PHARMACOLOGY

CHEAT SHEETS
PART 1

MEDICINES MADE
EASY
20 COMMON
DRUG CLASSES
COVERED
EASY TO
UNDERSTAND
PRINTABLE

By
Nyrah Saleem
@Healthwithnyrah
 Pharmacology Cheat Sheets
@healthwithnyrah

03 Opioid Agonists
04 Digoxin 13 Statins
05 Ace Inhibitors 14NSAIDs
06Benzodiazepines 15 Aspirin
07 Beta-Blockers 16Warfarin
Calcium Channel
08Blockers 18 Heparin
Proton pump
09Loop Diuretics 19 inhibitors
10Thiazide Diuretics 20Enoxaparin
11 Nitroglycerin 21 Levothyroxine
12 SSRIs 22 Desmopression
23 Tetracyclines
 Opioid Agonists
@healthwithnyrah

Medications
Codeine Morphine Naloxone
is the antidote for
Fentanyl Methadone opioid agonists.
Reverse the effects
Hydromorphone Meperidine of opioids

Action
Opioid againsts bind to a receptor and alter the CNS perception and emotional response
Activate MU and KAPPA receotots producing analgesia, sedation,
respiratory depression,.......
Indications
Opioid agonists are used for moderate to severe pain
Pre-op sedation, reduce anxiety
Suppress cough(Codeine)
bowel motility

Adverse effects
Vasodilation
Orthostatic hypotension ( BP) , dizziness Risk for falls
Confusion, Sedation
Constipation, nausea,vomitting......
Urinary retention
Respiratory depression ( respiration rate, depth, cough reflex)
Addiction, tolerance, dependence

Contraindications
Morphine is contraindicated in patients after biliary tract surgery
Use with caution in patients with COPD, asthma, head trauma, LOC, ICP, infants &
older adults due to the risk of respiratory depression

Nursing Implications
Opioid agonists dilate the peripheral blood vessels and can cause hypotension
Orthostatic hypotension (is more common in patients with underlying volume depletion)
Educate patients to rise slowly from a sitting to a standing position to prevent falls
Educate patients to fluid intake, fiber
Administer stool softener such as Docusate sodium to prevent constipation
Monitor intake & output
Watch for urine retention & constipation
Notify the provider if respiration rate < 12 and hold the medication
Avoid taking opioids + antihypertensives
 Digoxin (Lanoxin)

@healthwithnyrah

Narrow margin
Drug class Cardiac Glycoside of safety

Action
Increase the strength of myocardial contraction
Increase CO (cardiac output) & renal perfusion
Slow the HR

Indications
Heart failure ( HR )
Atrial fibrillation
Atrial flutter
Paroxysmal atrial tachycardia

Adverse effects
Nausea, vomiting, anorexia
Headache, drowsiness, weakness
Vision changes (a yellow hole around objects)
Bradycardia, palpitations
Arrhythmias

Contraindications
Digoxin is contraindicated in patients with: Therapeutic dose can cause toxicity
Ventricular fibrillation Digoxin has a
Ventricular tachycardia narrow margin

Heart block of safety

Use with caution in patients who are
Acute myocardial infarction pregnant or lactating due to potential
adverse effect on the fetus/neonate
Renal impairment,......

Nursing Implications
Monitor closely when administering digoxin to pediatric and genatric patients due to
having higher risk for toxicity
Check HR (opical pulse) for 1 minute prior to administering the medication.
The nurse must hold the drug if pulse <60 or > 100
Monitor the potassium level risk of hyperkalemia
Monitor the adverse effects and educate patients toreport adverse effects
( arrhythmia, vision changes...)
Monitor potassium level and sign of hypokalemia
Monitor the patient for digoxin blood levels
Therapeutic digoxin level: 0.5 - 2 ng / ml
The nurse must check the dose carefully to prevent medication errors
Administer IV doses "SLOWLY" over at least five minutes to prevent cardiac arrest
 Ace Inhibitors
Angiotensin Converting Enzyme Inhibitors
@healthwithnyrah

