Three Areas of Pharmacology

Three Areas of Pharmacology

It is important to note that the study of pharmacology includes three areas:

Image Pharmacokinetics: This is the study of how drugs are absorbed, distributed, metabolized, and excreted by the body. Elderly patients and patients with renal or liver disease frequently have difficulty metabolizing and excreting medications. These patients can develop drug toxicity more easily than those with no renal or liver impairment.

Image Pharmacodynamics: This is the study of how drugs are used by the body. For example, pharmacodynamics of oral hypoglycemics explain how the blood glucose is reduced by stimulating the pancreatic beta cells to produce more insulin, by also making insulin receptor sites more sensitive to insulin, and by increasing the number of insulin receptor cells. These drugs are effective only if the patient’s pancreas is producing some insulin.

Image Pharmacotherapeutics: This is the study of how the patient responds to the drug. A patient might experience side effects such as gastrointestinal symptoms to a number of medications, including antibiotics. Side effects might cause discomfort but are usually not severe enough to warrant discontinuation of the medication. Demerol (meperidine HCl) is a narcotic analgesic that can cause nausea and vomiting. To prevent these side effects, the physician frequently orders an antiemetic called Phenergan (promethazine) to be given with Demerol. These drugs have a synergistic effect that provides pain relief while preventing the discomfort of side effects.

Adverse effects of medications result in symptoms so severe that it is necessary to reduce the dosage or discontinue the medication completely. Antituberculars and anticonvulsants are two categories of medications that can have adverse effects on the liver. The nurse should carefully assess the patient’s liver function studies as well as assess for signs of jaundice that indicate drug-related hepatitis, in which case the medication will be discontinued.

setting:

<![if !vml]><![endif]> Anti-infectives: Used for the treatment of infections. Common side effects include GI upset.

<![if !vml]><![endif]> Antihypertensives: Lower blood pressure and increase blood flow to the myocardium. Common side effects include orthostatic hypotension. Other side effects are specific to types of antihypertensive prescribed.

<![if !vml]><![endif]> Antidiarrheals: Decrease gastric motility and reduce water content in the intestinal tract. Side effects include bloating and gas.

<![if !vml]><![endif]> Diuretics: Decrease water and sodium absorption from the loop of Henle (loop diuretics) or inhibit antidiuretic hormone (potassium-sparing diuretics). Side effects of non–potassium-sparing diuretics include hypokalemia.

<![if !vml]><![endif]> Antacids: Reduce hydrochloric acid in the stomach. A common side effect of calcium-and aluminum-based antacids is constipation. Magnesium-based antacids frequently cause diarrhea.

<![if !vml]><![endif]> Antipyretics: Reduce fever.

<![if !vml]><![endif]> Antihistamines: Block the release of histamine in allergic reactions. Common side effects of antihistamines are dry mouth, drowsiness, and sedation.

<![if !vml]><![endif]> Bronchodilators: Dilate large air passages and are commonly prescribed for clients with asthma and chronic obstructive lung disease. A common side effect of these is tachycardia.

<![if !vml]><![endif]> Laxatives: Promote the passage of stool. Types of laxatives include stool softeners, cathartics, fiber, lubricants, and stimulants.

<![if !vml]><![endif]> Anticoagulants: Prevent clot formation by decreasing vitamin K levels and blocking the clotting chain or by preventing platelet aggregation.

<![if !vml]><![endif]> Antianemics: Increase factors necessary for red blood cell production. Examples of antianemics include B12, iron, and Epogen (erythropoetin).

<![if !vml]><![endif]> Narcotics/analgesics: Relieve moderate to severe pain. Medications in this category include opioids (morphine and codeine), synthetic opioids (meperidine), and NSAIDs (ketorolac).

<![if !vml]><![endif]> Anticonvulsants: Used for the management of seizure disorder and the treatment of bipolar disorder. Medications used as anticonvulsants include phenobarbital, phenytoin (Dilantin), and lorazepam (Ativan).

<![if !vml]><![endif]> Anticholinergics: Cause the mucous membranes to become dry; therefore, oral secretions are decreased. Anticholinergics such as atropine are often administered preoperatively.

