Pharmacology

Medications for Cardiovascular Disorders

Analgesic/Antipyretic/NSAIDs
Acetaminophen
Acetylsalicylic Acid
Ibuprofen

Indications:
Relieve pain, fever, and inflammation
Selected Interventions
Instruct the client to take the medication with a
full glass of water and just after food
Warn the client that GI symptoms (nausea,
vomiting, bleeding, ulceration) can occur when
taking these medications on a long-term basis
Instruct the client to report tinnitus (ringing in
ear)
Angiotensin-converting Enzyme
Inhibitors (ACE)
Captopril
Enalapril
Lisinopril

Indications:
Prevent angiotensin I from converting to angiotensin
II, a potent vasoconstrictor, thereby decreasing
peripheral vascular resistance
Blocks the secretion of aldosterone from adrenal gland
Selected Interventions
Monitor the clients blood pressure; if less than
90/60 mmHg, hold and question the order
Teach the client about orthostatic hypotension
Instruct the client not to discontinue abruptly
Angiotensin II receptor Antagonists
Losartan
Valsartan

Indications:
Block angiotensin II at the receptor sites, thereby
decreasing peripheral vascular resistance
Block the secretion of aldosterone from the
adrenal gland
Selected Interventions
Monitor the clients blood pressure; if less than
90/60 mmHg, hold and question the order
Teach the client about orthostatic hypotension
Instruct the client not to discontinue abruptly
Antiarryhthmics
Class IA-quinidine, procainamide
Class IB- lidocaine
Class IC- flecainide
Class II- propranolol
Class II- amiodarone
Class IV- Calcium channel blockers;
atypical- adenosine
 Indications:
Reduce automacity, slow conduction of electrical
impulses through the heart, and prolong the
refractory period of myocardial cells
Selected Interventions
Take apical pulse rate before administering the drug.
Notify the health care provider if the rate falls below
60 bpm. Teach the client to monitor and record his
pulse
Make sure that the client is being closely monitored
on telemetry, with frequent blood pressure
monitoring; when administering IV, do not leave the
client
Monitor serum drug levels to maintain therapeutic
range
Antibiotics
Aminoglycosides (gentamycin, tobramycin)
Amoxicillin
Erythromycin
Penicillin
Tetracycline

Indications:
Prevent or treat infections caused by pathogenic
microorganisms
Selected Interventions
Before administering the first dose, assess the client
for allergies; also note whether a culture had been
obtained
After multiple doses, assess the client for
superinfection (thrush, yeast infection, diarrhea);
notify the health care provider if these occur
Assess the insertion site for phlebitis if antibiotics are
being administered IV
To assess the effectiveness of antimicrobial therapy,
monitor white blood cell (WBCs)
Anticholinergics
Atropine

Indications:
Block effects of vagus nerve stimulation
Selected Interventions
Monitor VS closely
Monitor telemetry
Administer at a rate of 1 mg or less over 1 minute
Anticoagulants
IV Heparin
Oral warfarin sodium
Low dose heparin (5,000 units) SC

Indications:
Prevent recurrence of emboli but have no effect on
emboli that are already present
Prophylactically prevent deep vein thrombosis; heparin
activates newly formed factor Xa and thrombin (low
dose heparin)
Selected Interventions
For heparin therapy, monitor PTT, for which therapeutic
range should be 1.5 to 2 times the normal PTT or control.
Antidote is protamine sulfate
For Coumadin therapy, monitor INR, for which the
therapeutic level is 2 to 3. Antidote is Aquamephyton
(Vitamin K)
Instruct the client to report bruising, unexplained, or dark,
tarry stools; use a soft-bristle toothbrush; be cautious
when using sharp objects and machinery; wear medi-alert
bracelet; and notify any health care provider (dentist,
pharmacist) that he is on anticoagulant therapy
 If bleeding occurs, instruct the client to apply
direct pressure to the wound; if bleeding does
stop after 5 minutes of direct pressure, tell him to
get medical help
For low dose heparin:
Administer SC in the abdomen, 1 (2.5 cm) from
the umbilicus. Do not aspirate; do not massage.
Not necessary to monitor PTT
Antilipemic Agents
Cholestyramine
Clofibrate
Colestipol
HMG-CoA reductase inhibitors
Lovastatin

