Pharmacology (HOME)
Generic Name: furosemideBrand name: Lasix Classification: Loop diureticWhy is patient/client receiving this? HTN and edema; can use with decreased GFR Dosage/Route: HTN: 40mg PO bid initially, then adjust Edema: 20-80mg PO/day IM IV: 20-40mg, may repeat in 1-2 hrRate of administration with IV meds: 10mg/mL at 20mg/min IV diluents compatible with IV medication: Larger doses diluted in 50 mL of D5W, D10W, D20W, D5/.9%NaCl, .9NaCl, 3%NaCl, or LR Major Side effects: -CNS: blurred vision, dizziness, headache, vertico -EENT: ototoxic, tinnitus -CV: hypotension -GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, increase in liver enzymes, nausea, pancreatitis, vomiting -GU: Increased BUN, excessive urination, nephrocalcinosis -DERM: erythema, rash, photosensitivity -ENDO: hypercholesterolemia, hyperglycemia, hypertriglyceridemia, heruricemia -HEMAT: Aplastic anemia -FandE: hypokalemia -MS: muscle cramps-Neuro: parasthesiaData used to indicate medication is effective: Daily weight, I and O (increased urine output), monitor BP and pulse (decrease in BP) Medication administration concerns: Increased fall risk, drug/drug interaction: digoxin toxicity, lithium toxicity, decreased effect when used w/ NSAIDSPatient/client teaching points: Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed Inform pt of fall risk status and interventions to prevent falls Generic Name: terazosinBrand name: Hytrin Classification: peripherally acting adrenergic Why is patient/client receiving this? HTN and BPH Dosage/Route: Initially 1-5 mg/day then increase to 5-10mg/day given as single dose or double dose (not to exceed 20 mg/day) Major Side effects: -CNS: dizziness, HA, weakness -EENT: blurred vision, nasal congestion, conjunctivitis -CV: first-dose orthostatic hypotension, arrhythmias, tachycardia, peripheral edema -RESP: dyspnea -GI: nausea, abd pain, diharrhea, dry mouth, vomiting -GU: erectile dysfunction, urinary frequency -DERM: purtitis -MS: back pain, extremity pain -Neuro: parasthesia -weight gain, fever Data used to indicate medication is effective: Daily weight, I and O (increased urine output), monitor BP and pulse (decrease in BP) Medication administration concerns: Increased fall riskPatient/client teaching points: Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed Inform pt of fall risk status and interventions to prevent falls Generic Name: metoprololClassification: beta blocker , selective Why is patient/client receiving this? Migraine, chonic angina, HTN, cardiac dysrhythmias, tremors, anxiety (negative chronotrope, inotrope, dromotrope) Dosage/Route: PO for hypertension: 25-100 mg/day as single dose initially OR 2 dividided doses. May be increased q7days PRN up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) for HF: 12.5-25 mg once daily, may be doubled q2 weeks up to 200/mg day. MI: IV 5 mg q 2 min for 3 doses followed by PO Rate of administration with IV meds: Over 1 min IV diluents compatible with IV medication: N/A Major Side effects: -CNS: fatigue, weakness, anxiety, depression, drowsiness, insomnia, change in mental status -EENT: blurred vision-RESP: bronchospasm -CV: bradycardia, HF, pulmonary edema, hypotension, peripheral vasoconstriction -GI: constipation, diharrhea, drug induced hepatitis -GU: urinary frequency -DERM: rashes - ENDO: hyperglycemia, hypoglycemia -Drug induced lupus syndrome Data used to indicate medication is effective: Monitor BP, pulse (45), ECG (decreased BP, pulse), I’s and O’s (normal to increased urine output), daily weights (no weight gain indicative of edematous HF) Medication administration concerns: take apical pulse for 1 min (withhold if arrythmatic or <50) hold under 45, monitor signs of HF NO LONGER FIRST LINE however given after MI for ventricular remodeling and protection, use in caution with brittle diabetics (masks s/e of hypoglycemia UNTIL SEVERE) Patient/client teaching