Pharmacokinetics (ADME)
A
Absorption
How drug enters circulation. Affected by route, food, pH, blood flow.
D
Distribution
Drug movement to tissues. Affected by protein binding, lipid solubility, BBB.
M
Metabolism
Primarily liver (CYP450 enzymes). First-pass effect reduces oral bioavailability.
E
Excretion
Primarily kidneys. Renal/hepatic impairment → dose adjustments required.
Cardiovascular Drugs
| Class | Examples | Use | Key Nursing Considerations |
|---|---|---|---|
| Beta-Blockers | Metoprolol, Atenolol, Carvedilol | HTN, HF, angina, arrhythmias | Monitor HR & BP; do not abruptly stop; assess for bradycardia |
| ACE Inhibitors | Lisinopril, Enalapril, Ramipril | HTN, HF, DM nephropathy | Monitor for dry cough, hyperkalemia, angioedema; check BUN/Cr |
| ARBs | Losartan, Valsartan, Candesartan | HTN, HF, DM nephropathy | Alternative to ACE inhibitors (no cough); monitor K⁺ and renal function |
| Loop Diuretics | Furosemide (Lasix), Bumetanide | Edema, HF, HTN | Monitor I&O, daily weight, electrolytes (↓K⁺, ↓Na⁺, ↓Mg²⁺) |
| Digoxin | Digoxin | HF, A-fib rate control | Narrow therapeutic index (0.5–2 ng/mL); assess apical HR; toxicity signs: nausea, visual changes, bradycardia |
| Statins | Atorvastatin, Rosuvastatin, Simvastatin | Hyperlipidemia, CV risk reduction | Monitor LFTs; assess for myopathy/rhabdomyolysis (muscle pain, ↑CK) |
Anticoagulants & Antiplatelets
| Drug | Mechanism | Monitor | Reversal Agent |
|---|---|---|---|
| Heparin (UFH) | Activates antithrombin III → inhibits thrombin & factor Xa | aPTT (1.5–2.5× normal), platelets (HIT risk) | Protamine sulfate |
| Warfarin | Inhibits vitamin K–dependent clotting factors (II, VII, IX, X) | INR (therapeutic range varies by indication) | Vitamin K, FFP, PCC |
| Enoxaparin (LMWH) | Factor Xa inhibitor (primarily) | Renal function; anti-Xa levels in special populations | Protamine sulfate (partial) |
| Rivaroxaban / Apixaban | Direct factor Xa inhibitors (DOACs) | Renal function; bleeding signs | Andexanet alfa |
| Dabigatran | Direct thrombin inhibitor (DOAC) | Renal function; bleeding signs | Idarucizumab |
| Aspirin | Irreversible COX inhibition → ↓TXA₂ | Bleeding, GI upset, tinnitus (toxicity) | No specific reversal; platelet transfusion |
Diabetes Medications
| Class | Examples | Mechanism | Key Nursing Points |
|---|---|---|---|
| Insulin (Rapid) | Lispro, Aspart, Glulisine | Glucose uptake | Give 0–15 min before meals; peak 1–2 hrs |
| Insulin (Long-Acting) | Glargine, Detemir, Degludec | Basal glucose control | Do NOT mix; no pronounced peak; give same time daily |
| Metformin | Metformin | ↓Hepatic glucose production | Hold before contrast dye; risk of lactic acidosis; check renal function |
| Sulfonylureas | Glipizide, Glyburide, Glimepiride | ↑Insulin secretion | Hypoglycemia risk; take with food |
| SGLT-2 Inhibitors | Empagliflozin, Dapagliflozin | ↑Urinary glucose excretion | UTI/yeast infection risk; DKA risk (even with normal glucose); hold before surgery |
| GLP-1 Agonists | Semaglutide, Liraglutide | ↑Insulin, ↓glucagon, ↓appetite | Nausea common; pancreatitis risk; weight loss benefit |
Pain Management
- WHO Analgesic Ladder – Step 1: Non-opioids (NSAIDs, acetaminophen) → Step 2: Mild opioids (tramadol, codeine) → Step 3: Strong opioids (morphine, oxycodone, fentanyl).
- Opioid Side Effects – Respiratory depression (most dangerous), constipation (always prevent), nausea/vomiting, urinary retention, sedation.
- Naloxone (Narcan) – Opioid reversal agent; short half-life (may need repeat doses or infusion); monitor for re-narcotization.
- NSAIDs – Avoid in renal impairment, GI ulcers, and >3rd trimester pregnancy; monitor for GI bleeding.
- Acetaminophen – Max 4 g/day (2 g/day in liver disease or heavy alcohol use); hepatotoxicity risk in overdose.
High-Alert Medications (ISMP)
- Insulin — always double-check dose and type; use dedicated insulin syringes.
- Anticoagulants — heparin infusion requires two-nurse verification of rate.
- Concentrated electrolytes (KCl, NaCl >0.9%) — never give undiluted IV KCl (fatal arrhythmias).
- Opioids — monitor respiratory rate, sedation level; have naloxone available.
- Chemotherapy agents — use PPE; verify with pharmacist; strict extravasation protocols.
- Neuromuscular blocking agents — must be on ventilator; keep reversal agents available.