UNDERSTANDING PHARMACOLOGY

Most Commonly Used Categories of Drugs in the Clinical Setting KeithRN.com

CARDIOVASCULAR DRUGS
Antihypertensives CENTRAL NERVOUS SYSTEM DRUGS (CONTINUED)
Ace Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Other
Beta Blockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Antiepileptics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Calcium Channel Blockers . . . . . . . . . . . . . . . . . . . . . . . 3 Antiparkinson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Vasodilators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Antiarrhythmic Agents UPPER GASTROINTESTINAL SYSTEM DRUGS
Class III Antiarrhythmic . . . . . . . . . . . . . . . . . . . . . . . . . 5 Antiemetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Digitalis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Proton Pump Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Antihyperlipidemics H2 Histamine Blockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Statins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 LOWER GASTROINTESTINAL SYSTEM DRUGS
Diuretics Laxatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Loop Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 RESPIRATORY SYSTEM DRUGS
K+ Sparing Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Bronchodilators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Thiazides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Inhaled Corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Anticoagulants/Antiplatelets SYSTEMIC DRUGS
Warfarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Anti-Inflammatory Medications
Direct-acting Oral Anticoagulants (DOACs) . . . . . . 9 Corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Heparin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Uric Acid Reducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Antiplatelet Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Anti-Infectives
CENTRAL NERVOUS SYSTEM DRUGS Broad-spectrum Antibiotics . . . . . . . . . . . . . . . . . . . . 20
Analgesics Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Non-Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Antifungals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
NSAIDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Miscellaneous
Muscle Relaxants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Antihistamines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Electrolytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Anxiolytics & Mood-Stabilizers Hormones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Anxiolytics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Selective Serotonin Reuptake Inhibitors (SSRIs) . . . 13 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
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Cardiovascular Drugs — Antihypertensives
Generic Name
Class Indications Adverse Effects Nursing Considerations
(Brand Name)
ACE captopril (Capoten) Used to treat: Most common Assess/Monitor
INHIBITORS enalapril (Vasotec) • hypertension side effects: • Obtain BP before administering; notify provider if SBP <90
• heart failure • cough • Renal/liver function
lisinopril (Prinivil, ———————————————— • hypotension • Serum electrolytes
Zestril) Contraindications:
• Signs of angioedema of the face, lips, throat or intestines
• pregnancy Severe adverse
• history of angioedema effects: Administration
• angioedema • These are PO medications only
Use with caution:
• acute renal failure
• black patients are Patient Education
at increased risk of • Change position slowly to prevent orthostatic hypotension
angioedema
• ischemic heart disease
• renal dysfunction

BETA atenolol (Tenormin) Used to treat: Most common Assess/Monitor

BLOCKERS metoprolol (Lopressor) • hypertension side effects: • Obtain BP before administering; notify provider if SBP <90
• heart failure • bradycardia • Obtain HR before administering; hold typically if HR <60
propranolol (Inderal) • angina pectoris • hypotension
———————————————— • dizziness Administration
Contraindications: • fatigue • If given intravenously, patient should be on a
• decompensated heart cardiac monitor
failure Severe adverse
Patient Education
• severe bradycardia effects:
• Change position slowly, especially with elderly,
» 2nd or 3rd-degree • bradycardia
to prevent orthostatic changes
heart block • heart failure
• hypoglycemia • Monitor blood glucose carefully if diabetic as beta-
Use with caution: blockers may mask symptoms of hypoglycemia
• bradycardia
• diabetes • Do not discontinue this drug abruptly
• liver disease

Cardiovascular Drugs — Antihypertensives continued >

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Cardiovascular Drugs — Antihypertensives [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

CALCIUM amlodipine (Norvasc) Used to treat: Most common Assess/Monitor

CHANNEL diltiazem (Cardizem) • hypertension side effects: • Obtain BP and HR before administering; notify provider
BLOCKERS • stable angina • edema, especially in if SBP <90
nifedipine (Procardia) ———————————————— the feet • Presence of peripheral edema
verapamil (Calan) Contraindications: • abdominal pain,
• symptomatic hypotension nausea, fatigue • Liver and kidney function
• heart blocks • Serum electrolytes
Severe adverse
Use with caution: Administration
effects:
• severe aortic stenosis • Intravenous administration of drips requires additional
• Cardiac arrhythmias
• hepatic impairment monitoring (frequent vitals, cardiac monitoring)
• elderly patients
Patient Education
• Change position slowly, especially with elderly, to prevent
orthostatic changes

Cardiovascular Drugs — Antihypertensives continued >

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Cardiovascular Drugs — Antihypertensives [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

