Pharmacological and Parental Therapies / 04
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Imagine a nurse during a busy shift, running from room to room, and in and out of the nurses’ station. While trying to remember the dobutamine order for one of their patients, she overhears a colleague mentioning a recent study about dopamine. Meanwhile, a doctor is speaking loudly on the phone, inquiring about a dose of depo-medrol, and a student asks another if it is related to solu-medrol. There are many drug names that a nurse must know and comprehend to feel secure when treating their patients. Understanding at least which system these drugs pertain to provides a sense of confidence for healthcare professionals.
While the pharmacology of each system can be wide and complex, healthcare professionals should at least be familiar with the most frequently administered medications, as well as their side effects, presentation, and dosing, to promote patient/client compliance and safety with these drugs.
2.1 Cardiovascular and Respiratory System
There is a variety in the types of medications that can be ordered to control or prevent limiting heart conditions. Two of the most used groups are antihypertensives and antiarrhythmics. Antihypertensives are primarily composed of angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers and beta blockers. Antiarrhythmics are classified into classes 1 through 4.
Antihypertensives
Antiarrhythmics
Table 1
Cardiovascular Medication
Adapted from Liu, Z., & Yang, B. (2019). Drug Development Strategy for Type 2 Diabetes: Targeting Positive Energy Balances. Curr Drug Targets, 20(8). http://doi.org/10.2174/1389450120666181217111500; Spechler, S.J. (2019). Proton Pump Inhibitors: What the Internist Needs to Know. Med Clin North Am. https://pubmed.ncbi.nlm.nih.gov/30466666/
Regarding medication for the respiratory system, bronchodilators are a significant part of the market. They are prescribed for patients/clients who have suboptimal airflow through the lungs measured by respiratory tests, O2 saturation levels in ambient air, or physical signs and symptoms of respiratory distress. They are organized into four main groups: adrenergic/sympathomimetics, methylxanthines, corticosteroids and anticholinergics.
In addition to the therapies already mentioned, we have combined products; these usually involve a two-bronchodilator combination, and the delivery mechanism is inhalation. The most common formulas include fluticasone + salmeterol, ipratropium + albuterol, and budesonide + formoterol.
Table 2
Bronchodilators
Adapted from Cleveland Clinic. (n. d.). Beers Criteria. https://my.clevelandclinic.org/health/articles/24946-beers-criteria; Sharma et al. (2023). Asthma Medications. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531455/
2.2 Endocrine and Reproductive System
There has been universal consensus over the last few years on the effective management of diabetes mellitus. Experts and guidelines concur that the disease requires an approach with an interprofessional perspective involving both lifestyle modifications like diet and exercise in combination with pharmacologic therapies as needed to meet individualized glycemic goals in each patient.
For optimal glycemic control, patients must combine lifestyle changes with oral pharmacologic agents, especially as type 2 diabetes mellitus progresses with continued loss of pancreatic beta-cell function and insulin production (Bhalla et al., 2020).
Healthcare providers should aim for therapies that consistently achieve glycemic control and fulfill educational goals for diabetes management (Bhalla et al., 2020).
These medications are organized in seven groups: sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, DDP-4 inhibitors and the various insulins. Another important function of endocrine pharmaceuticals is contraception, which is based on hormonal therapy.
Table 3
Endocrine Medication
Adapted from Bhalla et al. (2020). Contemporary Meta-Analysis of Extended Direct-Acting Oral Anticoagulant Thromboprophylaxis to Prevent Venous Thromboembolism. Am J Med. http://doi.org/10.1016/j.amjmed.2020.01.037; Colbert, B., & Woodrow, R. (2017). Essentials of Pharmacology for Health Professions. Cengage Learning.
Table 4
Types of Insulins
Adapted from Colbert, B., & Woodrow, R. (2017). Essentials of Pharmacology for Health Professions. Cengage Learning; Liu, Z., & Yang, B. (2019). Curr Drug Targets, 20(8). http://doi.org/10.2174/1389450120666181217111500
2.3 Gastrointestinal System
Gastrointestinal drugs are popular among patients given the fact that many of them are easy to acquire without a prescription, the most common ones being antiulcer and antiemetic drugs. The first group works by neutralizing or reducing acidity of stomach contents, and are organized into four main groups: antiacids, H2-receptor antagonists, mucosal protectants and proton pump inhibitors. Antiemetics work to prevent the patient from nausea and vomiting. In the traditional healthcare setting nausea may be one of the most common symptoms encountered, given the nature of the symptom itself is also amongst patients' main complaints while being taken to the emergency room. The origins of nausea range from a bodily defense against toxins to a nuanced blend of triggers such as stress, medication, or even fear. Different neurohumoral pathways might be implicated. (Michaels et al., 2018). These medications are organized in groups: serotonin-receptor antagonists, glucocorticoids, anticholinergics, benzamides and antihistamines.