<![if !vml]><![endif]> Mydriatics: Dilate the pupils. Mydriatics are used in the treatment of clients with cataracts.

<![if !vml]><![endif]> Miotics: Constrict the pupil. Miotics such as pilocarpine HCl are used in the treatment of clients with glaucoma.

Time-released Drugs

The following abbreviations indicate to the nurse that the drug is time-released. These preparations should not be crushed or opened:

<![if !vml]><![endif]> Dur = Duration

<![if !vml]><![endif]> SR = Sustained release

<![if !vml]><![endif]> CR = Continuous release

<![if !vml]><![endif]> SA = Sustained action

<![if !vml]><![endif]> Contin = Continuous action

<![if !vml]><![endif]> LA = Long acting

Enteric-coated tablets and caplets are those coated with a thick shell that prevents the medication from being absorbed in the upper GI tract, allowing the medication to be absorbed more slowly. Spansules are capsules containing time-released beads that are released slowly. The nurse should not alter the preparation of these types of medications. The physician should be notified to obtain an alternative preparation if the client is unable to swallow a time-released preparation.

Administering Medications

When preparing to administer medications, the nurse must identify the client by reviewing the physician’s order. She must also administer the medication by the right route. Many medications are supplied in various preparations. The physician orders the method of administration. The choice of medication administration is dependent on several factors, including the desired blood level, the client’s ability to swallow, and the disease or disorder being treated.

The Seven Rights of Administering Medication

The nurse is expected to use the seven rights when administering medications to the client. These include five rights of drug administration, plus two from the Patient’s Bill of Rights.

The Patient’s Bill of Rights was enacted to protect the client’s well-being, both mentally and physically. The client has the right to refuse treatment, which can include medications. The nurse must document any treatment provided to the client. Documentation of care given must be made promptly to prevent forgetting any details and to ensure that another nurse does not duplicate medication administration.

The seven rights of medication administration are

<![if !vml]><![endif]> Right client: Identification of the client must be done by asking the client to state his name and checking the identification band.

<![if !vml]><![endif]> Right route: The physician orders the prescribed route of administration.

<![if !vml]><![endif]> Right drug: Checking both the generic and trade names with the physician’s order ensures that the right drug is administered. If the client’s diagnosis does not match the drug category, the nurse should further investigate the ordered medication.

<![if !vml]><![endif]> Right amount: The nurse is expected to know common dosages for both adults and children.

<![if !vml]><![endif]> Right time: The nurse can administer the medication either 30 minutes before the assigned time or 30 minutes after.

<![if !vml]><![endif]> Right documentation (from the Patient’s Bill of Rights and legality issues in nursing): This right is different from the others in that it must be done to prevent duplicating drug administration.

<![if !vml]><![endif]> Right to refuse treatment (from the Patient’s Bill of Rights): The client has the right to refuse medication or treatment.

Understanding and Identifying the Various Drugs

It is important to know that drugs generally have several names. The following list explains these different names for you:

<![if !vml]><![endif]> Chemical name: This is often a number or letter designation that tells you the chemical makeup of the drug. This name is of little value to the nurse in practice.

<![if !vml]><![endif]> Generic name: This is the name given by the company that developed the drug, and it remains the same even after the patent is released and other companies are allowed to market the medication.

<![if !vml]><![endif]> Trade name: This is the name given to the drug by the originating company. After the drug has been released to the market for approximately four years, a trade-named medication can be released by an alternative company. The trade name will be different, while the generic name will remain the same.

It is much safer for the nurse to remember the generic name rather than the trade name because the trade name will probably change.

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Exam Alert

On the NCLEX exam, both the generic and trade names of medications might be included for clarification. The generic name will be given.

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Approximately 80% of the time generic drugs in the same category have common syllables. If you can identify the commonality within the generic names, you can more easily learn the needed information for the NCLEX. The sections that follow look at some commonly given categories of drugs and help you to recognize the commonalities in the names. As you will see, each drug has a common part in its name, which will help you to quickly identify a particular drug by the common part of the name for that drug category.

Angiotensin-Converting Enzyme Inhibitors

This category of drugs is utilized to treat both primary and secondary hypertension. These drugs work by inhibiting conversion of angiotensin I to angiotensin II. Notice that all the generic names include the syllable pril. When you see these letters, you will know that they are angiotensin-converting enzyme (ACE) inhibitors. Table 2.1 highlights these in more depth.

