Fentanyl

Classifications: Opioid Analgesic

Uses/Indications: Controls moderate to severe pain.
Actions: Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain
perception by binding to opiate receptors
Side Effects (most important, approximately 5): Constipation, Nausea, respiratory depression,
rash, euphoria.
Nursing Considerations: VS after parenteral route; note muscle rigidity, drug history,
hepatic/renal function tests

Hydromorphone
Classifications: Opiate Analgesic
Uses/Indications: Moderate to severe pain.
Actions: Inhibits ascending pain pathways in CNS increases pain threshold, alters pain
perception
Side Effects (most important, approximately 5): constipation, drowsiness, respiratory depression,
Nausea
Nursing Considerations: I&O ratio; check for decreasing output; may indicate urinary
retention, Bowel function, constipation
Tylenol
Classifications: nonopioid analgesic, antipyretic
Uses/Indications: Mild to moderate pain or fever, myalgia.
Actions: May block pain impulses peripherally that occur in response to inhibition of
prostaglandin synthesis.
Side Effects: Hepatoxicity, Nausea, urticaria, thrombocytopenia
Nursing Considerations: AST, ALT, bilirubin, creatinine before therapy if long-term
therapy is anticipated; may cause hepatic toxicity at doses. Type of pain, location, intensity,
duration, aggravating/alleviating factors.

Metronidazole
Classifications: Anti-infective
Uses/Indications: Intestinal amebiasis, amebic abscess, trichomoniasis, refractory trichomoniasis.
Actions: Direct-acting amebicide/trichomonad binds and disrupts DNA structure, thereby
inhibiting bacterial nucleic acid synthesis
Side Effects: Dizziness, Nausea, constipation, abdominal cramps
Nursing Considerations: WBC, wound symptoms, fever, skin or vaginal secretions; start
treatment after C&S is obtained
 Metoclopramide
Classifications: Cholinergic, antiemetic, GI stimulant
Uses/Indications: Prevention of nausea, vomiting induced by chemotherapy, radiation, delayed
gastric emptying, gastroesophageal reflux
Actions: Enhances response to acetylcholine of tissue in the upper GI tract, which causes the
contraction of gastric muscle;
Side Effects: Fatigue: Hypotension, diarrhea, headache
Nursing Considerations: GI assessment, assessment of mental status (drowsiness), look for
uncontrolled movement.

Metformin
Classifications: Anti-diabetic
Uses/Indications: Type 2 diabetes mellitus
Actions: Inhibits hepatic glucose production and increases the sensitivity of peripheral tissue to
insulin
Side Effects: lactic acidosis, diarrhea, nausea, anorexia
Nursing Considerations: Hypoglycemic reactions, during treatment; check LFTs periodically

Metoprolol
Classification: Beta Blocker (B1 Adrenergic) Antihypertensive, antianginal
Uses: Decreases BP, HR, and AV conduction
Actions: Blocks beta-adrenergic receptors in vascular smooth muscle
- Decreases rate of SA node discharge, increases recovery time
- Slows AV node conduction, decreases HR
Side Effects: AV block, bradycardia, pulmonary edema, chest pain
Nursing Consideration: Hold if HR <60, hold if SBP <90

Heparin
Classification: Anticoagulant, Anti-embolic
Uses: Prophylaxis for treatment of venous thrombosis
Action: Inhibition of conversion of prothrombin to thrombin preventing the creation of clots
Side Effects: Hemorrhage, vasospasm
Nursing Consideration: at risk for bleeding with procedures, at risk for bruising, check
aPTT

Hydrochlorothiazide
Classifications: Thiazide diuretic, Anti- hypertensive
Uses/Indications: Hypertension, diuresis, idiopathic edema therapy
Actions: Acts on distal tubule and ascending limb of the loop of Henle by increasing excretion of
water, sodium, chloride, potassium
Side Effects: Hypokalemia, hypotension, polyuria, dizziness, hypovolemia.
Nursing Considerations: Clients should be encouraged to eat potassium-rich foods like
bananas, and citrus. May take potassium supplements or add a potassium-sparing diuretic
like spironolactone.

