Classifications Pharmacological

7/31/2019 Classifications Pharmacological

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A Pharmacology1. Class: antianginal agents

a. type: nitratesi. action

arterial, venous, and capillary vasodilation by relaxing vascular smoothmuscle

o decreases myocardial oxygen consumption

o decreases preload with venous pooling

o decreases afterload by decreasing peripheral vascular

resistance

ii. example nitroglycerin (Nitro-bid IV 10-20 mcg/min, titrate according to blood

pressure) (Nitro-dur 1 transdermal patch daily, remove for 6-8 hoursdaily) (Nitro-stat 0.4 mg sublingual (SL) tablet under the tongue, mayrepeat every 5 minutes up to 3 tablets)

iii. uses: prophylaxis, treatment, and management ofangina, acute myocardialinfarction (MI)

iv. adverse effects

sudden, severe refractory hypotension when taken withsildenafil citrate (Viagra) or tadanafil (Cialis), methoglobinemia,contact dermatitis

headache, nausea, vomiting, dizziness

reflex tachycardia,postural hypotensionv. contraindications

severe anemia, cardiac tamponade

cerebral hemorrhage or trauma

hypovolemia, hypotension, shockvi. nursing care

establish baseline data and monitor during acute angina or IVadministration: blood pressure, heart rate, EKG, chest pain

may decrease effectiveness of heparin

withdraw treatment gradually to avoid angina

toxicity: CNS changes, hypotension, flushing, nausea

buccal area must be moist for SL absorption

may induce alcohol intoxication (without alcohol intake)

maintain a 6-8 hour nitrate-free period every 24 hours after acute

episode to avoid tolerance client teaching

o apply spray under tongue; do not chew tablets

o sit down when taking, change positions slowly

o report blurred vision or dry mouth, avoid alcohol

o keep tablets away from light, moisture, and body heat; change

tablets every 6 monthso use spray or sublingual tablets for immediate relief; combine

drug with rest for acute attacko rotate site of ointment or patch; remove ointment or patch and

clean skin for daily nitrate-free periodo for acute angina: take 1 tablet (or 1 spray under the tongue)

SL every 5 minutes up to three tablets, if not relieved seekemergency

b. type: isosorbide dinitrate, mononitratei. action

vasodilation by relaxing arterial and venous smooth muscleo decreases preload with venous pooling, peripheral vascular

resistance, and myocardial oxygen consumptionii. examples

isosorbide dinitrate (Isordil 5-40 mg by mouth daily in 4 doses)

isosorbide mononitrate (Imdur 10-20 mg by mouth daily in 2 does)iii. uses: maintenance therapy for angina, coronary artery disease (See also:

II.A.1.a nitrates: adverse effects, contraindications, nursing care)c. type: beta-adrenergic blocking agents (See also: II.A.4.e beta-adrenergic blocking

agents)d. type: calcium channel blocking agents (See also: II.A.4.d calcium channel blocking

agents)2. Class: Anticoagulants

1. Type: oral

i. action: interferes with vitamin Kdependent clotting factors in the liverresulting in prolonged bleeding time

ii. example: warfarin (Coumadin 2.5-10 mg by mouth daily for 2-5 days; then,titrate according to INR)

iii. uses: maintenance therapy and prophylaxis to suppress formation ofdangerous clots after MI, mechanical heart valve surgery, atrial fibrillation (afib) and atrial flutter (a flutter), heart failure, DVT, and pulmonary embolism(PE)

iv. adverse effects
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1. hemorrhage, peripheral skin necrosis2. bone marrow depression, liver dysfunction3. anorexia, many drug-drug interactions4. high-risk drug with older or incompetent clients

v. contraindications

1. clients at risk for falls, malabsorption syndrome2. severe hepatic or renal disease3. bleeding disorders and active bleeding4. recent invasive procedure to spinal cord

vi. nursing care

1. establish baseline data and monitor prothrombin time (PT) andinternational normalized ratio (INR), bleeding, bruising, liver functiontests (LFTs), headache, decreased level of consciousness, and risk offalls

2. high risk therapy for older clients in the community3. apply prolonged pressure to any puncture wounds to stop bleeding4. administration of vitamin K suppresses warfarin activity for 1-3 weeks:

may need to provide alternate anticoagulation5. client teaching

1. avoid alcohol, NSAIDs2. use electric razor for shaving3. seek emergency treatment for falls4. wear MedicAlert jewelry, monitor for bleeding5. take at same time daily, need for follow-up care and testing

6. avoid herbal remedies including Echinacea, licorice, andginseng7. avoid foods containing vitamin K (decreases effect of warfarin)

especially green leafy vegetables, broccoli, and liver2. type: low-molecular weight (LMW) heparin

i. action: blocks action of Factors Xa and Iia without appreciably affectingthrombin or prothrombin

ii. examples1. dalteparin (Fragmin 2500 international units by subcutaneous injection

daily)2. enoxaparin (Lovenox 1-1.5 mg/kg by subcutaneous injection daily)

iii. uses: prophylaxis against thromboembolic disorders associated with surgeryand bedrest

iv. adverse effects

1. hemorrhage, thrombocytopenia, angioedema2. increased bleeding times and bruising3. inflammation at injection site, dyspnea, rash

v. contraindications1. recent GI bleed or invasive spinal cord procedure

2. active bleeding, thrombocytopenia, uncontrolled HTNvi. nursing care (See also: II.A.2.a.vi anticoagulants: oral, nursing care)

1. establish baseline data and monitor CBC and platelets

2. does not effect PT, INR, or activated partial thromboplastin time (aPTT)

with therapeutic doses

3. lower risk ofheparin-induced thrombocytopenia (HIT) thanunfractionated heparin

4. give subcutaneously according to manufacturer's direction

5. client teaching: subcutaneous injection technique3. type: unfractionated heparin

i. action: inhibits conversion of prothrombin to thrombin thus preventing fibrinformation

ii. example: heparin sodium (Heparin Sodium Lock Flush Solution)

iii. uses: acute illness to suppress dangerous clot formation; unstable angina(USA), MI, CVA, DVT, PE, afib and flutter, disseminated intravascularcoagulation (DIC)

iv. adverse effects

1. HIT, bronchospasm, increased bleeding time2. rebound hyperlipidemia, fever, chills, rash

3. impairment ofendocrine systemv. contraindications

1. extensive burns, trauma; severe HTN

2. recent surgery or invasive spinal cord procedure3. thrombocytopenia, active bleeding, bleeding disorders

vi. nursing care (See also: II.A.2.a.vi anticoagulants: oral, nursing care)1. establish baseline data and monitor aPTT, CBC, and platelets2. highest risk of HIT

3. adjust dosage when given with nitroglycerin (NTG)

