ACE INHIBITORS
- It lowers blood pressure by stopping the angiotensin converting enzyme in the lung, which reduces the vasoconstrictor, angiotensin II. In other words, when you are playing cards, you may block the aces so your opponent will not win. This indeed will lower your blood pressure:
How do I remember all of these medications?
It's actually insanely easy!!! Remember they are pills and if you put an R after the P, you have a PRIL; these medications all end in PRIL.
Captopril
Enalapril
Lisinopril
Fosinopril
Ramipril
Benzaepril
What do I need to evaluate?
1. Blood pressure - since these meds reduce vasoconstriction, the pressure may go down too low. Observe for dizziness and/or tachycardia.
2. Some undesirable effects include an annoying dry cough, angioedema of the face, lips, tongue and pharynx. Uncommon side effects include rash & taste disturbances.
3. Monitor for hyponatremia and hyperkalemia
4. With Captopril, agranulocytosis or neutropenia may occur (ask about sore throats).
ALLOPURINOL (ZYLOPRIM)
Allopurinol (Zyloprim) is the DOC to prevent GOUT, decreases uric acid synthesis. Uric acid is the end product of purine metabolism. Condition of hyperurecemia may also occur in individuals receiving chemotherapy (secondaray gout). Meds for an acute attack may include colchicine, indomethacin (Indocin), or naproxen (Naprosyn).
Gout is generally rapid with swelling and a painful joint. Typically the uric acid crystals are in the large toe, but may also involve ankles and knees. During an acute attact, protect the affected joint by immobilizing the joint. Encourage gradual weight reduction. Instruct the client to avoid salicylates. Encourage high fluid intake (>3L/day) to increase excretion of uric acid & to prevent the development of uric acid stones.
Teach clients to avoid foods high in purines such as organ meats, shell fish, and preserved fish (anchovies, sardines) and avoid alcohol. We would like to see the urine output increased to 2 liters per day to help decrease the risk of stones. Clients at risk for stones may be given trisodium citrate for urine alkalinization.
Remember - clients with renal insufficiency should receive a reduced dose of Allopurinol.
G - Gulp 3 liters of fluid per day
O - Organ meats or wines not allowed
U - Urine output increased to 2 liters/day
T - Teach
AMINOPHYLLINE TOXICITY
Aminophylline (bronchodilator) is a wonderful & effective drug that relaxes & expands the bronchi reversing airway obstruction. This drug is commonly used in clients with problems such as: asthma, croup, chronic bronchitis & COPD.
Story: A girl named, Amily Toxicity received too much of this drug. We recommend that you stay out of her way! When she gets too much of this wonder drug, she THROWS UP. Amily has an "A" on her name for "hyperACTIVITY". When the level gets high, Amily starts bouncing off the walls. The "T" is for "TACHYCARDIA". Amily is so active that her heart rate must race (tachycardia) to keep up with her.
The therapeutic range for aminophylline level is 10-20 mcg/ml.
*Keep your eyes open, and your assessments will tell you the story about the effectiveness of this drug. If signs of toxicity occur, report to the provider or check the TBL.
ANTACIDS
Mag has had a history of an ulcer, but feels much better now since antacids coat her stomach lining. She, however, has developed another serious problem with DIARRHEA!!!! This is a major side effect of antacids containing magnesium such as Milk of Magnesia. The diarrhea must get under control or she will need to meet ALKALI, a cousin, which will assist her in correcting the metabolic acidosis which may occur as a complication from the diarrhea. Mag should be monitored for dehydration, hypokalemia, hyponatremia. If Mag were to remain on magnesium oxide for prolonged therapy, the magnesium level should be monitored periodically.
AL is also in the family and is taking an aluminum antacid such as amphogel for his ulcer symptoms. As you can see, Al's problem is constipation. He is so full of it that he can't get rid of it. CONSTIPATION is a major side effect of antacids containing aluminum.
Remember - Teach clients to take antacids one hour after meals and to refrain from taking other oral medications within 1-2 hours of any antacid.
