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Pharmacological and Parenteral Therapies 2

Antianginals

1. nitrates
  1. examples: nitroglycerin, isosorbide dinitrate (Isordil)
  2. action: dilate arterioles which lowers peripheral vascular resistance (afterload)
  3. uses: treatment and prevention of acute chest pain caused by myocardial ischemia
  4. adverse effects: postural hypotension, headache, flushing, dizziness
  5. contraindications
    - hypersensitivity
    - severe anemia
    - hypotension
    - hypovolemia
  6. nursing Interventions
    - monitor for orthostatic hypotension
    - monitor for tolerance with long term use
    - administer every five minutes but not more than three tablets in 15 minutes
    - if pain not relieved after 15 minutes and three tablets, notify physician immediately
    - instruct client
      - take pulse before taking medication
      - take oral preparations without food
      - when to seek medical attention
      - not to chew or swallow sublingual tabs
      - make position changes slowly
      - carry drug so that it is always within reach but avoid exposure to body heat and light
      - replace drug approximately every six months
      - avoid alcohol ingestion

beta-adrenergic blocking agents
1. examples: propranolol (Inderal), metoprolol (Lopressor)
2. action: inhibit sympathetic stimulation of beta receptors in the heart decreases heart rate and force of myocardial contraction thus decreasing myocardial oxygen consumption
3. uses: reduces frequency and severity of acute anginal attacks, dysrhythmias
4. side effects: blood dyscrasias, hypotension, GI disturbances, flushing of the skin
5. contraindications
  - hypersensitivity
  - cardiogenic shock
  - cardiac failure
6. nursing interventions
  - weigh daily. Report weight gain of five pounds or greater
  - monitor ECG if using for dysrhythmia
  - administer on an empty stomach
  - protect injectable solution from light
  - instruct client
    - take pulse before taking drug
    - not to discontinue medication abruptly
    - avoid hazardous activities if drowsiness occurs
    - make position changes slowly
    - take drug at same time each day
calcium channel blockers
1. examples: verapamil (Isoptin), nifedipine (Adalat), diltiazem (Cardizem)
2. action: prevent the movement of extracellular calcium into the cell resulting in coronary and peripheral artery dilation
3. uses: stable angina, dysrhythmias, hypertension
4. side effects: headache, drowsiness, dizziness, GI disturbances, flushing of the skin
5. contraindications: hypersensitivity
6. nursing interventions
  - monitor chest pain
  - monitor ECG if used for dysrhythmia
  - administer with food
  - instruct client
    - increase fluids to counteract constipation
    - take pulse before taking drug
    - avoid hazardous activities until stabilized on drug
    - limit caffeine consumption
    - avoid alcohol
    - change position slowly

Hypotension and shock
1. natural and synthetic catecholamines
2. examples: epinephrine, dopamine (Intropin), dobutamine (Dobutrex)
3. actions: increase cardiac output, (+) inotrope, (+) chronotrope
4. uses: dopamine and dobutamine: hypovolemic and cardiogenic shock, epinephrine: anaphylactic shock
5. adverse effects: dysrhythmias, hypotension, tissue necrosis if extravasation occurs. Tremors, anxiety, dizziness with epinephrine
6. contraindications
  1. hypersensitivity
  2. ventricular fibrillation
  3. tachydysrhythmias
  4. safety in children not known
7. nursing interventions
  1. correct hypokalemia before administering
  2. monitor vital signs frequently
  3. monitor ECG continuously during administration
  4. administer with infusion pump
  5. start drug slowly and increase according to health care provider's orders
  6. monitor injection site for extravasation
  7. protect solution from light
  8. do not use discolored solution
  9. stop the drug gradually

Anticoagulants
1. action: disrupt the blood coagulation process, thereby suppressing the production of fibrin
2. examples
  1. heparin: parenteral administration
  2. coumadin (Warfarin): oral administration
3. use
  1. pulmonary embolism
  2. deep vein thrombosis
  3. myocardial infarction
  4. atrial fibrillation
4. adverse side effects
  1. allergic responses such as chills, fever and urticaria
  2. use cautiously if client tends to bleed (hemophilia, peptic ulcer)
  3. GI disturbances- nausea and vomiting, diarrhea, abdominal cramps
5. contraindications
  1. hemophilia
  2. leukemia
  3. peptic ulcer
  4. blood dyscrasias
6. nursing interventions
  1. heparin: monitor APTT (activated partial thromboplastin time)
    - normal 40 seconds
    - at therapeutic levels, APTT increases by a factor of 1.5 to 2
  2. coumadin - monitor PT (prothrombin time)
    - normal 12 seconds
    - INR (International normalized ratio) two to three
  3. do baseline blood studies before therapy
  4. have antidote ready
    - heparin: protamine sulfate
    - coumadin: vitamin K
  5. monitor client for symptoms of hemorrhage such as increased pulse, decreased BP
  6. avoid salicylates (such as aspirin)
  7. avoid IM injections
  8. teach client
    - take medication at same time every day
    - wear medical alert jewelry: wearer takes anticoagulants (illustration )

use a soft toothbrush
do not use a straight razor; use an electric razor
avoid alcohol and smoking
report any signs of bleeding, red or black bowel movements, headaches, rashes, red or pink-tinged urine, sputum
avoid trauma
blood levels of the anticoagulant may be monitored
do not take over-the-counter (OTC) medications without health care provider's approval

