DRUG CLASSIFICATIONS

 Pharmacologic Profile  General Use  General Action and Information  Refers to all information presented in drug reference book  How is the medication used?  How does the medication work? What ‘other’ information is needed before reading further

◦ Contraindications ◦ Precautions ◦ Interactions  Why shouldn’t a pt take this?  What does the nurse need to do before administering the medication?  What medications interfere with normal drug action?

 Nursing Implications  Potential Nursing Diagnoses  Implementation  Actions and thoughts the nurse has before administering the medication  Added feature in some drug books  Actions the nurse takes while administering medications

 Patient/Family Teaching  Evaluation / Desired Outcomes  Suggestions for the nurse to use to educate pt and family about ordered medications  What is expected if the medication has been successful

 General Use: ◦ Management of Alzheimer’s Dementia  General Action: ◦ All agents act by increasing the amount of acetylcholine in the CNS by inhibiting cholesterase ◦ No agents can slow the progression of A.D. ◦ Current agents may temporarily improve cognitive function and therefore improve quality of life

 Nursing Implications: ◦ Assessment  Assess cognitive function throughout therapy  Monitor nausea, vomiting, anorexia, and weight loss  Medications: ◦ donepezil (Aricept) ◦ rivastigmine (Exelon)

 General Use:  Prevention and treatment of anemias  General Action: ◦ For iron deficiency anemia to promote transport of hemoglobin ◦ For water soluble vitamins needed for RBC production ◦ For low RBC count to promote production of RBC

 Nursing Implications: ◦ Assessment  Assess patient’s nutritional status and dietary history to determine possible causes for anemia  Assess for patient teaching needs  Medications: ◦ iron polysaccharide (Niferex) ◦ epoetin (Epogen) ◦ folic acid (Folate)

 General Use: ◦ Nitrates are used to treat and prevent attacks of angina ◦ Calcium channel blockers and beta blockers are used prophylactically in long-term management of angina  General Action: ◦ Nitrates dilate coronary arteries and cause systemic vasodilation ◦ Calcium channel blockers dilate coronary arteries ◦ Beta blockers decrease myocardial O2 consumption

 Nursing Implications: ◦ Assessment  Assess location, duration, intensity, and precipitating factors of pt’s anginal pain  Monitor BP and pulse periodically throughout therapy  Medications: ◦ atenolol (Tenormin) ◦ dilitazem (Cardizem) ◦ nitroglycerin (Nitro-Dur)

 General Use: ◦ Used in mgmt of various forms of anxiety including generalized anxiety disorder  General Action: ◦ Most agents cause generalized CNS depression

 Nursing Implications: ◦ Assessment  Assess degree of anxiety and level of sedation before and periodically throughout therapy  Prolonged high-dose therapy may lead to physical or psychological dependence  Medications: ◦ benzodiazepinesSSRI’s  alprazolam (Xanax)paroxetine hcl (Paxil)  diazepam (Valium)

 General Use: ◦ Suppression of cardiac arrhythmias  General Action: ◦ Correct cardiac arrhythmias by a variety of mechanisms, depending on group used. ◦ Goal - symptomatology  Hemodynamic performance

 Nursing Implications: ◦ Assessment  Monitor ECG, pulse and BP periodically throughout oral administration  Medications: ◦ procainamide (Pronestyl) ◦ lidocaine (Xylocard) ◦ propranolol (Inderal) ◦ amiodarone (Cordarone)

 General Use: ◦ Prevention and treatment of thromboembolic disorders including DVT, PE and A Fib w/ emboli  General Action: ◦ Used to prevent clot extension and formation ◦ DO NOT dissolve clots

 Nursing Implications: ◦ Assessment  Assess for signs of bleeding / hemorrhage  Monitor bleeding time  Toxicity / Overdose – needs to be reversed immediately. Use protamine sulfate for Heparin and Vitamin K for Warfarin  Medications: ◦ fondaparinux (Arixtra) ◦ heparin ◦ warfarin (Coumadin)

 General Use: ◦ Used to incidence / severity of seizures  General Action: ◦ Depresses abnormal neuronal discharges in CNS that may result in seizures ◦ May also work by preventing spread of seizure activity; depressing motor cortex; raising seizure threshold; or altering levels of neurotransmitters depending on the group.

 Nursing Implications: ◦ Assessment  Assess location, duration, and characteristic of seizure activity  Monitor serum drug levels routinely  Medications: ◦ phenobarbital (Luminal) ◦ diazepam (Valium) ◦ phenytoin (Dilantin) ◦ valproic Acid (Depakene)

 General Use: ◦ Used in tx of endogenous depression, often in conjunction with psychotherapy  General Action: ◦ Attempts to prevent the reuptake of dopamine, norepinephrine, and serotonin by presynaptic neurons, resulting in accumulation of these neurotransmitters.

