Hypokalemia, hyponatremia, hypovolemia or dehydration, hyperuricemia (gout), hypotension, hypercalcemia (kidney stone), hyperglycemia (insulin resistance), hyperlipidemia
Hypersensitivity (fever, rash, anaphylaxis), intersitial nephritis
Uses: HTN, CHF, chronic kidney disease , prevention of MI, stroke or cardiac death
N/V dysgeusia (lack of taste), dyspepsia, nasal congestion, fatigue, back pain
Dry, hacking cough, scratchy throat ( feel like feather in the throat) due to accumulation of bradykinin
↓glomerular filtration rate (GFR) -> acute renal dysfunction (↑Cr and ↑ BUN)
Orthostatic hypotension: dizziness, lightheaded, HA
Drug Names: losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), Candesartan (Atacand), olmesartan (Benicar), telmisartan (Micardis)
MOA: block angiotensin II receptor, leading to reduced cardiac workload, vasodilation, Na+ and water excretion.
Uses: HTN, CHF, chronic kidney disease , prevention of death after MI, stroke
SE/ADE: same as ACEIs, but more symptomatic hypotension, less cough and angioedema, as well as lower rate of discontinuation
DDI: additive effect when using with other BP drugs
Drug Names: Nifedipine (Procardia), Amlodipine, Felodipine (Plendil), Nicardipine (Cardene), Verapamil (Calan), Diltiazem (Cardizem)
MOA: Prevent Ca++ from entering the cells of heart and blood vessels walls , leading to vasodilation.
Uses: HTN, Angina, cardiac dysrhythmias
SE/ADE: rapid or slow HR, peripheral edema, OH, transient constipation and HA, dysrhythmias.
DDI: additive effect when using with other BP drugs
Drug names: clonidine (Catapres)
MOA: acting in CNS to ↓ NE release -> ↓stimulation of both α and βadrenergic receptors in heart (bradycardia and low cardiac output or CO) and the peripheral vascular system (A and V vasodilation->↓BP )
Use: not primary drug to treat HTN, pain, hot flashes, substances (alcohol, opiods, etc) withdrawal, ADHD and Tourette syndrome
SE/ADE: CNS depression (drowsiness and sedation), dry mouth, rebound HTN, constipation, impotence, Gynecomastia
Drug Names: -olol or -lol
MOA: Block beta1-adrenergic receptors from binding to NE and Epi mainly in the heart to ↓HR, ↓cardiac contraction force, ↓conduction rate (negative CID).
Types: β1Blockers, Nonselective β Blockers, and Combined α1 and β blockers
Uses: HTN, Angina, tachydysrhythmias, MI and post MI, HF, hyperthyroidism, migraine headache, stage anxiety, pheochromocytoma, and glaucoma.
CI: AV block, sinus bradycardia, HF, DM, and depression.
Hypertensive crisis: rapidly and severely ↑↑↑ BP Goal: early Dx and Tx to reduce morbidity and mortality
Types: hypertensive urgency and emergency.
HU or severe asymptomatic HTN: SBP ≥ 180 mmHg OR DBP ≥ 120 mmHg, w/o organ damage, S/S: severe HA, SOB, nosebleeds (epistaxis), and severe anxiety, no need IP care
HE or malignant hypertension: SBP ≥ 180 mmHg OR DBP ≥ 110 mmHg, w/ organ damage, S/S: CP, SOB, back pain, numbness/weakness, change in vision, difficulty speaking, IP care needed.
Nitroprusside (Nipride) vasodilator
ADE: N/V, muscle twitching, sweating, hot flash, hypotension, cyanide toxicity
Nicardipine (Cardene) CCB
ADE: tachycardia, HA, flushing, local phlebitis
ADE: short-acting di CCB, hypotension
ADE: A1 and beta blocker, excessive hypotension
Rx: steroids, OCs (estrogen component), NSAIDs, anticonvulsants, antidepressants (e.g., MAOI)
Street and OTC drugs: Cocaine, Nicotine, and St. John's Wort
Food: Na, ethanol, Licorice, tyramine food, and heavy metals (e.g., lead, mercury, lithium)
ADE: digoxin toxicity
Symptoms: hypersalivation, fatigue, nausea/vomiting/diarrhea/anorexia, Dysrhythmias, Bradycardia, visual disturbances (yellow or green halos around objects), confusion, dizziness, nightmares, agitation, and/or depression
Treatment: If signs of toxicity, hold drug and draw blood level for digoxin, give digoxin immune Fab (Digibind, DigiFab).
Concurrent use of thiazide and loop diuretics -> hypokalemia -> digi toxicity
ACEIs -> hyperkalemia -> reduce digoxin effect
Additive positive inotropic effect with sympathomimetic
Counteraction with non-di CCBs (verapamil)
Drug Names: Nitroglycerin, isosorbide
Potent smooth muscle relaxant (reduce coronary artery spasm) and vasodilator (dilate coronary arteries) increase supply.
