Major drug classes
Nurses must know the major drug classes: what they do, key side effects, and what to monitor. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
Analgesics
Paracetamol (acetaminophen) relieves pain and fever; overdose can cause severe liver damage, so total daily dose limits matter. NSAIDs such as ibuprofen reduce inflammation but can cause stomach bleeding and kidney problems. Opioids such as morphine relieve severe pain; monitor for respiratory depression, sedation, and constipation. Naloxone reverses opioid overdose.
Cardiovascular drugs
ACE inhibitors (names ending in '-pril', such as lisinopril) lower blood pressure; a dry cough is a common side effect, and angioedema is rare but serious. Beta-blockers ('-olol', such as metoprolol) slow the heart and lower blood pressure; check pulse and blood pressure before giving. Diuretics such as furosemide remove fluid; monitor potassium and fluid balance.
Digoxin
Digoxin strengthens heart contractions and slows heart rate. It has a narrow therapeutic index. Nurses commonly check the apical pulse for a full minute before giving it and withhold and report per protocol if the rate is below a set threshold (often 60 in adults). Signs of toxicity include nausea, vision changes (yellow-green halos), and arrhythmias; low potassium increases toxicity risk.
Anticoagulants
Heparin is given IV or subcutaneously and monitored with the aPTT for IV infusions; protamine sulfate reverses it. Warfarin is oral, monitored with the INR (a typical target is 2-3 for many conditions), and reversed with vitamin K. Direct oral anticoagulants (apixaban, rivaroxaban) need less monitoring. All raise bleeding risk.
Insulin and diabetes drugs
Insulin types differ in onset and duration: rapid-acting (lispro, aspart) given with meals; short-acting (regular); intermediate (NPH); and long-acting (glargine) for baseline control. Hypoglycaemia (often defined as glucose below 70 mg/dL, about 3.9 mmol/L) causes shakiness, sweating, and confusion and needs prompt treatment. Metformin is a first-line oral drug for type 2 diabetes.
Antibiotics
Antibiotics treat bacterial, not viral, infections. Ask about allergies before giving, especially to penicillins. Obtain cultures before the first dose when ordered. Watch for allergic reactions, C. difficile diarrhoea, and, with drugs such as vancomycin and aminoglycosides, kidney toxicity and hearing damage, which may require blood level monitoring.
Psychiatric medications
SSRIs such as sertraline treat depression and anxiety; effects take several weeks, and serotonin syndrome is a rare but serious risk with combined serotonergic drugs. Lithium for bipolar disorder has a narrow therapeutic range, roughly 0.6-1.2 mmol/L in many references; dehydration and low sodium raise toxicity risk. Antipsychotics can cause movement disorders and metabolic effects.
Worked example
A patient on digoxin and furosemide reports nausea and seeing yellow halos around lights. Their apical pulse is 52. These are warning signs of digoxin toxicity, possibly worsened by low potassium from the diuretic. The nurse withholds the dose per protocol, reports promptly to the provider, and anticipates checks of the digoxin level and potassium.
Key takeaways
Monitor paracetamol limits, NSAID bleeding, and opioid respiratory depression; naloxone reverses opioids. ACE inhibitors cause cough; check pulse and BP before beta-blockers; monitor potassium with diuretics. Check apical pulse before digoxin and watch for toxicity. Heparin uses aPTT and protamine; warfarin uses INR and vitamin K. Know insulin types and hypoglycaemia signs. Check allergies before antibiotics. SSRIs take weeks; lithium needs level monitoring.
Flashcard
Severe liver damage
Check your understanding
Which lab test is used to monitor warfarin therapy?