Furosemide
Classifications: Loop diuretic
Uses/Indications: Pulmonary edema; edema with HF, hepatic disease, nephrotic syndrome,
ascites, hypertension
Actions: Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the
loop of Henle
Side Effects: Orthostatic hypotension, Hypokalemia, hyponatremia, hyperglycemia
Nursing Considerations: Give earlier in the day as it causes an increase in urine output.
Warfarin (Coumadin)
Classifications: Anti-coagulant
Uses/Indications: arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI, stroke
prophylaxis, thrombosis prophylaxis, pulmonary embolism
Actions: Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit K–
dependent coagulation factors (II, VII, IX, X)
Side Effects: Petechiae, hematuria, fever, bleeding, anemia
Nursing Considerations: Monitor INR for therapeutic levels and risk of bleeding. Monitor
CBC.
ASA
Classifications: Non-opioid analgesics, nonsteroidal anti-inflammatory, anti-platelets, antipyretic
Uses/Indications: Mild to moderate pain or fever, including rheumatoid arthritis (RA),
osteoarthritis, thromboembolic disorders
Actions: Blocks pain impulses by blocking COX-1 in CNS reduces inflammation by inhibition
of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels;
decreases platelet aggregation
Side Effects: stomach ulcers, GI bleeding, hypotension, hepatoxicity
Nursing Considerations: AST, ALT, bilirubin, and creatinine if the patient is receiving long-
term therapy. Should assess ASA use before procedures that may cause bleeding (surgery)
 Ramipril
Classifications: Anti-hypertensive, ACE inhibitors
Uses/Indications: Hypertension, alone or in combination with thiazide diuretics
Actions: Inhibit the Renin-Angiotensin-Aldosterone System (RAAS). Work by stopping the
conversion of angiotensin I to angiotensin II.
Side Effects: hyperkalemia, hypotension, dizziness, chest pain, proteinuria, dry cough.
Nursing Considerations: educate the patient that when taking ACE inhibitors, avoid using
salt substitutes. Potassium is present in salt alternatives, and ACE inhibitors induce the
body to retain potassium.

Gravol
Classifications: Antiemetic, antihistamine, anticholinergic
Uses/Indications: Motion sickness, nausea, vomiting, vertigo
Actions: Blocks H1 receptors in the GI tract and muscarinic receptors in the vestibular system
Side Effects: drowsiness, hypotension, dry mouth & constipation
Nursing Considerations: Assess alertness (safety) and monitor for signs of retention (bowel
and bladder), GI assessment

Ondansetron
Classifications: Antiemetic
Uses/Indications: Nausea associated with chemotherapy, radiation, anesthesia, viral gastritis &
pregnancy
Actions: Acts on serotonin-blocking receptors peripherally, centrally, and in the small intestine.
Side Effects: Headache, constipation, diarrhea, dizziness, QT prolongation
Nursing Considerations: Monitor EKG in patients at risk. Monitor for effectiveness.

Pantoprazole
Classifications: Proton pump inhibitor
Uses/Indications: GERD, severe erosive esophagitis
Actions: Causes irreversible inhibition of H+, K+ ATPase, the enzyme that generates gastric acid
Side Effects: Headache, Nausea and vomiting, diarrhea, pneumonia, pancreatitis
Nursing Considerations: Administer before meals, monitor serum Mg with prolonged use,
and monitor for signs of pneumonia and fracture.
 Gliclazide
Classifications: Antidiabetic
Uses/Indications: Type 2 diabetes mellitus
Actions: Stimulates the release of insulin from pancreatic beta cells and may increase target cell
sensitivity to insulin
Side Effects: weight gain, hypoglycemia, hepatoxicity, heartburn
Nursing Considerations: Blood glucose, and A1c levels during treatment to determine
diabetes control. That product must be continued daily; about consequences of
discontinuing the product abruptly.

Bisacodyl
Classifications: Laxative, stimulant
Uses/Indications: Opioid-induced constipation, bowel or rectal preparation for surgery,
examination.
Actions: Stimulate intestinal motility & increase the amount of water and electrolytes within the
bowel
Side Effects: diarrhea, hypokalemia, muscle weakness, nausea, rectal burning
Nursing Considerations: Water consumption is important, GI assessment, I&O ratio to
identify fluid loss

Lactulose
Classifications: Laxative; ammonia detoxicant (hyperosmotic)
Uses/Indications: Chronic constipation, Hepatic encephalopathy – help with excretion of
ammonia
Actions: Prevents absorption of ammonia in the colon by acidifying stool; increases water
softens stool
Side Effects: Hypokalemia, diarrheas, N/V, Flatulence, abdominal cramps
Nursing Considerations: Monitor blood ammonia levels and tell patients to take a lot of
water. Take on an empty stomach for rapid action.

