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Anaphylactic Shock Exams
UPDATED ON FEBRUARY 11, 2021 BY MARIANNE BELLEZA, R.N.
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Kaye went on a picnic with her friends at the beach. Everyone brought food and shared them for
I
lunch. Moments after biting off a chunk of sandwich, Kaye went dizzy and complained of severe
-
shortness of breath. IT turned out that the sandwich is a peanut butter and jelly ensemble, and Kaye
is allergic to peanuts. She was immediately rushed to the emergency department and was diagnosed
with anaphylactic shock.
1. What is Anaphylactic Shock?

2. Pathophysiology
3. Statistics and Incidences
4. Causes
5. Clinical Manifestations
6. Prevention
7. Complications
8. Assessment and Diagnostic Findings
9. Medical Management
9.1. Pharmacologic Therapy
10. Nursing Management
10.1. Nursing Assessment
10.2. Nursing Diagnosis
10.3. Nursing Care Planning and Goals
10.4. Nursing Interventions
10.5. Evaluation
10.6. Discharge and Home Care Guidelines
10.7. Documentation Guidelines
11. Practice Quiz: Anaphylactic Shock
12. See Also
What is Anaphylactic Shock?

Anaphylactic shock occurs rapidly and is life-threatening.
consequences.
O
Anaphylactic shock is a systemic, type I hypersensitivity reaction that often has fatal
-
Anaphylaxis causes the immune system to release a flood of chemicals that can cause a
person to go into shock.
Pathophysiology
a
Anaphylaxis occurs in an individual after reexposure to an antigen to which that person has produced
IgE antibody. ( Immunoglobulin f)
a specific-
↳ cause allergic
reaction
Reexposure. Upon reexposure to the sensitized allergen, the allergen may cross-link the mast
-
cell or basophil surface-bound allergen-specific IgE resulting in cellular degranulation as well

as de novo synthesis of mediators.
Binding. Immunoglobulin E (IgE)e- binds to the antigen (the foreign material that provokes the
allergic reaction).
Activation. Antigen-bound IgE then activates FcεRI receptors on mast cells and basophils.
Inflammatory mediators release. This leads to the release of inflammatory mediators such
as @histamine. ( canter many of the symptoms of allergies )
Histamine release. Many of the signs and symptoms of anaphylaxis are attributable to
binding of histamine to its receptors; binding to H1 receptors mediates pruritus, rhinorrhea,
tachycardia, and bronchospasm.
Prostaglandin D2. Prostaglandin D2 mediates bronchospasm and vascular dilatation,
principle manifestations of anaphylaxis.
Leukotriene C4. Leukotriene C4 is converted into LTD4 and LTE4, mediators of hypotension,
-
bronchospasm, and mucous secretion during anaphylaxis in addition to acting as chemotactic
signals for eosinophils and neutrophils.
Statistics and Incidences

Anaphylaxis occurs worldwide and in different ages.
Worldwide, 0.05–2% of the population is estimated to experience anaphylaxis at some point
in life.
It occurs most often in young people and females.
Of people who go to a hospital with anaphylaxis in the United States about 0.3% die.
According to a peer-reviewed study, anaphylaxis very likely occurs in nearly 1 in 50 Americans
(1.6%).
Researchers also found that 13% of cases of anaphylaxis occur at hospitals or clinics, 6.4% at
a relative’s or a friend’s home, 6.1% in the workplace, 6.1% in the restaurant, and 2.6% at
school.
Causes
E-
Allergy symptoms aren’t usually life-threatening, but a severe allergic reaction can lead to
anaphylaxis.
= Food allergies. The most common anaphylaxis triggers in children are food allergies, such as
to peanuts, and tree nuts, fish, shellfish and milk.
Medication allergies. Certain medications, including antibiotics, aspirin and other over-the-
-
counter pain relievers, and the intravenous (IV) contrast used in some imaging tests.
-
Insect allergies. Stings from bees, yellow jackets, wasps, hornets and fire ants.
Latex allergy. Latex allergy develops after many previous exposures to latex.
Clinical Manifestations
An anaphylactic reaction produces the following symptoms:
Anxiety. The first symptoms usually include a feeling of impending doom or fright.
Skin reactions. Skin reactions such as hives, itching, and flushed or pale skin follow.
Shortness of breath. Constriction of the airways and a swollen tongue or throat could cause
wheezing and troubled breathing. Dyspnea
Hypotension. A low blood pressure occurs as one of the major symptoms of shock.
Tachycardia. The heart compensates through pumping faster and trying to deliver blood to all
body systems.
Dizziness. The patient may feel dizzy which could lead to fainting.
Prevention
Because anaphylactic shock occurs in patients already exposed to an antigen and who have
developed antibodies to it, it can often be prevented.
Avoid exposure to allergens. Teach the patient to avoid exposure to known allergens, may it
-
be food, drug, or an insect bite.
Desensitization. If a patient must receive a drug to which he’s allergic, prevent a severe
reaction by making sure he receives careful desensitization with gradually increasing doses of
the antigen or advance administration of steroids.
Monitoring. Closely monitor a patient undergoing diagnostic tests that use radiographic
contrast media, such as excretory urography, cardiac catheterization, and angiography.
angina → chest pain
Complications
The complications of anaphylactic shock include:
Respiratory obstruction. The trachea may close up due to severe inflammation which could
result to respiratory obstruction.
Systemic vascular collapse. Sudden loss of blood flow to the brain and other organs could
cause systemic vascular collapse.
Assessment and Diagnostic Findings

Because anaphylaxis is primarily a clinical diagnosis, laboratory studies are not usually required and
are rarely helpful.
Histamine and tryptase assessment. If a patient is seen shortly after an episode, plasma
histamine or urinary histamine metabolites, or serum tryptase measurements may be helpful in
confirming the diagnosis.
5-hydroxyindoleacetic acid levels. If carcinoid syndrome is considered, urinary 24-hour 5-
hydroxyindoleacetic acid levels should be measured.
Testing for food allergy. If the patient’s medical history and physical examination findings
suggest a possible association with food ingestion, percutaneous (puncture) food allergen–
-
specific skin tests and/or in vitro–specific IgE tests (eg, radioallergosorbent assay test [RAST]
-
or ImmunoCAP IgE tests [Phadia AB; Uppsala, Sweden]) can be performed, with an
understanding that both false-positive and false-negative results may occur.
Testing for medication allergy. If the patient’s history suggests ae- penicillin etiology and the
reagents are available, skin testing for penicillin should be performed with the appropriate
positive and negative controls.
Testing for suspected insect bites or sting. If the patient’s history suggests an insect sting,
allergen-specific
- -
skin testing to Hymenoptera venoms should be performed.
Medical Management
Treatment of anaphylactic shock include:
Remove antigen. Removing the causative antigen such as discontinuing an antibiotic agent
-
could stop the progression of shock.

Administer medications. Administer medications that restore vascular tone and provide
emergency support of basic life functions.
Cardiopulmonary resuscitation. If cardiac arrest and respiratory arrest are
-
0 imminent or have
occurred, cardiopulmonary resuscitation is performed.
CPI
Endotracheal intubation. Endotracheal intubation or tracheostomy may be necessary to
establish an airway.
Intravenous therapy. IV lines are inserted to provide access for administering fluids and
medications.
Pharmacologic Therapy
Medications used for a patient at risk or under anaphylactic shock are:
Epinephrine. Epinephrine is given for its vasoconstrictive reaction; for emergency situations,
an immediate injection of 1:1, 000 aqueous solution, 0.1 to 0.5 ml, repeated every 5 to 20
minutes is given.
I
allergy
[
Diphenhydramine. Diphenhydramine (Benadryl) is administered to reverse the effects of
histamine, thereby reducing capillary permeability.
-
Albuterol. Albuterol (Proventil) may be given to reverse histamine-induced bronchospasm.
Nursing Management
The nurse has an important role in preventing anaphylactic shock.
Nursing Assessment
Communication is an essential part of assessment.
Assess any kind of allergy. The nurse must assess all patients for allergies or previous
reactions to antigens.
Assess patient’s knowledge. The nurse must also assess the patient’s understanding of
previous reactions and steps taken by the patient and the family to prevent further exposure to
antigens.
New allergies. When new allergies are identified, the nurse advises the patient to wear or
carry identification that names the specific allergen or antigen.
Nursing Diagnosis
Based on the assessment data, the nursing diagnoses appropriate for the patient are:
Impaired gas exchange related to ventilation perfusion imbalance.

Altered tissue perfusion related to decreased blood flow secondary to vascular disorders
due to anaphylactic reactions.
Ineffective breathing pattern related to the swelling of the nasal mucosa wall.
Acute pain related to gastric irritation.
Impaired skin integrity related to changes in circulation.
Nursing Care Planning and Goals

Main Article: 4 Anaphylactic Shock Nursing Care Plans
The major goals for a patient with anaphylactic shock are:
¥
Client will maintain an effective breathing pattern, as evidenced by relaxed breathing at normal
rate and depth and absence of adventitious breath sounds.
Client will demonstrate improved ventilation as evidenced by an absence of shortness of
breath and respiratory distress.
-
Client will display hemodynamic stability, as evidenced by-

-
strong peripheral pulses; HR 60 to
100 beats/min with regular rhythm; systolic BP within 20 mm Hg of baseline; urine output
greater than 30 ml/hr; warm, dry skin; and alert, responsive mentation.
Client and significant others will verbalize understanding of allergic reaction, its prevention,
and management.
=
Client and significant others will verbalize understanding of need to carry emergency
components for intervention, need to inform health care providers of allergies, need to wear
-
medical alert bracelet/necklace, and the importance of seeking emergency care.
Nursing Interventions
Nursing interventions for the patient are:
KPH
ABC (Airway Breathing, Circulation)
, 1) CAB → Code Blue
Monitor client’s airway. Assess the client for the sensation of a narrowed airway.
Monitor the oxygenation status. Monitor oxygen saturation and arterial blood gas values.
Focus breathing. Instruct the client to breathe slowly and deeply.
→
Positioning. Position the client upright as this position provides oxygenation by promoting
I
maximum chest expansion and is the position of choice during respiratory distress.
Activity. Encourage adequate rest and limit activities to within client’s tolerance.
Hemodynamic parameters. Monitor the client’s central venous pressure (CVP), pulmonary
artery diastolic pressure (PADP), pulmonary capillary wedge pressure, and cardiac
output/cardiac index.
Monitor urine output. The renal system compensates for low blood pressure by retaining
water, and oliguria is a classic sign of inadequate renal perfusion.
Evaluation
Expected patient outcomes include:
Client maintained an effective breathing pattern.

Client demonstrated improved ventilation.
Client displayed hemodynamic stability.
Client and significant others verbalized understanding of allergic reaction, its prevention, and
management.
Client and significant others verbalized understanding of need to carry emergency
components for intervention, need to inform health care providers of allergies, need to wear
medical alert bracelet/necklace, and the importance of seeking emergency care.
Discharge and Home Care Guidelines
Upon discharge, the patient and family need to learn about the following:
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Emergency medications. The nurse should provide information about emergency

medications and plans that should be considered should a crisis reoccur.
Precipitating factors. The nurse must assist the client and/or family in identifying factors that
precipitate and/or exacerbate crises.
Documentation Guidelines
The focus of documentation include:
Assessment findings including respiratory rate, character of breath sounds; frequency,
_¥E
amount, and appearance of secretions; presence of cyanosis; laboratory findings; and
-
mentation level.
=Conditions that may 0 interfere with oxygen supply.

Pulses and BP, including above and below affected area. v18
e-
Client’s description of response to pain, specifics of pain inventory, expectations of pain
management, and acceptable level of pain.
Prior medication use.
Plan of care, specific intervention, and who is involved in planning.
Teaching plan.
Client’s responses to treatment, teaching, and actions performed.
Attainment or progress towards desired outcome.
Modifications to plan of care.
Long-term needs.
Practice Quiz: Anaphylactic Shock

Here are some practice questions for this study guide. Please visit our nursing test bank page for
more NCLEX practice questions.
fret bite
1. Nurse Ejay is assigned to a telephone triage. A client called who was stung by a honeybee
and is asking for help. The client reports of pain and localized swelling but has no respiratory
-
distress or other symptoms of anaphylactic shock. What is the appropriate initial action that
the nurse should direct the client to perform?
A. Removing the stinger by scraping it.
B. Applying a cold compress.
C. Taking an oral antihistamine.→ allergy
D. Calling the 911.
1. Answer: A. Removing the stinger by scraping it.
◦
A: Since the stinger will continue to release venom into the skin, removing the stinger should
E-
be the first action that the nurse should direct to the client.
B&C: After removing the stinger, Antihistamine and cold compress follow.
D: The caller should be further advised about symptoms that require 911 assistance.
-
O
2. Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity
-
to a drug should include which of the following actions first?
A. Administering oxygen
B. Inserting an I.V. catheter
C. Obtaining a complete blood count (CBC)
D. Taking vital signs
2. Answer: A. Administering oxygen
O
A: Giving oxygen would be the best first action in this case.
B: If the client doesn’t already have an I.V. catheter, one may be inserted now if anaphylactic
shock is developing.
C: Obtaining a CBC wouldn’t help the emergency situation.
D: Vital signs then should be checked and the physician immediately notified.
3. Following the initial care of a client with asthma and impending anaphylaxis from
-
hypersensitivity to a drug, the nurse should take which of the following steps next?
A. Administer beta-adrenergic blockers.

B. Administer bronchodilators.
C. Obtain serum electrolyte levels.
D. Have the client lie flat in the bed.
3. Answer: B. Administer bronchodilators.
B: Bronchodilators would help open the client’s airway and improve his oxygenation status.
_
A: Beta-adrenergic blockers aren’t indicated in the management of asthma because they may
cause bronchospasm.
C&D: Obtaining laboratory values wouldn’t be done on an emergency basis, and having the
client lie flat in bed could worsen his ability to breathe.
4. Anaphylactic shock is associated with which type of hypersensitivity?
A. Type I hypersensitivity.
B. Type II hypersensitivity.
C. Type III sensitivity.
D. Type IV sensitivity.
4. Answer: A. Type I hypersensitivity.
-
o
A: In type I hypersensitivity. is an allergic reaction provoked by reexposure to a specific type of
-
antigen referred to as an allergen.

B: In type II hypersensitivity the antibodies produced by the immune response bind to antigens
on the patient’s own cell surfaces.
C: Type III hypersensitivity occurs when there is accumulation of immune complexes
(antigen–antibody complexes) that have not been adequately cleared by innate immune cells,
giving rise to an inflammatory response and attraction of leukocytes.
D: Type 4 hypersensitivity is often called delayed type hypersensitivity as the reaction takes
two to three days to develop.
5. What are some conditions that may precipitate anaphylactic shock?

A. Insects.
B. Food.
C. Medicines.
D. All of the above.
5. Answer: D. All of the above.
D: Insects, food, or medicines could cause anaphylactic shock.

o_O
A: Insects such as bees and wasps could precipitate anaphylactic shock after biting the victim.
B: Food such as peanuts and seafood are some of the most common causes of anaphylactic
shock.
C: Medicines such as antibiotics gives a high risk of developing anaphylactic shock.
Aspirin
See Also
Other posts from the site you may like:
4 Anaphylactic Shock Nursing Care Plans
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Medical-Surgical Nursing
Albuterol, Allergies, Allergy, Anaphylactic Shock, Anaphylaxis, Anxiety, diphenhydramine, epinephrine,
Hypersensitivity
Osteoporosis
Neurogenic Shock
Marianne Belleza, R.N.

Marianne is a staff nurse during the day and a Nurseslabs writer at night. She is a registered nurse since 2015 and is
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HOME » NOTES » NURSING PHARMACOLOGY » ANTIHYPERLIPIDEMIC DRUGS
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Antihyperlipidemic Drugs Exams
UPDATED ON MAY 3, 2022 BY IRIS DAWN TABANGCORA, RN
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←
Antihyperlipidemic Drugs lower serum levels of cholesterol and various lipids. They are also called
as lipid-lowering agents; these drugs provide effective treatment for hyperlipidemia (increased lipid
level in the blood). The incidence of coronary artery disease (CAD), the most common cause of death
among adults, is higher in people with hyperlipidemia. High level of lipids and triglyceride is
→
associated with metabolic syndrome consist of insulin resistance, abdominal obesity, hypertension,
¥1T
-
and proinflammatory and prothrombotic states.