Medications
Benazapril
Captopril ACE inhibitors do not

Lisinopril directly affect the

heart rate
Enalapril
Quinapril
Action
Blocking the conversion of angiotensin to angiotensin

Indications
Hypertension
Heart failure
Diabetic neuropathy
Treatment after an acute myocardial infarction

Adverse Effects Angioedema

Dizziness Rapid swelling of lips, tongue, throat, face,
Headache and larynx
Hyperkalemia Angioedema can lead to airway abstruction
Persistent dry cough & death
Angioedema The risk for angioedema is higher in african
(edema of the face & airways) Americans than Caucasians
Reflex tachycardia
Constipation
Liver injury
Renal damage
(monitor blood urea nitrogen, creatine)
Hypotension - orthostatic hypotension

Drug-drug interations
Antihypertensive effects will be decreased when taken with NSAIDs (nonsteroidal
anti-inflammatory drugs)
Risk of hypersensitivity reactions if taken with allopurinol

Nursing considerations
ACE inhibitors are contraindicated in pregnancy because of their teratogenic effects
on the fetus
 Benzodiazepines
@healthwithnyrah

Medications
Alprazolam Estazolam Benzodiazepines should
Clonazepam Trizolam never be stopped abruptly
and should always be
Diazepam Temazepam tapered off gradually

Lorazepam Chlordiazepoxide
Midazolam Clorazepate

Action
Benzodiazepines bind to benzodiazepine receptors and enhance the effect of GABA
GABA (gamma-aminobutyric acid)
An inhibitory neurotransmitter of the central nervous system (CNS) that reduces the
stimulation of nerve cells, which can reduce stress, anxiety, and enhance sleep
Indications
Alcohol withdrawal Muscle spasms
Anxiety disorders Preoperative relief of anxiety
Agitation Seizures
Insomnia

Adverse effects
Drowsiness Bradycardia Constipation
Sedation Hypotension Dry mouth
Blurred vision Suicidal ideation Nausea
Lethargy Physical dependence Vomiting
Light-headedness

Nursing considerations
Avoid using alcohol and other CNS depressants
Benzodiazepines may cause drowsiness or dizziness
Instruct patients to avoid driving and other activities that require alertness
Administer at bedtime when possible due to sedative effect
Benzodiazepines should always be tapered off gradually to prevent rebound anxiety &
withdrawal reaction
Educate patients that antianxiety medications are prescribed for short-term therapy and
do not cure underlying problems
Antianxiety medications have potential addictive behavior
Avoid drinking grapefruit juice
 Beta - Blockers
( Beta - Adrenergic Antagonists )
@healthwithnyrah

Medications
Atenolol Labetalol ( Safe in pregnancy) )
Acebutalol Propranolol
Bisoprolol Sotalol
Carvedilol Do not stop the medication
abruptly because rebound
hypertension, angina, or
Metoprolol tartrate immideate-release rebound tachycardia can occur

Metoprolol Succinate extended-release

Action
Beta-Blockers inhibit the release of Catecholamines
Dopamine Result in decreased heart rate and
Norepinephrine BP, and decreased O 2 demand and
Epinephrine workload of the heart

Indications
Hypertension Prevention of myocardial infarction
Angina Migraines
Atrial Fibrillation
Adverse effects
Bradycardia Nausea, Vomiting Decreased Libido
Hypotension Hyperglycemia Edema
Dizziness Depression Fatigue
Bronchospasm Sleep Disturbances
Contraindications
Beta-Blockers are contraindicated in patients with
Asthma
Bradycardia, hypotension
Severe renal, hepatic disease
Nursing considerations
Use with caution in patient with diabetes because beta-blockers can mask hypoglycemia
Obtain the patient's heart rate and blood pressure prerior to the administration of the
medication
(Hold if HR < 60 bpm or BP < 90/60 mmttg )
Use with caution in patients taking antihypertensive agents
Educate the patients to take blood pressure and juice
Instruct patient to change positions slowly to prevent orthostatic hypotension
Monitor the patients for signs of HF or worsening HF (edema)
Monitor the patients for asthma symptoms (wheezing, dyspnea)
 Calcium channel Blockers
@healthwithnyrah