points: Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed, Inform pt of fall risk status and interventions to prevent fallsGeneric Name:propranolol Classification: nonselective betablocker , high alert (IV) Why is patient/client receiving this? Mgmt. of HTN, angina, arrhythmias, hypertrophic cardiomyobabthy, essential tremors, phenochromocytopa Dosage/Route: PO antianginal: 80-320 mg/day in 2 divided doses or once as extended release (DNC) antihypertensive: 40 mg twice daily IV antiarrythmhic: 1-3 mg, repeated after 2 min, again in 4hr if needed Rate of administration with IV meds: .5 mg/min Intermittent: infuse over 10-15 min IV diluents compatible with IV medication: direct iv: undiluted or each mg in 10mL of D5W Intermittent: may be diluted in 50mL normal saline, D5W, D51/2 saline, D5normal saline Major Side effects: -CNS: fatigue, weakness, mental depression, mental status change -RESP: bronchospasm , wheezing -CV: bradycardia, HF, arrhythmias, pulmonary edema, hypotension, peripheral vasoconstriction -GI: constipation, diharrhea, DERM: rashes - ENDO: hyperglycemia, hypoglycemia -anaphylaxis Data used to indicate medication is effective: Monitor BP, pulse (45), ECG (decreased BP, pulse), I’s and O’s (normal to increased urine output), daily weights (no weight gain indicative of edematous HF) Medication administration concerns: take apical pulse for 1 min (withhold if arrythmatic or <50) hold under 45, monitor signs of HF NO LONGER FIRST LINE however given after MI for ventricular remodeling and protection, use in caution with brittle diabetics (masks s/e of hypoglycemia UNTIL SEVERE) ; abrupt withdrawl can result in life threatening arrhythmias; anesthesia and verapamil (periph and central acting CCB) can exacerbate myocardial depression; additive bradycahrdia can occur with digoxin, additivie hypotension with antihypertensives Patient/client teaching points: Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed, Inform pt of fall risk status and interventions to prevent falls Don’t withdraw immediately Generic Name:captopril Classification: ACE inhibitor Why is patient/client receiving this? FIRSTLINE antihypertensive, also used to decrease progression of diabetic nephropathy; can retain K+ Dosage/Route: Hypertension: PO 12.5-25 mg 2-3 times daily, can be increased up to 150 mg 3 times daily HF and diabetic nephropathy: 25 mg PO 3xdaily MI: 12.5 mg 3x daily Rate of administration with IV meds: N/A IV diluents compatible with IV medication: N/A Major Side effects: -CNS: fatigue, weakness, anxiety, depression, drowsiness, insomnia, -EENT: blurred vision-RESP: cough-CV: hypotension, chest pain, edema, tachycardia -GI: metallic taste, constipation, diharrhea, constipation, abd pain –renal dysfunction -DERM: rashes - HEMAT: agranulocytomas, neutropenia -angioedema, fever Data used to indicate medication is effective: Monitor BP, pulse (45), ECG (decreased BP, pulse), monitor for signs of angioedema (Life threatening) , monitor for signs of neutropenia Medication administration concerns: increased risk of hypotension with other hypertensives AND hyperkalemia with potassium sparing diuretics Patient/client teaching points: Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed, Inform pt of fall risk status and interventions to prevent falls; notify signs of angioedema, Generic name: lisinopril Classification: ACE Inhibitor Why is patient/client receiving this? HTN and HF Dosage/Route: Hypertension: 10 mg PO once daily HF: 5 mg PO once daily Dose should be reduced for geriatric patients Major Side effects: -CNS: dizziness, drowsiness, fatigue, HA, vertigo, weakeness -RESP: cough, dyspnea -CV: hypotension, chest pain, edema, tachycardia -GI: taste disturbances-GU: renal dysfunction, renal failure-F/E: hyperkalemia -ENDO: hyperuricimia -angioedema Data used to indicate medication is effective: Monitor BP, pulse (decreased BP), decreased signs of HFMedication administration concerns: Signs of