Docusate Sodium
Classifications: emollient; stool softener, Laxative
Uses/Indications: Prevention of dry, hard stools
Actions: Increases water, and fat penetration in the intestine; allows for easier passage of stool
Side Effects: Nausea, Diarrhea, Cramps, Rash
Nursing Considerations: Monitor electrolyte levels as it cause secretion of electrolytes into
the intestine. May take up to three days to work, Take with a lot of water.
 Insulin
Classifications: Antidiabetic, Pancreatic hormone
Uses/Indications: Type 1 and 2 diabetes mellitus, gestational diabetes
Actions: Decreases blood glucose; by transport of glucose into cells and the conversion of
glucose to glycogen
Side Effects: hypoglycemia, dry mouth, lipodystrophy, anaphylaxis, rash
Nursing Considerations: Do not inject in the same area twice but leave at least an inch of
space. Store in a cool place to ensure effectiveness. Gently rotate the vial containing the
agent and avoid vigorous shaking to ensure uniform suspension of insulin.

Diazepam
Classifications: Anti-anxiety, Anticonvulsant
Uses/Indications: Anxiety, skeletal muscle relaxation, seizure disorders.
Actions: Potentiate effects of GABA, Act primarily in the limbic system and RAS so it can also
cause muscle relaxation and relief of anxiety without substantially affecting the functions of the
cortex
Side Effects: depression, constipation, arrhythmia, physical dependence, drowsiness.
Nursing Considerations: Monitor results of laboratory tests (renal and liver function) to
determine the appropriateness of therapy and the possibility of dose adjustment. Monitor
mental status. To avoid driving, activities that require alertness; drowsiness may occur.

Lorazepam
Classifications: Sedative, hypnotic; antianxiety
Uses/Indications: Anxiety, irritability with psychiatric or organic disorders, preoperatively;
insomnia;
Actions: Potentiate effects of GABA, Act primarily in the limbic system and RAS so it can also
cause muscle relaxation
Side Effects: dizziness, drowsiness, orthostatic hypotension, blurred vision, dry mouth
Nursing Considerations: Avoid taking alcohol with medication. To avoid driving, activities
that require alertness; drowsiness may occur.

Synthroid
Classifications: Thyroid hormone
Uses/Indications: Hypothyroidism, myxedema coma
Actions: Increases metabolic rate; controls protein synthesis; increases cardiac output, renal
blood flow
Side Effects: Hyperthyroidism, cardiac arrest, weight loss, menstrual irregularities
Nursing Considerations: test bone density baseline and periodically; bone loss may occur
with long-term therapy. Avoid iodine-rich food. To do the T3 and T4 tests to determine if the
patient is fit to keep taking medication.

Salbutamol
Classifications: Adrenergic β2-agonist, sympathomimetic, bronchodilator
Uses/Indications: Provide short-term and rapid symptomatic relief for patients with asthma and
COPD
Actions: Sympathomimetic drugs that activate beta2-adrenergic receptors promoting
bronchodilation and relieving bronchospasm
Side Effects: tachycardia, chest pain, hypokalemia, tremor, headache
Nursing Considerations: Assess lung sounds, pulse, and BP. Monitor potassium with
frequent use.

Ipratropium
Classifications: Anticholinergic, bronchodilator
Uses/Indications: Bronchospasm, COPD
Actions: blocks muscarinic cholinergic receptors in the bronchi preventing bronchoconstriction
Side Effects: Dry mouth, irritation to the pharynx, cough, dizziness, headache
Nursing Considerations: Rinsing the mouth after the use of the inhaler, good oral hygiene,
and sugarless gum or candy may minimize dry mouth. Monitor respiratory rate, heart
rate, and ABG.

Atorvastatin
Classifications: Antilipidemic
Uses/Indications: As an adjunct for primary hypercholesterolemia
Actions: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
Side Effects: Headache, constipation, abdominal cramps, myalgia, heartburn
Nursing Considerations: Change in the diet of the patient—possible toxicity when used with
grapefruit.