Indications:
Lower the serum cholesterol level by binding bile salts
in the bowel and forming an insoluble complex that is
excreted in the stool
Selected Interventions
Mix medication with 60 ml of water or fruit juice
to mask the unpleasant flavor
Instruct the client to increase his fluid intake to
prevent constipation
Instruct the client to take medication at night due
to enzyme that metabolizes cholesterol
Monitor the clients cholesterol level; it should be
<200 mg/dl
Antiplatelet Agents
Aspirin
Dipyridamole
Ticlopidine

Indications:
Inhibit the aggregation of platelets to form a plug;
platelets do not initiate thrombus formation as
readily when taking antiplatelets
Selected Interventions
Instruct the client to take his medication with
food to decrease gastric irritation
Remind the client to inform health care providers
that he is taking these medications and to be
careful when taking OTC medications
Instruct the client to report bruising, bleeding
gums, nosebleeds or bleeding in the stools
Beta-adrenergic Blockers
Atenolol
Metoprolol
Nadolol
Propanolol

Indications:
Decrease the heart rate and the force of contraction
and reduce vasoconstriction by antagonizing beta-
receptors in the myocardium and vasculature
Selected Interventions
Monitor pulse; if apical pulse falls below 60 bpm,
hold and question the order
Monitor BP; if less than 90/60 mmHg, hold and
question the order
Teach the client about orthostatic hypotension
Beta-adrenergics
Beta only- dobutamine
Beta or alpha plus beta- dopamine
Epinephrine
Metaraminol

Indications:
Increase myocardial contractility and heart rate,
which in turn raises blood pressure; alpha plus
beta-adrenergic activity
Selected Interventions
Must be administered on an IV continuous drip;
assess the IV site
Monitor BP atleast every 5 to 15 minutes
Epineprine is administered IVP
Calcium Channel Blockers
Diltiazem
Nifedipine
Verapamil

Indications:
Inhibit calcium ions from crossing myocardial and
vascular smooth muscle, thereby producing
vasodilation and decreased myocardial contractility
Selected Interventions
Monitor pulse; if apical pulse falls below 60 bpm,
hold and question the order
Monitor BP; if less tan 90/60 mmHg, hold and
question the order
Teach the client about orthostatic hypotension
Cardiac Glycosides
Digitoxin
Digoxin

Indications:
Increase the force of myocardial contractions and
slow heart rate and conduction through the
atrioventricular node and bundle of His
Selected Interventions
Monitor pulse; if apical pulse falls below 60 bpm,
hold and question the order
Monitor digoxin level (therapeutic level, 0.8 to
2)
Monitor potassium level (normal, 3.5 to 5.5
mEq/L); hypokalemia potentiates digoxin
toxicity (signs and symptoms include anorexia,
nausea and vomiting)
Corticosteriods
Oral hydrocortisone
Oral methyprednisolone
Oral prednisone

Indications:
Strenghten the biologic membrane, which inhibits
capillary permeability and prevents leakage of fluid
into the injured area and development of edema
(exact mechanism unknown)
Selected Interventions
Instruct the client to take medication exactly as
directed and to taper the drug rather than stop it
abruptly, which could cause serious withdrawal
symptoms leading to adrenal insufficiency, shock,
and death
Forewarn the client that the drug may cause
reportable cushings effects (weight gain, moon
face, buffalo hump and hirsutism) and may mask
signs and symptoms of infection
Diuretics
Loop diuretic- furosemide
Potassium-sparing diuretic-
spironolactone
Thiazide diuretic- chlorothiazide

Indications:
Decrease blood volume, which decreases the
workload of the heart
Selected Interventions
Monitor potassium level; do not administer if the
patient is hypokalemic or hyperkalemic
Monitor intake and output; increase fluid intake
Monitor blood pressure; if less tan 90/60 mmHg,
hold and question order
Teach the client about orthostatic hypotension
Teach the client to weigh himself daily and report
weight gain of more than 2 lb in 1 day
Question the order if the client is dehydrated
Low Molecular-Weight Heparin
Enoxaparin