VASO- hydralazine Used to treat: Most common Assess/Monitor

DILATORS (Apresoline) • hypertension side effects: • Obtain BP and HR before administering; notify provider
isosorbide (Imdur) • angina pectoris • diarrhea, loss of if SBP <90
———————————————— appetite, nausea, • Presence/resolution of chest pain
nitroglycerine (Minitran, Contraindications: vomiting
Notrostat, Nitrotab) • coronary artery disease • headache Administration
• mitral valve disease • dizziness • Nitrate patches must be taken off at night and reapplied in
• cardiomyopathies • hypotension the morning — do not leave on overnight
• nitroglycerin should not • Intravenous nitroglycerin — use vented, low-sorb tubing
be used for patients with Severe adverse
increased intracranial effects: Patient Education
pressure • hypotension • Dangerously low blood pressure can result if patients are
taking nitroglycerin or other nitrates with erectile
Use with caution:
dysfunction medications
• valve disease
• history of stroke • Tolerance to nitroglycerin may develop with excessive use
• renal disease • Do not discontinue these medications suddenly
• Avoid alcohol (may increase risk of hypotension)
• Treat headaches with aspirin or acetaminophen

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Cardiovascular Drugs — Antiarrhythmic Agents
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

CLASS III amiodarone Used to treat: Most common Assess/Monitor

ANTI- (Cordarone) • ventricular arrhythmias side effects: • Obtain heart rate before administering; notify provider if HR <60
ARRHYTHMIC dofetilide (Tikosyn) • atrial fibrillation • dizziness • QT interval
• atrial flutter • lightheadedness • Signs of pulmonary toxicity (crackles, decreased lung sounds,
sotalol (Betapace) —————————————— • fatigue pleuritic chest pain)
Contraindications: • bradycardia
• Signs of neurotoxicity (ataxia, muscle weakness, tingling,
• heart blocks • hypotension
tremors)
• long QT syndrome • shortness of breath
• severe bradycardia • Signs of thyroid dysfunction (hypo: lethargy, weight gain, edema;
Severe adverse hyper: tachycardia, weight loss, nervousness)
Use with caution: effects: • Liver and thyroid labs
• elderly patients • severe bradycardia
• bradycardia Administration
• prolonged QT
• hypotension • Patients receiving IV antiarrhythmic medications should
interval
• thyroid abnormalities be on a cardiac monitor
• heart block
• hepatic failure • pulmonary fibrosis/ • Use low-sorb filter tubing with amiodarone
toxicity • Obtain EKG after each dose of PO dofetilide for the first five doses
• hypo- or hyper- Patient Education
thyroidism • Do not discontinue medication abruptly
• Notify provider if taking any new medications, due to numerous
drug interactions

DIGITALIS digoxin (Lanoxin) Used to treat: Most common Assess/Monitor

• atrial fibrillation side effects: • Assess apical pulse for a full minute before giving; hold for
• heart failure • fatigue HR <60
• ventricular rate control • bradycardia • Electrolytes
—————————————— • anorexia, nausea, • Serum digoxin levels
Contraindications: vomiting
• Renal function
• ventricular fibrillation
Severe adverse • Signs of toxicity (abdominal pain, confusion, weakness, anorexia,
Use with caution: nausea and vomiting, bradycardia, visual changes — blurred
effects:
• elderly patients vision, green/yellow color disturbances)
• cardiac arrhythmias
• renal impairment
• digoxin toxicity Administration
• Parental administration is rarely used
Patient Education
• Report symptoms of digoxin toxicity
• This medication can increase the risk for falls

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Cardiovascular Drugs — Antihyperlipidemics
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

STATINS atorvastatin (Lipitor) Used to treat: Most common Assess/Monitor

lovastatin (Mevacor) • hyperlipidemia side effects: • Lipid panel
———————————————— • diarrhea, abdominal • Liver function
rosuvastatin (Crestor) Contraindications: pain, constipation • Serum creatine kinase
simvastatin (Zocor) • acute liver disease • muscle or joint pain
• Presence of muscle pain
• pregnancy • nasopharyngitis
• breastfeeding Administration
Severe adverse • Simvastatin should be taken in the evening
Use with caution:
effects:
• elderly patients Patient Education
• rhabdomyolysis
• renal failure • Avoid alcohol while taking this medication
• hepatotoxicity
• liver failure
• Immediately report unexplained muscle pain, tenderness,
or weakness
• Consult provider before starting new medications,
due to numerous drug interactions

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Cardiovascular Drugs — Diuretics
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

LOOP furosemide (Lasix) Used to treat: Most common Assess/Monitor

DIURETICS budesonide (Bumex) • edema associated with side effects: • Obtain BP before administering; notify provider if BP <90
heart failure, renal failure, • electrolyte • Potassium is the electrolyte that is most quickly
torsemide (Demadex) and cirrhosis of the liver imbalances depleted — assess for signs of hypokalemia (weakness,
———————————————— fatigue, increased PVCs on cardiac monitor)
Contraindications: Severe adverse
• anuria effects: • Serum potassium, sodium, and magnesium levels
• hypotension • Urine output and kidney function (creatinine, BUN, GFR)
Use with caution: • severe electrolyte
• electrolyte imbalances imbalances may Administration
• renal failure result in cardiac • Rapid administration of IV doses can result in ototoxicity
arrhythmias
Patient Education
• Change position slowly, especially with elderly, to prevent
orthostatic changes
• This drug will cause increased urine output

