CNUR 305 - Medications

Medication Reason for Pharmacologic Mechanism of action Most common Nursing Responsibilities
administration al class side effects (max.
3)

Mannitol Reduces intracranial or Diuretic Increase osmotic Transient volume Monitor vitals, lab work,
intraocular pressure, pressure, which expansion, neurological status. Monitor for
treatment of cerebral inhibits the electrolyte signs of electrolyte imbalances
edema reabsorption of water imbalances, Monitor ins and outs.
and electrolytes pulmonary edema

Nimodipine Management of Calcium Inhibits calcium from Arrhythmias, heart ~ Monitor vitals, do not give if
subarachnoid channel entering smooth failure systolic BP<90
hemorrhage, prevents blockers muscle cells ~ Monitor ins and outs
vascular spasms, ~ Avoid grapefruit
decreases neurological ~ Monitor for rash
impairment

Dexamethasone Management of cerebral Steroid, anti- Suppresses hypertension, ~ Monitor ins and outs/daily
edema, used systemically inflammatory inflammation and osteoporosis, weights
in many chronic diseases normal immune nausea/GI upset ~ Assess for changes in LOC
(inflammatory, allergy, response and headaches
hematological, endocrine, ~ May give with meals to
neoplastic, dermatologic) decrease GI upset
~ Treatment of airway
edema prior to extubating

Pantoprazole Decreases acid Proton pump Binds to enzyme when Abdominal pain, ~ Monitor bowel function -
secretions, management inhibitor gastric pH is acidic, hypomagnesemia, diarrhea, cramping, bloody
of GERD/duodenal ulcers which prevents diarrhea/bloody stools.
hydrogen ions from stools ~ Do not break/crush/ chew
entering gastric lumen tablets

Ranitidine Treatment and Antiulcer agent - Inhibits histamine at h2 Confusion, ~ Monitor for abdominal pain,
 management of Histamine h2 receptor site resulting arrhythmias, blood in stool, emesis.
duodenal/gastric ulcers, antagonists in decreased gastric abdominal pain ~ Administer with meals and at
treatment of GERD acid secretions bedtime to prolong effects
~ Avoid NSAIDs, alcohol,
caffeine, spicy foods

Enoxaparin Prevention of VTE, Antithrombotics Activates antithrombin Bleeding, anemia ~ Monitor for signs of bleeding,
pulmonary embolisms / low molecular on factor Xa and labs, stool
after surgery weight heparins thrombin to ~ Subcutaneous injection
~ Prevention and decrease/prevent clots
treatment of ischemic
complications

Warfarin Prevention and treatment Anticoagulant - Interferes with liver Bleeding, cramps ~ Monitor for bleeding
of VTE, PE. coumarins synthesis of vitamin K- ~ Monitor INR in B/W
Management of dependant clotting ~ Limited intake of vitamin K,
myocardial infarction factors antidote if bleeding is vitamin K

Rivaroxaban ~ Prevention or treatment Antithrombotics, Blocks the factor Xa Bleeding ~ Monitor for bleeding,
of VTE, DVT, PE factor Xa site to stop coagulation decrease in Hct/BP
~ Reduces risk for stroke inhibitor ~ Avoid alcohol, OTC meds,
or myocardial infarctions NSAIDs, aspirin, St. Johns wort

Apixaban ~ Decreases risk of Factor Xa Inhibits thrombin- Bleeding ~ Monitor for bleeding.
stroke, DVT, VTE, PE inhibitors, induced platelet ~ May bruise/bleed easily
~ Treatment if above antithrombotics aggregation, inhibits ~ Avoid NSAIDs, alcohol, St.
occur factor Xa John’s wort

Heparin Prevention/treatment of Antithrombotics Activates antithrombin Bleeding, heparin ~ Monitor for bleeding,
VTE, PE, atrial fibrillation on factor Xa and induced decreased BP or Hct
~ Prevention of clots thrombin to thrombocytopenia, ~ Monitor injection sites
forming or growing decrease/prevent clots anemia ~ Monitor platelets, aPTT
~ Avoid IM injections, NSAIDs,
aspirin
~ Use soft toothbrush
Aspirin For mild to moderate pain, NSAID, Decreases platelet Nausea, GI ~ Monitor for decreased liver
fever, and prevention of salicylates, aggregation, inhibits bleeding, GI upset function (increased AST, ALT)
Transient ischemic attacks antipalatelet production of ~ Toxicity: tinnitus, headache,
and myocardial infarctions prostaglandins to confusion, lethargy, diarrhea
decrease fever and ~ Give with food or after meals
inflammation to reduce GI upset
~ Avoid other NSAIDs if
possible

