Pharmacological Concepts Module B PDF - Nursing Guide

Spring 2025 Page 1 of 74 NURS3415 Module B Pharmacological Concepts Melloy Moore NURS3415 Ph...

Spring 2025 Page 1 of 74 NURS3415 Module B Pharmacological Concepts Melloy Moore NURS3415 Pharmacological Concepts Comprehensive Module B Didactic Learning Guide Learning Guides are intended to assist in the exploration of key concepts from the Module/Module Subsection. Learning Guides will be relevant not only to course exams, but also to ATI assessments, the NCLEX, and nursing practice. Module 1B Comfort ATI RN Pharmacology for Nursing Text - Unit 9 Medications for Pain and Inflammation Chapter 33 Non-Opioid Analgesics Aspirin (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) o Purpose: ▪ Therapeutic Uses: Inflammation suppression Analgesia for mild to moderate pain Fever reduction Dysmenorrhea (painful menstruation) Less blooding clotting factors (Aspirin), which protects against ischemic stroke and myocardial infraction (heart attack) Celecoxib suppresses inflammation, relieves pain, decreases fever, and can protect against colorectal cancer ▪ COX-1 inhibition: Reduces platelet aggregation (less blood clotting) Can cause kidney damage ▪ COX-2 inhibition: Reduces inflammation, fever, and pain Does not affect platelet aggregation (no impact on blood clotting) Spring 2025 Page 2 of 74 NURS3415 Module B Pharmacological Concepts o Complications: ▪ Gastrointestinal Discomfort: Dyspepsia (indigestion), abdominal pain, heartburn, nausea o Nursing Actions: ▪ Risk is increasing in older adults, clients who smoke or have alcohol use disorder, and those who have a history of peptic ulcers or previous inability to tolerate NSAIDs. ▪ Observe for indications of GI bleeding (passage of black or dark-colored stools, severe abdominal pain, nausea, vomiting). ▪ Administer a proton pump inhibitor (omeprazole) or an H2 receptor antagonist (cimetidine) to decrease the risk of ulcer formation. ▪ Use prophylaxis agents (misoprostol). ▪ Impaired Kidney Function: Decreased urine output, weight gain from fluid retention, increased BUN, and creatinine levels o Nursing Actions: ▪ Use cautiously with older adults and clients who have heart failure. ▪ Monitor I&O and kidney function (BUN, creatinine). ▪ Increased risk of heart attack and stroke: With non-aspirin NSAIDs o Nursing Actions: ▪ Use the smallest effective dose for clients who have cardiovascular disease ▪ Salicylism (can occur with aspirin) Manifestations: Tinnitus, sweating, headache, dizziness, and respiratory alkalosis ▪ Reye’s Syndrome (rare): Happens when aspirin is used for fever reduction in children and adolescents who have a viral illness (chickenpox or influenza) Spring 2025 Page 3 of 74 NURS3415 Module B Pharmacological Concepts o Contraindications/ Precautions: ▪ First-generation NSAIDs Avoid in: o Pregnancy (Risk Category D) o Peptic ulcer disease o Bleeding disorders (hemophilia, vitamin K deficiency) o Allergy to aspirins or other NSAIDs o Children/adolescents with viral illnesses (e.g., chickenpox, flu) Use cautiously in: o Older adults o Smokers o People with H. pylori infection, low blood volume, asthma, chronic hives, or bleeding disorders o People on ACE inhibitors or ARBs o People with kidney disease (especially with ketorolac, max use 5 days due to risks) ▪ Second-generation NSAIDs (e.g., Celecoxib) Use with caution: o Celecoxib is a last-choice option for chronic pain due to increased risk of heart attack (MI) and stroke o Contraindicated in people with sulfonamide allergies. o Interactions: ▪ Anticoagulants (heparin and warfarin) increase the risk of bleeding. ▪ Nursing Actions: Monitor PTT, PT, and INR o PTT: Checks how well your blood clots using one part of the clotting system. o PT: Measures how well your blood clots are using a different part of the clotting system. o INR: A way to make sure PT results are the same no matter where the test is done. o Nursing Administration: ▪ Use opioids to allow for lower dosing ▪ Administer parenterally first then switch to oral Spring 2025 Page 4 of 74 NURS3415 Module B Pharmacological Concepts o Nursing Evaluation of Medication Effectiveness: ▪ Reduction in inflammation ▪ Reduction of fever ▪ Relief from mild to moderate pain ▪ Relief from dysmenorrhea (painful menstruation) ▪ Be sure to list other first-generation NSAIDs: ▪ Aspirin ▪ Ibuprofen ▪ Naproxen ▪ Indomethacin ▪ Diclofenac ▪ Ketorolac ▪ Meloxicam ▪ Piroxicam ▪ Ketoprofen ▪ Be sure to address client education: ▪ Stop aspirin 1 week before an elective surgery or expected date of childbirth. QEBP ▪ Take NSAIDs with food, milk, or an 8 oz glass of water to reduce gastric discomfort. ▪ Do not chew or crush enteric-coated or sustained-release aspirin tablets. ▪ Be sure to address toxicity: ▪ Progresses from the mild findings in salicylism to sweating, high fever, acidosis, dehydration, electrolyte imbalances, coma, and respiratory depression ▪ Nursing Actions: Aspirin toxicity should be managed as a medical emergency in the hospital. Activated charcoal can be given to decrease absorption. Hemodialysis can be indicated. Cool the client with tepid water. Correct dehydration and electrolyte imbalance with IV fluids. Reverse acidosis and promote salicylate excretion with bicarbonate. Perform gastric lavage. (Stomach is washed out to remove toxic substances, ingested poisons, or harmful contents.) Spring 2025 Page 5 of 74 NURS3415 Module B Pharmacological Concepts What information stands out about Ketorolac? Hint: This medication has unique administration principles. o Administer first parenterally and then orally. No longer than 5 days (risk of gastrointestinal, cardiovascular, and renal complications) What information stands out about Celecoxib? Hint: This medication is a unique type of NSAID and has a unique and life-threatening adverse effect and contraindication. o Second-generation NSAID o Last-choice med due to increased risk of myocardial infarction and stroke (secondary suppression of vasodilation) o Contraindicated in patients with sulfonamide allergies Acetaminophen (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) o Purpose: ▪ Slows the production of prostaglandins in the central nervous system. ▪ Therapeutic Uses: Analgesic (relief of pain) effect Antipyretic (reduction of fever) effects Preferred to