Perfusion Drug Classification Chart

Perfusion Drug Classification Chart Classification ACE Inhibitors Angiotensin Converting Enzyme ARBs Angiotensin II Receptor Blockers Calcium Channel Blockers Drug Captopril, enalapril, benazepril, lisinopril Losartan, valsartan, Olmesartan Amlodipine, felodipine, nifedipine Verapamil, diltiazem Digoxin = Cardiotonic Agent Use (Indication) Hypertension Heart failure Hypertension Hypertension Angina Tachy-arrhythmias Heart failure Atrial fibrillation (chronic) Action Prevent angiotensin I angiotensin II conversion Prevent aldosterone release Decr. peripheral vascular resistance w/out incr. HR + contractility Block receptors to receive angiotensin II block vasoconstriction no aldosterone release incr. blood volume Peripheral arterial dilation by relaxing vascular smooth muscle Incr. pumping ability of heart Incr. force and velocity of myocardial contractions (inotropic +) Decr. HR (chronotropic -) Decr. Automaticity at SA node, decr. AV nodal conduction (dromotropic -) Headache, dizziness Facial flushing Dry skin Diarrhea, abdominal pain, dry mouth Kidney/ liver failure Headache, drowsiness Peripheral edema Bradycardia Hypotension Flushing, rash Nausea, constipation Agitation, fatigue, hallucinations, vertigo Arrhythmias, heart block Blurred vision, light flashes Anorexia, N/V/D Side Effects (Adverse Effects) Dry non-productive cough Impotence Angioedema Possible hyperkalemia (>5 meq/L) Nursing Assessment Monitor BP, HR, EKG Check lung sounds for cough Monitor electrolyte level Monitor BP, HR Baseline for weight, VS, skin condition Lab tests for renal and hepatic functions, electrolytes Monitor BP Monitor for peripheral edema Nursing Teaching Stand up slowly to prevent dizziness due to hypotension Watch diet; limit K+ foods (bananas, oranges, potatoes) No salt substitutes (+ K+) Watch diet: no incr. K+ foods, K+ supplements How to monitor BP + HR properly Healthy lifestyle – low sodium diet Do not drink grapefruit juice – incr. toxicity Orthostatic hypertension Take w/out food/ light meal Healthy lifestyle: low sodium, high fiber Nursing Implementations Reduce diuretic dosage/ withheld for 24 hrs. before starting ACE inhibitor Pt. to sit/lie down for 2-4 hrs. after initial dose Correct volume and sodium depletion before starting drug Monitor serum BUN, creatinine, potassium levels Monitor EKG closely for arrhythmias Monitor for reflex tachycardia and symptoms of HF 1 Digoxin Monitor HR, BP Assess for s/s of HF Monitor digoxin level for toxicity Monitor potassium level Lifestyle changes Incr. intake of K+ foods Limit salt intake Watch weight Monitor EKG Monitor potassium level, digoxin level @ ShopWithKey on Etsy Evaluation 2 Therapeutic response BP w/ in normal limits Perfusion Drug Classification Chart BP w/ in normal limits Adverse effects Patient’s understanding of drug therapy BP w/ in normal limits Adverse effects Therapeutic response Normal dig. Level: 0.5-2 ng/ ml Higher levels = toxicity @ShopWithKey on Etsy Classification Drug Perfusion Drug Classifications Chart 2 Nitroglycerin (antianginal agent) Antilipemic/ HMG-CoA Reductase Inhibitors(statins) Generic: Nitroglycerin Lovastatin, pravastatin, simvastatin, Fluvastatin Anticoagulant: Heparin Anticoagulant: Warfarin (Coumadin) Generic name: Heparin Generic Name: warfarin Angina attacks Acute angina pectoris HF after MI Hyperlipidemia Hypercholesterolemia (adolescents) CV disease prevention Thromboprophylaxis DVT PE Atrial fibrillation, MI DVT PE Reduces the cardiac O2 demand Increases blood flow through the collateral coronary arteries Inhibit HMG-CoA reductase (enzyme) used by liver to produce cholesterol Decreases rate of cholesterol production Blocks conversion of prothrombin to thrombin and fibrinogen to fibrin; reduces clotting mechanism in blood Inhibits vit. K dependent activation of clotting factors in liver Inhibits anticoagulant proteins Side Effects (Adverse Effects) Headache – diminishes w/ continued use Tachycardia, Palpitations Postural hypotension Peripheral edema Headache, peripheral neuropathy Blurred vision Myopathy Constipation, D/N/V Skin rash Fever, chills Hemorrhage, thrombocytopenia Hyperkalemia Osteoporosis Necrosis, hematoma, ulceration Vasculitis Bloating, taste perversion Hemorrhage Hepatitis Rash, chills Nursing Assessment Chest pain assessment: location, time, intensity HR, BP (quick drop) Monitor renal functions: myopathy causes protein in urine Monitor liver functions after 3 months at first; every 6-12 months after Monitor GI effects Keep in brown jar, in cool dark place Let it fizzle under tongue Ointment: on non-hair areas Rise slowly to prevent hypotension