4. high-risk therapy for women, older clients, and with renal or hepaticinsufficiency

5. antidote: protamine sulfate (Protamine Sulfate 1.0% 0.5-1 mg IV/100units of heparin given)

6. client teaching: subcutaneous injection technique

2. Antidysrhythmia agents (aka antiarrhythmia)
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1. information common to antidysrhythmia agentsi. use

1. eradication of frequent premature ventricular contractions that causehemodynamic instability or loss of consciousness

2. emergency eradication of ventricular dysrhythmias3. cardiopulmonary resuscitation4. chemical cardioversion of atrial and ventricular dysrhythmias

ii. adverse effects1. heart block2. most are have dysrhythmogenic potential (capable of causing

dysrhythmias)3. prolongation of QTc interval or QRS complex

1. increased risk of torsades des pointesiii. assist HCT to implement client teaching plan

1. count heart rate and pattern of rhythm, i.e., regularity2. provide acceptable range for heart rate3. report

1. new onset of irregular rhythm2. findings outside of acceptable parameters3. worsening heart rate, dizziness, lightheadedness, loss of

consciousness, and edema2. type: sodium channel blocking agents (Class I antidysrhythmia agents)

i. action: suppresses various phases in myocardial cell action potential byblocking sodium channels; stabilizes myocardial cell membrane

ii. example

1. lidocaine (Xylocaine 2 mg/min IV infusion: titrate according tofrequency of ventricular ectopy)

2. quinidine gluconate (Quinalan 325-650 mg by mouth every 6 hours,324-660 mg by mouth every 6-12 hours as extended-release tabs)

3. procainamide (Pronestyl 500-1000 mg by mouth every 4-6 hours, 1gram every 12 hours as sustained-release form)

iii. uses: ventricular dysrhythmias, chemical cardioversion with a fib and a flutter(except lidocaine)

iv. adverse effects1. dysrhythmias, heart block, torsades de pointes

Torsades de Pointe

2. respiratory depression, bone marrow depression3. nausea, vomiting, rash4. increases risk of digoxin toxicity and risk of bleeding with

anticoagulants

5. CNS effects including sedation, confusion, and seizures (especiallylidocaine)


prolonged QTc interval

hypotension and shock

heart block without pacemaker

prolonged therapy, use with cimetidinevi. nursing care

establish baseline data and monitor vital signs, EKG, QTc interval,neurological status, drug levels

prevent client injury: associated with many adverse effects

quinidine and procainamide reserved for use after many othertherapies have failed

client teachingo avoid citrus juices, antacids, and milk products

o take heart rate daily: report change in rhythm

e. beta-adrenergic blocking agents (Class II antidysrhythmia agents) (See also: II.A.4.3beta-adrenergic antagonists)

f. type: potassium channel blocking agents (Class III antidysrhythmia agents)1. action: slows the outward movement of potassium through myocardial cell

membranes and prolongs the action potential2. examples

i. amiodarone (Cordarone 400 mg by mouth daily)ii. sotalol (Betapace 160-320 mg by mouth daily in 2-3 doses)

3. uses: ventricular and supraventricular dysrhythmias, chemical cardioversionwith a fib and a flutter

4. adverse effects

i. pulmonary fibrosis, hypotension

ii. heart failure, heart block, sinus arrest, liver damage
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iii. nausea, vomiting, dizziness, weakness, photosensitivity5. contraindications

i. prolonged QTc intervalii. concomitant use with quinidine or procainamideiii. severe liver disease, heart block, cardiogenic shock

6. nursing care

i. establish baseline data and monitor vital signs, EKG, hepatic,pulmonary, endocrine, neurological, and GI function

ii. follow oral and IV administration guidelines: timing and rates ofinfusion are very important

iii. client teaching1. avoid taking with echinacea2. need for follow-up care and testing3. protect skin and eyes from UV rays4. monitor pulse and report changes in rhythm5. may take with meals but must be consistent

2. type: anticholinergic agent (See also: II.C.2.iii anticholinergics)1. action: competes with acetylcholine for muscarinic receptor sites to produce

mild vagal excitation

2. example: atropine (!high alert drug) (Atropine 0.51 mg up to 2 mg)3. use: bradycardia associated with increased vagal tone4. adverse effects

i. paradoxical bradycardia with sub-therapeutic dosing; angina,

tachycardiaii. anticholinergic effects

iii. atropine flush 15-20 minutes after injection3. type: acetylcholine-sensitive K+ current activator

1. action: shortens duration of action potential, causes hyperpolarization, andslows normal automaticity

2. example: adenosine (Adenocard 6 mg rapid IV bolus, may administer 12 mgrapid IV bolus in 1-2 minutes)

3. use: chemical conversion of supraventricular tachycardia after failure of vagalmaneuver

4. adverse effects

i. transient asystole, dysrhythmiasii. dyspnea, chest tightness, hypotension, flushing, nausea

5. contraindications: 2nd or 3rd degree AV block, sick sinus syndrome, cardiac

transplant6. nursing care

i. establish baseline data and monitor continuously during therapy: EKG,heart rate, blood pressure, respiratory rate

ii. monitor serum electrolytes

Therapeutic class: antihypertensive agent types:

4. Antihypertensive agentsa. information common to antihypertensive agents

i. uses: heart failure, primary and secondary HTNii. adverse effects

orthostatic hypotension,reflex tachycardia, bradycardia

dizziness, weakness, sexual dysfunction

nausea, vomiting, diarrhea, anorexia, and constipation

iii. contraindications

severe deficiencies in serum electrolytes

heart block, pediatrics, hypovolemiaiv. nursing care

establish baseline data and monitor blood pressure, K+, fluid andelectrolyte balance, renal function

older clients more susceptible to toxicity, labile hypotension, andorthostatic hypotension

client teachingo avoid OTC drugs, change positions slowly

o finding recognition

o take medication only as directed, when feeling well, and if

blood pressure is controlled (indicates that the therapy is

effective)o therapy most effective when combined with weight loss,

smoking cessation, and an active lifestyleb. type: ace inhibitor (ACEI)

i. action: inhibits conversion ofangiotensin I to angiotensin II in the lungspreventing vasoconstriction from angiotensin II and the release ofaldosterone

ii. examples

enalapril (Vasotec 10-40 mg twice daily by mouth, initiate therapy at2.5-5 mg)

lisinopril (Zestril 20-40 mg daily by mouth, initiate therapy at 2.5-5 mg)iii. uses: HTN and heart failureiv. adverse effects
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refractory cough, hyperkalemia

rash, renal and hepatic injury

v. contraindications: hyperkalemia and renal insufficiencyvi. nursing care (See also: II.A.4.a.iv information common to antihypertensive