Medications
Amlodipine Nimodipine
Clevidipine Nisoldipine
Diltiazem Verapamil
Felodipine 1. Do not stop the
medication abruptly
Nifedipine 2. Avoid grapefruit juice

Nicardipine

Action
Promote vasodilation of coronary and peripheral vessels
Calcium channel blockers work by blocking the flow of calcium ions into cardiac and
vascular smooth muscle cells, which rely on calcium for contraction
Relax vascular smooth muscle
Decrease cardiac contractility
Decrease the workload of heart The heart contracts less forcefully
and demands less oxygen

Indications
Hypertension Angina Dysrhythmias

Adverse effects
Bradycardia Headache
Hypotension Flushing of the skin
Reflex tachycardia Dizziness
Peripheral edema Fatigue
Constipation Gingival hyperplasia

Nursing considerations
Avoid the client's vital signs prior to giving medication
Educate client to avoid grapefruit juice
Grapefruit juice increases the amount of medication in the body by inhibiting the liver
enzymes responsible for drug breakdown may lead to severe hypotension
Monitor kidney function tests and liver enzyme levels
Educate client not to stop medication abruptly
Instruct client to report to the nurse if dizziness or fainting occurs
Monitor the patients for signs of heart failure such as peripheral edema or fluid retention
Weight the client daily
Teach client not to crush or chew sustained-releasetablets
 Loop Diuretics
@healthwithnyrah

Medications
Furosemide Instruct clients to take
Bumetanide medication in the morning to
avoid nocturia
Torsemide
Ethacrynic acid
Action
Loop diuretics work by blocking sodium-potassium-chloride, triple transporter at the
ascending limb of the loop of Henle
Indications
Remove excess fluid
Hypertension Nephrotic syndrome
Pulmonary edema Ascites associated with cirrhosis
Peripheral edema
Adverse effects
Electrolyte imbalances Hypokalemia which can lead to muscle cramps, weakness,
and cardiac arrhythmias
Hyponatremia, hypocalcemia, hypomagnesemia
Ototoxicity (furosemide only) caused by rapid administration
Dehydration
Hypotension Monitor potassium levels closely
Hyperuricemia
Orthostatic hypotension
Nursing considerations
Monitor the client's electrolyte levels closely ( K + )
Do not administer the medication if potassium < 3.5
K+
Educate client to eat food high in potassium
Monitor BUN, creatinine, and uric acid levels
Monitor daily weight (best indicator of fluid retention and fluid loss)
Closely monitor intake and output
Monitor the client's blood pressure closely because hypotension can occur due to sudden
drop in fluid volume
Educate client to change position slowly to minimize dizziness and prevent falls
Use with caution in clients experiencing Gout
Caution
Always administer IV furosemide slowly over 1-2 minutes
because rapid administration can cause hearing loss
Do not administer furosemide IV faster than 4 mg/ min
 Thiazide Diuretics
@healthwithnyrah

Medications
Hydrochlorothiazide
Chlorthiazide Use with caution in clients taking digoxin or lithium
Chlorthalidone Monitor the client closely for signs of digoxin or
Indapamide lithium toxicity
Metolzaone
Action
Block the reabsorption of water, sodium, and potassium in the kidney to remove excess
fluid in the body
Indications
Hypertension
Edema (due to kidney failure, heart failure, liver failure)
Diabetes insipidus
Postmenopausal osteoporosis
Adverse effects
Electrolyte imbalances
Hypokalemia can lead to muscle cramps & cardiac arrythmias
Hyponatremia
Hypomagnesemia Dehydration
Hypochloremia Photosensitivity
Hypocalcemia
Hyperuricemia, hyperglycemia
Orthostatic hypotension
Nursing considerations
Thiazide diuretics should be used with caution in clients taking Lithium
It can lead to increased lithium levels
Use caution in clients taking NSAIDs , digoxin , antihypertensive agents
Monitor electrolyte levels and vital signs closely
Closely monitor intake and output
Monitor daily weights
Closely monitor the client's blood glucose level
Use with caution in clients with gout(monitor uric acid levels)
Monitor BUN and creatinine
Monitor client to change positions slowly to prevent falls
Educate clients to use sunscreen due to increased photosensitivity
Avoid alcohol