- -
1. Antihyperlipidemic: Generic and Brand Names

2. Disease Spotlight: Coronary Artery Disease (CAD)
3. Bile Acid Sequestrants
3.1. Therapeutic Action
3.2. Indications
3.3. Pharmacokinetics
3.4. Contraindications and Cautions
3.4.1. Adverse Effects
3.5. Interactions
3.6. Nursing Considerations
3.6.1. Nursing Assessment
3.6.2. Nursing Diagnoses
3.6.3. Implementation with Rationale
3.6.4. Evaluation
4. HMG-CoA Reductase Inhibitors
4.2. Indications
4.5. Adverse Effects
4.6. Interactions
4.7.4. Evaluation
5. Cholesterol Absorption Inhibitors
5.2. Indications
5.6. Interactions
5.7.4. Evaluation
6. Practice Quiz: Antihyperlipidemic Drugs
7. Recommended Resources
8. See Also
9. References and Sources
Antihyperlipidemic: Generic and Brand Names

Here is a table of commonly encountered antihyperlipidemic drugs, their generic names, and brand
names:
Classification Generic Name Brand Name
Bile Acid Sequestrants cholestyramine Questran
colesevelam Welchol
colestipol Colestid
HMG-CoA Reductase Inhibitors atorvastatin 0

Lipitor
f-
fluvastatin Lescol
lovastatin Mevacor
pitavastatin statin Livalo
pravastatin Pravanchol
simvastatin Zocor
Cholesterol Absorption Inhibitor ezetimibe Zetia
Others:
Fibrates fenofibrate TriCor
finofibric acid Tripilix
gemfibrozil Lopid
Vitamin B niacin Niaspan
Disease Spotlight: Coronary Artery Disease

(CAD)
÷:÷
Due to various reasons, fatty streaks begin to develop in the endothelium of coronary arteries. " hardening of the
arteries
↳ thickening
or
in the
Over time, these fatty streaks develop into plaques (atheromas) and injure the lining of blood carted by a buildup ofplague
an artery
of
lining
.
inner
vessels. The inflammatory reaction begins, and it attracts white blood cells and platelets to the ""
.
I
area. These cells collect on the injured vessels and cause the atheroma to grow bigger, further ↳ causes CAD
•
narrowing the diameter of blood vessels, and therefore, limiting the blood flow.
The injury decreases the flexibility of the vessels, rendering it less distensible and less reactive
to neurochemical stimuli. Coronary arteries are now unable to balance oxygen demand and
blood supply.
If not acted promptly, this can lead to total vessel blockage and vessel rupture. CAD is the
leading cause of death worldwide, and its incidence is high in people with hyperlipidemia.
The cause of CAD remains unknown, but certain risk factors were identified, and these include
increasing age, male gender, sedentary lifestyle, smoking, obesity, high-fat diet, high-stress
- - - -
-
levels, menopause, and medical conditions like hypertension, gout, and diabetes.
→ uricacidbuia
Bile Acid Sequestrants
up
-
in the blood
These drugs are used to normalize high serum level of cholesterol.
Therapeutic Action
Bao
Bile acid sequestrants exert their effect in the intestines by binding into bile acids which
%
contain a high level of cholesterol.
The resultant insoluble complex formed by this combination is then excreted through feces.
→
As this happens, more LDL segments from the circulation will be absorbed by the intrahepatic
circulation to make more bile acids.
LDL → low-density cholesterol)

Indications lipoprotein ( Bad
Bile Acid Sequestrants are used as the _ - (high
treatment for primary hypercholesterolemia
cholesterol and high LDL) as an adjunct to diet and exercise.
Cholestyramine is also used to treat pruritus associated with partial biliary obstruction.
Tbtchiness
o
Children
Familial hypercholesterolemia treatment in children is limited to tight dietary restrictions of

calorie ando
o
-
fats because lipids in children are important for the development of the nervous
system. In cases that are unresponsive to dietary restrictions, other classes of
antihyperlipidemic are used.
o
Adults
tor
Bile acid sequestrants are used in combination with HMG-CoA reductase inhibitors for patients
#
whose lipid levels are challenging to normalize with the use of HMG-CoA reductase inhibitors
alone.
D-
However, for pregnant women, bile acid sequestrants are the drug of choice in lowering
cholesterol and lipid levels.
•
Older adults
The impact of lipid-lowering agents in older adults is not supported by any outcome data.
-
Instead, in taking care of this age group, reinforcement of lifestyle changes is given focus.
Older adults are instructed on drugs that= can’t be cut, crushed, and chewed.
Pharmacokinetics
0
Not absorbed systemically and is excreted in the feces.
Contraindications and Cautions

Allergy to bile acid sequestrants. Prevent severe hypersensitivity reactions.
Complete biliary obstruction. Prevent bile from being secreted into the intestines.
Abnormal intestinal function. Aggravated by the presence of bile acid sequestrants.
D-
Pregnancy and lactation. Potential decrease in absorption of fat and fat-soluble vitamins can
be detrimental to fetus or neonate.
Adverse Effects
The adverse effects of bile acid sequestrants nurses need to watch out for are as follows:
CNS: headache, anxiety, fatigue, drowsiness

GI: GI upset, constipation, fecal impaction, nausea, aggravated hemorrhoids
Hema: increased bleeding time, decreased production of clotting factors us Antiplatelet
Musculoskeletal: muscle aches, muscle pains
Anticoagulant .
Other: rash, fat-soluble vitamin deficiencies
Interactions slow down your body 's

Anticoagulantprocess
→
- failure * of making dots .
warfarin
☐
Bile acid sequestrants delay the-
absorption of thiazide diuretics, corticosteroids, digoxin, → heparin or
Cuomadin)
_
warfarin, and thyroid hormones. Therefore, if needed, these drugs are taken 1 hour before or
D- ( alto called
Tyantiwagwa#
4-6 hours after a meal.
blood alk called
Nursing Considerations
* Antiplatelet →
preventfrom dumping together
platelets
to form a dot .
Here are important nursing considerations when administering bile acid sequestrants: → aspirin and clopidogrel who have
taken by people
→ mainly heart attack or stroke
.
Nursing Assessment had a
These are the important things the nurse should include in conducting assessment, history taking,
and examination:
Assess for the mentioned contraindications to prevent potential adverse effects.

Conduct thorough physical assessment before beginning drug therapy to establish
baseline status, determine effectivity of therapy and evaluate potential adverse effects.
-
E-
-
Obtain baseline status for weight while noting recent manifestations that increases or
decreases to determine patient’s fluid status.
Assess neurological status, particularly orientation and alertness to determine any CNS
effects.
Assess bowel elimination patterns, including frequency of stool passage and stool
characteristics to monitor the development of constipation and possible fecal impaction.
Assess closely patient’s heart rate and blood pressure to identify cardiovascular changes
that may warrant change in drug dose
Inspect abdomen for distention and auscultate bowel sounds to assess for changes in GI
motility.
-
Monitor results of laboratory tests, particularly serum cholesterol and lipid levels to evaluate
the effectiveness of drug therapy.
Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
Acute pain related to CNS and GI effects

Risk for injury related to CNS drug effects and potential for bleeding
-
Altered elimination pattern related to constipation
Implementation with Rationale
These are vital nursing interventions done in patients who are taking bile acid sequestrants:
Administer powdered agents already mixed with fluids to ensure drug effectiveness.
Instruct client not to chew, crush, and cut tablets because these drugs are meant to be
broken down in the intestines and premature crushing will render active ingredients ineffective.
⑥
Administer drug before meals to ensure that drug is in the GI tract together with food.
Administer other drugs 1 hour before or 4-6 hours after bile acid sequestrants to avoid
drug interactions.
Arrange for a bowel program to effectively address constipation if it ever occurs.
Instruct patient to increase oral fluid intake and dietary fiber intake to prevent
constipation.
Provide comfort measures (e.g. small frequent meals for GI upset and instituting safety
measures for =drowsiness and weaknesses) to help patient tolerate drug effects.
Educate patient on drug therapy including drug name, its indication, and adverse effects to
watch out for to enhance patient understanding of drug therapy and thereby promote
adherence to drug regimen.
Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
Monitor patient response to therapy (serum lipid and cholesterol levels).

Monitor for adverse effects (e.g. headache, vitamin deficiency, and increased bleeding times.
Evaluate patient understanding on drug therapy by asking the patient to name the drug, its
indication, and adverse effects to watch for.
Monitor patient compliance to drug therapy.
Stops / blocks
HMG-CoA Reductase ⊖
Inhibitors bipitor
D-
This drug group increases the cell absorption of LDL by blocking the enzyme (HMG-CoA
reductase) regulating the rate-limiting step in the synthesis of cholesterol. With this alteration
-Goodcho1ertI
in fat metabolism, HDL increases slightly.
Drugs under this classification are chemically-modified compounds from the products of
fungi.
Therapeutic Action
In a sense, HMG-CoA reductase inhibitors 0block the completion of cholesterol synthesis in the
-
body.
These are primarily indicated as adjunct medicine with diet and exercise for treatment of high
cholesterol and LDL levels in the blood.
Indications
- - - o
Pravastatin, lovastatin, and simvastatin are indicated for patients with documented CAD to
slow progression of the disease. pitor
@
Together with these three agents, atorvastatin is used as prophylaxis for first myocardial
-
infarction attack for patients with multiple risk factors for CAD.
Er t attack
•
Children
Treatment for familial hypercholesterolemia for this age group is strictly limited to tight dietary
→
restrictions from fats and calories because lipids in this age group are important for
the development of nervous system.
◦
Adults
HMG-CoA reductase inhibitor is the drug - e

of choice for patients who have multiple risk factors
or have already developed CAD.
_
The importance of lifestyle changes (e.g. dietary restrictions, regular exercise, and smoking
cessation) should be emphasized to this age group.
This class is well-tolerated and is less expensive compared to other classes with the same
therapeutic effect. For cases who are slow to respond to this class alone, combination therapy
with niacin, fibrate, and bile acid sequestrants is instituted.
-
PREGNANCY CATEGORY X For women who are pregnant, this drug class is contraindicated
(pregnancy category X).
Ee
Older adults
Are more susceptible to drug toxicity because of underlying conditions that would interfere
with metabolism and excretion of drug.
Importance of mentioned lifestyle changes should also be emphasized.
Pharmacokinetics
Route Onset Peak Duration
Oral Slow 1-2 h 20-30 h
T1/2: 14 h
Metabolism: liver
Excretion: bile

Allergy to HMG-CoA reductase inhibitors. Prevent severe hypersensitivity reactions.
Active liver disease. Exacerbated by drug’s therapeutic effect and has potential to lead to
severe liver failure.
Pregnancy, lactation. Potential for drug adverse effects to fetus or neonate.
Impaired endocrine function. Problems can arise due to alteration in the formation of steroid
hormones.
Renal impairment. Caution is given to patients taking other statins and close monitoring in
instituted. Atorvastatin is not affected by renal diseases.
Adverse Effects
CNS: headache, dizziness, insomnia, fatigue, blurred vision, cataract development
CV: increased risk for cardiovascular effects with simvastatin started at 80 mg for new
patients
GI: flatulence, nausea, vomiting, cramps, abdominal pain, constipation
Hepatobiliary: increase liver enzymes, acute liver failure with use of atorvastatin and
fluvastatin
Interactions
Cyclosporine, erythromycin, gemfibrozil, niacin, antifungal drugs: increased risk for
rhabdomyolysis
Digoxin, warfarin: increased serum levels and resultant toxicity of HMG-CoA reductase
inhibitors
Oral contraceptives: increased serum estrogen
Grapefruit juice: increased serum levels and resultant toxicity
Here are important nursing considerations when administering HMG-CoA reductase inhibitors:
Nursing Assessment
and examination:
Assess for the mentioned contraindications to this drug (e.g. hypersensitivity, acute liver
disease, pregnancy etc.) to prevent potential adverse effects.
Conduct thorough physical assessment before beginning drug therapy to establish
baseline status, determine effectivity of therapy, and evaluate potential adverse effects.
Assess neurological status with particular focus on consciousness, reflexes, and affect.
Assess closely patient’s heart rate and blood pressure to identify cardiovascular changes
that may warrant change in drug dose.
Assess bowel patterns to determine possibility of developing constipation and resultant fecal
impaction.
Nursing Diagnoses
Disturbed sensory perception related to CNS effects

Risk for injury related to CNS effects

These are vital nursing interventions done in patients who are taking HMG-CoA reductase inhibitors:
Administer drug at bedtime to maximize effectiveness of the drug because peak of

_
cholesterol synthesis is from midnight to 5 AM. However, atorvastatin can be given at any hour
of the day.
Monitor serum cholesterol and LDL levels to determine effectiveness of drug therapy.
Monitor results of liver functions tests to determine possible liver damage.
Ensure patient has initiated a 3-6 month diet and exercise program before initiating drug
therapy to ensure need for drug therapy.
Emphasize the importance of lifestyle changes to the patient to decrease risk of CAD and
promote drug effectiveness.
Provide comfort and safety measures to help patient tolerate drug side effects.
watch out for to enhance patient understanding on drug therapy and thereby promote
Evaluation
Monitor patient response to therapy as evidenced by normal serum cholesterol and LDL levels,
absence of first MI, and slowing of CAD progression.
Monitor for adverse effects (e.g. cataracts, rhabdomyolysis, and acute liver disease).
Evaluate patient understanding on drug therapy by asking patient to name the drug, its
Cholesterol Absorption Inhibitors

O
Cholesterol absorption inhibitors are one of the new class of drugs approved (2003) to lower
-
serum cholesterol levels.

-
A controversy is linked to this drug because a study in 2008 failed to show positive benefits of
combining this class to statins. However, further studies are needed to validate this alleged
lack of effect of cholesterol-lowering agents.
Therapeutic Action
The therapeutic action of cholesterol absorption inhibitors are as follows:
Acting on the brush border of intestines, cholesterol absorption inhibitorsoblock the absorption
=
-
of dietary cholesterol. Consequently, less cholesterol goes to the liver and it increases the
-
cholesterol clearance to make up for the drop.
Indications
Cholesterol absorption inhibitors are indicated as follows:
-
Adjunct to diet and exercise as a monotherapy or in combination with HMG-CoA inhibitors or
-
bile acid sequestrants.

-
Used in combination with statins to treat homozygous familial hypercholesterolemia.
a-
Children
Not indicated for this age group.
e-
Adults
Used in combination with HMG-CoA inhibitors or bile acid sequestrants.

-
The importance of lifestyle changes (e.g. dietary restrictions, regular exercise, and smoking
cessation) should be emphasized to this age group.
Effect to fetuses and neonates is not known.
o_O
Older adults
Importance of mentioned lifestyle changes should also be emphasized.
Pharmacokinetics
Route Onset Peak
Oral Moderate 4-12 h
T1/2: 22 h
Metabolism: liver, small intestine
Excretion: urine, feces

Cholesterol absorption inhibitors are contraindicated with the following:
Allergy to cholesterol absorption inhibitors. Prevent severe hypersensitivity reactions.

Liver disease, pregnancy, lactation: not used if combined with statins because of the effects
of statins to these health conditions. Effect of this class to fetuses and neonates is not known.
Adverse Effects
The adverse effects of cholesterol absorption inhibitors are as follows:
CNS: headache, dizziness, fatigue

Respiratory: upper respiratory tract infection (URI)
GI: mild abdominal pain, diarrhea
Musculoskeletal: muscle aches and pains, back pain
Interactions
Assess the interaction of the drug with the following:
Cholestyramine, fenofibrate, antacid, gemfibrozil: elevated serum level of cholesterol

Utied to prevent organ rejection during
absorption inhibitors
- organ transplant cheat,
liar kidney
, 1) Immunosuppressant agent
Cyclosporine: increased toxicity of cholesterol absorption inhibitors
Fibrates: increased risk for development of cholelithiasis
Warfarin: increased serum warfarin levels
Here are important nursing considerations when administering cholesterol absorption inhibitors:
Nursing Assessment
and examination:
disease, pregnancy etc.). To prevent potential adverse effects.
Conduct thorough physical assessment before beginning drug therapy. To establish
baseline status, determine effectivity of therapy and evaluate potential adverse effects.
Assess neurological status. Give with a particular focus on orientation and reflexes to
determine CNS drug effects.
Assess closely patient’s heart rate and blood pressure. To identify cardiovascular changes
that may warrant a change in drug dose.
Assess bowel patterns. To determine the possibility of developing constipation and resultant
fecal impaction.
Monitor laboratory test results of serum cholesterol, LDL, and liver function. To
determine the potential for drug adverse effects and monitor effectiveness of therapy.
Nursing Diagnoses

Acute pain related to side-effect of drugs as evidenced by headache, myalgia, and GI distress
-
Risk for injury related to CNS effects true

pain
These are vital nursing interventions done in patients who are taking cholesterol absorption inhibitors:
Monitor serum cholesterol and LDL levels. To determine the effectiveness of drug therapy.
Monitor results of liver functions tests. To determine possible liver damage.
Ensure patient has initiated a 3-6 month diet and exercise program before initiating drug
therapy. To ensure the need for drug therapy.
Emphasize the importance of lifestyle changes. To the patient to decrease the risk of CAD
and promote drug effectiveness.
Provide comfort and safety measures. To help patient tolerate drug side effects.
Educate patient on drug therapy. Include in the teaching plan the drug name, its indication,
and adverse effects to watch out for to enhance patient understanding of drug therapy and
thereby promote adherence to the drug regimen.
Evaluation
Monitor patient response to therapy as evidenced by normal serum cholesterol and LDL
levels.
Monitor for adverse effects (e.g. muscle pains, respiratory infections, headache).
Practice Quiz: Antihyperlipidemic Drugs

Quiz time! Take our 7-item quiz about antihyperlipidemic drugs–perfect practice quiz for your NCLEX
exam!
O
1. Lipid levels of individuals with coronary artery disease (CAD) is usually high. All of the
following are factors of CAD, except:
A. Men
B. Gout
C. Untreated Chlamydia infections
÷
D. None of the above
2. Antihyperlipidemic agent that is used to decrease plasma cholesterol levels.
A. HMG-CoA reductase inhibitors

B. Phosphodiesterase inhibitors
C. Bile acid sequestrants
D. Cholesterol absorption inhibitor
3. A pregnant woman needs a lipid-lowering agent. What would be the best class of lipid-
lowering agent for pregnant women?
A. HMG-CoA reductase inhibitors
:
B. Bile acid sequestrants
C. Cholesterol absorption inhibitors
D. Phosphodiesterase inhibitors
← a-
4. The only statin with outcome data to show effectiveness in decreasing CAD and incidence of
myocardial infarction.
A. atorvastatin (Lipitor)
B. simvastatin (Zocor)
C. pravastatin (Pravachol)
D. fluvastatin (Lescol)
5. Which of the following medical conditions will render antihyperlipidemics ineffective?

:
A. biliary obstruction
B. diabetes mellitus
C. both A and B
D. none of the above
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6. This drug works on the brush border of the intestines.
A. ezetimibe
B. pitavastatin
C. gemfibrozil
D. colestipol
-
7. A patient who is taking a bile acid sequestrant complains of abdominal distention and
nausea. What should the nurse do?
A. Document, withdraw drug, and notify doctor.

B. Provide comfort measures.
C. Prepare emergency equipment at bedside.
D. Dismiss the complaint.
=
8. What vitamin plays a role in lowering cholesterol concentration?
A. Vitamin C
B. Vitamin E
C. Vitamin B3
D. Vitamin B2
9. When should statins be taken to maximize its therapeutic effects?
A. After meals
B. During meals
C. At night
D. In the mornings
÷
10. The doctor ordered atorvastatin for an obese client’s hyperlipidemia. This patient is
receiving erythromycin for a toe infection at the same time. The nurse knows that this
combination should be avoided because?
A. It increases risk of atorvastatin toxicity.

B. It can result to potentially fatal lipolysis.
C. It can result to breakdown of muscles.
D. It decreases the effectiveness of erythromycin.
Answers and Rationale
1. Answer: D. None of the above.
The incidence of CAD in men is higher than premenopausal women. Gout injures the blood vessels
because of accumulation of uric acid. Untreated bacterial infections can also contribute to CAD.
2. Answer: C. Bile acid sequestrants.
Bile acid contains a lot of cholesterol and bile acid sequestrants bind to them to form an insoluble
complex that is then excreted in the feces.
3. Answer: B. Bile acid sequestrants.
This is the drug of choice for women of childbearing age. HMG-CoA reductase inhibitor is pregnancy
category X.
4. Answer: C. pravastatin (Pravachol).
Pravastatin is an HMG-CoA reductase inhibitor that can prevent first MI even in patients who do not
have documented increase in cholesterol concentration.
5. Answer: A. biliary obstruction.
This condition can interfere with the mechanism of action of the drug, thereby reducing its
effectiveness.
6. Answer: A. ezetimibe.
It belongs to cholesterol absorption inhibitor class and by acting on the brush border of the
-
intestines, absorption of cholesterol is not allowed.
-
7. Answer: B. Provide comfort measures.
GI discomforts as evidenced by abdominal distention, nausea, and vomiting are common complaints
-
by patients taking bile acid sequestrants. The nurse should provide comfort measures to help
patients tolerate drug effects.
8. Answer: C. Vitamin B3.
@
Niacin is used as a treatment for hyperlipidemia that does not respond to diet and weight loss.
_
9. Answer: C. At night.
It is when the liver is processing the most lipids (midnight to 5 AM).
=
-
tenant
10. Answer: C. It can result in breakdown of muscles.
u¥gup
pimm
Rhabdomyolysis can occur if statins are combined with erythromycin, cyclosporine, and antifungal
=
.
drugs. Waste products from this muscle breakdown injure glomeruli and can lead to acute renal
failure.
Recommended Resources
Recommended resources and reference books. Disclosure: Includes Amazon affiliate links.
1. Focus on Nursing Pharmacology – Easy to follow guide for Pharmacology

2. NCLEX-RN Drug Guide: 300 Medications You Need to Know for the Exam – Great if you’re
reviewing for the NCLEX
3. Nursing 2017 Drug Handbook (Nursing Drug Handbook) – Reliable nursing drug handbook!
4. Lehne’s Pharmacology for Nursing Care – Provides key information on commonly used
drugs in nursing
5. Pharmacology and the Nursing Process – Learn how to administer drugs correctly and
safely!
6. Pharm Phlash Cards!: Pharmacology Flash Cards – Flash Cards for Nursing Pharmacology
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HOME » NOTES » ANTACIDS
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Antacids Exams
UPDATED ON MAY 3, 2022 BY MARIANNE BELLEZA, R.N.
Study Notes
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News
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Learn about the different antacids in this nursing pharmacology study guide.
e-
Antacids are used to chemically react with and neutralize the acid in the stomach. They can provide
rapid relief from increased acid levels. They are known to cause GI alterations such as diarrhea or
_
constipation and can alter the absorption of many drugs.

