Download General Use

DRUG CLASSIFICATIONS
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Pharmacologic Profile
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General Use
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General Action and
Information
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Refers to all information
presented in drug
reference book
How is the medication
used?
How does the medication
work? What ‘other’
information is needed
before reading further
◦ Contraindications
◦ Precautions
◦ Interactions
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Why shouldn’t a pt
take this?
What does the nurse
need to do before
administering the
medication?
What medications
interfere with normal
drug action?
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Nursing Implications
Potential Nursing
Diagnoses
Implementation
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Actions and thoughts
the nurse has before
administering the
medication
Added feature in some
drug books
Actions the nurse takes
while administering
medications
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Patient/Family
Teaching
Evaluation / Desired
Outcomes
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Suggestions for the
nurse to use to educate
pt and family about
ordered
medications
What is expected if the
medication has been
successful
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General Use:
◦ Management of Alzheimer’s Dementia
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General Action:
◦ All agents act by increasing the amount of
acetylcholine in the CNS by inhibiting
cholesterase
◦ No agents can slow the progression of A.D.
◦ Current agents may temporarily improve
cognitive function and therefore improve quality
of life
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Nursing Implications:
◦ Assessment
 Assess cognitive function throughout therapy
 Monitor nausea, vomiting, anorexia, and weight
loss
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Medications:
◦ donepezil (Aricept)
◦ rivastigmine (Exelon)
◦ Memantine (Namenda)
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General Use:
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Prevention and treatment of anemias
General Action:
◦ For iron deficiency anemia to promote transport
of hemoglobin
◦ For water soluble vitamins needed for RBC
production
◦ For low RBC count to promote production of RBC
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Nursing Implications:
◦ Assessment
 Assess patient’s nutritional status and dietary
history to determine possible causes for anemia
 Assess for patient teaching needs
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Medications:
◦ iron polysaccharide (Niferex)
◦ epoetin (Epogen)(Procrit)
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General Use:
◦ Nitrates are used to treat and prevent attacks of
angina
◦ Calcium channel blockers and beta blockers are
used prophylactically in long-term management
of angina
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General Action:
◦ Nitrates dilate coronary arteries and cause
systemic vasodilation
◦ Calcium channel blockers dilate coronary arteries
◦ Beta blockers decrease myocardial O2
consumption
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Nursing Implications:
◦ Assessment
 Assess location, duration, intensity, and
precipitating factors of pt’s anginal pain
 Monitor BP and pulse periodically throughout
therapy
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Medications:
◦ atenolol (Tenormin)
◦ nitroglycerin (Nitro-Dur)
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General Use:
◦ Used in mgmt of various forms of anxiety
including generalized anxiety disorder
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General Action:
◦ Most agents cause generalized CNS depression
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Nursing Implications:
◦ Assessment
 Assess degree of anxiety and level of sedation
before and periodically throughout therapy
 Prolonged high-dose therapy may lead to
physical or psychological dependence
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Medications:
◦ benzodiazepines
 alprazolam (Xanax)
lorazapam (Ativan)
 diazepam (Valium)
SSRI’s
paroxetine hcl
(paxil)
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General Use:
◦ Suppression of cardiac arrhythmias
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General Action:
◦ Correct cardiac arrhythmias by a variety of
mechanisms, depending on group used.
◦ Goal symptomatology
 Hemodynamic performance
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Nursing Implications:
◦ Assessment
 Monitor ECG, pulse and BP periodically
throughout oral administration
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Medications:
Lanoxin/Digoxin
◦ propranolol (Inderal)
◦ amiodarone (Cordarone)
◦ Cardizem
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General Use:
◦ Prevention and treatment of thromboembolic
disorders including DVT, PE and A Fib w/ emboli
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General Action:
◦ Used to prevent clot extension and formation
◦ DO NOT dissolve clots
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Nursing Implications:
◦ Assessment
 Assess for signs of bleeding / hemorrhage
 Monitor bleeding time
 Toxicity / Overdose – needs to be reversed
immediately. Use protamine sulfate for Heparin
and Vitamin K for Warfarin
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Medications:
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fondaparinux (Arixtra)
Heparin (PTT)
warfarin (Coumadin) (PT/INR)
Lovenox
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General Use:
◦ Used to
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incidence / severity of seizures
General Action:
◦ Depresses abnormal neuronal discharges in CNS
that may result in seizures
◦ May also work by preventing spread of seizure
activity; depressing motor cortex; raising seizure
threshold; or altering levels of neurotransmitters
depending on the group.
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Nursing Implications:
◦ Assessment
 Assess location, duration, and characteristic of
seizure activity
 Monitor serum drug levels routinely
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Medications:
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phenobarbital (Luminal)
diazepam (Valium)
phenytoin (Dilantin)
valproic Acid (Depakene)
Tegretol
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General Use:
◦ Used in tx of endogenous depression, often in
conjunction with psychotherapy
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General Action:
◦ Attempts to prevent the reuptake of dopamine,
norepinephrine, and serotonin by presynaptic
neurons, resulting in accumulation of these
neurotransmitters.
