Nursing Pharmacology PDF

NURSING PHARMACOLOGY This document and the information thereon are the property of PHINMA Education (Department of Nursing) ...

NURSING PHARMACOLOGY This document and the information thereon are the property of PHINMA Education (Department of Nursing)  NURSING PHARMACOLOGY Shock A complication most commonly caused by acute blood loss that can significantly alter the functions of the organs and tissue. Adrenergic drugs → cardiovascular system → ↑ pressure, ↑ blood flow, vasoconstriction Asthma A hypersensitivity reaction to specific triggers characterized by inflammatory reactions and bronchospasm. Beta adrenergic agonists are used in bronchospasm and other obstructive respiratory conditions ADRENERGIC AGONISTS Alpha- and Beta-Adrenergic Agonist drugs that stimulate the adrenergic receptors of are drugs that are generally sympathomimetics the sympathetic nervous system affect both alpha- and beta- receptors = stimulate also known as SYMPATHOMIMETICS all adrenergic receptors Clinical Use: Glaucoma NON-SELECTIVE ADRENERGIC AGONIST an eye condition characterized by increase in Epinephrine Adrenaline intraocular pressure. Norepinephrine Noradrenaline Alpha adrenergic agonist → dilate pupils Dopamine Used for shock → ↓ secretion of aqueous humor Heart stimulation → ↑ uveoscleral outflow = ↓ IOP → ↑ rate, ↑ contraction This document and the information thereon are the property of PHINMA Education (Department of Nursing)  NURSING PHARMACOLOGY Dilates renal and splanchnic Provide comfort measures (e.g. light control, arterioles → ↑ blood flow to the encouragement to void, monitoring bowel kidneys → No renal shut down functions, support and relaxation measures) to Ephedrine Used for hypotension under help patient cope with the sympathomimetic anesthesia, asthma, narcolepsy, effects of the drug. and obesity. Provide patient education about drug effects and Use of ephedrine is declining warning signs to report. because of the presence of a more selective adrenergic Alpha-specific Adrenergic Agonist agonist drugs that bind primarily to alpha-receptors rather than to beta-receptors. Contraindication and Cautions Clonidine, Midodrine, and Phenylephrine. Allergy to any component of the drug. Pheochromocytoma Alpha-1 selective Phenylephrine, Midodrine, Pulmonary hypertension Methoxamine Tachyarrhythmias and ventricular fibrillation. Alpha-2 selective Anti-hypertensive: Hypovolemia Clonidine, Methyldopa Halogenated hydrocarbon general anesthetics. Anti-glaucoma: This sensitizes the myocardium to catecholamines Apraclonidine, Brimonidine and could cause serious cardiac effects. Peripheral cardiovascular disease. Phenylephrine potent vasoconstrictor and alpha1-agonist Side Effect / Adverse Effects little or no effect on the heart or bronchi Related to sympathetic stimulation: headache, used in many combinations cold and allergy sweating, feelings of tension or anxiety, products piloerection Parenteral: for shock and shock-like states and CV: arrhythmias, hypertension, palpitations, paroxysmal supraventricular tachycardia angina, dyspnea Used to prolong local anesthesia and to maintain GI: nausea, vomiting, constipation blood pressure during spinal anesthesia. Because of vasoconstrictive effects, care must be Topically: allergic rhinitis and otitis media taken to avoid extravasation of any infused drugs. The vasoconstriction in the area of extravasation Midodrine can lead to necrosis and cell death in that area. Oral drug used to treat orthostatic hypotension in patients who do not respond to traditional Interactions therapy. Tricyclic antidepressant (TCA) and monoamine Activates alpha1-adrenergic receptors → oxidase inhibitors (MAOI). Increased effects of peripheral vasoconstriction, ↑ vascular tone & BP these drugs related to increased norepinephrine levels or increased receptor stimulation that Clonidine occurs with both drugs. TCAs increase stimulates alpha2-receptors of the CNS → ↓ CNS sympathomimetic effects with phenylephrine but outflow of NE. decreased antihypertensive effects with clonidine. Orally and transdermal: control hypertension Ma Huang, guarana, caffeine. Increased risk of Parenteral: epidural infusion for controlling hypertension especially with alpha agonists. cancer pain Propranolol. Paradoxical hypertension with clonidine Contraindication and Cautions Any other adrenergic antagonist. Loss of Allergy to any component of the drug. effectiveness of drugs. Severe hypertension or tachycardia. Narrow-angle glaucoma. Can be exacerbated by Nursing Responsibility arterial constriction. Use extreme caution in calculating and preparing Pregnancy and lactation. No adequate studies doses of these drugs because even small errors CV disease and vasospasm. could have serious effects. Thyrotoxicosis and diabetes. Sympathetic Use proper, aseptic technique when administering stimulation has thyroid-stimulating and glucose- ophthalmic or nasal agents (alpha- and