Exam 2 Drug List

Loop Diuretics (Potassium Wasting) (Furosemide)

• Use: Treat heart failure (HF), hypertension (HTN), renal dysfunction, nephrotic syndrome, acute pulmonary and peripheral edema
• Mechanism of Action (MOA): Inhibits sodium and water reabsorption from the loop of Henle and distal renal tubules; increases excretion of potassium, chloride, magnesium, ammonium, phosphate and calcium
• Nursing Responsibilities:
  • Weigh patient daily at the same time
  • Monitor urinary output (at least 30 mL/hr)
  • Monitor vital signs (especially blood pressure) for decreases
  • Monitor for hypokalemia signs (muscle weakness, abdominal distension, leg cramps, cardiac dysrhythmias)
  • Monitor serum potassium levels, especially in patients taking digoxin (digoxin toxicity can occur with hypokalemia)
  • Administer IV furosemide slowly to prevent hearing loss
• Side Effects (SE): Nausea, diarrhea, dizziness, tinnitus, abdominal cramps, constipation, rash, headache, weakness, blurred vision, muscle cramps, photosensitivity, paresthesia, injection site reaction (for IV)
• Adverse Reactions (AR): Hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, hypovolemia, orthostatic hypotension, diabetes mellitus, hearing loss, hypercholesterolemia, gout
• Long-Term Effects (LT): Aplastic or hemolytic anemia, leukopenia, thrombocytopenia, agranulocytosis, Stevens-Johnson syndrome
• Patient Education:
  • Take medication in the morning to prevent sleep disturbance and nocturia
  • Rise slowly to avoid orthostatic hypotension
  • Consume potassium-rich foods or supplements to prevent hypokalemia

Thiazide Diuretic (Hydrochlorothiazide)

• Use: Increase urine output to treat hypertension (HTN) and edema due to heart failure, nephrotic syndrome, and ascites
• Mechanism of Action (MOA): Acts on renal distal tubules, promoting sodium, potassium, and water excretion, decreasing preload and cardiac output, decreasing edema, and causing vasodilation, thus lowering blood pressure
• Nursing Responsibilities:
  • Weigh patient daily at the same time
  • Monitor urine output to determine fluid loss or retention
  • Monitor vital signs and serum electrolytes (potassium, glucose, uric acid, cholesterol)
  • Monitor for hypokalemia (muscle weakness, leg cramps, cardiac dysrhythmias)
  • Monitor for hyperglycemia
• Side Effects (SE): Dizziness, headache, blurred vision, anorexia, nausea, vomiting, diarrhea, abdominal cramps, constipation, rash, photosensitivity, paresthesia, weakness, erectile dysfunction
• Adverse Effects (AE): Orthostatic hypotension, hyponatremia, hypomagnesemia, hypochloremia, hyperglycemia, hypercalcemia, hyperuricemia, hypercholesterolemia, hypertriglyceridemia, metabolic alkalosis, pulmonary edema, ocular hypertension, gout
• Long-Term Effects (LT): Hypokalemia, aplastic anemia, leukopenia, hemolytic anemia, thrombocytopenia, agranulocytosis, renal failure, Stevens-Johnson syndrome
• Patient Education:
  • Rise slowly to avoid orthostatic hypotension
  • Monitor blood glucose periodically, as hydrochlorothiazide can increase blood glucose levels in prediabetic patients

Potassium Sparing Diuretic (Spironolactone)

• Use: Edema, HTN, HF, hypokalemia, and hyperaldosteronism
• Mechanism of Action (MOA): Inhibits aldosterone effects on distal renal tubules to promote sodium and water excretion and potassium retention
• Nursing Responsibilities:
  • Monitor daily weights
  • Monitor urinary output (report if less than 30 mL/hr)
  • Monitor for hyperkalemia signs (nausea, diarrhea, abdominal cramps, numbness/tingling of hands and feet, leg cramps, tachycardia progressing to bradycardia, peaked T wave on ECG)
• Side Effects (SE): Nausea, vomiting, diarrhea, abdominal cramps, dizziness, drowsiness, headache, confusion, weakness, muscle cramps, gout, paresthesia, dehydration, ataxia, erectile dysfunction
• Adverse Reactions (AR): Hyperkalemia, hypomagnesemia, hyponatremia, hypocalcemia, hypovolemia, hyperglycemia, hyperuricemia, orthostatic hypotension, bradycardia, metabolic acidosis/alkalosis
• Long-Term Effects (LT): Agranulocytosis, leukopenia, thrombocytopenia, renal/hepatic failure, Stevens–Johnson syndrome
• Patient Education:
  • Avoid foods rich in potassium
  • Do not discontinue the drug without consulting a healthcare provider
  • Take medication with or after a meal