K+ SPARING spironolactone Used to treat: Most common Assess/Monitor

DIURETICS (Aldactone) • edema associated with liver side effects: • Obtain BP before administering; notify provider if BP <90
failure, heart failure, • gynecomastia • Monitor urine output and reduction in edema
or hypertension • diarrhea, nausea, • Serum potassium levels
———————————————— vomiting
• Renal function
Contraindications: • somnolence
• Addison disease Administration
• hyperkalemia Severe adverse • Avoid use of potassium supplements
effects: • Use PPE when handing tablets or crushing pills
Use with caution:
• electrolyte
• renal failure
imbalances, Patient Education
(especially • Avoid high potassium foods, including salt substitutes
hyperkalemia) • Take this medication consistently with food
• hepatotoxicity • This drug will cause increased urine output
• nephrotoxicity

Cardiovascular Drugs — Diuretics continued >

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Cardiovascular Drugs — Diuretics [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

THIAZIDES chlorothiazide (Diuril) Used to treat: Most common Assess/Monitor

chlorthalidone • edema side effects: • Obtain BP before administering; notify provider if SBP <90
(Thalitone) • hypertension • photosensitivity • I&O and/or daily weight
———————————————— • hyperglycemia • Presence/resolution of edema
hydrochlorothiazide Contraindications: • diarrhea, loss of
(HCTZ, Microzide) • Serum electrolytes
• anuria appetite, nausea,
metolazone (Zaroxolyn) vomiting Administration
Use with caution:
• dizziness • Thiazides interact with many other medications
• renal failure
• liver failure Patient Education
Severe adverse
• if taking lithium • Notify provider before beginning any new drug or
effects:
• electrolyte supplement
imbalances • This drug will cause increased urine output
• hepatotoxicity
• renal failure
• pulmonary edema

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Cardiovascular Drugs — Anticoagulants/Antiplatelets
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

WARFARIN warfarin (Coumadin) Used to treat: Most common Assess/Monitor

• prevention of blood side effects: • Assess for signs of bleeding before administering this medication
clots for patients with • minor bleeding • Most recent INR (therapeutic range is most often 2–3)
atrial fibrillation or prolonged • Signs of bleeding (black, tarry, or maroon stool, bruising,
• pulmonary embolism bleeding time hematuria, bleeding gums)
• venous
thromboembolism Severe adverse Administration
—————————————— effects: • Use proper procedures for handling potentially
Contraindications: • GI bleeding hazardous drugs
• hemorrhage • If giving via feeding tube, pause the tube feeding as directed by
• recent or potential pharmacy
surgery or other • This medication is typically given in the evenings so that INR
procedure with can be drawn and dose adjustments can be made before the
potential for bleeding next dose
Use with caution: • Vitamin K is the reversal agent for warfarin
• vitamin K deficiency Patient Education
• diabetes • Immediately report signs of bleeding
• elderly patients • Immediately report any falls, especially if a fall results
• renal impairment in hitting the head
• Avoid large amounts of foods containing Vitamin K
(such as leafy greens)

DIRECT- apixaban (Eliquis) Used to treat: Most common Assess/Monitor

ACTING dabigatran (Pradaxa) • prevention of thrombus side effects: • Assess for signs of bleeding before administering
ORAL ANTI- formation • minor bleeding this medication
COAGULANTS rivaroxaban (Xarelto) • DVT or prolonged Administration
(DOACs) • pulmonary embolism bleeding time • May be taken with or without food
——————————————
• Medication may be crushed and administered in a puree
Contraindications: Severe adverse
or via a feeding tube
• active bleeding effects:
• GI bleeding Patient Education
Use with caution:
• intracranial bleeding • Notify providers that you are taking this medication,
• before procedures that
• hematuria especially if invasive procedures are ordered
may cause bleeding
• hepatic failure • Do not discontinue this medication abruptly
• ESRD • There are multiple significant drug interactions for DOACs;
consult with provider before starting new medications
• Report signs/symptoms of bleeding

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Cardiovascular Drugs — Anticoagulants/Antiplatelets [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

HEPARIN heparin Used to treat: Most common Assess/Monitor

enoxaparin (Lovenox) • atrial fibrillation side effects: • Assess for signs of bleeding before administering this
• DIC • thrombocytopenia medication
• Venous thromboembolism • increased liver • Heparin aPTT or AntiXa labs for dose titration for
prophylaxis or treatment amino-transferase patients on GTTs
• Venous catheter occlusion level • Platelets
• warfarin bridging
• INR (if bridging to warfarin)
———————————————— Severe adverse
Contraindications: effects: • Hgb and hematocrit
• severe thrombocytopenia • heparin-induced • Liver function
• uncontrolled active thrombocytopenia
Administration
bleeding (HIT)
• Heparin can be administered intravenously or
• anemia
Use with caution: subcutaneously (never orally)
• thrombocytopenia
• severe hypertension • Enoxaparin is administered subcutaneously — avoid the
• bleeding
• history of umbilicus area
thrombocytopenia
• Do not remove air bubble from prefilled enoxaparin syringes
• hepatic disease
• major surgery • Heparin lock flush should not be used for anticoagulation
• Protamine sulfate is the reversal agent for heparin