Avoid alcohol Lifestyle changes: low cholesterol and triglycerides diet, increase fiber Don’t use with grapefruit juice No alcohol: incr. risk of hepatotoxicity Monitor for hyperkalemia Check vial and order carefully; comes in various concentrations Monitor platelet count Monitor VS Discourage smoking Use a soft toothbrush: bleeding gums Inspect for bleeding and contact MD immediately: gums, nosebleeds, tarry stools, bruises on legs and arms IV or SQ Inspect pt. for bleeding (gums, stool, nosebleeds) Inspect pt. for bruises on arms and legs Don’t stop abruptly (coagulability), wean off with warfarin Antidote: Protamine Sulfate aPTT (1.5-2.5 times the control, w/out signs of hemorrhage DVT prevention effectiveness Effectiveness for PE Use (Indication) Action Nursing Teaching Nursing Implementations Evaluation Give sublingually x3, 5 minutes apart Wear gloves to prevent own absorption of medication Drug effectiveness: if it does not help after 3 administrations, call MD Admin. drug at bedtime: cholesterol synthesis from midnight to 5am. Provide comfort and safety measures Educate pt. on importance of lifestyle changes Monitor response to therapy: cholesterol and LDL levels, absence of MI Monitor for adverse effects Monitor for major bleeding Monitor INR Assess HR, BP Monitor platelet count Avoid cranberry juice: incr. bleeding Avoid K rich foods; impairs anticoagulation (leafy greens) Avoid large amounts of alcohol Inspect for bruising Use soft toothbrush, electric razor Daily INR until stable in therapeutic range Avoid all IM injections Monitor for purple-toe syndrome Give platelets to prevent bleeding Antidote: Aquamephyton (Vit K) PT: (1.5 times the control) PT : INR = 2:3 (normal ratio) Perfusion Drug Classifications Chart 2 Evaluate pt. understanding on drug therapy Adrenergic Agonists (Sympathomimetic) Adrenergic Antagonists (Sympatholytic) (Beta Blockers) atenolol, metoprolol, propranolol, timolol Cholinergic (Parasympathomimetic) bethanechol, carbachol, pilocarpine amiodarone, carvedilol, labetalol Anticholinergic (Parasympatholytic) flavoxate, trospium, ipratropium, darifenacin, atropine Airway obstruction (epinephrine) Allergy reaction (epinephrine) Cardiac arrest (epi, dobutamine) Hypotension (norepinephrine) Shock (dopamine, epi, norepi.) Ophthalmic preparation Stimulate alpha + beta receptors Stimulate CNS (fight or fight) Increase HR and contractility Vasoconstriction Bronchodilation Decrease GI secretions Increase BS Arrythmia Tachycardia Hypertension Dyspnea Pulmonary hypertension Restlessness, anxiety Angina (atenolol) Arrhythmias Hypertension (propranolol) Glaucoma (timolol) Prophylaxis of migraine Arrhythmias (amiodarone) Heart Failure, MI Hypertension (carvedilol, labetalol) Glaucoma (carbochol, pilocarpine) Block effect of beta receptors Depress CNS Decrease HR and contractility Vasodilation Decrease HR, BP, BS Increase smooth muscle contractility + secretions (GI, Respiratory, Urinary, Renal) Constrict pupils Bradycardia Hypotension Bronchospasm GI disturbance Lethargy, Depression Disorientation Assess for allergies, BP, HR, RR, BS Auscultate for adventitious sounds Establish baseline assessment to monitor for adverse effects Take apical pulse before administration Auscultate lungs for wheezing Monitor HR, BP, RR, and BS Bradycardia, HF Hypotension Pulmonary edema Stroke Decreased exercise tolerance Hypoglycemia Depression, vertigo Assess for contraindications, allergies. Monitor lab results for renal +liver functions. Assess VS, auscultate lungs, assess GI COPD, asthma (ipratropium) GU, incontinence (darifenacin) GI disorders, diarrhea Involuntary muscle movement Motion sickness (scopolamine) Bradycardia (atropine) Increase HR, BP Relax smooth muscle Decrease secretions, GI motility Bronchodilation Increases bladder capacity Decreases urinary urgency and frequency Dilated pupils, blurred vision Dry mouth Decreased GI/GU motility Urinary retention Tachycardia Insomnia, mental confusion Nursing Teaching Pupils are dilated and sensitive to light. Adverse effects and warning signs to report. Take apical P. + BP; <60bpm call MD Signs of hypoglycemia and how to monitor BS (<50mg/dl)-call MD Do not stop abruptly Nursing Implementations Administer promptly and w/ caution Monitor 30 mins after administration Do not discontinue abruptly Provide comfort – light control Monitor VS, level of consciousness and mood Assess for blurred vision, tinnitus, epistaxis, edema Monitor BS and liver function Classification Drug Use (Indication) Action Side Effects (Adverse Effects) Nursing Assessment dopamine, dobutamine epinephrine, norepinephrine Do not stop abruptly Implement lifestyle