HNN215 DRUG DIARY

Drug Class Examples Action Significant Risks Nursing

(ADRs) Considerations

Non-narcotic analgesics Panadol- paracetamol, Inhibits prostaglandin Liver toxicity Mild- moderate pain
Herron, Panadol osteo synthesis in CNS & activates
deactivates descending
pathways.

Non-steroidal anti-
inflammatory drugs (NSAIDs)
Narcotic analgesics
Nurofen/Ibuprofen Analgesic, anti-
Voltaren rapid inflammatory, anti-pyretic
Celebrex actions.
Diclofenac Inhibits production of
prostaglandins by COX
reducing inflammation &
analgesia.
Morphine Acts on opioid receptors in
Endone CNS/GIT, effect varies
Targin depending on affinity for
Fentanyl opioid receptors.
Risk of GIT bleeding Use lowest effective dose
NSAID induced renal Monitor renal function
impairment
Increased CV events
Respiratory depression Mild- moderate or
Hypotension moderate- severe pain
Bradycardia Assess sedation and side
Urinary retention affects
Constipation

Adjuvants Diazepam Work with analgesics to

Lignocaine increase pain relief.
Clonidine
Drug Class Examples Action Significant Risks Nursing
(ADRs) Considerations

Beta- lactams Cefazolin Interferes with bacterial cell Anaphylaxis Will deactivate
Penicillin Ceftriaxone wall synthesis resulting in lysis Generally well tolerated aminoglycosides if given
Cephalosporins Amoxycillin of the cell wall (rupture) and Superinfections with together
death of bacteria cell. prolonged use Allergies/reactions
Rare: rash, angioedema Avoid rapid IV infusion
With or without food
Glycopeptides Vancomycin Inhibits bacterial cell wall Hypersensitivity- rash etc. Monitor renal function
synthesis. Increased risk of Falls risk
nephrotoxicity/ ototoxicity Avoid rapid infusion
Monitor trough levels in pt
with renal impairment

Aminoglycosides Gentamicin Bind to ribosomes, smaller 30s Ototoxicity Monitor creatinine clearance
Broad spectrum subunits. Nephrotoxicity and renal function
Protein synthesis is inhibited, Monitor for tinnitus
cell dies. Measure peak/trough levels

Macrolides Erythromycin Target ribosomes, bind to Super infection Avoid rapid infusion
Azithromycin larger 50s subunits. Altered heart electricity levels Renal monitoring
Erythrocin Inhibit protein synthesis, cell GIT disturbances
dies.

Antifungals Clotrimazole Inhibits formation of Effects differ for each pt. Renal failure: dose
Imadazoles (broad Flucanozole ergosterol, disrupting cell Taken on empty stomach adjustment
spectrum) membrane synthesis. causes GIT disturbances Hepatic impairment: half life
Triazoles (narrow spectrum) Interferes with metabolism of Hepatotxicity extends could worsen
hydrogen peroxide in cell, Fatigue/ dyspepsia Heart failure/ diabetes
cell dies.
Drug Class Examples Action Significant Risks Nursing
(ADRs) Considerations

Beta blockers Atenolol Block beta receptors in heart, Bradycardia MUST be slowly reduced when
Metoprolol peripheral vasculature, other Hypotension ceased
Bisoprolol organs. Bronchospasm May mask signs of
Decrease HR, BP, cardiac Alteration of glucose hypoglycaemia
contractility. metabolism Can cause asthma in patients
Slows conduction through with asthma.
atrioventricular node.
Calcium Channel Blockers Amlodipine Block inward current of Vasodilatory effects: Differ greatly in duration of
Diltiazem calcium cells in cardiac headache, flushing, action
Verapamil conduction system, hypotension Can cause further depression
myocardium & vascular of cardiac function in heart
smooth wall. failure

Antiarrhythmic Digoxin Increases efficiency of heart-
Amiodarone cardiac output, alters activity
of ANS
Decreased AV nodal
conduction
Increased myocardial
contraction
Decreases SA node activity,
slows AV conduction, weak
beta blocking effect.
Worsening of arrhythmias-
narrow therapeutic range
CNS disturbances
Toxicity
Potential to worsen arrhythmia
CNS toxicity
Pulmonary toxicity
Assess for S&S of toxicity
Assess renal
function/electrolyte levels
Admin requires close
nurse/medical supervision
Close monitoring of ECGs,
electrolyte levels, chest xrays
IV- continuous cardiac
monitoring

Electrolytes Potassium Plays vital role in cell Hypokalemia IV- slowly infuse
Magnesium metabolism and cardiac and Hyperkalaemia Diffused
neuromuscular function. Hypermagnesaemia According to hospital protocol
Hypomagnesaemia
Drug Class Examples Action Significant Risks Nursing
(ADRs) Considerations

ACE Inhibitors Captopril Block conversion of Angiotensin Hypotension Monitor renal

Enalapril I to Angiotensin II. Dizziness/headache function/electrolytes
Perindopril Reduce BP & vascular Renal impairment Review use of NSAIDs (damage
Ramipril resistance. Hyperkalaemia renal function)
Inhibits aldosterone release.

