Pharmacology HESI Review
Cardiac Drugs/Diuretics
Digoxin (Lanoxin) – positive inotrope (increases force of contraction); negative chronotrope (decreases
heart rate). How do you assess for this? (Always take AP for a full minute!)
Client with long hx of daily digoxin and furosemide (Lasix) use; creates a high risk for dig toxicity (Lasix
can cause hypokalemia, which can lead to dig toxicity)
Digoxin taken with dronedarone (Multaq), which is another antidysrhythmics, can significantly increase
blood levels of digoxin and further increase the effects.
Digoxin toxicity – know normal digoxin level (0.5 – 2 ng/mL); serum potassium (K+) level (3.5 to 5.0
mEq/L); low potassium or magnesium levels may increase risk for digoxin toxicity; S/S of dig toxicity
include anorexia, bradycardia, headache, dizziness, confusion, nausea, and visual disturbances
(blurred vision, yellow vision, and/or halo vision); hold digoxin if AP less than 60.
Calcium channel blockers (-dipine; amlodipine [Norvasc], nifedipine [Procardia]) – produce vasodilation
and reflex tachycardia (↓BP and ↑HR). Verapamil and diltiazem produce vasodilation and
cardiosuppression (↓BP and ↓HR).
Beta blockers (atenolol, propranolol, esmolol, etc.) – remember beta1 and beta2 receptors (if not
cardioselective, will also block beta2 receptors on the lungs) so be aware of any respiratory conditions such
as asthma, emphysema, COPD, etc. Always check AP and BP before giving beta blocker. Do not give if HR
below 60. Never stop abruptly! Must taper. May cause angina or even an MI.
Labetalol (beta blocker) for HTN: Notify prescriber for low pulse rate and do not give med; SE is weight
gain (fluid retention) – pulmonary assessment (which is…). Remember monitoring weight is one of the
best indicators of fluid gain or loss – 1 kg (2.2 lb) = 1,000 mL fluid gain or loss in 24 hrs.
Pt. in CCU/ICU on nitro drip; becomes hypotensive, titrate (decrease rate of) nitro drip (is it OK to give
nitroglycerin to a patient who is hypertensive? YES!!!)
Furosemide (Lasix) – loop diuretic; rapid acting; used for rapid diuresis in emergencies (pulmonary edema);
may produce hypokalemia (assess for muscle cramps, muscle weakness). Hypotension, F/E abnormalities,
dehydration. SE: dizziness, HA, tinnitus, N/V/D, ↓ K+, hyperglycemia, ototoxicity with aminoglycosides
(-mycin drugs).
May need potassium supplement. Foods containing potassium: dried fruits, fish, leafy veggies, squash,
beans, meats, nuts, bananas, potatoes, dairy products.
IV potassium (KCl) – assess overall condition of the veins. Use large vein, like antecubital (AC) vein when
administering potassium. Venous access is important because IV potassium can irritate the vein. Have
patient notify nurse immediately if burning at site. IV K+ extravasation can cause necrosis of tissues.
Don’t give IV push. ALWAYS DILUTED. Infuse at a rate no greater than 10 mEq/hr for peripheral
IV and 20 mEq/hr for central line. Always use infusion pump. Assess IV site every hour.
Antihypertensives and low potassium (K+); hypokalemia. Antihypertensive effects are more pronounced in
the elderly. Which antihypertensives will raise potassium?
Sodium polystyrene sulfonate (Kayexalate) – administered via NG tube or as enema to reduce serum
potassium levels when potassium levels are at life-threatening values. To correct severe hyperkalemia, IV
administration of dextrose and insulin, sodium bicarbonate, and calcium gluconate or chloride is often
required, followed by orally or rectally administered Kayexalate or even hemodialysis to eliminate the extra
potassium from the body. Therapeutic range of K+ 3.5-5.0 mEq/L.
2019 Page 1
, Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) – potassium-sparing diuretic
(can cause ↑K+). Blocks receptors for aldosterone. Inhibits sodium and water reabsorption. Teach: Take in
a.m. (diuretics in the morning if possible); avoid salt substitutes, ACE inhibitors, ARBs. Often taken with
other (thiazide) diuretics to treat edema, hypertension, heart failure. Can be taken with other meds that
lower K+.
Lab value for atorvastatin (Lipitor) – HDL should increase; LDL and total cholesterol decrease. Other statin
drugs include rosuvastatin (Crestor), fluvastatin, lovastatin, simvastatin, pravastatin. LFTs routinely and CK
for any c/o of muscle pain. How do you evaluate effectiveness? Teaching diet low in animal fats; high in
fiber.
Adrenergics/SNS Drugs & Adrenergic Blockers
Miotics – agents that reduce intraocular pressure by increasing the outflow of fluids from the eye, and they
are usually used to reverse angle-closure glaucoma or prevent angle-closure in eyes with narrow chamber
angles. See Cholinergic Drugs.