Feline indigestion & heartburn
1. Antacids: Generic and Brand Names

2. Disease Spotlight: Ulcer Disease
3. What are antacids?
4. Therapeutic actions
5. Indication
6. Pharmacokinetics
7. Contraindications and Cautions
8. Adverse effects
9. Interactions
10. Nursing considerations
10.2. Nursing Diagnosis and Care Planning
10.3. Nursing Implementation with Rationale
10.4. Evaluation
11. Practice Quiz: Antacids
13. See Also
Antacids: Generic and Brand Names
Here is a list of the most commonly encountered antacids and their brand names.
Classification Generic name Brand name
Antacids aluminum salts AlternaGEL
calcium salts Oystercal, Tums
magaldrate Losopan, Riopan
magnesium salts Milk of Magnesia, others
sodium bicarbonate Bell-ans
Disease Spotlight: Ulcer Disease
I
a-
Erosions in the lining of the stomach and adjacent areas of the GI tract are called peptic ulcer.
Ulcer patients present with a predictable description of gnawing, burning pain often occurring
a few hours after meals.
Many of the drugs that are used to affect GI secretions are designed to prevent, treat, or aid in
the healing of these ulcers.
Further research led many to believe that, because acid production was often normal in ulcer
patients, ulcers were caused by a defect in the mucous lining that coats the inner lumen of the
stomach to protect it from acid and digestive enzymes.
Treatment was aimed at improving the balance between the acid produced and the mucous
layer that protects the stomach lining.
What are antacids?

e-
2-
Antacids are a group of inorganic chemicals that neutralize stomach acid.
Antacids are available OTC, and many patients use them to self-treat a variety of GI symptoms.
The choice of an antacid depends on adverse effects and absorption factors.
Therapeutic actions
The desired actions of antacids include the following:
Neutralize stomach acid by direct chemical reaction.

Symptomatic relief of an upset stomach associated with hyperacidity, as well as the
hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity,
and hiatal hernia.
Indication
Antacids are indicated for the following:
Symptomatic relief of GI hyperacidity, treatment of hyperphosphatemia, prevention of

formation of phosphate urinary stones.
Treatment of calcium deficiency, prevention of hypocalcemia.
Prophylaxis of stress ulcers, relief of constipation.
Pharmacokinetics
Many of these antacids are available in combination forms to take advantage of the acid-neutralizing
-
effect and block adverse effects.

-
Oral Rapid 30 min 1-3h
IV Immediate Rapid Unknown
T 1/2: Unknown
Excretion: Unchanged in urine

The following are contraindications and cautions when using antacids:
Allergy. The antacids are contraindicated in the presence of any known allergy to antacid
products or any component of the drug to prevent hypersensitivity reactions.
Co-morbidities. Caution should be used in the following instances: any condition that can be
exacerbated by electrolyte
- -
or acid-based imbalance to prevent exacerbations and serious
adverse effects; any electrolyte imbalance , which could be exacerbated by the electrolyte-
changing effects of these drugs; GI obstruction which could cause systemic absorption of the
drugs and increase adverse effects; renal dysfunction, which could lead to electrolyte
disturbance if any absorbed antacid is neutralized properly.
Pregnancy and lactation. Antacids are contraindicated for pregnant and lactating women
because of the potential for adverse effects on the fetus or neonate.
Adverse effects
Adverse effects when using antacids include:
GI: Gastric rupture.

Systemic alkalosis: headache, nausea, irritability, weakness, tetany, confusion.
Misc: Hypokalemia.
Interactions
Antacids can greatly affect the absorption of drugs from the GI tract.
Alkalinity. Most drugs are prepared for an acidic environment, and an alkaline environment
-
can prevent them from being broken down for absorption or can actually neutralize them so
that they cannot be absorbed.
Nursing considerations
Nursing considerations for a patient using antacids include the following:
Nursing Assessment
History taking and physical exam in a patient using antacids include:
Assess for possible contraindications and cautions: any history of allergy to antacids to
prevent hypersensitivity reactions; renal dysfunction, which might interfere with the drug’s
excretion; electrolyte disturbances, which could be exacerbated by effects of the drug; and
current status of pregnancy or lactation due to possible effects on the fetus or newborn.
Perform a physical examination to establish baseline data before beginning therapy, determine
the effectiveness of the therapy, and evaluate for any potential adverse effects associated with
the drug.
Inspect the abdomen; auscultate bowel sounds to ensure GI motility.
Assess mucous membrane status to evaluate potential problems with absorption and
hydration.
Monitor laboratory test results, including serum electrolyte levels and renal function tests, to
monitor for adverse effects of the drug and potential alterations in excretion that may
necessitate dose adjustment.
Nursing Diagnosis and Care Planning

Nursing diagnoses related to drug therapy might include the following:
Diarrhea related to GI effects.

Risk for constipation related to GI effects.
Imbalanced nutrition: less than body requirements related to GI effects.
Risk for imbalanced fluid volume related to systemic effects.
Deficient knowledge regarding drug therapy.
Nursing Implementation with Rationale

The nursing interventions for patients using antacids are:
Adequate drug absorption. Administer the drug apart from any other oral medications
approximately 1 hour before or 2 hours after to ensure adequate absorption of the other
medications.
→
Ensure therapeutic levels. Have the patient chew tablets thoroughly and follow with water to
ensure that therapeutic levels reach the stomach to=decrease acidity.
Perform diagnostic testing. Obtain specimens for periodic monitoring of serum electrolytes
to evaluate drug effects.
Prevent imbalances. Assess the patient for any signs of acid-base or electrolyte imbalance to
ensure early detection and prompt interventions.
Institute a bowel program. Monitor the patient for diarrhea or constipation to institute a
bowel program before severe effects occur.
Ensure adequate nutritional status. Monitor the patient’s nutritional status if diarrhea is
severe or constipation leads to decreased food intake to ensure adequate fluid and nutritional
intake to promote healing and GI stability.
Provide patient support. Offer support and encouragement to help the patient cope with the
disease and the drug regimen.
Educate the patient. Provide thorough patient teaching, including the drug name and
prescribed dose, schedule for administration, signs and symptoms of adverse effects and
measures to prevent or minimize them, warning signs that may indicate possible problems and
the need to notify the health care provider immediately.
Evaluation
Evaluation of a patient using antacids include:
Monitor patient response to the drug (relief of GI symptoms caused by hyperacidity).

Monitor for adverse effects (GI effects, imbalances in serum electrolytes, and acid-base
status).
Evaluate the effectiveness of the teaching plan (patient can name the drug and dosage, as well
as describe the adverse effects to watch for, specific measures to avoid them, and measures
to take to increase the effectiveness of the drug).
Monitor the effectiveness of comfort measures and compliance with the regimen.
Practice Quiz: Antacids

Here’s a 5-item quiz from our nursing test bank about antacid study guide. Please visit our nursing
test bank page for more NCLEX practice questions.
1. Which of the following statements describes the action of antacids?

A. Antacids block the production of gastric acid
B. Antacids enhance the action of acetylcholine
C. Antacids block dopamine
D. Antacids neutralize gastric acid
1. Answer: D. Antacids neutralize gastric acid
e-
Option D: Antacids act to bring the pH above 3.
Options A, B, and C: Other choices are incorrect because they describe actions of antiacid
drugs.
2. Patient Gavin is taking antacids, which instruction would be included in the teaching plan?
A. “Avoid taking other medications within 2 hours of this one.”

B. “Continue taking antacids even when pain subsides.”
C. “Weigh yourself daily when taking this medication.”
D. “Take the antacids with 8 oz of water.”
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2. Answer: A. “Avoid taking other medications within 2 hours of this one.”
Option A: The client should be instructed to avoid taking other medications within 2 hours of
the antacid.
Option B: A histamine receptor antagonist should be taken even when the pain subsides.
Option C: Daily weights are indicated if the client is taking a diuretic, not an antacid.
Option D: Water, which dilutes the antacid, should not be taken with an antacid.
3. Nurse Victoria is teaching a group of middle-aged men about peptic ulcers. When
discussing risk factors for peptic ulcers, the nurse should mention:
A. A history of hemorrhoids and smoking

B. A sedentary lifestyle and smoking
C. Alcohol abuse and smoking
D. Alcohol abuse and a history of acute renal failure
3. Answer: C. Alcohol abuse and smoking
Option C: Risk factors for peptic (gastric and duodenal) ulcers include alcohol abuse,
smoking, and stress.
Options A & B: A sedentary lifestyle and a history of hemorrhoids aren’t risk factors for peptic
ulcers.
Option D: Chronic renal failure, not acute renal failure, is associated with duodenal ulcers.
4. Which of the following tests can be used to diagnose ulcers?
A. Barium swallow
B. Abdominal x-ray
C. Esophagogastroduodenoscopy (EGD) Endoscopy
D. Computed tomography (CT) scan
4. Answer: C. Esophagogastroduodenoscopy (EGD)
Option C: The EGD can visualize the entire upper GI tract as well as allow for tissue specimens and
electrocautery if needed.
-
O
Option A: The barium swallow could locate a gastric ulcer.
-
Options B and D: A CT scan and an abdominal x-ray aren’t useful in the diagnosis of an ulcer.
5. The hospitalized client with GERD is complaining of chest discomfort that feels like
heartburn following a meal. After administering an ordered antacid, the nurse encourages the
client to lie in which of the following positions?
A. On the stomach with the head flat

B. Supine with the head of the bed flat
C. On the right side with the head of the bed elevated 30 degrees
D. On the left side with the head of the bed elevated 30 degrees
5. Answer: D. On the left side with the head of the bed elevated 30 degrees.
Option D: The left side-lying position with the head of the bed elevated is most likely to give
relief to the client.
Options A, B, C: These include lying flat on the back or on the stomach after a meal or lying
on the right side.

drugs in nursing
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Antihistamines Exams
Study Notes
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causer the signs &
symptoms of allergy
☐
Antihistamines selectively block the effects of histamine at the histamine-1 receptor sites,
7-
-
decreasing the allergic response. Antihistamines are used for the relief of symptoms associated with
seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and
angioedema.
Learn about the uses and nursing care plan considerations and nursing diagnoses needed for
patients taking antihistamines in this nursing pharmacology study guide.
1. Antihistamines: Generic and Brand Names

2. Disease Spotlight: Seasonal Rhinitis
3. What are Antihistamines?
4. Therapeutic Actions
5. Indication of Antihistamines
6. Pharmacokinetics of Antihistamines
8. Adverse Effects of Antihistamines
9. Interactions
10. Nursing Considerations for Antihistamines
10.4. Evaluation
11. Practice Quiz: Antihistamines
13. See Also
Antihistamines: Generic and Brand Names

Here is a table of commonly encountered antihistamines, their generic names, and brand names:
First generation brompheniramine Bidhist
carbinoxamine Histex, Palgic
chlorpheniramine Aller-Chlor, others
clemastine Tavist
cyclizine Marezine
cyproheptadine (generic)
dexchlorpheniramine (generic)
dimenhydrinate Dimetabs, others
diphenhydramine 0
Benadryl, others
hydroxyzine Vistaril, others
①
meclizine Nantes , Vomiting , Dizziness
Motion
// site wear
Antivert
promethazine Phenergan
triprolidine Zymine
Second generation (nonsedating) azelastine Astelin
0
cetirizine Zyrtec
desloratadine Clarinex
fexofenadine Allegra
levocetirizine Xyzal
E-
loratadine Claritin
Disease Spotlight: Seasonal Rhinitis

Seasonal rhinitis is an inflammation of the nasal cavity, commonly called hay fever, that afflicts
many people.
This condition occurs when the upper airways respond to a specific antigen (e.g., pollen, mold,
dust) with a vigorous inflammatory response, resulting again in nasal congestion, sneezing,
=
-
-
stuffiness, and watery eyes.

-
What are Antihistamines?

Antihistamines ◦ block the release or action of histamine, a chemical released during inflammation
J
that increases secretions and narrows airways.
Antihistamines are found in multiple OTC preparations that are designed to relieve respiratory
-
-
symptoms and treat allergies.
When choosing an antihistamine, the individual patient’s reaction to the drug is usually the
governing factor.
e-
Because first-generation antihistamines have greater anticholinergic effects with resultant
-
←
drowsiness, a person who needs to be alert should be given one of the second-generation,
less sedating antihistamines.
o
Because of their OTC availability, these drugs are often misused to treat colds and influenza.
-
Therapeutic Actions
The desired actions of antihistamines are as follows:
o
Selectively block the effects of histamine at the histamine-1 receptor sites, decreasing the
-
allergic response.
Anticholinergic (atropine-like) and antipruritic effects.
↳ antidote for cholinergicithy
-
drug
Indication of Antihistamines
Antihistamines are indicated for the following:
Relief of symptoms of seasonal and perennial allergic rhinitis, allergic conjunctivitis,

-
uncomplicated urticarial, and angioedema.

Relief of nasal and non-nasal symptoms of seasonal and perennial allergic rhinitis.
Relief of discomfort associated with dermographism; used as adjunctive therapy in
=
anaphylactic reactions.
Relief of nausea and vomiting associated with motion sickness. vomiting nausea dizziness
↳⇒g( , ,
Pharmacokinetics of Antihistamines
The antihistamines are well-absorbed orally, with an onset of action ranging from 1 to 3 hours.
-
Route Onset Peak Onset
Oral 15-30 min 1-4h 4-7h
IM 20-30 min 1-4h 4-7h
IV Rapid 30-60 min 4-8h
T 1/2: 2.5 to 7 hours | Metabolization: Liver | Excretion: Urine

The following are contraindications and cautions when using antihistamines:
Pregnancy and lactation. Antihistamines are contraindicated during pregnancy and lactation
unless the benefit to the mother clearly outweighs the potential risk to the fetus or baby.
Renal or hepatic impairment. They should be used with caution in renal or hepatic
impairment, which could alter the metabolism and excretion of the drug.
Arrhythmias. Special care should be taken when these drugs are used by any patient with a
I
history of arrhythmias or prolonged QT intervals because fatal cardiac arrhythmias have been
associated with the use of certain antihistamines and drugs that increase QT intervals,
including erythromycin.
> irregular heartbeat
Adverse Effects of Antihistamines

Adverse effects from the use of antihistamines include:
CNS: Drowsiness and sedation.

GI: Drying of the GI mucous membranes, GI upset, nausea.
GU: Dysuria, urinary hesitancy.
Skin: Skin eruption and itching.
Interactions
Interactions involved in the use of antihistamines include:
Monoamine inhibitor (MAOI). Anticholinergic effects may be prolonged if diphenhydramine is

-
taken with a monoamine inhibitor.

Ketoconazole/erythromycin. Interaction of fexofenadine with ketoconazole or erythromycin
may raise fexofenadine concentrations to toxic levels.
Nursing Considerations for Antihistamines

Nursing considerations for a patient using antihistamines include the following:
Nursing Assessment
History taking and examination of a patient using antihistamines may include the following:
Assess for possible contraindications or cautions: any history of allergy to antihistamines;

pregnancy and lactation; and prolonged QT interval, which are contraindications to the use of
the drug; and renal or hepatic impairment, which requires cautious use of the drug.
Perform a physical examination to establish baseline data for assessing the effectiveness of
-
the drug and the occurrence of any adverse effects associated with the drug therapy.
Assess the skin color, texture, and lesions to monitor for anticholinergic effects or allergy.
Evaluate orientation, affect, and reflexes to monitor for changes due to CNS effects.
Assess respirations and adventitious sounds to monitor drug effects.
Evaluate renal and liver function tests to monitor for factors that could affect the metabolism
or excretion of the drug.

Nursing diagnoses and nursing care plans related to medical therapy with an antihistamine may
include:
Acute pain related to GI, CNS or skin effects of the drug.

Disturbed sensory perception (Kinesthetic) related to CNS effects.

Nursing interventions for patients using antihistamines include the following:
e-
Proper administration. Administer drug on an empty stomach, 1 hour before or 2 hours after
-
meals, to increase the absorption.

-
Drug effectiveness. Note that the patient may have a poor response to one of these agents
but a very effective response to another; the prescriber may need to try several different
agents to find the one that is most effective.
Relief from dry mouth. Because of the drying nature of antihistamines, patients often
experience dry mouth, which may lead to nausea and anorexia; suggest sugarless candies or
lozenges to relieve some of the discomforts.
Safety measures. Provide safety measures as appropriate if CNS effects occur to prevent
patient injury.
Increase fluid intake. Increase humidity and push fluids to decrease the problem of thickened
secretions and dry nasal mucosa.
Ensure voiding. Have
problem.
- O
patient void before each dose to decrease urinary retention if this is a
-
Skin care. Provide skin care as needed if skin dryness and lesions become a problem to
prevent skin breakdown.
Avoid alcohol. Caution the patient to avoid alcohol while taking these drugs because serious
sedation can occur.
Avoid OTC drugs. Caution the patient to avoid excessive dose and to check OTC drugs for the
presence of antihistamines, which are found in many OTC preparations and could cause
toxicity.
Health teaching. Provide thorough patient teaching, including the drug name and prescribed
dosage measure to help avoid adverse effects, warning signs that may indicate problems, and
the need for periodic monitoring and evaluation, to enhance patient knowledge about the drug
therapy and promote compliance.
Encourage patient support. Offer support and encouragement to help the patiente- cope with
the disease and the drug regimen.
-
Evaluation
Evaluation of a patient using antihistamines include:
Monitor patient response to the drug (relief of the symptoms of allergic rhinitis).
Monitor for adverse effects (skin dryness, GI upset, sedation and drowsiness, urinary
retention, thickened secretions, glaucoma).
Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse
effects to watch for, specific measures to avoid them, and measures to take to increase the
effectiveness of the drug.
Monitor the effectiveness of comfort and safety measures and compliance with the regimen.
Practice Quiz: Antihistamines

Here’s a 5-item quiz for this antihistamine study guide. Please visit our nursing test bank page for
1. A nurse is giving teachings to a client receiving Desloratadine (Clarinex). Which of the

following statements made by the client will need further instructions?
A. “I can eat gum after I drink the medicine”

B. “I can take the medicine on an empty stomach“
C. “I should avoid using alcohol”
D. “I will avoid driving while using this medication”
1. Answer: B. “I can take the medicine on an empty stomach”.

