Antilipemics

Key Drugs – Medication Indication Nursing Implications

Generic/Trade Class (Why would a (List the most important one for
Mechanism of Action
(Not all med classes patient take a each of the following: assessment,
(In your own words)
will have key drugs) medication from implementation, labs, and patient
this class?) teaching)
Atorvastatin (lipitor) HMG-CoA it inhibits the HMG-CoA to lower their LDL A- assess patients diet paying attention to
reductase coenzyme, which is responsible hypercholesterolemia their fat intake.
inhibitors for catalyzing an early step in the
(statins) synthesis of cholesterol I-may be administered with or without regards
to food.

L- evaluate serum cholesterol and triglycerides

periodically during therapy.

T- instruct patient to take medication as

directed, don’t double up on doses and dont
stop taking abruptly.
Cholestyramine Bile acid binds to the acid in the GI tract hypercholesterolemia, A- assess patients diet paying attention to fat
(Questran) sequestrants and forms and insoluble elevated LDL intake
complex. results in an increased
clearance of cholesterol I- administer other medications 1 hr before or
4-6 hours after this medication

L- serum cholesterol and triglyceride levels

should be elevated before starting therapy.

T- instruct patient to take their medication

Niacin (nicotinic acid) B vitamin niacin large doses cause a decrease in
lipoprotein and triglyceride
synthesis by inhibiting the
release of free fatty acids from
adipose tissue and decreasing
hepatic lipoprotein synthesis.
before meals. medication should be used in
conjunction with dietary restrictions.
increases HDL and A- assess patient for signs of niacin deficiency
lowering triglycerides, prior to and periodically during therapy.
total serum
cholesterol and LDL I-extended release tablets should be
swallowed whole.
 L- monitor serum glucose and uric acid levels

T- inform patient that cutaneous flushing and

a sensation of warmth, especially in the face
and neck and ears.
Gemfibrozil (lopid) Fibric acid decreases triglyceride production lower triglyceride A- obtain patients diet history paying
derivatives by the liver levels attention to fat intake.
(Fibrates)
I- administer 30 mins prior to breakfast or
dinner

L- monitor serum triglyceride levels and

cholesterol levels before and periodically
during therapy

T- take medication as directed, don’t skip a

dose or double up on a dose or stop taking
abruptly.
ezetimibe (zetia) Other inhibits the absorption of reduce total A- obtain a diet history and pay attention to
antilipemics cholesterol in the small intestine cholesterol levels their fat intake

I- administer medication without regards to

meals

L- elavulate serum cholesterol and triglyceride

levels before initiating.

T- take medication as prescribed, don’t double

up on doses and dont stop taking abruptly.

Thyroid and Adrenal Medications / Analgesics and Anti-inflammatory Medications

Key Drugs – Medication Indication Nursing Implications
Generic/Trade Class (Why would a (List the most important one for
Mechanism of Action
(Not all med classes patient take a each of the following: assessment,
(In your own words)
will have key drugs) medication from implementation, labs, and patient
this class?) teaching)
Levothyroxine Thyroid -replacement or -thyroid A- Assess apical pulse and BP. Monitor height
(Synthroid) Replacement supplementation to thyroid supplementation in and weight.
Drugs hormones hypothyroidism
-treatment or I- Administer with a full glass of water and on
suppression of an empty stomach.
euthyroid goiters
L- Monitor thyroid function studies. Monitor
thyroid stimulating hormone serum levels.

T- Explain it does not cure hypothyroidism.

This therapy is life long.
Propylthiouracil Antithyroid Drugs -inhibits the synthesis of thyroid -Patients with A- Monitor for response of systems for
(Propyl-Thyracil) hormones Grave’s disease, hypothyroidism. Assess patient for skin rash or
hypothyroidism, or swelling.
toxic multinodular
goiter I- Administer at same time in relation to meals
eery day.

L- Do thyroid function studies. We would

monitor WBCs and differential counts.

T- Instruct patient to monitor weight 2-3 times

weekly. This medication may cause
drowsiness. Advise patient to carry
identification showing medication regimen.
methylprednisolone Adrenal Drugs -suppresses inflammation and -used systemically A- Assess patient for signs of adrenal
(Solu-Medrol) (Corticosteroids) the normal immune response and locally in insufficiency. Monitor intake and output ratios.
-Glucocorticoids inflammatory disease
prednisone I- Administer medication in the morning.
(Sterapred) Administer with meals to limit GI irritation.

hydrocortisone L- Monitor serum electrolytes and glucose.

(Colocort) Periodic adrenal function tests.

