Transcript General Use
DRUG CLASSIFICATIONS
Pharmacologic Profile
General Use
General Action and
Information
Refers to all information
presented in drug
reference book
How is the medication
used?
How does the medication
work? What ‘other’
information is needed
before reading further
◦ Contraindications
◦ Precautions
◦ Interactions
Why shouldn’t a pt
take this?
What does the nurse
need to do before
administering the
medication?
What medications
interfere with normal
drug action?
Nursing Implications
Potential Nursing
Diagnoses
Implementation
Actions and thoughts
the nurse has before
administering the
medication
Added feature in some
drug books
Actions the nurse takes
while administering
medications
Patient/Family
Teaching
Evaluation / Desired
Outcomes
Suggestions for the
nurse to use to educate
pt and family about
ordered
medications
What is expected if the
medication has been
successful
General Use:
◦ Management of Alzheimer’s Dementia
General Action:
◦ All agents act by increasing the amount of
acetylcholine in the CNS by inhibiting
cholesterase
◦ No agents can slow the progression of A.D.
◦ Current agents may temporarily improve
cognitive function and therefore improve quality
of life
Nursing Implications:
◦ Assessment
Assess cognitive function throughout therapy
Monitor nausea, vomiting, anorexia, and weight
loss
Medications:
◦ donepezil (Aricept)
◦ rivastigmine (Exelon)
General Use:
Prevention and treatment of anemias
General Action:
◦ For iron deficiency anemia to promote transport
of hemoglobin
◦ For water soluble vitamins needed for RBC
production
◦ For low RBC count to promote production of RBC
Nursing Implications:
◦ Assessment
Assess patient’s nutritional status and dietary
history to determine possible causes for anemia
Assess for patient teaching needs
Medications:
◦ iron polysaccharide (Niferex)
◦ epoetin (Epogen)
◦ folic acid (Folate)
General Use:
◦ Nitrates are used to treat and prevent attacks of
angina
◦ Calcium channel blockers and beta blockers are
used prophylactically in long-term management
of angina
General Action:
◦ Nitrates dilate coronary arteries and cause
systemic vasodilation
◦ Calcium channel blockers dilate coronary arteries
◦ Beta blockers decrease myocardial O2
consumption
Nursing Implications:
◦ Assessment
Assess location, duration, intensity, and
precipitating factors of pt’s anginal pain
Monitor BP and pulse periodically throughout
therapy
Medications:
◦ atenolol (Tenormin)
◦ dilitazem (Cardizem)
◦ nitroglycerin (Nitro-Dur)
General Use:
◦ Used in mgmt of various forms of anxiety
including generalized anxiety disorder
General Action:
◦ Most agents cause generalized CNS depression
Nursing Implications:
◦ Assessment
Assess degree of anxiety and level of sedation
before and periodically throughout therapy
Prolonged high-dose therapy may lead to
physical or psychological dependence
Medications:
◦ benzodiazepines
alprazolam (Xanax)
diazepam (Valium)
SSRI’s
paroxetine hcl
(Paxil)
General Use:
◦ Suppression of cardiac arrhythmias
General Action:
◦ Correct cardiac arrhythmias by a variety of
mechanisms, depending on group used.
◦ Goal symptomatology
Hemodynamic performance
Nursing Implications:
◦ Assessment
Monitor ECG, pulse and BP periodically
throughout oral administration
Medications:
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procainamide (Pronestyl)
lidocaine (Xylocard)
propranolol (Inderal)
amiodarone (Cordarone)
General Use:
◦ Prevention and treatment of thromboembolic
disorders including DVT, PE and A Fib w/ emboli
General Action:
◦ Used to prevent clot extension and formation
◦ DO NOT dissolve clots
Nursing Implications:
◦ Assessment
Assess for signs of bleeding / hemorrhage
Monitor bleeding time
Toxicity / Overdose – needs to be reversed
immediately. Use protamine sulfate for Heparin
and Vitamin K for Warfarin
Medications:
◦ fondaparinux (Arixtra)
◦ heparin
◦ warfarin (Coumadin)
General Use:
◦ Used to
incidence / severity of seizures
General Action:
◦ Depresses abnormal neuronal discharges in CNS
that may result in seizures
◦ May also work by preventing spread of seizure
activity; depressing motor cortex; raising seizure
threshold; or altering levels of neurotransmitters
depending on the group.
Nursing Implications:
◦ Assessment
Assess location, duration, and characteristic of
seizure activity
Monitor serum drug levels routinely
Medications:
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phenobarbital (Luminal)
diazepam (Valium)
phenytoin (Dilantin)
valproic Acid (Depakene)
General Use:
◦ Used in tx of endogenous depression, often in
conjunction with psychotherapy
General Action:
◦ Attempts to prevent the reuptake of dopamine,
norepinephrine, and serotonin by presynaptic
neurons, resulting in accumulation of these
neurotransmitters.