Indications:
Prophylactically prevent DVT; LMW molecules are
short and preferentially inactivate newly formed
factor Xa
Selected Interventions
Administer in the anterolateral abdominal wall.
Do not aspirate; do not massage. Do not insert an
air bubble into the syringe. Not necessarily to
monitor PTT
Opiod Analgesics
Codeine
Hydrocodone
Hydromorphone
Morphine
Propoxyphene

Indications:
Relieve moderate to severe pain by reducing pain
sensation, producing sedation and decreasing the
emotional upset often associated with pain; most often
schedule drugs
Selected Interventions
Assess the pain for location, type, intensity and what
increases or decreases it, rate pain on scale on 1 (no
pain) to 10 (worst pain)
Rule out any complications. Is this pain routine or
expected? Is this pain a complication that needs
immediate intervention?
Medicate according to pain scale findings.
Institute safety measures- bed in low position, side
rails up, and call light within reach
Evaluate effectiveness of pain medication in 30
minutes
Nitrates
Isosorbide dinitrate nitroglycerin- SL,
topical, patch, tablet, IV

Indications:
Reduce myocardial oxygen demand by
promoting vasodilation and by increasing
oxygen supply to myocardial tissue
Selected Interventions
Inform the client that a headache is a common
adverse effect
Monitor blood pressure; teach client about
orthostatic hypotension
For topical administration, be sure to wear gloves,
remove the old patch, apply to a hairless area and
date and time the new patch
For IV administration, dilute the drug and administer
by continuous infusion, with constant monitoring of
blood pressure and pulse
Stool Softeners
Docusate calcium
Docusate sodium

Indications:
Decrease the surface tension of the fecal mass to
allow water to penetrate into the stool; prevents
the client from straining on defecation
Selected Interventions
Instruct the client to increase his fluid and fiber
intake
Instruct the client that he does not have to have a
daily bowel movement, what is normal for him,
and about not getting constipated
Thrombolytic Agents
Alteplase
Streptokinase
Urokinase

Indications:
Dissolve thrombi or emboli in the coronary
arteries
Selected Interventions
Follow hospital protocol when administering a
thrombolytic agent
Monitor the client for internal bleeding every 15
to 30 minutes for the first 8 hours and then every
4 hour throughout therapy
Vasodilators
Diazoxide
Hydralazine
Nitroprusside sodium

Indications:
Decrease preload (venous dilators) and afterload
(arterial dilators); act directly on blood vessels to
cause dilation and decrease peripheral vascular
resistance
Selected Interventions
Monitor blood pressure; if less than 90/60
mmHg, hold and question the order
For IV administration, have the client on a cardiac
monitor
Keep the client on bed rest, with safety
precautions instituted
Central Alpha Agonists
Clonidine
Methyldopa

Indications:
Stimulate alpha-adrenergic receptors in the central
nervous system, resulting in decreased sympathetic
outflow
Selected Interventions
Monitor pulse; if apical pulse falls below 60 bpm,
hold and question the order
Monitor BP; if less tan 90/60 mmHg, hold and
question the order
Teach the client about orthostatic hypotension
Medications for Renal and Urinary Disorders
Alkalizing Agents
Bicitra
Shohls Solution
Sodium bicarbonate

Indications:
Elevate the plasma pH, thereby causing potassium
to move into the cells and lower the serum
potassium levels
Selected Interventions
Monitor arterial blood gases for signs of
metabolic acidosis and alkalosis
Antibiotics
Ciprofloxacin
Nitrofurantoin
Sulfisoxazole
Trimethoprim-sulfamethoxazole

Indications:
Prevent bacterial growth in the kidneys and
bladder
Selected Interventions
Before administering the first dose, assess the client for
allergies; also note whether a culture had been obtained
After multiple doses, assess the client for superinfection
(thrush, yeast infection, diarrhea); notify the health care
provider if these occur
Assess the insertion site for phlebitis if antibiotics are
being administered IV
To assess the effectiveness of antibiotic therapy, monitor
urinalysis
Antiemetics
Benzquinamide
Dimenhydrinate
Promethazine
Scopolamine
Trimethobenzamide
Hydrochloride

Indications:
Relieve nausea and vomiting by inhibiting medullary
chemoreceptor triggers; drug choice depends on the
cause of vomiting
Selected Interventions
Advise the client that this medication may cause
drowsiness
Because the medication may cause chemical
irritation, administer by deep IM injection into a
large muscle mass
Measure emesis and maintain accurate intake
and output; monitor for dehydration
Calcium Supplements
Parenteral calcium salts
(eg. Calcium gluconate,
chloride, gluceptate)
Os-Cal