angioedema (facial swelling, dyspnea) and HF Patient/client teaching points: Pt should avoid salt substitues containing high levels of potassium or sodium, Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed, Major side effect of ACE Inhibitors is cough which may exacerbate symptoms of COPD, Change in taste is temporary, Notify nurse for rash, mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, swelling of face, difficulty breathing (hypersensitivity reaction) Generic name: acetazolamide Brand name Diamox Classification: Proximal diuretic Why is patient/client receiving this? Altitude sickness, decrease pressure in retinopathy, edema due to HF; inhibits carbonic anhydrase, decreases reabsorption of HCO3-, increases osmotic diuresis Dosage/Route: PO: glaucoma- 250-1000 mg/day 1-4 divided doses Epilepsy: 4-16 mg/kg/day in 1-4 divided doses altitutde sickness: 250 mg 2-4 times/day edema: 250-375 mg/day IV:glaucoma: 250-500 mg/day; Edema: 250-375 mg/day Rate of administration with IV meds: Direct IV: not to exceed 500 mg/min Intermittent: 15-30 min IV diluents compatible with IV medication:Direct IV: reconstitute 500 mg in 5mL of sterile water Intermittent: 50-100 mL D5W, NS, D10W, 1/2Saline, LR []=5-10 mg/mL Major Side effects: -CNS: depression, fatigue, weakness, -EENT: transient nearsightedness, -GI: anorexia, metallic taste, N/V, -Endo: Hyperglycemia, -Hemat: hemolytic anemia, aplastic anemia, leukopenic anemia METAB: weight loss; -Allergic reaction incl. anaphylaxis Data used to indicate medication is effective: reduction of edema Medication administration concerns: creates alkaline urine increases renal excretion of weak acid medications; contraindicated in someone with hepatic failure, give with meal to ease GI distress; SULFA allergy, encourage fluids to prevent renal stones (2000-3000 mL per day) Patient/client teaching points: Pt should avoid salt substitues containing high levels of potassium or sodium, Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed, Major side effect of ACE Inhibitors is cough which may exacerbate symptoms of COPD, Change in taste is temporary, Notify nurse for rash, mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, swelling of face, difficulty breathing (hypersensitivity reaction) Generic Name:hydrochlorothiazide Classification: early distal diuretic Why is patient/client receiving this? Management of mild to moderate HTN, treatment of edema associated with HF, renal dysfunction, cirrhosis, glucocorticoid therapy and estrogen therapy Dosage/Route: Hypertension: PO 125 mg-2g/day in 1-2 days IV: 500 mg-1 g/day in 1-2 divided doses Rate of administration with IV meds: direct 3-5 minIV diluents compatible with IV medication: Reconstitute with 18mL of sterile water; diluted further with NS or D5W [conc up to 28 mg/mL]Major Side effects: -CNS diziness, drowsiness, lethargy, weakness -EENT: blurred vision-RESP: cough-CV: hypotension -GI: anorexia, cramping, hepatitis, n/v pancreatitis -DERM:photosensitivity, rashes -Fand E: hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnamesia, hyponatremia, hypophosphytemia, hypovolemia - HEMAT: thrombocytopenia -hyperuricemia Data used to indicate medication is effective: monitor daily weight, Is and Os, BP, assess for symptoms especially with digoxin (can cause digoxin toxicity), Medication administration concerns: SULFA Allergy, administer in morning to avoid disruption, may give with food or milk to minimize GI Patient/client teaching points: Take caution in repositioning in bed, take several minutes to move from lying down, to sitting up, to getting out of bed, Inform pt of fall risk status and interventions to prevent falls; use sunscreen and protective cloting, Generic Name:spironolactone Classification: potassium sparing diuretic Why is patient/client receiving this? Counteract K+ loss, used with thiazides to treat edema/hypertension; primary aldosteronism; hormonal antagonist to