E-
Option B: This medicine should be taken with food or milk to minimize gastrointestinal upset.
Option A: Use gum or hard candy to minimize dry mouth.
Options C and D: The medication causes drowsiness so avoid taking alcohol or engaging in
activities which require mental alertness such as driving a car.
2. Nurse Zeke is giving instructions to her client who is taking antihistamine. Which of the
→
following nurse teachings is appropriate for the client?
A. Expect a relief in 24 hours

B. Be aware that you may have →
increased saliva dry mouth
C. Be aware that you may need to take a decongestant
D. Avoid ingesting alcohol
2. Answer: D. Avoid ingesting alcohol.
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Option D: Because alcohol and antihistamines have sedating properties, concurrent

administration of these drugs should be avoided.
Option A: Not all antihistamines last 24 hours.
Option B: Dry mouth is a common side effect, not increased salivation.
-
Option C: Antihistamines and decongestants are often given together.
3. Andrew has vertigo, which antihistamine is best for his condition?

↳ lipongzx
A. Terfenadine
B. Guaifenesin
C. Meclizine
D. Hydrocodone
3. Answer: C. Meclizine.
↳ Motion sickness
•
Option C: Meclizine (Antivert) is given for vertigo and motion sickness.
-
Option A: Terfenadine is an antihistamine, but meclizine is the standard drug in the treatment
of vertigo.
Option B and D: Choices C and D are not antihistamines.
4. Raul, a 20-year-old student, used to buy OTC drugs whenever he feels sick. Which of the
following statements best describes the danger of self-medication with over-the-counter
drugs?
A. Clients are not aware of the action of over-the-counter drugs.

B. Clients are not aware of the side effects of over-the-counter drugs.
C. Clients minimize the effects of over-the-counter drugs because they are available without a
prescription.
D. Clients do not realize the effects of over-the-counter drugs.
4. Answer: C. Clients minimize the effects of over-the-counter drugs because they are
available without a prescription.
Option C: This choice is correct because it includes the other three risks noted in choices A,
B, and D.
5. Which histamine-2 antagonist is associated with the most drug interactions?
A. Prilosec
B. Nizatidine
C. Ranitidine
D. Cimetidine
5. Answer: D. Cimetidine.
Option D: Cimetidine was the first histamine-2 antagonist developed and is associated with the most
O
toxic drug interactions of the group.
-

drugs in nursing
safely!
See Also
Here are other nursing pharmacology study guides:
Nursing Pharmacology – Study Guide for Nurses
Gastrointestinal System Drugs
Antacids
Histamine-2 Antagonists
Proton Pump Inhibitors
Respiratory System Drugs
Antihistamines
Bronchodilators and Antiasthmatics
Decongestants
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HOME » NOTES » ANTITUSSIVES
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Antitussives Exams
Study Notes
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Antitussives are drugs thatD-suppress the cough reflex. Persistent coughing can be exhausting and
can cause muscle strain and further irritation of the respiratory tract. Many disorders of the
→
respiratory tract are accompanied by an uncomfortable, unproductive cough. Coughing is a naturally
protective way to clear the airway of secretions or any collected material, and antitussives prevent
these actions.
Learn about the uses and nursing care plan considerations needed for patients taking antitussives in
this nursing pharmacology study guide.
1. Common Antitussives and Its Generic Names

2. Disease Spotlight: The Common Colds
3. What are antitussives?
4. Therapeutic actions of antitussives
5. Indication of antitussives
6. Pharmacokinetics
8. Adverse Effects
9. Interactions
10. Nursing Considerations for Antitussives
10.3. Nursing Interventions with Rationale
10.4. Evaluation
11. Practice Quiz: Antitussives
13. See Also
14. Sources and References
Common Antitussives and Its Generic Names

Here is a table of commonly encountered antitussives, their generic names, and brand names:
Antitussives benzonatate O
Tessalon
O
codeine codeine
dextromethorphan Benylin
hydrocodone Hycodan
Disease Spotlight: The Common Colds

The viruses that cause the common cold invade the tissues of the upper respiratory tract, initiating
the release of histamine and prostaglandins, causing an inflammatory response.
As a result of the inflammatory response, the mucous membranes become engorged with
blood, the tissues swell, and the goblet cells increase the mucus production.
These effects cause the person with a common cold to complain of sinus pain, nasal
=
Seasonal rhinitis thiamine :)
congestion, runny nose, sneezing, watery eyes, scratchy throat, and headache.
The swelling can block the outlet of the eustachian tube, which drains the inner ear and
equalizes pressure across the tympanic membrane.
If this outlet becomes blocked, feelings of ear stuffiness and pain can occur.
What are antitussives?

-
O
Antitussives act on the cough-control center in the medulla to suppress the cough reflex; if the
-
cough is nonproductive and irritating, an antitussive may be taken.

Therapeutic actions of antitussives
The desired actions of antitussives are as follows:
Acts directly on the medullary cough center of the brain to depress the cough reflex.
Because they are=
-
centrally acting, they are not the drugs of choice for anyone who has a head
injury or could be impaired by central nervous system depression.
Indication of antitussives
Antitussives are indicated for the following:
Local anesthetic on the respiratory passages, lungs, and pleurae, blocking the effectiveness of
the stretch receptors that stimulate a cough reflex.
For relief of moderate to moderately severe pain.
For the treatment of dry cough, drug withdrawal syndrome, opioid type drug dependence, and
pain. ↳ NSAID ( pain)
Pharmacokinetics
Codeine, hydrocodone, and dextromethorphan are rapidly absorbed, metabolized in the liver, and
- -
excreted in urine; they cross the placenta and enter breast milk.
Oral 25-30 minutes 2 hours 3-6 hours
Metabolism: Liver
Excretion: Urine

The following are contraindications and cautions for the use of antitussives:
Patent airways. Patients who need to cough to maintain the airways (e.g., postoperative
patients and those who have undergone abdominal or thoracic surgery) to avoid respiratory
canter shortness
distress. breath
of
Asthma and emphysema. Patients with asthma and emphysema are contraindicated because
cough suppression could lead to • accumulation of secretions and a loss of respiratory reserve.
=
Addiction. Patients who are hypersensitive to or have a history of addiction to narcotics;
codeine is a narcotic and has addiction potential
Sedation. Patients who need to drive or be alert should use codeine, hydrocodone, and
dextromethorphan with extreme caution because these drugs can cause sedation and
drowsiness.
Pregnancy. Patients who are pregnant and lactating, because of the potential for adverse
effects on the fetus or baby, including sedation and CNS depression.
Adverse Effects
Adverse effects from the use of antitussives include:
CNS: Drowsiness and sedation.

GI: Nausea, constipation, dry mouth, GI upset.
Interactions
Interactions involved in the use of antitussives are:
Antidepressant
g)
Monoamine oxidase inhibitors (MAOI). Dextromethorphan should not be used with MAOIs
±
because hypotension, fever, nausea, myoclonic jerks, and coma could occur.
Nursing Considerations for Antitussives

The nursing considerations in administering antitussives include:
Nursing Assessment
Assessment and history taking in a patient using antitussives include the following:
Assess for possible contraindications and cautions (e.g., history of allergy to the drug, cough
for more than 1 week, and pregnancy and lactation).
Perform a physical examination to establish baseline data.
Monitor the temperature to evaluate for possible underlying infection.
Assess respirations and adventitious sounds.
Evaluate=orientation and affect.

The following nursing diagnoses related to antitussive drug therapy may be included in your nursing
care plans:
Ineffective airway clearance related to excessive drug effects.

Disturbed sensory perceptions related to CNS effects.
Nursing Interventions with Rationale

The nursing interventions essential for patients using antitussive medications are:
:
Prevent overdosage. Ensure that the drug is not taken any longer than recommended to
prevent serious adverse effects and severity respiratory tract problems.
Assess underlying problems. Arrange for further medical evaluation for coughs that persist
or are accompanied by high fever, rash, or excessive secretions; To detect the underlying
cause of coughing, and to arrange for appropriate treatment of the underlying problem.
Provide other relief measures from cough. These nursing interventions may include
humidifying the room, providing fluids, use of lozenges, and cooling room temperature.
Educate the patient. Provide thorough patient teaching, including the drug name and
prescribed dosage, measures to help avoid adverse effects, warning signs that may indicate
problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge
about drug therapy and promote compliance.
Provide emotional support. Offer support and encouragement to help the patient cope with
the disease and the drug regimen.
Evaluation
Evaluation of a patient using antitussives include the following:
Monitor patient response to the drug (control of non-productive cough).

Monitor for adverse effects (respiratory depression, dizziness, sedation).
Evaluate the effectiveness of the teaching plan.
Monitor the effectiveness of other measures to relieve cough.
Practice Quiz: Antitussives
Here’s a 5-item exam for this antitussive study guide. Please visit our nursing test bank page for
1. Stephanie will be having her exam in pharmacology tomorrow. She should be aware that
antitussive is indicated to:
A. Encourage removal of secretions through coughing

B. Relieve rhinitis Decongestant
C. Relieve a dry cough Antitussive
D. Control a productive cough
✓ Expectorant
1. Answer: C. Relieve a dry cough.
→
Option C: An antitussive is a cough suppressant.
Options A and D: Represents the action of an expectorant.
portion of the
@
Option B: Describe the action of a decongestant. lungs involved in
exchange
2. Which of the following pathophysiological mechanisms that occur in the lung parenchyma
allows pneumonia to develop?
]
A. Atelectasis
Collapse sa
B. Bronchiectasis airway
C. Effusion Accumulation of excess pleural fluid
D. Inflammation
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2. Answer: D. Inflammation.
Option D: The common feature of all type of pneumonia is an inflammatory pulmonary

response to the offending organism or agent.
⇐
-
Options A and B: Atelectasis and bronchiectasis indicate a collapse of a portion of the airway
that doesn’t occur in pneumonia.
Option C: An effusion is an accumulation of excess pleural fluid in the pleural space, which
may be a secondary response to pneumonia.
Too
3. Antitussives are useful in blocking the cough reflex and preserving the energy associated
with prolonged, nonproductive coughing. Antitussives are best used with the following except:
A. Postoperative patients
B. COPD patients who tire easily
C. Patients with a dry, irritating cough
D. Asthma patients
3. Answer: D. Asthma patients.
Option D: Patients with asthma need patent airways which coughing could provide.
Options A, B, and C: These conditions may warrant the use of antitussives.
4. Antitussives are indicated for which of the following patients?
A. Timothy who has difficulty of breathing

B. David who has just recovered from narcotine addiction History X
C. Aubry who has dry cough
D. Kelley who is pregnant
4. Answer: C. Aubry who has dry cough.
Option C: One of the indications of administration of antitussives is a nonproductive, irritating

-
-
-
cough.
e-
Option A: Antitussives suppress the cough reflex which could compromise the airway of
someone who has difficulty of breathing.
Option B: Narcotine addiction is a contraindication for administering of antitussives.
Option D: Antitussives are contraindicated for a patient who is pregnant.
5. Use of antitussives is associated with which of the following adverse effects?
I
A. Drowsiness
B. Constipation
C. Nausea
D. All of the above
5. Answer: D. All of the above.
Options A, B, and C: All of these symptoms are adverse effects of antitussives.

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HOME » NOTES » NURSING PHARMACOLOGY » EXPECTORANTS AND MUCOLYTICS
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Expectorants and Mucolytics Exams
Study Notes
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g)
o
#
Expectorants are drugs that liquefy the lower respiratory tract secretions. They are used for the
symptomatic relief of respiratory conditions characterized by a dry, nonproductive cough.
Mums
Mucolytics work to break down mucus to aid high-risk respiratory patients in coughing up thick,
tenacious secretions. Fema
Learn about the uses and nursing care plan considerations needed for patients taking expectorants
and mucolytics in this nursing pharmacology study guide.
1. Expectorants and Mucolytics: Generic and Brand Names

2. Disease Spotlight: Chronic Obstructive Pulmonary Disease
3. Expectorants
3.1. What are Expectorants?
3.2. Therapeutic actions
3.3. Indications of Expectorants and Mucolytics
3.6. Adverse effects
4. Mucolytics
4.1. Description
4.2. Therapeutic Actions
4.3. Indications
5. Nursing Considerations for Expectorants and Mucolytics
5.4. Evaluation
6. Practice Quiz: Expectorants and Mucolytics
8. See Also
Expectorants and Mucolytics: Generic and

Brand Names
Here is a table of commonly encountered expectorant and mucolytics, their generic names, and
brand names:
•÷
Expectorant guaifenesin Mucinex
①
Mucolytic Pampagawat ng
pkma
acetylcysteine Mucomyst
dornase alfa Pulmozyme
Disease Spotlight: Chronic Obstructive

Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a permanent, chronic obstruction of the
◦
-
-
airways, often related to -

cigarette smoking.
e
COPD is caused by two related disorders- emphysema and chronic bronchitis- both of which
result in airflow obstruction on expiration, as well as overinflation of the lungs and poor gas
exchange.
o
-
Emphysema is characterized by loss of the elastic tissue of the lungs, destruction of alveolar
Cantor shortness of breath
-
walls, and resultant alveolar hyperinflation with a tendency to collapse with expiration.
←
Chronic bronchitis is a permanent inflammation of the airways with mucus secretion, edema,
and post inflammatory defenses.
Expectorants
What are Expectorants?
Expectorants increase productive cough to clear the airways.
÷
They liquefy lower respiratory tract secretions, reducing the viscosity of these secretions and
making it easier to cough them up.
Expectorants are available in many OTC preparations, making them widely available to the
patient without advice from a health care provider.
Therapeutic actions
The desired actions of expectorants include:
Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface
tension of these fluids, allowing easier movement of the less viscous secretions.
Indications of Expectorants and Mucolytics

Expectorants are indicated for the following:
Symptomatic relief of respiratory conditions characterized by a dry, nonproductive cough.
Pharmacokinetics
e-
Guaifenesin is rapidly absorbed, with an onset of 30 minutes and a duration of 4 to 6 hours.
Oral 30 min Unknown 4-6h
T 1/2: Unknown | Metabolization: Unknown | Excretion: Unknown

The following are contraindications and cautions when using expectorants:
0
Allergy. This drug should not be used in patients with a known allergy to the drug to prevent
hypersensitivity reactions.
±
Pregnancy or lactation. This drug should be used with caution in pregnancy and lactation
because of the potential adverse effects on the fetus or baby.
a-
Cough. This drug should not be used with persistent coughs, which could be indicative of an
underlying medical problem.
Adverse effects
Adverse effects from the use of expectorants:
GI: Nausea, vomiting, anorexia.

CNS: Headache, dizziness.
Underlying cough: The most important consideration in the use of these drugs is discovering
the cause of the underlying cough; prolonged use of the OTC preparations could result in the
masking of important symptoms of a serious underlying disorder.
Respiratory: Rhinorrhea, bronchospasm.
Skin: Rash.
Mucolytics
Description
0
Mucolytics increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk
-
respiratory patients who are coughing up thick, tenacious secretions.
Patients may be suffering from conditions such as chronic obstructive pulmonary disease
(COPD),= cystic fibrosis, pneumonia, or tuberculosis.
Therapeutic Actions
The desired actions of mucolytics include: anti-inflammatory
'
7 ex: paracetamol
- 0
Protect liver cells from being damaged during episodes of acetaminophen toxicity because it
D-
normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of
acetaminophen.
Affects the mucoproteins in the respiratory secretions by splitting apart disulfide bonds that
are responsible for holding the mucus material together.
The result is a decrease in the tenacity and viscosity of the secretions.
-
Dornase alfa is a mucolytic prepared by recombinant DNA techniques that selectively break
down respiratory tract mucus by separating extracellular DNA from proteins.
Indications
Mucolytics are indicated for the following:
Liquefaction of secretions in high-risk respiratory patients who have difficulty moving

secretions including postoperative patients (e.g., patients with tracheostomies to facilitate
-
airway clearance and suctioning).

Clearing of secretions for diagnostic tests (e.g., diagnostic bronchoscopy).
Used orally to protect the liver from acetaminophen toxicity.
Treatment of atelectasis from thick mucus secretions.
9.to or partial collapse
of an entire hang
Pharmacokinetics
-
Mucolytics may be administered by nebulization or by direct instillation into the trachea via an
endotracheal tube or tracheostomy. Intubation
-
Instilation inhalation 1 min 5-10 min 2-3h
Oral 30-60 min 1-2h Unknown
T 1/2: 6.25 hours | Metabolization: Liver | Excretion: Urine

The following are contraindications and cautions when using mucolytics:
cid
Medical conditions. Caution should be used in cases of acute bronchospasms, peptic ulcer,
-
and esophageal varices because the increased secretions could aggravate the problem.
Adverse Effects
Adverse effects from the use of expectorants and mucolytics include the following:
GI: Nausea, vomiting, anorexia.

CNS: Headache, dizziness.
Underlying cough: The most important consideration in the use of these drugs is discovering
the cause of the underlying cough; prolonged use of the OTC preparations could result in the
masking of important symptoms of a serious underlying disorder.
Respiratory: Rhinorrhea, bronchospasm.
Skin: Rash.
Nursing Considerations for Expectorants and

Mucolytics
Nursing considerations when using expectorants and mucolytics include the following:
Nursing Assessment
History taking and physical examination of a patient using expectorants and mucolytics include:
Assess for possible contraindications and cautions: any history of allergy to the drug;
persistent cough due to smoking, asthma, or emphysema, which would be cautions to the use
of the drug; and very productive cough, which would indicate an underlying problem that
should be evaluated.
Perform a physical examination to establish baseline data for assessing the effectiveness of
-
the drug and the occurrence of any adverse effects associated with the drug therapy.
Assess the skin for the presence of lesions and color to monitor for any adverse reactions.
Monitor temperature to assess for underlying infection.
Assess respirations and adventitious sounds to evaluate the respiratory response to the drug
↳ wheezing stridor
effects. ,
Monitor orientation and affect to monitor CNS effects of the drug.

Monitor blood pressure and pulse to evaluate cardiac response to drug treatment.

Nursing diagnoses related to the use of expectorants or mucolytics are:
Acute pain related to GI, CNS, or skin effects of the drug.
Disturbed sensory perception (Kinesthetic) related to CNS effects.
Ineffective airway clearance related to bronchospasm.

The nursing interventions for patients using expectorants include:
E- e-
Proper administration. Caution the patient not to use these drugs for longer than 1 week and
to seek medical attention if the cough persists after that time to evaluate for any underlying
medical condition and to arrange for appropriate treatment.
Prevent GI upset. Advise the patient to take small, frequent meals to alleviate some of the GI
discomfort associated with these drugs.
Ensure safety. Advise the patient to avoid driving or performing dangerous tasks if dizziness
and drowsiness occur to prevent patient injury.
Avoid overdosage. Alert the patient that these drugs may be found in OTC preparations and
that care should be taken to avoid excessive doses.
Provide health education. Provide thorough patient teaching, including the drug name and
about drug therapy and to promote compliance.
o
Offer support. Offer support and encouragement to help the patient cope with the disease
and with the drug regimen.
Nursing interventions for patients using mucolytics include:

=
y
tic
Ensure drug effectiveness. Avoid combining other drugs in the nebulizer to avoid the
formation of precipitates and potential loss of effectiveness of either drug.
Proper drug delivery. Dilute concentrate with sterile water for injection if buildup becomes a
-
problem that could impede drug delivery.