Patient Education
• Rotate injection sites
• Report signs of bleeding or thrombocytopenia

ANTI- aspirin (Bayer) Used to treat: Most common Assess/Monitor

PLATELET clopidogrel (Plavix) • acute MI side effects: • Assess for signs of bleeding before administering this
DRUGS • CVA • rash medication
prasugrel (Effient) • Prevention of thrombosis • diarrhea Administration
ticagrelor (Brilinta) after PCI • minor bleeding • May be taken with or without food
• PAD
———————————————— Severe adverse Patient Education
Contraindications: effects: • Report signs/symptoms of bleeding
• active bleeding • Agranulocytosis • Inform providers about use of drug prior to procedures
• GI bleeding that may cause bleeding
Use with caution:
• Intracranial • Do not discontinue abruptly
• patients taking PPIs
hemorrhage • Do not take with NSAIDs or aspirin, due to increased
• before major surgery
risk for bleeding

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Central Nervous System Drugs — Analgesics
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

NON-OPIOIDS acetaminophen Used to treat: Most common Assess/Monitor

(Tylenol) • pain side effects: • Presence and resolution of pain
• fever • nausea, vomiting • Presence and resolution of fever
———————————————— • constipation • Liver function
Contraindications:
Severe adverse • Monitor for acetaminophen toxicity
• severe hepatic disease
effects: Administration
Use with caution: • Liver failure
• ETOH abuse • Most often given PO
• Stevens-Johnson
• severe renal impairment • Maximum daily dose is 4000 mg from all sources; be aware
syndrome
of other medications that may contain acetaminophen

Patient Education
• Many non-prescription drugs contain acetaminophen
• Do not drink alcohol while taking this drug

NSAIDs celecoxib (Celebrex) Used to treat: Most common Assess/Monitor

ibuprofen • pain side effects: • Presence and resolution of pain
(Advil, Motrin) • fever • headache • Presence and resolution of fever
• inflammation • constipation • Liver function
indomethacin (Indocin) ———————————————— • nausea, vomiting
• Renal function
ketorolac (Toradol) Contraindications:
• history of adverse reaction Severe adverse • Signs of bleeding — may increase bleeding time
naproxen (Alleve)
• CABG surgery effects: Administration
• weeks 20-30 of pregnancy • GI bleeding • Give PO NSAIDs with food to reduce risk of GI bleed
Use with caution:
Patient Education
• older adults
• Do not take with other NSAIDs (including aspirin)
• severe heart failure
• when taking other drugs • Do not drink alcohol or smoke while taking this medication
that increase risk of GI
effects
• hepatic dysfunction
• renal dysfunction

Central Nervous System Drugs — Analgesics continued >

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Central Nervous System Drugs — Analgesics [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

OPIOIDS codeine Used to treat: Most common Assess/Monitor

fentanyl • acute pain side effects: • Assess BP, HR, RR, and LOC closely before and after giving
• chronic pain • confusion • Pain or sedation level
hydromorphone • air hunger/shortness of • sedation • Bowel function
(dilaudid) breath • hypotension
• Signs/symptoms of respiratory depression or sedation
morphine (MS Contin, ———————————————— • constipation
Roxanol) Contraindications: • nausea Administration
• respiratory depression • Give the lowest dose in a range to avoid complications
oxycodone (Oxycontin) Severe adverse
• known or suspected GI • Stool softeners and laxatives are often prescribed and
obstruction effects: given with opioid drugs
Combination drugs:
• Respiratory
codeine/acetaminophen Use with caution: • Opioids are controlled substances and require a witness
depression
(Tylenol #3) • older adults if a portion of the dose is not given
• Orthostatic
• hepatic dysfunction hypotension • Understand the route of administration — can be given
hydrocodone/ via IV, IM, subq, sublingual, PO, transdermal
• renal dysfunction • Drug dependence/
acetaminophen
• impaired consciousness drug withdrawal • Understand the peak for the medication and route of
(Vicodin, Norco)
syndromes administration
oxycodone/
acetaminophen Patient Education
(Percocet) • High potential for misuse; however, opioids are typically
not addictive when used as directed for acute pain
• Chronic use of opioids can result in drug tolerance,
which can result in higher doses needed to achieve
adequate pain relief
• Do not discontinue abruptly

MUSCLE cyclobenzaprine Used to treat: Most common Assess/Monitor

RELAXANTS (Flexaril) • muscle spasm side effects: • Presence and reduction of pain, muscle stiffness
———————————————— • dizziness • Monitor for increased risk of sedation and weakness
methocarbamol
Contraindications: • fatigue for elderly patients
(Robaxin) • arrhythmias • somnolence
Administration
• when using MAOIs • dry mouth
• Give extended-release capsules at approximately
• CHF • constipation
the same time each day
• heart blocks
• hyperthyroidism Severe adverse • Administer cautiously for patients receiving other
effects: sedating medications
Use with caution:
• Cardiac Patient Education
• elderly patients
dysrhythmias • Muscle relaxants are intended for short-term use
• hepatic dysfunction
• Liver impairment
• history of urinary retention