<![if !vml]><![endif]>

TABLE 2.1 Angiotensin-Converting Enzyme Inhibitors

When working with angiotensin-converting enzyme inhibitors, it is important to know the potential side effects. The following list details the possible side effects/adverse reactions with this drug category:

<![if !vml]><![endif]> Hypotension

<![if !vml]><![endif]> Hacking cough

<![if !vml]><![endif]> Nausea/vomiting

<![if !vml]><![endif]> Rashes

<![if !vml]><![endif]> Angioedema

The following items are nursing considerations to know when working with ACE inhibitors:

<![if !vml]><![endif]> Monitor the vital signs frequently.

<![if !vml]><![endif]> Monitor the white blood cell count.

<![if !vml]><![endif]> Monitor the potassium and creatinine levels.

<![if !vml]><![endif]> Monitor the electrolyte levels.

Beta Adrenergic Blockers

Beta adrenergic blockers are drugs that help lower blood pressure, pulse rate, and cardiac output. They are also used to treat migraine headaches and other vascular headaches. Certain preparations of the beta blockers are used to treat glaucoma and prevent myocardial infarctions. These drugs act by blocking the sympathetic vasomotor response.

Notice the syllable olol. When you see these letters, you will know that these drugs are beta blockers. Table 2.2highlights these beta blockers in more detail.

<![if !vml]><![endif]>

TABLE 2.2 Beta Adrenergic Blockers

The potential side effects/adverse reactions of beta adrenergic blockers are listed here:

<![if !vml]><![endif]> Orthostatic hypotension

<![if !vml]><![endif]> Bradycardia

<![if !vml]><![endif]> Nausea/vomiting

<![if !vml]><![endif]> Diarrhea

<![if !vml]><![endif]> May mask hypoglycemic symptoms

The following list gives you some nursing interventions for working with clients using beta adrenergic blockers:

<![if !vml]><![endif]> Monitor the client’s blood pressure, heart rate, and rhythm.

<![if !vml]><![endif]> Monitor the client for signs of edema. The nurse should assess lung sounds for rales and rhonchi.

<![if !vml]><![endif]> Monitor the client for changes in lab values (protein, BUN, creatinine) that indicate nephrotic syndrome.

<![if !vml]><![endif]> Teach the client to:

<![if !vml]><![endif]> Rise slowly

<![if !vml]><![endif]> Report bradycardia, dizziness, confusion, depression, or fever

<![if !vml]><![endif]> Taper off the medication

Anti-Infectives (Aminoglycosides)

Anti-infective drugs include bactericidals and bacteriostatics. They interfere with the protein synthesis of the bacteria, causing the bacteria to die. They are active against most aerobic gram-negative bacteria and against some gram-positive organisms.

Notice that these end in cin, and many of them end in mycin. So, when you see either of these syllables, you know these are anti-infectives. Table 2.3 explains the various anti-infectives.

<![if !vml]><![endif]>

TABLE 2.3 Anti-Infective Drugs

The following list highlights some possible side effects/adverse reactions from the use of anti-infectives (aminoglycosides):

<![if !vml]><![endif]> Ototoxicity

<![if !vml]><![endif]> Nephrotoxicity

<![if !vml]><![endif]> Seizures

<![if !vml]><![endif]> Blood dyscrasias

<![if !vml]><![endif]> Hypotension

<![if !vml]><![endif]> Rash

The following are nursing interventions you need to be aware of when working with clients using anti-infectives (aminoglycosides):

<![if !vml]><![endif]> Obtain a history of allergies.

<![if !vml]><![endif]> Monitor intake and output.

<![if !vml]><![endif]> Monitor vital signs during intravenous infusion.

<![if !vml]><![endif]> Maintain a patent IV site.

<![if !vml]><![endif]> Monitor for therapeutic levels.

<![if !vml]><![endif]> Monitor for signs of nephrotoxicity.

<![if !vml]><![endif]> Monitor for signs of ototoxicity.

<![if !vml]><![endif]> Teach the client to report any changes in urinary elimination.