Dabigatran ~ Reduces risk of stroke, Thrombin Directly inhibits Abdominal pain, ~ Monitor for bleeding, aPTT,
DVT, PE, VTE inhibitors thrombin diarrhea, bleeding renal function

Clopidogrel Reduces the risk of stroke Platelet Blocks the binding of Bleeding/ Monitor for bleeding, platelet
and myocardial infarction aggregation ATP to platelet thrombocytopenia levels
inhibitors receptors Consult HCP before taking
(antiplatelet) OTC meds

Lorazepam Decreased seizures, Benzodiazepine Depresses the CNS by Dizziness, Monitor seizures - durations,
anxiety, treatment of acting on GABA lethargy, frequency, characteristics.
status epilepticus drowsiness ~ Seizure precautions
~ May cause dependency
~ Avoid alcohol, opioids

Gabapentin ~ Decreases seizures, Anticonvulsant May affect transport of Ataxia, confusion, ~ Monitor for respiratory
postherpetic pain, restless amino acids and depression depression if administered with
leg syndrome stabilize neuron opioids or other CNS
membranes depressants
~ Seizure precautions

Baclofen Decreased muscle Skeletal muscle Inhibits reflexes of the Dizziness, ~ observe for drowsiness
spasticity which may be relaxant spine drowsiness, ~ Administer with food or milk
caused by MS or spinal nausea to minimize GI upset
cord lesions ~ Change position slowly

Phenytoin ~ Prevention and Hydantoins - Limits seizure Nausea, ~ Assess oral hygiene - to
treatment of tonic-clonic anticonvulsant production by altering hypotension (If IV), decrease gingival hyperplasia
 seizures or complex ion transport, decrease double vision ~ Assess mental status
partial seizures synaptic transmission ~ Monitor BP, ECG, respiratory
~ Can also manage function
neuropathic pain ~ Seizure precautions

Valproic acid Suppression of seizure Anticonvulsant Increases levels of Visual ~ Assess for suicidal
activity, decreases mania GABA disturbances, tendencies, mood, behavior
and migraines thrombocytopenia, ~ Monitor hepatic function
tremors ~ Monitor GI - abdominal pain,
Nausea, vomiting, etc.

Carbamazepine ~ Prevention and Anticonvulsant, Decreased synaptic Drowsiness, ~ Monitor for changes in
treatment of seizures, mood stabilizer transmission in the ataxia, suicidal behavior
management of trigeminal CNS by affecting thoughts ~ Seizure protocol - safety
neuralgia pain, decreased sodium channels in ~ Give with food to reduce GI
mania neurons upset
~ Avoid grapefruit

Phenobarbital Anticonvulsant in seizures, Barbiturates CNS depressant, “Hangover”, ~ Monitor respiratory status,
produces sedation (Sedative- decreases motor hypotension, vital signs
hypnotics) activity. respiratory ~ Assess LOC
depression ~ Seizure precautions
~ Avoid alcohol, opioids
~ Sleep hygiene teaching

Fenofibrate Decreases LDL Fibric acid Inhibits triglyceride fatigue/weakness, ~ Diet history
cholesterol, triglycerides, derivatives synthesis deep vein ~ Lipid-lowering diet
total cholesterol to (lipid-lowering thrombosis ~ Monitor liver function labs
decrease risk of agent)
pancreatitis

Naloxone Reverses CNS depression Opioid Blocks the effects of Nausea, vomiting, ~ Monitor respiratory rate, BP,
and respiratory depression antagonist opioids arrhythmias LOC
caused by opioid ~ Assess pain levels as it also
overdose reverses analgesic effects
Hydralazine Lowers Blood pressure in Vasodilator Vasodilates peripheral Tachycardia, drug- ~ Monitor BP and pulse
hypertensive patients, and (antihypertensiv arteries induced lupus ~ Administer with meals to
decreases afterload in e) syndrome enhance absorption
patients with heart failure ~ Low sodium diet, weight loss,
smoking cessation, exercise
~ Weights often to assess for
fluid retention