NSAIDs for children suspected of having a viral infection (e.g. chicken pox, influenza) o Complications: ▪ Adverse effects are rare for therapeutic dosages. o Contraindications / Precautions: ▪ Pregnancy Risk Category B for oral, rectal use, and C for IV use. ▪ Avoid clients who have hypersensitivity to a component, or severe liver impairment or disease, kidney impairment, chronic alcohol use disorder, malnutrition. ▪ Use IV form cautiously for clients who are breastfeeding. o Interactions: ▪ Alcohol increases the risk of liver damage. ▪ Warfarin - risk of bleeding (acetaminophen slows warfarin metabolism) o Nursing Administration: ▪ Read med labels Spring 2025 Page 6 of 74 NURS3415 Module B Pharmacological Concepts take 1 acetaminophen product at a time ▪ Administer with water - with or without food Adults - take for 10 days max Children - take for 5 days max ▪ Nursing Evaluation of Medication Effectiveness: ▪ Relief of pain ▪ Reduction of fever ▪ Be sure to address toxicity: ▪ Results in liver damage with early manifestations of nausea, vomiting, diarrhea, sweating, and abdominal discomfort progressing to hepatic failure, coma, and death ▪ Beginning manifestations: nausea vomiting diarrhea sweating abdominal discomfort ▪ Progressed manifestations: hepatic failure coma death ▪ Be sure to address antidote: ▪ acetylcysteine (via duodenal tube to prevent emesis and subsequent aspiration) ▪ Be sure to address client education: ▪ Take acetaminophen as prescribed and not to exceed recommended daily dosages. Parents should carefully follow the provider’s advice regarding administration to children. ▪ Remain aware of the potential risk of liver damage with consumption of alcohol. ▪ Observe for indications of bleeding (bruising, petechiae, hematuria). ▪ Contact provider if fever persists past 3 days: Adults - 10 days max Children - 5 days max Chapter 34 Opioid Agonists and Antagonists Spring 2025 Page 7 of 74 NURS3415 Module B Pharmacological Concepts Morphine (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) o Purpose: ▪ Act on mu receptors (produces analgesia, respiratory depression, euphoria, sedation) and kappa receptors (produces analgesia, sedation, decreased GI motility) ▪ Relieves moderate-severe pain ▪ Sedation ▪ Reduction of bowel motility relief of diarrhea o Complications: ▪ Respiratory Depression ▪ Constipation ▪ Orthostatic hypotension ▪ Urinary retention ▪ Cough Suppression ▪ Sedation ▪ Biliary colic (a type of abdominal pain caused by gallstones blocking a bile duct) ▪ Nausea/vomiting ▪ Opioid toxicity triad coma respiratory depression pinpoint pupils o Contraindications / Precautions: ▪ Pregnancy/Lactation - use with caution ▪ Should not be used After biliary tract surgery ▪ Should not be used for Premature infants during/after delivery (respiratory depressant effects) ▪ Precautions: asthma, emphysema, head injuries, infants, older adults extremely obese (metabolized at a slower rate) IBS (risk of megacolon/paralytic ilueus) Enlarged prostate (risk of acute urinary retention) Hepatic/Renal disease o Interactions: ▪ CNS depressants (barbiturates, phenobarbital, benzodiazepines, alcohol) have additive CNS depression action. Spring 2025 Page 8 of 74 NURS3415 Module B Pharmacological Concepts ▪ Anticholinergic agents (atropine/scopolamine), antihistamines (diphenhydramine), tricyclic antidepressants (amitriptyline) - additive anticholinergic effects (constipation, urinary retention) ▪ Antihypertensives - additive hypotensive effects o Nursing Administration: ▪ Assess pain levels on a regular basis. Document the client’s response. ▪ Take baseline vital signs. If the respiratory rate is less than 12/min, notify the provider and withhold the medication. ▪ Follow controlled substance procedures. ▪ Double-check opioid doses with another nurse prior to administration. ▪ Administer IV opioids slowly over 4 to 5 min. Have naloxone and resuscitation equipment available. ▪ Warn clients not to increase dosage without consulting the provider. ▪ For clients who have cancer, administer opioids on a fixed schedule around the clock. Administer supplemental doses as needed. ▪ Advise clients who have physical dependence not to discontinue opioids abruptly. Opioids should be withdrawn slowly, and the dosage should be tapered over a period of 3 days. ▪ Closely monitor patient-controlled analgesia (PCA) pump settings (dose, lockout interval, 4-hr limit). Reassure clients regarding safety measures that safeguard against self-administration of excessive doses. Encourage clients to use PCA prophylactically prior to activities likely to augment pain levels. ▪ When switching clients from PCA to oral doses of opioids, make sure the client receives adequate PCA dosing until the onset of oral medication takes place. ▪ The first administration of a transdermal fentanyl patch will take several hours (up to 24 hours) to achieve the desired therapeutic effect. Administer short-acting opioids as needed prior to onset of therapeutic effects and for breakthrough pain. o Nursing Evaluation of Medication Effectiveness: ▪ Relief of moderate to severe pain (postoperative pain, cancer pain, myocardial pain) ▪ Cough suppression ▪ Resolution of diarrhea Spring 2025 Page 9 of 74 NURS3415 Module B Pharmacological Concepts ▪ Be sure to list other opioid agonists: ▪ Fentanyl ▪ Meperidine ▪ Methadone ▪ Codeine ▪ Oxycodone ▪ Hydromorphone ▪ Route of Administration: ▪ Morphine: Oral, subcutaneous, IM, IV, epidural, intrathecal QPCC ▪ Fentanyl: IV, IM, transmucosal, transdermal ▪ Meperidine: Oral, subcutaneous, IM, IV ▪ Codeine: Oral, subcutaneous, IM, IV ▪ Methadone: Oral, subcutaneous, IM ▪ Oxycodone: Oral, rectal ▪ Hydromorphone: Oral, subcutaneous, IM, IV ▪ Be sure to address how to minimize the risk of adverse effects: ▪ Start with a low dose: Begin with the smallest amount to reduce risks. ▪ Watch breathing: Check for slow or shallow breathing, especially at high doses. ▪ Preventing constipation: Use stool softeners and encourage fluids. ▪ Hydrate: Keep the patient well-hydrated to protect kidneys. ▪ Monitor sedation: Avoid risky activities if drowsy. ▪ Adjust for older adults: Lower doses for elderly or those with liver/kidney issues. ▪ Watch for nausea: Offer anti-nausea meds if needed. ▪ Avoid alcohol and sedatives: These can increase the risk of severe side