ANTI-ANXIETY
Clients who are anxious may feel like they are going 'BATS". These BATS will assist you in remembering these anti-anxiety drugs:
B - BETA ADRENERGIC BLOCKERS may be used for a rapid heart rate
- BENZODIAZEPINES such as alprayalam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan) and others decrease anxiety by depressing the limbic and subcortical central nervous system.
A - ANTIHISTAMINES such as hydroxyzine (Atarax) may decrease anxiety if the client is a potential abuser of benzodiazepines.
T - TRICYCLICS and MAO inhibitors may be used for panic attacks.
S - SSRI's may be effective in managing anxiety
ANTI-COAGULANTS
Coumadin and Heparin are used to inhibit thrombus and clot formation. They chip away at the clot to make it smaller. Clotting times will be prolonged which will assist in maintaining the flow or "stream of blood."
The key to successfully remembering the lab reports and antidotes for the appropriate anticoagulants are to think of (H) looking like 2 tt's in Heparin. The lab report necessary to evaluate while clients are on heparin is Ptt. The antidote has also 2 t's in it (protamine sulfate).
Coumadin's antidote is vitamin K. C and K sound alike which help with association. The lab report which needs to be monitored is Pt.
Labs now report INR (international normalized ratio) values. The range for most clients on anticoagulants is 2-3. The exceptions are mechanical heart valves and recurrent thromboembolism clients who should be anticoagulated to an INR of 3-4.5.
ANTICHOLINERGICS
The major side effects of these medications are easily seen below. Some examples of these medications include: Atropine, Methantheline (Banthine), and Dicyclomine hydrochloride (Bentyl). Of course, these drugs are given because of the desirable effects of decreasing salivation, lacrimation, urination, diarrhea and GI motility. Blurred vision and dilated pupils are also side effects. It's when we get too much that we get in trouble.
4 CAN'Ts: (Side Effects)
CAN'T PEE
CAN'T SEE
CAN'T SPIT
CAN'T SHIT
Remember - These meds are contraindicated in closed an open angle glaucoma, prostatic hypertrophy and obstructive bowel disease.
BETA-BLOCKERS
Beta blockers are a group of drugs that can be remembered using the acronym BETA. People taking these drugs may need TLC.
B - BRONCHOSPASM (so we don't want to give them to people with asthma or bronchoconstrictive disease!).
E - ELICITS A DECREASE IN CARDIAC OUTPUT AND CONTRACTILITY
T - TREATS HYPERTENSION
A - AV CONDUCTION DECREASES (short for treats arrhythmias, especially fast ones by decreasing the heart rate and cardiac output!)
REMEMBER STOP BETA-BLOCKERS WITH BRONCHOCONSTRICTIVE DISEASES.
T - TENORMIN (atenolol) used for hypertension and angina (watch for renal impairment as this drug is renally excreted)
L - LOPRESSOR (metoptolol) used for hypertension and angina (C/I in sinus bradycardia, 2nd or 3rd degree block, metabolized in liver and NOT renally excreted).
C - CORGARD (nadolol) used for hypertension and angina ( renally excreted, C/I in bronchial asthma, sinus bradycardia or 2nd or 3rd degree heart block).
CALCIUM CHANNEL BLOCKERS
This group of medications are often called "Don't Give a Flip Pills" by the clients who take them because that's exactly how they feel. Their blood pressure is lowered (calcium influx blocked), pulse is decreased, and if they move too quickly they get dizzy. They are much happier being a couch potato and taking life easy. A few examples of the calcium channel blockers include Cardizem, Cardene, Procardia and Calan. Each of these common Calcium Channel Blockers have a Ca in them which makes it easy to remember! These medications should be administered with meals and milk. Some general undesirable effects of these medications include constipation, bradycardia, peripheral edema, hypotension, dizziness, heart blocks, and worsening of CHF.
Remember - Calcium Channel blockers should not be given in clients who are in CHF or cardiogenic shock because they can decrease the heart rate too much.