Angiotensin receptor Candesartan Block Angiotensin II with Dizziness/headache Similar to ACE inhibitors
antagonists Irbesartan specific Angiotensin II Hypotension Alternative for ACE intolerance
Telmisartan receptors. GI disturbances
Inhibits aldosterone release.

Vasodilators Glyceryl Trinitrate (GTN) Primarily a venodilator, affects Vasodilatory effects- Pt education for use/storage os
arterial smooth muscle. hypotension sublingual spray
Reducing myocardial O2 Flushing GTN patches need GTN free
requirements Palpitations periods to avoid tolerance
Fainting

Lipid lowering agents (statins)
Atorvastatin Inhibits HMG-COA reductase Myalgia Baseline bloods taken initially
Rosuvastatin enzyme. Mild transient GI symptoms Abnormal hepatic function
Simvastatin Decreases plasma/LDL Sleep disturbances tests
cholesterol, increases HDL RARE/SERIOUS: myopathy, More effective taken in evening
cholesterol. rhabdomyolysis
Improves endothelial function-
stabilizes atherosclerotic
plaque.
Drug Class Examples Action Significant Risks Nursing
(ADRs) Considerations

Diuretics Frusemide (Lasix) Inhibits sodium, chloride Dehydration Start with low dose
Loop Erthacryic acid (Edecril) &water reabsorption in Electrolyte imbalances BD doses normally 6hrs
ascending Loop of Henle. (hypokalaemia, Frequent U&E
Increased output (diuresis). hypomagnesaemia, High potassium diet
hyponatraemia, Frusemide 250mg IV infused,
hypocalcaemia) not as bolus.
Diuretics Hydrocholothiazide Promote increased sodium Dehydration Similar to loop diuretics
Thiazide/thiazide like (Dichlotride) &chloride excretion, inhibits Electrolyte imbalance
Chlorthalidone (Hygoten) H20 reabsorption. Increased calcium
Vasodilate peripheral
arterioles.

Diuretics Aldactone Inhibits sodium reabsorption Electrolyte imbalance Administer am

Potassium sparing Amiloride in distal convoluted tubule Weakness Monitor U&E
by blocking sodium Headache Avoid rapid positional
channel/antagonizing Nausea/vomiting changes
aldosterone.

Anticoagulants Heparin Inactivate clotting factors IIA
Injectable Enoxaparin (Clexane) (thrombin) & XA by binding
to antithrombin III (natural
coagulation inhibitor).
Enoxaparin greater effect on
XA than thrombin.
Bleeding Monitor for S&S of bleeding
Bruising/pain at site Pt education to report signs
Hyperkalaemia of bleeding
Mild reversible FBE &coagulation profile
thrombocytopenia (low Heparin is reversed by
platelet count) protamine
Use with caution in
elderly/renal impairment
Drug Class Examples Action Significant Risks Nursing
(ADRs) Consideration

Anticoagulants Aspirin Inhibits platelet aggregation GI upset Cease 7 days prior to

Oral by disabling COX.
Decrease synthesis of
thromboxane A2 (inducer of
platelet aggregation).
Allergies surgery
Potential for bleeding Effective in reducing death
post myocardial infarction
Antiplatelet may be as low
as 100mg

Anticoagulants Warfarin Inhibits synthesis of Vitamin K Haemorrhage Several days for full effect
Oral dependent clotting factors. Tissue necrosis Dose is critical
Stops blood clotting. Alopecia Guided by INR tests- pt with
Purple discolouration in toes warfarin 2-3
Hepatic dysfunction Regular INR tests
Take tablets at same time
each day- 4pm
Many interactions
Different brands- different
doses
Pt education
signs/symptoms of bleeding
Drug Class Examples Action Significant Risks Nursing
(ADRs) Considerations

Beta- 2 agonists Salbutamol (Ventolin) Stimulate beta-2 receptors, SNS simulation: tremor, Assess for signs and
Short acting Terbultaline relaxing bronchial smooth palpitations, headache symptoms of hypokalaemia
muscle leading to High doses cause Assess blood test results
bronchodilation. hypokalaemia Educate pt on reliever meds
Reliever medication Onset: 5 mins duration: 3
hours
Beta-2 agonists Formoterol Stimulate beta-2 receptors, Tremor, palpitations, Preventer medication
Long acting Salmetarol relaxing bronchial smooth headache Educate pt
muscle leading to Tachycardia Onset: 20 mins. Duration: 12
bronchodilation. hours