<![if !vml]><![endif]> Monitor peak and trough levels.

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Tip

Tests on peak and trough levels are done to obtain a blood level and determine the dosage needed for the client. They should be done 30–60 minutes after the third or fourth IV dose or 60 minutes after the third or fourth IM dose. Trough levels should be drawn 5 minutes before the next dose if possible. The client should be taught to report any change in renal function or in hearing because this category can be toxic to the kidneys and the auditory nerve.

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Caution

These drugs are frequently used to treat super-infections such as methicillin-resistant staphylococcus aureus (MRSA). Clients with MRSA can exhibit the following symptoms: fever, malaise, redness, pain, swelling, perineal itching, diarrhea, stomatitis, and cough.

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Benzodiazepines (Anticonvulsants/Antianxiety)

These drugs are used for their antianxiety or anticonvulsant effects.

Notice that all these contain the syllable pam, pate, or lam. Table 2.4 gives you a breakdown of these drug types.

<![if !vml]><![endif]>

TABLE 2.4 Benzodiazepines (Anticonvulsants/Sedative/Antianxiety) Drugs

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Tip

Not all the benzodiazepines contain pam; some of them contain pate and lam, as in aprazolam (Xanax). However, they all contain azo or aze.

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The following list gives you some possible side effects and adverse reactions from the use of this classification of drugs:

<![if !vml]><![endif]> Drowsiness

<![if !vml]><![endif]> Lethargy

<![if !vml]><![endif]> Ataxia

<![if !vml]><![endif]> Depression

<![if !vml]><![endif]> Restlessness

<![if !vml]><![endif]> Slurred speech

<![if !vml]><![endif]> Bradycardia

<![if !vml]><![endif]> Hypotension

<![if !vml]><![endif]> Diplopia

<![if !vml]><![endif]> Nystagmus

<![if !vml]><![endif]> Nausea/vomiting

<![if !vml]><![endif]> Constipation

<![if !vml]><![endif]> Incontinence

<![if !vml]><![endif]> Urinary retention

<![if !vml]><![endif]> Respiratory depression

<![if !vml]><![endif]> Rash

<![if !vml]><![endif]> Urticaria

The following are some nursing interventions to know when working with the client taking benzodiazepines:

<![if !vml]><![endif]> Monitor respirations.

<![if !vml]><![endif]> Monitor liver function.

<![if !vml]><![endif]> Monitor kidney function.

<![if !vml]><![endif]> Monitor bone marrow function.

<![if !vml]><![endif]> Monitor for signs of chemical abuse.

Phenothiazines (Antipsychotic/Antiemetic)

These drugs are used as antiemetics or neuroleptics. These drugs are also used to treat psychosis in those clients with schizophrenia. Some phenothiazines, such as Phenergan (promethazine) and Compazine (prochlorperzine), are used to treat nausea and vomiting.

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Caution

Because they are irritating to the tissue, Z-track method should be used when administering phenothiazines by intramuscular injection. If the client is allergic to one of the phenothiazines, she probably is allergic to all of them. If the client experiences an allergic reaction or extrapyramidal effects, a more severe reaction, she should be given Benadryl (diphenhydramine hydrochloride) or Cogentin (benztropine mesylate).

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Notice that all these contain the syllable zine (see Table 2.5).

<![if !vml]><![endif]>

TABLE 2.5 Phenothiazines (Antipsychotic/Antiemetic) Drugs

The following list gives you some possible side effects and adverse reactions from the use of phenothiazines:

<![if !vml]><![endif]> Extrapyramidal effects

<![if !vml]><![endif]> Drowsiness

<![if !vml]><![endif]> Sedation

<![if !vml]><![endif]> Orthostatic hypotension

<![if !vml]><![endif]> Dry mouth

<![if !vml]><![endif]> Agranulocytosis

<![if !vml]><![endif]> Photosensitivity

<![if !vml]><![endif]> Neuroleptic malignant syndrome

The following are some nursing interventions to know when working with a client taking phenothiazines:

<![if !vml]><![endif]> Protect the medication from light.

<![if !vml]><![endif]> Do not mix the liquid forms of Prolixin (Fluphenazine HCL) with any beverage containing caffeine, tannates, or pectin due to physical incompatibility.