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Central Nervous System Drugs — Anxiolytics & Mood-Stabilizers
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ANXIOLYTICS alprazolam (Xanax) Used to treat: Most common Assess/Monitor

clonazepam (Klonipin) • anxiety side effects: • Level of consciousness, sedation
• premedication for • dizziness • Presence or resolution of anxiety
diazepam (Valium) procedures • drowsiness • Resolution of seizure if being used to control
lorazepam (Ativan) • status epilepticus • lethargy status epilepticus
————————————————
Severe adverse • Respiratory status
Contraindications:
• acute narrow-angle effects:
Administration
glaucoma • delirium
• Use caution when administering opioids or other
• respiratory insufficiency sedating medications
Use with caution: • Give the lowest ordered dose that is effective
• patients receiving other
Patient Education
CNS depressants
• This drug has the potential for misuse
• elderly patients
• hepatic failure • Do not discontinue abruptly
• renal failure • Avoid alcohol and other CNS depressants
• debilitated patients

SELECTIVE citalopram (Celexa) Used to treat: Most common Assess/Monitor

SEROTONIN • major depressive disorder side effects: • Mood and affect
escitalopram (Lexapro)
REUPTAKE • panic disorders • constipation • Serum sodium levels
INHIBITORS fluoxetine (Prozac) • PTSD • diarrhea • Increased risk of suicidal tendencies
(SSRIs) paroxetine (Paxil) ———————————————— • indigestion
• Weight gain
Contraindications: • nausea
sertraline (Zoloft) • MOAIs • dizziness Administration
• headache • Most medications can be given with or without food
Use with caution:
• insomnia
• seizure disorders Patient Education
•reduced libido
• It may take several weeks for the therapeutic effect
Severe adverse to be noticeable
effects: • Alcohol use is not recommended
• suicidal thoughts
• serotonin syndrome • Report to provider any worsening depression or
suicidal ideation
• Avoid sudden discontinuation of drug

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Central Nervous System Drugs — Other
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ANTI- carbamazepine Used to treat: Note: not all anti- Assess/Monitor

EPILEPTICS (Tegretol) • seizures epileptics have the same • Presence or reduction of seizure activity
gabapentin (Neurontin) • neuropathic pain adverse effects • Serum drug levels
(gabapentin) • Pain reduction (for gabapentin)
levetiracetam (Keppra) ———————————————— Most common
phenytoin (Dilantin) Contraindications: side effects: Administration
• depends on the specific • drowsiness • Use PPE for drugs with special handling precautions
drug • ataxia
• Some medications may interact with tube feedings
• weakness
Use with caution: • GI disturbance Patient Education
• pregnancy • Do not discontinue abruptly (risk for seizure)
Severe adverse
• Avoid antacids due to risk for decreased absorption
effects:
• hypotension • Avoid alcohol due to risk of changes in drug serum levels

ANTI- carbidopa (Lodosyn) Used to treat: Most common Assess/Monitor

PARKINSON • Parkinson’s disease side effects: • Presence or improvement of Parkinson’s effects (rigidity,
carbidopa/levodopa
• Parkinsonism • vitamin B6 tremors, shuffling gait, drooling)
(Sinemet)
———————————————— deficiency • Liver/kidney labs
Contraindications: • nausea • For adverse reactions during the dosage adjustment period
• narrow-angle glaucoma • confusion
• history of melanoma • dizziness Administration
• Can give with food to minimize GI upset
Use with caution:
Severe adverse • Administer consistently at scheduled times if divided doses
• severe cardiovascular
effects:
disease Patient Education
• melanoma
• endocrine disease • Medication may wear off at the end of the dosing interval
• dyskinesia
• hepatic disease
• depression • The oral form may discolor saliva, sweat or urine to
• renal disease
• hallucinations dark red, brown, or black
• suicidal thoughts • High-fat/high-protein/high-calorie meals may delay
absorption
• Avoid sudden discontinuation of drug

Central Nervous System Drugs — Other continued >

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Central Nervous System Drugs — Other [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ANTI- haloperidol (Haldol) Used to treat: Most common Assess/Monitor

PSYCHOTICS olanzapine (Zyprexa) • agitation side effects: • Assess mood and mental status
• restlessness • constipation • Monitor for a decrease in agitation or restlessness
quetiapine (Seroquel) • hallucinations • dry mouth if given as a PRN
risperidone (Risperdal) • bipolar disorder • blurred vision • Presence of extrapyramidal side effects
• schizophrenia • Extrapyramidal side
• Presence of dystonic reactions
———————————————— effects
Contraindications: • increased serum • Worsening of suicidal thoughts or behaviors
• depends on the cholesterol • QT interval
specific drug • increased liver • Cholesterol/liver labs
enzymes • CBC
Use with caution:
• elderly patients Severe adverse Administration
• prolonged QT interval effects: • Give with food to minimize GI irritation
• suicidal thoughts
and behaviors Patient Education
• prolonged QT • Use caution when rising from a sitting or lying down position
interval to reduce the risk of orthostatic hypotension
• drug-induced • Report signs of tardive dyskinesia
leukopenia or • Do not discontinue drug abruptly
neutropenia • Avoid alcohol while taking this drug