Beta Blockers (Metoprolol)

• Use: Control hypertension, acute myocardial infarction, angina, heart failure
• Mechanism of Action (MOA): Blocks beta-1 adrenergic receptors in cardiac tissues
• Nursing Responsibilities:
  • Obtain medication and herbal history from patient
  • Assess blood pressure and pulse
  • Monitor vital signs and compare to baseline

Calcium Channel Blockers (Amlodipine)

• Use: Treat hypertension and coronary artery disease
• Mechanism of Action (MOA): Inhibits influx of calcium across myocardial and vascular smooth muscle cell membranes, decreasing myocardial contractility
• Nursing Responsibilities: Monitor blood pressure (BP). Report a sudden drop in BP

Angiotensin-Converting Enzyme Inhibitors (ACE) (Lisinopril)

• Use: Treat hypertension (HTN) and heart failure (HF), decreasing development of HF after myocardial infarction (MI)
• Mechanism of Action (MOA): Blocks the conversion of angiotensin I to angiotensin II.
• Nursing Responsibilities:
  • Monitor blood pressure (BP)
  • Monitor laboratory tests related to renal function (BUN, creatinine, protein), blood glucose

Angiotensin II Receptor Blocker (ARB) (Valsartan)

• Use: Treat hypertension (HTN) and heart failure (HF), decreasing development of post-myocardial infarction (MI) HF.
• Mechanism of Action (MOA): Potent vasodilator; inhibits binding of angiotensin II (prevents release of aldosterone)
• Nursing Responsibilities: Monitor blood pressure (BP); monitor laboratory tests related to renal function (BUN, creatinine, protein) and liver enzymes

Direct-Acting Vasodilators (Hydralazine)

• Use: Moderate-to-severe hypertension
• Mechanism of Action (MOA): Relaxes smooth muscles of blood vessels, especially arteries, causing vasodilation
• Nursing Responsibilities:
  • Monitor patient's blood pressure and heart rate (HR)
  • Use with caution in older adults, monitor for lupus-like syndrome

Cardiac Glycosides (Digoxin)

• Use: Heart failure, atrial fibrillation, and atrial flutter
• Mechanism of Action (MOA): Inhibits sodium-potassium ATPase, increasing cardiac contractility and output, decreasing ventricular rate.
• Nursing Responsibilities: Monitor for drug-drug and herb-drug interactions; monitor serum potassium levels (low potassium enhances digoxin action); monitor for digoxin toxicity (anorexia, nausea, vomiting, diarrhea, bradycardia, cardiac dysrhythmias, visual disturbances)

Alpha-Adrenergic Blocker (Prazosin)

• Use: Hypertension, benign prostatic hypertrophy
• Mechanism of Action (MOA): Dilates peripheral blood vessels by blocking alpha-adrenergic receptors
• Nursing Responsibilities: Monitor vital signs (especially blood pressure and heart rate) and report changes; monitor daily weights to monitor for fluid retention.

Nitrates (Nitroglycerin)

• Use: Control angina, acute myocardial infarction (AMI), hypertensive emergency, pulmonary edema, and heart failure
• Mechanism of Action (MOA): Decrease myocardial demand for oxygen; decrease preload by dilating veins; indirectly decrease afterload.
• Nursing Responsibilities: Position patient sitting or lying down when administering for the first time; monitor vital signs; Offer sips of water with administration; 2nd and 3rd doses may be administered in 5 min increments if systolic blood pressure is within parameters.