Dilates all blood vessels, primarily venous circulation (decrease preload) reduce cardiac demand.
Uses: Treat and prevent angina.
SE/ADE: HA, OH, Hypotension, reflex tachycardia, tolerance/dependence, ↑ICP
DDIs: concurrent use of alchol, BB, CCBs, diuretics and phosphodiesterase inhibitor hypotension
CIs: TBI, inadequate cerebral perfusion, Hypotension (line, VS q2-5min)tachy, Severe anemia
Pregnancy Category C
CI: bradycardia, heart block, liver/thyroid/pulmonary dysfunction, HF
DDIs: multiple interactions, given alone
Nursing Implication and Pt Education:
Baseline and F/U monitoring on EKG, PFTs, CXR, Thyroid labs, LFTs, and eye exam
LONG HALF LIFE (Amiodarone T1/2= 58 days), can take 2-3 months for SE/ADEs to resolve.
Monitor S/S pulmonary toxicity, HF
LMWH and XaI Uses: DVT and PE prophylaxis and treatment, unstable angina, acute coronary syndrome (ACS), Coumadin bridging.
IV or SubQ, IV dose based on Partial thromboplastin time (PTT, 24-36 seconds)
Heparin and LMWH: hemorrhage, hematoma, Heparin-induced thrombocytopenia (HIT), and toxicity/overdose
XaI: hemorrhage, thrombocytopenia, epidural and spinal hematoma
DDI: additive bleeding when using with aspirin, NSAIDs, and other anticoagulants.
Drug Name: Aspirin, abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat), clopidogrel (Plavix), ticlopidine (Ticlid), pentoxifylline (Trental), dipyridamole (Persantine), cilostazol (Pletal)
MOA: Prevent platelet from clumping together or aggregation, AKA, "blood slicker"
Uses: Prevent Unstable angina (chest pain), AMI, recurrent MI, CVA, claudication, prevention of post stent thrombosis
Aspirin: GI upset (N/V/dyspepsia), hemorrhagic stroke and bleeding, thrombocytopenia, tinnitus
Plavix: Bleeding , thrombotic thrombocytopenic purpura (TTP), neutropenia, agranulocytosis, SJS
CI: not preg women in 3rd trimester and chilren w/ vial infection (ASA), not in pts w/ bleeding disorder, PUD, active hemorrhage, and renal/hepatic disorders
DDIs: additive bleeding if concurrent use of Plavix, NSAIDs, ASA, warfarin, heparin and other bleeding-inducing drugs.
Monitor VSs, CBC, plt, hearing
Aspirin's antiplatelet effects last 7 days because the lifespan of platelets is 7 days,
Off aspirin for 1 week before any invasive procedure (surgery, dental, scopes, catheter, etc)
Instruct pts to take enteric-coated ASA or w/food, or use PPI
Instruct pts to monitor s/s bleeding
Instruct pts to avoid concurrent use of antiplatelets, anticoagulants and NSAIDS
Use electric razor and soft toothbrush
Pre: Hx allergies, C &S, WBCs, VS (temp), mental status,
EE (fever, WBCs, s/s)
SE/AE (BM, skin, yeast infection, )
Monitor vital organs (ears, liver, kidneys)
EE: most broad, bactericidal, high TI (↓ s/s of infection)
SE/AE: low toxicity, GI upset, hypersensitivity (cross-reaction with penicillin), allergy, bleeding, thrombophlebitis with IV infusion, kidneys, SJS, and suprainfection
AB resistance: Inactivated by β-lactamase like Penicillins
Monobactams or Vancomycin: (non β-lactam)
resistance to β-lactamase , bactericidal
Use: serious G+ infections (bone, skin, LRT)
MRSA: Methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis
CDAD (clostridium difficile associated disease): oral dose used when metronidazole not working (2nd line)
SE: GI upset (N/V/D/A)
AE: Allergy, ototoxicity (hearing loss), "red man" syndrome (Give it SLOWLY), nephrotoxicity, Thrombophlebitis, cardiac (AF), Vancomycin-resistant Enterococcus (VRE)
Monitor peak and trough blood level, IV site, VS(BP), Skin
Aminoglycosides (e.g., gentamicin)
Nausea, vomiting, rash, fever, lethargy
Macrolides (e.g., azithromycin)
N/V/D, loss of appetite, abdominal pain photosensitivity
Tetracyclines (e.g., doxycycline)
N/V/D, tooth discoloration and hypoplasia, rash, photosensitivity, yeast infections
Clindamycin: GI upset, site irritation, thrombophlebitis
Zyvox: N/D, HA, Hypertension (vasoconstriction)
Aminoglycosides (e.g., gentamicin): Ototoxicity, nephrotoxicity, ↑neuromuscular blockade effect, neurologic disorders caused by streptomycin
Macrolides(e.g., azithromycin): ototoxicity, hepatotoxicity, metabolism of other drugs (e.g., Digoxin, warfarin), long QT (cardiac death)
Tetracyclines (e.g., doxycycline): Increased intracranial pressure (CNS toxic), kidney and liver toxicity and suprainfection
Clindamycin: ↓ liver function, ↓ white blood cell counts, give slowly by IV (shock, cardiac arrest)
Linezolid (Zyvox): ↓ blood cell counts, damage to optic nerve, HTN
Aminoglycosides: hearing, temperature, I&O, BUN, Cr, peak and trough for Gentamicin, monitor RR and O2SAT in pts taking NMB or skeletal muscle relaxants
Tetracyclines : Monitor GI, I/O, kidney and liver functioning, bleeding.