Prevent skin breakdown. Note that patients receiving acetylcysteine by face mask should
have the residue wiped off the face mask and off the face with plain water to avoid skin
breakdown.
Proper use of nebulizer. Review use of the nebulizer with patients receiving dornase alfa at
home to ensure the most effective use of the drug.
Proper storage. Patients should be cautioned to store the drug in the refrigerator, protected
from light.
Dornase alfa use. Caution cystic fibrosis patients receiving dornase alfa about the need to
-
e-
continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy
that improves respiratory symptoms, and other therapies are still needed.
Provide health education. Provide thorough patient teaching, including the drug name and
about drug therapy and to promote compliance.
Provide support. Offer support and encouragement to help the patient cope with the disease
and with the drug regimen
Evaluation
Evaluation of a patient using expectorants and mucolytics include the following:
Monitor patient response to the drug (improved effectiveness of cough).

Monitor for adverse effects (skin rash, GI upset, bronchospasm, CNS effects).
Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse
effects to watch for, specific measures to avoid them, and measures to take to increase the
effectiveness of the drug).
Monitor the effectiveness of comfort and safety measures and compliance with the regimen.
Practice Quiz: Expectorants and Mucolytics

Here’s a 5-item quiz for this expectorants and mucolytics study guide. Please visit our nursing test
bank page for more NCLEX practice questions.
1. A client is prescribed with Guaifenesin (Mucinex). The nurse determines that the client
understands the proper administration of this medication if the client states that he or she will:
A. Take an additional dose once fever and cough persist

B. Limit oral fluid intake
C. Drink extra fluids while taking this medication
D. Take the medication with meals only
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1. Answer: C. Drink extra fluids while taking this medication
o -
lubricate the throat while taking this medication

o
Option C: Guaifenesin is an expectorant. Drink extra fluids to help loosen the congestion and
-
Option A: Additional doses should not be taken without the prescription of the doctor.
- o
Option B: Fluids are needed to loosen the secretions.
-
Option D: The medication does not have to be taken with meals.
bronchodilators
eaergic
2. A nurse is about to administer Albuterol (Ventolin HFA) 2 puff and Budesonide (Pulmicort
Turbohaler) 2 puff by metered dose inhaler. The nurse plans to administer by?
A. Alternating with a single puff each, starting with albuterol.

B. Alternating with a single puff each, starting with budesonide.
C. Albuterol inhaler first then the budesonide.
D. Budesonide inhaler first then the albuterol.
2. Answer: C. Albuterol inhaler first then the budesonide.
Option C: If two different inhaled medications are prescribed and one of the medications
o
E-
contains a corticosteroid, administer the bronchodilator (Albuterol) first and the corticosteroid
(Budesonide) second; this will allow for the widening of the air passages by the bronchodilator,
-
making the corticosteroids more effective. dilator

Cho
3. A client with a chronic obstructive pulmonary disease is prescribed with Ipratropium

(Combivent). Upon reviewing the medical history of the patient, the nurse questions the
prescription if which of the following is noted?
A. History of a previous infection

B. History of allergy to peanut
C. History of allergy to egg
D. History of smoking
3. Answer: B. History of allergy to peanut.
•
Option B: The client with a peanut allergy should not take ipratropium because the product
contains soy lecithin, which is in the same plant family as peanuts.
-
4. The nurse should instruct a client who is taking an expectorant to:
A. Take antihistamines
B. Avoid vaporizers
C. Restrict fluids
D. Increase fluids
4. Answer: D Increase fluids.
o
Option D: Increasing fluids will help liquefy secretions and facilitate removal.
-
Option A: Taking antihistamines does not have any effect for the client.
Option B: Avoiding vaporizers would not help in liquefying secretions.
Option C: Restricting fluids could not help in mobilizing the secretions.
5. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client
indicated a need for further teaching? tic
A. Inhales the mist and quickly exhales.

B. Presses the canister down with finger as he breathes in.
C. Removes the cap andO shakes the inhaler well before use.
-
•
D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.
5. Answer: A. Inhales the mist and quickly exhales.
o
Option A: The client should be instructed to hold his or her breath at least 10 to 15 seconds
before exhaling the mist.
Options B, C, D: These are all correct procedures when using an inhaler.

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HOME » NOTES » NURSING PHARMACOLOGY » DIURETICS
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Diuretics Exams
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Diuretics are drugs that primarily increase the excretion of sodium. To some extent, they also
-
increase the volume of urine produced by the kidneys.
By blocking the absorptive capacity of cells lining the renal tubules for sodium, intravascular volume
and the eventual leaking of fluid from capillaries is reduced and prevented.
It is used in the management of diseases like glaucoma, hypertension, and edema in heart failure,
-
-
-
liver failure, and renal diseases.
1. Diuretics: Generic and Brand Names

2. Disease Spotlight: Edema, Hypertension, and Glaucoma
3. Thiazide and Thiazide-like Diuretics
3.2. Indication
3.6. Interactions
4. Loop Diuretics
4.2. Indications
4.6. Interactions
5. Carbonic Anhydrase Inhibitors
5.2. Indications
5.6. Interactions
6. Potassium-Sparing Diuretics
6.2. Indications
6.6. Interactions
7. Osmotic Diuretics
7.2. Indications
8. Nursing Considerations for Diuretic Drugs
8.2. Nursing Diagnoses
8.3. Implementation with Rationale
8.4. Evaluation
9. Practice Quiz: Diuretic Agents
11. See Also
Diuretics: Generic and Brand Names

Here is a table of commonly encountered diuretic agents, their generic names, and brand names:
Thiazide diuretics
Thiazide diuretics bendroflumethiazide Naturetin
:
chlorothiazide Diuril
hydrochlorothiazide HydroDIURIL
hydroflumethiazide Saluron
methyclothiazide Enduron
Thiazide-like diuretics chlorthalidone Hygroton
indapamide Lozol
metolazone Mykrox, Zaroxolyn
Loop diuretics bumetanide Bumex
ethacrynic acid Edecrin
%
furosemide Lasix
torsemide Demadex
Carbonic Anhydrase Inhibitors acetazolamide Diamox
methazolamide Glauctabs, MZM, Neptazane
Potassium-sparing Diuretics amiloride Midamor

spironolactone Aldactone
triamterene Dyrenium
0
Osmotic Diuretics 0
mannitol Osmitrol
↳↓↑¥ʰ¥%::
Disease Spotlight: Edema, Hypertension, and
Glaucoma
Edema is the accumulation of fluids in the interstitial spaces. It can be typically seen in patients with
=_
heart failure (HF), cirrhosis and other liver diseases, and renal diseases.
Edema in HF is caused by activation of the renin-angiotensin system due to an inefficient

pumping activity of the heart. As a result, blood volume increases and sodium is retained.
-__
Cirrhosis and other liver diseases present with edema because of two reasons: 1) reduced
-
plasma protein production leading to decreased oncotic pressure (pressure that holds the fluid
in); and 2) portal system obstruction due to hepatic vessel congestion.
Edema in renal diseases is because of damaged basement membrane which makes it possible
E- e
for plasma proteins to be lost into urine.
Hypertension is persistent higher-than-normal blood pressure and is primarily idiopathic (no known
cause). When not acted upon promptly, this can lead to multiple organ failure and severe
cardiovascular complications. Diuretic agents are used in management of hypertension to reduce
=
blood pressure by decreasing circulating fluid volume and sodium.
Glaucoma is an eye disease that is characterized by increased intraocular pressure (IOP), which is
the pressure inside the eyes. When not acted upon promptly, high IOP can damage optic nerve and
cause irreversible blindness. Diuretic agents are used in the management of glaucoma by enhancing
-
the
-
osmotic pull to effectively-
remove some fluid in the eye, decreasing the IOP.
-
A. Thiazide and Thiazide-like Diuretics

Thiazide diuretics belong to a chemical class of drugs called sulfonamides. Thiazide-like
-
diuretics have different chemical structure but work in the same mechanism as that of thiazide
diuretics.
This is among the most commonly used class of diuretics.
-
Therapeutic Action
It causes active pumping out of chloride from the cells lining the ascending limb of Loop of
=
-
Henle and distal tubule by blocking the chloride pump. Since sodium passively moves with
-
chloride to maintain electrical neutrality, both sodium and chloride are excreted in the urine.
-
Indication
◦
Considered to be a milder form of diuretics compared to loop diuretics.
=
First-line drugs for management of essential hypertension
Children
Has established pediatric dosing guidelines used for the treatment of edema in heart defects
and hepatorenal diseases; control of hypertension in children.
→
-
=
Effect of diuretics may be abrupt in children because of their rapid metabolism so caution is
exercised by careful monitoring of serum electrolyte changes and for evidence of fluid volume
changes.
◦
Adults
Are more likely to use diuretics on long-term basis and should be educated on warning signs
=
of fluid volume changes that need prompt medical attention.
e-
They should be instructed to weigh themselves daily to monitor for fluid retention or sudden
fluid loss.
Conditions that may aggravate fluid loss like vomiting, diarrhea, and profuse sweating should
_
be emphasized to them because these may change the need for diuretics.
Use of diuretics to influence fluid shifts in pregnant patients is not appropriate. However, it
should not be stopped if indicated for a specific medical cause provided that they are made
-
O
aware of the possible effects to the fetus. Lactating women should switch to an alternative
-
method of feeding as this drug may have potential effect to the baby.
←
Older adults
Have medical conditions where thiazide diuretics and thiazide-like diuretics are usually
indicated.
The possibility of older adult patients having renal and hepatic impairments requires health
care team to be cautious of the use of this drug.
The lowest dose possible is started initially and it is titrated slowly based on patient’s
-
response.
Frequent monitoring of serum electrolytes, activity level, and dietary intake is a must.
Pharmacokinetics
Oral 2h 4-6 h 6-12 h
T1/2: 5.6 – 14 h
Metabolism: liver
Excretion: urine

Allergy to loop diuretics. Prevent severe hypersensitivity reactions.
Fluid and electrolyte imbalances. Can be potentiated by the changes in fluid and electrolyte
levels caused by diuretics.
Severe renal failure, anuria. May prevent diuretics from working; can precipitate crisis stage
due to blood flow changes brought about by diuretics.
Systemic lupus erythematosus (SLE). Can precipitate renal failure because the disease
already causes changes in glomerular filtration.
Glucose tolerance abnormalities and diabetes mellitus. Worsened by glucose-elevating
effect of some diuretics
Gout. Already reflects abnormality in tubular reabsorption and secretion.
Liver disease. Could interfere with drug metabolism and lead to drug toxicity.
-
Bipolar disorder. Can be exacerbated by calcium changes brought about by the use of this
drug.
Pregnancy, lactation. Can cause potential adverse effects to the fetus and baby. Routine use
of this drug in pregnancy is not appropriate and should be used only when there is underlying
pathological conditions. For lactating
- O
women, an alternative method of feeding should be
-
instituted.
Adverse Effects
CNS: weakness
CV: hypotension, arrhythmias
GI: GI upset
GU: hypokalemia (can precipitate hyperglycemia), hypercalcemia, hyperuremia, slightly-
alkalinized urine (can lead to bladder infections)
Interactions
o must be taken separated by
Cholestyramine or colestipol: decreased absorption of diuretics;
-
at least 2 hours.
-
Digoxin: increased risk for digoxin toxicity because of changes in serum potassium levels
Quinidine: increased risk for quinidine toxicity
Antidiabetic agents: decreased
-
effectivity of antidiabetics
Lithium: increased risk for lithium toxicity
B. Loop Diuretics
→
This type of diuretics exerts its main effect on the loop of Henle. Hence, so named.
•
Referred to as high-ceiling diuretics because they are capable of causing greater degree of
diuresis compared to other types.
-
Therapeutic Action
← =
Blocks the action of chloride pump in the ascending limb of the loop of Henle, where 30% of
sodium is normally reabsorbed. This causes decreased reabsorption of chloride and sodium.
Exerts the same effect on the descending limb of loop of Henle and distal tubule causing
sodium-rich urine.
Indications
Indicated for treatment of acute HF, acute pulmonary edema, and edema associated with HF
-
←_=
or with renal or liver disease, and hypertension.
Drug of choice when rapid and extensive diuresis is needed. It can produce a fluid loss up to
20 pounds per day.
Proven to be effective even with the presence of acid-base disturbances, renal failure,
electrolyte imbalances, and nitrogen retention.
Also used in the treatment of pulmonary edema but its effect only influences the blood that
-
reaches the nephrons.

-
Ethacrynic acid is used less frequently in the clinical setting because newer drugs are more
potent and reliable.
◦
Children
Furosemide is used when a stronger diuretic is needed but dose should not be more than 6
mg/kg/d.
Ethacrynic acid is used in oral form in some situations buto
-
not in infants.
Bumetanide is generally not recommended for children but is indicated when the child is
taking other ototoxic drugs (e.g. antibiotics). It causes less hypokalemia and makes it ideal for
children taking digoxin at the same time.
◦
Adults
→
fluid loss.
Pregnant women
Use of diuretics to influence fluid shifts in pregnant patients is-

not appropriate. However, it
aware of the possible effects to the fetus.
-
e
Lactating women should switch to an alternative method of feeding as this drug may have
-
potential effect to the baby.
o
Older adults
indicated.
=
The ←lowest dose possible is started initially and it is titrated slowly based on patient’s
response.
Pharmacokinetics
Oral 60 min 60-120 min 6-8 h
IV, IM 5 min 30 min 2h
T1/2: 120 min

Metabolism: liver
Excretion: urine

Allergy to thiazides and sulfonamides. Prevent severe hypersensitivity reactions.
Electrolyte depletion. Can be potentiated by the changes in fluid and electrolyte levels
caused by diuretics.
Severe renal failure, anuria. Exacerbated by the effects of the drug.
Systemic lupus erythematosus (SLE). Can precipitate renal failure because the disease
already causes changes in glomerular filtration.
Glucose tolerance abnormalities and diabetes mellitus. Worsened by glucose-elevating
effect of some diuretics
Gout. Already reflects abnormality in tubular reabsorption and secretion.
Hepatic coma. Exacerbated by fluid shifts associated with drug use.
pathological conditions. For lactating women, an alternative method of feeding should be
instituted.
Adverse Effects
CNS: dizziness
CV: hypotension
GI: GI upset
GU: hypokalemia (can precipitate hyperglycemia), increased bicarbonate excretion (can lead
to alkalosis), hypocalcemia and tetany
EENT: ototoxicity, reversible loss of hearing
Eye , Ear, Nose Throat
,
Interactions
Aminoglycosides or cisplatin: increased ototoxicity effect of loop diuretics
Anticoagulants: increased anticoagulation effects
Indomethacin, ibuprofen, salicylates and other NSAIDs: decreased antihypertensive effects
and loss of sodium
• Carbonic Anhydrase Inhibitors

Relatively mild diuretics.
Therapeutic Action
.
Inhibits the action of the enzyme carbonic anhydrase, the catalyst for the formation of sodium
_
bicarbonate stored as alkaline reserve in the renal tubules and is important for the excretion of
=-
hydrogen.
o
It slows down the movement of hydrogen ions which leads to greater amount of sodium and
-
bicarbonate lost in the urine.
Indications
o
Most often used for the treatment of glaucoma. Inhibition of carbonic anhydrase results in
decreased secretion of aqueous humor of the eyes.
Also used as adjunct to other diuretics when more intense diuresis is needed.
o
Children
Not indicated for children
oAdults
fluid loss.
0Pregnant women
- O
-
O
Older adults
=
indicated.
•
response.
Pharmacokinetics
Oral 1h 2-4 h 6-12 h
Sustained-release oral 2h 8-12 h 18-24 h
IV 1-2 min 15-18 min 4-5 h
T1/2: 5-6 h
Metabolism: N/A
Excretion: urine (unchanged)

Allergy to carbonic anhydrase inhibitors, thiazides, antibacterial sulfonamides. Prevent
severe hypersensitivity reactions.
Chronic noncongestive angle-closure glaucoma. Not effectively treated by this drug.
Fluid and electrolyte imbalance, renal or hepatic disease, adrenocortical insufficiency,
respiratory acidosis, chronic obstructive pulmonary disease (COPD). Could be
exacerbated by fluid and electrolyte changes caused by these drugs.
instituted.
Adverse Effects
CNS: paresthesia, confusion, drowsiness
CV: hypotension
GU: hypokalemia (can precipitate hyperglycemia), increased loss of bicarbonate (can lead to
metabolic acidosis)
Interactions
Salicylate, lithium: increased excretion of these drugs
D. Potassium-Sparing Diuretics
sodium & secrete potassium
P retained
-
€
Less powerful than loop diuretics but they retain potassium instead of wasting it.
Typically used for patients who have high risk for hypokalemia associated with diuretic use.
Therapeutic Action spares

the potassium
D
This type of diuretics causes a loss of sodium while promoting the retention of potassium.
-
-000 =
-
Spironolactone acts as aldosterone antagonist which blocks the action of aldosterone in the
distal tubule. On the other hand, amiloride and triamterene block potassium secretion
through the tubule.
Indications
This is often used as adjuncts with thiazide or loop diuretics or in patients who are especially
at risk if hypokalemia develops.
←Spironolactone is the drug of choice for treating hyperaldosteronism typically seen in
-
patients with liver cirrhosis and nephrotic syndrome.
I
Children
Spironolactone is the only potassium-sparing diuretic recommended for children.

=
Adults
Instruct to avoid potassium-rich foods (e.g. avocados, bananas, broccoli, tomatoes, and dried
fruits) and to have regular monitoring of serum potassium levels.
Pregnant Women
I
Older adults
indicated.
=
response. Frequent monitoring of serum electrolytes, activity level, and dietary intake is a
must.
Pharmacokinetics
Oral 24-48 h 48-72 h 48-72 h
T1/2: 20 h
Metabolism: liver

Allergy to potassium-sparing diuretics. Prevent severe hypersensitivity reactions.
Hyperkalemia, renal disease, anuria. Exacerbated by the effects of the drug.
instituted.
Adverse Effects
CNS: lethargy, confusion, ataxia
CV: arrhythmias
Musculoskeletal: muscle cramps
GU: hyperkalemia, increased loss of bicarbonate (can lead to metabolic acidosis)
Associated with various androgen effects such as hirsutism, gynecomastia, deepening of the
-
voice, and irregular menses.
-
Interactions
Salicylates: decreased diuretic effect
⇐ Osmotic Diuretics
o
This type of diuretic exerts their therapeutic effect by pulling water into the renal tubule
_
without loss of sodium.