<![if !vml]><![endif]> Monitor liver enzymes.

<![if !vml]><![endif]> Monitor renal function.

<![if !vml]><![endif]> Protect the client from overexposure to the sun.

Glucocorticoids

These drugs are used in the treatment of conditions requiring suppression of the immune system or to decrease inflammatory response. They are also used in Addison’s disease, chronic obstructive pulmonary disease (COPD), and immune disorders. These drugs have anti-inflammatory, anti-allergenic, and anti-stress effects. They are used for replacement therapy for adrenal insufficiency (Addison’s disease); as immunosuppressive drugs in post-transplant clients; and to reduce cerebral edema associated with head trauma, neurosurgery, and brain tumors.

Notice that all these contain sone or cort (see Table 2.6).

<![if !vml]><![endif]>

TABLE 2.6 Glucocorticoid Drugs

The following list gives you some possible side effects and adverse reactions from the use of this drug type:

<![if !vml]><![endif]> Acne

<![if !vml]><![endif]> Poor wound healing

<![if !vml]><![endif]> Leukocytosis

<![if !vml]><![endif]> Ecchymosis

<![if !vml]><![endif]> Bruising

<![if !vml]><![endif]> Petechiae

<![if !vml]><![endif]> Depression

<![if !vml]><![endif]> Flushing

<![if !vml]><![endif]> Sweating

<![if !vml]><![endif]> Mood changes (depression), insomnia, hypomania

<![if !vml]><![endif]> Hypertension

<![if !vml]><![endif]> Osteoporosis

<![if !vml]><![endif]> Diarrhea

<![if !vml]><![endif]> Hemorrhage

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Caution

These drugs can cause Cushing’s syndrome. Signs of Cushing’s syndrome include moon faces, edema, elevated blood glucose levels, purple straie, weight gain, buffalo hump, and hirsutism.

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The following are nursing interventions used when working with a client taking glucocorticoids:

<![if !vml]><![endif]> Monitor glucose levels.

<![if !vml]><![endif]> Weigh the client daily.

<![if !vml]><![endif]> Monitor blood pressure.

<![if !vml]><![endif]> Monitor for signs of infection.

Antivirals

These drugs are used for their antiviral properties. They inhibit viral growth by inhibiting an enzyme within the virus. Herpetic lesions respond to these drugs. Clients with acquired immune deficiency syndrome (AIDS) are often treated with this category of drugs either alone or in combination with other antiviral drugs. These drugs are also used to treat herpetic lesions (HSV-1, HSV-2), varicella infections (chickenpox), herpes zoster (shingles), herpes simplex (fever blisters), encephalitis, cytomegalovirus (CMV), and respiratory syncytial virus (RSV).

Notice that all these drug names contain vir. Table 2.7 lists some of these drug types.

<![if !vml]><![endif]>

TABLE 2.7 Antiviral Drugs

The following list gives some side effects and adverse effects that are usually associated with this drug category:

<![if !vml]><![endif]> Nausea

<![if !vml]><![endif]> Vomiting

<![if !vml]><![endif]> Diarrhea

<![if !vml]><![endif]> Oliguria

<![if !vml]><![endif]> Proteinuria

<![if !vml]><![endif]> Vaginitis

<![if !vml]><![endif]> Central nervous side effects (these are less common):

<![if !vml]><![endif]> Tremors

<![if !vml]><![endif]> Confusion

<![if !vml]><![endif]> Seizures

<![if !vml]><![endif]> Severe, sudden anemia

The following nursing interventions are used when working with a client taking antivirals:

<![if !vml]><![endif]> Tell the client to report a rash because this can indicate an allergic reaction.

<![if !vml]><![endif]> Watch for signs of infection.

<![if !vml]><![endif]> Monitor the creatinine level frequently.

<![if !vml]><![endif]> Monitor liver profile.

<![if !vml]><![endif]> Monitor bowel pattern before and during treatment.

