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- Webster pack
- Drug diary
- Medic alert bracelet
- Get significant other involved in care
- Warfarin fact sheet
- Check pt understanding of medications
- Limit to one pharmacy to dispense medications

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Warfarin
Class: Anticoagulant
MOA: Warfarin is a vitamin K antagonist. It interferes with the synthesis of vitamin K (potassium)- the primary clotting factors affected by Warfarin are II, VII, IX, and X in the liver. These factors are essential for the production of fibrin, which is involved in the clotting process. By inhibiting the production of these clotting factors, warfarin reduces the ability of the blood to form clots.

Drug - drug interactions: (check NIMC)
Specific antibiotics+ antifungals:
- Amiodarone: inhibits metabolism of the drug and increases risk of bleeding
- Aspirin: risk of bleeding
- NSAIDS: risk of bleeding
- Paracetomol: risk of bleeding
- Vitamin K: increases effect of Warfarin
Signs & Symptoms:
- bleeding
Rare:
- skin necrosis
- purple discolouration of the toes
- alopecia
- allergic reaction
Nursing considerations to prevent, assess or manage risk:
- narrow therapeutic range
- many drugs interact
- warning bracelet
- accurate dosage and administration

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This will be added once we get to :)

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Did you have difficulty trying to find the right words?
Consider how your patients feel when we try to provide education

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What patient education would you provide Angela?
How would you best explain this to her?

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Atorvastatin
Class: statin
MOA: Increase hepatic uptake of cholesterol from the blood, reduce concentrations of cholesterol (LDL --> low density lipoprotein) & small increase in HDL (high density lipoprotein)
Drug - drug interactions: (check NIMC)
erythromiocine may increase concentration of atorvastatin and risk of myopathy or rhabdomyolysis (evidence mainly from epidemiological studies);
Signs & Symptoms Mild GI symptoms Headache
Myalgia (muscle pain) Increase risk diabetes
Nursing considerations to prevent, assess or manage risk: Monitor aminotransferase & creatine kinase at baseline
Time of admin important

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This will be added once we get to :)

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Ramipril
Class: ACE inhibitor
MOA: interferes with the conversion of angiotensin I to Angiotensin II by inhibiting the action of ACE which results in decreased blood pressure by dilating peripheral blood vessels.
Drug-drug interactions: (check NIMC) not with the combination of anti-inflammatory drugs and drugs for the treatment of potassium concentration.
Signs & Symptoms Hypotension, dizziness, headache, renal impairment, hyperkalemia
Nursing considerations to prevent, assess or manage risk:
Monitor renal function, electrolytes, and review use of NSAIDS, monitor for high plasma potassium

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Bisoprolol
Class: B blocker
MOA:
Competitively block beta receptors in heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver.
Beta-blockers reduce heart rate, BP and cardiac contractility; also depress sinus node rate and slow conduction through the atrioventricular (AV) node, and prolong atrial refractory periods.

Indications: hypertension, angina, MI, tachyarrhythmias, heart failure) and the prevention of migraine

Drug - drug interactions: (check NIMC):
Treatment with drugs that cause bradycardia may further decrease heart rate and cause heart block and hypotension; avoid combination with verapamil
Signs & Symptoms: Beta-blockers may impair peripheral circulation.
acute hypoglycaemia
fatigue, dizziness, abnormal vision, alteration of glucose and lipid metabolism, nausea, diarrhoea, bronchospasm,

Nursing considerations to prevent, assess or manage risk
:
This medicine may cause dizziness or tiredness especially at the start of treatment or when the dose is increased; if affected, do not drive or operate machinery.

Monitor for therapeutic effectiveness.

Monitor BP frequently during periods of dose adjustment or drug withdrawal.

Monitor for activity-induced angina both during therapy and following discontinuation of drug.

Monitor for and report severe hypotension and bradycardia.

Monitor for bronchospasms in patients with a history of asthma or COPD.

Monitor diabetics for loss of glycemic control.

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Frusemide
Class: loop diuretics
MOA: Furosemide inhibits tubular reabsorption of sodium and chloride in the proximal and distal tubules and the thick ascending loop of Henle by inhibiting the sodium-chloride cotransport system resulting in excessive excretion of water along with sodium, chloride, magnesium, and calcium
Drug - drug interactions: (check NIMC)
Certain antibiotics, lithium, NSAIDs

Signs & Symptoms
Dehydration, Electrolyte disturbances - Hypokalaemia, Hyponatraemia, Hypocalcaemia, Hypomagnesaemia

Nursing considerations to prevent, assess or manage risk:
Monitor daily weight, I&O  amount and location of edema, lung sounds.
Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs. Monitor BP and pulse before and during administration.

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Spironalactone
Class: Potassium sparing (diuretic)
aldosterone antagonist
MOA: inhibits sodium absorption by acting as an aldosterone antagonist, therefore increasing sodium and water excretion and reducing potassium excretion
Drug - drug interactions: (check NIMC): potassium increasing (NSAIDs, trimethoprim)
Signs & Symptoms: hyperkalaemia (high potassium), hyponatremia (low sodium), nausea and vomiting
Nursing considerations to prevent, assess or manage risk:  pt with renal failure, monitor electrolytes, monitor renal function, don't take additional potassium.
Monitor intake and output.
Watch for cardiac dysrhythmias.
Monitor levels of electrolytes (too much potassium, too little sodium)
Monitor blood glucose levels
Follow blood urea nitrogen and creatinine levels regulary.
Administer during the morning to prevent nocturia.

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Note: Always consider:
Is there anything in the patient's condition/ past history that may increase the risks?

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What would they be for this medication chart?

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?
Its not only the prescribed medication that needs to be considered; over the counter (OTC) needs to be also included when considering drug interactions

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Compare and contrast the significant risks for each of the drug classes. How might you identify these in your patient?

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Compare and contrast the significant risks for each of the drug classes. How might you identify these in your patient?

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What were your significant risks? Are they significant?
Do you understand the MoA of how the patient might develop the risk?
What assessments would you need to do help you identify the risks?
Did you need to go and look them up again?