agents)

administer on empty stomach

client teachingo take 1 hour before and 2 hours after eating

o avoid salt substitutes containing potassium

o

increased risk of hypersensitivity if given with allopurinolc. type: angiotensin II-receptor blocker (ARB)i. action: binds to angiotensin II receptors to block vasoconstriction and release

of aldosteroneii. examples

losartan (Cozaar 50-100 mg by mouth daily in 1-2 doses)

valsartan (Diovan 160-320 mg by mouth twice daily)iii. uses: HTN and heart failureiv. adverse effects: hyperkalemiav. nursing care (See also: II.A.4.a.iv information common to antihypertensive

agents)

relatively few drug-drug interactions

client teaching: may take with food, avoid salt substitutes containingpotassium

d. type: calcium channel blocker (CCB)i. action: block movement of calcium into muscle cellii. examples

amlodipine (Norvasc 5-10 mg by mouth daily)

diltiazem (Cardizem 30-120 mg by mouth 3-4 times daily, Cardizem SR180-240 mg by mouth daily)

verapamil (Calan XR 120-240 mg by mouth daily; IV 5-10 mg/kg, mayrepeat with 10 mg in 15-30 minutes)

iii. uses: HTN, angina, and dysrhythmiasiv. adverse effects

precipitous hypotension

heart block and heart failure

venous pooling, peripheral edema

hypotensive effect of diltiazem potentiated with cycloSPORINEv. contraindications: heart block and sick sinus syndromevi. nursing care (See also: II.A.4.a.iv information common to antihypertensive

agents)

client teaching: do not take with grapefruit juice

e. type: beta-adrenergic blocking agents (antagonists)

i. action: selective (beta1-adrenergic receptors) and non-selective (beta1- andbeta2-adrenergic) blockers of the sympathetic nervous system (SNS) resultingin

slower heart rate

decreased vasoconstriction

decreased myocardial oxygen consumptionii. examples

selective blockerso atenolol (Tenormin 50-100 mg by mouth daily; IV 5 mg, may

repeat 2 times)o metoprolol (Toprol 100-450 mg by mouth 1-2 times daily; IV 5

mg every 2 minutes for 3 doses)

non-selective blockero propranolol (Inderal 80-240 mg by mouth in 2-4 divided doses

daily; IV 1-3 mg, may repeat in 2 minutes)

iii. uses: heart failure, hypertension, heart rate control, angina, and migraineheadache prophylaxis

iv. adverse effects

bradycardia, heart block, heart failure, hypotension

depression, decreased exercise tolerance

suppresses clinical indicators ofhypoglycemia bronchospasm (not as common with cardioselective forms)


thyrotoxicosis , diabetes mellitus (DM)

peripheral vascular disease (PVD)

chronic obstructive pulmonary disease (COPD)vi. nursing care (See also: II.A.4.iv information common to antihypertensive

agents)

establish baseline data and monitor breath sounds and peripheralperfusion

avoid concomitant use ofclonidine and nonsteroidal anti-inflammatorydrug (NSAID)
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taper dose before discontinuing, do not discontinue before surgery

check with provider for administration limits for heart rate and bloodpressure

client teaching: take pulse or blood pressure before administrationf. type: combined alpha and beta-adrenergic blocking agents

i. action: blocks all SNS receptors and inhibits release ofepinephrine (Epi) andnorepinephrine (NE) resulting in decreased vasoconstriction, slower heart rate,and increased renal perfusion

ii. examples

carvedilol (Coreg 6.25-25 mg twice daily by mouth, increase dose in 2weeks intervals)

labetalol (Normodyne 400-800 mg 2-3 times daily by mouth)

guanethidine (Ismelin 25-50 mg daily by mouth)iii. uses: heart failure, HTN secondary to renal failure, refractory HTNiv. adverse effects

cerebrovascular accident (CVA), bronchospasm,pulmonary edema

serious dysrhythmias when combined with CCBs

masks signs of hypoglycemia

impaired peristalsis, decreased exercise tolerance

v. contraindications: heart block, acute asthma, DM, and shockvi. nursing care (See also: II.A.4.a.iv information common to antihypertensive

agents)

establish baseline data and monitor for heart block, bronchospasm,pulmonary edema, and liver failure

taper dose before discontinuingg. type: alpha-adrenergic blocking agents

i. action: non-selective blocker of alpha-adrenergic receptors (of SNS)ii. examples: phentolamine (Regitine 5 mg IV bolus, then 0.5-1 mg/min;

subcutaneously 5-10 mg)

iii. uses: HTN associated with pheochromocytoma, extravasation of epinephrineand dopamine

iv. adverse effects

angina and myocardial infarction (MI), CVA, profoundhypoglycemia

nausea, vomiting, and diarrhea

v. contraindications: coronary artery disease (CAD) and MI

vi. nursing care potentiated by alcohol; suppressed with epinephrine and ephedrine

h. type: alpha1-blocking agentsi. action: blocks alpha1-receptors of SNSii. examples

prazosin (Minipress 6-15 mg by mouth daily in divided doses, not toexceed 40 mg in divided doses)

terazosin (Hytrin 1-5 mg by mouth daily in 2 doses, not to exceed 20mg daily in 2 doses)

tamsulosin (Flomax 0.4-0.8 mg by mouth daily after meals)

iii. uses: hypertension, benign prostatic hypertrophy (BPH)

iv. adverse effects: angina, priapism, headache, peripheral edemav. contraindications: hepatic and renal failure; do not take with sildenafil (Viagra)

or tadalafil (Cialis)vi. nursing care (See also: II.A.4.a.iv information common to antihypertensive

agents): provide small frequent meals to manage GI discomfort

i. type: alpha2- agonistsi. action: displaces NE and stimulates alpha2-receptors of SNS resulting in

decreased release of norepinephrine in the peripheryii. example: clonidine (Catapres 0.1-0.6 mg by mouth (twice daily), transdermal

daily over 1 week)iii. uses: HTN, chronic pain related to canceriv. adverse effects

bradycardia

dry mouth, sedation

nausea, vomiting, anorexia, headache, urinary retention

v. contraindications narrow-angle glaucoma

vasospastic disease

thyrotoxicosis or DMvi. nursing care (See also: II.A.4.a.iv information common to antihypertensive

agents)

taper dose before discontinuing

do not discontinue before surgery

do not administer with tricyclic antidepressants or propranololj. type: centrally acting vasodilators

i. action: directly relaxes arteriolar vascular smooth muscle resulting in loweredperipheral vascular resistance and reflex tachycardia
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ii. example: hyrALAZINE (Apresoline 200-300 mg by mouth daily divided in 4doses) (do not confuse with hydrOXYzine)