Indications:
Strengthen skeletal system by supplementing
calcium intake
Selected Interventions
Assess for hypocalcemia by checking for
Chovosteks and Trousseaus signs
Explain to the client that vitamin D increases
calcium absorption in the GI tract
Increase dietary intake of calcium (milk
products, green leafy vegetables)
Erythropoietin
Epogen
Epoetin alfa

Indications:
Aid in the production of red blood cells
Selected Interventions
May be administered IV or SC in clients not
receiving dialysis
Monitor blood pressure, complete blood count,
with differential blood urea nitrogen and platelet
counts
Folic Acid Supplements
Apo-folic
Folvite

Indications:
Supplement folic acid intake; minimum daily
requirement is 50 g (Folic Acid is found in most
meats, fresh vegetables, and fresh fruits but is
destroyed when cooked more than 15 minutes)
Selected Interventions
May be given orally, IM, IV or SC
Histamine Receptor Antagonists
Cimetidine
Famotidine
Ranitidine

Indications:
Block receptors that control the secretion of
hydrochloric acid by the parietal cells
Selected Interventions
Instruct the client to continue taking the
medication regularly, even after pain subsides
When administering IV, dilute the medication
and monitor the client closely
Emphasize the importance of adhering to all
aspects of therapy
Ion Exchange Resins
Sodium polystyrene sulfonate

Indications
Exchange a sodium ion for a potassium ion in the
intestinal tract
Selected Interventions
If administered by retention enema, the client
should retain for 30 minutes
Sorbitol is often administered with medication
to induce a diarrhea-type effect
Monitor serum potassium level
Iron Supplements
Ferrous Sulfate (Oral)
Iron-dextran injection

Indications:
Supplement daily iron, an essential component of
protein that carry or use oxygen; most part of
hemoglobin
Selected Interventions
Administer IM medications by Z-track and in
large muscle mass; liquid preparation can stain
teeth, so administer through a straw; parenteral
doses may cause anaphylactic reactions
Instruct the client to take iron with food to
decrease stomach irritation; vitamin C increases
absorption of iron
Inform the client that feces turn dark black and
tarry; instruct on ways to prevent constipation
Opiod Analgesics
Codeine
Hydrocodone
Hydromorphone
Morphine
meperidine
Propoxyphene

Indications:
Relieve moderate to severe pain by reducing pain
sensation, producing sedation and decreasing the
emotional upset often associated with pain; most
often schedule drugs
Selected Interventions
Assess the pain for location, type, intensity and
what increases or decreases it, rate pain on scale
on 1 (no pain) to 10 (worst pain)
Rule out any complications. Is this pain routine or
expected? Is this pain a complication that needs
immediate intervention?
Medicate according to pain scale findings.
Institute safety measures- bed in low position, side
rails up, and call light within reach
Evaluate effectiveness of pain medication in 30
minutes
Phosphate-binding Agents
Aluminum hydroxide

Indications
Decrease absorption of phosphate from the
intestines, thereby decreasing serum phosphate
levels
Selected Interventions
Instruct client to restrict sodium intake, drink
plenty of fluids and follow a low phosphate diet
Proton Pump Inhibitor
Omeprazole

Indications:
Prevent the final transport of hydrogen into the
gastric lumen by binding an enzyme on gastric
parietal cells
Selected Interventions
Instruct the client to take medication regularly
as prescribed by the health care provider
Instruct the client to avoid any products that
may cause GI irritation
Medications for Hematologic Disorders
 Aminoglycosides (gentamycin,
tobramycin)
Amoxicillin
Erythromycin
Penicillin
Tetracycline

Indications:
Prevent or treat infections caused by
pathogenic microorganisms
 Before administering the first dose, assess the
client for allergies; also note whether a culture
had been obtained
After multiple doses, assess the client for
superinfection (thrush, yeast infection,
diarrhea); notify the health care provider if
these occur
Assess the insertion site for phlebitis if
antibiotics are being administered IV
To assess the effectiveness of antimicrobial
therapy, monitor white blood cell (WBCs)
 Acetaminophen
Aspirin

