Medications on Med Test 

 
⊕ Metoprolol ( Lopressor )  
ß adrenergic antagonist 

● Route: IV & Oral

● Generation: Second Generation ß-blocker
● Action: a selective ß​1​ receptor blocker; decreases cardiac output, peripheral resistance, cardiac oxygen
consumption, and depressed renin secretion. Preferred to non-selective ß-blockers for patients with asthma
and/or diabetes.
● Uses:
HTN: primary indication for the use of this drug.
Angina
Cardiac dysrhythmias
MI
Heart failure
● Adverse effects: can cause heart failure if used incautiously.
● Pharmacokinetics: Lipid soluble, First pass effect with 40% bioavailability, hepatic metabolism, renal excretion.
● Contraindications: Patients with sinus bradycardia and AV block greater than first degree. Use with care in
patients with heart failure. Fairly safe to use in diabetic patients but will still mask the common warning signs
of hypoglycemia.
● Nursing considerations:
Baseline data: For all patients, must determine baseline heart rate. For patients with HTN,
determine supine and standing blood pressures. For patients with angina pectoris, determine
the incidence, severity, and circumstances of anginal attacks. For patients with cardiac
dysrhythmias, obtain a baseline ECG.
Ongoing evaluations: For patients with HTN, monitor blood pressure and heart rate before
each dose. For patients with angina pectoris, advise patients to record the incidence,
circumstances, and severity of attacks. For patients with cardiac dysrhythmias, monitor for
improvement in the ECG.

⊕ Lisinopril ( Prinivil ) 
ACE Inhibitor  

● Route: PO
● Action: Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the
vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other
vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and decrease aldosterone levels.
Net result is systemic vasodilation.
● Therapeutic Effects: Lowering of BP in hypertensive patients. Increased survival and decreased symptoms in
patients with heart failure. Increased survival after myocardial infarction.
● Contraindications: hypersensitivity, history of angioedema with previous use of ACE inhibitors, do not use
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 while pregnant or breastfeeding.
● Adverse effects: Dizziness*, headache, weakness, cough*, hypotension*, chest pain, abdominal pain, diarrhea,
nausea, vomiting, erectile dysfunction, impaired renal function, rash, hyperkalemia, angioedema*

⊕ Furosemide ( Lasix )  

High Ceiling / Loop Diuretic 

● Route: Oral, IV, IM

● Action: blocks the reabsorption of sodium and
chloride (20%) in the ascending loop of Henle.
By blocking solute reabsorption, furosemide
prevents passive reabsorption of water. Since a
substantial amount (20%) of filtered NaCl is
normally reabsorbed in the loop of Henle,
interference with reabsorption here can
produce profound diuresis.
● Uses: pulmonary edema; hepatic, cardiac, or
renal edema; HTN unresponsive to other, less
efficacious diuretics; renal impairment.
● Adverse Effects:
Electrolytes: hyponatremia,
hypochloremia, hypokalemia
(must monitor as it can cause dysrhythmias), other lab value such as hyperuricemia (can
precipitate gout), hyperglycemia. Hypovolemia, hypotension (orthostatic, especially in the
elderly), and ototoxicity (in about 6-7% of patients). Pregnant women and lactating mother
should not take furosemide.
● Interactions:
NSAIDS inhibit prostaglandins, thus preventing the increase in renal blood flow and partially
blunting the diuretic effect.
Digoxin toxicity, in the presence of hypokalemia, is increased.
Lithium toxicity in the presence of hyponatremia is at an increased risk.
Should not administer other ototoxic drugs such as aminoglycosides (Gentamicin).
● Nursing Care: Monitor for signs of dehydration, dry mouth, unusual thirst, and oliguria. Dehydration can
promote thromboembolism so must monitor the patient for symptoms (headache, pain in chest, pelvis, or
calves.)
Baseline data: daily weights, I&O, electrolytes (specifically Na and K), why you’re giving the
drug, blood pressure (both sitting and standing), pulse, respirations. For patients with edema,
record sites and extent of the edema. For patients with ascites, measure abdominal girth. For
acutely ill patients, assess lung sounds.

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⊕ Warfarin ( Coumadin ) 

● Uses: DVT prevention, heart valves, atrial fibrillation, TIA, MI

● Action: Decreases production of vitamin K dependent factors II, VII, IX, X, and prothrombin. It is a vitamin K
antagonist.
● Route: only given orally
● Contraindications: severe thrombocytopenia, patients undergoing lumbar puncture, regional anesthesia, eye,
brain, or spinal cord surgery, liver disease, vitamin K deficiency, ETOH abuse, pregnancy and/or lactation.
● Drug-drug interactions: interacts with EVERYTHING!
● Increases the effects of:
Amiodarone, cephalosporines, gemfibrosil, antifungals, quinidine, and tamoxifen.
● Decreases the effects of:
carbamazepine, phenobarbital, phenytoin, rifampin, sulcrafate, Vitamin K.
● Adverse effects: bleeding is the major complication
● Nursing care: High alert drug. Monitor high risk patients.
Obtain baseline vitals, PT/INR, and possibly genetic testing. Has a much slower onset than heparin (takes days), plasma
levels vary so have to monitor PT and INR. Monitor patient for bleeding.
Reconcile drug list to monitor for additional medications that may cause bleeding. Some patients may undergo genetic
testing for genes VKORC1 and CYP2C9. The CYP2C9 gene inactivates warfarin in the liver. Patient education on signs of
bleeding, adherence to dosing schedule and the necessity to watch their diet to prevent vitamin K fluctuations. If the
vitamin K level increases then the amount of warfarin needed will also need to be increased. Instruct patients to avoid
spinach, leafy greens, and hummus specifically. Instruct patient to wear a medical bracelet.
● Therapeutic levels: dependent but generally:
PT ratio: 1.3-2
− INR: 2-4.5
Reversal agent: Vitamin K is used to treat overdose.