T- Instruct patient on correct technique of

medication administration. Don’t stop the
medication suddenly.
Fludrocortisone Adrenal Drugs -causes sodium reabsorption, -sodium loss and A- Monitor BP throughout therapy. Monitor for
(Florinel) (Corticosteroids) hydrogen and potassium hypotension fluid retention. Closely monitor patients with
-Mineralcorticoids excretion, and water retention associated with Addison’s disease to watch for significant
adrenocortical increase in weight or BP.
insufficiency
I- Tablets that are scored may be broken.

L- Monitor serum electrolytes.

T- Advise patient to follow dietary

modifications prescribed. Instruct patient to
take medication as directed.
morphine sulfate Opioid Agonist -binds to opiate receptors in the -moderate to severe A- Assess type, location, and intensity of the
(Duramorph) CNS pain pain. Assess risk for opioid addiction or abuse.
-antitussive-lower
hydromorphone doses I- Medication may be administered with food
(Dilaudid) or milk.

oxycodone hydrochloride L- May increase plasma amylase and lipase

(Oxycontin) concentrations.

fentanyl T- Instruct patient on how and when to

(Sublimaze) request pain medication. May cause
drowsiness or dizziness. Advise patients to
change position slowly.
naloxone Opioid Antagonist -competitively blocks the effects -reversal of CNS and A- Monitor respiratory rate, rhythm and depth.
(Narcan) of opioids, including CNS and respiratory Assess patient for level of pain.
respiratory depression depression because
of suspected opioid I- Resuscitation equipment should be available
overdose when administering this medication.

L- N/A

T- Explain the purpose and instructions for use

to caregiver.
Salicylates Nonsteroidal anti- -produce analgesia and reduce -mild to moderate A- Assess pain and limitation of movement.
aspirin inflammatory inflammation and fever by pain Assess for fever.
(Acuprin) agents (NSAIDs) inhibiting production or -fever
prostoglandins
Acetic Acid Derivatives -prophylaxis of TIA I-Administer after meals with food or an
indomethacin and MI antacid.
(Indocin)
Cycoloxygenase-2 (COX-2) L- Monitor hepatic function and monitor serum
Inhibitors salicylate levels.
celecoxib
(Celebrex) T- Instruct patient to take these with a full
Enolic Acid Derivatives glass of water. Caution patient to not use
meloxicam alcohol when taking these.
(Mobicox)

Propionic Acid Derivatives

ibuprofen
(Advil)
Allopurinol Antigout Drugs -inhibits the production of uric -prevention of attack A- Monitor intake and output ratios. Monitor
(Aloprim) acid of gouty arthritis and for joint pain and swelling.
nephropathy
I- May be administered after milk or meals.

L- Monitor serum and uric acid levels. Monitor

blood glucose. Monitor hematologic, renal,
and liver functions.

T- Instruct patient to report skin rash or

irritation. Advise patient not to take with
alcohol.

Rapid-acting Insulins Lowers blood glucose by Control of A- Assess for symptoms of hypo- &
increasing uptake in skeletal hyperglycemia in hyperglycemia
Insulin lispro (Humalog u- muscles diabetic patients
100 or u-200) I- Due to short duration of action, insulin
lispro must be used with a longer acting
insulin, insulin infusion pump or in
combination with oral sulfonylurea agents

L- Monitor blood glucose every 6 hr during

therapy, monitor serum potassium in pt.’s at
risk for hypokalemia

Short-acting Lowers blood glucose by
increasing uptake of fat and
Regular Insulin (Humulin skeletal muscle and stops the
R) liver glucose production
Intermediate-acting Lowers blood glucose by
increasing glucose uptake in
insulin isophane skeletal muscles and fat
suspension (NPH)
Long-acting Lowers blood glucose by
increasing glucose uptake in
insulin glargine skeletal muscle and fat by
stopping the production of
insulin detemir glucose in the liver
T- Demonstrate technique for mixing insulins
by drawing up insulin lispro first and rolling
intermediate acting insulin vial between
palms instead of shaking
Control of A- Assess for hypo- & hyperglycemia
hyperglycemia in
diabetic patients I- Administer regular insulin within 15-30
minutes before meal
L- Monitor blood glucose every 6 hr, monitor
serum potassium in pt.’s at risk for
hypokalemia
T- Instruct pt. in proper testing of serum
glucose and ketones as these need to be
closely monitored
Control of A- Monitor body weight periodically/watch for
hyperglycemia in signs of hypo-& hyperglycemia
patients with
diabetes I- Administer NPH insulin within 30-60
minutes before a meal
L- Monitor blood glucose every 6 hr, serum
potassium (for pt.’s at risk for hypokalemia)
T- Emphasize the importance of regular
follow-up, especially during the first few
weeks of therapy
Adjunct to diet and A- Monitor for hypersensitivity reactions
exercise in the especially in a pt. with history of anaphylaxis
treatment of type 2 or angioedema with another GLP-1 receptor
DM agonist
I- Pt.’s stabilized on a diabetic regimen who
are exposed to stress, fever, trauma, infection
or surgery may require administration of
insulin

Biguanides Decreases insulin resistance,
metformin intestinal absorption of glucose
and liver glucose production
(Actos, Avandia) Thiazolidinediones Decrease insulin resistance
which causes muscle cells to
become more sensitive to
insulin
L- Monitor blood glucose every 6 hr, also
monitor renal function when starting or
increasing insulin glargine dose in pt.’s with
renal impairment and in pt.’s with severe GI
reactions
T- Maintain adequate hydration (2 L
liquid/day) to minimize risk of renal failure
Maintenance of A- When combined with oral sulfonylureas,
blood glucose observe for signs and symptoms of
hypoglycemic reactions (abd. pain, sweating,
hunger, weakness, dizziness, headache,
tremor, tachycardia, anxiety)
I- Metform should be temporarily
discontinued in pt.’s requiring surgery
involving restricted intake of food and fluids.
Withhold metformin when use in tests or
procedures that require fasting or injection of
any iodinated dye and resume after 48 hrs.
L- Monitor serum glucose and glycosylated
hemoglobin during therapy to evaluate the
effectiveness of therapy
T- Inform pt. that metformin may cause
unpleasant metallic taste that usually resolves
spontaneously
Antidiabetic A- Assess for symptoms of hypo- &
hyperglycemia
I- Do not give if pt. has liver disease or chronic
renal disease, cardiomegaly, CHF or
pregnancy, significant edema
L- Liver tests
 T- Premenopausal women need to be using
birth control, ovulation may resume

acarbose (Precose) Alpha-glucosidase Stops enzyme alpha glucosidase Lowering blood A- Observe for signs of hypoglycemia
Inhibitors in small intestine which results glucose in diabetic
miglitol (Glyset) in delayed absorption of glucose patients I- PO: Administer with first bite of each meal
3 times/day

L- Monitor serum glucose and glycosylated

hemoglobin during therapy

T- Encourage pt. to follow prescribed diet,

glipizide Sulfonylureas Lowers blood sugar by getting
the pancreas to release insulin
and increasing the sensitivity to
insulin at receptor sites
medication and exercise regimen to prevent
hypo- & hyperglycemic episodes
Lowers blood sugar A- Assess pt. allergy to sulfonamides
in diabetic patients
I- Use caution in elderly- may cause
hypoglycemia

L- Monitor CBC periodically during therapy.

Report decrease in amounts of blood counts
promptly

T- Caution pt. to avoid other medications

especially aspirin and alcohol while on this
therapy
repaglinide (Prandin) Meglitinides Gets the pancreas to secrete For patients with A- Observe for signs and symptoms of
more insulin from beta cells type 2 DM hypoglycemic reactions
nateglinide (Starlix)
I- Administer up to 30 minutes before meals

L- Monitor fasting serum glucose and

glycosylated hemoglobin periodically

T- Instruct pt. to take before each meal,

exactly as prescribed
canaglifozin (Invokana) SGLT2 Inhibitors works with insulin to prevent For patients with A- Monitor for infection, new pain,
glucose reabsorption from the type 2 DM tenderness, sores or ulcers involving lower
dapaglifozin (Farxiga) GFR in kidneys limbs; discontinue if this occurs

empagliflozin (Jardiance) I- Administer before first meal of the day

L- Monitor hemoglobin A1C prior to and

periodically during therapy

T- Instruct pt. in proper testing of blood

glucose

sitagliptin (Januvia) Incretin Mimetics Delays breakdown of incretin Improved control of A- Monitor signs of pancreatitis
(DDP-IV inhibitors) hormones by stopping the blood glucose
enzyme DPP-IV I- May be administered without regard to
food, swallow tablet whole

L- Monitor A1C periodically during therapy

T- Advise healthcare provider promptly if

swelling of hands, feet, or ankles; rash; hives;
or swelling of face, lips, or throat occur

pramlintide (Symlin) Amylin agonist enhances glucose-dependent Improved control of A- Assess hemoglobin A1C, recent blood
insulin secretion postprandial glucose monitoring data, history of insulin-
hyperglycemia induced hypoglycemia, current insulin
regimen and body weight prior to initiation of
therapy

I- Administer immediately prior to major

meals

L- Monitor blood glucose frequently, including

pre- and post meals and at bedtime

T- May cause difficulty concentrating, caution

pt. to avoid driving or other activities
requiring alertness until response to
medication is known
Coagulation Modifier Medications
Key Drugs – Medication Indication Nursing Implications
Generic/Trade Class (Why would a (List the most important one for
Mechanism of Action
(Not all med classes patient take a each of the following: assessment,
(In your own words)
will have key drugs) medication implementation, labs, and patient
from this class?) teaching)
PO Anticoagulants A- Assess for signs of bleeding or hemorrhage
warfarin - Coumadin (traditional) inhibits prothrombin, factor IX, prevent DVT, PE, (black stool, hematuria, bleeding gums,
X, XII, VII. antagonizes vitamin K thrombotic events nosebleeds)
IV/SQ
I- Double check all heparin doses before
heparin
administration. Careful monitoring is needed
enoxaparin - Lovenox
with both medications.
inhibits thrombin, factor IX, X, DVT, PE, MI,
XI, XII (preferred for L- Heparin = PTT, platelets, AST, ALT
inhibits factor Xa pregnancy) Warfarin = PT, INR, platelets, CBC

T- Advise patient to report any unusual

bruising or bleeding. Do not take NSAIDs.
dabigatran - Pradaxa Anticoagulants binds with and inhibits the strokes, emboli, a- A- Assess for s/s of bleeding and blood loss -
(Newer – inhibit action of thrombin in the body fib, PE, DVT can be fatal.
specific clotting
factors) I- Administer twice daily with a full glass of
water, swallow whole (do not chew or crush).

L- PTT or ECT, not INR, renal function

T- Inform patient that they may bleed more

easily. Advise patient to report any signs of
bleeding.
aspirin Antiplatelet – prevents platelets from prevent MI, after an A- Assess for hypersensitivity reactions in
Aspirin clumping or forming clots, MI, prevent ischemic patients with asthma, allergies, nasal polyps.
inhibits COX-2 strokes, acute
coronary syndromes
 I- Use lowest effective dose for the shortest
period of time. Administer with food.

L- hepatic function, AST, ALT, alkaline

phosphate, salicylate levels, VMA, TSH, 5-
HIAA, prothrombin time

T- Caution the use of alcohol, puts patient at

clopidogrel - Plavix ADP inhibitors prevents platelets from
clumping or forming clots,
inhibits ADP
increased risk for GI bleeding.
prevent MI, after an A- Monitor for thrombocytopenia. May occur
MI, prevent ischemic even after short exposure.
strokes, acute
coronary syndromes, I- Do not confuse with Paxil. Administer once
prevent thrombi daily.

L- CBC, bleeding time, serum bilirubin, hepatic

enzymes, cholesterol, NPN, uric acid

T- Advise patient to report any fever, chills,

weakness, sore throat, rash, bleeding,
paleness, purple patches, or neurological
changes.
eptifibatide - Integrilin Glycoprotein IIb/IIIa prevents platelets from prevent MI, after an A- Assess for bleeding. Minimize use of IM
Receptor clumping or forming clots, MI, prevent ischemic injections, arterial/venous punctures and
Antagonists (Super inhibits glycoprotein strokes, acute urinary catheters.
Aspirins) coronary syndromes
I- Accidental overdose can result in death,
double check all doses before administration.

L- He, HgB, platelets, creatinine, PT, PTT, ACT

T- Inform patient to notify if any bleeding is

alteplase (t-PA) Thrombolytic Drugs causes fibrinolysis, converts
plasminogen into plasma to
directly dissolve blood clots
noticed. Teach patient the purpose of the
medication.
ischemic stroke, MI, A- Assess for bleeding every 15-30 minutes.
occlusion of shunt, Assess neurological status carefully
PE, DVT throughout therapy.

I- Only to be given in settings where

hematologic function and clinical response
 can be appropriately monitored. Overdose
can result in death.

L- He, HgB, platelets, FDP, fibrinogen,

prothrombin time, thrombin time

T- Explain the purpose of the medication and

the need for close monitoring. Need adequate
bedrest.
desmopressin (DDAVP) Antifibrinolytic prevents the lysis of fibrin in the prevents bleeding A- Assess for s/s of water intoxication such as
Drugs body, results in clot formation after surgery or confusion, drowsiness, headache, weight gain
hyperfibrinolysis or difficulty urinating.

I- Begin oral doses 12hrs after last intranasal

dose. Monitor response closely.

L- VIII coag., PTT

T- Caution patients on the use of alcohol with

this medication.