aldosterone Dosage/Route: PO: Edema 25-200 mg/day in 1-2 doses; HTN: 50-100 mg/day Rate of administration with IV meds:IV diluents compatible with IV medication: Major Side effects: -CNS dizziness, clumsiness, headache –CV: arrhythmias, DERM: photosynsetivity ENDO: breast tenderness, gynecomastia, hirstruism, FandE: hyperkalemia, hyponatremia, HEMAT: agranulocytoma Data used to indicate medication is effective: Monitor Is and Os, daily weights, assess for signs of hypokalemia or hyperkalemia (Increased risk with diabetic pts), assess for rashes Medication administration concerns: Increased risk of hyperkalemia when used with ACE inhibitors, ARBS, NSAIDS, may increase toxicity from lithium, increase effects of digoxin, effectiveness decreased by NSAIDS Patient/client teaching points: Avoid salt substitutes, may cuase dizziness, rash, muscle weakness or cramps, Generic Name:mannitol Classification: osmotic diuretic Why is patient/client receiving this? IV used for treatment of acute oliguric renal failure, edema, increased intracranial or intraocular pressure Dosage/Route: IV: edema, renal failure 50-100 g as a 5-25% solution; reduction of intracranial/intraocular pressure: .25-2 g/kg as 15-25% solution over 30-60 min Rate of administration with IV meds: Oliguria: 30-50 ml/hr; increased intracranial pressure: dose over 30-60 min; intraocular admin over 30 min IV diluents compatible with IV medication: Uniluted, if crystalized warm up with water bath Major Side effects: -CNS confusion, HA, EENT: blurred vision, rhinitis, CV: volume expansion, chest pain, HF, pulmonary edema, tachycardia, GI: n/v thirst, GU: renal failure, urinary retention, FandE: dehydration, hyperkalemia, hypernatremia, hypokalemia, hyponatremia, -Phlebitis at site Data used to indicate medication is effective: monitor vital signs, urine output, pulm. Artery pressures, assess for s/s of dehydration or fluid overload, neurological statusMedication administration concerns: Increased risk of digoxin toxicity Patient/client teaching points: SIGNS EFFECTIVE: 30-50 cc/hr Generic Name:losartanBrand name: Cozaar Classification: angiotensin II receptor blocker Why is patient/client receiving this? HTN, treatment of diabetic nephropathy, prevention of stroke in patients with HTN and left ventricular hypertrophy VASODIALATION Dosage/Route: PO: hypertension: 50 mg once daily initially Hepatic impairment: 25 mg initially Rate of administration with IV meds: IV diluents compatible with IV medication: Major Side effects: less side effects -CNS: dizziness, anxiety, depression; CV: hypotension, chest pain, edema, tachycardia, Derm: rashes, EENT: nasal congestion, pharyngitis/rhinitis/sinusitis, GI: abd pain, diarrhea, GU: impaired renal function FandE: hyperkalemia ANGIOEDEMA Data used to indicate medication is effective: assess orthostatics, monitor for signs of ANGIOEDEMA, daily weight, monitor for fluid overload Medication administration concerns: Should not be used with DRI, may not be effective in blacks, NSAIDS and COX-2 Inhibitors may block hypertensive effects and increase renal effects; may increase serum digoxin levels ; can retain K+ (not as well as ACE but can increase risk of hyperkalemia) Patient/client teaching points: SIGNS EFFECTIVE: avoid salt substitutes high in potassium, hypotension (fall risk), Generic Name aliskirenBrand name: Tekturna Classification: direct renin inhibitor (DRI) Why is patient/client receiving this? HTN (NO RENAL PROTECTION AT ALL) Dosage/Route: PO: 150 mg/day initially, can be increased up to 300 mg Rate of administration with IV meds: IV diluents compatible with IV medication: Major Side effects: less side effects -RESP: cough, CV: hypotension, GI: abdpain, diarrhea, dyspespsia, reflux, ANGIOEDEMA Data used to indicate medication is effective: monitor bp and pulse frequently Medication administration concerns: Contraindicated in hypersensitivity, and concurrent use with ACE inhibitor