Mydriatics – agents used to produce dilation of pupils for eye exams and ocular surgery (use of Snellen
chart for eye exams).
Remember that many decongestants and bronchodilators have sympathomimetic effects (adrenergic effects).
SE include ↑ HR, nervousness, insomnia, etc. Don’t take at night. Bronchodilators that stimulate β2
receptors can also stimulate β1 if dose is high enough (loses selectivity). Don’t forget cardiac assessment.
Drugs Affecting Coagulation
Anticoagulants and geriatrics (elderly) – risky either way. Think safety!
Patient discharged on warfarin (Coumadin) – teach how to avoid bleeding: soft toothbrush, electric razor,
don’t go without shoes, etc. Teaching – maintain vitamin K foods (greens- spinach, mustard greens,
swiss chard, etc.) in diet (don’t increase or decrease); PT/INR monitoring; avoid activities that may cause
bleeding.
Enoxaparin (Lovenox) – for DVT prophylaxis; subcutaneous injection only (NOT IV or PO).
Pentoxifylline (Trental) – produces platelet inhibition and vasodilation; used for treating intermittent
claudication and ischemic pain.
Remember that heparin sodium for injection is not same as hep-lock solution. They are NOT
interchangeable. Concentration of hep-lock solution is either 10 units/mL or 100 units/mL. Heparin for
injection is 10,000 units/mL or 20,000 units/mL or even 50,000 units/mL.
Heparin is high-alert medication – requires another nurse to check dosage. Bleeding is potential SE.
Observe for bleeding gums, epistaxis, black stools, easy bruising, headaches, etc. Protamine sulfate is
antidote/reversal agent. Monitor aPTT and platelets.
Heparin IV stat – nursing action (verify labs; have a 2nd RN check dose).
Opoiods/Analgesics/NSAIDs
Opioids (morphine, hydrocodone, oxycodone, hydromorphone [Dilaudid] codeine) can produce CNS
depression (be aware of safety for patients attempting to ambulate) and respiratory depression;
administer naloxone; (Narcan) reverses respiratory depression but also reverses analgesia; may need to
titrate dose and give repeated doses to prevent sudden withdrawal (repeat dose at 2-3 minute intervals)
(opioid double dose – be aware of LOC and RR). Remember naloxone has shorter half-life than opioids.
SE: constipation, pruritus, urinary retention, ↓ BP, ↓ HR.
2019 Page 2
Cardiac Drugs/Diuretics
Digoxin (Lanoxin) – positive inotrope (increases force of contraction); negative chronotrope (decreases
heart rate). How do you assess for this? (Always take AP for a full minute!)
Client with long hx of daily digoxin and furosemide (Lasix) use; creates a high risk for dig toxicity (Lasix
can cause hypokalemia, which can lead to dig toxicity)
Digoxin taken with dronedarone (Multaq), which is another antidysrhythmics, can significantly increase
blood levels of digoxin and further increase the effects.
Digoxin toxicity – know normal digoxin level (0.5 – 2 ng/mL); serum potassium (K+) level (3.5 to 5.0
mEq/L); low potassium or magnesium levels may increase risk for digoxin toxicity; S/S of dig toxicity
include anorexia, bradycardia, headache, dizziness, confusion, nausea, and visual disturbances
(blurred vision, yellow vision, and/or halo vision); hold digoxin if AP less than 60.
Calcium channel blockers (-dipine; amlodipine [Norvasc], nifedipine [Procardia]) – produce vasodilation
and reflex tachycardia (↓BP and ↑HR). Verapamil and diltiazem produce vasodilation and
cardiosuppression (↓BP and ↓HR).
Beta blockers (atenolol, propranolol, esmolol, etc.) – remember beta1 and beta2 receptors (if not
cardioselective, will also block beta2 receptors on the lungs) so be aware of any respiratory conditions such
as asthma, emphysema, COPD, etc. Always check AP and BP before giving beta blocker. Do not give if HR
below 60. Never stop abruptly! Must taper. May cause angina or even an MI.
Labetalol (beta blocker) for HTN: Notify prescriber for low pulse rate and do not give med; SE is weight
gain (fluid retention) – pulmonary assessment (which is…). Remember monitoring weight is one of the
best indicators of fluid gain or loss – 1 kg (2.2 lb) = 1,000 mL fluid gain or loss in 24 hrs.
Pt. in CCU/ICU on nitro drip; becomes hypotensive, titrate (decrease rate of) nitro drip (is it OK to give
nitroglycerin to a patient who is hypertensive? YES!!!)
Furosemide (Lasix) – loop diuretic; rapid acting; used for rapid diuresis in emergencies (pulmonary edema);
may produce hypokalemia (assess for muscle cramps, muscle weakness). Hypotension, F/E abnormalities,
dehydration. SE: dizziness, HA, tinnitus, N/V/D, ↓ K+, hyperglycemia, ototoxicity with aminoglycosides
(-mycin drugs).
