Nursing Assignment: Medication Chart and Nursing Implications

This nursing assignment provides a medication chart with information on various drugs, their uses, side effects, interactions, and nursing implications. It also includes a summary of the mechanism of action of Atorvastatin.

Nursing Assignment
1

Medication chart:
Name: Aspirin
Use: Aspirin is useful to reduce fever and relieve mild pain.
Side effects: Side effects of aspirin include stomach upset, heartburn, bleeding, difficulty in
hearing, ringing in the ears, alteration in quality and quantity of urine, persistent nausea and
vomiting, yellowing of eyes and skin, dizziness and tiredness.
Interaction: Aspirin and warfarin together can increase chances bleeding and patient might be
at risk of a major haemorrhage.
Nursing implication: Nurse should assess signs of bleeding James. Moreover, nurse should
advise to him to drink abundant amount of fluids while consuming fluids. Nurse should
discontinue aspirin if he is suffering through unrelieved GI discomfort1.
Name: Metformin
Use: Metformin is useful in type 2 diabetes patients to reduce blood glucose level. Metformin
is specifically useful in patients who are overweight.
Side effects: Metformin is associated with side effects such as nausea, vomiting, stomach
upset, diarrhea and weakness.
Interaction: Use of metformin with furosemide together augment the effect of metformin
which may lead to condition such as lactic acidosis. Combination use of ramipril with
metformin may lower the effect of metformin; hence, there might be possibility of too low
glucose level.
Nursing implications: Nurse should monitor gastrointestinal complains while administering
higher doses of metformin because higher doses are associated with gastrointestinal
complains. Hence, nurse should advise him to take metformin with meals to avoid
gastrointestinal complains. Nurse should advise him to take it on daily basis and do not
discontinue it abruptly. Monitor blood and urine glucose levels frequently for monitoring
effectiveness to assess effectiveness of metformin2.
1 Skidmore-Roth, L. (2012). Mosby's Drug Guide for Nursing Students - E-Book. 10th
edition.
Elsevier Health Sciences. Sydney Australia.
2 Tiziani, A. P. (2010). Havard's Nursing Guide to Drugs. 8th edition. Sydney
Australia. Elsevier Health Sciences.
2

Name: Ramipril
Use: Ramipril is useful in the treatment of hypertension.
Side effects: Side effects of ramipril include dizziness, lightheadedness, tiredness, fainting,
and weakness.
Interaction: Combination use of ramipril with metformin may lower the effect of metformin;
hence, there might be possibility of too low glucose level.
Nursing implications: Nurse should assess BP for every 3-6 hours after its administration and
at the end of dosing interval prior to next dosing. Nurse should report to physician, in case of
diminished antihypertensive effect. Moreover, nurse should record the first dose of
hypotension. BUN and serum creatinine also should be monitored regularly because increase
in the BUN and serum creatinine might advocate reduction in dose or discontinuation of
ramipril. Nurse should educate patient to consume adequate amount of fluid and to avoid
consumption of potassium supplements3.
Name: Metoprolol
Use: Metoprolol is useful in the management of multiple cardiac issues such as heart failure,
heart attack and blood pressure.
Side effects: Side effects of metoprolol include hypersensitivity such as erythematous rah,
fever, respiratory distress and sore throat. Other side effects of metaprolol include dizziness,
fatigue, insomania, depression, bradycardia, palpitation, angina pectoris, nausea, heartburn,
diarrhea, gastric pain, eosinophilia, thrombocytopenic and nonthrombocytopenic purpura, dry
skin, skin eruption, dry mouth, hypoglycaemia, and bronchospasm.
Interaction: Coadministration of metoprolol and furosemide might affect lower blood
pressure and slow heart rate.
Nursing implications : Multiple readings of BP should be taken close to dosing interval.
Nurse should monitor patients with hypertension and congestive heart failure. Different
symptoms such as dyspnea, orthopnea, night cough, and edema should be monitored. Nurse
should evaluate different parametres such as blood cell counts, blood glucose, liver and
3 Wilson, B. A., Shannon, M., and Shields, K. (2018). Pearson Nurses Drug Guide
2018. Pearson Education. London, United Kingdom.
3