iii. uses: acute hypertension associated with pregnancy, essential hypertensioniv. adverse effects

shock, myelosuppression, reflex tachycardia, angina

headache, tremors, dizziness, peripheral neuritis

anorexia, paralytic ileus, rash, nasal congestion, flushingv. contraindications: maternal bleeding, CAD, mitral valve diseasevi. nursing care

establish baseline data and monitor FHTs, maternal blood pressure,

heart rate, EKG, breath sounds, CBC, weight, edema administration

o give orally with food

o hypertension in pregnancy: given IV bolus, monitor vital signs

every 15 minutes

client teachingo report chest pain, severe fatigue, muscle or joint pain

o avoid OTC drugs

o change positions slowly

vii. type: diuretics (See also: II.H.1 diuretics)5. Antilipid agents

i. type: bile acid sequestrants

ii. action: bind with bile acid in small intestine leading to decreased absorption

and increased excretion of fat in stooliii. example: cholestyramine (Questran 4-20 grams by mouth once or twice daily)

iv. uses: in combination with low fat diet to lower serum lipids, primaryhypercholesterolemia, and elevated low-density lipoprotein (LDL)

v. adverse effects

increased bleeding time

headache, nausea, constipation

decreased absorption of fat-soluble vitaminsvi. contraindications

bleeding disorders, biliary obstruction

post-cholecystectomy, abnormal bowel functionvii. nursing care

bowel sounds administering, serum lipids, bowel pattern, bleeding

prevent constipation, monitor: vitamin deficiency and increasedbleeding times

administrationo do not crush or chew tablets

o give with food; do not administer in dry form

o administer 1 hour before or 4-6 hours after thiazide, diuretics,

digoxin, warfarin, thyroid hormone, or glucocorticoids

client teachingo must take with food

o report bleeding, muscle pain

o prevent constipation with increased fluids, fiber, and physical

activityc. type: HMG-COA reductase inhibitors (statins)

1. action: controls final step in cholesterol formation by blocking formation of cellular

cholesterol leading to decreased serum cholesterol and slightly increased high-densitylipoproteins (HDL)

2. examples

atorvastatin (Lipitor 20-40 mg by mouth daily)

simvastatin (Zocor 5-10 mg by mouth daily at bedtime)

rosuvastatin (Crestor 5-10 mg by mouth daily)

2. uses: hypercholesterolemia, arteriosclerosis , and DM in combination with low-fat diet and exercise3. adverse effects

increased risk of rhabdomyolysis when given witherythromycin, cyclosporine, antifungal agents, and otherantilipid drugs, and with higher doses

cataracts, liver and renal dysfunction

flatulence, abdominal cramping, nausea, and vomiting increases estrogen level when taking oral contraceptives

increased risk of toxicity when given with digoxin or warfarin4. contraindications

alcoholism, allergy to fungus

active liver disease, impaired endocrine function5. nursing care

establish baseline data and monitor liver and renal function tests,LDLs, HDLs, muscle pain, vision

administer at bedtime, may take with food

client teachingo promptly report vision changes, muscle pain
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o monitor for bleeding, dark urine, and dark stool

o maintain regular follow-up care and testing

o most effective when combined with lifestyle changes including

low-fat diet, weight loss, high-fiber diet, and exercise

c. type: fibrates

action: decreases synthesis of hepatic LDLs and cholesterol

exampleso clofibrate (Atromid-S)

o gemfibrozil (Lopid 600 mg by mouth twice daily)

uses: familial hypercholesterolemia not responding to diet and othertherapy

adverse effects: rhabdomyolysis

contraindications: concomitant use with statins

nursing careo establish baseline data and monitor serum lipids, muscle pain,

LFTs, RFTsd. type: niacin

action: inhibits release offatty acid from adipose tissue, improvesremoval oftriglycerides from plasma

example: niacin (Niaspan 1-2 grams three times daily)

uses: hyperlipidemia not responding to diet and weight loss

adverse effectso increases serum uric acid levelo intense cutaneous flushing, nausea, and abdominal pain

nursing careo establish baseline data and monitor serum lipids, uric acid,

joint paino give at bedtime

o often combined with bile acid sequestrants, but administer 4-6

hours after the bile acid sequestrantse. type: LDL absorption inhibitors

i. action: inhibits absorption of lipids from small intestinesii. example: ezetimibe (Zetia 10 mg by mouth daily)iii. uses: to decrease serum levels of cholesterol, LDLs, and triglycerides, and to

increase HDLs in hypercholesterolemiaiv. adverse effects

sinusitis, muscle and back pain

abdominal pain, diarrhea

effect greatly increased when given with cyclosporinev. contraindications: liver disease or unexplained increase in LFTsvi. nursing care

establish baseline data before initiating therapy and monitor duringtreatment: LFTs, lipid levels, muscle pain, bowel pattern

do not give with HMG-COA reductase inhibitors (statins)

client teachingo take with or without food

o most effective when combined with low-fat diet and weight

loss6. Antiplatelet agents

a. type: aspirinvii. action: inhibits prostaglandin formationviii. examples: acetylsalicylic acid (Bayer 81325 mg by mouth daily)

ix. uses: prophylaxis against ischemic attacks in brain and heart, to decrease riskof death or MI in clients with angina; also classified as antipyretic, non-steroidal anti-inflammatory drug (NSAID), and analgesic

x. adverse effects

bleeding and bruising, tinnitus, GI upset and erosion

hemolytic anemiaxi. contraindications

asthma, sensitivity to other NSAIDs

history of GI bleeding, bleeding disorders

within 10 days of invasive procedure or surgery

children


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o take with plenty of fluids

b. type: adenosine diphosphate inhibitor

i. action: inhibits platelet aggregation by preventing adenosine diphosphatebinding to platelet receptor

ii. example

clopidogrel (Plavix 75 mg by mouth daily)

ticlopidine (Ticlid 250 mg by mouth twice daily with food)iii. uses: secondary prevention of MI, CVA, and unstable angina; established PVDiv. adverse and side effects

myelotoxicity, thrombotic thrombocytopenic purpura chest pain,edema, HTN

flu-like findings, headache, dizziness, rash

epistaxisv. contraindications

closed head bleeding or injury

history of bleeding or bleeding disordervi. nursing care

establish baseline data and monitor platelet count, lipids

discontinue 7-10 days before surgery

protect medication from light

client teachingo increased bleeding effect with anticoagulants, NSAIDs,

feverfew, garlic, ginger, and ginkgoc. type: non-nitrate vasodilator (See also: II.A.10 vasodilators)