or ARBS in patients with diabetes or moderate to severe renal impairment Patient/client teaching points: SIGNS EFFECTIVE: antihypertensive effects 90% achieved in 2 weeks Generic Name:verapamil Brand name: Classification: calcium channel blocker Why is patient/client receiving this? HTN, treatment of angina, prophylaxis of vasc. HA, (Negative notrope, negative dromotrope [autorhythmicity of SA]) Acts at arteries AND heart Dosage/Route: PO: 80-120 mg 3 times daily Extended release 120-240 mg/single dose IV: 5-10 (75-150 mcg/kg); may repeat with 10mg after 15-30 min Rate of administration with IV meds: 2 minIV diluents compatible with IV medication: undiluted, concentration= 2.5mg/mL Major Side effects: -CNS: abnormal dreams, anxiety, confusion, dizziness/lightheadednesss, psychiatric disturbances, EENT: blurred vision, disturbed equilibrium, epistaxis, RESP: cough, dyspnea, SOB CV: arrhythmias, HF, bradycardia, chest pain, hypotension, palpations, edema of lower extremities GI: increase liver enzymes, constipation, diarrhea, GU: dysuria, polyuria, frequency DERM: rash, photosensitivity, ENDO: gynecomastiaData used to indicate medication is effective: monitor bp and pulse frequently MUST HAVE PULSE OF 45, monitor ecg can result in prolonged PR interval, monitor Is and Os, signs of HF, monitor for angina Medication administration concerns: use in caution with decreased kidney/liver function, effects dampened by NSAIDs, may increase serum digoxin levels; MAY MAKE HF worse; grape juice can increase serum levels, more effective in blacks Patient/client teaching points: SIGNS EFFECTIVE: urinary frequency (fall risk interventions) , encourage pts to continue taking medications for angina (nitro, beta blockers) Generic Name:diltiazemBrand name: Classification: calcium channel blocker Why is patient/client receiving this? HTN, angina, supraventricular achyarrhythmias and rapid ventricular rates in atrial flutter or fibrillation Dosage/Route: PO: 30-120 mg 3-4 times daily or 60-120 mg twice dailyIV: .25 mg/Kg may repeat with .35mg/Kg after 15-30 min Rate of administration with IV meds: 2 minIV diluents compatible with IV medication: undiluted, concentration= 5mg/mL Major Side effects: less side effects -CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, nervousness, psychiatric disturbances, weakenss EENT: blurred vision, disturbed equilibrium RESP: cough, dyspnea CV: arrhythmias, HF, peripheral edema, bradycardia, chest pain, hypotension, palpations, syncope, tachycardia GU: nocturia, polyuria, GI: n/v, Derm: photosensitivity, rash; ENDO: gynecomastia, hyperglycemia, HEMAT: anemia, leukopenia, thrombocytopenia Data used to indicate medication is effective: monitor bp and pulse frequently MUST HAVE PULSE OF 45, monitor ecg can result in prolonged PR interval, monitor Is and Os, signs of HF, monitor for angina Medication administration concerns: use in caution with decreased kidney/liver function, effects dampened by NSAIDs, may increase serum digoxin levels; MAY MAKE HF worse; grape juice can increase serum levels, more effective in blacks Patient/client teaching points: SIGNS EFFECTIVE: urinary frequency (fall risk interventions) , encourage pts to continue taking medications for angina (nitro, beta blockers) Generic Name:amlodipineBrand name: Classification: calcium channel blocker Why is patient/client receiving this? Acts only in periphery; HTN and angina Dosage/Route: PO: 5-10 mg once daily Rate of administration with IV meds: IV diluents compatible with IV medication: Major Side effects: less side effects -CNS: dizziness, fatigue; CV: peripheral edema, angina, bradycardia, hypotension, palpitations Data used to indicate medication is effective: monitor bp and pulse frequently MUST HAVE PULSE OF 45, monitor is and os daily weight, signs of HF, assess angina Medication administration concerns: use MAY MAKE HF worse; grape juice can increase serum levels, more effective in