Macrolides : check med list for high risk drugs, EKG for QT baseline, liver function
linezolid (Zyvox): monitor blood pressure, restrice Tyramine -rich foods
Rash, N/V, headache, abdominal pain, dizziness, changes in taste, burning urination (perineal area), changed blood glucose level
Serious heart dysrhythmias (esp. hypokalemia),
neurotoxicity, peripheral neuropathy
Stevens-Johnson syndrome, photosensitivity
Suprainfection (thrush, vaginal yeast infection)
Drug name: sulfamethoxazole /trimethoprim (SMX-TMP, Bactrim, Septra), Silver sulfadiazine (silvadene),
MOA: Stop bacteria making folic acid, which is essential for production of DNA, RNA and protein. Bacteriostatic (bactericidal for UTI),
broad spectrum (G+/G-)
Treat some nonbacterial infections
UTI, Otitis media, respiratory infections (e.g. pneumonia), and diarrhea caused by bacteria
CI: Not for pts w/ folate deficiency, sulfa allergy, preg/nursing women, renal/liver dysfunction.
MRSA: Hospital-acquired infections (HA-MRSA),
50% ICU patients,
Skin contact w/ drainage, indwelling catheter, IV line, ET
Pneumonia, abscesses, sepsis, death
Vancomycin (Vancocin), linezolid (zyvox)
Community-acquired MRSA (CA-MRSA)
Direct contact (warm, moist);
Treatment with cipro, clindamycin, gentamicin
MOA: Slow viral reproduction by stopping viral DNA production.
Use: Epstein-Barr virus, cytomegalovirus, herpes simplex virus 1 and 2, varicella-zoster virus
Side effects - headache, dizziness, GI upset (N/V/A), malaise (not feeling well)
Adverse effects - Nephrotoxicity, leading to kidney damage and failure, Bone marrow suppression (red, white, purple), phlebitis
MOA: Stop viral reproduction by inhibiting the release of virus into respiratory epithelial cells to multiply
Use: influenza A viral infection
Side effects - dizziness, blurred vision, dry mouth, constipation, orthostatic hypotension,(anticholinergic SE/ADEs)
Adverse effects (amantadine) - CNS sedation, tachycardia, may worsen glaucoma, urinary retention, and depression,
*Rimantadine has fewer nervous system SE, safer
LFT, blood glucose level, CBC
Skin (jaundice, rash, blisters, and itching), blood glucose
Take the drugs exactly as prescribed to prevent recurrence and drug resistance.
No cure, but reduce viral load ;
Many D-D interactions, serious AE.
Call doctor if having yellow skin, dark urine, or light stool (liver toxicity)
Drug name: -vir-, -dine
Oral: Abacavir (ziagen), zidovudine (AZT)
MOA: Reduce viral replication/reproduction by inhibiting reverse transcriptase , lowering viral DNA production, slowing viral reproduction
Uses: HIV infection
Side effects - headache, GI upset with fatty or fried foods
Adverse effects - hepatotoxicity, lactic acidosis, BMS, (red, white, purple), peripheral neuropathy with long-term use
Avoid fatty foods and fried foods (pancreatitis)
Loss of sensation increases risk for injury
Stop abacavir if flu-like symptoms develop
Drug name: -vir-
MOA: Reduce HIV reproduction by inhibiting the reverse transcriptase from converting viral RNA to DNA, lowering viral DNA production.
Uses: HIV infection
Side effects - rash, GI upset, headache, difficulty sleeping, flu-like symptoms (fever, chills, aches)
Adverse effects - anemia, liver toxicity, rash, SJS
Notify prescriber of adverse reactions
Take at least 1 hr before or 2 hr after antacids
Keep all medical appointments for blood work (CBC, LFT)