7. Diruetics (Additional Information diuretics II.H.1)8. Positive inotropes: improve myocardial contractility and cardiac output

a. type: cardiac glycoside

i. action: slows A-V conduction, improves cardiac output, and improvesmyocardial contractility

ii. example: digoxin (Lanoxin 0.125-0.25 mg by mouth daily)

iii. uses: heart failure, ventricular rate control in atrial fibrillation (a fib) and atrialflutter (a flutter)

iv. adverse effects

bradycardia, heart block,dysrhythmias

xanthopsia, muscle weakness

nausea, vomiting, diarrhea, and anorexiav. contraindications

ventricular fibrillationVentricular Fibrillation

Ventricular Tachycardia

heart block

hypokalemiavii. nursing interventions

establish baseline data and monitor heart rate, intake and output,serum potassium

check if heart rate is within parameters established by provider,usually >50 bpm

monitor for toxicityo therapeutic range 0.8 to 2.0 ng/ml

o pediatrics: dysrhythmias

o adults: visual disturbances, nausea and vomiting, anorexia

o older clients: higher risk of toxicity

client teachingo take medication as prescribed

o avoid St. Johns Wort, licorice, ginsengo take heart rate daily before administration

o perform daily weight: report > 2 pound increase in 24 hours

o finding recognition: irregular pulse or change in rhythm, heart

rate < 60 bpm2. type: phosphodiesterase inhibitor

vi. action: blocks action of phosphodiesterase leading to increased myocardialcontractility and vasodilation, increased myocardial oxygen consumption, anddysrhythmias

vii. examples: inamrinone (Inocor) and milrinone (Primacor)viii. uses: IV therapy for heart failure unresponsive to digoxin, diuretics, and

vasodilators; bridge to transplantation
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ix. adverse effects

lethal ventricular dysrhythmias

chest pain, hypotension

nausea, vomiting, anorexiax. contraindications

acute MI, hypovolemia, severe heart valve disease

allergy to bisulfitesxi. nursing care

establish baseline data and monitor vital signs and (EKG), platelets,fluid balance, BNP

administration: protect drug from light, administer in large borecatheter

client may be maintained on therapy at home

client teachingo establish reliable emergency response for cardiac arrest,

unstable angina, syncope, or change in level of consciousness(LOC)

o long-term IV therapy

9. Thrombolytics

a. action: binds with plasminogen to dissolve thrombi (clots) in coronary arteries within 4to 6 hours ofmyocardial infarction. Activated conversion of plasminogen to plasmin.Plasmin is able to break down clots (fibrin).

b. examples

i. streptokinase (Streptase)ii. urokinase (Abbokinase)

c. usesi. myocardial infarction

ii. deep venous thrombosis

iii. pulmonary embolismiv. thrombosed intravenous catheters

d. contraindicationsi. CNS neoplasmsii. active bleeding or severe hypertensioniii. cerebral embolism, thrombosis, hemorrhageiv. recent arterial diagnostic procedure or surgeryv. recent major surgery, trauma, invasive spinal procedures

e. adverse side effects

i. bleedingii. reperfusion injury, dysrhythmias

iii. allergic reactions: urticaria, itching, flushing headachef. nursing interventions

i. monitor CBC, coagulation studies, and hypersensitivityii. monitor for bleeding (overt and occult, abdominal girth)

iii. keep available: aminocaproic acid (fibrinolysis inhibitor)iv. avoid IM injections prior to administrationv. monitor neurological status, reperfusion injury, and dysrhythmia

10. Vasodilatorsa. type: non-nitrate

i. action: coronary artery vasodilation with action similar to papaverine;antiplatelet properties and mild positive inotrope

ii. example: dipyridamole (Persantine 225-400 mg by mouth in 3-4 doses daily)iii. uses

reduce need for nitrates


adjunct for thallium stress test

prevention of postoperative thromboembolic complicationsiv. adverse effects: usually dose related; headache, dizziness, peripheral

vasodilation, nausea, and vomitingv. nursing care

establish baseline therapy and monitor blood pressure

therapeutic effect may take 2-3 months to appear

client teaching: change positions slowlyb. type: peptide hormone, synthetic

i. action: inhibits anti-diuretic hormone (ADH) to increase urine output and

relaxes vascular smooth muscleii. example: beta-natriuretic hormone, nesiritide (Natrecor 0.1 mcg/kg/min titrate

to cardiac output)iii. adverse effects

hypotension, dysrhythmias

insomnia, dizziness, confusion

fever, abdominal pain, pruritus, rashiv. contraindications

cardiogenic shock or PAP, PCWP

cardiac tamponade or constrictive pericarditisv. nursing care
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establish baseline data and monitor vital signs, PCWP, cardiac output,fluid and electrolyte balance, and urine output continuously duringtherapy

monitor serum creatinine

extremely expensive, made from recombinant DNA

solution is extremely dilute; very carefully calculate mcg/kg/min;requires loading dose

c. type: nitrate (See also: II.A1.a antianginal agents)d. type: calcium channel blockers (See also: antihypertensives II.A.4.d)

11. Vasopressors

a. type: alpha- & beta-adrenergic agonists, sympathomimetic agents

i. action: increases heart rate, vasoconstricts peripheral vessels to increaseblood pressure, and dilates renal and splanchnic vessels to improve perfusionvia stimulation of sympathetic nervous system; opposite action of alpha- orbeta-blockers>

ii. examples

dopamine hydrochloride, seeAgents used as vasopressors (Intropin0.5-10 mg/kg/min IV titrated to blood pressure)

norepinephrine bitartrate (Levophed 2-30 mcg/min IV titratedaccording to blood pressure and vasoconstriction)

epINEPHrine (Adrenalin 1 mg IV bolus every 3-5 minutes in cardiacarrest) (See also: bronchodilators: epINEPHrine II.B.1)

iv. uses: improve cardiac output and perfusion of vital organs in shock states and

profound hypotensionv. adverse effects

angina, dysrhythmias, vasoconstriction, necrosis

impairs glucose metabolism (epi)

nausea, vomiting, headache

disproportionate increase in diastolic blood pressurevi. contraindications: pheochromocytoma, PVD, hypovolemia, tachydysrhythmiasvii. nursing care

establish baseline data and monitoro blood pressure, heart rate, and rhythm every 15 minutes

o peripheral perfusion, urine output, chest pain

infuse in central venous catheter with infusion pump, protect infusionfrom light

solution is very dilute (epi): carefully calculate dosage, based onmcg/kg of body weight/minute

antidote for extravasationo stop infusion and remove IV tubing

o phentolamine mesylate 10-15 ml subcutaneously into affected

tissuec. type: beta-agonist, sympathomimetic agent

action: selectively stimulates cardiac beta1-adrenergic receptors;primarily increases cardiac output; increases blood pressure withoutconcomitant increase in heart rate