Cholesterol-Lowering Agents

This drug type is used to help the client lower cholesterol and triglyceride levels and to decrease the potential for cardiovascular disease. Notice that all these contain the syllable vastatin. It should be noted that many advertisements call these “statin” drugs. These drugs should not be confused with the statin drugs used for their antifungal effects. These can include nystatin (trade name Mycostatin or Nilstat). Table 2.8 lists some of the cholesterol-lowering agents.

<![if !vml]><![endif]>

TABLE 2.8 Cholesterol-Lowering Drugs

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Caution

This category should not be taken with grapefruit juice and should be taken at night. The client should have regular liver studies to determine the presence of liver disease.

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Here is a list of side effects and adverse reactions that could occur with the use of cholesterol-lowering agents:

<![if !vml]><![endif]> Rash

<![if !vml]><![endif]> Alopecia

<![if !vml]><![endif]> Dyspepsia

<![if !vml]><![endif]> Liver dysfunction

<![if !vml]><![endif]> Muscle weakness (myalgia)

<![if !vml]><![endif]> Headache

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Caution

Rhabdomyolysis, a muscle-wasting syndrome, has been linked with the use of cholesterol-lowering agents. The client should be instructed to report cola-colored urine and unexplained muscle soreness and weakness to the physician because these can be signs of rhabdomyolysis.

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The following nursing interventions are used when working with a client taking cholesterol-lowering agents:

<![if !vml]><![endif]> Include a diet low in cholesterol and fat in therapy.

<![if !vml]><![endif]> Monitor cholesterol levels.

<![if !vml]><![endif]> Monitor liver profile.

<![if !vml]><![endif]> Monitor renal function.

<![if !vml]><![endif]> Monitor for muscle pain and weakness.

Angiotensin Receptor Blockers

These drugs block vasoconstrictor- and aldosterone-secreting angiotensin II. They are used to treat primary or secondary hypertension and are an excellent choice for clients who complain of the coughing associated with ACE inhibitors. Notice that all these contain sartan. Table 2.9 lists some of these drugs.

<![if !vml]><![endif]>

TABLE 2.9 Angiotensin Receptor Blocker Drugs

The following list gives some side effects and adverse effects that accompany the use of angiotensin receptor blockers:

<![if !vml]><![endif]> Dizziness

<![if !vml]><![endif]> Insomnia

<![if !vml]><![endif]> Depression

<![if !vml]><![endif]> Diarrhea

<![if !vml]><![endif]> Nausea/vomiting

<![if !vml]><![endif]> Impotence

<![if !vml]><![endif]> Muscle cramps

<![if !vml]><![endif]> Neutropenia

<![if !vml]><![endif]> Cough

The following nursing interventions are used when working with a client taking angiotensin receptor blocker agents:

<![if !vml]><![endif]> Monitor blood pressure.

<![if !vml]><![endif]> Monitor BUN.

<![if !vml]><![endif]> Monitor creatinine.

<![if !vml]><![endif]> Monitor electrolytes.

<![if !vml]><![endif]> Tell the client to check edema in feet and legs daily.

<![if !vml]><![endif]> Monitor hydration status.

Histamine 2 Antagonists

These drugs are used in the treatment of gastroesophageal reflux disease (GERD), acid reflux, and gastric ulcers. They inhibit histamine 2 (H2) release in the gastric parietal cells, therefore inhibiting gastric acids.

Notice that all these contain the syllable tidine (see Table 2.10).

<![if !vml]><![endif]>

TABLE 2.10 Histamine 2 Antagonist Drugs

The following list gives some side effects and adverse effects associated with histamine 2 antagonists:

<![if !vml]><![endif]> Confusion

<![if !vml]><![endif]> Bradycardia/tachycardia

<![if !vml]><![endif]> Diarrhea

<![if !vml]><![endif]> Psychosis

<![if !vml]><![endif]> Seizures

<![if !vml]><![endif]> Agranulocytosis

<![if !vml]><![endif]> Rash

<![if !vml]><![endif]> Alopecia

<![if !vml]><![endif]> Gynecomastia

<![if !vml]><![endif]> Galactorrhea

Following are some nursing interventions when working with a client taking H2 antagonists:

<![if !vml]><![endif]> Monitor the blood urea nitrogen levels.

<![if !vml]><![endif]> Administer the medication with meals.