Administer thiazide diuretics early in the day

Instuct client to take medication in the morning
to avoid nocturia
 Nitroglycerin
@healthwithnyrah

Action
Nitroglycerin produce vasodilation dilates coronary arteries to increase myocardial
perfusion
Indications
Acute anginal attack
Chronic stable angina
Adverse effects
Headache
Hypotension
Reflex tachycardia
Dizziness, faintness, flushing
Dry mouth
Weakness
Nursing considerations
Instruct the client to lie down or sit down when the medication is administerd to prevent
falls
Contraindicated in clients taking Phsphodiesterase inhibitors
Phsphodiesterase inhibitors such as Sildenafil (viagra) , Tadalafil (cialis)
Have similar mechanism as nitroglycerin and can lead to severe hypotension
Contraindicated in clients with hypotension
Obtain vital signs prior to giving medication
Withhold if systolic blood pressure is < 90 mm Hg
Educate the client that headache is a common side effect and can be treated with
Acetaminophen
Instruct client to properly store the medication (tablets) in a dark, tightly closed bottle and
replace every 3-6 months
Contraindicated in clients with closed angle glaucoma because nitrogen can increase
intraocular pressure
Nitrogen come in different forms, educate client how to safely use each form
Sublingual Nitroglycerin Transdermal Patch Sustained-release
medications
Instruct the client to take 1 Instruct client to apply to Instruct client not to chew
tablet for chest pain(angina) hairless area(arm/upper body) or crush sustained-release
medications
Immediately call 911 if angina Patch should be replaced and
doesn't resolve after the 1st
dise
a different side should be
used each day Chew
Client can take 1 tablet every
5 minutes for a total of 3 Instruct client to remove patch
every 12 hours
Crush
doses in 15 minutes
Educate clients that burning Client needs 10-12 hours of
or tingling sensation may "patch-free" each day to avoid
occur tolerance
 SSRIs
Serotonin-Selective Reuptake Inhibitors
@healthwithnyrah

Indications
Fluoxetine (Prozac) Citalopram (Celexa)
Paroxetine (Paxil) Escitalopram (Lexapro)
Sertraline (Zoloft) Fluvoxamine (Luvox)

Action
SSRIs block the reuptake of serotonin allowing the neurotransmitter to remain in the
synaptic cleft with extra time to exert its effects
SEROTONIN: a neurotransmitter that plays a major role in behavior, depression, eating,
nausea, and vomiting
indications
Depression
Generalized anxiety disorder
Eating disorders Post traumatic Stress disorder
Anxiety disorders Panic disorders
Obsessive-compulsive disorder (OCD)

Adverse effects
weight gain
Reduce sex drive (decresed libido) Risk for non-compliance
Increased risk of suicidal thoughts and behavior
Dry mouth Closely monitor
Nausea, Vomiting suicidal client especially
those with an increase
Insomnia in energy & food

Serotonin Syndrome
Delirim (change in mental status)
Muscle rigidity
Tremors, seizures Agitation Confusion Hallucinations

Diarrhea, abdominal pain

Hyperthermia, sweating
Tachycardia, hypertension

Nursing considerations
Closely monitor vital signs specially BP & HR
Educate the client that SSRIs can cause sexual dysfunction
Instruct client to avoid alcohol
Risk of serotonin syndrome is increased when SSRIs are dextromethorphan, migrain
medications(sumatriptan), tramadol, NSAIDs, aspirin......
Do not stop SSRIs abruptly Serotonin withdrawal can occur
Educate client that it takes 4-6 weeks for full therapeutic effect
Client with liver and renal disease have an increased risk of toxicity
 Statins
HMG - CoA Reductase Inhibitors (Antihyperlipidemic)
@healthwithnyrah