Indications:
Produce diaphoresis and vasodilation by acting
on the brains thermoregulatory center
 Do not give aspirin to children because of its
association with Reyes Syndrome
Watch for GI distress and possible bleeding
from aspirin
Report any tinnitus (ringing in ears), as sign of
aspirin toxicity
 Oral hydrocortisone
Oral methyprednisolone
Oral prednisone

Indications:
Strenghten the biologic membrane, which
inhibits capillary permeability and
prevents leakage of fluid into the injured
area and development of edema (exact
mechanism unknown)
 Instructthe client to take medication exactly
as directed and to taper the drug rather
than stop it abruptly, which could cause
serious withdrawal symptoms leading to
adrenal insufficiency, shock, and death
Forewarn the client that the drug may cause
reportable cushings effects (weight gain,
moon face, buffalo hump and hirsutism) and
may mask signs and symptoms of infection
 Adrenalin

Indications
Cause bronchodilation and vasoconstriction to
relieve bronchial edema
 Administered subcutaneously with TB syringe;
rotate vial to mix suspension
Common adverse effects are increased heart
rate, muscle tremors, anxiety, and nervousness;
large doses can produce an acute hypertensive
episode and cardiac arrhythmias
 Apo-folic
Folvite

Indications:
Supplement folic acid intake; minimum daily
requirement is 50 g (Folic Acid is found in most
meats, fresh vegetables, and fresh fruits but is
destroyed when cooked more than 15 minutes)
 May be given orally, IM, IV or SC
 Diphenhydramine

Indications:
Inhibit H1 release by selectively binding to H1-
receptors
 Teach the client to avoid alcohol, driving or
engaging in hazardous activities because
medication causes drowsiness, which may
subside with continued use
Encourage sucking on hard candy or ice chips
for relief of dry mouth
 Gamma globulin

Indications:
Provide passive immunity by immunoglobulin G
antibodies to protect against infection
 Before administering, obtain allergy and
immunization history
After administering, monitor the client closely
for signs and symptoms of allergic reaction
 Ferrous Sulfate (Oral)
Dextran (Parenteral)
Liquid Iron

Indications:
Synthesize heme, the essential protein of
hemoglobin
 Oral
Inform the client that his stool will be dark and
tarry; instruct him on ways to prevent
constipation
Tell the client to notify his health care provider of
adverse effects, such as diarrhea, constipation,
GI upset or nausea and vomiting that become
severe or intolerable
Tell the client to store iron safely out of reach of
children (in whom iron poisoning is fatal)
 Parenteral
Administer using Z-track technique to avoid
leakage into SC tissue
Caution the client that preparation may discolor
skin and cause local pain
Be alert for possible anaphylactic reaction
 Liquid
Forewarn the client that liquid iron may stain
teeth
Suggest diluting the iron and administering it
through a straw or dropper placed at the back of
the tongue
 Codeine
Hydrocodone
Hydromorphone
Morphine
Propoxyphene

Indications:
Relieve moderate to severe pain by reducing
pain sensation, producing sedation and
decreasing the emotional upset often
associated with pain; most often schedule
drugs
 Assess the pain for location, type, intensity and
what increases or decreases it, rate pain on scale
on 1 (no pain) to 10 (worst pain)
Rule out any complications. Is this pain routine or
expected? Is this pain a complication that needs
immediate intervention?
Medicate according to pain scale findings.
Institute safety measures- bed in low position,
side rails up, and call light within reach
Evaluate effectiveness of pain medication in 30
minutes
 Metaraminol
Norepinephrine

Indications
Rapidly restore blood pressure in anaphylaxis by
producing vasoconstriction and stimulating the
heart
 Monitor the clients vital signs, intake and
output, mental status, peripheral pulses and
skin color
The client should be telemetry and monitored
closely
 Vitamin B12 injection

Indications:
Stimulate a key reaction in the synthesis of
thymidylate, a component of DNA; deficiency
results in the release of too few blood cells
 Must be given IM to bypass the intestine for
systemic absorption
Vitamin B12 injections are virtually free of
adverse effects; initially taken by daily
injections and then monthly throughout life
Medications for GI Disorders
 Aluminum hydroxide
Calcium carbonate
Dihydroxyaluminum
sodium carbonate
Magaldrate
Magnesium hydroxide