Antidysrhythmics

action
1. prevent abnormal heart rhythms
2. action depends on type of antidysrhythmics drug
examples
1. class I: sodium channel blockers - quinidine (Quinidex), lidocaine; decreases myocardial excitability and contractility
2. class II: beta blockers -propranolol (Inderal); stabilizes cell membrane
3. class III: conduction delayers- bretylium (Bretylol); decreases conduction and excitability of myocardial cells
4. class IV: calcium channel blockers - verapamil (Isoptin);inhibits influx of calcium ions across cell membrane during cardiac contraction; reduces cardiac excitability and dilates main coronary arteries
5. others - digoxin (Lanoxin), adenosine (Adenocard); slows heart rate, improves pumping ability of the heart
use: to treat abnormalities in cardiac rate and rhythm

adverse effects
1. hypotension
2. nausea and vomiting
3. blood dyscrasias
4. toxicity such as CNS disturbances due to neurotoxicity, and diarrhea due to GI irritation
nursing interventions
1. monitor cardiac rhythm
2. monitor blood levels
3. monitor for blood dyscrasias
4. administer oral preparations with meals
5. monitor EKGs
6. use infusion-control devices for IV administration
7. teach client
  - report changes in heart rate and/or rhythm
  - report any side effects

Managing respiratory disease

Bronchodilators

Mucolytics

Antitussives

Antituberculosis agents

Antihistamines

Anti-inflammatory

Bronchodilators
1. action:
  1. dilate air passages in the lungs, specific action dependent on type of drug.
  2. increase heart rate
  3. act on the autonomic nervous system
2. examples
  1. beta-adrenergic: abuterol (Proventil, Ventolin), metaproterenol (Alupent)
  2. xanthines: aminophylline, theophylline (Theo-Dur) acts on bronchial smooth muscle
  3. epinephrine HCL (Adrenalin) - increases the rate and strength of cardiac contraction through the sympathetic nervous system
  4. isoproterenol HCL (Isuprel) - increases the heart rate by stimulating the beta-adrenergic blocking agent of the sympathetic nervous system
3. use
  1. bronchospasms
  2. asthma
4. adverse effects
  1. dizziness
  2. tremors
  3. anxiety
  4. palpitations
  5. gastric disturbances
  6. headache
  7. tachycardia
  8. dysrhythmias
5. contraindications
  1. hypersensitivity
  2. narrow angle glaucoma
  3. tachydysrhythmias
  4. severe cardiac disease
6. nursing interventions
  1. monitor theophylline levels (normal ten to 20 mcg/dl)
  2. monitor intake and output, and vital signs
  3. monitor EKG, vital signs during therapy
  4. teach clients
    - take medication as prescribed only
    - report adverse effects
    - stop smoking during therapy
    - take with meals
    - avoid OTC drugs

Mucolytics/expectorants

action
1. mucolytics: disrupt molecular bonds and thins mucus
2. expectorants: stimulate a gastric mucosal reflex to increase production of lung mucous
examples
1. mucolytic: acetylcysteine (Mucomyst)
2. expectorant: guaifenesin (Robitussin)
uses
1. asthma
2. acute or chronic bronchopulmonary disease
3. cystic fibrosis
4. mucomyst: acetaminophen toxicity
adverse side effects
1. oropharyngeal irritation
2. bronchospasm
3. gastric effects
contraindications
1. increased intracranial pressure
2. status asthmaticus
nursing interventions
1. monitor respiratory status
2. teach client
  - take no fluids directly after oral administration
  - do take plenty of fluids
  - encourage coughing and deep breathing, especially before treatment

Antitussives
1. action: to supress coughs through medullary cough center or indirect action on sensory nerves
2. examples
  1. narcotic: codeine, hydrocodone bitartrate (Hycoda)
  2. nonnarcotic - dextromethorphan (Robitussin)
3. use: colds, respiratory congestion, pneumonia, bronchitis, TB, cystic fibrosis, emphysema
4. adverse effects
  1. drowsiness
  2. nausea
  3. dry mouth
  4. dizziness
5. contraindications
  1. hypothyroidism
  2. iodine sensitivity
6. nursing interventions
  1. monitor blood counts with long term therapy
  2. increase fluid intake
  3. humidify client's room
  4. teach client
    - increase fluid intake if not contraindicated
    - do not to take fluids immediately after medication
    - avoid driving and other hazardous activity especially if taking narcotic type
    - antitussives add to the effects of alcohol

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