Indications
Atorvastatin (Lipitor) Educate clients to report unexplained muscle
Flusvastation (Lesco) pain because rhabdomyolysis can occur
Lovastatin (Mevacor)
Rosuvastatin (Crestor) Monitor client for signs of liver damage
( liver enzymes, jaundice, abdominal pain.......)
Simvastatin (Zocor)
Pravastatin (Pravachol)
Action
Inhibit HMG-CoA reductase from completing the synthesis of cholestrol which can
lower the levels of:
Cholestrol
LDL (Low-density lipoprotein)
Trigylcerides
indications
These medications are used in the treatment of:
Hypercholesterolemia to lower the level of cholesterol, low-density lipoprotein (LDL),
and triglycerides
Slow the progression of Coronary Artery Disease (CAD) reduce the risk for
myocardial infarction, stroke, and atherosclerosis

Adverse effects
Nausea Headache Muscle cramps
Vomiting Dizziness Rhabdomyolysis:
Breakdown of
muscles
Abdominal pain Blurred vision
Constipation Increased liver enzymes
Flatulence Pruritis

Contraindications
Not recommended during pregnancy (pregnancy category ) and breastfeeding

Nursing considerations
Educate client to take simvastatin in the evening due to having short half-live
Closely monitor client for complain of muscle pain, weakness, increased level of creatine
phosphokinase (CPK), and creatine kinase (CK)
Instruct client to report unexplained muscle pain due to the risk of rhabdomyolysis
Monitor liver enzyme levels due to the risk of liver damage
Do not administer Lovastatin with Anticoagulants or Gemfibrozil
Access cholestrol and triglycerin levels before the start of therapy
 NSAIDs
@healthwithnyrah

Nonsteroidal Anti-inflammatory Drugs

Medications
Celecoxib (Celebrex) Ketorolac (Toradol)
NSAIDs are not
Ibuprofen (Motrin, Advil) recommended during
Indomethacin (Indocin) pregnancy & lactation
Naproxep (Naprosyn) Risk of bleeding

Action
NSAIDs inhibit COX-1 and COX-2 enzymes, and the synthesis of prostaglandin
COX-1 : protects stomach lining, blood clotting, maintains renal sodium and water balance
COX-2 : is active at sites of injury, respond to injury (trigger pain)
Indications
NSAIDs are used in the treatment of:
NSAISs can help relieve
Rheumatoid arthritis pain, inflammation, and
Fever, pain reduce body
Osteoarthritis temperature

Acute gout
Adverse effects
Nausea, Vomiting, Dizziness Fluid retention
Bleeding Pruritis
Bronchospasm
GI irritation can cause peptic ulcers and risk of GI bleeding
Nephrotoxic. low renal blood flow
Drug-drug interactions
NSAIDs decreases the effectiveness of antihypertensive medications such as loop
diuretics and beta-blockers
Hypoglycaemia can occur if Ibuprofen is taken with Insulin

contraindications
NSAIDs are contraindicated in patients with renal, hepatic, or cardiac dysfunction (heart
failure)

Nursing Implications
Use the caution in patient with history of GI bleeding, peptic ulcer, asthma, diabetes,
andalcohol use
Access patients for Hx of hepatic or renal disease, GI bleeding, peptic ulcer
Educate patient to avoid NSADIs for 1-2 weeks prior to surgery
NSAIDs can be taken with food or milk to prevent GI upset
Monitor patient closely and instruct patient to report for signs of bleeding such as tarry
block stools, petechiae, bleeding gums, echymosis
 Aspirin (Acetylsalicylic acid)
Nonsteroidal Anti-inflammatory Drugs
@healthwithnyrah