blacks Patient/client teaching points: SIGNS EFFECTIVE: dizziness, avoid grape juice Generic Name:hydralazine Brand name: Classification: vasodilator Why is patient/client receiving this? Moderate to severe HTN w/ diuretic, HF unresponsive to conventional therapy (arterioles with no sympathetic action) Dosage/Route: PO: 10 mg 4 times daily initially, may increase up to 25mg 4 times daily and then up to 50 mg 4 times daily (up to 300 mg/day), once maintenance is achieved, should use twice daily IV: .5-40 mg repeated as needed Eclampsia: 5 mg q 15-20 min pH 3.4-4Rate of administration with IV meds: 1min IV diluents compatible with IV medication: undiluted, concentration= 20mg/mL Major Side effects: less side effects -CNS: dizziness, drowsiness, HA CV: REFLEX TACHYCARDIA angina, arrhythmias, edema, orthostatic hypotension; GI: diharrhea, N/V DERM: rash, Fand E: NA Retention –MISC drug induced lupus syndrome Data used to indicate medication is effective: monitor bp and pulse frequently, be aware of slow acetylator which poses risk for toxicity, some rapid leading to treatment failureMedication administration concerns: more significant drop in diastolic pressure, Patient/client teaching points: SIGNS EFFECTIVE: orthostatic hypotension (fall risk interventions) , encourage pts weigh twice a week at home, monitor for signs of HFGeneric Name:clonidine Brand name: Classification: central acting adrenergics Why is patient/client receiving this? Moderate HTN; stimulates alpha adrenergic receptors in CNS which results in decreased sympathetic outflow Dosage/Route: PO: 100 mcg BID, increase by 100-200 mcg/day q 2-4 days until 200-600 mcg/day in 2-3 divided dosesTransdermal: 100-300 mcg/24 hr applied every 7 days Major Side effects: less side effects -CNS: dizziness, drowsiness, depression CV: hypotension, AV block, bradycardia; GI: diharrhea, N/V DERM: rash, Fand E: NA Retention –MISC withdrawl phenomenon Data used to indicate medication is effective: monitor bp and pulse, Is and Os, daily weight, pain, opioid withdrawl (tachycardia, fever, runny nose, diarrhea, sweating, n/v, irritability, stomach cramps, shivering, large pupils, difficulty sleeping) Medication administration concerns: RISK OF REBOUND HTN AND CAN AFFECT ALPHA 1 LEADING TO SEVERE HTN CRISIS Patient/client teaching points: Generic Name:digoxin Brand name: Classification: digitalis glycosilide HIGH ALERTWhy is patient/client receiving this? HF, atrial fib and atrial flutter paroxysmal atrial tachycardia (positive inotrope, negative chronotrope and dromotrope; increases refractory period Dosage/Route: IV: .5-1 mg given as ? dose initially and one quare of initial dose in each of 2 subsequent doses at 6-12 hrs PO: .75-1.5 mg given as 50% dose initially and one quarer of initial dosein each of 2 subsequent doses at 6-12 hr intervals Direct; undiluted or dilute 1 mL in 4mL of sterile water for IM injection, D5W or NS Admiinster over at least 5 min Major Side effects: less side effects -CNS: fatigue, HA, weakenss, EENT: blurred, yellow or green vision, CV: arrhythmias, bradycardia, ECG changes, AV block, SA block GI: anorexia, n/v, Hemat: thrombocytopenia, Metab: electrolyte imbalances Data used to indicate medication is effective: monitor bp and pulse, APICAL for 1 full minute, must be above 60, Monitor ECG through IV administration and each dose (notify for bradycardia or new rythms), monitor is and os, daily weights, asses for edema, auscultate for rales/crackles Medication administration concerns: loop diuretics, thiazide, corticosteroids and laxatives may cause hypokalemia which can result in toxicity; addative bradycardia with betablockers, diltiazem (CCB), verapamil (CCB) clonidine (vasodialator), use with sympathomimetics may increase risk of toxicity DIGITALIS TOXICITY: biggest sign is unresponsiveness with dose Goals: Decrease HR, Increase CO ................
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