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⊕ Regular ( Humulin R )  
Insulin 

− Onset: moderately rapid. 30-60 minutes

− Peak: 1-5 hours
− Duration of action: 6-10 hours
− Use: Used before meals, basal glycemic control

⊕ Metformin ( Glucophage ) 
Biguanide 

● Use:
− Type II DM
− Polycystic ovary disease
● Action:
− Decreases production of glucose in the liver
− Sensitizes insulin receptors at target tissue which increases glucose uptake in muscle and adipose tissue
− Slight reduction of glucose pabsorption in the gut.
● Pharmacokinetics: absorbed in the small intestine, not metabolized, excreted unchanged in the kidneys.
● Adverse effects:
− GI disturbances
− Decreased absorption of B​12​ and folic acid
− Lactic acidosis (indicated by hyperventilation, myalgia, malaise, somnolence)
− DOES NOT cause hypoglycemia when used alone.

⊕ Lispro ( Humalog )  

Insulin 

− Onset: very rapid. 15-30 minutes

− Peak: 0.5-2.5 hours
− Duration of action: 3-6 hours, short duration
− Use: Administered with meals (just before or immediately following), used in conjunction with intermediate or
long acting

⊕ Docusate Sodium ( Colace ) 

Laxative 

● Route: PO
● Action: Senna’s metabolite acts as a local irritant on the colon, stimulating peristalsis. Docusate
promotes incorporation of water into stool, resulting in softer fecal mass.
● Therapeutic Effects: Softening and passage of stool.
● Contraindications: hypersensitivity, abdominal pain, nausea or vomiting.
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 ● Adverse effects: electrolyte imbalances, dehydration, abdominal cramps, nausea, vomiting, diarrhea, rash,
urine discoloration

⊕ Hydrochlorothiazide ( HydroDIURIL )  

Thiazide Diuretic 

● Route: Oral
● Action: Blocks reabsorption of sodium and chloride in the distal convoluted tubule. Thiazides produce lower
urine output than loop diuretics because where they work in the kidney only reabsorbs 10% of sodium and
chloride. The ability of thiazides to promote diuresis is dependent on adequate kidney function. These drugs
are ineffective when GFR is low (less than 15- 20 ml/min). Hence, in contrast to loop diuretics, thiazides
cannot be used to promote fluid loss in patients with severe renal impairment.
● Uses: Hypertension (drug of choice) and edema from mild to moderate heart failure.
− Reduces BP by two mechanisms: reduction of blood volume and reduction of arterial resistance. Reduced
blood volume is responsible for the initial antihypertensive effects. Reduced vascular resistance develops
over time and is responsible for long-term antihypertensive effects.
● Adverse effects: Electrolyte imbalances (hyponatremia, hypochloremia, hypokalemia) hyperuricemia and
hyperglycemia, hypovolemia, and blood pressure.
● Interactions: use cautiously with other antihypertensive drugs, NSAIDs, Digoxin, and Lithium.
● Nursing Care: daily weights, I&O, reason for administration, blood pressure, pulse, respirations, monitor for
dehydration, monitor for thromboembolism.

⊕ Morphine 
Pure Strong opioid agonist 
Mu and Kappa agonist 

● Class: II
● Natural source: seedpod of the poppy
● Route: Oral, IM, IV, SQ, epidural, intrathecal
● Action: mimics actions of endogenous opioid peptides at mu receptors. It produces analgesia,
sedation, euphoria, respiratory depression, cough suppression, and reduced GI motility.
● Use: relief of pain.
● Adverse effects: Respiratory depression, constipation, orthostatic hypotension, urinary retention,
cough suppression, emesis, miosis, biliary colic.
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 ● Pharmacokinetics: hepatic metabolism→1​st ​pass effect for oral doses.
● Precautions: be very cautious with use in patients with decreased respiratory reserve, head injuries,
infants and the elderly, patients with inflammatory bowel disease, liver impairment, prostatic
hypertrophy.
● Drug interactions
− Adverse: other CNS depressants, anticholinergic drugs, hypotensive drugs (can potentiate
hypotension).
− Beneficial: amphetamines (work against the sedative effects), phenothiazines, antiemetics,
dextromethorphan (enhances the analgesic effect).