Action
Aspirin inhibits prostaglandins and the synthesis of vasoconstrictor (thromboxane A 2)
Prostaglandin: can cause an increase in body temperature
Thomboxane A2: can increase blood clot formation & platelet aggregation
Indications
Fever
Mild to moderate pain
Rheumatoid arthritis
Osteoarthritis
Reduce risk of myocardial infarction (MI), ischaemia stroke, transient ischaemic attacks
Contraindications
Allergy to salicylate, NSAIDs Children (especially those with chickenpox or influenza)
Bleeding disorders Risk for Reye's syndrome( swelling in the brain & liver)
Impaired renal function
Surgery, dental work
Pregnancy, lactation
Adverse Effects
Bleeding abnormalities (hemolytic, increased Bleeding time
Blood loss Tinnitus (Ringing in the ear)
Heartburn Dizziness
Nausea, vomiting Headaches
Dyspepsia Flushing
Avoid aspirin in children due to the risk of
Salicylism
Salycylism can occur when patient has high levels of aspirin in their body(aspirin poisoning)
S/S: tinnitus (ringing in ears)
Dizziness Metabolic acidosis
Nausea, Vomiting Tachypnea, hyperventilation
Confusion Pulmonary edema
Tetany(muscle cramps, spasms) Organ failure(cardiovascular,
respiratory renal)
Nursing considerations
Avoid aspirin in children due to the risk of Reye's syndrome
Avoid aspirin during pregnancy & lactation to prevent harm to the fetus/neonate
Instruct patients to stop taking Aspirin 1-2 weeks before surgery to reduce the risk for
bleeding
Monitor patient for signs of bleeding such as dark tarry stools, coffee ground emesis
 Warfarin (Anticoagulant)
@healthwithnyrah

Action
Warfarin inhibit the liver from making vitamin k The antidote of
warfarin is:
dependent clotting factors (II, VII, IX, X) and prothrombin Phytonadione (Vitamin
k)

Medications
Warfarin is used for long term anticoagulant
Prevent PreventPrevent deep vein thrombosis(DVT) due to bedrest
or post-surgical
Pulmonary Embolism
embolism formation

Due to Afib, MI, thrombosis,

heart valve damage
Contraindications
Contraindicated for pregnancy Pregnancy category
Contraindicated in patients with active bleeding, bleeding disorders, hemorrhagic brain
injuries.....
Adverse effects
Bleeding (Bleeding gums, GI tract) Liver damage, jaundice, purple toe syndrome
(discolored, painful toes), Alopecia
Dermatitis
Bone marrow deppression
Bruising, dermal necrosis
Osteoporosis & fracture can occur with long term use
drug-drug interactions
Medications to avoid while taking warfarin :
Salicylates Sulfonamides
Corticosteroids Cimetidine
NSAIDs Allopurinol
Anti-infectives can increase the effect of warfarin
Oral contraceptives can decrease the effect of warfarin
Nursing considerations
Monitor INR(international noramlized ration) level daily to determine a safe dose for patient
INR is the standarized measure of prothrombin levels, Warfarin help raise INR to an
appropriate level Therapeutic INR level: 2-3
Only administer warfarin when INR is below or within the therapeutic range
Monitor PT & INR PT normal range 11-12.5 seconds
When INR is above the therapeutic range, Hold the medication & report to the provider
Onset: Take 3-5 days to reach therapeutic level (not for acute situation)
Bridge therapy: Subcu heparin is used to bridge patient to warfarin until INR reaches the
therapeutical range
 Warfarin
@healthwithnyrah

Patient Education

Due to the risk of bleeding, the nurse must educate patient to take safety measues :

Use electric razor, Soft toothbrush

Wear sleeves to protect the skin

Avoid alcohol and medications that can increase the risk of bleeding
such as NSAIDs, aspirin, acetaminophen

Avoid/limit activities that can increase the risk of injury

Monitor pateints for signs of bleeding such as bleeding gums,

epistaxis, hermaturia, blood in stool ( bright red, dark/tarry stool),
coffee ground emesis, petechiae, abdominal pain.......
Educate patient to maintain a consistent intake of vitamin K to
prevent bleeding
Educate patient to notify the health care provider about the use of
warfarin
Warfarin must be stopped prior to surgery, dental procedures,
colonoscopy........ INR level must be checked prior to the
procedure