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Nursing Implications:
◦ Assessment
 Assess mental status and affect
 Assess for suicidal tendencies
 Restrict amount of drug available to pt
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Medications:
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duloxetine (Cymbalta)
amitriptyline (Elavil)
phenelzine (Nardil)
Zoloft
Paxil
Prozac
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General Use:
◦ Used in mgmt of type 1 and type 2 Diabetes
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General Action:
◦ Insulin lowers blood glucose by transport of
glucose into cells and promotes conversion of
glucose to glycogen
◦ Oral medications stimulate secretion of insulin by
beta cells
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Nursing Implications:
◦ Assessment
 Observe for s&s of hypoglycemic reaction
 Monitor serum glucose
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Medications:
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metformin (Glucophage)
glyburide (Diabeta)
Pioglitazone (Actos)
liraglutide (Victoza)
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General Use:
◦ Used to manage nausea & vomiting of many
causes
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General Action:
◦ Act on the chemoreceptor trigger zone to inhibit
n&v
◦ Some act by diminishing motion sickness
◦ Others decrease n&v by its effect on gastric
emptying
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Nursing Implications:
◦ Assessment
 Assess n&v, bowel sounds, abdominal pain
before and following administration
 Monitor hydration; I&O
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Medications:
◦ ondansetron (Zofran)
◦ promethazine (Phenergan)
◦ metoclopramide (Reglan)
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General Use:
◦ Tx of hypertension of many causes, most
commonly essential HTN
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General Action:
◦ Used to lower blood pressure to a normal level
or to the lowest level tolerated
◦ Classified into groups according to their site of
action
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Nursing Implications:
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Medications:
◦ Assessment
 Monitor BP, pulse frequently during dosage
adjustment and periodically throughout therapy
 Monitor I&O
 Monitor compliance through frequency of refills
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clonidine (Catapres)
ramipril (Altace)
olmesartan (Benicar)
propranolol (Inderal)
metoprolol (Lopressor)
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General Use:
◦ Treatment and prophylaxis of various bacterial
infections
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General Action:
◦ Kill (bacteriocidal) or inhibit growth
(bacteriostatic)
of susceptible pathogenic bacteria
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Nursing Implications:
◦ Assessment
 Assess for s&s of infection prior to and
throughout tx
 Check allergies especially for penicillin &
cephalosporins
 Obtain specimens for C&S prior to beginning tx
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Medications:
◦ gentamicin (Garamycin)
◦ piperacillin / tazobactam (Zosyn)
◦ levofloxacin (Levaquin)
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General Use:
◦ Used for tx of various solid tumors, lymphomas
and leukemias
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General Action:
◦ Act by many different mechanisms
◦ Action may not be limited to neoplastic cells
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Nursing Implications:
◦ Assessment
 Monitor for bone marrow depression
 Assess for bleeding (gums, bruising, urine
etc)
 Monitor I&O, appetite, nutritional intake
 Monitor IV site carefully & maintain patency
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Medications:
◦ methotrexate (Folex)
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General Use:
◦ Used to tx and prevent thromboembolic events
such as stroke and MI
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General Action:
◦ Inhibit platelet aggregation
◦ Prolongs bleeding time
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Nursing Implications:
◦ Assessment
 Assess pt for s&s increased thrombosis
 Monitor bleeding time
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Medications:
◦ dipyridamole (Persantine)
◦ clopidogrel (Plavix)
◦ Asprin
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General Use:
◦ Tx of acute and chronic psychoses, particularly
when accompanied by increased psychomotor
activity
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General Action:
◦ Blocks dopamine receptors in the brain
◦ Alters dopamine release and turnover
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Nursing Implications:
◦ Assessment
 Assess pt’s mental status before / periodically
 Monitor BP, pulse, resp before / frequently
 Observe pt taking meds to prevent hoarding
 Monitor pt for onset of akathisia, parkinsonian
and dystonia, tardive dyskinesia
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Medications:
◦ chlorpromazine (Thorazine)
◦ risperidone (Risperdal)
◦ Haldol
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General Use:
◦ Used in replacement doses systemically to tx
adrenocortical insufficiency
◦ Larger doses used for the anti-inflammatory,
immunosuppressive, or antineoplastic activity
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General Action:
◦ Produce profound and varied metabolic effects
◦ Modify normal immune response
◦ Suppresses inflammation
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Nursing Implications:
◦ Assessment
 Assess involved systems
 Assess for signs of adrenal insufficiency
 Children should have periodic evaluations of
growth
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Medications:
◦ hydrocortisone (Solu-Cortef)
◦ methylprednisolone ( Solu-Medrol)
◦ dexamethasone (DexPak)
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General Use:
◦ Thiazide and loop diuretics used for tx HTN,
edema d/t CHF or other causes
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General Action:
◦ Enhance selective excretion of various