kidney function on regular basis. Nurse need to monitor hypoglycaemia and associated
symptoms such as BP and HR because metoprolol mask hypoglycaemia; hence, there are
chances that hypoglycaemia can be extended after administration of metoprolol. Nurse should
ensure that dose of metoprolol should be reduced gradually at the time of discontinuation of
drug because sudden withdrawal lead to anginal attack and myocardial infraction4.
Name: Warfarin
Use: Warfarin is useful in treatment of blood clot which can reduce risk of stroke or heart
attack.
Side effects: Side effects of warfarin include major or minor haemorrhage, hypersensitivity
reactions, anorexia, abdominal cramps, stoamatitis, hepatitis and jaundice.
Interaction: Aspirin and warfarin together can increase chances bleeding and patient might be
at risk of a major haemorrhage. Cefazolin may increase the effectiveness of warfarin; hence,
there is possibility of more bleeding
Nursing implications: Nurse should determine prothrombin time before treatment and daily
after treatment until maintenance dose is decided. During the administration of maintenance
dose, prothrombin time should be determined after every 3-4 weeks. Urine analysis, stool
analysis and liver function tests should be carried out after the administration of maintenance
dose. Drug should be stopped immediately after occurrence of hypersensitivity reaction5.
Name: Furosemide
Use: Furosemide is used as a diuretic drug.
Side effects: Furosemide is associated with risk factors such as Dizziness, lightheadedness,
headache, blurred vision, loss of appetite, stomach upset, diarrhea, constipation, muscle
cramps, weakness, confusion, drowsiness, unusual dry mouth, unusual increased thirst,
nausea/vomiting, fast/irregular heartbeat, fainting, seizures.
4 Wilson, B. A., Shannon, M., and Shields, K. (2018). Pearson Nurses Drug Guide
2018. Pearson Education. London, United Kingdom.
5 Tiziani, A. P. (2010). Havard's Nursing Guide to Drugs. 8th edition. Sydney
Australia. Elsevier Health Sciences.
4

Interaction: Coadministration of metoprolol and furosemide might affect lower blood
pressure and slow heart rate. Oxycodone and furosemide in combination lower blood
pressure.
Nursing implications : Nurse should monitor BP and vital signs on the regular basis. Abrupt
alteration in fluid and electrolyte balance might precipitate substantial side effects. Hence,
nurse should monitor the patient for dehydration, hypovolemia, circulatory collapse and
hypotension. Nurse should monitor glucose and HbA1C in patients with diabetes because
furosemide can precipitate hyperglycaemia in such patients. Nurse should monitor daily salt
and fluid intake and also should avoid fluid loses with large quantity of water6.
Name: Potassium chloride
Use: Potassium chloride is useful in preventing low levels of blood potassium.
Side effects: Side effects associated with potassium chloride include severe throat irritation,
stomach bloating, vomiting, and stomach pain.
Nursing implications: Nurse should monitor electrolyte balance on regular basis. Monitor and
report GI ulceration7.
Name: Pantoprazole
Use: Pantoprazole is used as an antacid.
Side effects: Pantoprazole is associated with side effects such as headache, diarrhea, muscle
spasm, seizure, flatulence, insomania, skin rash and abdominal pain.
Interaction: Concomitant administration of pantoprazole and warfarin results in the
potentiating effect of warfarin raising International normalized ratio (INR).
6 Skidmore-Roth, L. (2012). Mosby's Drug Guide for Nursing Students - E-Book. 10th
edition.
Elsevier Health Sciences. Sydney Australia.
7 Skidmore-Roth, L. (2012). Mosby's Drug Guide for Nursing Students - E-Book. 10th
edition.
Elsevier Health Sciences. Sydney Australia.
5