Indications:
Neutralize the hydrochloric acid secreted by the
stomach
 Instruct the client to take 1 and 3 hours after
meals and at bedtime; instruct him to avoid
taking them with other medications
Instruct the client to chew antacid tablets
(not swallow them whole) and shake liquids
before taking them
 Aminoglycosides (gentamycin, tobramycin)
Amoxicillin
Erythromycin
Penicillin
Tetracycline

Indications:
Prevent or treat infections caused by
pathogenic microorganisms
 Before administering the first dose, assess the client
for allergies; also note whether a culture had been
obtained
After multiple doses, assess the client for
superinfection (thrush, yeast infection, diarrhea);
notify the health care provider if these occur
Assess the insertion site for phlebitis if antibiotics
are being administered IV
To assess the effectiveness of antimicrobial therapy,
monitor white blood cell (WBCs)
 Atropine Sulfate
Glycopyrrolate
Propantheline
Scopalamine

Indications:
Inhibits the actions of acetylcholine at
cholinergic receptor sites, thereby decreasing
gastric secretions
 Advise the client that adverse effects include
drowsiness and dry mouth
Encourage increased fluid intake
Caution the client to avoid activities, such as
driving, that require alertness and
concentration until the effects of the drug are
known
 Attapulgite
Diphenoxylate and atropine
Loperamide
Bismuth subsalicylate

Indications:
Absorb excess water from stool
 To assess the effectiveness of the medication,
record the number and consistency of stools
Monitor intake and output, daily weight and
serum electrolyte levels
 Benzquinamide
Hydroxyzine
Metoclopramide
Promethazine
Trimethobenzamide Hydrochloride

Indications:
Relieve nausea and vomiting by inhibiting
medullary chemoreceptor triggers; drug choice
depends on the cause of vomiting
 Advise the client that this medication may
cause drowsiness
Because the medication may cause chemical
irritation, administer by deep IM injection
into a large muscle mass
Measure emesis and maintain accurate intake
and output; monitor for dehydration
 Nystatin suspension

Indications:
Treat infection caused by fungi; fungal infections
are resistant to antibiotics
 Instruct the client to rinse his mouth with
water to cleanse it, swish and swallow to
coat the oral mucosa, and hold the
suspension in his mouth for atleast 2 minutes
 Dicyclomine hydrochloride

Indications:
Relax the smooth muscle of the GI tract without
anticholinergic effects
 Instruct the client to take doses before meals
and at bedtime unless a timed-release form is
used
 Oral- dexamethasone,
hydrocortisone,
methyprednisolone,
prednisone
IV- Solu-Cortef, Solu-Medrol

Indications:
Combat severe immune or inflammatory
responses
 Instruct the client to take medication exactly
as directed and to taper the drug rather than
stop it abruptly, which could cause serious
withdrawal symptoms leading to adrenal
insufficiency, shock, and death
Forewarn the client that the drug may cause
reportable cushings effects (weight gain,
moon face, buffalo hump and hirsutism) and
may mask signs and symptoms of infection
 Cimetidine
Famotidine
Ranitidine

Indications:
Block receptors that control the secretion of
hydrochloric acid by the parietal cells
 Instruct the client to continue taking the
medication regularly, even after pain subsides
When administering IV, dilute the medication
and monitor the client closely
Emphasize the importance of adhering to all
aspects of therapy
 Bulk laxatives
Psyllium
Stimulant laxatives
Bisacodyl
Senna
Stool softeners
Docusate calcium
Docusate sodium
Saline (osmotic) laxatives
Magnesium citrate
Magnesium hydroxide
 Indications:
Absorb water and increase fecal bulk; stimulate
peristalsis through mucosal irritation; ease stool
passage by facilitating the mixing of water with
fecal mass; retain and increase water in the feces
 Administer a bulk laxative with fluid and give
immediately before it congeals
Avoid overuse, which causes laxative
dependence
Inform the client that a daily bowel
movement is not necessary for normal bowel
elimination
 Misoprostol
Sucralfate