beta- elevating effects Renal or hepatic impairment. adrenergic agonists) to prevent injection and assure the therapeutic effectiveness of the drug. Side Effects / Adverse Effects Monitor patient response closely (vital signs, ECG, CNS: anxiety, restlessness, depression, fatigue, urine output) to ensure the most benefit with the strange dreams, personality changes least amount of toxicity. Sympathetic stimulation: blurred vision, Maintain phentolamine on standby in case photosensitivity extravasation occurs. Save the area by infiltrating CV: arrhythmias, ECG changes, blood pressure 10 mL of saline containing 5-10 mg of changes, peripheral vascular problem phentolamine. GI: nausea, vomiting, anorexia This document and the information thereon are the property of PHINMA Education (Department of Nursing)  NURSING PHARMACOLOGY GU: decreased urinary output, difficulty urinating, Thyrotoxicosis and diabetes. Sympathetic dysuria, changes in sexual function stimulation has thyroid-stimulating and glucose- Sudden withdrawal can lead to: tachycardia, elevating effects hypertension, arrhythmias, flushing, and even Severe renal impairment death. Taper drugs over 2-4 days. Side Effects / Adverse Effects Interactions CNS: anxiety, restlessness, fatigue, fear, tremor, MAOIs: severe hypertension, headache, and headache hyperpyrexia with phenylephrine CV: tachycardia, angina, myocardial infarction, TCA: increased sympathomimetic effects with palpitations phenylephrine; decreased antihypertensive effects Respiratory: difficulty of breathing, with clonidine bronchospasm, severe pulmonary edema Digoxin, beta-blockers, antipsychotics: increased GI: nausea, vomiting, anorexia, GI upset drug effects with midodrine Others: sweating, pupil dilation, rash, muscle Adrenergic antagonists: loss of effectiveness of cramps adrenergic agonists Interactions Nursing Responsibilities Other sympathomimetic drugs: increased Do not discontinue abruptly to prevent rebound sympathomimetic effects hypertension of clonidine Beta-blockers: decreased therapeutic effects Monitor blood pressure, orthostatic blood pressure, pulse, rhythm, and cardiac output Nursing Responsibilities regularly to adjust dose or discontinue the drug of Monitor pulse and blood pressure carefully during CV effects are severe. administration to arrange to discontinue the drug Maintain phentolamine on standby when at any sign of toxicity. administering phenylephrine in case Ensure that a beta-blocker is readily available extravasation occurs. Save the area by infiltrating when giving parenteral isoproterenol in case 10 mL of saline containing 5-10 mg of severe reaction occurs. phentolamine within 12 hours after extravasation Use minimal doses of isoproterenol needed to to preserve tissue. achieve desired effects to prevent adverse effects Provide comfort measures (e.g., rest and and maintain patient safety. environmental control) to help patient cope with Provide comfort measures to help patient cope the drug effects. with the drug effects. Provide patient education about drug effects and Provide patient education about drug effects and warning signs to report to promote understanding warning signs to report to promote understanding and compliance. and compliance. Beta-Specific Adrenergic Agonist ADRENERGIC ANTAGONISTS that bind primarily to beta-receptors rather than These drugs occupy the adrenergic receptor site to alpha-receptors. so released norepinephrine can be prevented Treatment of bronchial spasm, asthma, and other from activating the receptor obstructive pulmonary conditions. Also known as SYMPATHOLYTICS Nonselective Adrenergic Blocking Agents Non-selective Isoproterenol used to treat cardiac-related conditions Beta-agonist blocks both α and β → sympathetic response is Beta-1 selective Dobutamine inhibited → ↓ BP, ↓ Pulse rate, ↓ renin agonists ideal for hypertension and heart failure Beta-2 selective Bronchodilators: used to treat essential hypertension alone or in agonists Salbutamol/Albuterol, combination with diuretics or antiarrhythmic Terbutaline, Salmeterol, Carvedilol & Labetalol Formoterol Contraindications and Cautions Tocolytics: Allergy to any component of the drug Ritodrine, Isoxsuprine Bradycardia and heart blocks Hepatic impairment Contraindication and Cautions Asthma Allergy to any component of the drug Shock or heart failure Pulmonary hypertension Lactation Anesthesia with halogenated hydrocarbons. Can sensitize the myocardium to catecholamines and Adverse Effects could cause a severe reaction CNS: dizziness, paresthesia, insomnia, Eclampsia, uterine hemorrhage, and intrauterine depression, fatigue, vertigo death. Can be complicated by uterine relaxation or CV: arrhythmias, hypotension, heart failure, increased blood pressure pulmonary edema, CVA Respiratory: bronchospasms, cough, rhinitis, bronchial obstruction This document and the information thereon are the property of PHINMA Education (Department of