Nursing implications: Nurse should monitor angioedema and severe skin reactions.
Moreover, urea breath test also should be carried out after 4-36 weeks of completion of
therapy8.
Name: Atorvastatin
Use: Atorvastatin is used as anti-hyperlipidimic drug for the treatment of patients with
cardiovascular disease with high levels of lipids.
Side effects: Side effects of atorvastatin include memory problem, confusion, muscle pain,
weakness, tenderness, abdominal pain, dizziness and allergic reaction.
Nursing implications : Nurse should assess lipid lowering effect within 2-4 weeks after
initiation of therapy. Moreover, liver function test should be carried out after 6 and 12 weeks.
Assess muscle pain, tenderness and weakness on the regular basis and inform physician about
the abnormal occurrence of such symptoms9.
Name: Oxycodone
Use: Oxycodone is an opioid analgesic and useful for the management of moderate to severe
pain.
Side effects: Oxycodone is associated with side effects such as nausea, vomiting,
constipation, lightheadedness, dizziness, drowsiness, agitation, confusion, hallucinations,
abdominal pain, difficulty in urination, loss in appetite, weight loss, itching and rashes.
Interaction : Oxycodone and furosemide in combination lower blood pressure.
Nursing implications: Nurse should monitor effectiveness of drug regular basis. Nurse should
consult physician if nausea continues after initial few days of administration. Potential of
drug abuse is high with consumption of oxycodone hence nurse should monitor patient for
psychic and physical dependence. Nurse should monitor for hepatic functions and
hematologic status of the regular basis. Moreover, nurse should also monitor patient for
8 Skidmore-Roth, L. (2012). Mosby's Drug Guide for Nursing Students - E-Book. 10th
edition.
Elsevier Health Sciences. Sydney Australia.
9 Tiziani, A. P. (2010). Havard's Nursing Guide to Drugs. 8th edition. Sydney
Australia. Elsevier Health Sciences.
6

respiratory depression and circulatory collapse. Nurse should educate patient that there
should not be any change either increase or decrease in dose of oxycodone10.
Name: Cefazolin
Use: Cefazolin is used as antibiotic for the management of infection related to surgery and
wound.
Side effects: Side effects of cefazolin include diarrhea, stomach pain or upset stomach,
vomiting, rash, dizziness, headache, fatigue, itching and transient hepatitis.
Interaction: Cefazolin may increase the effectiveness of warfarin; hence, there is possibility
of more bleeding.
Nursing implications: Nurse should determine history of hypersensitivity to cephalosporins
and penicillins. Nurse should order culture testing before and after administration of cefazolin
for the presence of microorganisms. BUN and creatinine levels should be monitored on the
regular basis. Onset of diarrhea should be promptly reported because cefazoline can cause
drug related GI disturbance. Signs and symptoms of superinfection should be monitored and
reported immediately. Nurse should advise James to continue medications until physician’s
instruction or antibiotic course completion because abrupt discontinuation of antibiotic is
attributable to reinfection11.
10 Skidmore-Roth, L. (2012). Mosby's Drug Guide for Nursing Students - E-Book. 10th
edition.
Elsevier Health Sciences. Sydney Australia.
11 Wilson, B. A., Shannon, M., and Shields, K. (2018). Pearson Nurses Drug Guide
2018. Pearson Education. London, United Kingdom.
7