exampleo dobutamine hydrochloride (Dobutrex 2.5-15 mcg/kg IV titrated

to blood pressure, cardiac output)o isoproterenol (Isuprel 2-6 mcg/kg IV titrated to blood pressure

and heart rate) uses: cardiogenic shock, preparation for pediatric cardiac

catheterization

adverse effectso HTN, tachydysrhythmias, vasoconstriction

o angina, nausea, vomiting

contraindications: tachydysrhythmias, idiopathic subaortic stenosis

nursing careo establish baseline data and monitor cardiac output, peripheral

perfusion, urine output, chest paino monitor blood pressure, heart rate, and rhythm every 15

minuteso control with infusion pump: carefully calculate dosage based

on mcg/kg of body weight/minuteo infuse in central venous catheter

o antidote for extravasation: stop infusion, remove IV tubing

o increased risk of peripheral vasoconstriction when given with

beta-adrenergic blockersc. type: alpha-agonist

action: direct stimulation of SNS resulting in vasoconstriction

example: phenylephrine (Neo-Synephrine 100-180 mcg IV, may repeatinitial dose every 10-15 minutes)

use: profound hypotension

adverse effectso dysrhythmias, tachycardia, gangrene, anaphylaxis
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o headache, dizziness, weakness, anxiety, tremor

o insomnia, nausea, vomiting

contraindicationso narrow-angle glaucoma, pheochromocytoma

o ventricular fibrillation, tachydysrhythmias, HTN, peripheral

vascular disease

nursing careo establish baseline data and monitor blood pressure, heart rate,

EKG, urine output, fluid volume status, ventricular fillingpressures

B. Managing respiratory conditions

1. Bronchodilatorsa. information common to bronchodilators

i. action: most effective agents are short-acting beta adrenergic agonists causingdirect relaxation of bronchial smooth muscle

ii. nursing care

encourage smoking cessation therapy

establish baseline data and monitor throughout therapyo breath sounds, oxygen saturation (SaO2)

o vital signs and EKG

iii. client teaching

report worsening findings

avoid caffeine and OTC drugs

eat small, frequent meals to ameliorate GI upset take medication only as directed; do not take extra doses

client teaching: use of delivery method: oral, meter-dose inhaler (MDI),nebulizer

b. type: adrenergic agonist (sympathomimetic)i. action

stimulates and enhances SNS effects to relax bronchial smooth muscle

may increase rate and depth of respirations

inhibits release of inflammatory mediators (short-term effect)ii. examples:

short-actingo type: alpha1- and beta2-adrenergic agonists, non-selective

adrenomimetic

1. epINEPhrine (Adrenalin, Primatene Mist*) (See also:II.A.11.a vasopressors: alpha- & beta-adrenergicagonists, sympathomimetic)

2. isoproterenol (Isuprel) (See also: II.A.11.bvasopressors: beta-agonist, sympathomimetic agents)

3. terbutaline** (Brethine)4. ritodrine (Yutopar) (See also: III.C.2.b.2 tocolytic

agents)o type: beta2-adrenergic agonists, selective adrenomimetic

1. albuterol **(Proventil 2 inhalations via metered-doseinhaler every 4-6 hours) (See also: I.D.5.a metered-dose inhaler)

2. metaproterenol** (Alupent)3. levalbuterol (Xopenex 0.63-1.25 mg via nebulizer every

6-8 hours) long-acting

o salmeterol (Serevent 50 mcg inhaled as dry powder every 12

hours)iii. uses

acute bronchospasm, anaphylaxis (epi)

asthma, chronic bronchitis, and COPD

prophylaxis for exercise-induced asthmaiv. adverse effects

desired effect lost when dose exceeds therapeutic level leading too angina, dysrhythmia, increased myocardial oxygen

consumptiono hypertension, peripheral vasoconstriction,hypoperfusion to

non-vital organso *associated with tachydysrhythmias, hypertension,

death

impaired glucose metabolism (epi)

tremor, nervousness, insomniav. contraindications


diabetes mellitus,hyperthyroidism

unstable angina, hypertension, cardiac diseasevi. nursing care

establish baseline data and monitor breath sounds, SaO2 and vitalsigns
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** available in oral therapy

small frequent meals to ameliorate nausea, vomiting, anorexia

client teachingo take before other inhaled medications and 30-60 minutes

before exerciseo report chest pain or palpitations

o avoid OTC drugs, stimulants including caffeinated beverages

and dark chocolate, Primatene Mist (may result in death)c. type: xanthines

i. actions

stimulates the SNS: acts directly on bronchial smooth muscle to dilateairways and on medulla in brainstem to increase rate and depth ofrespirations

inhibits release of inflammatory mediators in anaphylaxisii. examples

caffeine

aminophylline (Truphylline up to 13 mg/kg or 900 mg/day given in 3doses)

theophylline (Slo-bid)iii. uses: bronchospasm, asthma, COPD, chronic bronchitis, anaphylaxisiv. adverse effects

respiratory arrest, hypotension and seizures indicative of toxicity

dizziness in older clients

palpitations, dysrhythmias nausea, anorexia, vomiting, insomnia, nervousness, headache


CAD and heart failure

ischemic cardiomyopathy

severe liver or kidney diseasevi. nursing care

monitor drug levels: has narrow therapeutic range at 10-20 mcg/ml

do not exceed administration rate of 20 mg/min

dilute in 5% dextrose in water

less effective with smoking and St. Johns Wort

client teachingo maintain consistent diet

o avoid charcoal-broiled foodo take at the same time everyday

o drink plenty of caffeine-free beverages

d. type: anticholinergici. action

blocks muscarinic receptors, Ach release, and stimulation ofvagusnerve

results in bronchodilation, diminished secretions, low CNS effect

less inhibitory effect on mucociliary clearance

parasympatholytic, acts like atropine sulfateii. examples

ipratropium bromide (Atrovent, inhaler 1-4 inhalations 3-4 times daily,not to exceed 24 inhalations in 24 hours)

tiotropium bromide, long duration of action (Spiriva, inhaler 18 mcgdaily)

iii. uses

COPD

prophylaxis for bronchospasm; maintenance therapy for chronicbronchitis; allergic rhinitis

not rescue therapy, less effective for asthmaiv. adverse effects

worsening ofnarrow-angle glaucoma

dry mouth, blurred vision, constipation, urinary retention, coughv. contraindications

narrow-angle glaucoma

acute bronchospasm

vi. nursing care establish baseline data and monitor urine output

client teachingo not for use in acute bronchospasm

o wait 5 minutes before administering other inhaled medications

or as directed by providero wait 30-60 seconds between puffs, rinse mouth after each

