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Spironalactone

Class: Potassium- sparing Diuretics

MOA: Spironolactone competitively inhibits aldosterone dependant sodium potassium exchange channels in the distal convoluted tubule. This action leads to increased sodium and water excretion, but more potassium retention. The increased excretion of water leads to diuretic and also antihypertensive effects.

Drug - drug interactions: (check NIMC): Acebutolol, neurofen, aceclofenac

Signs & Symptoms :
stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, or weakness or heaviness of the legs.

Nursing considerations to prevent, assess or manage risk:

Monitor intake and output.

Watch for cardiac dysrhythmias.

Monitor levels of electrolytes (too much potassium, too little sodium).

Tell patients to report cramps, weakness, fatigue, nausea, or any of the above side effects mentioned.

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Warfarin
Class: Anticoagulant
MOA: Inhibits the vitamin K- dependant synthesis of biologically active forms of the calcium dependent clotting factors II, VII, IX, and X.
Drug - drug interactions: (check NIMC)
- aspirin or aspirin containing products
- many antibiotics
- antacids or laxatives
- acetaminophen
- antifungal medications
cold or allergy medicines
- ibuprofen
- medications that treat irregular heart rhythms.
Signs & Symptoms
- severe bleeding
- red or brown urine
- black or bloody stool
- joint pain
- coughing up blood
- vomiting of blood
- severe headache or stomach pain
- vision changes, dizziness
Nursing considerations to prevent, assess or manage risk:
- simvastatin
- penicillin
- cephalosporin
- macrolides
- sulphonamides
- azole antifungals
- amiodarone
- do not use if the patient is pregnant
- platelet ratio
- do not give any IM injections
- double check all the drugs
- give vitamin k readily available, incase of overdose
- frequent follow ups, including blood tests
- patient education

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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:belongs to called HMG CoA reductase inhibitors (statins).
MOA: inhibiting the enzyme HMG- COA reductase; hepatic cholesterol synthesis; inhibiting the enzyme will lead to reduction in plasma cholesterol
Drug - drug interactions: (check NIMC) it interacts with warfarin
Signs & Symptoms myalgia, mild transient GI symptoms; headache, sleep disturbance, dizziness
Nursing considerations to prevent, assess or manage risk:
baseline blood test;
abnormal hepatic function (initial liver function test);
more effective when taken in evening;
avoid stopping statins if with symptoms of ACS, stopping associated with increased cardiac events

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This will be added once we get to :)

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Drug Class: ACE INHIBITOR
MOA: Works by blocking the conversion of angiotensin 1 to angiotensin 2 which reduces blood pressure and vascular resistance.
Interactions: NSAIDS,
Drug - drug interactions: (check NIMC)
Signs & Symptoms - Hypotension, Hyperkalaemia, Headache, Dizziness and Renal Impairment
Nursing considerations to prevent, assess or manage risk:
-monitor renal function and electrolyte balance
-in elderly start treating with lower doses

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Bisoprolol
Class: Beta-blockers

MOA: Reduces cardiac workload by decreasing contractility and need of oxygen by inhibiting adrenergic receptors. It also reduces renin output in the kidneys which typically also increases BP.

Drug - drug interactio.ns: (check NIMC)
Taking with ibuprofen can impair antihypertensive effect of drug.
Can interact with other drugs that cause bradycardia.

Signs & Symptoms reduces heart rate, BP, cardiac contractility, depressess sinus node rate and atrioventricular conduction.

Nursing considerations to prevent, assess or manage risk:

Take BP before administering
Bisoprolol may mask symptoms of hypoglycaemia

Assess Pts for falls risk

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Frusemide
Class: Loop Diuretic
MOA:
- Inhibits sodium, chloride and water reabsorption in ascending loop of Henle
- Thus increases osmotic pressure within tubules and excretion of potassium, magnesium and calcium
- Water also drawn from peritubular caps
- Therefore increased output (diuresis)
- Have minimal effect on proximal and distal tubules and most of the effect is found in the first part of the ascending loop of Henle
Drug - drug interactions: (check NIMC)
- NSAID
- ACE-Inhibitors
Signs & Symptoms
- Dehydration
- Electrolyte imbalances
- Hypokalaemia, hyponatraemia, hypocalcemia,
hypomagnesaemia
Nursing considerations to prevent, assess or manage risk:
- Assess blood pressure
- Monitor electrolytes (potassium)
- Promote potassium-rich diet
- Assess renal function
- Assess for dehydration, intake and output

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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?