Mechanism of action:
1) Atorvastatin:
Atorvastatin exhibit its action through acting as competitive inhibitor of HMG-CoA (3-
hydroxy-3-methylglutaryl-coenzyme A) reductase. HMG-CoA reductase catalyzes the
reduction of HMG-CoA to mevalonate. Conversion of HMG-CoA to mevalonate is the rate
limiting step in the biosynthesis of hepatic cholesterol biosynthesis. Atorvastatin specifically
exhibit its action in the liver. It decreases the de novo cholesterol synthesis and increases the
expression of low-density lipoprotein receptors (LDL receptors) on hepatocytes which
augment capacity of hepatocytes to uptake LDL and reduces quantity of LDL-cholesterol in
the blood. In addition to this atorvastatin decreases the triglycerides levels in the blood and
increases the HDL (high density lipoproteins)-cholesterol. In addition to this atorvastatin
reduces blood levels of very low-density lipoprotein-cholesterol (VLDL-C), intermediate
density lipoproteins (IDL) and multiple apolipoprotein B (apo B) containing particles12.
Alterations in the different types of lipids in the blood results in the improvement in
endothelial dysfunction, improved stability of atherosclerotic plaques, decreased stress and
inflammatory response and impeding thrombogenic response. Epidemiologic investigations
also demonstrated that alterations in the total-C, LDL-C and HDL-C are responsible for
different cardiovascular mortality and morbidity. Atorvastatin reduces LDL-C blood levels in
few patients with familial hypercholesterolemia (FH). Other lipid lowering drugs usually do
not exhibit this effect. Atorvastatin exhibit its lipid lowering effect in homozygous and
heterozygous FH, nonfamilial forms of hypercholesterolemia, and mixed dyslipidemia13.
Atorvastatin exhibit different effects on lipid levels in the different patients. Atorvastatin
reduces total-C, LDL-C, VLDL-C, apo B, and triglycerides and increases HDL-C in patients
with hypertriglyceridemia. On the other hand, atorvastatin reduces intermediate density
lipoprotein cholesterol (IDL-C) in patients with dysbetalipoproteinemia. Not only LDL but
also cholesterol-enriched triglyceride-rich lipoproteins, VLDL and IDL are responsible for
12 Weng, T.C., Yang, Y.H., Lin, S.J., and Tai, S.N. (2010). Tai SH. A systematic review
and meta-analysis on the therapeutic equivalence of statins. Journal of Clinical
Pharmacy and Therapeutics, 35(2), 139-51.
13 Ferreira, A.M., and Marques, S. P. (2017). Defining the Place of
Ezetimibe/Atorvastatin in the Management of Hyperlipidemia. American Journal of
Cardiovascular Drugs, 17(3), 169-181.
8

atherosclerosis. Elevated levels of triglycerides are usually occurred in the form of triad with
low HDL-C and small LDL particles. Hence, it is necessary to act on all these components of
triad for the prevention coronary artery diseases. Atorvastatin exhibit its action on all the
components of the triad. Moreover, total triglycerides have not been determined as the
independent risk factor for the coronary heart disease. It has been demonstrated that drug
dosage exhibits more correlation with reduction in LDL levels as compared to the systemic
drug concentration. Reduction in stress and inflammatory response also play significant role
in the atherogenic condition. Atorvastatin exhibit its anti-inflammatory response through
allosterically binding to the β2 integrin function-associated antigen-1 (LFA-1) which plays
significant role in leukocyte trafficking and in T cell activation14.
2) Metoprolol:
Metoprolol exhibit its action through acting as beta1-selective (cardioselective) adrenergic
receptor blocker. By blocking, beta1- adrenergic receptors in the heart muscle cells,
metoprolol reduces slope of phase 4 in the nodal action potential and prolong the
repolarization of phase 3. It decreases the phase 4 slope in the nodal action potential through
reducing Na+ uptake and prolong phase 3 repolarization through slowing down K+ release.
Beta1 receptor get stimulated through biochemical called as epinephrine. Stimulation of beta1
receptor through results in the increased heart rate and augmented strength of contraction. It
is also evident that at higher concentration, metoprolol also exhibits inhibition of beta 2
adrenoreceptors which are mainly located in the bronchial and vascular musculature. Beta
blocker potential of metoprolol results in the reduction in the cardiac output and heart output
during both upon exercise and rest, reduction in systolic blood pressure post exercise,
inhibition of tachycardia induced by isoproterenol and reduction of reflex orthostatic
tachycardia15. Metoprolol exhibit reduced cardiac output action through producing negative
chronotropic and inotropic effects. Metoprolol is devoid of action such as membrane
14 Adams, S.P., Tsang, M., and Wright, J.M. (2015). Lipid-lowering efficacy of
atorvastatin. Cochrane database of systematic reviews, 12,(3),CD008226. doi:
10.1002/14651858.CD008226.pub3.
15 Ripley, T.L., and Saseen, J.J. (2014). β-blockers: a review of their pharmacological
and physiological diversity in hypertension. Annals of Pharmacotherapy, 48(6), 723-
33.
9