Ondansetron Prevention of nausea and Five ht3 Blocks the effects of Constipation, ~ Assess bowel sounds,
vomiting antagonists, serotonin at 5-HT3 diarrhea, headache abdominal distention
antiemetics receptor sites ~ May cause serotonin
syndrome (mental changes,
diaphoresis, tachycardia)

Diazepam Decreased seizure Benzodiazepine Depresses the CNS by Dizziness, ~ Monitor BP, pulse, RR.
activity, status epilepticus, acting on GABA. Also drowsiness, ~ Monitor IV site
skeletal muscle spasms. produces skeletal lethargy, ~ Risk for falls d/t dizziness
Can also be used for muscle relaxation by respiratory ~ Assess mental status
anxiety disorder or for inhibiting spinal depression ~ Seizure protocols - safety
preoperative sedation polysynaptic pathways ~ May cause dependency
~ Avoid CNS depressants

Dimenhydrinate ~ Decreases vestibular Antiemetic, Inhibits vestibular Anorexia, ~ Assess N&V, bowel sounds,
stimulation which can antihistamine stimulation, CNS drowsiness abdominal pain
prevent motion sickness, depressant properties ~ Monitor ins and outs
nausea, vomiting, ~ Assess for dehydration
dizziness, vertigo ~ Oral hygiene - may cause dry
mouth

Metoclopramide Decreases nausea & Antiemetics Blocks dopamine Drowsiness, ~ Monitor N&V, abdominal
vomiting, receptors; stimulates restlessness, dry distention, bowel sounds
gastroesophageal reflux. motility of upper GI mouth, ~ Assess for extrapyramidal
Can also decrease tract and speeds up constipation effects (parkinson, dystonia,
hiccups gastric emptying akathisia, dyskinesia)
~ Avoid concurrent use of CNS
depressants
Penicillin Treatment of infections - Penicillins - anti- Binds to bacterial cell Diarrhea, ~ Monitor infection (vitals,
pneumonia, strep throat, infective wall, resulting in cell nausea/vomiting, sputum, urine/stool, WBC)
syphilis, gonorrhea, etc. death hypersensitivity ~ Monitor for reaction - rash,
reactions wheezing, pruritus)
~ Monitor bowel function/GI

Bisacodyl Treatment of constipation, Stimulant Stimulates peristalsis; Abdominal cramps, ~ Assess color, consistency,
evacuation of bowel/colon laxatives alters fluid and nausea, diarrhea amount of stool.
electrolytes, causing ~ Assess bowel sounds,
fluid accumulation in function
the colon ~ Taking on empty stomach
produces more rapid results
~ Take with glass of water/juice
~ Encourage fluids

Docusate Prevention of constipation; Stool softener Incorporates water into Cramps, diarrhea ~ Assess abdominal distention,
softening and passage of stool to soften stool. bowel sounds, bowel function
stool May also collect ~ Assess color, consistency,
fluid/electrolytes in amount of stool.
colon ~ Administer with glass of
water or juice, empty stomach
= faster

Salbutamol Prevention and treatment Adrenergic - Binds to beta2 Nervousness, ~ Assess lung sounds, pulse,
(Albuterol) of bronchospasm in bronchodilator receptors in airway restlessness, chest BP
asthma or COPD; smooth muscle; pain, palpitations ~ Note sputum produced -
prevents exercise-induced relaxes airway smooth amount, color
bronchospasm muscle with ~ Pulmonary function tests
bronchodilation

Ipratropium Maintenance therapy of Anticholinergic, Inhibits cholinergic Bronchospasm, ~ Assess respiratory status
airway obstruction due to bronchodilators receptors in bronchial cough, sore throat ~ Administer adrenergic
COPD; management of smooth muscle bronchodilators first, then
bronchospasms caused causing decreased ipratropium, then
by asthma cGMP, which produces corticosteroids
bronchodilation ~ Oral hygiene
Insutalin Lispro Control of hyperglycemia Pancreatics Lowers blood glucose Hypoglycemia, risk ~ Take blood glucose prior to
(Humalog) in patients with type 1 and (Antidiabetic) by stimulating glucose for hypokalemia administering
2 diabetes uptake in skeletal ~ Hypoglycemia: cool, clammy,
~ Rapid-acting insulin: muscle/fat and confusion, drowsiness,
onset 15 mins, peak 1-2 inhibiting hepatic tachycardia
hours, duration 3-4 hours glucose production ~ Hyperglycemia: flushed/dry
skin, rapid/deep breaths,
polyuria, thirst
~ Give with meals