<![if !vml]><![endif]> If the client is taking the medication with antacids, make sure he takes antacids one hour before or after taking these drugs.

<![if !vml]><![endif]> Cimetidine can be prescribed in one large dose at bedtime.

<![if !vml]><![endif]> Sucralfate decreases the effects of histamine 2 receptor blockers.

Proton Pump Inhibitors

These drugs suppress gastric secretion by inhibiting the hydrogen/potassium ATPase enzyme system. They are used in the treatment of gastric ulcers, indigestion, and GERD.

Notice that all these drugs contain the syllable prazole and should be given prior to meals. Table 2.11 highlights proton pump inhibitor drugs.

<![if !vml]><![endif]>

TABLE 2.11 Proton Pump Inhibitors

The following list gives some side effects and adverse effects associated with proton pump inhibitors:

<![if !vml]><![endif]> Headache

<![if !vml]><![endif]> Insomnia

<![if !vml]><![endif]> Diarrhea

<![if !vml]><![endif]> Flatulence

<![if !vml]><![endif]> Rash

<![if !vml]><![endif]> Hyperglycemia

Some nursing interventions to use when working with a client taking proton pump inhibitors are as follows:

<![if !vml]><![endif]> Do not crush pantoprazole (Protonix). Use a filter when administering IV pantoprazole.

<![if !vml]><![endif]> Advise the client to take proton pump inhibitors before meals for best absorption.

<![if !vml]><![endif]> Monitor liver function.

Anticoagulants

These drugs are used in the treatment of thrombolytic disease. These drugs are used to treat pulmonary emboli, myocardial infarction, and deep-vein thrombosis; after coronary artery bypass surgery; and for other conditions requiring anticoagulation.

Notice that all these drugs contain the syllable parin and are heparin derivatives. The client should have a PTT check to evaluate the bleeding time when giving heparin. The antidote for heparin is protamine sulfate. Table 2.12 lists some common anticoagulants.

<![if !vml]><![endif]>

TABLE 2.12 Anticoagulant Drugs

The following list gives side effects and adverse effects of heparin derivatives:

<![if !vml]><![endif]> Fever

<![if !vml]><![endif]> Diarrhea

<![if !vml]><![endif]> Stomatitis

<![if !vml]><![endif]> Bleeding

<![if !vml]><![endif]> Hematuria

<![if !vml]><![endif]> Dermatitis

<![if !vml]><![endif]> Alopecia

<![if !vml]><![endif]> Pruritus

Nursing interventions to use in caring for a client taking an anticoagulant (heparin derivative) include the following:

<![if !vml]><![endif]> Blood studies (hematocrit and occult blood in stool) should be checked every three months.

<![if !vml]><![endif]> Monitor PTT often for heparin (therapeutic levels are 1.5–2.0 times the control). There is no specific bleeding time done for enoxaparin (Lovenox); however, the platelet levels should be checked for thrombocytopenia.

<![if !vml]><![endif]> Monitor platelet count.

<![if !vml]><![endif]> Monitor for signs of bleeding.

<![if !vml]><![endif]> Monitor for signs of infection.

More Drug Identification Helpers

These are some of the commonly given medications that allow you to utilize the testing technique of commonalities. Looking at these similarities will help you manage the knowledge needed to pass the NCLEX and better care for your clients.

Here are some other clues that can help you in identifying drug types:

<![if !vml]><![endif]> Caine = anesthetics (LidoCAINE)

<![if !vml]><![endif]> Mab = monoclonal antibodies (PalivazuMAB)

<![if !vml]><![endif]> Ceph or cef = cephalosporins (CEFatazime)

<![if !vml]><![endif]> Cillin = penicillins (AmpiCILLIN)

<![if !vml]><![endif]> Cycline = tetracycline (TetraCYCLINE)

<![if !vml]><![endif]> Stigmine = cholinergics (PhyoSTIGMINE)

<![if !vml]><![endif]> Phylline = bronchodilators (AminoPHYLLINE)

<![if !vml]><![endif]> Cal = calciums (CALcimar)

<![if !vml]><![endif]> Done = opioids (MethoDONE)

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Caution

Do not give tetracycline to pregnant women or small children. It stains the child’s teeth dark and stunts the growth of small children.