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DRUG CLASSIFICATIONS Pharmacologic Profile General Use General Action and Information 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 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? Nursing Implications Potential Nursing Diagnoses Implementation Actions and thoughts the nurse has before administering the medication Added feature in some drug books Actions the nurse takes while administering medications Patient/Family Teaching Evaluation / Desired Outcomes Suggestions for the nurse to use to educate pt and family about ordered medications What is expected if the medication has been successful General Use: ◦ Management of Alzheimer’s Dementia 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 Nursing Implications: ◦ Assessment Assess cognitive function throughout therapy Monitor nausea, vomiting, anorexia, and weight loss Medications: ◦ donepezil (Aricept) ◦ rivastigmine (Exelon) ◦ Memantine (Namenda) General Use: 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 Nursing Implications: ◦ Assessment Assess patient’s nutritional status and dietary history to determine possible causes for anemia Assess for patient teaching needs Medications: ◦ iron polysaccharide (Niferex) ◦ epoetin (Epogen)(Procrit) 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 General Action: ◦ Nitrates dilate coronary arteries and cause systemic vasodilation ◦ Calcium channel blockers dilate coronary arteries ◦ Beta blockers decrease myocardial O2 consumption Nursing Implications: ◦ Assessment Assess location, duration, intensity, and precipitating factors of pt’s anginal pain Monitor BP and pulse periodically throughout therapy Medications: ◦ atenolol (Tenormin) ◦ nitroglycerin (Nitro-Dur) General Use: ◦ Used in mgmt of various forms of anxiety including generalized anxiety disorder General Action: ◦ Most agents cause generalized CNS depression 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 Medications: ◦ benzodiazepines alprazolam (Xanax) lorazapam (Ativan) diazepam (Valium) SSRI’s paroxetine hcl (paxil) General Use: ◦ Suppression of cardiac arrhythmias General Action: ◦ Correct cardiac arrhythmias by a variety of mechanisms, depending on group used. ◦ Goal symptomatology Hemodynamic performance Nursing Implications: ◦ Assessment Monitor ECG, pulse and BP periodically throughout oral administration Medications: Lanoxin/Digoxin ◦ propranolol (Inderal) ◦ amiodarone (Cordarone) ◦ Cardizem General Use: ◦ Prevention and treatment of thromboembolic disorders including DVT, PE and A Fib w/ emboli General Action: ◦ Used to prevent clot extension and formation ◦ DO NOT dissolve clots 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 Medications: ◦ ◦ ◦ ◦ fondaparinux (Arixtra) Heparin (PTT) warfarin (Coumadin) (PT/INR) Lovenox General Use: ◦ Used to 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. Nursing Implications: ◦ Assessment Assess location, duration, and characteristic of seizure activity Monitor serum drug levels routinely Medications: ◦ ◦ ◦ ◦ ◦ phenobarbital (Luminal) diazepam (Valium) phenytoin (Dilantin) valproic Acid (Depakene) Tegretol General Use: ◦ Used in tx of endogenous depression, often in conjunction with psychotherapy General Action: ◦ Attempts to prevent the reuptake of dopamine, norepinephrine, and serotonin by presynaptic neurons, resulting in accumulation of these neurotransmitters. Nursing Implications: ◦ Assessment Assess mental status and affect Assess for suicidal tendencies Restrict amount of drug available to pt Medications: ◦ ◦ ◦ ◦ ◦ ◦ duloxetine (Cymbalta) amitriptyline (Elavil) phenelzine (Nardil) Zoloft Paxil Prozac General Use: ◦ Used in mgmt of type 1 and type 2 Diabetes 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 Nursing Implications: ◦ Assessment Observe for s&s of hypoglycemic reaction Monitor serum glucose Medications: ◦ ◦ ◦ ◦ metformin (Glucophage) glyburide (Diabeta) Pioglitazone (Actos) liraglutide (Victoza) General Use: ◦ Used to manage nausea & vomiting of many causes 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 Nursing Implications: ◦ Assessment Assess n&v, bowel sounds, abdominal pain before and following administration Monitor hydration; I&O Medications: ◦ ondansetron (Zofran) ◦ promethazine (Phenergan) ◦ metoclopramide (Reglan) General Use: ◦ Tx of hypertension of many causes, most commonly essential HTN 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 Nursing Implications: Medications: ◦ Assessment Monitor BP, pulse frequently during dosage adjustment and periodically throughout therapy Monitor I&O Monitor compliance through frequency of refills ◦ ◦ ◦ ◦ ◦ clonidine (Catapres) ramipril (Altace) olmesartan (Benicar) propranolol (Inderal) metoprolol (Lopressor) General Use: ◦ Treatment and prophylaxis of various bacterial infections General Action: ◦ Kill (bacteriocidal) or inhibit growth (bacteriostatic) of susceptible pathogenic bacteria 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 