Nursing)  NURSING PHARMACOLOGY GI: nausea, vomiting, diarrhea, anorexia, CV: hypotension, orthostatic hypotension, angina, flatulence MI, cerebrovascular accident, flushing, GU: decreased libido, impotence, dysuria, Peyronie tachycardia, arrhythmia disease. Ephedrine and epinephrine. Decreased Others: decreased exercise tolerance, hypertensive and vasoconstrictive effects hypoglycemia, rash Alcohol. Increased hypotension Carvedilol has been associated with hepatic failure related to its effects on the liver. Nursing Responsibilities Abrupt withdrawal: MI, stroke, arrhythmias Monitor heart rate and blood pressure closely and related to increased hypersensitivity to frequently for changes to anticipate the need to catecholamines that develops when the receptor discontinue the drug if adverse reactions are sites have been blocked. severe. Inject phentolamine directly into area of Interactions extravasation of epinephrine or dopamine to Volatile liquid anesthetics (e.g. halothane, prevent local cell death. isoflurane). Increased risk of excessive Institute safety measures to prevent injury if the hypotension. patient experiences weakness, dizziness, or Antidiabetics. Increased effects of antidiabetics so orthostatic hypotension. hypoglycemia should be watched out for. Provide comfort measures to help patient cope Verapamil and diltiazem. Potentially dangerous with drug effects. conduction system disturbances if combined with Provide patient education about drug effects and carvedilol. warning signs to report to enhance knowledge about drug therapy and promote compliance. Nursing Responsibilities Alpha-1 Adrenergic Blocking Agents Do not discontinue abruptly after chronic therapy specific affinity for alpha1-receptors because hypersensitivity to catecholamines may Blocks α1 → Vasodilation → ↓ BP develop and patient could have severe reaction; α2 is not blocked → no reflex tachycardia taper drug slowly over two weeks, monitoring the ↓ total peripheral resistance patient. ↑ high-density lipoprotein, ↓ total cholesterol Educate patient about positive lifestyle changes Blocks receptor in prostate and bladder (e.g. diet, exercise, smoking cessation) to aid in → relaxation of bladder and prostate lowering blood pressure. → improved urine flow in male patients Assess heart rate for changes that might suggest Prazosin, Doxazosin, Terazosin: used in mild to arrhythmia. Obtain blood pressure in various moderate hypertension positions to assess for orthostatic hypotension. Tamsulosin, Alfuzosin: treatment of benign Monitor GI function and need for increased access prostatic hypertrophy (BPH) to bathroom facilities and need for increased fluid intake related to diarrhea. Contraindications and Cautions Provide comfort measures to help patient cope Allergy to any component of the drug with drug effects. Heart or renal failure. Can be exacerbated by Provide patient education about drug effects and blood pressure-lowering effects of the drug warning signs to report to enhance knowledge Hepatic impairment about drug therapy and promote compliance Pregnancy & lactation Nonselective Alpha-Adrenergic Blocking Agents Adverse Effects specific affinity for alpha-receptor sites CNS: headache, weakness, dizziness, fatigue, Phentolamine drowsiness, depression o Blocks α1 → Vasodilation → ↓ BP CV: arrhythmia, hypotension, edema, HF, angina o Blocks α2 → ↑ reflex tachycardia when BP is ↓ GI: nausea, vomiting, diarrhea, abdominal pain o used to prevent cell death and tissue sloughing Vasodilation drug effect: flushing, rhinitis, after extravasation of IV NE and Dopamine reddened eyes, nasal congestion, priapism o For treatment of severe hypertension reactions caused by manipulation of pheochromocytoma Interactions before and during surgery Nitrates, calcium-channel blockers, angiotensin- o For diagnosis of pheochromocytoma converting-enzyme inhibitors. Increased hypotensive effects. Contraindications and Cautions Allergy to any component of the drug. To prevent Nursing Responsibilities hypersensitivity reaction Monitor blood pressure, pulse, rhythm, and Coronary artery disease or MI. Potential cardiac output regularly to evaluate for changes exacerbation of these conditions. that may indicate a need to adjust dose or Pregnancy and lactation. Potential effects to fetus discontinue the drug if CV effects are severe. or neonates. Establish safety precautions if CNS effects or Adverse Effects orthostatic hypotension occurs to prevent patient CNS: headache, weakness, dizziness injury. GI: nausea, vomiting, diarrhea Interactions This document and the information thereon are the property of PHINMA Education (Department of Nursing)  NURSING PHARMACOLOGY Arrange for small, frequent meals if GI upset is NSAIDs. Decreased antihypertensive effect severe to relieve discomfort and maintain Epinephrine. Initial hypertensive episode followed nutrition. by bradycardia Provide comfort measures to help patient cope Ergot