Understanding Common Drugs in Nursing Practice
As a nursing student or professional nurse, you’ll encounter a vast array of drugs throughout your career. However, you become most familiar with the ones you frequently administer. If you’re new to the field and unsure which drugs to prioritize, this compilation of the most Common Drugs Nurses Should Know Before the First Clinical Day will prove invaluable across various acute care scenarios. Although this resource doesn’t cover every medication aspect, it offers essential information such as their indications, specific administration guidelines, and key side effects and assessments.
Diphenhydramine Why it’s used:
Diphenhydramine is frequently employed to address pruritus linked to opioid medications and allergic reactions, spanning from mild to anaphylaxis. It’s also administered preemptively before patients receive blood products or chemotherapy to ward off mild allergic reactions. In some cases, it’s used to manage dystonic reactions to medications. Despite its sedative properties, diphenhydramine can induce paradoxical excitation in children and acute confusion in older adults.
Administration details: Diphenhydramine can be given orally (PO) or intravenously (IV). When used as a preventative measure against mild allergic reactions, it’s administered 30 minutes to 1 hour before administering blood products or chemotherapy.
Side effects and assessment: Common side effects include drowsiness and dry mouth. Elderly patients should be closely monitored for acute confusion, which can be particularly pronounced.
Furosemide Why it’s used: Furosemide is a diuretic for preventing and managing fluid volume overload and hypertension, often in patients with heart failure. It may also be prescribed for individuals with edema due to liver disease or renal impairment.
Administration details: Furosemide can be administered PO or IV. If given twice daily, the second dose is not administered after 1700 to minimize sleep disruption and frequent bathroom visits. IV furosemide is usually administered as an IV push, although it may be given as a continuous infusion in critically ill patients.
Side effects and assessment: Furosemide’s action on the Loop of Henle can lead to significant potassium losses, necessitating close monitoring for hypokalemia and potential potassium supplementation. Additionally, it can cause volume losses resulting in hypotension, including orthostatic hypotension, increasing the risk of falls. Patients should be educated on changing positions slowly. Key assessments include monitoring fluid volume status, potassium levels, creatinine levels, and blood pressure. If used for treating or preventing pulmonary edema, additional assessments such as auscultating lung sounds, measuring SpO2, and observing work of breathing (WOB) are necessary to ensure efficacy.
Hydralazine
Why it’s used: Hydralazine is prescribed to manage hypertension by inducing arterial vasodilation. Administration details: Hydralazine is available in oral (PO) and intravenous (IV) formulations. When administering orally, it’s recommended to give with meals to ensure consistent absorption.
Side effects and assessment: Tachycardia is a common side effect of hydralazine, often limiting its use as a first-line agent for hypertension. Other adverse effects may include headache, flushing, and dizziness. Key assessments for patients on hydralazine include monitoring blood pressure and heart rate.
Gabapentin
Why it’s used: Gabapentin, a CNS depressant, falls under various classifications, making it a versatile medication. It belongs to the therapeutic classes of anticonvulsants, analgesics, and mood stabilizers. Although its official indications include treating seizures, postherpetic neuralgia, and restless leg syndrome, one of its most common off-label uses is for neuropathic pain management.
Administration details: Gabapentin is available in immediate-release and extended-release oral formulations. Patients may be prescribed high doses and multiple capsules. It’s crucial to double-check the dose whenever opening multiple blister packs.
Side effects and assessment: The primary side effect of gabapentin is drowsiness, accompanied by potential confusion, dizziness, and ataxia. Patients concurrently taking other CNS depressants, such as antihistamines or opioids, face an increased risk of CNS depression.
Levothyroxine
Why it’s used: Levothyroxine is prescribed to replace thyroid hormone in individuals with hypothyroidism.
Administration details: Levothyroxine can be administered intravenously (IV) or orally (PO), typically around 0600 before the day’s first meal. If taken orally, waiting 30 to 60 minutes before eating breakfast is recommended. Avoiding foods and medications containing iron, calcium, magnesium, or zinc for about four hours before or after levothyroxine administration is essential, as they can bind levothyroxine and hinder its absorption.
Side effects and assessment: Side effects from levothyroxine are usually only observed with excessive doses, resembling hyperthyroidism symptoms such as tachycardia, sweating, diarrhea, and heat intolerance.
Further information on levothyroxine can be reviewed using the Straight A Nursing DRRUGS framework in the article “Focus on Pharm: Levothyroxine” or by tuning in to the Straight A Nursing podcast, episode 219.
Lisinopril
Why it’s used: Lisinopril, an ACE inhibitor, manages hypertension and heart failure by disrupting the RAAS pathway, inhibiting angiotensin-converting enzyme, and blocking the conversion of angiotensin I to angiotensin II. This leads to vasodilation and reduced blood pressure.
Administration details: Lisinopril is available in PO form as a tablet or an oral solution.
Side effects and assessment: A common side effect of ACE inhibitors is a dry cough, prompting some patients to seek alternative treatments. Additionally, lisinopril can cause hypotension, dizziness, renal impairment, and hyperkalemia, especially in patients also taking potassium supplements or potassium-sparing diuretics. Key assessments include monitoring potassium levels and blood pressure.
Metformin
Why it’s used: Metformin is prescribed to maintain optimal blood glucose levels in individuals with Type 2 diabetes by decreasing hepatic glucose production, reducing intestinal glucose absorption, and increasing insulin sensitivity.