-
o
Only one osmotic diuretic is currently available, mannitol (Osmitrol).
Therapeutic Action
Mannitol is a sugar that is not well reabsorbed by the tubules and it acts to pull large amounts
of fluid into the urine due to the osmotic pull exerted by large sugar molecule.
This also pulls fluid into the vascular system from extravascular spaces like aqueous humor.
Indications
Mannitol is usually used in acute situations when it is necessary to decrease IOP before eye
surgery or during acute attacks of glaucoma.
Diuretic of choice in cases of increased cranial pressure or acute renal failure due to shock,
drug overdose, or trauma.
Also available as an irrigant in transurethral prostatic resection and other transurethral
procedures.
=
Children
Not indicated for children
Adults
- -
=
Pregnant women
Older adults
indicated.
=
The• lowest dose possible is started initially and it is titrated slowly based on patient’s
response. Frequent monitoring of serum electrolytes, activity level, and dietary intake is a
must.
Pharmacokinetics
IV 30-60 min 1h 6-8 h
Irrigant Rapid Rapid Short
T1/2: 15-100 min

Metabolism: N/A
Renal disease, anuria, pulmonary congestion, intracranial bleeding, dehydration, HF.
Exacerbated by large shifts in fluid related to drug use.
instituted.
Adverse Effects
CNS: light-headedness, confusion, headache
CV: hypotension, cardiac decompensation, shock
GI: nausea, vomiting
GU: fluid and electrolyte imbalance
Most common and potentially dangerous adverse effect related to an osmotic diuretic is the
sudden drop in fluid levels.
Nursing Considerations for Diuretic Drugs

Here are important nursing considerations when administering this drug:
Nursing Assessment
and examination:
Assess for the mentioned cautions and contraindications (e.g. drug allergies, fluid and
electrolyte disturbances, hepatorenal diseases, glucose tolerance abnormalities, etc.) to
prevent any untoward complications.
Perform a thorough physical assessment to establish baseline data before drug therapy
begins, to determine
- =
effectiveness of therapy, and to evaluate for occurrence of any adverse
effects associated with drug therapy.
Inspect skin (note presence of edema and status of skin turgor) to determine hydration status
and have a baseline data for effectiveness of drug therapy.
Assess cardiopulmonary status (blood pressure, pulse rate, heart and lung sounds, etc.) to
evaluate fluid movement and state of hydration. It is also to monitor the effects on the heart
and lungs.
Obtain an accurate body weight to provide baseline to monitor fluid balance.
-
Monitor intake and output and voiding patterns to evaluate fluid balance and renal function.
Evaluate liver status to determine potential problems in drug metabolism.
Monitor the results of laboratory tests (e.g. serum electrolyte levels especially potassium and
calcium, uric acid and glucose levels, etc.) to determine drug’s effect.
Monitor liver and renal function tests to identify need for possible dose adjustment and toxic
effects.
Nursing Diagnoses
Impaired urinary elimination related to drug effect

Imbalanced nutrition: less than body requirements related to GI upset and metabolic changes
Risk for deficient fluid volume related to increase fluid volume excretion
Risk for injury related to changes in fluid volume and electrolyte balance

These are vital nursing interventions done in patients who are taking diuretics:
Administer drug with food or milk if GI upset is a problem to buffer drug effect on the stomach
lining.
Administer intravenous diuretics slowly to prevent severe changes in fluid and electrolytes.
Administer oral form early in the day to prevent increased urination during sleep hours.
Monitor patient response to drugs through vital signs, weight, serum electrolytes and
hydration to evaluate effectiveness of drug therapy.
Assess skin condition to determine presence of fluid volume deficit or retention.
Provide comfort measures (e.g. skin care, nutrition referral, etc.) to help patient tolerate drug
effects.
Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
=
Educate client on drug therapy to promote compliance.
Evaluation
Monitor patient response to therapy (e.g. weight, urinary output, edema changes, blood
-
pressure).
Monitor for adverse effects (e.g. electrolyte imbalance, hyperglycemia, hyperuricemia, acid-
=
base disturbances, etc).
Practice Quiz: Diuretic Agents

Quiz time! Take our 5-item quiz about diuretic agents!
Questions
ADVERTISEMENTS
-
1. Most diuretics’ effect in the body is __________.
A. loss of sodium
B. loss of potassium
C. loss of calcium
D. retention of potassium
2. What is the only potassium-sparing diuretics that can be used in children?
diuretics
A. Furosemide p
B. Spironolactone
C. Amiloride
D. Triamterene
-
3. A patient receiving diuretics should alert the nurse if she feels the following:
A. insomnia
B. low-grade fever
C. muscle weakness
D. all of the above
÷
4. What is the first loop diuretic introduced?
A. Furosemide
B. Bumetanide
C. Torsemide
D. Ethacrynic acid
5. A patient admitted for cerebral swelling complained of feeling light-headed and nauseous
while receiving mannitol. What should the nurse do?
A. Document, withdraw, and notify doctor.

B. Decrease mannitol flow.
C. Provide comfort measures.
D. Increase mannitol flow.
1. Answer: A. loss of sodium.
Most diuretics prevent cells lining the renal tubules from reabsorbing an excessive proportion of the
sodium ions in the glomerular filtrate.
2. Answer: B. Spironolactone.
Potassium-sparing diuretics include spironolactone, amiloride, and triamterene. Both amiloride and
.
triamterene are not for use in children. Use of spironolactone in children would require careful
monitoring of electrolytes.
3. Answer: C. muscle weakness.
ÉÉ
This is a sign of hypokalemia and would require prompt intervention. Other signs and symptoms of
hypokalemia include arrhythmia and muscle cramps.
4. Answer: A. Furosemide
Furosemide was the first loop diuretic to be approved in the United States (1966) and is still
widely used today.
Ethacrynic acid was the second loop diuretic to be approved for use in the United States
(1967), but is now rarely used.
Bumetanide is a potent loop diuretic that was approved for use in the United States in 1983
and continues to be used for the treatment of edema.
Torsemide was approved for use in edema in the United States in 1993 and is still in common
use used for both edema and hypertension.
5. Answer: A. Document, withdraw, and notify doctor.
D-
A sudden drop in fluid level is one of the most potentially fatal adverse effects of mannitol.
Manifestations include hypotension, lightheadedness, nausea, and confusion.

drugs in nursing
safely!
See Also
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HOME » NOTES » NURSING PHARMACOLOGY » DRUGS AFFECTING COAGULATION (ANTICOAGULANTS, ANTIPLATELETS, THROMBOLYTICS)
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Drugs Affecting Coagulation Exams
(Anticoagulants, Antiplatelets, Study Notes
Thrombolytics) Online CAP

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These groups of drugs affect clot formation and resolution by hindering different steps in clotting
formation which include altering the formation of platelet plug (antiplatelet drugs), interfering the
clotting cascade and thrombin formation (anticoagulant drugs), and stimulating the plasmin system
-
to break down the formed clot (thrombolytic agents).
1. Coagulation Drugs: Generic and Brand Names

2. Disease Spotlight: Thromboembolic and Hemorrhagic Disorders
3. Antiplatelet Agents
3.2. Indications
3.6. Interactions
3.7.4. Evaluation
4. Anticoagulants
4.2. Indications
4.6. Interactions
4.7.4. Evaluation
5. Thrombolytic Agents
5.2. Indications
5.6. Interactions
5.7.4. Evaluation
6. Practice Quiz: Drugs Affecting Coagulation
8. See Also
Coagulation Drugs: Generic and Brand Names

Here is a table of commonly encountered antiplatelet, anticoagulant, and thrombolytic agents, their
generic names, and brand names:
-Antiplatelet agents 0
aspirin Aspro Clear, Disprin
cilostazol Pletal
dipyridamole Persantine
tirofiban Aggrastat
•
Anticoagulants •
warfarin •
Coumadin
dabigatran Pradaxa
rivaroxaban Xarelto
-
Thrombolytic Agents alteplase Activase
reteplase Retavase
tenecteplase TNKase
urokinase Abbokinase
Others:
-
Low-molecular weight heparins dalteparin Fragmin
enoxaparin a
Lovenox
tinzaparin Innohep
Anticoagulant adjunctive therapy lepirudin Refludan
protamine sulfate
0
vitamin K
Hemorrheologic agent pentoxifylline Trental
blocked artery canted by

Embolism →
such
foreign body
as
Disease Spotlight: Thromboembolic and a ,
air bubble
blood dot
-
or an .
Hemorrhagic Disorders
-
Disorders that directly affect coagulation process are divided into two main categories: 1)
thromboembolic disorders, which involveD- overproduction of clots; and 2) hemorrhagic disorders,
0=-0
which is characterized by ineffective clotting process leading to excessive bleeding.
Thromboembolic disorders include medical conditions (e.g. CAD) which involve overproduction of
clots which result into decreased
-
blood flow and total vessel occlusion. Manifestations include
hypoxia, anoxia, and even necrosis. These disorders are treated by drugs that interfere with normal
coagulation process to prevent formation of clots.
-
On the other hand, less common hemorrhagic disorders is characterized by excessive bleeding.
These are treated by drugs that promote the clotting process. Some of these conditions include:
8-
Hemophilia: characterized by genetic lack of clotting factors
=
Liver disease: characterized by non-production of proteins and clotting factors necessary for
clot formation
Bone marrow disorders: characterized by insufficient quantity of platelets rendering them
ineffective
A. Antiplatelet Agents
This drug class exerts its action by decreasing the responsiveness of platelets to stimuli that
=D
cause it to clump or aggregate. Through this, formation of platelet plug is decreased.
Therapeutic Action
By blocking receptor sites on the platelet membrane, platelet adhesion and aggregation is
inhibited.
Also, platelet-platelet interaction as well as interaction of platelets to clotting chemicals are
prevented.
Indications
AD → aspirin
Primarily indicated for cardiovascular diseases that have potential for development of vessel
occlusion.
Other indications include maintenance of arterial and venous grafts, preventing
÷:
cerebrovascular occlusion, and including them as adjunct to thrombolytic therapy for
treatment of myocardial infarction.
One drug, anagrelide, blocks the production of platelets in the bone marrow.
Children
Only heparin and warfarin are indicated for children but these drugs alone require careful dose
calculation.
÷
Adults
Caution is particularly important to prevent injury (e.g. using electric razor and soft-bristled
toothbrush).
It is also important that adults are educated on what to do should bleeding occurs (e.g.
applying firm pressure) as well as what signs of bleeding should be watched out for.
Other drugs taken should be documented because there are a lot of drug interactions with
these drug class. It should also be emphasized that periodic blood tests is expected to monitor
the effect of therapy.
Pregnant women
For pregnant women, it is not advisable unless the benefit to the mother would clearly
e-
outweigh the risk for the fetus. On the other hand, for lactating women, it is generally
inadvisable.
Older adults
Are more susceptible to drug toxicity and drug-to-drug interactions.

Careful monitoring of liver and kidney function is important for this age group.
Therapy is always started at the lowest level possible and adjusted accordingly.
Pharmacokinetics
Oral 5-30 min 0.25-2 h 3-6 h

T1/2: 15 min – 12 h
Metabolism: liver
Excretion: bile

Allergy to antiplatelet agents. Prevent severe hypersensitivity reactions.
Known bleeding disorder. Increased risk of excessive blood loss
Recent surgery. Increased risk of bleeding in unhealed blood vessels
Closed head injuries. Increased risk of bleeding in injured blood vessels of the brain
o
History of thrombocytopenia. Anagrelide decreased bone marrow production of platelets.
Pregnancy, lactation. Generally inadvisable because of potential adverse effects to fetus or
neonate
Adverse Effects
CNS: headache, dizziness, weakness
GI: GI distress, nausea
Skin: skin rash
Hema: bleeding (oftenly occurs while brushing the teeth)
Interactions
Increased risk of bleeding if combined with another drug that affects blood clotting.
Here are important nursing considerations when administering antiplatelet agents:
Nursing Assessment
and examination:
Conduct thorough physical assessment before beginning drug therapy to establish baseline
status, determine effectivity of therapy, and evaluate potential adverse effects.
Obtain baseline status for complete blood count and clotting studies to determine any
potential adverse effects.
Nursing Diagnoses

Acute pain related to CNS and GI effects
Risk for injury related to CNS effects and bleeding tendencies
These are vital nursing interventions done in patients who are taking antiplatelet agents:
Administer drug with meals to relieve GI upset.

Provide comfort measures for headache because pain due to headache may decrease patient
compliance to treatment regimen.
Educate patient on ways to promote safety like using electric razor, soft-bristled toothbrush,
and cautious movement because any injury at this point can precipitate bleeding.
Evaluation
Monitor patient response to therapy (e.g. increased bleeding time, prevention of occlusive
events).
Monitor for adverse effects (e.g. bleeding, headache, GI upset).
B. Anticoagulants
Bye-interfering with clotting cascade and thrombin formation, anticoagulants are able to
-
interfere with the normal clotting process.
Therapeutic Action
O
Warfarin, an oral agent in this class, reduces Vitamin K-dependent clotting factors. As a result,
-
clotting process is prolonged.
• o
Two new oral agents, dabigatran and rivaroxaban, directly inhibits thrombin (last step in
clotting process) and factor Xa, respectively.
o @
Heparin and antithrombin block formation of thrombin from prothrombin.
Indications
Among the many indications for this drug class include: stroke and systemic emboli risk
-
reduction, nonvalvular atrial fibrillation, and deep vein thrombosis.

Heparin is used for prevention of blood clots in blood samples, dialysis, and venous tubing. It
- _
also does not enter breastmilk so it is the- anticoagulant of choice for lactating women.
←
Antithrombin is a naturally-occurring anticoagulant and is a natural safety feature in the
clotting system.
o
Children
Only heparin and warfarin are indicated for children but these drugs alone require careful dose
e-
calculation.
Adults
-
toothbrush).
-
I
these drug class. It should also be emphasized that periodic blood tests is expected to monitor
the effect of therapy.
Pregnant women
outweigh the risk for the fetus. On the other hand, for lactating women, it is generally
inadvisable.
e-
Older adults

Pharmacokinetics
IV Immediate Minutes 2-6 h
Subcutaneous 20-60 min 2-4 h 8-12 h
T1/2: 30-180 min

Metabolism: cells
Excretion: urine

Allergy to anticoagulants. Prevent severe hypersensitivity reactions.
Known bleeding disorder, recent trauma/surgery, presence of indwelling catheters,
threatened abortion, GI ulcers. These conditions can be compromised by increased bleeding
tendencies.
Pregnancy, lactation. Warfarin is a contraindication.
Adverse Effects
→
"
Warfarin is associated with alopecia, dermatitis, bone marrow depression, and less frequently
- -
with prolonged and painful erections.

Direct drug toxicity is characterized by nausea, GI upset, diarrhea, and hepatic dysfunction.
- - - -
Interactions
Anticoagulants, salicylates, penicillin, cephalosporin: increased bleeding if combined with
-
heparin
Nitroglycerin: decreased anticoagulation if combined with heparin
Cimetidine, clofibrate, glucagon, erythromycin: increased bleeding if combined with warfarin
Vitamin K, phenytoin, rifampin, barbiturates: decreased anticoagulation if combined with
warfarin
Antifungals, erythromycin, phenytoin, rifampin: alteration in metabolism of dabigatran and
rivaroxaban beraiosis
Here are important nursing considerations when administering anticoagulants:
Nursing Assessment
and examination:
=
Obtain baseline status for complete blood count and clotting studies to determine any
potential adverse effects.
Nursing Diagnoses
Ineffective tissue perfusion related to blood loss

00
Disturbed body image related to direct drug toxicity characterized by rash and alopecia
Risk for injury related to bleeding tendencies and bone marrow depression

These are vital nursing interventions done in patients who are taking anticoagulants:
tiny spots of
bleeding under the
in the mucous membrane
q
.
Assess for signs signifying blood loss (e.g. petechiae, bruises, dark-colored stools, etc.) to
determine therapy effectiveness and promote prompt intervention for bleeding episodes.
Establish safety precautions (e.g. raising side rails, ensuring adequate room lighting, padding
sides of bed, etc.) to protect patient from injury.
Maintain antidotes on bedside (e.g.- O
protamine sulfate for heparin, Vitamin K for warfarin) to
-
-
promptly treat drug overdose.

Evaluate effectiveness by monitoring the following blood tests: prothrombin time (PT) and
international normalized ratio (INR) for warfarin; and whole blood clotting time (WBCT) and
activated partial thromboplastin time (APTT) for heparin.
Evaluation
Monitor patient response to therapy (e.g. increased bleeding time)

Monitor for adverse effects (e.g. bleeding, bone marrow depression, alopecia, etc.).
C Thrombolytic Agents
jibber
the at
.
Thrombolytic agents promote clot resolution, the process of activating the plasmin system to
Obreak down the thrombus or clot that has been formed.
-
Therapeutic Action
O
The conversion of plasminogen to plasmin is the body’s natural anticlotting system.
- -
Thrombolytic agents’ action to activate this promotes breakdown of fibrin threads and
dissolution of formed clots.
It is necessary to prevent vessel occlusion and therefore, to deliver adequate blood flow to
body systems.
Indications
For treatment of acute
-
MI, pulmonary embolism, and -acute ischemic stroke.
Also for clearing of occluded intravenous catheters and central venous access devices.
:
Children
Not indicated for this age group.
Adults
toothbrush).
these drug class.
It should also be emphasized that periodic blood tests is expected to monitor the effect of
therapy.
•
Pregnant women
outweigh the risk for the fetus.
o
On the other hand, for lactating women, it is generally inadvisable.
-
←
Older adults

Pharmacokinetics
IV Immediate End of injection N/A
T1/2: unknown
Metabolism: plasma
Excretion: unknown

Allergy to thrombolytics. Prevent severe hypersensitivity reactions.
Known bleeding disorder, recent trauma/surgery, acute liver disease, cerebrovascular
accident within 2 months, GI ulcers. These conditions can affect normal clotting factors and
normal plasminogen production.
Pregnancy, lactation. Potential adverse effects to fetus or neonate.
Adverse Effects
CV: cardiac arrhythmias, hypotension
Hema: bleeding (most common)
Hypersensitivity reaction (uncommon) is characterized by rash, flushing, and bronchospasm.
Interactions
Anticoagulant, antiplatelet: increased risk of bleeding
=
Here are important nursing considerations when administering thrombolytics:
Nursing Assessment
and examination:
ADVERTISEMENTS
disease, CVA within 2 months, etc.) to prevent potential adverse effects.
Obtain baseline status for complete blood count, fecal occult blood test (FOBT), and clotting
-
studies to determine any potential adverse effects.
Nursing Diagnoses
Decreased cardiac output related to cardiac arrhythmias and potential for bleeding
Risk for injury related to clot-dissolving effects

These are vital nursing interventions done in patients who are taking thrombolytics:
of
%di¥g
Assess for signs signifying blood loss (e.g. petechiae, bruises, dark-colored stools, etc.) to
determine therapy effectiveness and promote prompt intervention for bleeding episodes.
Establish safety precautions (e.g. raising side rails, ensuring adequate room lighting, padding
sides of bed, etc.) to protect patient from injury.
Evaluate effectiveness by monitoring coagulation studies to adjust drug dose appropriately.
Evaluation
Monitor patient response to therapy (e.g. dissolution of blood clot and return of blood flow)
Monitor for adverse effects (e.g. bleeding, anemias, hypotension, etc.).
Practice Quiz: Drugs Affecting Coagulation