LOOP DIURETICS
Lou la Bell has been given a loop diuretic such as Lasix or Ethacrynate Sodium and is very dizzy. Her blood pressure has decreased too much after her excessive peeing. You would also feel as if you were spinning in a tube over the falls if you lost this much urine (volume). It may be very useful to teach her to get up slowly so she won't fall.
The life guard must blow his whistle in order to get her some assistance. She feels that the ringing in her ears just won't go away. Dizziness and ringing in the ears are major adverse effects from loop diuretics.
A few other adverse reactions include : hypokalemia, hypocalcemia (tetany), hyperglycemia, and hyperurecemia. While aplastic anemia and agranulocytosis may occur, they are RARE!
Remember - Keep a close watch on blood pressure, potassium and calcium levels. Teach foods high in potassium and calcium. Potassium supplements may be necessary.
DILANTIN (DIAL AT TEN)
Dilane has a seizure and is taking the drug dilatin. She does not feel well and is calling the nurse at 10:00am. Her therapeutic level for Dilantin should be 10-20mcg/ml (EASY TO REMEMBER. THERE IS A TIN (TEN) IN DILANTIN). Her adverse reactions from this medication include gingival hyperplasia, GI disturbances, hepatotoxicity, ataxia, hypocalcemia, & decrease in absorption of Vit. D (milk and sunshine will help this problem).
If Dilane's level becomes toxic, be sure to inform the provider. The drug will likely be decreased.
Remember - Teach good oral hygiene and nutrition.
NSAIDs
NSAIDs are a group of medications that prevent prostaglandin synthesis.
What does it mean? Prostaglandins contribute to the following: inflammation, body temperature, pain transmission, platelet aggregation and other actions. These prostaglandins are not stored, but are released on demand.
What type of physical problems may benefit from NSAIDs? Fever and inflammation (ie. arthritis) can be reduced by these medications.
Are there any undersirable effects from NSAIDs? There are several undesirable effects that the nurse mus assess and educate clients to report. These include GI upset or bleeding, ototoxicity (ringing of the ears), hepatic necrosis, or nephritis.
As a nurse, what should be included in the plan of care?
1. Administer medications with food to decrease GI irritation.
2. Teach clients about actions and side effects and report any dark, tarry stools, "coffee ground or bloody emesis", other GI distress or ringing of the ears.
3. Instruct client to inform health care providers about these medications prior to any dental or otehr type of surgery. NSAIDs should be discontinued approximately 5-7 days before the procedure to prevent any complications of bleeding.
4. NSAIDS are not the drugs of choice if the client has any compromise in either the renal or the liver.
5. Evaluate the effectiveness of the NSAIDs.
PITOCIN
Pitty Pitocin, this pregnant woman, is slow to begin active labor, so the Doc decides to induce by using PITOCIN. Watch for those major side effects!
Visualize Pitty sitting in a row boat looking into a PIT watching the "TETANIC" sink into the ocean" (OCIN). Complications of this drug are TETANIC CONTRACTIONS. Pitocin of course is a stimulant; so as Pitty watches the ship sink, her PRESSURE elevates! Just as a sinking ship takes in all that salty WATER, poor Pitty is left holding the excess fluid in her body (observe I & O). She gets so nervous with all this happening that she goes into CARDIAC ARRHYTHMIAS causing Pitty's baby OXYGEN hunger and FETAL HEART IRREGULARITIES. This is so upsetting to Pitty that she gets NAUSEATED and VOMITS all over the row boat.
STOP THAT PITOCIN DRIP!!!!
TYLENOL (ACETAMINOPHEN OVERDOSE)
A major undesirable effect of tylenol overdose is hepatic necrosis. It is like we have taken a hammer and beaten "the hell out of the liver". The dose of tylenol should not exceed 4g/day. Other side effects are negligible with recommended dosage. With acute poisoning, the following adverse effects may occur: anorexia, nausea and vomiting, epigastric or abdominal pain, HEPATOTOXICITY, hypoglycemia, and hepatic coma.
Tylenol (Acetaminophen) is a very useful drug for pain and fever. (Refer to Poison Control for more specific plans).
Remember - Do not administer to clients with liver disease.