Table 5
Gastrointestinal Medications
Adapted from Colbert, B., & Woodrow, R. (2017). Essentials of Pharmacology for Health Professions. Cengage Learning; Michels et al. (2018). Modification of the Associations Between Duration of Oral Contraceptive Use and Ovarian, Endometrial, Breast, and Colorectal Cancers. JAMA Oncology, 4(4). https://doi.org/10.1001/jamaoncol.2017.4942
2.4 Hematologic and Immune System
A serious risk in the hematologic system is the formation of thrombus. Antithrombotic drugs include anticoagulants and antiplatelets. Irregularities in the blood vessel wall and clotting elements lead to the transformation of liquid fibrinogen into solid fibrin, causing clotting. Various anticoagulant choices are available, and medical professionals determine the appropriate one based on its intended use, patient's choice, the effectiveness of anticoagulants in certain clinical scenarios, and established treatment recommendations.
There are several conditions in which anticoagulation should be avoided, the nurse needs to inform the MD if the patient/client has one of the following: active bleeding, gastrointestinal bleeding, coagulopathy, recent major surgeries, acute intracranial hemorrhage, major trauma, aortic dissection or aneurysm, and the geriatric or pregnant patients.
Anticoagulants are organized in groups: heparin, warfarin, factor Xa inhibitor and New Oral Anticoagulants (NOAC). Antiplatelets are organized in antiplatelet agents, low molecular weight heparins and group IIa-IIb inhibitors.
Table 6
Hematologic Medications
Adapted from Bhalla et al. (2020). Contemporary Meta-Analysis of Extended Direct-Acting Oral Anticoagulant Thromboprophylaxis to Prevent Venous Thromboembolism. Am J Med. http://doi.org/10.1016/j.amjmed.2020.01.037; Colbert, B., & Woodrow, R. (2017). Essentials of Pharmacology for Health Professions. Cengage Learning; Schug et al. (2020). Acute Pain Management: Scientific Evidence. Australian and New Zealand College of Anesthetists and Faculty of Pain Medicine. https://www.anzca.edu.au/resources/college-publications/acute-pain-management/apmse5.pdf; Su et al. (2020). Meta-analysis of the Efficacy and Safety of Non-vitamin K Antagonist Oral Anticoagulants with Warfarin in Latin American Patients with Atrial Fibrillation. Medicine. https://doi.org/10.1097/MD.0000000000019542
2.5 Musculoskeletal, neurologic and pain management
In this group of medications, there is a broad variety of drugs, from over-the-counter PO administered compounds to intricately delivered IV pump drugs. They also provide solutions for some of the most common symptoms in various medical contexts, including emergency rooms and medical-surgical floors. Analgesics may be administered via the following routes: oral, intramuscular, rectal, IV bolus (push), continuous subcutaneous narcotic infusion, continuous epidural analgesia, transdermal patches, or patient-controlled analgesia. Major analgesic groups are nonsteroidal anti-inflammatory drugs and opioids.
Table 7
Musculoskeletal, Neurologic and Pain Management Medications
Adapted from Cohen et al. (2023). Opioid Analgesics. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459161/; Ghlichloo, I., & Gerriets, V. (2023). Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547742/; Schug et al. (2020). Acute Pain Management: Scientific Evidence. Australian and New Zealand College of Anesthetists and Faculty of Pain Medicine. https://www.anzca.edu.au/resources/college-publications/acute-pain-management/apmse5.pdf
2.6 Infectious diseases
Since Alexander Fleming’s discovery of Penicillin in 1928, allopathic medicine has come to rely heavily on anti-infective drugs for treating infections and preventing them in surgical settings or in patients with a compromised immune system. The following table shows the different families within these drugs, indications, adverse reactions and most importantly the Key to the Nursing Process which considers the best practices for nurses to adopt while treating and educating a client/patient. Modern antibiotics are organized in groups: penicillin, antipseudomonal penicillin (and combinations), semisynthetic, tetracyclines, aminoglycosides, cephalosporins, carbapenems, monobactam, macrolides, fluoroquinolones, lacosamide, streptogramin, and oxazolidinone.
Table 8
Antibiotics
Adapted from Moore, L. S. P., & Hatcher, J.C. (2020). Infectious Diseases: Microbiology and Virology. Cambridge University Press.
The pharmacology of systems can be a daunting subject given that in modern medicine there is a wide selection of drugs that may target the same disease. For a better understanding, it is vital for the nurse to grasp the mechanisms of action, adverse reactions, and, especially, all the information contained in the Key for The Nursing Process. It is essential for the nursing professional to instruct patients/clients on the use of and precautions necessary for reaching therapeutic goals with their pharmacologic treatments.
At the same time, the nurse should also be aware of interactions and contraindications of a given drug and correlate this information with the patient's/client's overall condition. Are these the best treatment choices considering the patient’s individual and social context, support system, level of understanding, and ability to comply with medication?
As a leader and advocate for the patient, the nurse should also raise awareness within the treatment team if the drug of choice may not be the best option, considering the aforementioned issues.
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