alkaloids. Peripheral ischemia may occur with drug effects. Insulin and other antidiabetic agents. Potential Provide patient education about drug effects and change in blood glucose levels warning signs to report to enhance knowledge about drug therapy and promote compliance. Nursing Responsibilities Do not stop these drugs abruptly after chronic Beta Adrenergic Blocking Agents (Beta-blockers) therapy, but taper gradually over 2 weeks (-) Dromotropism = lesser conduction velocity because long-term use of these drugs can (-) Inotropism = lesser force sensitize the myocardium to catecholamines, and (-) Chronotropism = lesser rate severe reactions could occur. Non-selective Nadolol, Sotalol, Timolol, Continuously monitor any patient receiving an Propranolol intravenous form of these drugs to avert serious Beta-1 selective / Metoprolol, Acebutolol, complications caused by rapid sympathetic Cardioselective Celiprolol, Betaxolol, Atenolol, blockade. Bisoprolol, Esmolol Provide comfort measures to help patient cope NON-SELECTIVE with drug effects. Used to treat CV problems to prevent reinfarction Provide patient education about drug effects and after MI. warning signs to report to enhance knowledge Propranolol about drug therapy and promote compliance. o Can protect a patient against a second heart attack SELECTIVE BETA-1 ANTAGONIST o Prophylaxis in acute migraine headache Useful in hypertensive patient with impaired o Management of sympathetic symptoms of pulmonary function hyperthyroidism Do not block β2 = no bronchoconstriction o Management of stage fright Blocks β1 → ↓ excitability of the heart, ↓ CO, ↓O2 Timolol and Carteolol in ophthalmic form are used consumption for reduction of intraocular pressure in patients ↓ renin = ↓ BP with open-angle glaucoma. Treatment for cardiac arrhythmias, hypertension, and chronic angina Contraindications and Cautions Prevention of reinfarction Allergy to any component of the drug In oral form, used to decrease intraocular Bradycardia, heart blocks, shock, HF pressure and to treat open-angle glaucoma Bronchospasm, COPD, acute asthma Pregnancy neonatal apnea, bradycardia, and Contraindications and Cautions hypoglycemia can occur (except sotalol) Allergy to any component of the drug Lactation. Potential effects to the neonate include Bradycardia, heart blocks, cardiogenic shock, HF. slowed heart rate, hypotension, and hypoglycemia Pregnancy and lactation Diabetes = mask hypoglycemia Diabetes, thyrotoxicosis, COPD Thyrotoxicosis Adverse Effects Renal or hepatic dysfunction CNS: headache, fatigue, dizziness, depression, paresthesia, sleep disturbances, memory loss, Adverse Effects disorientation CNS: headache, fatigue, dizziness, depression, CV: bradycardia, heart block, HF, hypotension, paresthesia, sleep disturbances, memory loss, peripheral vascular insufficiency disorientation Respiratory: rhinitis, bronchospasm, dyspnea CV: bradycardia, heart block, HF, hypotension, GI: GI upset, nausea, vomiting, diarrhea, gastric peripheral vascular insufficiency pain, colitis Respiratory: difficulty of breathing, coughing, GU: decreased libido, impotence, dysuria, Peyronie bronchospasm, severe pulmonary edema, severe disease bronchial obstruction Other: decreased exercise tolerance, hypo- or GI: GI upset, nausea, vomiting, diarrhea, gastric hyperglycemia, liver changes pain, colitis Abrupt withdrawal: angina, MI, hypertension, GU: decreased libido, impotence, dysuria, Peyronie stroke disease Other: decreased exercise tolerance, hypo- or Interactions hyperglycemia, liver changes Clonidine, NSAIDs, rifampin, barbiturates. Abrupt withdrawal: angina, MI, hypertension, Decreased hypertensive effects stroke Epinephrine. Initial hypertensive episode followed Interactions by bradycardia Clonidine. Paradoxical hypertension can occur; Lidocaine. Increased serum levels and toxicity of increased rebound hypertension with clonidine lidocaine withdrawal. This document and the information thereon are the property of PHINMA Education (Department of Nursing)  NURSING PHARMACOLOGY Prazosin. Increased risk for orthostatic hypotension Verapamil, cimetidine, methimazole, propylthiouracil. Increased effects of selective beta1-blockers Nursing Responsibilities Do not stop these drugs abruptly after chronic therapy, but taper gradually over 2 weeks because long-term use of these drugs can sensitize the myocardium to catecholamines, and severe reactions could occur. Continuously monitor any patient receiving an intravenous form of these drugs to avert serious complications caused by rapid sympathetic blockade. Give oral forms of metoprolol with food to facilitate absorption. Provide comfort measures to help patient cope with drug effects. Provide patient education about drug effects and warning signs to report to enhance knowledge about drug therapy and promote compliance. This document and the information thereon are the property of PHINMA Education (Department of Nursing)