effects. Spring 2025 Page 10 of 74 NURS3415 Module B Pharmacological Concepts ▪ Be sure to address the patient-controlled analgesia (PCA) pump: ▪ Closely monitor patient-controlled analgesia (PCA) pump settings (dose, lockout interval, 4-hr limit). Reassure clients regarding safety measures that safeguard against self-administration of excessive doses. Encourage clients to use PCA prophylactically prior to activities likely to augment pain levels. ▪ When switching clients from PCA to oral doses of opioids, make sure the client receives adequate PCA dosing until the onset of oral medication takes place. What information stands out about Fentanyl? Hint: This medication has unique routes of administration. o Can be administered IV, IM, transmucosal, and transdermal Naloxone (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) o Purpose: ▪ Interfere with the action of opioids by competing for opioid receptors ▪ No effect in the absence of opioids ▪ Therapeutic Uses: Treatment of opioid abuse by preventing euphoria (naltrexone) Reversal of effects of opioids (respiratory depression [naloxone]) Reversal of respiratory depression in an infant (naloxone) Reversal of severe opioid-caused constipation in clients who have late-stage cancer or other disorders (methylnaltrexone, alvimopan) Reversal of post-operative opioid effects (respiratory depression, ileus) o Complications: ▪ Tachycardia and Tachypnea ▪ Abstinence syndrome: cramping hypertension vomiting reversal of analgesia o Contraindications / Precautions: ▪ Pregnancy/Lactation - use with caution ▪ Opioid dependency ▪ Acute hepatitis/liver failure and during lactation Spring 2025 Page 11 of 74 NURS3415 Module B Pharmacological Concepts o Interactions: ▪ o Nursing Administration: ▪ Administer IV, IM, Subcutaneous - do not administer orally ▪ Observe withdrawal manifestations or pain ▪ Titrate the dosage to achieve reversal of respiratory depression but not pain management ▪ Monitor respirations ▪ Administer slowly o Nursing Evaluation of Medication Effectiveness: ▪ Reversal of respiratory depression: regular respirations no shortness of breath ▪ Reduced euphoria and decreased craving for alcohol in dependency ▪ Constipation and ileus relieved Chapter 35 Adjuvant Medications for Pain Ibuprofen (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) ▪ Purpose: Used to treat inflammation and fever and relieve mild to moderate pain and dysmenorrhea. ▪ Complications: Bone marrow suppression o Observe for indications of easy bruising and bleeding, fever, or sore throat, and notify the provider if they occur. Gastrointestinal distress MI or stroke o Monitor cardiac and neurologic status, especially in older adult clients and those who have a history of cardiac disease or risk factors for MI or stroke. ▪ Contraindications/ Precautions: Avoid after 30 weeks of gestation, use cautiously with lactation. Ibuprofen is contraindicated in clients who have a history of bronchospasms with aspirin or other NSAIDs, and those who have severe kidney/hepatic disease. Use caution with clients who have bleeding, GI, or cardiac disorders. Use caution with older adult clients Spring 2025 Page 12 of 74 NURS3415 Module B Pharmacological Concepts ▪ Interactions: can reduce effectiveness of antihypertensives, furosemide, thiazide diuretics, and oral antidiabetic medications. Aspirin, corticosteroids, alcohol, and tobacco can increase GI effects. NSAIDs can increase levels of oral anticoagulants and lithium. There is an increased risk of bleeding with the use of other NSAIDs, thrombolytics, antiplatelets, anticoagulants, and salicylates. ▪ Nursing Administration: Client’s self-report: o The most important way to assess pain is by listening to what the client says about their pain. Pain management plan: o Clients should have a clear plan for managing their pain. Older adults: o Be extra careful with older clients, as they are more likely to have side effects or interactions with pain medications. Adjuvant medications: o Some pain-relief meds are used for other purposes, so explain to clients that they’re being used to help with pain, not their original purpose. ▪ Nursing Evaluation of Medication Effectiveness: Relief of depression, seizures, dysrhythmia, and other manifestations that aggravate the client’s pain level Decreased opioid adverse effects Relief of neuropathic pain Decreased cancer bone pain Relief of neuralgia (a sharp, shocking pain that occurs when a nerve is irritated or damaged) ▪ Be sure to address client education: Take with food, milk, or antacid. Monitor for medication effectiveness. Report blood in urine Do not crush or chew enteric coated pill Spring 2025 Page 13 of 74 NURS3415 Module B Pharmacological Concepts Chapter 36 Miscellaneous Pain Medications Sumatriptan (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) o Purpose: ▪ to treat migraines and cluster headaches o Complications: ▪ Chest pressure (heavy arms or chest tightness) ▪ Coronary artery vasospasm/angina ▪ Dizziness or vertigo o Contraindications/ Precautions: ▪ Pregnancy/Lactation - only use if benefit outweighs risk ▪ Liver failure ▪ Ischemic heart disease ▪ History of MI ▪ Uncontrolled hypertension o Interactions: ▪ Concurrent use of MAOIs - MAOI toxicity ▪ Concurrent use with ergotamine - vasospastic reaction ▪ SSRIs - serotonin syndrome (confusion, agitation, hyperthermia, diaphoresis, possible death) o Nursing Administration: ▪ Antiemetics (metoclopramide) are useful as adjunct medications o Nursing Evaluation of Medication Effectiveness: ▪ Reduced intensity/frequency of migraines ▪ Prophylaxis against migraine attacks ▪ Termination of migraines ▪ Reduced size/frequency of dosage ▪ Be sure to address client education: ▪ Avoid stress and fatigue (alcohol, wine, aged cheese) ▪ Lie down in dark, quiet places ▪ Notify the provider of continuous or severe chest pain ▪ Avoid driving or operating heavy machinery until medication effects are known. Spring 2025 Page 14 of 74 NURS3415 Module B Pharmacological Concepts Lidocaine (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) o Purpose: ▪ Decrease pain by blocking conduction of pain impulses in a circumscribed area ▪ No loss of consciousness ▪ Parenteral: pain management for surgical, dental, labor and delivery, diagnostic procedures regional anesthesia (spinal, epidural) ▪ Topical: control laryngeal/esophageal reflexes (endoscopic procedures) Control pain for skin/mucous membrane disorders Control pain for minor procedures (IV, Pediatric injection, wart removal) o Complications: ▪ CNS excitation: seizures respiratory depression unconsciousness ▪ Hypertension, cardio suppression: Bradycardia heart block reduced contractile force cardiac arrest ▪ Allergic Reactions: Allergic dermatitis to anaphylaxis ▪ Labor and Delivery labor can be prolonged (decrease in uterine contractility) can cross placenta and result in fetal bradycardia/CNS depression ▪ Spinal Headache: ▪ Urinary Retention o Contraindications/ Precautions: ▪ Pregnancy/Lactation: use only if benefit outweighs risk ▪ Supraventricular dysrhythmias/heart block ▪ Liver and Kidney dysfunction ▪ Heart failure ▪ Myasthenia ▪ Do not add epi for use in fingers, nose, or any other end arteries (gangrene from vasoconstriction) Spring 2025 Page 15 of 74 NURS3415 Module B Pharmacological Concepts o Interactions: ▪ Antihypertensive meds - additive hypotensive effects o Nursing Administration: ▪ Maintain comfortable position ▪ Injection: vasoconstrictors (epi) are often used in combo to prevent the spread of anesthetic (decreased chance of systemic toxicity, prolongs anesthesia) clean and shave site monitor vital signs/level of consciousness IV access and resuscitation equipment ready protect numb areas from injury ▪ Spinal/Epidural nerve blocks: monitor for hypotension, anaphylaxis, seizure, dura puncture monitor for respiratory depression and sedation monitor site for hematoma or infection indications Assess the level of sensory block Administer IV fluids (compensate for sympathetic blocking effects) have client lie for 12 hrs. to minimize headache notify the provider of client is unable to void after 8 hrs. ▪ Topical Cream (EMLA): apply 1 hr. before routine proc./superficial puncture, 2 hr. before deep puncture/extensive proc. Do not wrap or heat area Clean skin with aseptic solution prior to procedure NPO client until normal pharyngeal sensation returns Monitor vital signs and LOC o Nursing Evaluation of Medication Effectiveness: ▪ Client undergoes procedure without experiencing pain ▪ Pain is relieved Spring 2025 Page 16 of 74 NURS3415 Module B Pharmacological Concepts What information stands out about EMLA? Hint: This medication has unique administration principles. o Apply 1 hr. before routine procedures or superficial puncture o Apply 2 hrs. before more extensive procedures or deep puncture o Apply to smallest surface area o Avoid wrapping/heating the area o Clean skin with aseptic solution prior to procedure o Keep client NPO until normal pharyngeal sensation returns (1 hr.) o Monitor patient's first oral intake o Can be applied at home o Monitor vital signs and loc Module 2B Elimination ATI RN Pharmacology for Nursing Text - Unit 4 Medications Affecting the Cardiovascular System Chapter 18 Medications Affecting Urinary Output Furosemide (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) ▪ Purpose: ▪ High-ceiling loop diuretics work in the loop of Henle in the kidneys. ▪ They block sodium and chloride reabsorption and prevent water reabsorption, leading to increased urination. ▪ Cause significant fluid loss (diuresis), even in people with severe kidney issues. ▪ Increase excretion of water, potassium, sodium, chloride, magnesium, and calcium. ▪ Therapeutic Uses: ▪ Pulmonary edema due to heart failure ▪ Edema from liver, heart, or kidney disease (when other diuretics don’t work) ▪ Hypertension (specifically torsemide) ▪ Unlabeled use: Hypercalcemia (high calcium levels) Spring 2025 Page 17 of 74 NURS3415 Module B Pharmacological Concepts ▪ Administration routes: ▪ Oral, IV, IM. ▪ Complications: ▪ Dehydration ▪ Hypotension (advise client to avoid sudden changes of position and arise slowly from lying down or sitting) ▪ Ototoxicity (transient with furosemide and irreversible with ethacrynic acid) ▪ Nurse should avoid the use of other ototoxic medications (aminoglycoside antibiotics - gentamicin-) ▪ Hypokalemia ▪ Less than 3.5 mEq/L ▪ Monitor electrolyte levels ▪ Monitor cardiac status and potassium levels ▪ Hyponatremia ▪ Hypomagnesemia ▪ Hypochloremia ▪ Hypocalcemia ▪ Adverse Effects: ▪ Hyperglycemia, hyperuricemia, decrease in HDL cholesterol levels, increase in LDL cholesterol levels ▪ Increase in triglycerides level ▪ Contraindications/ Precautions: ▪ Pregnancy: ▪ Furosemide safety during pregnancy is not known. ▪ Lactation: ▪ Safety for breastfeeding is not established. ▪ Contraindications: ▪ Do not use in people with anuria (no urine output). ▪ Use cautiously in people with: ▪ Severe liver disease ▪ Diabetes ▪ Dehydration ▪ Low electrolytes ▪ Gout ▪ Be cautious if taking: ▪ Digoxin ▪ Lithium ▪ Ototoxic drugs (can harm hearing) ▪ NSAIDs or antihypertensives ▪ Hypoproteinemia (low protein levels) can lead to hearing problems with furosemide use. Spring 2025 Page 18 of 74 NURS3415 Module B Pharmacological Concepts ▪ Interactions: ▪ Digoxin toxicity (irregular heart rhythms) can happen if potassium levels are low (hypokalemia). ▪ Nursing Actions: ▪ Monitor heart status, potassium, and digoxin levels regularly. ▪ Potassium-sparing diuretics are often used with loop diuretics to help prevent low potassium. ▪ Administer potassium supplements if prescribed by the doctor. ▪ Caution: ▪ Using antihypertensives together with diuretics can lower blood pressure too much. ▪ Monitor blood pressure ▪ Monitor lithium levels, adjust dosage if needed ▪ Monitor for a decrease in the effectiveness of the diuretic (a decrease in urine output) ▪ Nursing Administration: ▪ Obtain baseline data: Check blood pressure, weight, electrolytes, and the extent of edema (swelling). ▪ Weigh clients at the same time daily, with the same clothes and linens, usually in the morning after waking up. ▪ Monitor blood pressure and input/output (I&O). ▪ Avoid giving medication late in the day to prevent needing to urinate at night (nocturia). Give doses at 0800 and 1400. ▪ Administer furosemide: Oral, IM, IV bolus (push dose), or continuous IV. Give IV bolus at 20 mg/min or slower to prevent sudden low blood pressure or low blood volume. ▪ If potassium level drops below 3.5 mEq/L, monitor ECG and contact the doctor—potassium supplements may be needed. ▪ Fall precautions for