Indication MI, acute ischemic stroke, occluded central lines

Action converts plasminogen to plasmin which degrades the fibrin found in clots Therapeutic Class thrombolytics Pharmacologic Class plasminogen activators

Nursing Considerations

 contraindicated in active bleeding

 monitor closely for signs of bleeding (petechiae)

o q 15 min X1hr

o q 15-30 min X 8 hr

 use caution with patient who have had recent surgery

 may cause intracranial hemorrhage

 monitor for anaphylaxis

 use caution with uncontrolled hypertension

 assess neuro status during therapy

Indication management of high cholesterol (hypercholesterolemia), primary prevention of cardiovascular disease

Action lowers total cholesterol as well as LDL while slightly increasing HDL. Inhibits HMG-CoA reductase which plays a role in the liver in cholesterol formation Therapeutic Class lipid-lowering agent

Pharmacologic Class HMG-CoA reductase inhibitor Similar Medications simvistatin (Zocor), rosuvastatin (Crestor) Nursing Considerations

 contraindicated in active liver disease

 may cause rhabdomyolysis

 monitor renal function

 monitor serum cholesterol before, about 4 weeks after starting, and frequently during drug therapy

 monitor liver function tests

 instruct patient to report muscle weakness (sign of rhabdomyolysis

Indication pain, fever

Action inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response

Therapeutic Class antipyretic, non-opioid analgesic Nursing Considerations

 do not exceed 4g of acetaminophen per day to limit risk for liver, renal, and cardiac damage

 overdose will lead to hepatotoxicity

 Acetadote is the antidote for overdose

 may increase risk for bleed with warfarin therapy

 may alter blood glucose measurements

Indication genital herpes, herpes zoster, chicken pox Action interferes with viral DNA synthesis

Therapeutic Class antiviral

Pharmacologic Class purine analogues Nursing Considerations

 may cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea

 monitor renal panel during administration

 assess lesions

 instruct patient to use proper protection during sexual intercourse

Indication bronchodilator used to prevent airway obstruction in asthma and COPD Action binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways

Therapeutic Class bronchodilator

Pharmacologic Class adrenergic Nursing Considerations

 may decrease the effectiveness of Beta Blockers

 use caution with

o heart disease

o diabetes

o glaucoma

o seizure disorder

 overuse of inhalers can lead to bronchospasm

 monitor for chest pain and palpitations

 can decrease digoxin levels

Indication osteoporosis (aging, menopause, corticosteroid induced)

Action inhibits osteoclast activity leading to inhibition of resorption of bone Therapeutic Class bone resorption inhibitor

Pharmacologic Class bisphosphnates Nursing Considerations

 take first thing in the morning with full glass of water 30 min prior to eating

 assess serum calcium and vitamin D

 may lead to muscle pain

Indication anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis

Action works in CNS to produce anxiolytic effect causing CNS depression.

Therapeutic Class antianxiety agent

Pharmacologic Class benzodiazepine Nursing Considerations

 use caution with existing CNS depression, sleep apnea, renal dysfunction, hepatic dysfunction.

 may cause CNS depression, drowsiness, lethargy

 may lead to physical dependence, may experience tolerance effect

 assess anxiety and mental status

 Flumazenil is the antidote for overdose

 Grapefruit juice may increase blood levels

Indication ventricular arrhythmias, SVT, ACLS protocol for v-fib and vTACH

Action prolongs action potential, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation

Therapeutic Class Antiarrhythmic class III, Potassium channel blocker Pharmacologic Class none Nursing Considerations

 may lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension

 increases risk for QT prolongation

 increases digoxin levels

 increases activity of warfarin

 monitor EKG continuously while on therapy

 assess for signs and symptoms of ARDS

 monitor liver function test

 check dosage with another RN

 teach pt to monitor pulse daily and report abnormalities

 avoid drinking grapefruit juice

Indication depression, anxiety, insomnia

Action increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects

Therapeutic Class antidepressant Pharmacologic Class tricyclic antidepressant

Nursing Considerations

 contraindicated in MI, heart failure, QT prolongation, glaucoma

 may increase risk for suicidal ideation

 may cause arrhythmias, hypotension, EKG changes

 may cause alterations in blood glucose levels

 may lead to general sedation and lethargy

 do not use within 2 weeks of MAOIs

 Instruct pt to take medication exactly as instructed

 monitor for orthostatic hypotension

 may lead to photosensitivity, instruct patient to use sunscreen

 may turn urine blue/green color.

Indication hypertension, angina Action blocks transport of calcium into muscle cells inhibiting excitation and contraction

Therapeutic Class antihypertensive

Pharmacologic Class Ca channel blocker Nursing Considerations

 may cause gingival hyperplasia

 grapefruit juice may increase drug level

 monitor blood pressure and pulse prior to and during therapy

 monitor intake and output

 assess for signs of CHF

 assess characteristics of angina

 instruct patient of interventions for hypertension and how to take blood pressure