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Upper Gastrointestinal System Drugs
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ANTIEMETICS ondansetron (Zofran) Used to treat: Most common Assess/Monitor

prochlorperazine • nausea/vomiting side effects: • Presence and resolution of nausea/vomiting
(Compazine) ———————————————— • constipation • Monitor for prolonged QT
Contraindications: • diarrhea • Monitor for extrapyramidal side effects (prochlorperazine)
promethazine • patients taking • headache
(Phenergan) apomorphine • fatigue Administration
• Prochlorperazine is • Be sure hands are dry when handling oral disintegrating
contraindicated for children Severe adverse tablets (ondansetron)
effects: • Liquid not required for the oral soluble film (ondansetron)
Use with caution: • prolonged QT
• prolonged QT • Select the form of the drug that is most appropriate for the
interval patient’s level of nausea (for example, a patient with severe
• electrolyte abnormalities • torsades de pointes
• prochlorperazine should nausea may not be able to tolerate an oral tablet)
• serotonin syndromes
be used cautiously with • tardive dyskinesia Patient Education
elderly patients (prochlorperazine) • Do not chew or swallow the oral film form of ondansetron

PROTON PUMP omeprazole (Prilosec) Used to treat: Most common Assess/Monitor

INHIBITORS • acid reflux side effects: • Resolution of acid reflux symptoms
pantoprazole (Protonix)
• duodenal ulcers • abdominal pain • Serum magnesium levels
• erosive esophagitis • constipation • Serum vitamin B12
• gastric ulcers • diarrhea Administration
———————————————— • nausea • Administer 30 minutes before meals for best effect
Contraindications:
• Omeprazole capsules may be opened and sprinkled with
• when used with rilpivirine Severe adverse
1 tbsp of puree — do not crush or chew
effects:
Use with caution:
• hypomagnesemia Patient Education
• elderly patients
• Taking this medication for longer than a year can increase the
• vitamin B12 deficiency
risk of some adverse effects

H2 HISTAMINE cimetidine (Tagamet) Used to treat: Most common Assess/Monitor

BLOCKERS • indigestion side effects: • Resolution of GI symptoms
famotidine (Pepcid)
• acid reflux • abdominal pain • CBC assessment needed
ranitidine (Zantac) ———————————————— • constipation Administration
Contraindications: • diarrhea • Administer 30 to 60 minutes before meals
• hypersensitivity
Severe adverse Patient Education
Use with caution: • Monitor for side effects
effects:
• elderly patients
• arrhythmias • Notify provider before starting new medications, as
H2 histamine blockers can interact with many drugs
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Lower Gastrointestinal System Drugs
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

LAXATIVES bisacodyl (Dulcolax) Used to treat: Most common Assess/Monitor

docusate (Colace) • constipation side effects: • Assess for abdominal distention, tenderness, and
• bowel preparation for • abdominal cramps presence of bowel sounds
lactulose GI procedure • diarrhea • Assess color, consistency, and amount of last stool
polyethylene glycol • neurogenic bowel
———————————————— Severe adverse Administration
(Miralax)
Contraindications: effects: • Hold for loose stools
sennosides (Sennokot) • bowel obstruction • electrolyte • Understand route of administration for these medications
• appendicitis imbalances (may be PO, enema, or a suppository)
• gastroenteritis • Administer oral preparations with a full glass of water
Use with caution: • Avoid milk products or antacids within 1 hour of bisacodyl
• extended use • When mixed with some form of thickened water,
• inflammatory bowel polyethylene glycol will become a thin liquid
disease
Patient Education
• Do not use for more than one week unless directed
by provider
• Report rectal bleeding
• Bowel movement should occur within 15 to 60 minutes after
a suppository, up to 12-24 hours after PO forms

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Respiratory System Drugs
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

BRONCHO- Short-acting: Used to treat: Most common Assess/Monitor

DILATORS albuterol sulfate • asthma side effects: • Respiratory status
(Proventil, Ventolin) • COPD • tachycardia • Pulse, BP
———————————————— • nervousness • Amount, color, and character of sputum
ipratropium bromide Contraindications: • restlessness
(Atrovent) • hypersensitivity • palpitations Administration
levalbuterol (Xopenex) • Inhaled medications are typically given with metered-dose
Use with caution: Severe adverse inhalers (MDI) or nebulized
tiotropium (Spiriva) • cardiovascular disorders effects:
• hyperthyroidism • Use a spacer for individuals who have difficulty coordinating
albuterol/ipratropium • paradoxical
inhalation from an MDI
bromide (Duoneb) bronchospasm
Patient Education
Long-acting: • Report to provider if needing to increase the frequency
formoterol (Foradil) for symptom relief
salmeterol (Serevent) • Use proper technique for inhaler