 Nursing Implications: ◦ Assessment  Assess mental status and affect  Assess for suicidal tendencies  Restrict amount of drug available to pt  Medications: ◦ duloxetine (Cymbalta) ◦ amitriptyline (Elavil) ◦ phenelzine (Nardil)

 General Use: ◦ Used in mgmt of type 1 and type 2 Diabetes  General Action: ◦ Insulin lowers blood glucose by transport of glucose into cells and promotes conversion of glucose to glycogen ◦ Oral medications stimulate secretion of insulin by beta cells

 Nursing Implications: ◦ Assessment  Observe for s&s of hypoglycemic reaction  Monitor serum glucose  Medications: ◦ metformin (Glucophage) ◦ sitagliptin (Januvia) ◦ glimepiride (Amaryl)

 General Use: ◦ Used to manage nausea & vomiting of many causes  General Action: ◦ Act on the chemoreceptor trigger zone to inhibit n&v ◦ Some act by diminishing motion sickness ◦ Others decrease n&v by its effect on gastric emptying

 Nursing Implications: ◦ Assessment  Assess n&v, bowel sounds, abdominal pain before and following administration  Monitor hydration; I&O  Medications: ◦ ondansetron (Zofran) ◦ promethazine (Phenergan) ◦ metoclopramide (Reglan)

 General Use: ◦ Tx of hypertension of many causes, most commonly essential HTN  General Action: ◦ Used to lower blood pressure to a normal level or to the lowest level tolerated ◦ Classified into groups according to their site of action

 Nursing Implications: ◦ Assessment  Monitor BP, pulse frequently during dosage adjustment and periodically throughout therapy  Monitor I&O  Monitor compliance through frequency of refills  Medications: ◦ clonidine (Catapres) ◦ ramipril (Altace) ◦ olmesartan (Benicar) ◦ propranolol (Inderal) ◦ metoprolol (Lopressor)

 General Use: ◦ Treatment and prophylaxis of various bacterial infections  General Action: ◦ Kill (bacteriocidal) or inhibit growth (bacteriostatic) of susceptible pathogenic bacteria

 Nursing Implications: ◦ Assessment  Assess for s&s of infection prior to and throughout tx  Check allergies especially for penicillin & cephalosporins  Obtain specimens for C&S prior to beginning tx  Medications: ◦ gentamicin (Garamycin) ◦ piperacillin / tazobactam (Zosyn) ◦ levofloxacin (Levaquin)

 General Use: ◦ Used for tx of various solid tumors, lymphomas and leukemias  General Action: ◦ Act by many different mechanisms ◦ Action may not be limited to neoplastic cells

 Nursing Implications: ◦ Assessment  Monitor for bone marrow depression  Assess for bleeding (gums, bruising, urine etc)  Monitor I&O, appetite, nutritional intake  Monitor IV site carefully & maintain patency  Medications: ◦ cisplatin (Platinol) ◦ tamoxifen (Tamoxifen) ◦ methotrexate (Folex)

 General Use: ◦ Used to tx and prevent thromboembolic events such as stroke and MI  General Action: ◦ Inhibit platelet aggregation ◦ Prolongs bleeding time

 Nursing Implications: ◦ Assessment  Assess pt for s&s increased thrombosis  Monitor bleeding time  Medications: ◦ dipyridamole (Persantine) ◦ clopidogrel (Plavix)

 General Use: ◦ Tx of acute and chronic psychoses, particularly when accompanied by increased psychomotor activity  General Action: ◦ Blocks dopamine receptors in the brain ◦ Alters dopamine release and turnover

 Nursing Implications: ◦ Assessment  Assess pt’s mental status before / periodically  Monitor BP, pulse, resp before / frequently  Observe pt taking meds to prevent hoarding  Monitor pt for onset of akathisia, parkinsonian and dystonia, tardive dyskinesia  Medications: ◦ chlorpromazine (Thorazine) ◦ risperidone (Risperdal)

 General Use: ◦ Used in replacement doses systemically to tx adrenocortical insufficiency ◦ Larger doses used for the anti-inflammatory, immunosuppressive, or antineoplastic activity  General Action: ◦ Produce profound and varied metabolic effects ◦ Modify normal immune response ◦ Suppresses inflammation

 Nursing Implications: ◦ Assessment  Assess involved systems  Assess for signs of adrenal insufficiency  Children should have periodic evaluations of growth  Medications: ◦ hydrocortisone (Solu-Cortef) ◦ methylprednisolone ( Solu-Medrol) ◦ dexamethasone (DexPak )