Medications: ◦ gentamicin (Garamycin) ◦ piperacillin / tazobactam (Zosyn) ◦ levofloxacin (Levaquin) General Use: ◦ Used for tx of various solid tumors, lymphomas and leukemias General Action: ◦ Act by many different mechanisms ◦ Action may not be limited to neoplastic cells 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 Medications: ◦ methotrexate (Folex) General Use: ◦ Used to tx and prevent thromboembolic events such as stroke and MI General Action: ◦ Inhibit platelet aggregation ◦ Prolongs bleeding time Nursing Implications: ◦ Assessment Assess pt for s&s increased thrombosis Monitor bleeding time Medications: ◦ dipyridamole (Persantine) ◦ clopidogrel (Plavix) ◦ Asprin General Use: ◦ Tx of acute and chronic psychoses, particularly when accompanied by increased psychomotor activity General Action: ◦ Blocks dopamine receptors in the brain ◦ Alters dopamine release and turnover 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 Medications: ◦ chlorpromazine (Thorazine) ◦ risperidone (Risperdal) ◦ Haldol General Use: ◦ Used in replacement doses systemically to tx adrenocortical insufficiency ◦ Larger doses used for the anti-inflammatory, immunosuppressive, or antineoplastic activity General Action: ◦ Produce profound and varied metabolic effects ◦ Modify normal immune response ◦ Suppresses inflammation Nursing Implications: ◦ Assessment Assess involved systems Assess for signs of adrenal insufficiency Children should have periodic evaluations of growth Medications: ◦ hydrocortisone (Solu-Cortef) ◦ methylprednisolone ( Solu-Medrol) ◦ dexamethasone (DexPak) General Use: ◦ Thiazide and loop diuretics used for tx HTN, edema d/t CHF or other causes General Action: ◦ Enhance selective excretion of various electrolytes and water by affecting renal mechanisms for tubular secretion and reabsorption 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 Medications: ◦ ◦ ◦ ◦ furosemide (Lasix) mannitol (Osmitrol) hydrochlorothiazide (HCTZ) Aldactone General Use: ◦ Used in tx of deficiency states including diabetes, hypothyroidism, menopause 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 Nursing Implications: ◦ Monitor pt for sx’s of hormonal excess or insufficiency Medications: ◦ ◦ ◦ ◦ calcitonin (Miacalcin) estrogens levothyroxine (Synthroid) insulins General Use: ◦ Used to control mild to moderate pain and/or fever General Action: ◦ Most inhibit prostaglandin synthesis peripherally for analgesic effect Centrally for antipyretic effect Nursing Implications: ◦ Assessment Assess pain and limitation of movement Assess fever; note associated S&S Monitor liver, renal and hematologic lab values Medications: ◦ ibuprofen ◦ ASA ◦ acetaminophen 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 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 Medications: ◦ ◦ ◦ ◦ ibuprofen - Advil, Motrin naproxen sodium – Aleve celecoxib – Celebrex Ketorolac - Toradol General Use: ◦ Mgmt moderate to severe pain General Action: ◦ Opioids bind to opiate receptors in the CNS ◦ Alters perception of and response to pain Nursing Implications: ◦ Assessment Assess pain – type, location, intensity Assess BP, pulse, resp before and during therapy Assess prior analgesic hx Assess bowel function periodically Medications: fentanyl transdermal (Duragesic) hydromorphone (Dilaudid) oxycodone (Oxycontin) Morphine General Use: ◦ Sedatives provide sedation ◦ Hypnotics are used to manage insomnia General Action: ◦ Cause generalized CNS depression Nursing Implications: ◦ Assessment Monitor BP, pulse, resp status frequently w/ IV Assess sleep patterns if for insomnia Medications: ◦ phenobarbital (Luminal) ◦ lorazepam (Ativan) ◦ zolpidem (Ambien) General Use: ◦ Spasticity associated w/ spinal cord lesions ◦ Symptomatic relief of acute painful MS conditions General Action: ◦ Act either centrally or directly to relax muscle fibers Nursing Implications: ◦ Assessment Assess for pain, muscle stiffness, ROM before and periodically throughout tx Medications: ◦ Flexaril ◦ baclofen (Lioresal) ◦ diazepam (Valium) General Use: ◦ Acute mgmt coronary thrombosis (MI) ◦ Mgmt massive pulmonary emboli, DVT, arterial thromboembolism General Action: ◦ Converts plasminogen to plasmin which then breaks down fibrin in clots Nursing Implications: ◦ Begin tx ASAP after onset sx’s ◦ Monitor VS q 4 hours Medications: ◦ streptokinase (Streptase) General Use: ◦ Acute vascular headaches General Action: ◦ Smooth muscle vasoconstriction Nursing Implications: ◦ Assessment Assess pain, location, intensity, duration Assess for photophobia, phonophobia, n&v Assess for frequency of migraine attacks Medications: ◦ ergotamine (Ergomar) ◦ sumatriptan (Imitrex) Statin drugs Pravastatin (Pravachol) Atorvastatin (Lipitor) Assess for severe muscle soreness Meds should always be taken in the evening (6pm). -dopa drugs. levadopa carbidopa (Lodosyn) (Sinemet) – mix of Levodopa and Carbidopa. 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!