Dalteparin
Classifications: Anticoagulant
Uses/Indications: Used to prevent the formation of clots, OR extension of DVT or Pulmonary
embolus (PE) so that those clots do not enlarge or break off into emboli.
Actions: Inactivates 2 major clotting factors in the blood (Xa and Thrombin). This causes
clotting action to be suppressed
Side Effects: bleeding, hypersensitivity, thrombocytopenia, injection site reaction.
Nursing Considerations: Monitor aPTT for therapeutic levels, and note INR for risk of
bleeding, and risk for bruising.

Digoxin
Classifications: Cardiac glycoside, inotropic, antidysrhythmic
Uses/Indications: Heart failure, Atrial Fibrillation
Actions: Inhibits the sodium-potassium
ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in
increased cardiac output
Side Effects: hypotension, drowsiness, bradycardia
Nursing Considerations: Monitor product levels; therapeutic level 0.5-2 ng/mL, draw ≥6-8 hr
after last dose, optimally 12-24 hr after a dose. Monitor Vital signs e.g., HR, BP. Monitor
electrolytes, Hgb, and Hct.

Vancomycin
Classifications: Anti-infective
Uses/Indications: all kinds of infectious pathogens
Actions: Inhibits bacterial cell-wall synthesis, blocks glycopeptides
Side Effects: ototoxicity, anaphylaxis, nephrotoxicity
Nursing Considerations: WBC, urine, stools, sputum, wound characteristics throughout
treatment; obtain C&S before starting treatment—adequate intake of fluids (2 L/day) to
prevent nephrotoxicity.
 METOPROLOL
Classification: Beta Blocker (B1 Adrenergic) Antihypertensive, antianginal
Uses: Decreases BP, HR, and AV conduction
Actions: Blocks beta-adrenergic receptors in vascular smooth muscle decreases rate of SA node
discharge and increases recovery time. Slows AV node conduction, decreases HR
Side Effects: AV block, bradycardia, pulmonary edema, chest pain
Nursing Consideration: Hold if HR <60, hold if SBP <90

Plavix (Clopidogrel)
Classifications: Platelet aggregation inhibitor
Uses/Indications: Secondary prevention of atherothrombotic events, Acute coronary syndrome
in combination with ASA, Atrial fib
Actions: Inhibits adenosine diphosphate (ADP), induced platelet aggregation
Side Effects: Bleeding, diarrhea, Gi bleeding, hypertension, dizziness
Nursing Considerations: CBC, PT, Liver function test, therapeutic effects, HOLD 5 DAYS
BEFORE SURGERY. TO AVOID TAKING WITH GRAPEFRUIT

AMIODARONE (Pacerone)
Classifications: Antidysrhythmic (Class 3)
Uses/Indications: Hemodynamically ventricular tachycardia (vtach), recurrent Vfib, Vfib not
controlled by first line.
Actions: Prolongs duration of action potential and effective refractory period, increases PR and
QT intervals, decreases sinus rate, decreases peripheral vascular resistance
Side Effects: Headache, orthostatic hypotension, hyperkalemia, diarrhea, dizziness
Nursing Considerations: Monitor HR, BP lying, standing, and sitting Electrolytes, and avoid
potassium-sparing diuretics and potassium-rich foods.

NITROGLYCERIN
Classifications: Antianginal, coronary vasodilator
Uses/Indications: Angina, control of heart failure in the setting of acute mi, control of
preoperative hypertension
Actions: Decreases preload and afterload which are responsible for increasing left ventricular
end-diastolic pressure, dilates coronary arteries
Side Effects: Hypotension, Headache, tachycardia, dizziness
Nursing Considerations: Monitor BP and HR, Reassess vitals after each dose given, Can only
give 3 doses with 5 mins intervals.
 BISOPROLOL
Classifications: Antihypertensives
Uses/Indications: Mild to moderate hypertension
Actions: Blocks Beta 1 adrenergic receptors within cardiac muscles, slows conduction of AV
node, decreases HR which decreases 02 consumption in the myocardium
Side Effects: Hypotension, 2nd or 3rd-degree heart failure, bradycardia, bronchospasm, vertigo
Nursing Considerations: HR and BP, crackles, edema in feet, wheezing, coughing

AMLODIPINE
Classifications: Antianginal, Antihypertensive, Calcium Channel Blocker
Uses/Indications: Chronic stable angina pectoris, hypertension.
Actions: Inhibits calcium ion influx across cell membranes during cardiac depolarization,
relaxation of coronary smooth muscles
Side Effects: Bradycardia, pulmonary edema, hypotension, muscle cramps, gastric pain
Nursing Considerations: BP, pulse, respiration.