NPH Insulin Control of hyperglycemia Pancreatics Lowers blood glucose hypoglycemia ~ Take blood glucose prior to
in patients with type 1 and (antidiabetic) by stimulating glucose administering
2 diabetes uptake in skeletal ~ Hypoglycemia: cool, clammy,
~ Intermediate acting: muscle/fat and confusion, drowsiness,
onset 2-4 hours, peak 4- inhibiting hepatic tachycardia
10 hrs, duration 10-16 glucose production ~ Hyperglycemia: flushed/dry
hours skin, rapid/deep breaths,
polyuria, thirst

Humulin R ~ Control of Pancreatics Lowers blood glucose Hypoglycemia, ~ Take blood glucose prior to
(Regular insulin) hyperglycemia in patients (antidiabetic) by stimulating glucose hypokalemia administering
with type 1 and 2 diabetes uptake in skeletal ~ Hypoglycemia: cool, clammy,
~ Short acting insulin: muscle/fat and confusion, drowsiness,
onset 30-60 mins, peak 2- inhibiting hepatic tachycardia
4 hours, duration 5-7 glucose production ~ Hyperglycemia: flushed/dry
hours skin, rapid/deep breaths,
polyuria, thirst
~ 30 to 60 mins before meals

Insulin Glargine ~ Control of Pancreatics Lowers blood glucose Hypoglycemia ~ Take blood glucose prior to
(Lantus) hyperglycemia in patients (antidiabetic) by stimulating glucose Hypokalemia administering
with type 1 and 2 diabetes uptake in skeletal ~ Hypoglycemia: cool, clammy,
~ Long acting insulin: muscle/fat and confusion, drowsiness,
onset 3-4 hours, no peak, inhibiting hepatic tachycardia
duration 24 hours glucose production ~ Hyperglycemia: flushed/dry
skin, rapid/deep breaths,
 polyuria, thirst
~ Monitor body weight
periodically
~ Monitor serum potassium

Nystatin (5 mL) Treatment of Antifungal Binds to fungal cell Diarrhea, nausea, ~ Inspect mucous membranes
oropharyngeal candidiasis membrane allowing vomiting ~ Patient should swish in
leakage of cellular mouth for several minutes
contents. before swallowing
~ Shake well before
administering

Perindopril Reduction of blood Ace inhibitor Block the conversion Hypotension, ~ Take vitals (BP) before
pressure in hypertensive of angiotensin 1 to cough, angioedema giving.
patients angiotensin 2 which is
a vasoconstrictor, ~ Hold if Systolic BP is below
causing vasodilation 55.
instead. ~ Monitor for angioedema –
swelling of face, extremities,
eyes, lips, tongue, etc.

Metamucil Management of Bulk forming Combines with water Cramps, intestinal ~ Assess for abdominal
constipation or chromic agent (laxative) in intestines to form a obstruction, distention, bowel sounds,
watery diarrhea (Patient viscous solution that vomiting normal bowel patterns
has C.difficile) promotes peristalsis. ~ Assess stool produced.
~ Mix with a full glass of water
or juice.

Hydromorphone Decrease moderate to Opioid agonist Binds to opiate Constipation, ~ Monitor respiratory rate, if
severe pain levels receptors in the CNS. hypotension, drops below 10, administer
associated with Alters response to respiratory naloxone to reverse.
osteomyelitis painful stimuli and depression ~ Monitor pain levels and
 produces CNS response to medication
depression. ~ Monitor bowel function.

Pregabalin 75 Treatment of neuropathic Nonopioid Binds to calcium Peripheral edema, ~ Monitor for changes in mood/
mg pain associated with spinal analgesic channels in CNS dry mouth, behavior
cord injury tissues which regulate dizziness ~ Assess pain and response to
medication
neurotransmitter
~ May cause edema, weight
release gain.

