07 Practical Nursing Pharmacology

A safe medication process

Medication effects depend on the medicine, dose, route, patient, and clinical context. Common medication patterns support clinical judgment but do not replace an order, a current drug reference, or facility policy.

Before administration, confirm the correct patient, medication, dose, route, and time. Follow applicable facility checks for allergies, indication, documentation, and the patient’s right to refuse. Compare the medicine with the current order and medication record, and clarify discrepancies rather than guessing.

Review relevant assessments and laboratory results. Consider age, pregnancy status, kidney and liver function, and possible interactions with prescription medicines, over-the-counter products, and supplements. Follow the nurse practice act, delegation rules, orders, and facility policy; seek clarification when a dose, assessment, or action is uncertain.

Blood pressure, fluid balance, and heart medicines

ACE inhibitors and ARBs, including lisinopril and losartan, lower blood pressure and may support treatment of heart failure and some kidney conditions. Monitor blood pressure and ordered kidney-function and potassium tests. Dizziness or low blood pressure, increased potassium, and kidney-function changes are concerns. ACE inhibitors may cause a dry cough; swelling of the face, lips, or tongue may signal angioedema. These medicines require prescriber review in pregnancy. Teach patients to report fainting, persistent cough, or swelling urgently, to check before using potassium supplements or salt substitutes, and not to change or stop a dose without prescriber guidance.

Beta blockers and calcium channel blockers, including metoprolol, amlodipine, and diltiazem, lower blood pressure; some also reduce heart rate or control certain heart-rhythm problems. Check blood pressure and pulse as directed by the order and policy, follow ordered hold parameters, and clarify concerns. Low blood pressure, dizziness, or a slow heart rate may occur; some calcium channel blockers can cause ankle swelling or constipation. Teach patients to rise slowly and not to stop treatment on their own. Beta blockers should not be stopped abruptly without medical advice.

Diuretics such as furosemide and spironolactone increase salt and water removal, helping reduce edema and sometimes blood pressure. Monitor intake and output, weight, blood pressure, ordered electrolytes, and kidney function. Dehydration, dizziness, kidney-function changes, and electrolyte abnormalities are concerns. Loop diuretics may lower potassium, while potassium-sparing drugs may raise it. Teach patients to follow their individualized fluid, salt, and potassium instructions and not to add potassium unless advised.

Medicines that reduce blood clots

Anticoagulants and antiplatelets, including warfarin, apixaban, aspirin, and clopidogrel, reduce the formation or growth of blood clots by different mechanisms. Bleeding is the major shared risk. Assess for unusual bruising, blood in urine or stool, persistent bleeding, and falls or head injury. Warfarin has important food and drug interactions and requires ordered INR monitoring; monitoring differs among anticoagulants. Teach patients to check with a clinician or pharmacist before starting, stopping, or changing medicines or supplements, to keep monitoring appointments, and to follow the specific missed-dose instructions.

Blood glucose and infection medicines

Insulin and other glucose-lowering medicines lower blood glucose; insulin replaces or supplements the body’s insulin. Verify the exact insulin product, concentration, dose, and timing, use the correct device, and follow independent-check requirements. Coordinate mealtime insulin with food and the prescribed plan. A delayed or missed meal, a change in activity, or an incorrect dose can increase the risk of hypoglycemia. Teach patients to recognize and treat low glucose according to their care plan and to know how to access prescribed glucagon for severe hypoglycemia.

Antibiotics treat susceptible bacterial infections, not viral illnesses such as colds or flu. Reactions vary by drug; nausea, diarrhea, and rash can occur, while severe allergy or severe diarrhea needs prompt assessment. Verify and document allergy details, and monitor response and adverse effects. Teach patients to take antibiotics exactly as prescribed, not to share or save them, and to contact a clinician about concerning effects.

Pain relievers and corticosteroids

Pain relievers such as acetaminophen, NSAIDs, and opioids reduce pain; some medicines in this group also reduce fever or inflammation. Too much acetaminophen can cause severe liver injury. Check combination products to avoid duplicate acetaminophen, teach patients to follow label or prescribed limits, and advise them to seek guidance when liver disease or other risks apply. NSAIDs can cause gastrointestinal bleeding and may increase cardiovascular or kidney risks.

Opioids such as morphine can cause sedation, constipation, and dangerous slowing of breathing, especially with alcohol or other sedating medicines. Assess pain and sedation, and monitor breathing as directed. Teach patients not to combine opioids with alcohol or unapproved sedatives, drive while impaired, or share the medicine.

Corticosteroids such as prednisone reduce inflammation and suppress immune activity; they may also replace deficient corticosteroid hormones. They may raise blood glucose and blood pressure, affect mood or sleep, and increase infection risk. Long-term treatment can suppress the body’s own steroid production. Monitor for infection and relevant glucose or blood-pressure changes. Patients should not stop prolonged therapy suddenly; any tapering must follow prescriber instructions.

Respiratory and cholesterol medicines

Short-acting bronchodilators such as albuterol relax airway muscles to relieve wheezing or shortness of breath. Check respiratory status and response, and teach correct inhaler or nebulizer technique. Shakiness, nervousness, and a fast or irregular heartbeat may occur. Worsening breathing needs prompt attention. If rescue medicine is needed more often than directed or is not relieving symptoms, the patient should contact a clinician.

Statins such as atorvastatin lower LDL cholesterol and reduce cardiovascular risk for appropriate patients. Muscle symptoms may occur; serious muscle injury is rare. Liver-enzyme changes can occur, while clinically significant liver injury is uncommon. Ask about new muscle pain, tenderness, weakness, or dark urine, and report concerning symptoms. Review other medicines and supplements for interactions; patients should discuss therapy with the prescriber before stopping it.

Evaluate effects and respond to changing conditions

After administration, evaluate whether the intended effect occurred and watch for adverse effects. Teach the patient what the medicine is for, how to take it, what not to combine it with, and which symptoms need prompt or emergency attention. Report and document significant findings.

For example, if a patient scheduled for mealtime insulin becomes suddenly nauseated and says they cannot eat, do not assume the usual dose is safe to give unchanged. Check the current glucose and order, confirm the meal and insulin timing, and promptly clarify the plan with the responsible clinician according to policy. Continue monitoring for hypoglycemia symptoms and document actions and the patient’s response. The judgment is to connect the medication’s effect with the patient’s immediate condition rather than administer automatically.

Recognize and escalate urgent findings, especially severe allergy, significant bleeding, hypoglycemia, or slowed breathing. When uncertain, pause and clarify.