DILTIAZEM
Classifications: Calcium Channel Blockers, Antiarrhythmic class 4, Antihypertensive
Uses/Indications: Immediate Release (IR): stable angina, coronary spasms, a fib, Controlled
Release ( CR): Hypertension, stable angina
Actions: Inhibits calcium ion influx across cell membranes during cardiac depolarization,
relaxation of coronary smooth muscles
Side Effects: Headache, dysrhythmia, bradycardia, hypotension, edema
Nursing Considerations: Monitor for heart failure: dyspnea, weights, I&O, Pulse BP. If systolic
BP <90 or HHR<60 hold the dose and notify prescriber.

TICAGRELOR (Brilinta)
Classifications: Platelet Inhibitor
Uses/Indications: Secondary prevention of atherothrombotic events
Actions: Reversibly binds to the platelet receptor preventing platelet activation
Side Effects: Hypertension, headache, Bleeding, Hypotension
Nursing Considerations: Monitor for signs of thromboembolism, monitor for bleeding, do not
use in those undergoing CABG, do not discontinue abruptly as it may increase risk for MI
 METOLAZONE
Classifications: Diuretic, Antihypertensive
Uses/Indications: Edema accompanying heart failure and renal impairment, mild to moderate
hypertension
Actions: Acts on the distal tubule by increasing the excretion of water, decreases GFR
Side Effects: Stevens-Johnson Syndrome, hypotension, hypokalemia, hypercalcemia,
hyperglycemia, urinary frequency
Nursing Considerations: Daily weight, I&O, Monitor electrolytes, monitor HR and BP, monitor
for signs of heart failure.

PERINDOPRIL
Classifications: Antihypertensive, ACE inhibitor
Uses/Indications: Hypertension, Heart failure, CV event prophylaxis
Actions: Selectively suppresses the renin-angiotensin-aldosterone system (RAAS), Inhibits ACE
preventing the conversion of angiotensin 1 to angiotensin 2
Side Effects: Dry cough, hypotension, hyperkalemia, tachycardia, angioedema, tinnitus
Nursing Considerations: Monitor BP and HR, Monitor electrolytes, Kidney and liver function
tests, hydration status

VALSARTAN (Diovan)
Classifications: Antihypertensive, Angiotensin Receptor Blockers (ARB’s)
Uses/Indications: Mild to moderate hypertension, post-MI
Actions: Blocks the vasoconstrictor and aldosterone-secreting effect of angiotensin 2
Side Effects: Cough, AV block, hepatoxicity, hypotension, dysrhythmia
Nursing Considerations: Hydration status Vital signs: BP, HR, Blood studies: BUN, creatinine,
LFT, potassium

APIXABAN (Eliquis)
Classifications: Anticoagulant
Uses/Indications: DVT, PE
Actions: Inhibits factor Xa and indirectly inhibits platelet aggregation induced by thrombin
Side Effects: GI bleed, Hypotension, Rash
Nursing Considerations: Hypersensitivity, monitor for signs and symptoms of bleeding, Neuro
assessment, Monitor for therapeutic effects
 RIVAROXABAN
Classifications: Anticoagulant
Uses/Indications: DVT, PE
Actions: Competitively inhibits free and clot-bound factor Xa
Side Effects: Steven Johnson Syndrome, Bleeding, hepatoxicity
Nursing Considerations: Monitor for signs and symptoms of bleeding, Avoid abrupt
discontinuation, Avoid if pregnant and breastfeeding, Monitor liver function test

MORPHINE
Classifications: Opioid analgesic
Uses/Indications: Symptomatic relief of severe pain
Actions: Depresses pain impulse transmission at the spinal cord level by interacting with opioid
receptors
Side Effects: Respiratory depression, bradycardia, confusion, sedation, urinary retention,
constipation
Nursing Considerations: Pain assessment before and after giving medication, GI assessment,
monitoring vital signs, Monitoring for changes in CNS

TYLENOL#3 (Codeine/ Acetaminophen)

Classifications: Opiate analgesic (300mg of acetaminophen and 15-30mg of codeine)
Uses/Indications: Mild to moderately severe pain
Actions: Blocks pain impulse generation and inhibits ascending pain pathways thus altering the
perception and response to pain.
Side Effects: Constipation, hypotension, drowsiness, Nausea, and Vomiting
Nursing Considerations: