HESI Pharmacology Medication Study Guide
Cardiac Drugs/Diuretics
Digoxin – 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 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.
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.
Nitroglycerin transdermal patch for treating chest pain (angina) – remove at night to allow 8 hours
without patch (can produce tolerance in 24 hours); may use SL nitro when wearing patch if patient
having chest pain
Why wear gloves when applying nitroglycerin paste or patch? (severe vasodilation, ↓BP, intense HA
[may give acetaminophen for HA])
Angina – for chest pain, if VS OK, leave nitro patch on and administer PRN SL nitro
Pt. in CCU/ICU on nitro drip; becomes hypotensive, decrease rate of nitro drip
Calcium channel blockers – dipine (like amlopidine) and verapamil (Calan) and diltiazem (Cardizem). –
dipine affect vessels only (vasodilation). SE: dizziness, facial flushing, hypotension, edema. Verapamil
(Calan) and diltiazem (Cardizem) also affect heart. Monitor BP, HR (↓). Constipation is SE. Avoid
grapefruit juice.
Aliskiren (Tekturna) – (direct renin inhibitor for HTN); teach don’t take if pregnant (stop drug if become
pregnant); don’t take with high fat meal. May increase K+, so don’t take with other drugs that ↑ K+.
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. Calculate and set the rate as ordered, know anticipated duration of therapy, know restrictions
imposed by patient’s history. Don’t give IV push; infuse at a rate no greater than 20 mEq/hr;
concentration no greater than 40 mEq/L. Always use infusion pump. Assess IV site every hour.
Antihypertensives and low potassium (K+); hypokalemia. Antihypertensive effects are more pronounced
in the elderly.
Osmitrol (Mannitol) – osmotic diuretic; effectiveness determined by ↓ ICP. NOT used for peripheral
edema; used to treat pt. with closed head injury; effective response is decreased ICP
Summer 2016 Page 1
, Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) – potassium-sparing
diuretic (can cause ↑K+). Blocks receptors for aldosterone. Inhibits sodium and water reabsorption.
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?
Adrenergics/SNS Drugs & Adrenergic Blockers
Remember: alpha 1 stimulation – vasoconstriction; beta 1 (one heart), beta 2 (two lungs)
Mydriatics – agents used to produce dilation of pupils for eye exams and ocular surgery
Tamsulosin (Flomax) – alpha1 adrenergic blocker; ↓ smooth muscle contraction of prostate capsule and
bladder neck. Used for treating sx of BPH. Alpha 1 blockers –zosin – antihypertensives.
Effects of dopaminergic activation – causes dilation of the renal vasculature; this effect is exploited in the
treatment of shock; by dilating renal blood vessels, we can improve renal perfusion and can thereby
reduce the risk of renal failure. Dopamine itself is the only drug available that can activate dopamine
receptors. It should be noted that when dopamine is given to treat shock, the drug also enhances cardiac
performance (because it actives beta1 receptors in the heart.)
Catecholamines (epinephrine, norepinephrine, dopamine, dobutamine, etc.) must be watched carefully
for extravasation! The FDA has this to say about treating dopamine extravasation:
To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible
with 10 to 15 mL of saline solution containing 5 to 10 mg of Regitine (brand of phentolamine), an
adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, and the solution
liberally infiltrated throughout the ischemic area. Sympathetic blockade with phentolamine causes
immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. Therefore,
phentolamine should be given as soon as possible after the extravastation is noted.
Epi-Pen (Epinephrine Auto Injector). Single dose of epinephrine that can be injected (IM) into the
middle of the outer thigh (even through clothes). Seek emergency medical treatment immediately. SE:
increase in heart rate, stronger or irregular heartbeat, sweating, nausea or vomiting, difficulty breathing,
paleness, dizziness, weakness, shakiness, headache, apprehension, nervousness or anxiety. These side
effects may go away if patient rests.
Remember that many decongestants and bronchodilators have sympathomimetic effects (adrenergic
effects). SE include ↑ HR, nervousness, insomnia, etc. 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.
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.
Pentoxifylline (Trental) for intermittent claudication (like cilastozal [Pletal]) – treats ischemic pain.
Prasugrel (Effient) is an antiplatelet like clopidogrel (Plavix). Watch for S/S bleeding. Used primarily
after interventional radiologic procedures (like coronary stents) and for patients who do not respond to
clopidogrel.
Summer 2016 Page 2
Cardiac Drugs/Diuretics
Digoxin – 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 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.
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.
Nitroglycerin transdermal patch for treating chest pain (angina) – remove at night to allow 8 hours
without patch (can produce tolerance in 24 hours); may use SL nitro when wearing patch if patient
having chest pain
Why wear gloves when applying nitroglycerin paste or patch? (severe vasodilation, ↓BP, intense HA
[may give acetaminophen for HA])
Angina – for chest pain, if VS OK, leave nitro patch on and administer PRN SL nitro
Pt. in CCU/ICU on nitro drip; becomes hypotensive, decrease rate of nitro drip
Calcium channel blockers – dipine (like amlopidine) and verapamil (Calan) and diltiazem (Cardizem). –
dipine affect vessels only (vasodilation). SE: dizziness, facial flushing, hypotension, edema. Verapamil
(Calan) and diltiazem (Cardizem) also affect heart. Monitor BP, HR (↓). Constipation is SE. Avoid
grapefruit juice.
Aliskiren (Tekturna) – (direct renin inhibitor for HTN); teach don’t take if pregnant (stop drug if become
pregnant); don’t take with high fat meal. May increase K+, so don’t take with other drugs that ↑ K+.
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. Calculate and set the rate as ordered, know anticipated duration of therapy, know restrictions
imposed by patient’s history. Don’t give IV push; infuse at a rate no greater than 20 mEq/hr;
concentration no greater than 40 mEq/L. Always use infusion pump. Assess IV site every hour.
Antihypertensives and low potassium (K+); hypokalemia. Antihypertensive effects are more pronounced
in the elderly.
Osmitrol (Mannitol) – osmotic diuretic; effectiveness determined by ↓ ICP. NOT used for peripheral
edema; used to treat pt. with closed head injury; effective response is decreased ICP
Summer 2016 Page 1
, Spironolactone (Aldactone), amiloride (Midamor); triamterene (Dyrenium) – potassium-sparing
diuretic (can cause ↑K+). Blocks receptors for aldosterone. Inhibits sodium and water reabsorption.
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?
Adrenergics/SNS Drugs & Adrenergic Blockers
Remember: alpha 1 stimulation – vasoconstriction; beta 1 (one heart), beta 2 (two lungs)
Mydriatics – agents used to produce dilation of pupils for eye exams and ocular surgery
Tamsulosin (Flomax) – alpha1 adrenergic blocker; ↓ smooth muscle contraction of prostate capsule and
bladder neck. Used for treating sx of BPH. Alpha 1 blockers –zosin – antihypertensives.
Effects of dopaminergic activation – causes dilation of the renal vasculature; this effect is exploited in the
treatment of shock; by dilating renal blood vessels, we can improve renal perfusion and can thereby
reduce the risk of renal failure. Dopamine itself is the only drug available that can activate dopamine
receptors. It should be noted that when dopamine is given to treat shock, the drug also enhances cardiac
performance (because it actives beta1 receptors in the heart.)
Catecholamines (epinephrine, norepinephrine, dopamine, dobutamine, etc.) must be watched carefully
for extravasation! The FDA has this to say about treating dopamine extravasation:
To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible
with 10 to 15 mL of saline solution containing 5 to 10 mg of Regitine (brand of phentolamine), an
adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, and the solution
liberally infiltrated throughout the ischemic area. Sympathetic blockade with phentolamine causes
immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. Therefore,
phentolamine should be given as soon as possible after the extravastation is noted.
Epi-Pen (Epinephrine Auto Injector). Single dose of epinephrine that can be injected (IM) into the
middle of the outer thigh (even through clothes). Seek emergency medical treatment immediately. SE:
increase in heart rate, stronger or irregular heartbeat, sweating, nausea or vomiting, difficulty breathing,
paleness, dizziness, weakness, shakiness, headache, apprehension, nervousness or anxiety. These side
effects may go away if patient rests.
Remember that many decongestants and bronchodilators have sympathomimetic effects (adrenergic
effects). SE include ↑ HR, nervousness, insomnia, etc. 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.
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.
Pentoxifylline (Trental) for intermittent claudication (like cilastozal [Pletal]) – treats ischemic pain.
Prasugrel (Effient) is an antiplatelet like clopidogrel (Plavix). Watch for S/S bleeding. Used primarily
after interventional radiologic procedures (like coronary stents) and for patients who do not respond to
clopidogrel.
Summer 2016 Page 2