Nursing Implications:
◦ Assessment
Assess mental status and affect
Assess for suicidal tendencies
Restrict amount of drug available to pt
Medications:
◦ duloxetine (Cymbalta)
◦ amitriptyline (Elavil)
◦ phenelzine (Nardil)
General Use:
◦ Used in mgmt of type 1 and type 2 Diabetes
General Action:
◦ Insulin lowers blood glucose by transport of
glucose into cells and promotes conversion of
glucose to glycogen
◦ Oral medications stimulate secretion of insulin by
beta cells
Nursing Implications:
◦ Assessment
Observe for s&s of hypoglycemic reaction
Monitor serum glucose
Medications:
◦ metformin (Glucophage)
◦ sitagliptin (Januvia)
◦ glimepiride (Amaryl)
General Use:
◦ Used to manage nausea & vomiting of many
causes
General Action:
◦ Act on the chemoreceptor trigger zone to inhibit
n&v
◦ Some act by diminishing motion sickness
◦ Others decrease n&v by its effect on gastric
emptying
Nursing Implications:
◦ Assessment
Assess n&v, bowel sounds, abdominal pain
before and following administration
Monitor hydration; I&O
Medications:
◦ ondansetron (Zofran)
◦ promethazine (Phenergan)
◦ metoclopramide (Reglan)
General Use:
◦ Tx of hypertension of many causes, most
commonly essential HTN
General Action:
◦ Used to lower blood pressure to a normal level
or to the lowest level tolerated
◦ Classified into groups according to their site of
action
Nursing Implications:
Medications:
◦ Assessment
Monitor BP, pulse frequently during dosage
adjustment and periodically throughout therapy
Monitor I&O
Monitor compliance through frequency of refills
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clonidine (Catapres)
ramipril (Altace)
olmesartan (Benicar)
propranolol (Inderal)
metoprolol (Lopressor)
General Use:
◦ Treatment and prophylaxis of various bacterial
infections
General Action:
◦ Kill (bacteriocidal) or inhibit growth
(bacteriostatic)
of susceptible pathogenic bacteria
Nursing Implications:
◦ Assessment
Assess for s&s of infection prior to and
throughout tx
Check allergies especially for penicillin &
cephalosporins
Obtain specimens for C&S prior to beginning tx
Medications:
◦ gentamicin (Garamycin)
◦ piperacillin / tazobactam (Zosyn)
◦ levofloxacin (Levaquin)
General Use:
◦ Used for tx of various solid tumors, lymphomas
and leukemias
General Action:
◦ Act by many different mechanisms
◦ Action may not be limited to neoplastic cells
Nursing Implications:
◦ Assessment
Monitor for bone marrow depression
Assess for bleeding (gums, bruising, urine
etc)
Monitor I&O, appetite, nutritional intake
Monitor IV site carefully & maintain patency
Medications:
◦ cisplatin (Platinol)
◦ tamoxifen (Tamoxifen)
◦ methotrexate (Folex)
General Use:
◦ Used to tx and prevent thromboembolic events
such as stroke and MI
General Action:
◦ Inhibit platelet aggregation
◦ Prolongs bleeding time
Nursing Implications:
◦ Assessment
Assess pt for s&s increased thrombosis
Monitor bleeding time
Medications:
◦ dipyridamole (Persantine)
◦ clopidogrel (Plavix)
General Use:
◦ Tx of acute and chronic psychoses, particularly
when accompanied by increased psychomotor
activity
General Action:
◦ Blocks dopamine receptors in the brain
◦ Alters dopamine release and turnover
Nursing Implications:
◦ Assessment
Assess pt’s mental status before / periodically
Monitor BP, pulse, resp before / frequently
Observe pt taking meds to prevent hoarding
Monitor pt for onset of akathisia, parkinsonian
and dystonia, tardive dyskinesia
Medications:
◦ chlorpromazine (Thorazine)
◦ risperidone (Risperdal)
General Use:
◦ Used in replacement doses systemically to tx
adrenocortical insufficiency
◦ Larger doses used for the anti-inflammatory,
immunosuppressive, or antineoplastic activity
General Action:
◦ Produce profound and varied metabolic effects
◦ Modify normal immune response
◦ Suppresses inflammation
Nursing Implications:
◦ Assessment
Assess involved systems
Assess for signs of adrenal insufficiency
Children should have periodic evaluations of
growth
Medications:
◦ hydrocortisone (Solu-Cortef)
◦ methylprednisolone ( Solu-Medrol)
◦ dexamethasone (DexPak)
General Use:
◦ Thiazide and loop diuretics used for tx HTN,
edema d/t CHF or other causes
General Action:
◦ Enhance selective excretion of various
electrolytes and water by affecting renal
mechanisms for tubular secretion and
reabsorption
Nursing Implications:
◦ Assessment
Assess fluid status throughout tx
Monitor daily wt, I&O, amt & location edema,
lung sounds, skin turgor, mucous membranes
Monitor electrolytes – esp potassium
Medications:
◦ furosemide (Lasix)
◦ mannitol (Osmitrol)
◦ hydrochlorothiazide (HCTZ)
General Use:
◦ Used in tx of deficiency states including diabetes,
hypothyroidism, menopause
General Action:
◦ Natural or synthetic substances have specific
effect on target tissue
◦ Differ greatly in their effects depending on
individual agent and function or target tissue
Nursing Implications:
◦ Monitor pt for sx’s of hormonal excess or
insufficiency
Medications:
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calcitonin (Miacalcin)
estrogens
levothyroxine (Synthroid)
insulins
General Use:
◦ Used to control mild to moderate pain and/or
fever
General Action:
◦ Most inhibit prostaglandin synthesis
peripherally for analgesic effect
Centrally for antipyretic effect
Nursing Implications:
◦ Assessment
Assess pain and limitation of movement
Assess fever; note associated S&S
Monitor liver, renal and hematologic lab values
Medications:
◦ ibuprofen
◦ ASA
◦ acetaminophen
General Use:
◦ Used to control mild to moderate pain, fever , and
various anti-inflammatory conditions
General Action:
NSAIDs have analgesic, antipyretic and antiinflammatory properties
Analgesic and anti-inflammatory are d/t
inhibition of prostaglandins
Nursing Implications:
◦ Pts w/ asthma, allergies and nasal polyps more at
risk for hypersensitivity.
◦ Assess pain, limitation of movement, fever
◦ Evaluate effectiveness
◦ Most NSAIDS prolong bleeding time due to
suppressed platelet aggregation
◦ Monitor for GI blood loss – give w/ food
Medications:
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ibuprofen - Advil, Motrin
naproxen sodium – Aleve
celecoxib – Celebrex
Ketorolac - Toradol
General Use:
◦ Mgmt moderate to severe pain
General Action:
◦ Opioids bind to opiate receptors in the CNS
◦ Alters perception of and response to pain
Nursing Implications:
◦ Assessment
Assess pain – type, location, intensity
Assess BP, pulse, resp before and during
therapy
Assess prior analgesic hx
Assess bowel function periodically
Medications:
fentanyl transdermal (Duragesic)
hydromorphone (Dilaudid)
oxycodone (Oxycontin)
General Use:
◦ Sedatives provide sedation
◦ Hypnotics are used to manage insomnia
General Action:
◦ Cause generalized CNS depression
Nursing Implications:
◦ Assessment
Monitor BP, pulse, resp status frequently w/ IV
Assess sleep patterns if for insomnia
Medications:
◦ phenobarbital (Luminal)
◦ lorazepam (Ativan)
◦ zolpidem (Ambien)
General Use:
◦ Spasticity associated w/ spinal cord lesions
◦ Symptomatic relief of acute painful MS conditions
General Action:
◦ Act either centrally or directly to relax muscle
fibers
Nursing Implications:
◦ Assessment
Assess for pain, muscle stiffness, ROM before
and periodically throughout tx
Medications:
◦ carisoprodol (Soma)
◦ baclofen (Lioresal)
◦ diazepam (Valium)
General Use:
◦ Acute mgmt coronary thrombosis (MI)
◦ Mgmt massive pulmonary emboli, DVT, arterial
thromboembolism
General Action:
◦ Converts plasminogen to plasmin which then
breaks down fibrin in clots
Nursing Implications:
◦ Begin tx ASAP after onset sx’s
◦ Monitor VS q 4 hours
Medications:
◦ streptokinase (Streptase)
◦ alteplase (Activase)
General Use:
◦ Acute vascular headaches
General Action:
◦ Smooth muscle vasoconstriction
Nursing Implications:
◦ Assessment
Assess pain, location, intensity, duration
Assess for photophobia, phonophobia, n&v
Assess for frequency of migraine attacks
Medications:
◦ ergotamine (Ergomar)
◦ sumatriptan (Imitrex)
There are more classifications listed in the
12th Edition of Davis Drug Guide
Additional review of these classifications will
occur during the coming ‘systems’ lectures
Independent study is always an option as
well!