Administration details: Metformin is administered orally (PO) and is typically withheld if the patient receives IV contrast due to the increased risk of acute kidney injury.
Side effects and assessment: Common side effects related to metformin include gastrointestinal issues such as abdominal bloating, diarrhea, and nausea/vomiting, along with a metallic taste in the mouth. Monitoring bowel habits and fluid volume status is crucial if diarrhea and vomiting occur. Blood glucose levels should also be closely monitored, especially if the patient takes other glucose-lowering medications.
Metoprolol
Why it’s used: Metoprolol, a beta blocker, reduces heart rate and blood pressure. It’s primarily prescribed for hypertension, angina pectoris, and heart failure. Off-label uses include managing tachycardia, tremors, and anxiety due to its effects on the sympathetic nervous system.
Administration details: Metoprolol can be administered orally (PO) or intravenously (IV). Due to its ability to slow the heart rate, it’s crucial to assess the pulse before administration, with instructions to withhold if it falls below 50 or 60 bpm as specified in the order.
Side effects and assessment: Common side effects of metoprolol include bradycardia, fatigue, and weakness. Regular monitoring of the patient’s heart rate and blood pressure is essential due to metoprolol’s mechanism of action.
Morphine
Why it’s used: Morphine, an opioid analgesic, is prescribed to alleviate pain.
Administration details: Morphine is available in intravenous (IV), epidural, intrathecal, rectal, and oral (PO) formulations, including extended-release tablets. PO morphine can be administered with food or milk to reduce gastrointestinal upset.
Side effects and assessment: Key side effects to monitor with morphine (or any opioid) include respiratory depression and sedation, especially when used concurrently with other opioids or medications causing CNS depression like benzodiazepines. Additional common side effects comprise hypotension, nausea, and pruritus. Respiratory status, blood pressure, and pain levels should be assessed regularly.
Prednisone
Why it’s used: Prednisone is employed to manage various conditions such as autoimmune diseases, asthma, allergies, and inflammatory disorders.
Administration details: Prednisone is available in tablet and oral solution forms. Daily or less frequent doses are administered in the morning to coincide with the body’s natural cortisol release. Taking prednisone with meals helps minimize potential gastrointestinal upset.
Side effects and assessment: Common side effects include mood swings, hypertension, hyperglycemia, and nausea. Long-term use of prednisone may lead to complications like osteoporosis, delayed wound healing, muscle wasting, and a cushingoid appearance (buffalo hump and moon face). Monitoring blood glucose levels, blood pressure, and skin integrity is crucial for prednisone patients.
Simvastatin
Why it’s used: Simvastatin is employed to treat hyperlipidemia and mitigate complications like myocardial infarction and stroke.
Administration details: Simvastatin is available in tablet form and oral suspension. Typically administered once daily in the evening, patients are advised to avoid grapefruit juice to prevent potential toxicity.
Side effects and assessment: Common side effects include rash, abdominal cramps, diarrhea, and constipation. Monitoring lipid levels, bowel habits, and signs of muscle weakness is essential. Muscle weakness may indicate a serious reaction such as rhabdomyolysis.
Warfarin
Why it’s used: Warfarin, an anticoagulant, prevents blood clots, pulmonary embolism, and thrombotic stroke in patients with atrial fibrillation. It’s also employed to prevent thrombus formation post-prosthetic valve placement.
Administration details: Warfarin is administered orally (PO), with the dose varying based on the patient’s international normalized ratio (INR). Due to potential daily dosage adjustments, monitoring laboratory results and adherence to administration instructions is necessary.
Side effects and assessment: The primary concern with warfarin is bleeding. Daily monitoring of INR levels is essential to assess therapeutic levels and bleeding risk (a higher INR indicates a greater risk of bleeding). Generally, a therapeutic INR falls between 2 and 3, but this can vary depending on the indication for warfarin therapy.
Frequently Asked Questions About 12 Common Drugs A Nurse Should Know Before Their First Clinical Day
What are the primary uses of metoprolol?
Metoprolol is primarily prescribed to reduce heart rate and blood pressure in conditions such as hypertension, angina pectoris, and heart failure.
How should simvastatin be taken?
Simvastatin is typically administered once daily in the evening to treat hyperlipidemia. Avoiding grapefruit juice while taking simvastatin to prevent potential toxicity is important.
What are the administration details for warfarin?
Warfarin is taken orally, with dosage adjusted based on the patient’s INR. It’s essential to monitor for signs of bleeding, with INR levels typically maintained between 2 and 3.
How is morphine usually administered?
Morphine is available in various forms including intravenous, oral, and rectal. Oral morphine can be taken with food to minimize gastrointestinal upset.
What are the common side effects of morphine?
Common side effects of morphine include respiratory depression, sedation, hypotension, nausea, and pruritus.
What conditions is gabapentin used for?
Gabapentin is commonly used off-label for managing neuropathic pain, although its official indications include seizures and postherpetic neuralgia.
What are some common side effects of gabapentin?
Common side effects of gabapentin include drowsiness, dizziness, and ataxia.
How should prednisone be taken?
Prednisone is typically taken orally with meals to minimize gastrointestinal upset. It’s important to follow the prescribed dosage and schedule the healthcare provider provides.