 General Use: ◦ Thiazide and loop diuretics used for tx HTN, edema d/t CHF or other causes  General Action: ◦ Enhance selective excretion of various electrolytes and water by affecting renal mechanisms for tubular secretion and reabsorption

 Nursing Implications: ◦ Assessment  Assess fluid status throughout tx  Monitor daily wt, I&O, amt & location edema, lung sounds, skin turgor, mucous membranes  Monitor electrolytes – esp potassium  Medications: ◦ furosemide (Lasix) ◦ mannitol (Osmitrol) ◦ hydrochlorothiazide (HCTZ)

 General Use: ◦ Used in tx of deficiency states including diabetes, hypothyroidism, menopause  General Action: ◦ Natural or synthetic substances have specific effect on target tissue ◦ Differ greatly in their effects depending on individual agent and function or target tissue

 Nursing Implications: ◦ Monitor pt for sx’s of hormonal excess or insufficiency  Medications: ◦ calcitonin (Miacalcin) ◦ estrogens ◦ levothyroxine (Synthroid) ◦ insulins

 General Use: ◦ Used to control mild to moderate pain and/or fever  General Action: ◦ Most inhibit prostaglandin synthesis  peripherally for analgesic effect  Centrally for antipyretic effect

 Nursing Implications: ◦ Assessment  Assess pain and limitation of movement  Assess fever; note associated S&S  Monitor liver, renal and hematologic lab values  Medications: ◦ ibuprofen ◦ ASA ◦ acetaminophen

 General Use: ◦ Used to control mild to moderate pain, fever, and various anti-inflammatory conditions General Action: NSAIDs have analgesic, antipyretic and anti- inflammatory properties Analgesic and anti-inflammatory are d/t inhibition of prostaglandins

 Nursing Implications: ◦ Pts w/ asthma, allergies and nasal polyps more at risk for hypersensitivity. ◦ Assess pain, limitation of movement, fever ◦ Evaluate effectiveness ◦ Most NSAIDS prolong bleeding time due to suppressed platelet aggregation ◦ Monitor for GI blood loss – give w/ food  Medications: ◦ ibuprofen - Advil, Motrin ◦ naproxen sodium – Aleve ◦ celecoxib – Celebrex ◦ Ketorolac - Toradol

 General Use: ◦ Mgmt moderate to severe pain  General Action: ◦ Opioids bind to opiate receptors in the CNS ◦ Alters perception of and response to pain

 Nursing Implications: ◦ Assessment  Assess pain – type, location, intensity  Assess BP, pulse, resp before and during therapy  Assess prior analgesic hx  Assess bowel function periodically  Medications: fentanyl transdermal (Duragesic) hydromorphone (Dilaudid) oxycodone (Oxycontin)

 General Use: ◦ Sedatives provide sedation ◦ Hypnotics are used to manage insomnia  General Action: ◦ Cause generalized CNS depression

 Nursing Implications: ◦ Assessment  Monitor BP, pulse, resp status frequently w/ IV  Assess sleep patterns if for insomnia  Medications: ◦ phenobarbital (Luminal) ◦ lorazepam (Ativan) ◦ zolpidem (Ambien)

 General Use: ◦ Spasticity associated w/ spinal cord lesions ◦ Symptomatic relief of acute painful MS conditions  General Action: ◦ Act either centrally or directly to relax muscle fibers

 Nursing Implications: ◦ Assessment  Assess for pain, muscle stiffness, ROM before and periodically throughout tx  Medications: ◦ carisoprodol (Soma) ◦ baclofen (Lioresal) ◦ diazepam (Valium)

 General Use: ◦ Acute mgmt coronary thrombosis (MI) ◦ Mgmt massive pulmonary emboli, DVT, arterial thromboembolism  General Action: ◦ Converts plasminogen to plasmin which then breaks down fibrin in clots

 Nursing Implications: ◦ Begin tx ASAP after onset sx’s ◦ Monitor VS q 4 hours  Medications: ◦ streptokinase (Streptase) ◦ alteplase (Activase)

 General Use: ◦ Acute vascular headaches  General Action: ◦ Smooth muscle vasoconstriction

 Nursing Implications: ◦ Assessment  Assess pain, location, intensity, duration  Assess for photophobia, phonophobia, n&v  Assess for frequency of migraine attacks  Medications: ◦ ergotamine (Ergomar) ◦ sumatriptan (Imitrex)

 There are more classifications listed in the 12 th Edition of Davis Drug Guide  Additional review of these classifications will occur during the coming ‘systems’ lectures  Independent study is always an option as well!