changes, diet, exercise, to lower BP. Medication administration and side effects. Change position slowly. Do not discontinue abruptly Assess HR, BP, BS. Safety precautions if dizzy, vertigo Monitor GI function and increase bathroom access Asses for contraindications Establish baseline status Assess neurological status to evaluate CNS effects Monitor VS, auscultate lung sounds Sugarless lozenges for dry mouth Small & frequent meals for GI discomfort. Safety precautions Void before taking medication Monitor pt. response closely, HR, BP, I&O Comfort measures for dry mouth, constipation, light control. Provide patient teachings Evaluation Monitor pt. response to the drug Monitor BP increase + improved breathing Monitor for adverse effects Observe BP decrease w/ minimal adv. effects Monitor for adverse effects Monitor BP improvement and HF Monitor for upset Gi, liver failure, CV changes Evaluate teaching effectiveness, comfort Monitor pt. response to the drug Monitor for adverse effects Evaluate effectiveness of teaching plan & comfort measures Oxygenation Drug Classification Chart Classification Drug Use (Indication) Beta Adrenergic Agonists (Sympathomimetic) salmeterol (Serevent Diskus), levalbuterol (Xopenex), epinephrine, albuterol Acute asthma attack Bronchospasm in acute/chronic asthma Exercise-induced asthma Bronchodilator – B2 receptor agonist Action Side Effects (Adverse Effects) Nursing Assessment Nursing Teaching Nursing Implementations Evaluation Arrythmia Tachycardia Hypertension Dyspnea Pulmonary hypertension Restlessness, anxiety Assess for allergies, BP, HR, RR, BS Auscultate for adventitious sounds Establish baseline assessment Pupils are dilated and sensitive to light. Adverse effects and warning signs to report. Administer promptly and w/ caution Monitor 30 mins after administration Do not discontinue abruptly Monitor pt. response to the drug Monitor BP increase + improved breathing Anticholinergic (Parasympatholytic) Ipratropium (Atrovent), tiotropium (Spiriva), umeclidinium COPD, asthma (ipratropium) GU, incontinence (darifenacin) GI disorders, diarrhea Involuntary muscle movement Motion sickness (scopolamine) Bradycardia (atropine) Bronchodilator Increase HR, BP Relax smooth muscle Decrease secretions, GI motility Increases bladder capacity Dilated pupils, blurred vision Dry mouth, constipation Decreased GI/GU motility Urinary retention Tachycardia Insomnia, mental confusion Not for pts. w/ peanut allergies Asses for contraindications Establish baseline status Assess neurological status to evaluate CNS effects Monitor VS, auscultate lung sounds Sugarless lozenges for dry mouth Small & frequent meals for GI discomfort. Safety precautions Void before taking medication Monitor pt. response closely, HR, BP, I&O Comfort measures for dry mouth, constipation, light control. Provide patient teachings Monitor pt. response to the drug Monitor for adverse effects Evaluate effectiveness of teaching plan & comfort measures Inhaled Corticosteroids Xanthine beclomethasone, budesonide, ciclesonide, fluticasone, triamcinolone Chronic asthma Not for acute asthmatic attacks Theophylline (10-20 mg/mL), aminophylline, dyphylline, caffeine Decrease inflammatory response in the airway Increase airflow and facilitate respiration Increase beta-adrenergic receptor activity Immunosuppression (sore throat, coughing, dry mouth) Oral fungal infections Growth retardations in pediatrics w/ long term use Irritability, headache Bronchodilator Direct effect on smooth muscle of respiratory tract and blood vessels Symptomatic relief -prevent bronchial asthma Narrow therapeutic margin CNS stimulation – Seizures CV stimulation – tachycardia, arrythmia, angina, hypotension GI distress – N/V/D Assess for contraindications: pt. with AIDS, fungal infections Monitor theophylline level Draw after first dose Assess HR, BP, RR – no antidote for quick relief Gargle and rinse mouth to prevent fungal infections Wean for 1-2 weeks (adrenal glands) Report weight gain (5+ lb./week) Monitor for side effects Monitor temperature Assess respirations and adventitious sounds Oral care Monitor pt. response to the drug Monitor for adverse effects Evaluate effectiveness of teaching plan & comfort measures Report 1st case of cardiac disturbances Take during the day – stimulant Avoid chocolate & coffee intake Don’t crush/ alter dosage form Relief symptoms/ prevention of bronchial asthma Reversal of bronchospasm associated with COPD Administer during the day – keep pt. awake Give with milk/ food to avoid GI distress Ensure dietary control of caffeine Relief of respiratory difficulty Monitor adverse effects and drug interactions