Rifampin 300 Bactericidal action against Rifamycin Inhibits RNA synthesis Red discoloration ~ Patient teaching on red/
mg susceptible organisms – by blocking RNA of tears and urine, orange color of saliva, sweat,
staphylococcus aureus Antitubercular transcription in abdominal pain, tears, urine, etc, may occur.
susceptible organisms diarrhea
~ Give on empty stomach at
least 1 hour before meal or 2
hours after. Give with food if
GI upset

Vitamin D Helps to prevent Fat soluble Maintenance of normal Not common; ~ Monitor electrolyte levels
osteoporosis and reduce vitamin serum calcium and Nausea, vomiting, ~ Assess for bone pain and
bone fractures and slows phosphorous levels in dry mouth, weakness, and for signs of
bone mineral loss bloodstream by weakness calcium imbalance
enhancing efficacy of (Trousseau’s/chvostek’s,
small intestine to tetany, weakness, etc.)
absorb

Amlodipine ~ reduce blood pressure, Calcium channel ~ Inhibits transport of ~ peripheral edema ~ Monitor blood pressure and
decreased frequency and blockers calcium in ~ dizziness, fatigue pulse periodically
severity of angina myocardial/vascular ~ Monitor intake/output, weights
cells.
~Notify if having chest pain; may
cause drowsy.
~ Low sodium diet, exercise,
 weight control

Bisoprolol ~ Management of Beta blocker ~ Blocks stimulation of ~ fatigue/ weakness ~ Monitor BP/pulse frequently
hypertension/ decreases HR B1 adrenergic receptors ~ Bradycardia, HF, and before administering each
and BP to decrease BP. pulmonary edema day.
~ Monitor ins and outs
~ Change positions slowly

Candesartan Lowers blood pressure in Angiotensin 2 ~ Blocks vasoconstrictor ~ Hypotension, ~ Take blood pressure before
hypertensive patients receptor and aldosterone-secreting impaired renal administration.
antagonist effects of angiotensin 2 at function, ~ Monitor for signs of
receptor sites. angioedema
angioedema – dyspnea, facial
swelling.
~ Monitor daily weights,
symptoms of fluid overload.

Citalopram Manage depression and Selective Selectively inhibits the ~ sweating ~ Assess for suicidal tendencies,
anxiety serotonin reuptake of serotonin in ~ Abdominal pain, mood changes.
reuptake inhibitor CNS anorexia, diarrhea, ~ Assess sexual function
dry mouth, tremor

Cyanocobalamin ~ Vitamin B12 deficiency, Water soluble Coenzyme for metabolic ~ Hypersensitivity ~ Signs of B12 deficiency (pallor,
anemia vitamins processes including fat reactions, headache neuropathy, psychosis, red
and carbohydrate (Not common) tongue)
metabolism and protein
synthesis

Rabeprazole Decreases acid secretions, Proton pump Binds to enzyme when Abdominal pain, ~ Monitor bowel function -
management of inhibitor gastric pH is acidic, hypomagnesemia, diarrhea, cramping, bloody stools.
GERD/duodenal ulcers which prevents hydrogen diarrhea/bloody ~ Do not break/crush/ chew
ions from entering gastric stools
tablets
lumen

Gliclazide Lowers blood glucose in Sulfonylureas Lowers blood glucose by Hypoglycemia, ~ Check blood glucose levels
 diabetic patient stimulating release of abdominal pain, periodically while administering
insulin from the pancreas nausea/vomiting ~ Monitor for signs of
and increases sensitivity hypoglycemia: cool, clammy,
to insulin
confusion, drowsiness,
tachycardia
~ Give with meals at the same
time everyday

Lansoprazole Helps diminish accumulation Proton Pump Binds to an enzyme in Diarrhea, Monitor bowel function,
(30mg) of acid in the gastric lumen. Inhibitor the presence of acidic dizziness, diarrhea, abdominal cramping,
gastric pH. Helps with headache. fever and any signs of bloody
gastroesophageal stools.
reflux disease (GERD)
and healing of stomach
ulcers.
Tinzaparin Prevents formation of Anticoagulant, Helps treat DVT by *Bleeding*, Assess for signs of bleeding and
thrombi (clots) Antithromboti reducing thrombus thrombocytope hemorrhage bleeding (bleeding
c formation nia, gums, hematuria etc)
hypersensitivity
reactions