treatment

2. Mucolytics and expectorantsa. mucolytics

i. action: thins respiratory secretions by splitting disulfite bonds in secretions;mobilizes secretions
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ii. type: acetylcysteine (Mucomyst 70 mg/kg every 4 hours for 18 doses)iii. uses

clients having difficulty with mobilizing and coughing up secretions

COPD, cystic fibrosis, pneumonia

acetaminophen overdoseiv. adverse effects

GI upset

stomatitis, rash, bronchospasmv. contraindications

acute bronchospasm, esophageal varices

peripheral vascular diseasevi. nursing care

as mucolytics: give by nebulizer

as antidote for acetaminophen poisoning: direct instillation, dilute withsterile water for injection

most effective when combined with adjunct therapy: encourageambulation plus coughing and deep breathing

b. expectorantsi. action: liquefies respiratory secretions by decreasing the surface tension

ii. type: guaifenesin (Robitussin 200-400 mg by mouth every four hours)iii. uses

clients having difficulty mobilizing and coughing up secretions

dry, nonproductive cough common cold, acute bronchitis, influenza

iv. adverse effects

low side effect profile

GI upset, allergy, headachev. nursing care

identify and resolve etiology of cough

establish baseline data and monitor appearance and amount ofsecretions

most effective when combined with adjunct therapy: encourageambulation, coughing and deep breathing

client teachingo guaifenesin found in many OTC combination products: avoid

using combination products for expectoranto must be given with plenty of water to be effective

o avoid dairy products and caffeinated beverages

3. Antitussive

a. type: narcotic [opioid]

i. action: cough suppression by depression of cough center in medulla ofbrainstem, similar to morphine; moderate histamine releasing action

ii. example

codeine 30-60 mg by mouth every 4-6 hours

hydrocodone bitartrate (Vicodin 5 mg by mouth every 4-6 hours)iii. uses

gold standard for cough suppression

cough due to pharyngitis, sinusitis, and pneumonia

analgesia, analgesia for head injuries, cranial surgeryiv. adverse effects

dizziness, dependence

sedation, over-stimulation

constipation, nausea, rash

increased viscosity of secretions

respiratory depression (weakest of the opioids)v. contraindications

clients who need to cough: asthma, postoperative thoracic surgeriesvi. nursing care

establish baseline data and monitor level of consciousness, respiratoryrate, bowel movements, temperature

provide adjunct therapy to relieve cough: expectorants, fluid,

humidification, lozenges client teaching

o take only as directed

o change positions slowly; ask for help before getting up and

avoid dangerous activities until full effects of treatment arewell established

o take with food to avoid nausea

o drink fluids, increase fiber in diet, ambulate, and establish

personal bowel habits to prevent constipationb. type: non-narcotic

i. benzonatate
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action: cough suppressant without suppression ofrespiratory center attherapeutic doses; acts like tetracaine hydrochloride

example: benzonatate (Tessalon 300-600 mg by mouth three timesdaily)

uses: acute and chronic respiratory condition to decrease frequencyand intensity of cough

adverse effectso low side effect profile

o drowsiness, sedation headache

o nausea, constipation, rash

nursing careo establish baseline data and monitor appearance and amount of

secretionso client teaching

1. swallow soft capsules whole: if dissolves in the mouth,may suppress gag reflex

2. store capsules in air tight container

ii. dextromethorphan

action: cough suppression by depressing the medulla; in therapeuticdoses comparable to codeine but without CNS depression andanalgesia, much less likely to cause constipation, drowsiness, or GIupset

examples: dextromethorphan hydrobromide (Benylin DM, Robitussin

DM up to 120 mg/day in divided doses) uses: temporary relief of cough spasms in nonproductive coughs

adverse effectso GI upset, constipation

o dizziness and drowsiness, especially in older clients

o hyperexcitability, especially in children

contraindications: children < 2 years-old, asthma, productive cough,hepatic dysfunction

nursing careo humidify air

client teachingo report cough lasting > 7-10 days

o do not crush or chew extended release forms

o avoid irritants, should not completely suppress cougho do not overdose dextromethorphan by taking combination

product4. Type: antituberculosis agents

a. general antituberculosis agents

i. actions: bacteriostatic or bactericidal anti-infective agents for treatmentofMycobacterium tuberculosis infection

ii. examples

first-line therapy

second-line therapy

iii. use: used in combination with other antituberculosis agents; none indicated formonotherapy

iv. adverse effects

hepatotoxicity, nephrotoxicity , myelosuppression

nausea, vomiting, anorexia, abdominal pain

many drug-drug interactions with other therapies and antituberculosisagents


hepatic or renal dysfunction

seizure disorder and neuritisvi. nursing care

establish baseline data and monitoro sputum cultures, liver function tests (LFT)

o CBC, PT

o BUN and creatinine (RFTs)

review drug-drug interactions for incompatibility

M. tuberculosis eradicated after three negative sputum cultures in arow

o client teaching

1. report- worsening symptoms, return of fever- rash, decreased urine output, edema, weight gain- dyspnea, hallucinations,jaundice

o avoid alcohol

o take as directed with plenty of fluids

o change positions slowly when altering dosages

o duration of therapy months to years; need for long-term care

and follow-up testing
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o continue taking antituberculosis therapy until instructed to

stop; continue therapy when feeling good and whennoncontagious

b. first-line therapy

i. isoniazid (INH 15 mg/kg up to 900 mg by mouth, IM 2-3 times weekly)

action: bacteriostatic agent that interferes with DNA ofM. tuberculosis

use: highly specific treatment for tuberculosis infection; usuallyincluded in antituberculosis pharmacotherapy

adverse effectso agranulocytosis

o visual disturbances, connective tissue syndromes

o paresthesias and peripheral neuropathy

o impaired vitamin absorption and glucose metabolism

contraindication: acute liver dysfunction

nursing careo establish baseline data and monitor blood sugar

o administer on empty stomach, 1 hour before or 2 hours after

meals; may give by deep IM injectiono client teaching

1. monitoring blood sugar2. avoid foods with histamine: skip-jack tuna, sauerkraut

juice, yeast extract3. report tingling, numbness, or burning of extremities:

may indicate toxicity4. avoid foods with tyramine: aged cheese, cured meat,

smoked fish

ii. rifampin (Rifadin 10 mg/kg by mouth, IV 2-3 times weekly)

action: inhibits RNA synthesis in M. tuberculosis

adverse effectso hepatorenal syndrome

o pseudomembranous colitis, heartburn

contraindicationso meningococcal disease

o obstructive biliary disease

o intermittent therapy with rifampin: significantly increases risk

of developing drug resistant organisms and hepatorenal

syndrome nursing care

o monitor PT

o use oral form for pediatrics

o client teaching

report bleeding or bruising

do not interrupt prescribed drug regimen

benign staining of excreted body fluids and stooliii. ethambutol (Myambutol 15-25 mg/kg by mouth 2-3 times weekly)