older adults on diuretics. ▪ Monitor for chest, calf, or pelvic pain and contact the provider if pain occurs. ▪ Nursing Evaluation of Medication Effectiveness: ▪ Decrease in pulmonary or peripheral edema ▪ Weight loss ▪ Decrease in blood pressure ▪ Increase in urine output ▪ Decrease in calcium level Spring 2025 Page 19 of 74 NURS3415 Module B Pharmacological Concepts ▪ Be sure to address client education: ▪ Monitor for manifestations of postural hypotension (light-headedness, dizziness). If this occurs, sit or lie down. ▪ Notify the provider of tinnitus, which can indicate ototoxicity. ▪ Teach clients to consume high-potassium foods (bananas, potatoes, dried fruits, nuts, spinach, citrus fruit). ▪ Teach clients to observe and report manifestations of hypokalemia (nausea, vomiting, fatigue, leg cramps, and general weakness). ▪ If taking for hypertension, track blood pressure and weight regularly and keep a log. ▪ Stand up slowly to avoid dizziness (postural hypotension). Monitor blood pressure and check for signs of low blood volume (hypovolemia). If feeling faint or dizzy, sit or lie down. ▪ Reporting significant weight loss, lightheadedness, dizziness, stomach problems, or weakness to the doctor—these could be signs of low potassium or low blood volume. ▪ Eat foods high in potassium. ▪ If you have diabetes, keep an eye on blood glucose levels (they may go up). ▪ Watch for signs of electrolyte imbalances and report to your doctor. ▪ Report signs of ototoxicity (hearing problems), like vertigo, ringing/buzzing, or a full feeling in the ears. Hydrochlorothiazide (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) ▪ Purpose: ▪ Blocks reabsorption of sodium and chloride, prevents reabsorption of water ▪ Promotes diuresis when renal function is not impaired ▪ 1st choice for essential hypertension ▪ edema of mild to moderate heart failure and liver and kidney disease ▪ reduce urine production for diabetes insipidus ▪ promote reabsorption of calcium and can reduce the risk for postmenopausal osteoporosis Spring 2025 Page 20 of 74 NURS3415 Module B Pharmacological Concepts ▪ Complications: ▪ Dehydration ▪ Hyponatremia ▪ Hypokalemia ▪ Hypochloremia ▪ Hyperglycemia ▪ Hyperuricemia ▪ Hypomagnesemia ▪ Increased lipids ▪ Contraindications/ Precautions: ▪ Pregnancy - use with caution (risk of jaundice or thrombocytopenia) ▪ Lactation - Thiazide diuretics ▪ Renal impairment ▪ Precautions: ▪ Cardiovascular disease ▪ Diabetes Mellitus ▪ Hypokalemia ▪ Hyperlipidemia ▪ Hypomagnesemia ▪ Gout ▪ Patients taking digoxin, lithium, and antihypertensives ▪ Interactions: ▪ Med and food interactions same as loop diuretic meds ▪ Thiazide diuretics No risk of hearing loss - can be combined with ototoxic meds ▪ Nursing Administration: ▪ Obtain baseline data – ▪ orthostatic BP, weight, electrolytes, location/extent of edema ▪ Monitor potassium ▪ Alternate-day dosing to decrease electrolyte imbalances ▪ Weigh patients at the same time every day ▪ Monitor BP and I&O ▪ Nursing Evaluation of Medication Effectiveness: ▪ Decrease in BP ▪ Decrease in edema ▪ Increase in Urine output ▪ Reduced urine output in diabetes insipidus ▪ Preserved bone integrity in postmenopausal patients Spring 2025 Page 21 of 74 NURS3415 Module B Pharmacological Concepts ▪ Be sure to address client education: ▪ Take 1st thing in the morning and by 1400 (prevent nocturia) ▪ Weigh self at same time - notify provider if weight gain is more than 3 Ibs a day, lightheadedness, dizziness, GI distress, general weakness ▪ Consume high potassium foods and 1500 mL fluid/day ▪ Take meds with/after meals ▪ For hypertension - Monitor BP and weight ▪ With diabetes - monitor blood glucose Spironolactone (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) ▪ Purpose: ▪ Potassium-sparing diuretic ▪ Blocks action of aldosterone (sodium/water retention) resulting in potassium retention and excretion of sodium + water ▪ Administered for heart failure ▪ Treat hypertension and edema ▪ Complications: ▪ Hyperkalemia ▪ Endocrine effects ▪ deepened voice ▪ impotence ▪ irregularities of menstrual cycle ▪ gynecomastia ▪ hirsutism ▪ Drowsiness, metabolic acidosis ▪ Contraindications/ Precautions: ▪ Pregnancy - fetal harm ▪ Hyperkalemia, taking potassium supplements/another potassium sparing diuretic ▪ Severe kidney failure and anuria ▪ Precautions: ▪ Kidney or liver disease ▪ Electrolyte imbalances ▪ Metabolic acidosis ▪ Interactions: ▪ ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors - increased risk of hyperkalemia ▪ Potassium supplements, salt substitutes, potassium sparing diuretic - increased risk of hyperkalemia ▪ Nursing Administration: Spring 2025 Page 22 of 74 NURS3415 Module B Pharmacological Concepts ▪ Obtain baseline ▪ Weigh at the same time each day ▪ Monitor BP, I&O, ECG, Potassium levels ▪ Nursing Evaluation of Medication Effectiveness: ▪ Maintenance of expected potassium levels: 3.5-5.0 mEq/L ▪ Weight loss ▪ Decrease in blood pressure and edema ▪ Be sure to address client education: ▪ Avoid salt substitutes that contain potassium ▪ Reduce intake of potassium-rich foods (oranges, bananas, potatoes, dates, raisins) ▪ Monitor BP and weight ▪ Report cramps, diarrhea, thirst, altered menstruation, deepened voice ▪ Avoid activities that require alertness Mannitol (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) ▪ Purpose: ▪ Osmotic diuretic ▪ Reduce intracranial pressure and intraocular pressure - raise serum osmolality and draw fluid back into vascular and extravascular space ▪ Prevents kidney failure (hypovolemic shock and severe hypotension) by preserving urine flow ▪ Decreases intracranial pressure by drawing off fluid from brain ▪ Decreases intraocular pressure by drawing ocular fluid into bloodstream ▪ Promotes sodium retention and water excretion (patients w/ hyponatremia and fluid volume excess) ▪ Complications: ▪ Heart failure ▪ Pulmonary edema ▪ Rebound increased intracranial pressure ▪ Fluid and electrolyte imbalances, metabolic acidosis ▪ Contraindications/ Precautions: ▪ Active intracranial bleed ▪ Anuria ▪ Severe pulmonary edema ▪ Severe dehydration Spring 2025 Page 23 of 74 NURS3415 Module B Pharmacological Concepts ▪ Renal failure ▪ Precautions: ▪ Heart failure ▪ Pregnant/Breast feeding ▪ Renal insufficiency ▪ Electrolyte imbalances ▪ Interactions: ▪ Lithium excretion