electrolytes and water by affecting renal
mechanisms for tubular secretion and
reabsorption
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Nursing Implications:
◦ Assessment
 Assess fluid status throughout tx
 Monitor daily wt, I&O, amt & location edema,
lung sounds, skin turgor, mucous membranes
 Monitor electrolytes – esp potassium
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Medications:
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furosemide (Lasix)
mannitol (Osmitrol)
hydrochlorothiazide (HCTZ)
Aldactone
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General Use:
◦ Used in tx of deficiency states including diabetes,
hypothyroidism, menopause
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General Action:
◦ Natural or synthetic substances have specific
effect on target tissue
◦ Differ greatly in their effects depending on
individual agent and function or target tissue
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Nursing Implications:
◦ Monitor pt for sx’s of hormonal excess or
insufficiency
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Medications:
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calcitonin (Miacalcin)
estrogens
levothyroxine (Synthroid)
insulins
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General Use:
◦ Used to control mild to moderate pain and/or
fever
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General Action:
◦ Most inhibit prostaglandin synthesis
 peripherally for analgesic effect
 Centrally for antipyretic effect
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Nursing Implications:
◦ Assessment
 Assess pain and limitation of movement
 Assess fever; note associated S&S
 Monitor liver, renal and hematologic lab values
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Medications:
◦ ibuprofen
◦ ASA
◦ acetaminophen
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General Use:
◦ Used to control mild to moderate pain, fever , and
various anti-inflammatory conditions
General Action:
NSAIDs have analgesic, antipyretic and antiinflammatory properties
Analgesic and anti-inflammatory are d/t
inhibition of prostaglandins
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Nursing Implications:
◦ Pts w/ asthma, allergies and nasal polyps more at
risk for hypersensitivity.
◦ Assess pain, limitation of movement, fever
◦ Evaluate effectiveness
◦ Most NSAIDS prolong bleeding time due to
suppressed platelet aggregation
◦ Monitor for GI blood loss – give w/ food
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Medications:
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ibuprofen - Advil, Motrin
naproxen sodium – Aleve
celecoxib – Celebrex
Ketorolac - Toradol
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General Use:
◦ Mgmt moderate to severe pain
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General Action:
◦ Opioids bind to opiate receptors in the CNS
◦ Alters perception of and response to pain
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Nursing Implications:
◦ Assessment
 Assess pain – type, location, intensity
 Assess BP, pulse, resp before and during therapy
 Assess prior analgesic hx
 Assess bowel function periodically
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Medications:
fentanyl transdermal (Duragesic)
hydromorphone (Dilaudid)
oxycodone (Oxycontin)
Morphine
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General Use:
◦ Sedatives provide sedation
◦ Hypnotics are used to manage insomnia
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General Action:
◦ Cause generalized CNS depression
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Nursing Implications:
◦ Assessment
 Monitor BP, pulse, resp status frequently w/ IV
 Assess sleep patterns if for insomnia
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Medications:
◦ phenobarbital (Luminal)
◦ lorazepam (Ativan)
◦ zolpidem (Ambien)
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General Use:
◦ Spasticity associated w/ spinal cord lesions
◦ Symptomatic relief of acute painful MS conditions
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General Action:
◦ Act either centrally or directly to relax muscle
fibers
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Nursing Implications:
◦ Assessment
 Assess for pain, muscle stiffness, ROM before
and periodically throughout tx
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Medications:
◦ Flexaril
◦ baclofen (Lioresal)
◦ diazepam (Valium)
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General Use:
◦ Acute mgmt coronary thrombosis (MI)
◦ Mgmt massive pulmonary emboli, DVT, arterial
thromboembolism
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General Action:
◦ Converts plasminogen to plasmin which then
breaks down fibrin in clots
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Nursing Implications:
◦ Begin tx ASAP after onset sx’s
◦ Monitor VS q 4 hours
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Medications:
◦ streptokinase (Streptase)
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General Use:
◦ Acute vascular headaches
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General Action:
◦ Smooth muscle vasoconstriction
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Nursing Implications:
◦ Assessment
 Assess pain, location, intensity, duration
 Assess for photophobia, phonophobia, n&v
 Assess for frequency of migraine attacks
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Medications:
◦ ergotamine (Ergomar)
◦ sumatriptan (Imitrex)
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Statin drugs
Pravastatin (Pravachol)
Atorvastatin (Lipitor)
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Assess for severe muscle soreness
Meds should always be taken in the evening
(6pm).
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-dopa drugs.
levadopa
carbidopa (Lodosyn)
(Sinemet) – mix of Levodopa and Carbidopa.
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There are more classifications listed in the
12th Edition of Davis Drug Guide
Additional review of these classifications will
occur during the coming ‘systems’ lectures
Independent study is always an option as
well!