action: inhibits RNA synthesis

adverse effects: anaphylaxis, color blindness, retrobulbar neuritis

contraindication: optic neuritis

nursing care

o encourage regular eye examso establish baseline data and monitor uric acid level

o optic toxicity appears within first 7 months of therapy; usually

disappears after therapy is discontinuedo client teaching

report decreased urine output, edema and weight gainiv. streptomycin (See also: II.K.5.b.1 antibiotics: aminoglycosides)(Streptomycin 1

gram IM 2-3 times weekly)d. second-line therapy

1. ethionamide (Trecator-SC)

action: bacteriostatic and bactericidal

use: in combination with other antituberculosis therapy when first-lineagents have failed

adverse effectso exfoliative dermatitis

o heartburn, stomatitis, diarrhea

o impaired glucose metabolism

contraindicationso hypersensitivity to ethionamide, isoniazid, and niacin

o severe liver dysfunction

client teachingo promptly report skin rash

o take with food to decrease GI upset

o may take as single dose before bedtime

2. pyrazinamide
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3. cycloserine (Seromycin)4. aminoglycoside antibiotics (See also: II.K.5.b.1 antibiotics:aminoglycosides)

2. Anti-inflammatory agents (used in respiratory conditions; available as inhalants)a. glucocorticoid (inhaled)

1. actions

inhibits phagocytosis

reduces capillary permeability

stabilizes leukocyte membrane

decreases release of inflammatory mediators2. examples

flunisolide (Nasalide 2 metered-dose inhalations twice daily)

fluticasone propionate (Flovent 88-440 mcg/spray inhalations twicedaily)

triamcinolone acetomide (Azmacort 55 mcg/spray, 2 inhalations 3-4times daily)

beclomethosone dipropionate (Vanceril 84 mcg/spray, 1-2 inhalations2-4 times daily)

3. uses

long-term prophylactic treatment for asthma

bronchial asthma not responding to conventional therapy

preferred long-term therapy for adults and children with persistentasthma

adverse effects (same side effect profile as oral or IV therapy, muchless likely to occur with inhaled therapy)

hypothalamic-pituitary-adrenal axis suppression, opportunisticinfections, impaired healing, increased skin fragility, impairedglucose metabolism and hypokalemia

nausea, vomiting, PUD

insomnia, confusion, psychosis

muscle wasting, osteoporosis, cataracts, Cushing's disease, fluidretention

4. contraindications

renal dysfunction

prolonged pediatric therapy

immunosuppression, active respiratory infection

5. nursing care establish baseline data and monitor

o weight, blood pressure, infection

o blood sugar, renal function

collaborate with dietitian and provider to manage fluid retention,hyperglycemia, and hypokalemia

client teachingo not rescue therapy: not indicated for acute asthma or allergic

attack

therapeutic effect takes 1-2 weeks

be prepared for acute asthma attacko report infections and fever, worsening findings

o low-sodium diet, blood glucose testing

o avoid sick people, wash hands frequentlyo meal planning for daily calorie restrictions

o rinse mouth after treatment to avoid Candida albicans

overgrowth (thrush)d. type: mast cell stabilizer

action: inhibits release of histamine and slow reacting substance ofanaphylaxis (SRS-A) but without antihistaminic properties

exampleso cromolyn sodium (Nasalcrom 5.2 mg sprays, 1 inhalation each

nostril 3-4 times daily)o nedocromil sodium (Tilade 1.75 mg sprays, 2 sprays each

nostril 2-3 times daily)

uses: prophylactic treatment of asthma, allergic rhinitis, conjunctivitis;not for use with acute asthma

adverse effectso angioedema

o dry mouth, bitter aftertaste

o nasopharyngeal irritation

o nausea, transient ocular stinging

contraindicationso acute asthma

o aerosol administration in clients with CAD or dysrhythmias

nursing careo establish baseline data and monitor breath sounds, SaO2,

secretions
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o stop treatment with angioedema or bronchospasm

o pediatric dose with MDI: usually one-half of adult dose

o asthma findings may increase while tapering hydrocortisone

therapyo client teaching

not rescue therapy: not indicated for acute asthma orallergic attack

1. therapeutic effect takes 1-2 weeks2. be prepared for acute asthma attack

may stain soft contact lenses

use of inhaler or drug delivery device

does not eliminate need for other therapies

minimize throat irritation by following treatment withsips of water, lozenges

e. type: leukotriene-receptor antagonists

action: selectively interferes with leukotrienes to inhibit bronchospasmand airway edema

exampleo zafirlukast (Accolade 20 mg by mouth daily)

o montelukast (Singular 10 mg by mouth daily)

uses: prophylaxis against asthma and exercise induced asthma

adverse effectso fever, headache

o Churg-Strauss syndromeo generalized pain, back pain

contraindication: acute asthma

nursing careo establish baseline data and monitor breath sounds, SaO2,

respiratory rate, liver functiono administer 1 hour before or 2 hours after meals

o client teaching

take on regular basis: missing a dose may result in alapse in therapeutic effect

report flu-like findings, worsening condition, jaundice,dark urine or stool

6. Antihistamines (See also antihistamines II.K.2)

a. type: first generation antihistamines (for respiratory tract)i. action: potent H1 receptor antagonist (histamine blocking agent) to block the

effects ofhistamineii. example: azelastine

Optivar 2 sprays per nostril twice daily

iii. uses: seasonal allergic rhinitis, itching eyes associated with seasonal allergiesiv. adverse effects

drowsiness, fatigue

bitter taste

headache, rhinitis

dry mouth, nausea

v. contraindications: concurrent use ofCNS depressantsvi. nursing care

establish baseline data and monitor upper respiratory systemcongestion; drowsiness; reddened, itchy eyes, other clinical indicatorsof hypersensitivity

prime delivery unit before dispensing

client teachingo avoid

alcohol

getting nasal spray in eyes

driving, dangerous activity until adverse effects arewell-established

o blow nose before instillation: tilt head forward slightly and sniff

gentlyb. type: second generation antihistamines

i. action: blocks effects of histamine by blocking H1 receptor and mast cellrelease of inflammatory mediators

ii. examples

loratadine (Claritin)

fexofenadine (Allegra)

desloratadine (Clarinex)iii. uses: relief from itchy, watery eyes, nasal congestion, and runny nose due to

allergic rhinitis

iv. adverse effects: flu-like findings, drowsiness, dizziness, dry mouth,dysmenorrhea

v. contraindications: renal or hepatic impairmentvi. nursing care
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Classifications Pharmacological

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