through kidneys increased ▪ Increased risk for hypokalemia w/ cardiac glycosides ▪ Nursing Administration: ▪ Continuous IV ▪ Use a filter needle ▪ Monitor daily weight, I&O, blood electrolytes, BP ▪ Monitor for dehydration, increased edema ▪ Obtain baseline orthostatic BP, weight, electrolytes, location/extent of edema ▪ Monitor potassium ▪ Monitor for increased ICP (change in LOC, pupils, headache, nausea, vomiting) ▪ Monitor for metabolic acidosis (drowsiness, restlessness) ▪ Nursing Evaluation of Medication Effectiveness: ▪ Normal kidney function ▪ urine output 30mL/hr. ▪ blood creatine 0.6-1.3 mg/dL (males) and 0.5-1.1 mg/dL (females) ▪ BUN levels 10-20 mg/dL ▪ Decrease in intracranial pressure ▪ Decrease in intraocular pressure ▪ Be sure to address client education: ▪ Get up slowly, monitor BP, assess for hypovolemia ▪ Sit/lie down if faint/dizzy ▪ Report weight loss, lightheadedness, dizziness, GI distress, general weakness Perfusion ATI RN Pharmacology for Nursing Text - Unit 4 Medications Affecting the Cardiovascular System Chapter 19 Medications Affecting Blood Pressure Spring 2025 Page 24 of 74 NURS3415 Module B Pharmacological Concepts Captopril (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration) ▪ Purpose: ▪ ACE inhibitors block the conversion of angiotensin I to angiotensin II. ▪ They increase bradykinin levels, which leads to: ▪ Vasodilation (relaxes blood vessels, especially arteries) ▪ Increased excretion of sodium and water, and potassium retention (affects kidney function) ▪ Reduced damage to blood vessels and the heart caused by angiotensin II and aldosterone. ▪ Therapeutic Uses: ▪ Hypertension (high blood pressure) ▪ Heart failure (help the heart pump more effectively) ▪ Post-myocardial infarction (reduces death risk and heart failure) ▪ Diabetic and nondiabetic kidney disease (helps protect kidney function) ▪ Prevention of cardiovascular events (e.g., heart attack or stroke), especially with ramipril for high-risk patients. ▪ Complications: ▪ First-dose Orthostatic hypotension ▪ Nursing actions: ▪ If the client is already taking a diuretic, stop the medication temporarily for 2 to 3 days prior to the start of an ACE inhibitor ▪ Taking another type of antihypertensive medication increases the hypotensive effects of an ACE inhibitor. ▪ Start treatment with low dosage of the medication ▪ Monitor Blood pressure after initiation of treatment ▪ If hypotension occurs-place client in supine position or intravenous fluid may be indicated ▪ Cough ▪ Related to ACE (kinase II) which results in an increase in bradykinin ▪ Hyperkalemia Spring 2025 Page 25 of 74 NURS3415 Module B Pharmacological Concepts ▪ Nursing actions: ▪ Monitor potassium levels (normal range 3.5 to 5 mEq/L) ▪ Advis client to avoid the use of salt substitutes containing potassium ▪ Monitor for manifestations of hyperkalemia (numbness and tingling) and paresthesia in hands and feet (paresthesia= the feeling of tingling, numbness, or a "pins and needles" sensation on the skin) ▪ Rash and Dysgeusia (altered taste) ▪ Angioedema ▪ Swelling of the tongue and oral pharynx ▪ Neutropenia ▪ Rare but serious complication of captopril ▪ Nursing Actions: ▪ Monitor WBC counts every 2 weeks for 3 months, then periodically. ▪ This condition is reversible when detected early. ▪ Inform clients to notify the provider at the first indications of infection (fever, sore throat). Discontinue medication. ▪ Contraindications/ Precautions: ▪ Warnings: ▪ Pregnancy: ACE inhibitors should not be used during pregnancy. ▪ Lactation: ACE inhibitors should not be used while breastfeeding. ▪ Contraindications: ▪ Do not use if the person has had an allergic reaction or swelling (angioedema) from ACE inhibitors before. ▪ Avoid in people with bilateral renal artery stenosis (narrowing of both kidney arteries) or those with just one kidney. ▪ Use cautiously in people with: ▪ Kidney problems or collagen vascular disease (conditions like lupus). Spring 2025 Page 26 of 74 NURS3415 Module B Pharmacological Concepts ▪ These people are at higher risk of developing neutropenia (low white blood cell count), so they need to be monitored closely for signs of infection. ▪ Interactions: ▪ Diuretics can contribute to first dose hypotension ▪ Antihypertensive medications can have an additive hypotensive effect ▪ Potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia ▪ ACE inhibitors can increase levels of lithium ▪ Make sure to monitor lithium levels to avoid toxicity ▪ Use of NSAIDs can decrease the antihypertensive effect of ACE inhibitors ▪ Avoid concurrent use ▪ Nursing Administration: ▪ Administer ACE inhibitors orally except enalaprilat, which is the only ACE inhibitor for IV use ▪ Be sure to list other angiotensin-converting enzyme (ACE) inhibitors: ▪ Enalapril ▪ Enalaprilat ▪ Fosinopril ▪ Lisinopril ▪ Ramipril ▪ Moexipril ▪ Benazepril ▪ Quinapril ▪ Trandolapril ▪ Perindopril ▪ Be sure to address client education: ▪ Change positions slowly: If you feel dizzy, lightheaded, or faint, lie down. ▪ Dry cough: If you develop a dry cough, inform your provider and stop the medication. ▪ Diuretics: Stop taking diuretics 2-3 days before starting an ACE inhibitor. ▪ Dosage: If you add an ACE inhibitor, your medication dosage may need adjustment. ▪ Potassium supplements: Only take them if prescribed. Avoid salt substitutes with potassium. Spring 2025 Page 27 of 74 NURS3415 Module B Pharmacological Concepts ▪ Formulation: This medication can be taken alone or with hydrochlorothiazide. ▪ Blood pressure: Check blood pressure at least 2 hours after the first dose to monitor for low blood pressure. ▪ Timing: Take captopril or moexipril at least 1 hour before meals. Other ACE inhibitors can be taken with or without food. ▪ Notify your provider if: You experience a cough, rash, changes in taste, or signs of infection. ▪ Rising slowly: Stand up slowly to avoid dizziness. ▪ Alertness: Avoid activities that require focus until you know how the medication affects you. ▪ Let me know if you need further clarification! Losartan (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration) ▪ Purpose: ▪ These medications block the action of angiotensin II in the body. This results in the following: ▪ Vasodilation (arterioles and veins) ▪ Excretion of sodium and water (by decreasing release of aldosterone) ▪ Therapeutic Uses: ▪ Hypertension (high blood pressure) ▪ Heart failure (valsartan and candesartan are used) ▪ Stroke prevention (losartan helps reduce the risk) ▪ Delay kidney damage in people with diabetes (irbesartan and losartan) ▪ Protect against heart attack, stroke, and death from heart problems in people who can’t take ACE inhibitors (telmisartan) ▪ Reduce death risk after a heart attack (valsartan) ▪ Slow eye damage from diabetes (losartan helps with diabetic retinopathy) ▪ Extra Note: ▪ ARBs block the effects of angiotensin II, while ACE inhibitors block the formation of angiotensin II. ▪ Unlike ACE inhibitors, ARBs are less likely to cause: ▪ High potassium levels (hyperkalemia). Spring 2025 Page 28 of 74 NURS3415 Module B Pharmacological Concepts ▪ Cough. ▪ So, ARBs tend to have fewer side effects related to these issues. ▪ Complications: ▪ Angioedema ▪ Nursing actions: ▪ Treat severe effects with subcutaneous injection of epinephrine ▪ Discontinue medication ▪ Fetal injury (only if client is pregnant) ▪ Hypotension ▪ Nursing actions: ▪ Monitor blood pressure, Advise clients to rise slowly from a sitting position ▪ Dizziness, lightheadedness ▪ Contraindications/ Precautions: ▪ Warnings: ▪ Pregnancy: ARBs should not be used during pregnancy. ▪ Lactation: ARBs should not be used while breastfeeding. ▪ Reproductive: ▪ If you can get pregnant, use contraception while taking ARBs to avoid harming the fetus. ▪ Kidney Issues: ▪ ARBs should not be used if you have bilateral renal stenosis (narrowing of both kidneys) or only one kidney because they can harm kidney function. ▪ Angioedema History: ▪ Be cautious if you’ve had angioedema (swelling) with an ACE inhibitor. ▪ Interactions: ▪ Antihypertensive medications can have an additive effect when used with ARBs. ▪ Nursing actions: ▪ Adjust dosage of medication if ARBs are added to the treatment regimen. ▪ Increased risk for lithium toxicity ▪ Nursing actions: ▪ Monitor lithium levels and adjust dosage. Spring 2025 Page 29 of 74 NURS3415 Module B Pharmacological Concepts ▪ Nursing Administration: ▪ Administer medications by oral route. ▪ Take ARBs with or without food. ▪ Be sure to address client education: ▪ Observe for manifestations (skin wheals, swelling of tongue and pharynx) and notify the provider immediately. ▪ If a client is of childbearing age, use contraception while on this medication. ▪ Avoid activities that require alertness until effects are known. ▪ Medication is prescribed as a single formulation or in combination with hydrochlorothiazide. ▪ If taken for heart failure, monitor weight and edema Verapamil, Diltiazem (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration) ▪ Purpose: ▪ Verapamil and Diltiazem: ▪ Calcium channel blockers: ▪ Relax and widen blood vessels (arteries and arterioles), lowering blood pressure. ▪ Reduce the force of the heart’s contractions, slow the heart rate, and slow the electrical signals through the AV node. ▪ These effects happen mainly in the arterioles and the heart. ▪ Veins aren’t significantly affected by these medications. therapeutic Uses Nifedipine Amlodipine Nicardipine Felodipine Verapamil, diltiazem Angina pectoris X X X X Hypertension X X X X X Cardiac dysrhythmias (atrial fibrillation, atrial flutter, SVT) X ▪ Complications: ▪ Orthostatic hypotension and peripheral edema ▪ Nursing actions Spring 2025 Page 30 of 74 NURS3415 Module B Pharmacological Concepts ▪ Monitor blood pressure, edema, and daily weight. ▪ Instruct clients to observe for swelling in the lower extremities and notify the provider if it occurs. ▪ A diuretic can be prescribed to control edema. ▪ Instruct clients about the manifestations of postural hypotension (lightheadedness, dizziness). If these occur, advise clients to sit or lie down. Can be minimized by getting up slowly. ▪ Constipation (primarily verapamil) ▪ Suppression of cardiac function ▪ Bradycardia, heart failure ▪ Nursing actions: ▪ Monitor ECG, pulse rate, and rhythm. ▪ Dysrhythmia ▪ QRS complex is widened, and QT interval is prolonged. ▪ Nursing actions: ▪ Monitor vital signs and ECG. ▪ Acute toxicity ▪ Resulting in hypotension, bradycardia, AV block, and ventricular tachydysrhythmias ▪ Nursing actions: ▪ Monitor vital signs and ECG. Gastric lavage and cathartic can be indicated. ▪ Administer medications (norepinephrine, calcium, isoproterenol, lidocaine, and IV fluids). ▪ Have equipment for cardioversion and cardiac pacer available. ▪ Contraindications/ Precautions: ▪ Warnings: ▪ Pregnancy: ▪ Verapamil: Safety during pregnancy isn’t known. ▪ Lactation: ▪ Verapamil: Safety while breastfeeding isn’t known. Spring 2025 Page 31 of 74 NURS3415 Module B Pharmacological Concepts ▪ Verapamil: ▪ Should not be used in people with: ▪ Low blood pressure, heart block, digoxin toxicity, or severe heart failure. ▪ Should not be used while breastfeeding. ▪ Both medications: (Verapamil and Nifedipine) ▪ Use cautiously in older adults or people with kidney/liver issues, mild heart failure, or GERD (acid reflux). ▪ Interactions: ▪ Verapamil can raise digoxin levels, which increases the risk of digoxin toxicity. This can lead to more heart problems, like slowing the heart rate (AV block). ▪ Nursing Actions: ▪ Monitor digoxin levels to make sure they stay in the safe range. ▪ Check vital signs for a slow heart rate (bradycardia) and signs of AV block (slower heartbeats). ▪ Using beta blockers with verapamil can cause heart failure, AV block, and bradycardia (slow heart rate). ▪ Nursing Actions: ▪ Space out the use of IV verapamil and beta blockers by several hours. ▪ Monitor ECG and heart rate regularly. ▪ Grapefruit juice with verapamil or diltiazem can cause toxicity. ▪ Nursing Actions: ▪ Watch for signs of toxicity: low blood pressure, slow heart rate, and AV block. ▪ Advise patients to avoid grapefruit juice. ▪ Nursing Administration: ▪ For IV administration of verapamil, administer injections slowly over a period of 2 to 3 min. ▪ Teach clients to monitor blood pressure and heart rate, as well as keep a blood pressure record. Withhold medication and notify provider for pulse less than 50/min and systolic blood pressure less than 90 mm Hg. Spring 2025 Page 32 of 74 NURS3415 Module B Pharmacological Concepts ▪ Be sure to list other calcium channel blockers: ▪ Nifedipine ▪ Amlodipine ▪ Felodipine ▪ Nicardipine ▪ Isradipine ▪ Nislodipine ▪ Be sure to address client education: ▪ Increase intake of high fiber food and oral fluids, if not restricted. ▪ Observe for suppression of cardiac function (slow pulse, activity intolerance), and notify provider if these occur. Discontinue medication if needed. ▪ Do not chew or crush sustained-release tablets. ▪ If with angina, record pain frequency, intensity, duration, and location. Notify the provider if attacks increase in frequency, intensity, and/or duration. ▪ Change positions slowly and avoid activities that require alertness until effects are known. Clonidine (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration) ▪ Purpose: ▪ Centrally acting alpha2 agonists ▪ How the medication works: ▪ Acts on the Central Nervous System (CNS) to reduce sympathetic nerve activity. ▪ Less stimulation of adrenergic receptors (alpha & beta) in the heart and blood vessels. ▪ Leads to: ▪ Bradycardia (slower heart rate) and decreased cardiac output (less blood pumped by the heart). ▪ Vasodilation (widening blood vessels), lowering blood pressure. ▪ Therapeutic uses: ▪ Primary hypertension (high blood pressure) — used alone or with other medications. ▪ Severe cancer pain — given by epidural infusion. ▪ ADHD (Attention Deficit Hyperactivity Disorder). ▪ Migraine headaches (investigational use). Spring 2025 Page 33 of 74 NURS3415 Module B Pharmacological Concepts ▪ Flushing from menopause. ▪ Tourette syndrome (to help manage symptoms). ▪ Withdrawal from alcohol, tobacco, or opioids. ▪ Complications: ▪ Drowsiness and sedation ▪ Nursing actions: Drowsiness will diminish as use of medication continues. ▪ Dry mouth ▪ Rebound hypertension if abruptly discontinued ▪ Nursing actions: Discontinue clonidine gradually over 2 to 4 days. ▪ Contraindications/ Precautions: ▪ Pregnancy: ▪ Clonidine: Not proven safe during pregnancy. ▪ Lactation (breastfeeding): ▪ Clonidine: Safety not established during breastfeeding. ▪ Other warnings: ▪ Avoid using the transdermal patch on skin affected by scleroderma or lupus. ▪ Contraindicated (should not be used) for people with: ▪ Bleeding disorders or who are on blood thinners (anticoagulants). ▪ Use cautiously if you’ve had: ▪ Stroke ▪ Asthma ▪ COPD (Chronic Obstructive Pulmonary Disease) ▪ Recent heart attack (MI) ▪ Diabetes ▪ Major depression ▪ Chronic kidney disease. ▪ Interactions: ▪ Antihypertensive medications can have an additive hypotensive effect. ▪ Client Education: ▪ Observe for manifestations of hypotension (dizziness, lightheadedness, faintness). ▪ Lie down if feeling dizzy, lightheaded, or faint, and change positions slowly. Spring 2025 Page 34 of 74 NURS3415 Module B Pharmacological Concepts ▪ Concurrent use of prazosin, MAOIs, and tricyclic antidepressants can counteract the antihypertensive effect of clonidine. ▪ Nursing actions: Monitor clients for therapeutic effect. Monitor blood pressure. Do not use concurrently. ▪ Additive CNS depression can occur with concurrent use of other CNS depressants (alcohol). ▪ Client Education: ▪ Be aware of additive CNS depression with alcohol and avoid use. ▪ Nursing Administration: ▪ Administer medication by oral, epidural, and transdermal routes (clonidine only). ▪ Medication is usually administered twice a day in divided doses. Take larger dose at bedtime to decrease the occurrence of daytime sleepiness. ▪ Transdermal patches are applied every seven days. Advise clients to apply patch on hairless, intact skin on torso or upper arm. ▪ Be sure to address client education: ▪ Avoid activities that require mental alertness until manifestations subside. ▪ Related to Dry mouth: ▪ Be compliant with the medication regimen. ▪ Dry mouth usually resolves in 2 to 4 weeks. ▪ Chew gum or suck on hard candy and take small amounts of water or ice chips. ▪ Do not discontinue treatment without consulting the provider. Metoprolol, Propranolol (Purpose, Complications, Contraindications/Precautions, Interactions, Nursing Administration, Nursing Evaluation of Medication Effectiveness) ▪ Purpose: ▪ Cardio-selective (affects the heart only): Metoprolol (Beta1). ▪ Nonselective (affects the heart and lungs): Propranolol (Beta1 and Beta2). ▪ How they work: ▪ Block beta1 receptors in the heart, which: ▪ Slow the heart rate. Spring 2025 Page 35 of 74 NURS3415 Module B Pharmacological Concepts ▪ Weaken the heart’s muscle contraction, reducing cardiac output. ▪ Slow the electrical signals through the heart. ▪ Some beta-blockers (like carvedilol and labetalol) also block alpha receptors, which widen blood vessels. ▪ Reduce renin release, lowering angiotensin II, leading to more vasodilation and helping the body remove sodium and water. ▪ Therapeutic uses: ▪ Primary hypertension (high blood pressure) – lowers vascular resistance over time. ▪ Angina (chest pain), tachydysrhythmias (fast heart rhythms), heart failure, and heart attack. ▪ Prevents fast heart rate caused by vasodilators. ▪ Also used for: ▪ Hyperthyroidism ▪ Migraine headaches ▪ Pheochromocytoma (adrenal tumor) and Glaucoma (eye condition). ▪ Complications: ▪ Bradycardia (slow heart rate): ▪ Nurse Action: Monitor pulse. If below 50 beats/min, stop the medication and notify the doctor. ▪ Caution with diabetes: It can hide fast heart rate (a sign of low blood sugar). Clients with diabetes should check their blood sugar to avoid hypoglycemia. ▪ Decreased cardiac output (less blood pumped by the heart): ▪ Nurse Action: Use carefully in clients with heart failure. Start with a low dose and increase gradually. ▪ Signs of worsening heart failure: Shortness of breath, swelling, weight gain, tiredness. Report these to the doctor. ▪ AV block (problem with heart’s electrical system): ▪ Nurse Action: Get a baseline ECG and keep monitoring. ▪ Orthostatic hypotension (low blood pressure when standing): ▪ Advice: Sit or lie down if feeling dizzy or faint. Rise slowly and avoid sudden position changes. Spring 2025 Page 36 of 74 NURS3415 Module B Pharmacological Concepts ▪ Rebound myocardium excitation (heart becomes extra sensitive after stopping medication): ▪ Nurse Action: Don’t stop beta blockers suddenly. Taper off over 1-2 weeks. ▪ Beta2 Blockade (e.g., propranolol): ▪ Bronchoconstriction (narrowing of airways): ▪ Nurse Action: Avoid using in clients with asthma. Use a beta1 selective agent for those wit