May need potassium supplement. Foods containing potassium: dried fruits, fish, leafy veggies, squash,
beans, meats, nuts, bananas, potatoes, dairy products.
IV potassium (KCl) – assess overall condition of the veins. Use large vein, like antecubital (AC) vein when
administering potassium. Venous access is important because IV potassium can irritate the vein. Have
patient notify nurse immediately if burning at site. IV K+ extravasation can cause necrosis of tissues.
Don’t give IV push. ALWAYS DILUTED. Infuse at a rate no greater than 10 mEq/hr for peripheral
IV and 20 mEq/hr for central line. Always use infusion pump. Assess IV site every hour.
Antihypertensives and low potassium (K+); hypokalemia. Antihypertensive effects are more pronounced in
the elderly. Which antihypertensives will raise potassium?
Sodium polystyrene sulfonate (Kayexalate) – administered via NG tube or as enema to reduce serum
potassium levels when potassium levels are at life-threatening values. To correct severe hyperkalemia, IV
administration of dextrose and insulin, sodium bicarbonate, and calcium gluconate or chloride is often
required, followed by orally or rectally administered Kayexalate or even hemodialysis to eliminate the extra
potassium from the body. Therapeutic range of K+ 3.5-5.0 mEq/L.
2019 Page 1
, Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) – potassium-sparing diuretic
(can cause ↑K+). Blocks receptors for aldosterone. Inhibits sodium and water reabsorption. Teach: Take in
a.m. (diuretics in the morning if possible); avoid salt substitutes, ACE inhibitors, ARBs. Often taken with
other (thiazide) diuretics to treat edema, hypertension, heart failure. Can be taken with other meds that
lower K+.
Lab value for atorvastatin (Lipitor) – HDL should increase; LDL and total cholesterol decrease. Other statin
drugs include rosuvastatin (Crestor), fluvastatin, lovastatin, simvastatin, pravastatin. LFTs routinely and CK
for any c/o of muscle pain. How do you evaluate effectiveness? Teaching diet low in animal fats; high in
fiber.
Adrenergics/SNS Drugs & Adrenergic Blockers
Miotics – agents that reduce intraocular pressure by increasing the outflow of fluids from the eye, and they
are usually used to reverse angle-closure glaucoma or prevent angle-closure in eyes with narrow chamber
angles. See Cholinergic Drugs.
Mydriatics – agents used to produce dilation of pupils for eye exams and ocular surgery (use of Snellen
chart for eye exams).
Remember that many decongestants and bronchodilators have sympathomimetic effects (adrenergic effects).
SE include ↑ HR, nervousness, insomnia, etc. Don’t take at night. Bronchodilators that stimulate β2
receptors can also stimulate β1 if dose is high enough (loses selectivity). Don’t forget cardiac assessment.
Drugs Affecting Coagulation
Anticoagulants and geriatrics (elderly) – risky either way. Think safety!
Patient discharged on warfarin (Coumadin) – teach how to avoid bleeding: soft toothbrush, electric razor,
don’t go without shoes, etc. Teaching – maintain vitamin K foods (greens- spinach, mustard greens,
swiss chard, etc.) in diet (don’t increase or decrease); PT/INR monitoring; avoid activities that may cause
bleeding.
Enoxaparin (Lovenox) – for DVT prophylaxis; subcutaneous injection only (NOT IV or PO).
Pentoxifylline (Trental) – produces platelet inhibition and vasodilation; used for treating intermittent
claudication and ischemic pain.
Remember that heparin sodium for injection is not same as hep-lock solution. They are NOT
interchangeable. Concentration of hep-lock solution is either 10 units/mL or 100 units/mL. Heparin for
injection is 10,000 units/mL or 20,000 units/mL or even 50,000 units/mL.
Heparin is high-alert medication – requires another nurse to check dosage. Bleeding is potential SE.
Observe for bleeding gums, epistaxis, black stools, easy bruising, headaches, etc. Protamine sulfate is
antidote/reversal agent. Monitor aPTT and platelets.
Heparin IV stat – nursing action (verify labs; have a 2nd RN check dose).
Opoiods/Analgesics/NSAIDs
Opioids (morphine, hydrocodone, oxycodone, hydromorphone [Dilaudid] codeine) can produce CNS
depression (be aware of safety for patients attempting to ambulate) and respiratory depression;
administer naloxone; (Narcan) reverses respiratory depression but also reverses analgesia; may need to
titrate dose and give repeated doses to prevent sudden withdrawal (repeat dose at 2-3 minute intervals)
(opioid double dose – be aware of LOC and RR). Remember naloxone has shorter half-life than opioids.
SE: constipation, pruritus, urinary retention, ↓ BP, ↓ HR.
2019 Page 2