Anticoagulant Oral (Warfarin)

• Use: Prevent thrombosis associated with pulmonary embolism (PE), myocardial infarction (MI), unstable angina, prosthetic heart valves, deep vein thrombosis (DVT), and percutaneous coronary intervention (PCI); treat atrial fibrillation
• Mechanism of Action (MOA): Inhibits hepatic synthesis of Vitamin K-dependent clotting factors (II, VII, IX, and X) and anticoagulant proteins.
• Nursing Responsibilities: Obtain a history of bleeding or clotting disorders, including alcohol or severe liver or kidney disease. Report if drug-drug or drug-herb interactions are suspected; monitor blood pressure (BP); monitor laboratory tests related to renal function (BUN, creatinine, protein), and blood glucose

Anticoagulant Subcutaneous or IV (Heparin)

• Use: Prevent thromboembolism; Treat deep vein thrombosis (DVT), disseminated intravascular coagulation (DIC), and acute coronary syndrome
• Mechanism of Action (MOA): Inactivates thrombin, which prevents the conversion of fibrinogen to fibrin.
• Nursing Responsibilities: Monitor vital signs (pulse, BP), monitor activated partial thromboplastin time (aPTT), assess for bleeding

Thrombolytic (Alteplase)

• Use: Promote fibrinolysis (dissolve clots) and decrease permanent tissue damage; associated with acute myocardial infarction (MI), pulmonary embolism (PE), ischemic stroke, occluded intravenous catheter.
• Mechanism of Action (MOA): Promotes conversion of plasminogen to plasmin, an enzyme that digests fibrin matrix of clots.
• Nursing Responsibilities: Monitor vital signs, assess for bleeding, avoid administering aspirin or NSAIDs, monitor ECG for reperfusion dysrhythmias.

Antiplatelet (Aspirin or Clopidogrel)

• Use: Prevention and treatment of stroke, myocardial infarction (MI), transient ischemic attack (TIA), prosthetic heart valves and thromboembolism prophylaxis
• Mechanism of Action (MOA): Inhibits cyclooxygenase (COX), an enzyme needed by platelets to synthesize thromboxane A2 (TXA2)
• Nursing Responsibilities: Monitor lab values (platelets, white blood cells, BUN, creatinine, electrolytes); avoid in patients with bleeding

Antihyperlipidemic (Atorvastatin)

• Use: Decrease cholesterol levels and serum lipids, especially low-density lipoprotein (LDL) and triglycerides
• Mechanism of Action (MOA): Inhibits HMG-CoA reductase, the enzyme necessary for hepatic production of cholesterol
• Nursing Responsibilities: Monitor blood lipid levels; monitor liver function tests (ALT, ALP, GGT); advise patients to take medication with sufficient water or with meals.

Peripheral Vasodilator (Cilostazol)

• Use: Prevention of thrombosis and myocardial infarction (MI), cerebral vascular accident (CVA), transient ischemic attack (TIA), and for intermittent claudication
• Mechanism of Action (MOA): Inhibits platelet aggregation and causes vasodilation, especially in the femoral vasculature.
• Nursing Responsibilities: Monitor vital signs, especially blood pressure and heart rate (tachycardia and orthostatic hypotension can be problematic); monitor for side effects.

Hyperkalemia Treatments (Calcium Gluconate, Sodium Polystyrene Sulfonate)

• Use: Oral and intravenous (IV) treatment and prevention of hypocalcemia; adjunct to prevent postmenopausal osteoporosis
• Mechanism of Action (MOA): Transmits nerve impulses; contracts skeletal and cardiac muscles; maintains cellular permeability; promotes strong bones and teeth
• Nursing Responsibilities: Assess patient for signs/symptoms of calcium imbalance (hypocalcemia or hypercalcemia); assess serum calcium levels (normal range is 8.6 to 10.2 mg/dL). Assess and document albumin levels (normal range is 3.4–5.4 g/dL)

Understand the use, mechanism, and nursing responsibilities for loop diuretics like Furosemide. Learn about monitoring patient weight, urinary output, vital signs, and potassium levels. Be aware of potential side effects such as nausea, dizziness, and hypokalemia.