● Nursing care: Pain is a subjective experience, there are no objective measures, you must listen to your
patients! Pain assessment should include: location, type of pain, what makes the pain better or worse.
Should assess for psychological factors that could worsen pain (anxiety, fear, anger).
− Assess RR, BP, pulse, pain level prior to and post administration.
− Be alert to those with increased sensitivity to respiratory depression.
− Ensure adequate physical activity, dietary fiber, fluids to reduce constipation risk. Prophylactic
drug may be needed.
− Ensure patients cough and deep breathe.
− Move slowly from sitting to standing. Assess for lightheadedness and dizziness.
− Check for bladder distention and encourage to void every 4 hours, monitor I&O.
− Assess for any other anticholinergic drugs that may worsen the symptoms of urinary retention
(Oxybutynin).
− Advise to avoid hazardous activities that require mental clarity.
− Combine medication use with non-pharmacological interventions to enhance pain control
(splinting, positioning, distractions, etc.).
● Morphine toxicity
− Classic symptoms: coma, respiratory depression, pinpoint pupils.
− Treatment: ventilatory support if a severe overdose, administration of an opioid antagonist
such as Narcan.
● Dosing Schedule: dosage must be individualized. Opioids should be administered on a fixed schedule,
not PRN. If appropriate, patient controlled analgesia provides better pain control than fixed schedule.

⊕ Digoxin ( Lanoxin )  

Cardiac Glycoside 
Only oral inotropic agent available 

● Action: inhibits Na, K-ATPase which indirectly causes increase in intracellular calcium which increases
contractility.
− Renal excretion
− Narrow therapeutic range (0.5-0.8 ng/mL)
● Outcomes:
− Improves cardiac output
− Decreases heart rate
− Decreases heart size
− Reduces fluid retention
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 − Function status can improve
● Drug-drug interactions:
− Diuretics, especially furosemide and hydrochlorothiazide
− ACEi also influence potassium
● Adverse effects
− Dysrhythmias: chance is increases by pre-existing heart disease, hypokalemia, and elevated
digoxin levels
− GI: anorexia, nausea, vomiting
− CNS: fatigue, visual disturbances (blurred vision, halos around dark objects, yellow tinge to
vision)
● Effect on K​+
− Hypokalemia while taking digoxin can lead to toxicity.
− If there is a high K​+ ​level, it will impair the therapeutic response.
− Need to keep potassium levels within normal range (3.5-5 mEq/L)

⊕ Potassium Chloride ( KCl ) 

Mineral and electrolyte replacement 

● Route: PO
● Action: Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell. Activator in many
enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth
muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.
● Therapeutic Effects: Replacement. Prevention of deficiency.
● Contraindications: hyperkalemia, severe renal impairment, untreated Addison’s disease, hyperkalemic familial
periodic paralysis.
● Adverse effects: confusion, restlessness, weakness, arrhythmias*, ECG changes, abdominal pain, diarrhea,
flatulence, nausea, vomiting.

⊕ Alteplase ( tPa ) 
Fibrinolytic 

● Uses: acute MI, pulmonary embolism, acute ischemic stroke, clogged central venous catheters.
● Action: promotes conversion of plasminogen to plasmin → degrades clots
● Absolute contraindications: any prior intracranial hemorrhage, known structural cerebral vascular lesion,
ischemic stroke within the last 3 months except ischemic stroke within 4.5 hours, known intracranial
neoplasm, active internal bleeding (other than menses), suspected aortic dissection.
● Nursing implications: High risk drug, monitor for high risk patients. Have to get baseline vitals, CBC, PLT, PTT,
PT, and fibrinogen. Observed for bleeding, intracranial hemorrhage is the greatest concern. Once given avoid
SQ, IM, and arterial sticks. Minimize patient manipulation and invasive procedures. Pressure dressings may be
needed for existing puncture sites or previous sites. Patient should not shave, if necessary use an electric
razor. Use cautiously with other drugs that cause bleeding. Bleeding management includes the DC of drug,
blood products (RBC, FFP), reverse fibrinolysis with aminocaproic acid (Amicar) which is a clotting promoter.
 
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⊕ Candesartan ( Atacand ) 
ARB 

● Route: PO
● Action: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II at various receptor sites,
including vascular smooth muscle and the adrenal glands.
● Therapeutic Effects: Lowering of BP in patients with hypertension. Reduced cardiovascular death and
heart-failure-related hospitalizations in patients with heart failure.

● Contraindications: hypersensitivity, bilateral renal artery stenosis, severe hepatic impairment, do not use
while pregnant or breastfeeding.
● Adverse Effects: hypotension*, chest pain, edema, hyperkalemia, impaired renal function, arthralgia,
angioedema*

⊕ Amlodipine ( Norvasc )  

Calcium Channel Blocker 

● Route: PO
● Action: Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in
inhibition of excitation-contraction coupling and subsequent contraction.
● Therapeutic Effects: Systemic vasodilation resulting in decreased BP. Coronary vasodilation resulting in
decreased frequency and severity of attacks of angina
● Contraindications: hypersensitivity, systolic BP <90 mmHg
● Adverse Effects: peripheral edema*, angina, bradycardia, hypotension, palpitations, flushing