stabilization or intrinsic sympathomimetic effect. Metoprolol exhibit reduction in cardiac
output and heart rate which are dependent on the dose and concentration of drug16.
Metoprolol exhibit its antihypertensive effect by acting as competitive antagonism of
catecholamines at cardiac adrenergic neurons which result in the reduced cardiac output. It
also exhibits antihypertensive effect through central action which results in the decreased
sympathetic outflow to the periphery. Moreover, inhibition renin activity is also responsible
for the antihypertensive effect of metoprolol. Metoprolol exhibit its effect in angina pectoris
through blocking catecholamine-induced augmentation in heart rate. Moreover, it also
exhibits its effect in angina pectoris through blocking catecholamine dependent augmentation
in velocity and extent of myocardial infraction and blood pressure. Metoprolol lowers the
oxygen requirement by the heart; hence, it is beneficial in the long-term management of
angina pectoris. Metoprolol also exhibit action through suppressing norepinephrine-induced
augmentation in the sarcoplasmic reticulum (SR) Ca2+ leak and impulsive SR Ca2+ release.
Evidence suggested that Metoprolol exhibit selective beta1 adrenergic blocking activity which
is evident from its inability to reverse beta2-mediated vasodilating effect of epinephrine. On
the other hand, non-selective beta blockers completely reverse the vasodilating effect through
epinephrine. Moreover, selective beta1 blocking activity of metoprolol is evident from its
potential of reducing FEV1 and FVC with lesser intensity as compared to the nonselective
beta-blocker propranolol17.
16 Fonseca, V.A. (2010). Effects of beta-blockers on glucose and lipid metabolism.
Current Medical Research and Opinion, 26(3), 615-29.
17 Ripley, T.L., and Saseen, J.J. (2014). β-blockers: a review of their pharmacological
and physiological diversity in hypertension. Annals of Pharmacotherapy, 48(6), 723-
33.
10

References:
Adams, S.P., Tsang, M., and Wright, J.M. (2015). Lipid-lowering efficacy of atorvastatin.
Cochrane database of systematic reviews, 12,(3),CD008226. doi:
10.1002/14651858.CD008226.pub3.
Ferreira, A.M., and Marques, S. P. (2017). Defining the Place of Ezetimibe/Atorvastatin in
the Management of Hyperlipidemia. American Journal of Cardiovascular Drugs,
17(3), 169-181.
Fonseca, V.A. (2010). Effects of beta-blockers on glucose and lipid metabolism. Current
Medical Research and Opinion, 26(3), 615-29.
Ripley, T.L., and Saseen, J.J. (2014). β-blockers: a review of their pharmacological and
physiological diversity in hypertension. Annals of Pharmacotherapy, 48(6), 723-33.
Skidmore-Roth, L. (2012). Mosby's Drug Guide for Nursing Students - E-Book. 10th edition.
Elsevier Health Sciences. Sydney Australia.
Tiziani, A. P. (2010). Havard's Nursing Guide to Drugs. 8th edition. Sydney Australia.
Elsevier Health Sciences.
Weng, T.C., Yang, Y.H., Lin, S.J., and Tai, S.N. (2010). Tai SH. A systematic review and
meta-analysis on the therapeutic equivalence of statins. Journal of Clinical Pharmacy
and Therapeutics, 35(2), 139-51.
Wilson, B. A., Shannon, M., and Shields, K. (2018). Pearson Nurses Drug Guide 2018.
Pearson Education. London, United Kingdom.
11