Indications:
Protect the ulcer from the destructive action of
the digestive enzyme pepsin by changing
stomach acid into viscous material that binds to
proteins in ulcerated tissue
 Instruct the client to take the medication 30
to 60 minutes before meals and at bedtime
Advise the client to take the medication 1
hour before or after taking an antacid
Tablets may be difficult to chew; liquid
preparations are available
 Codeine
Hydrocodone
Hydromorphone
Morphine
Propoxyphene
Indications:
Relieve moderate to severe pain by reducing pain
sensation, producing sedation and decreasing the
emotional upset often associated with pain; most
often schedule drugs
 Assess the pain for location, type, intensity and
what increases or decreases it, rate pain on scale
on 1 (no pain) to 10 (worst pain)
Rule out any complications. Is this pain routine
or expected? Is this pain a complication that
needs immediate intervention?
Medicate according to pain scale findings.
Institute safety measures- bed in low position,
side rails up, and call light within reach
Evaluate effectiveness of pain medication in 30
minutes
 Omeprazole
Pantoprazole

Indications:
Prevent the final transport of hydrogen into the
gastric lumen by binding an enzyme on gastric
parietal cells
 Instruct the client to take medication
regularly as prescribed by the health care
provider
Instruct the client to avoid any products that
may cause GI irritation
Administer IV pantoprazole with a filter
Pharmacology
Medications for Endocrine and Metabolic
Disorders
Adrenocortical Steroid Inhibitors
Aminoglutethimide
Ketoconazole
Mitotane

Indications
Decrease cortisol production; used to reduce
hyperadrenalism caused by ectopic adrenocorticotropic
hormone secretion by a tumor that cannot be totally
eradicated
Selected Interventions
Administer in divided doses to reduce nausea and
vomiting, and instruct the client to continue taking
the medication despite discomfort
Inform the client to take safety precautions because
medication may cause drowsiness and orthostatic
hypotension
Alpha-glucosidase Inhibitors
Acarbose

Indications:
Slow the digestion of some carbohydrates; aftermeal
blood glucose peaks are not as high
Selected Interventions
Instruct the client to take medication daily and to
continue other measures (diet, exercise) to decrease
blood glucose levels
Advise the client that insulin may be needed during
times of increased stress
Forewarn the client that possible adverse effects
may include hypoglycemia
Antidiuretic Hormone Replacement
Agents
Desmopressin
Vasopressin

Indications
Conserve renal water by increasing urine osmolality
and decreasing urine flow rate
Selected Interventions
May be administered intranasally; instruct the client
to notify the health care provider if nasal stuffiness
occurs
IM injection must be administered deep IM be sure
to warm oil-based medications
Instruct the client to report signs of water
intoxication (drowsiness, lethargy, headache, sudden
weight gain, severe nasal congestion); caution
against adjusting dosage without consulting his
health care provider
Antithyroid Agents
Methimazole
Propylthiouracil

Indication:
Interferewith conversion of iodine into thyroglobulin,
thereby inhibiting thyroid hormone synthesis
Selected Interventions
Advise the client to report flulike symptoms and
fever immediately; they may be drug-induced.
Tell the client to report signs and symptoms of
hyperthyroidism
Caution the client not to use or eat products
containing iodine, such as cough medicines, iodized
salt or shellfish; tell him to notify his health care
providers if he is taking product containing these
substances
Biguanides
Metformin

Indications
Keep the liver from releasing too much glucose
Selected Interventions
Instruct the client to take medication daily and to
continue other measures (diet, exercise) to decrease
blood glucose levels
Advise the client that insulin may be needed during
times of increased stress
Forewarn the client that possible adverse effects
may include hypoglycemia
D-phenylalanine Derivatives
Nateglinide

Indications
Stimulate the release of insulin from beta cells
Selected Interventions
Instruct the client to administer at least 1 to 30
minutes before meals
Instruct the client to omit when skipping a meal
Electrolyte Replacement
Calcium gluconate

Indication:
Maintain capillary integrity and normal functioning of
the nervous, muscular, and skeletal system
Selected Interventions
Administer the amount prescribed slowly through a
large vein to avoid infiltration, which may cause
severe necrosis and sloughing of tissue
Keep the client on bed rest atleast 1 hour after
drug administration to prevent orthostatic
hypotension
Keep the medication at the bedside with the
necessary IV equipment
Growth Hormone Medications
Bromocriptine