Anticholinergic Ipratropium bromide Promotes bronchodilation by Dry mouth Used as alternative or

(antimuscarinics) (Atrovent) inhibiting cholinergic Nausea combined with short acting
Antitussives- reduces Tiotropium (Spiriva)- long bronchomotor tone. Taste disturbance beta-2 agonist.
frequency of involuntary acting Decreased vagal tone in Throat irritation For severe acute asthma
cough airway. attacks
Corticosteroid Beclomethasone Reduce airway inflammation Dysphonia (difficulty Rinse mouth with water,
Inhaled Fluticasone and bronchial hyper-activity. speaking) gargle and spit
(Long term prevention) Mimics effects of naturally Oral pharyngeal candiasis Not for immediate relief
produced hormones in (thrush) Daily doses
adrenal gland. Bruising
Corticosteroid IV- hydrocortisone Decreases inflammation by Adrenal suppression Withdraw gradually
Systemic- IV/oral Oral- prednisolone decreasing production of Sodium/water retention Take tablet/oral liquid with
inflammatory mediators. Oedema food
Enhance beta-2 agonist Hypertension
actions. Hyperglycaemia
Suppress immune response. Diabetes
Delayed healing
Osteoporosis
Bruising
Drug Class Examples Action Significant Risks Nursing
(ADRs) Considerations

Antiemetics ‘setrons’ Work centrally and CAUTION: QT interval Monitor liver function tests
5HT3 Antagonists Ondansetron peripherally to block 5HT3 prolongation risk factors and S&S of liver damage
Tropisetron receptors. Well tolerated
Constipation

Antiemetics Metoclopramide (Maxalon) Bind to or inhibit dopamine 2 Akathisia- motor restlessness, CAUTION: don’t give with
Dopamine 2 Antagonists Domperidone receptors. agitation, inability to remain bowel obstruction
still Identify, treat, remove cause
Keep up fluids
Prevention is best

GORD Mylanta Neutralise hydrochloric acid Constipation/diarrhoea Can decrease effect of

Antacids secreted by gastric parietal Abdominal discomfort other medications- separate
cells. High magnesium by 2hrs

GORD Esomeprazole Inactivate the proton pump, GIT upset Assess ongoing use regularly
Proton Pump Inhibitors Pantoprazole suppressing both stimulated
and basal acid secretion.

GORD Ranitidine Competitively block H2 Infrequent/rare Some specialists use larger

Histamine 2 Antagonists receptor on parietal cells, Generally well tolerated dose
reducing gastric acid
secretion.
Drug Class Examples Action Significant Risks Nursing
(ADRs) Considerations

Constipation Senna Direct stimulation of nerve Nausea CAUTION: salt based

Stimulant endings in colon to increase Bloating laxatives and the elderly
peristalsis. Abdominal discomfort Acute abdominal discomfort
Rectal irritation Best given before bed

Constipation Coloxyl Allows water to mix with “ “ To prevent straining after

Stool Softeners Docusate faeces to soften stool, easier certain surgeries.
passage. “ “
CAUTION: pts on a sodium-
restricted diet
Plenty of fluids
Constipation Lactulose Hypertonic- draws water into “ “ “ “
Osmotic Colonlytely colon, increasing pressure in
intestine stimulating bowel
movements.

Constipation Psyllium- Metamucil Absorbs water, increases “ “ “ “

Bulk Forming
Glycaemic lowering agents Class- Biguanides e.g
Oral Metformin
Class- Sulfonylureas e.g
Gliclazide
Glycaemic lowering agents Ultra short acting: Novorapid
Injectable- Insulin Short acting: Actrapid
Long acting: Lantus
stool volume/bulk- stimulates
peristalsis.
Inhibits glucose production in
liver &enhances cell
sensitivity to insulin.
Increases insulin secretion
from beta cells in pancreas.
Increase or restore ability to
metabolise glucose by
enhancing cellular glucose
uptake.
Admin on empty stomach
with adequate fluid
Mix powder/liquid just before
use
GI intolerance Take with or after food
Hypoglycaemia Used when dietary changes,
exercise and weight loss
aren’t enough
Hypoglycaemia Close BGL monitoring
Hypokalaemia Adjust doses according
Insulin lipodystrophy Manage risk
Insulin insensitivity Timing of admin is key