic stable angina
- Unstable angina
- Coronary stent (PTCA)
- Acute myocardial infarction (AMI), previous AMI and to prevent AMI
- Mild-to-moderate non-visceral pain; headache, miagraine
- Inflammation associated pain
Key mechanism of action:
- suppresses platelet synthesis
- Suppresses platelet aggregation by causing irreversible inhibition of cyclooxgenase, an enzyme required by platelets to synthesize TXA2. TXA2 acts on the vascular smooth muscle to cause vasoconstriction
Both of these factors: platelet aggregation and suppression of TXA2 vasoconstriction reduces the risk of arterial thrombosis
2x adverse effects
- Increases the risk of GI bleeding and haemorrhagic stroke
- tinnitus, nausea, GI irritation
- salicylate toxicity
Major nursing considerations
- elderly patients are at greater risk of adverse effects
- may increase blood levels of sodium valporate, sulfonamides and methotrexate