Indication
Suppress the release of growth hormone and prolactin
Selected Interventions
Administer with meals to minimize GI distress
Instruct the client to report vision problems, severe
nausea or vomiting and acute headaches
Advise the client to limit his use of alcohol
Insulin
Rapid-acting- Humulin R, regular insulin
Intermediate acting- Humulin N, NPH
Long-acting- Humulin L, ultralente
Insulin- 70/30 (70% NPH and 30% R), 60/40,
50/50

Indications
Replace endogenous insulin and maintain blood glucose
levels by regulating protein, carbohydrate and fat
metabolism
Selected Interventions
Answer five questions before administering insulin:
When does insulin peak (This is the time that
hypoglycemic reaction may occur)?
Rapid-acting: 2 to 4 hours
Intermediate- acting: 6 to 8 hours
Long-acting: 16-24 hours
Humalog: within 15 minutes

What meal covers the peak time? Glucose or food is

the antidote for insulin (eg. 7am regular insulin is
covered by breakfast)
 Isthe client receiving nothing by mouth? If so, question
the insulin order
What is the blood clients blood glucose level? If below
90 mg/dl, question the insulin order
Where will the shot be injected? Absorption is best in
the abdomen
Teach and demonstrate preparation: administration
techniques; injection sites and rotation; insulin and
equipment care, storage, and disposal
Iodine-containing Agents
Lugols solution
Potassium iodide

Indications
Inhibit
release of stored thyroid hormone and retard
hormone synthesis
Selected Interventions
Administer for short term before thyroidectomy;
medication has a short half life
Dilute oral iodine solution in juice or beverage of
choice; administer through straw with fluids to
prevent staining of teeth
Mineralocorticoids
Fludrocortisone

Indications:
Replace hormones; major effect: sodium-retaining
activity associated with potassium loss
Selected Interventions
Explain that additional doses may be needed in
times of stress
Instruct the client to report weight gain and severe
headache
Sulfonylureas
Acetohexamide
Chlorpropamide
Glipizide
Glyburide
Tolbutamide

Indication
Reduce blood glucose levels by stimulating pancreatic insulin
production and make cell receptor sites more receptive to
circulating insulin
Selected Interventions
Instruct the client to take medication daily and to
continue other measures (diet, exercise) to decrease
blood glucose levels
Advise the client that insulin may be needed during
times of increased stress
Forewarn the client that possible adverse effects
may include hypoglycemia
Synthetic Glucocorticoids
Cortisone
Dexamethasone
Hydrocortisone sodium succinate
Methylprednisolone
Prednisone

Indications
Replace adrenocortical; major activities are metabolic
effects on carbohydrate, protein and fat metabolism and
anti-inflammatory and immunosupressive activity
Selected Interventions
Inform the client that the medication cannot be
stopped abruptly but should be discontinued
gradually to prevent withdrawal symptoms and
possibly, shock or death
Identify signs and symptoms of cunshingoid effects
to report, including weight gain, moon face,
buffalo hump and hirsutism
Explain the dosage may need to be increased
during times of increased stress; instruct the client
to carry medication or medical identification
Thiazolidinediones
Pioglitazone
Rosiglitazone maleate

Indications
Make muscle cells more sensitive to insulin, decreasing
blood glucose levels
Selected Interventions
Instruct the client to take the medication daily and
to continue other measures (diet, exercise) to
decrease blood glucose levels
Advise the client that insulin may be needed during
times of increased stress
Forewarn the client that possible adverse effects
may include hypoglycemia
Thyroid Hormone
Levothyroxine

Indication
Raise metabolic rate, promote gluconeogenesis,
increase use of stored glycogen, stimulate protein
synthesis and affect protein and carbohydrate
metabolism and cell growth
Selected Interventions
Administer in the morning to avoid bedtime insomnia
Instruct the client to notify his health care provider
of signs and symptoms of hypothyroidism and
hyperthyroidism
Monitor cardiac response to increase metabolic rate
and oxygen requirements
Vitamins and Minerals
Oral calcium
Vitamin D

Indication
Replace therapy for deficit
Selected Interventions
Observe the client for symptoms of hypercalcemia
(eg nausea, vomiting, headache, mental confusion,
anorexia)