Risk of Bleeding
 Heparin HE
50
PA
0
R IN
per 0 u s p
u n it

Anticoagulant
@healthwithnyrah

Action
Heparin binds with antithrombin to inactivate factor Xa, thrombin, and the conversion
of fibrinogen to fibrin
Indications
Heparin is used to treat thrombotic conditions such as:
Pulmonary embolism The antidote for
Stroke heparin is Protamine
sulfate
Heart attack
DVT
Disseminated intravascular coagulation (DIC)
Onset
Immediate onset via IV
30-60 minutes via subcu

Adverse effects
Hemorrhage (easy bruising, haematoma)
Blood in stool or emesis
Heparin-Induced Thrombocytopenia
Elevated liver enzymes
Low hemoglobin, hematocrit, OT thrombocyte count
Ecchymosis, petechiae, purpura

Labs
Normal activated partial thromboplastin time (aPTT) 30-40 seconds
aPTT therapeutic range should be 1.5-2 times the baseline
aPTT must be checked every 4-5 hours until stable response,then check daily per
facility policy
aPTT too high decrease dose or stop infusion
aPTT too low Increase dose or administer bolus dose

Nursing considerations
Heparin prevents existing clots from getting larger and the formation of new clots
Heparin doesn't break up existing clots
Heparin is a high alert medication that requires a verification of second nurse for
administration
Monitor patient for ecchymosis, petechiae,abdominal pain, jaundice,GI bleeding(dark tarry
stool, coffee ground emesis), bleeding gum, epistaxis
Monitor aPTT and platelet count
Inject Heparin subcutaneously into the abdomen at a 90 degree angle (do not rub the
injection site)
 Proton Pump Inhibitors
@healthwithnyrah

Medications
Omeprazole
Esomeprazole (Nexium)
Lansoprazole
Pantoprazole

Action
PPIs suppress the production of gastric acid by binding an enzyme on gastric parietal
cells

Indications
Gastric ulcers Zollinger-Ellison syndrome (hypersecretory condition)
Duodenal ulcers Erosive gastritis
Gastroesophageal reflux disease

Onset
Oral PPIs have an onset of 2-4 hours with a duration of 24 hours or longer

Adverse effects
Diarrhoea, nausea, vomiting
Headache, abdominal pain
Vitamin B12 deficiency, hypomagnesemia
Fractures
Pneumonia

Nursing considerations
Use with caution in elderly patients &patients with hepatic diseases
Educate patients to take medication before meal
Instruct patients to report diarrhoea or respiratory symptoms long term use of PPI
can predispose patient to the risk of having pneumonia, C.difficile, and GI infections
Long-term use of PPIs could lead to osteoporosis fractures due to decreased calcium
absorption
Educate patient to maintain adequate intake of calcium and vitamin D
Not for children under 2 years
Avoid taking antacids and PPI together because antacids can effect the absorption of PPIs
Prolonged therapy of PPIs can increase the effect of warfarin and also lower B12 levels
PPIs can decrease the effectiveness of "clopidogrel" (an antiplatelet medication)
which can increase the risk of stroke or myocardial infarction
 Enoxaparin
@healthwithnyrah

Action
Low-molecular-weight heparin (LMWH)
Inactive newly formed factory Xa
Enoxaparin has similar mechanism of action as heparin which can provide predictable
anticoagulant response
Enoxaparin had longer half-life and duration than standard heparin

Indications
Enoxaparin can be used in the treatment of:
Pulmonary embolism
Prevent post-op deep vein thrombosis (DVT)
Prevent ischemic complications in unstable angina and heart attack

Adverse effects
Bleeding
Easy bruising
Risk of thrombocytopenia
Black or bloody stools
Irritation at the injection site

Nursing considerations
Enoxaparin does not require aPTT monitoring
Has lower risk of thrombocytopenia than heparin, monitor platelets
Administor enoxaparin subcutaneously at a 90 degree angle in the left or right side of the
abdomen at least 2 inches away from umbilicus
Enoxaparin comes in pre-filled syringes, Do not expel air bubble in pre-filled syringes
Educate patients to report unexplained bruising, bleeding or dark blood stools
Do not massage the injection site to prevent bruising

NCLEX Tip:
Administer enoxaparin

90
at a
Degree
Angle
 Levothyroxine
@healthwithnyrah

Action
Levothyroxine is a thyroid hormone
Enhance metabolic rate and gluconeogenesis
Stimulates protein synthesis