INHALED beclomethasone Used to treat: Most common Assess/Monitor

CORTICO- (QVAR) • asthma side effects: • Respiratory status
STEROIDS • COPD • oral candidiasis
budesonide (Pulmicort) Administration
———————————————— (thrush)
fluticasone (Flovent) Contraindications: • throat/nasal • Not a rescue medication — will not treat an acute
• status asthmaticus or other irritation bronchospasm
mometasone • Prime inhaler before initial use only
acute episodes of asthma • hoarseness
(Asmanex)
Use with caution: Patient Education
Combination Drugs: Severe adverse
• hypertension • Rinse mouth with water after inhaling the drug to
effects:
budesonide/formoterol • diabetes mellitus prevent oral thrush
• osteoporosis
(Symbicort) • hepatic insufficiency • This medication may cause increased glucose levels
• glaucoma
• renal insufficiency
• pregnancy
• untreated infection

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Systemic Drugs — Anti-Inflammatory Medications
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

CORTICO- cortisone (Cortone) Used to treat: Most common Assess/Monitor

STEROIDS dexamethasone • allergic reactions side effects: • Blood glucose levels
(Decadron) • adrenal insufficiency • depression • Serum potassium and sodium levels
• dermatologic conditions • hypertension • WBC
hydrocortisone (Cortef) • rheumatic conditions • GI disturbances
• Signs of adrenal insufficiency (hypotension, weight loss,
methylprednisolone • inflammatory processes or • bruising
weakness, nausea/vomiting, confusion, peripheral edema)
(Solu-Medrol) diseases
———————————————— Severe adverse
prednisone (Deltasone) Administration
Contraindications: • Give oral medications with meals to avoid GI irritation
prednisone effects:
• serious infection • These drugs have many interactions
(Solumedrol) • hyperglycemia
Use with caution: • fluid and electrolyte
Patient Education
• hypertension imbalances
• Do not discontinue abruptly
• diabetes mellitus • adrenal insufficiency
• hepatic insufficiency
• renal insufficiency
• pregnancy
• untreated infection

URIC ACID allopurinol (Alloprim) Used to treat: Most common Assess/Monitor

REDUCERS • gout side effects: • Serum uric acid levels
colchicine
———————————————— • rash • Liver function
Contraindications: • GI disturbances • Renal function
• hypersensitivity
• Joint swelling/joint pain
Severe adverse
Use with caution:
effects: Administration
• hepatic insufficiency
• hepatic failure • Administer after a meal to reduce gastric irritation
• renal insufficiency
• renal failure
Patient Education
• Increase fluid during therapy to reduce the risk of
kidney stones

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Systemic Drugs — Anti-Infectives
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

BROAD- ceftriaxone (Rocephin) Used to treat: Most common Assess/Monitor

SPECTRUM clindamycin (Cleocin) • bacterial infections where side effects: • Signs/symptoms of worsening infection
ANTIBIOTICS the infectious agent has • diarrhea, nausea, • CBC
meropenem not been identified vomiting
Note: broad- (Merrem IV) • Renal function
———————————————— • photosensitivity
spectrum • Liver function
piperacillin-tazobactam Contraindications:
antibiotics are (Zosyn) • hypersensitivity Severe adverse • Bleeding (some antibiotics can interact with anticoagulants)
not considered a effects: • Signs of antibiotic-associated diarrhea
pharmacologic vancomycin (Vancocin) Use with caution: • rash
class • hepatic impairment • hives Administration
• renal impairment • anaphylaxis • Obtain blood and specimen cultures before administering
• C. diificile colitis the first dose
• nephrotoxicity • Most broad-spectrum antibiotics are administered
• ototoxicity intravenously or intramuscularly
• Drug may need to be reconstituted before administration
• Check for compatibility with fluids or other medications
if given intravenously
• Vancomycin is a vesicant — monitor IV site frequently;
do not give through a midline catheter

Patient Education
• Do not take antidiarrheal while on this medication unless
directed by healthcare provider
• Antibiotics may decrease the effectiveness of birth control —
use backup contraception while taking

Systemic Drugs — Anti-Infectives continued >

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Systemic Drugs — Anti-Infectives [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ANTIBIOTICS Cephalosporins: Used to treat: Most common Assess/Monitor

cephalexin (Keflex) • bacterial infections side effects: • Signs/symptoms of worsening infection
cefuroxime (Ceftin) where the infectious • diarrhea, nausea, • CBC
ceftriaxone agent has not been vomiting • Renal function
cefepime identified • photosensitivity
• Liver function
Penicillins: ———————————————
Contraindications: Severe adverse • Bleeding (some antibiotics can interact with
amoxicillin (Amoxil) effects: anticoagulants)
ampicillin (Polycillin) • hypersensitivity
• sulfonamides are • rash • Signs of antibiotic-associated diarrhea
penicillin G • hives
combination drugs contraindicated in
• anaphylaxis Administration
(Augmentin, Unasyn, Zosyn) children under 2
• C. diificile colitis • If indicated, obtain blood and specimen cultures
• tetracyclines are
Sulfonamides: • nephrotoxicity before administering the first dose
contraindicated for
sulfamethoxazole/ children under 9 • ototoxicity • Antibiotics can be administered in many forms —
trimethoprim (Bactrim) PO, IV, IM, or topically
sulfadiazine Use with caution:
• Unless contraindicated, oral medications are generally
sulfasalazine (Azulfidine) • renal impairment
better tolerated with food
• hepatic impairment
Tetracyclines: • pregnancy • Antacids can decrease absorption — do not give together
doxycycline (Doxy) • for patients receiving • Do not give tetracyclines with dairy products
tetracycline (Tetracyn) other nephrotoxic drugs
Patient Education
Carbapenems: (additive effect)
• Do not take antidiarrheal while on this medication
ertapenem (Invanz) • neuromuscular disease
unless directed by healthcare provider
meropenem (Merrem IV)
• Antibiotics may decrease the effectiveness of birth
Aminoglycosides: control — use backup contraception while taking
gentamycin
• Take oral antibiotics with a full glass of water
streptomycin
tobramycin • Some drugs may interact with alcohol — avoid it during
antibiotic therapy
Macrolides:
azithromycin (Zithromax)
erythromycin
Lincosamides:
clindamycin
lincomycin
Fluoroquinolones:
ciprofloxacin (Cipro)
levofloxacin (Levaquin)

Systemic Drugs — Anti-Infectives continued >

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Systemic Drugs — Anti-Infectives [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ANTI- clotrimazole (Lotrimin) Used to treat: Most common Assess/Monitor

FUNGALS fluconazole (Diflucan) • fungal infections of the side effects: • Signs/symptoms of worsening infection
skin, systemic fungal • headache • Renal function
miconazole (Monistat) infections • rash • Hepatic function
nystatin ———————————————— • GI disturbances
Contraindications: • abdominal, joint, or Administration
• most systemic antifungals muscle pain • Systemic antifungals interact with many drugs
are contraindicated during • Understand the route of administration
pregnancy Severe adverse
effects: Patient Education
Use with caution: • hepatic toxicity • Complete the full course of therapy
• hepatic impairment
• Avoid intercourse while being treated for vaginal
• renal dysfunction
yeast infection

Systemic Drugs — Miscellaneous

Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ANTI- diphenhydramine Used to treat: Most common Assess/Monitor

HISTAMINES (Benadryl) • allergic reactions side effects: • Signs/symptoms of worsening allergic reaction
• insomnia • drowsiness • Improvement of symptoms
• motion sickness • dry mouth
———————————————— • dizziness Administration
Contraindications: • May be administered intravenously, intramuscularly,
• newborns Severe adverse topically, or orally
• nursing mothers effects: • Do not push IV Benadryl fast — no more than
• anaphylaxis 25 mg per minute
Use with caution:
• elderly patients Patient Education
• Young children may experience paradoxical excitement
• Avoid occlusive dressings directly on skin where topical
cream has been applied
• Avoid alcohol or other CNS depressants

Systemic Drugs — Miscellaneous continued >

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Systemic Drugs — Miscellaneous [CONTINUED]
Generic Name
Class (Brand Name) Indications Adverse Effects Nursing Considerations

ELECTROLYTES magnesium sulfate Used to treat: Most common Assess/Monitor

potassium chloride • electrolyte imbalances side effects: • Serum electrolytes
(K-Dur) (hypomagnesemia, • abdominal pain • Worsening signs of hypokalemia (weakness, fatigue,
hypokalemia, • nausea, vomiting increased PVCs on cardiac monitor
potassium phosphate hypophosphatemia) • diarrhea
(K-Phos) or sodium • Signs of hyperkalemia (bradycardia, fatigue, muscle
———————————————— weakness, confusion, peaked T-waves on cardiac monitor)
phosphate (Na-Phos) Contraindications: Severe adverse
• hypermagnesemia, effects: Administration
hyperkalemia, • cardiac arrhythmias • Administer PO potassium with meals
hyperphosphatemia • Do not crush extended-release tablets
• IV potassium can be mixed with lidocaine by the
pharmacy to reduce vascular irritation

Patient Education
• Avoid potassium-containing salt substitutes and potassium-
sparing diuretics

HORMONES levothyroxine Used to treat: Most common Assess/Monitor

(Synthroid) • hypothyroidism side effects: • Assess apical pulse and BP prior to giving periodically
———————————————— • palpitations • Thyroid function tests (T3-T4-TSH)
Contraindications: • diarrhea
• hyperthyroidism • anxiety Administration
• Give on an empty stomach in the morning (at least one hour
Use with caution: Severe adverse before a meal and other medications)
• cardiovascular disease effects: • Hold enteral feedings for one hour before and after
• adrenal insufficiency • hyperthyroidism — giving medication
• diabetes typically only when
• Do not give within four hours of antacids, iron, or
• pernicious anemia given in large doses
calcium supplements

Patient Education
• Symptom improvement may not be noticeable for
several weeks
• Do not discontinue the drug abruptly

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UNDERSTANDING PHARMACOLOGY KeithRN.com
Most Commonly Used Categories of Drugs in the Clinical Setting

References
Ford, S. M. (2018). Roach’s introductory clinical pharmacology (11th ed.). Wolters Kluwer.

Micromedex. (2022). IBM Micromedex drug ref (Version 2.0.2). [Mobile app].

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