Quiz time! Take our 3-item quiz about drugs affecting coagulation.
0
1. Which organ(s) produce(s) clotting factors?
A. Bone marrow
B. Spleen and other lymphoid tissues
O C. Liver
D. Both B and C
O
2. What is the first reaction to a blood vessel injury?
-
A. Vasodilation and swelling
÷
B. Vasoconstriction
C. Bleeding
D. Blood coagulation
3. Which of the following substances will alert the nurse for an increased risk of bleeding in a
patient taking clopidogrel?
A. Chamomile tea
B. Orange juice
C. Candied mushrooms
D. Peanuts
1. Answer: C. Liver.
The liver produces a cascade of clotting factors that contributes to the process of coagulation by
breaking down fibrinogen into insoluble fibrin threads.
2. Answer: B. Vasoconstriction.
O
This is especially helpful for very small injuries to the blood vessel because vasoconstriction can seal
-
-
off any break and allow the area to heal.
3. Answer: A. Chamomile tea.
#
Increased bleeding with no other cause or link found should lead to the possibility of herbal
interactions with drugs. Other herbal sources that can increase the risk of bleeding in patients taking
anticoagulants include psyllium, turmeric, garlic, ginkgo, chestnut seed, and goldenseal.

drugs in nursing
safely!
See Also
Antacids

Home
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HOME » NOTES » NURSING PHARMACOLOGY » ANTIANGINAL DRUGS
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Antianginal Drugs Exams
Study Notes
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NurseLife
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Follow us
ADVERTISEMENTS
-÷
Antianginal drugs are used primarily to restore the balance between the oxygen supply and demand
of the heart. These drugs dilate the coronary vessels to increase the flow of oxygen to the ischemic
=
regions. Other than that, they also decrease the workload of the heart so the organ would have less
demand for oxygen. Learn about antianginal drugs, nitrates, beta-blockers, and calcium channel
blockers in this simplified guide for nursing pharmacology.
1. Antianginal Drugs: Generic and Brand Names

2. Disease spotlight: Coronary Artery Disease
3. Nitrates
3.2. Indications
3.6. Interactions
3.7. Nursing Management
3.7.4. Evaluation
4. Beta-Adrenergic Blockers
4.1. Therapeutic action
4.2. Indications
4.6. Interactions
4.7.2. Nursing Diagnosis
4.7.4. Evaluation
5. Calcium-Channel Blockers
5.5. Interactions
5.6.2. Nursing Diagnosis
5.6.4. Evaluation
6. Practice Quiz: Antianginal Drugs
8. See Also
Antianginal Drugs: Generic and Brand Names

Nitrates and Nitrites amyl nitrate °

Vaporole
I
Isosorbide mononitrate Imdur, Monoket
Isosorbide dinitrate Isordil, Sorbitrate
Nitroglycerin Nitro-Bid, Nitrostat
Beta-adrenergic blockers acebutolol Sectral

•
esmolol Brevibloc
@
metoprolol high blood Toprol, Toprol XL
nadolol Corgard
0
propranolol Inderal, Lopressor
timolol Blocadren
Calcium-channel blockers amlodipine Norvasc
diltiazem left Diltiazem, Diltiazem SR
nicardipine Cardene
①
nifedipine BP labor (delay
,
labor) Adalat, Procardia
verapamil Calan, Isoptin
Others:
Piperazineacetamides ranolazine Ranexa
Nonnitrate coronary vasodilators dipyridamole Persantine
Disease spotlight: Coronary Artery Disease µ

Coronary Artery Disease (CAD) is the narrowing of blood vessels supplying oxygen and nutrients to
the heart, primarily due to the development of fatty tumors (atheromas) in the lumen of blood vessels
in a process called atherosclerosis.
This pathologic process attracts platelets and clotting factors to the area, causing a much
larger obstruction to the vessels. The vessels also lose their natural ability to be elastic,
resulting to inability to dilate and constrict. The heart stimulates the blood vessels to deliver
more blood but blood delivery is limited by narrow vessel diameter, resulting to low oxygen
"I
supply of the heart.
on
-
.
As a consequence of hypoxia, pain (angina) is felt.
There are two types of angina:
-
classic angina (of exercise), which occurs due to diminished coronary blood flow to the heart;
and
-
vasospastic/Prinzmetal’s/variant angina, which is caused by-
reversible vasospasm even at rest.
Both types decrease oxygen supply of the heart.
A. Nitrates
Nitrates are antianginal agents that provide fast action to directly relax smooth muscles and
depress muscle tone without affecting nerve activity.
-0--0
Nitrates reduce preload and myocardial muscle tension by dilating the veins. Also, they reduce
-
afterload by dilating the arteries. Both of these actions lower oxygen demand by decreasing
the workload of the heart.
Therapeutic Action
←
The main effect is drop in systemic blood pressure.
It compensates by increasing blood flow to healthy arteries and veins because affected
-
vessels already lose their elasticity.
Indications
Children: May be used only for congenital heart defects and cardiac surgery because they
- -
can cause potentially dangerous changes in blood pressure.

Adults: Should be educated on drug’s various forms and their proper administration, storage,
-
effectiveness, and manifestations that would warrant prompt medical help. Lifestyle
-
modifications such as smoking cessation, low-fat diet, and weight loss should be encouraged
-
to promote effectiveness of Antianginal therapy.

Older adults: Safety measures should be instituted as they are prone to adverse effects like
-
arrhythmias and hypotension. They should receive initial low dose because of probably hepatic
- a
2- •
and renal impairments which can interfere with metabolism and excretion of drugs.
Use during pregnancy is not established.
Sublingual nitroglycerin is most effective for recurrent variant angina.
Continuous infusion or transdermal patch for unstable angina.
Pharmacokinetics
Route Onset Duration
IV unstable angina 1-2 min 3-5 min

Sublingual tablet recurrent variant angina 1-3 min 30-60 min
Translingual spray 2 min 30-60 min
Transmucosal tablet 1-2 min 3-5 min
Oral SR tablet 20-45 min 8-12 h
Topical Ointment 30-60 min 4-8 h
Transdermal 30-60 min 24 h
T1/2: 1-4 min

Metabolism: liver
Excretion: kidney (urine)

Allergy to nitrates – prevent hypersensitivity reactions
Severe anemia – decreased cardiac output (CO) caused by nitrates isD-
-
dangerous for blood
with low-oxygen binding capacity
-
Head trauma and cerebral hemorrhage – relaxation of cerebral vessels can lead to intracranial
#
bleeding
Pregnancy and lactation – potential harm to fetus
Hepatic and renal disease – alteration in drug metabolism and excretion
Conditions that can limit CO (e.g. hypovolemia, hypotension, etc.
Intraocular →
pressure Ett
→ Brain
Intracranial pressure
Adverse Effects
CNS: throbbing headache, dizziness, weakness
GI: nausea, vomiting, incontinence
CV: hypotension, reflex tachycardia, syncope
EENT: pallor, flushing, sweating → fainting / passing out
Large dose leads to methemoglobinemia and cyanosis.
Interactions
Ergot derivatives: risk for hypertension; decreased antianginal effect
Heparin: decreased therapeutic effect of nitrates
↳ Protamine sulfate (antidote)
PDE-5 inhibitors: risk for severe hypotension
Nursing Management
Nursing Assessment
Presence of mentioned contraindications and cautions

Skin color and integrity, especially for transdermal or topical forms of nitrates
Pain and activity level
Neurological status (level of consciousness, affect, reflexes, etc.)
Cardiopulmonary status (BP; take heart rate in full minute)
Electrocardiogram as ordered
Laboratory tests (e.g. CBC, liver and kidney function tests, etc.)
Nursing Diagnoses
00
Decreased cardiac output related to vasodilation and hypotensive effects of the drug
Risk for Injury related to adverse effects on neurological and cardiovascular status
Ineffective Tissue Perfusion related to low oxygen supply to myocardial cells

Instruct patient not to swallow sublingual preparations to ensure therapeutic effects. Take
three tablets with a 5-minute interval, for a total of three doses. If the pain does not subside,
seek medical help.
Ask for presence of burning sensation to ensure drug potency.
Protect drug from sunlight to maintain drug potency.
0
For sustained release forms, take drug with water and do not crush for these preparations
need to reach GIT intact.
Rotate injection sites and provide skin care as appropriate to prevent skin abrasion and
bkaⁿsi#
breakdown.
Avoid abrupt stop of long-term therapy. Taper doses for 4-6 weeks to prevent myocardial
infarction. ↳ reduction in daily opioid dosage to improve a patient's safety profile ¥ᵈY
Provide comfort measures: small frequent meals, appropriate room temperature and lights,
noise reduction, ambulation assistance, reorientation, and skin care.
Evaluation
Monitor patient response to therapy (pain assessment).
Monitor for presence of mentioned adverse effects.
Monitor for effectiveness of comfort measures.
Monitor for compliance to drug therapy regimen.
Monitor laboratory tests.
.
• Beta-Adrenergic Blockers
0
Beta-adrenergic blockers are drugs which block or lyse the effects of sympathetic
-
stimulation. Hence, they are also called as sympatholytics.
Therapeutic action
Main effects include decreased blood pressure, contractility and heart rate by blocking the
beta-receptors in the heart and juxtaglomerular apparatus of the kidneys. These combined
effects reduce the oxygen demand of the heart.
Usually used in therapy with nitrates because of reduced adverse effects and increased
exercise tolerance.
e
Not indicated for variant angina because therapeutic effect of drugs can cause vasospasm.
=
Indications
Nadolol is used for management of chronic angina. It is the drug of choice in angina patients
with hypertension.
Propranolol is the prototype drug of this class. It is used for treatment of angina and syncope.
Nebivolol, the newest adrenergic blocking agent does not produce the same adverse effects
seen in propranolol.
Pharmacokinetics
Oral 15 min 90 min 15-19 h
IV Immediate 60-90 min 15-19 h
T1/2: 3-4 h
Metabolism: liver
e-
Food increases bioavailability of propranolol.
Propranolol is the only drug under this class that can cross the blood-brain barrier.

Bradycardia, heart block, and cardiogenic shock – blocking effect of drugs exacerbates these
conditions
Pregnancy and lactation – potentially harmful effects to the fetus or neonate
Diabetes, chronic obstructive pulmonary disease (COPD), thyrotoxicosis, and peripheral
vascular diseases – blocking effect prevents maintaining homeostatic requirements of these
diseases
Adverse Effects
CNS: emotional depression, dizziness, fatigue, sleep disturbances
GI: gastric pain, nausea, vomiting, colitis, diarrhea
CV: heart failure, reduced cardiac output, arrhythmia
Respiratory: dyspnea, cough, bronchospasm
Interactions
Clonidine: increased rebound hypertension
=
NSAIDs: decreased antihypertensive effects
Epinephrine: hypertension followed by bradycardia
Ergot alkaloids: peripheral ischemia
Insulin and oral hypoglycemic agents: alteration in blood glucose levels without the patient
experiencing manifestations of hypo- or hyperglycemia
Nursing Assessment
Assess for presence of mentioned contraindications and cautions.
=
Assess neurological status to determine presence of neurological adverse effects. Focus on
level of orientation and sensory function.
Monitor blood pressure and heart rate accurately. Be sure to count the heart rate in one full
minute.
Auscultate lungs to determine presence of possible respiratory adverse effects.
Check color and sensation of extremities. Measure capillary refill. This is to evaluate presence
of insufficiencies in the peripheral vascular system.
Monitor laboratory test results (e.g. electrolyte levels and renal function tests) to ascertain risk
for arrhythmia and discern whether dose adjustment is needed.
Nursing Diagnosis
Decreased Cardiac Output related to decreased heart rate, blood pressure, and contractile
properties of the heart
Ineffective Tissue Perfusion related to decreased blood flow to the heart
Risk for Injury related to possible alterations in CNS while on drug therapy
Give drug as ordered following safe and appropriate administration to ensure therapeutic
effects.
Provide comfort measures: ambulation assistance, raised siderails, appropriate room light and
temperature, and rest periods
Monitor cardiopulmonary status closely to detect possible alterations in vital signs which
signal need for dose adjustment and to prevent related adverse effects.
Educate client about the need to not abruptly stop therapy as this can lead to rebound
hypertension and myocardial infarction. Taper
Evaluation
Monitor patient response to therapy.

C. Calcium-Channel Blockers
Calcium-channel blockers are drugs which block heart contraction by inhibiting movement of
-
=
calcium ions, thereby altering arterial and cardiac muscle action potentials.
They basically produce vasodilation and relief of spasm.
:
They do not increase lipid levels.
Serve as a substitute for classic and variant angina when beta-blockers and nitrates are
contraindicated.
Therapeutic Action
By blocking contractions, loss of muscle tone and vasodilation occur, consequently decreasing
peripheral resistance.
Relieves vasospasm in variant angina, thereby increasing blood flow to the heart.
Can block atherosclerotic process in endothelial cells
Indications
Treatment of variant angina, chronic angina and effort-associated angina
Pharmacokinetics
Oral 30-60 min 2-3 h 2-4 h
SR, ER 30-60 min 6-11 h Varies
IV Immediate 2-3 min Varies
T1/2: SR (3.5-6h); ER (6-7h)

Metabolism: liver

Allergy to drugs
Heart block and sick sinus syndrome – conduction problems in these disease may be
exacerbated by slow conduction effect of drugs
Renal and hepatic dysfunctions – alteration with metabolism and excretion of drugs
Heart failure – worsened by decreased cardiac output effect of the drug
Adverse Effects
CNS: dizziness, lightheadedness, fatigue, and headache
GI: nausea, hepatotoxicity effect of the drug
CV: hypotension, bradycardia, peripheral edema
EENT: flushing, rash
Interactions
Cyclosporine with diltiazem: increased serum level and toxicity of cyclosporine
Cyclosporine with verapamil: heart block and digoxin toxicity. Verapamil increases level of
digoxin.
Digoxin with verapamil: depressed myocardial conduction
General anesthesia with verapamil: serious respiratory distress
Nursing Assessment
Assess for presence of mentioned contraindications and cautions.
Inspect skin color and integrity to determine presence of adverse effects on skin.
Assess the patient’s complaint of pain and the activity level prior to and after the onset of pain
to aid in identifying possible contributing factors to the pain and its progression.
Monitor cardiopulmonary status closely as the drug can cause severe effects on these two
body systems.
Nursing Diagnosis
Decreased Cardiac Output related to hypotension and vasodilating effect of the drugs
Risk for Injury related to cardiovascular and CNS adverse drug effects

Monitor blood pressure and heart rate and rhythm to detect possible development of adverse
effects.
Provide comfort measures for the patient to tolerate side effects (e.g. small frequent meals for
nausea, limiting noise and controlling room light and temperature to prevent aggravation of
stress which can increase demand to the heart, etc.)
Educate client on measures to avoid angina attacks (e.g. diet changes, rest periods, etc.)
Emphasize to the client the importance of strict adherence to drug therapy to ensure
maximum therapeutic effects.
Evaluation
Monitor patient response to therapy.
Practice Quiz: Antianginal Drugs

Quiz time! Take our 5-item quiz about antianginal agents!
O
1. Type of angina which involves spasm of the blood vessels
-
A. Stable angina
B. Pre-infarction angina
C. Unstable angina
E
D. Prinzmetal angina
2. Contraction and relaxation in each cardiac cycle is controlled by:

A. autonomic nervous system
B. the heart
C. cranial nerves
D. central nervous system
3. All of the following can cause arrhythmia, except:
A. acidosis
B. respiratory depression
C. hyperkalemia
D. none of the above
→
4. Verapamil and diltiazem belong to which class of antiarrhythmics?
A. Class IV
B. Class III
C. Class Ia
D. Class II
5. The conduction system of the heart include the following:
A. Sinoatrial node
B. Bundle of Purkinje
C. His Fibers
D. Atriomyocardial node
1. Answer: D. Prinzmetal angina.
It is an unusual type of angina that involves the spasm of blood vessels and not just by narrowing of
=
vessels. Person with prinzmetal angina has angina at rest and associated ECG changes.
2. Answer: B. the heart.
Contraction and relaxation is controlled by impulses arising spontaneously in the SA node and
transmitted via a specialized conducting system to activate all parts of the muscle almost
simultaneously. These- 0
rhythmic and continuous contractions are controlled by the heart itself.
3. Answer: D. None of the above.
ADVERTISEMENTS
Electrolyte disturbances, hypoxic conditions, acidosis or accumulation of waste products, and

=
structural damage of the conduction system can lead to arrhythmia.
4. Answer: A. Class IV.

D-
Verapamil and diltiazem are calcium-channel blockers and belong to Class IV antiarrhythmics.
-
5. Answer: A. Sinoatrial node.
Path of conduction is as follows: SA node -> AV node -> Bundle of His -> Purkinje fibers.

drugs in nursing
safely!
See Also
Antacids
Antihistamines
Bronchodilators and Antiasthmatics
Decongestants
Expectorants and Mucolytics
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HOME » NOTES » NURSING PHARMACOLOGY » CARDIOTONIC-INOTROPIC DRUGS
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Cardiotonic-Inotropic Drugs Exams
Study Notes
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Cardiotonic-inotropic drugs are particularly useful for patients with heart failure (HF), wherein the
=
heart is not able to effectively pump the blood towards different body organs. As a result, cells of the
body are deprived of oxygen and nutrients. Cardiotonic agents are drugs used to increase the
contractility of the heart. Included below is a pharmacology guide for nurses on the various effects of
cardiotonic-inotropic agents.
1. Generic and Brand Names

2. Disease Spotlight: Heart Failure (HF)
3. Cardiac Glycosides
3.2. Indications
3.6. Interactions
3.7.4. Evaluation
4. Phosphodiesterase Inhibitors
4.2. Indications
4.6. Interactions
4.7.4. Evaluation
5. Practice Quiz: Cardiotonic-Inotropic Agents
7. See Also
Generic and Brand Names

Here is a table of commonly encountered cardiotonic-inotropic drugs, their generic names, and
brand names:
Cardiac glycosides deslanoside Cedilanid-d
8
digitoxin Crystodigin
digoxin =
Lanoxin, Lanoxicaps
Phosphodiesterase inhibitors amrinone, inamrinone Inocor
cilostazol Pletal
milrinone Primacor
enoximone Perfan
Disease Spotlight: Heart Failure (HF)

Heart failure is a syndrome characterized by dysfunction of cardiac muscles.
-
It can occur in a number of heart conditions which can overwork the heart muscles. Some of
these conditions include:
⇐
Coronary artery disease (CAD), which leads to insufficient blood supply for the myocardium
and is also the most common cause of HF;
Cardiomyopathy, which leads to enlargement of the heart and myocardial fatigue; and
Valvular heart diseases, which can cause reflux and overloading of blood to the ventricles
which consequently over stretches the myocardium.
←
Clinical manifestations depend on the side of the heart which failed:
Left-sided HF
E-
Primarily reflects pulmonary manifestations because the left ventricle cannot push blood
=
towards the peripheral systems.
As a result, there is engorgement of pulmonary veins, which leads to difficulty of breathing.
Other manifestations include: tachypnea (rapid breathing), dyspnea (discomfort associated
with breathing), and orthopnea (increased difficulty of breathing when lying down). Patient
also experiences coughing and hemoptysis (coughing up of blood). In severe cases, •
His#pulmonary edema (filling up of fluid in the lung spaces) occurs which is life-threatening
because it⊖ interferes with_
gas exchange.
Right-sided heart failure
→
Occurs when the right side of the heart has the need to exert more force in order to push
blood towards the pulmonary circulation.
This side is usually a low-pressure system so when this happens, the pressure in this side rises
and venous return can’t enter.
Neck veins become O
-
distended and central venous pressure isO
increased. Organs like liver and
-
-
spleen are0 enlarged because they are congested with blood.

-
Also, dependent areas like the limbs develop pitting edema because fluid pools in these
areas.
A. Cardiac Glycosides
Cardiac glycosides are cardiotonic agents from foxglove or digitalis plants. They exert their
_=
effects on the cardiac muscles by affecting levels of intracellular calcium. In turn, the
contractility of the muscles is increased.
Therapeutic Action
=
Allows more calcium to enter during contraction, therefore increasing the force of contraction
– positive inotropic effect.
Consequently, there is increased cardiac output and renal perfusion. A good blood supply to
the kidney decreases renin release. This downplays the activity of renin-angiotensin-
aldosterone system (RAAS) which causes more fluid to be excreted in the body through urine.
A decrease in blood volume eases the workload of the heart.
Another mechanism of this drug is to- decrease the workload of the heart and slow down
relaxation of the cells. Therefore, this drug can increase the strength of contractility without
-
increasing the rate of contraction (negative chronotropic effect).
Indications
Primarily indicated for decreasing workload of the heart and relieving HF.
-
o
-
Digoxin is especially indicated for atrial flutter, atrial fibrillation, and paroxysmal atrial
tachycardia.
Children
Widely used in the treatment of heart defects in children but the margin of safety for drug
=
dosage is small so the nurse should recalculate and re-validate the dose with another
nurse before administration.
Serum level of digoxin and signs of digitalis toxicity should be monitored carefully.
Adults
This age group should be educated on manifestations that should be reported signifying drug
toxicity.
Also, adults are cautioned against utilization of different brands of digoxin as differences in
bioavailability can increase the chance of toxicity.
It is important for these patients to be taught how to take their own heart rate and assess its
regularity.
Safety of this drug for pregnant women is not established. As for lactating women, although
e-
-
digoxin enters breast milk, it has not been associated with adverse effects in neonates but
caution is still exercised.
Older adults
Older adults are more susceptible to drug toxicity because of underlying conditions that would
interfere with metabolism and excretion of drug. Hepatic & renal malfunction
-
Renal and hepatic function should always be monitored.
:
Relatives should be instructed on how to take heart rate and assess its regularity.
Careful attention should be given to other drugs taken by older adult patients as well as their
alternative therapies.
Pharmacokinetics
Oral 30-120 min 2-6 h 6-8 d
IV 5-30 min 1-5 h 4-5 d
T1/2: 30-40 h
Metabolism: N/A

Allergy to any component of digitalis preparation. Prevent severe hypersensitivity
reactions.
Ventricular tachycardia or fibrillation. These are potentially fatal arrhythmias and should be
treated with another drug.
Heart block (sick sinus syndrome). Can be worsened by drug’s effect on slowing conduction
through AV node
Idiopathic hypertrophic subaortic stenosis (IHSS). Obstruction of outflow tract to the aorta
can result from increasing the force of contraction and this can lead to other severe problems.
Acute myocardial infarction (MI). Increasing the force of contraction can damage the heart
muscles more.
Renal insufficiency. Drug is excreted through urine and the existing renal insufficiency can
contribute to development of drug toxicity.
Pregnancy and lactation. Can cause potential adverse effects to the fetus or neonate.
Adverse Effects
CNS: headache, weakness, drowsiness, vision changes (most commonly reported is seeing
yellow halo around objects)
CV: arrhythmias
GI: GI upset, anorexia
NURSING ALERT! Signs and symptoms of digitalis toxicity: anorexia, nausea, vomiting,
malaise, depression, irregular heart rhythms (e.g. heart block, heart arrhythmias, and
ventricular tachycardia)
Interactions
0
Digoxin immune Fab or DigiFab: antidote; these antibodies bind molecules of digoxin, making
them unavailable at site of action. Used when serum digoxin is >10 ng/mL and serum
potassium is >5 mEq/L. immunosuppressive agentfrom
Verapamil, amiodarone, quinine, erythromycin, tetracycline, cyclosporine: increased
Cyclosporine :
: used to prevent the body rejecting the transplanted
therapeutic and toxic effects of digoxin. Combination of digoxin with any of these drugs would organ
Antibiotic
warrant decrease in dose of digoxin to prevent toxicity. Tetracycline :
: Acne
for
Potassium-losing diuretics: increased risk of cardiac arrhythmias Tylenol substitute
: aspirin
Thyroid hormones, metoclopramide, penicillamine: decreased therapeutic effects of Quinine Antimalaria

:
digoxin. Increasing the dose of digoxin is important.

Cholestyramine, charcoal, colestipol, antacids, bleomycin, cyclophosphamide,
methotrexate: decreased absorption of digoxin. In this case, digoxin must be taken 2-4 hours
after taking any of these drugs.
St. John’s wort, psyllium: decreased therapeutic effect of digoxin
Ginseng, hawthorn, licorice: increased risk of digoxin toxicity
Here are important nursing considerations when administering cardiac glycosides:
Nursing Assessment
and examination:
Assess for the mentioned contraindications to this drug (e.g. renal insufficiency, acute MI,
hypersensitivity, etc.) to prevent potential adverse effects.
status, determine effectivity of therapy and evaluate potential adverse effects.
Obtain baseline status for weight while noting recent manifestations that increase or
Assess closely patient’s heart rate and blood pressure to identify cardiovascular changes that
may warrant a change in digoxin drug dose.
Auscultate heart sounds to note the presence of abnormal sounds and possible conduction
problems.
Determine urinary pattern and output to assess gross indication of renal function.
Obtain baseline electrocardiogram (ECG) to identify heart rate and rhythm.
Monitor serum electrolyte and renal function test results to determine whether changes in
drug dose is needed or not.
Nursing Diagnoses
Risk for fluid volume deficit related to increased renal perfusion as effect of the drug
Decreased cardiac output related to inefficient myocardial contractility
Ineffective tissue perfusion related to decreased blood flow to different parts of the body
These are vital nursing interventions done in patients who are taking cardiac glycosides:
Check drug dose and preparation carefully to avoid medication errors because drug has
narrow safety margin.
o_O
Do not administer drug with food and antacids to prevent decreased in drug absorption.
IMPORTANT! Count apical pulse for one full minute before administering drug to monitor
for adverse effects.
O
Drug is withheld if pulse is less than 60 beats per minute in adults and 90 beats per minute
-
in infants.
-
Apical pulse is taken after one hour and if it remains low, nurse must document it, withhold
the dose, and inform doctor.
Assess pulse rhythm to detect arrhythmias which are early signs of drug toxicity.
Weigh the patient daily to monitor for fluid retention and HF. Assess dependent areas for
presence of edema and note its degree of pitting to assess severity of fluid retention.
Monitor serum digoxin level as ordered (normal: 0.5-2 ng/mL) to evaluate therapeutic dosing
-
and development of adverse effects.

Provide comfort measures (e.g. small frequent meals for GI upset, instituting safety measures
for drowsiness and weaknesses, and providing adequate room lighting for patients with visual
disturbances) to help patient tolerate drug effects.
Promote rest periods and relaxation techniques to balance supply and demand of oxygen.
Ensure maintenance of emergency drugs and equipment at bedside (e.g. potassium salts and Atropine : antidote for cholinergic toxicity
@ atropine in case of clinically significantC treatment for bradycardia
@
:
lidocaine for arrhythmias, phenytoin for seizures, low
anesthetic
I
Lidocaine : an
heart rate, and cardiac monitor) to promote prompt treatment in cases of severe toxicity.
Evaluation
Monitor patient response to therapy through assessing manifestations of HF, arrhythmia, and
serum level of digoxin.
Monitor for adverse effects (e.g. visual changes, HF, and arrhythmias).
B. Phosphodiesterase Inhibitors
Phosphodiesterase inhibitors aid in increasing force of myocardial contractility through their
enzyme-blocking effect. This in turn, increases the flow of calcium into the myocardial cells.
Therapeutic Action
By blocking the enzyme phosphodiesterase, cyclic adenosine monophosphate (cAMP)
increases. cAMP stimulates flow of calcium towards the myocardium and thereby, increases
force of cardiac contractility.
Increases intracellular calcium and prolongs effect of sympathetic stimulation. This leads to
three major effects: vasodilation, increased oxygen consumption, and arrhythmias.
÷
Indications
Only indicated for short-term treatment of patients not responding to cardiac glycosides,
vasodilators, and diuretics.
= -0
Drug use is only limited to severe situations because it is associated with fatal ventricular
arrhythmias.
Children
O
Drug is not recommended for this age group
-
Adults
This age group should be educated on manifestations that should be reported signifying drug
adverse effects.
It is important for these patients to be taught how to take their own heart rate and assess its
regularity.
Pregnant women
O
Safety of this drug for pregnant and lactating women is not established.
-
Older adults
→
Renal and hepatic function should always be monitored. Relatives should be instructed on how
to take heart rate and assess its regularity.
Careful attention should be given to other drugs taken by older adult patients as well as their
alternative therapies.
Pharmacokinetics
Oral Immediate 10 min 8h
T1/2: 2.3-3.5 h
Metabolism: liver
Excretion: urine and feces

Allergy to phosphodiesterase inhibitors and bisulfites. Prevent severe hypersensitivity
reactions.
Severe aortic or pulmonary valvular disease. Exacerbated by increased contraction.
Acute MI. Exacerbated by increased contraction and oxygen demand.
Conditions with fluid volume deficit. Exacerbated by increased renal perfusion which
ultimately leads to increased urine output.
Adverse Effects
CV: ventricular arrhythmias, ventricular fibrillation, hypotension, chest pain
GI: nausea, vomiting, GI upset, abdominal pain
Hema: thrombocytopenia
Associated hypersensitivity reactions: vasculitis, pericarditis, pleuritis, and ascites
Burning at intravenous injection site
Interactions
In solution together with furosemide: precipitate formation
Here are important nursing considerations when administering phosphodiesterase inhibitors:
Nursing Assessment
and examination:
Assess for the mentioned contraindications to this drug (e.g. fluid volume deficit, acute MI,
E-
hypersensitivity, etc.) to prevent potential adverse effects.
Assess closely patient’s heart rate and blood pressure to identify cardiovascular changes that
may warrant change in drug dose.
Determine urinary pattern and output to assess gross indication of renal function.
Obtain baseline electrocardiogram (ECG) to identify heart rate and rhythm.
Monitor serum electrolyte, complete blood count, and renal and hepatic function test results to
determine whether changes in drug dose is needed or not.
Nursing Diagnoses
Risk for fluid volume deficit related to increased renal perfusion as effect of the drug
Decreased cardiac output related to inefficient myocardial contractility and hypotension
Risk for injury related to easy bruising 20 thrombocytopenia
Ineffective tissue perfusion related to decreased blood flow to different parts of the body

These are vital nursing interventions done in patients who are taking phosphodiesterase inhibitors:
Protect drug from light to prevent drug from degradation.

Ensure patency of intravenous access to promote safe administration of drug.
Weigh patient daily and fluid intake and output to evaluate resolution of HF.
Assess skin condition, noting presence of petechiae and other manifestations of easy bruising
and bleeding to assess presence of thrombocytopenia.
Monitor intravenous injection site to promote prompt interventions in cases of burning
sensation and/or irritation.
Provide comfort measures (e.g. small frequent meals for GI upset, instituting safety measures
for drowsiness and weaknesses, and providing adequate room lighting for patients with visual
disturbances) to help patient tolerate drug effects.
Evaluation
Monitor patient response to therapy through assessing for manifestations of resolution of HF.
Monitor for adverse effects (e.g. thrombocytopenia, HF, and arrhythmias).
Practice Quiz: Cardiotonic-Inotropic Agents
Quiz time! Take our 8-item quiz about cardiotonic-inotropic agents!
Questions
=
1. The primary treatment for heart failure (HF) is ___________.
A. Increasing the heart rate so the heart can pump more blood
B. Decreasing the heart rate so the heart can rest
C. Increasing contractility so the heart will be able to pump more blood
D. Decreasing contractility to prevent muscle fatigue
2. The most common cause of HF is ______________.
A. Hypertension
B. Valvular heart diseases
C. Cardiomyopathy
D. Coronary artery disease (CAD)
a
3. Digoxin was prescribed to a patient with ventricular tachycardia. What should the nurse do?
_
A. Administer the drug as ordered.

-B. Discuss the order with the doctor.
C. Discontinue other intravenous medications before administering digoxin.
D. Count apical pulse for one full minute before administering.
I
4. What is the antidote for digoxin intoxication?
A. Diphenhydramine
B. Atropine sulfate
C. Digoxin immune fab (Digibind, DigiFab).
D. Phosphodiesterase inhibitors
Which is the best nursing intervention for this assessment finding?

o
5. An infant who is receiving cardiac glycosides has an apical pulse of 80 beats per minute.
A. Administer drug as ordered.

B. Withdraw the drug and notify doctor.
C. Assess apical pulse every hour for the next five hours.
D. Decrease drug dose and administer.
ADVERTISEMENTS
- n_
6. What signals the novice nurse that intravenous milrinone was combined to furosemide in
management of patients with heart failure?
A. Presence of bubbles
B. Pink discoloration of the solution
C. Formation of precipitates
D. No obvious sign. Solution is clear.
-
7. What is the therapeutic level for digoxin?
A. 0.5-2 ng/mL
B. 1.5-2 ng/mL
C. 0.5-1.5 mg/mL
D. 0.5-2 mg/mL
-
8. In severe cardiac glycoside toxicity, all of the following should be in the bedside, except
_________.
A. Lidocaine
B. Phenytoin
C. Calcium channel blocker
D. A and B only
1. Answer: C. Increasing contractility so the heart will be able to pump more blood.
The complete answer would be to make the heart beat efficiently, that is to increase its force of
contraction without increasing the heart rate. Through this, more blood is pumped every beat without
overwhelming the heart because rate of contraction is not increased.
2. Answer: D. Coronary artery disease (CAD).
It accounts for 95% of HF cases. CAD results to insufficient supply of blood in the heart. This leads to
hypoxia and loss of function of heart muscles.
3. Answer: B. Discuss the order with the doctor.
Digoxin is contraindicated in patients with ventricular tachycardia and fibrillation because these are
potentially fatal arrhythmias and need to be treated with other medications.
4. Answer: C. Digoxin immune fab (Digibind, DigiFab).
Digoxin Immune Fab or DigiFab, DigiBind should be administered for serum digoxin levels of >10
-
O
=ng/mL and serum potassium level of >5 mEq/mL.
5. Answer: B. Withdraw the drug and notify doctor.
O O
A low apical pulse (less than 90 for infants and less than 60 for adults) can signal drug toxicity.
-
-
6. Answer: C. Formation of precipitates.
-
Phosphodiesterase inhibitor-furosemide combination should be avoided. Alternate lines should be
used if both of these drugs are given intravenously.
7. Answer: A. 0.5-2 ng/mL.
8. Answer: C. Calcium channel blockers.
Fo -
e
Lidocaine and potassium salts are used to treat arrhythmias. Phenytoin is for the treatment of
seizures. Other medications and equipment at the bedside include atropine for treatment of
increased heart rate, and a cardiac monitor.

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Care Plans Exams Study Notes Career NurseLife News

Anaphylactic Shock Exams

UPDATED ON FEBRUARY 11, 2021 BY MARIANNE BELLEZA, R.N.

1. What is Anaphylactic Shock?

What is Anaphylactic Shock?

cell or basophil surface-bound allergen-specific IgE resulting in cellular degranulation as well

Statistics and Incidences

Assessment and Diagnostic Findings

could stop the progression of shock.

Albuterol. Albuterol (Proventil) may be given to reverse histamine-induced bronchospasm.

Impaired gas exchange related to ventilation perfusion imbalance.

Nursing Care Planning and Goals

The major goals for a patient with anaphylactic shock are:

Client will display hemodynamic stability, as evidenced by-

medical alert bracelet/necklace, and the importance of seeking emergency care.

Client maintained an effective breathing pattern.

Discharge and Home Care Guidelines

Emergency medications. The nurse should provide information about emergency

The focus of documentation include:

Assessment findings including respiratory rate, character of breath sounds; frequency,

=Conditions that may 0 interfere with oxygen supply.

Practice Quiz: Anaphylactic Shock

1. Answer: A. Removing the stinger by scraping it.

to a drug should include which of the following actions first?

2. Answer: A. Administering oxygen

A. Administer beta-adrenergic blockers.

3. Answer: B. Administer bronchodilators.

4. Anaphylactic shock is associated with which type of hypersensitivity?

4. Answer: A. Type I hypersensitivity.

antigen referred to as an allergen.

5. What are some conditions that may precipitate anaphylactic shock?

5. Answer: D. All of the above.

D: Insects, food, or medicines could cause anaphylactic shock.

4 Anaphylactic Shock Nursing Care Plans

Marianne Belleza, R.N.

Antihyperlipidemic Drugs Exams

UPDATED ON MAY 3, 2022 BY IRIS DAWN TABANGCORA, RN

and proinflammatory and prothrombotic states.

1. Antihyperlipidemic: Generic and Brand Names

Antihyperlipidemic: Generic and Brand Names

Classification Generic Name Brand Name

Bile Acid Sequestrants cholestyramine Questran

HMG-CoA Reductase Inhibitors atorvastatin 0

pitavastatin statin Livalo

Cholesterol Absorption Inhibitor ezetimibe Zetia

Fibrates fenofibrate TriCor

finofibric acid Tripilix

Vitamin B niacin Niaspan

Disease Spotlight: Coronary Artery Disease

These drugs are used to normalize high serum level of cholesterol.

LDL → low-density cholesterol)

Familial hypercholesterolemia treatment in children is limited to tight dietary restrictions of

Contraindications and Cautions

CNS: headache, anxiety, fatigue, drowsiness

Other: rash, fat-soluble vitamin deficiencies

Interactions slow down your body 's

Nursing Assessment had a

Assess for the mentioned contraindications to prevent potential adverse effects.

Acute pain related to CNS and GI effects

Altered elimination pattern related to constipation

Implementation with Rationale

Monitor patient response to therapy (serum lipid and cholesterol levels).

HMG-CoA reductase inhibitor is the drug - e

Oral Slow 1-2 h 20-30 h