Indications
Levothyroxine is used in the treatment of:
Hypothyroidism
Thyroid hormone dedicit
Myxedema coma

Adverse effects
Nausea, diarrhoea
Abdominal cramps, loss of appetite
Weight loss
Overdose can do: Long-term therapy can cause:
Tachycardia, angina, palpitations Osteoporosis
Hypertension Risk for a-fib
Nervousness, tremor
Insomnia
Heat tolerance
Sweating

contraindications
Foods such as soy products, walnut, grapefruit juice, and cottonseed meal can decrease
the absorption and effect of levothyroxine

Wait at least 4 hours before or after taking levothyroxine to take iron or calcium
Nursing considerations
Thyroid hormone replacement is a life-long therapy
Educate patients to take levothyroxine on an empty stomach 30-60 minutes before meal
Monitor TSH, T 3, and T4 levels
Instruct patients to take medication at the same time daily
Monitor patient's vital signs and weight
Instruct patients to report signs of hyperthyroidism (tachycardia, palpitations, angina,
sweating) because they could indicate toxicity
Use with caution in older adults or patients with impaired cardiac function
Educate patients that it take several weeks for the therapeutic effect to be seen and
avoid caffeine or iron suppelements within 30mins o aking it
 Desmopression
@healthwithnyrah

Action
Desmopression is an anti-diuretic hormone
Enhance water absorption of water in the kidneys which promote anti-diuretic effect and
regulates fluid balance

Indications
Desmopression is used in the treatment of diabetes insipid to increase urine osmolality &
decrease urine flow rate

Adverse effects
Nausea
Abdominal cramps
Headache Headache, Drowsiness, lethagy
Water intoxication Sudden weight gain
Severe nasal congestion
Flushing

Nursing Implications
Monitor weight and vital signs especially BP
Educate patients on the proper use of intranasal medication
Educate patients to check their weight daily and report sudden weight gain
Administer intranasally
Instruct patients to report nasal stuffiness
Also available in oral tablets Diabetes insipidus
Monitor I and O, urine osmolarity Increased
Thirst
Monitor electrolyte levels
Educate patient to report signs of water intoxication: Excessive
Headache Urination
Drowsiness
Lethagy Dehydration
Fatigue
Sudden weight gain Headache
Severe nasal congestion
 Tetracyclines
Antibiotic
Medications
@healthwithnyrah

Doxycycline Tetracycline Children under the age of 8

Minocycline Tigecycline Pregnant women

Action
Tetracycline are Broad spectrum antibiotics that can suppress the growth of bacteria
by inhibiting the bacterial protein synthesis. This will prevent the replication of bacteria
Suppressing the growth of Gram-negative & Gram-positive bacteria
indications
Lyme disease Chlamydia
Rocky mountain spotted fever Syphilis
Typhus, cholera, anthrax
Acne, rosacea
Peptic ulcer disease that caused by Helicobacter pylori

Adverse effects
Nausea, Vomiting, Diarrhoea
Superinfections (C. difficile, pseudomembranous colitis.........)
Monitor patient for diarrhoea
Photosensitivity reactions

Contraindications
Do not administer tetracycline to Children under 8 years or pregnant women(pregnancy
category D)
Tetracycline may cause permanent teeth discoloration in child's developing teeth
May lead to liver toxicity in patients with renal diseases

Drug-drug interactions
Oral tetracyclines can decrease the effectiveness of oral contraceptives

Nursing considerations
Educate patient to complete the full course of prescribed antibiotics even when their
symptoms have improved
Instruct patient to have medications on an empty stomach
Avoid taking tetracyclines with antacids containing aluminium, calcium, magnesium
Avoid taking tetracycline with milk or milk products because dairy, calcium, iron & zinc can
decrease the obsorption of the medication in the stomach
Educate female patients to use a different method of contraception to avoid pregnancy
Phototoxicity: Teach patients to use safety precautions such as wearing sleeves and
sunscreen when in sunlight