Class: Calcium Salts

Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions

Calcium gluconate Hypocalcemia Hypercalcemia IV Unknown Increase
Calcium chloride Hypermagnesemia Digoxin toxicity hypercalcemia with
Hypoparathyroidism thiazide diuretics.
Ventricular fibrillation
Cardiac toxicity
caused by Renal calculi
hyperkalemia

Mechanism of Action

Maintains nervous, muscular, skeletal function. Maintains normal cardiac contractility, coagulation of blood. Affects secretory activity
of endocrine, exocrine glands. Reverses the respiratory depression and potential arrhythmias caused by magnesium toxicity.
Advantages/Disadvantages
Side Effects Adverse Effects

Hypotension Widening QRS complex

Bradycardia Cardiac arrest
Dysrhythmias Seizures
Nausea/Vomiting IV site extravasation
Constipation
Dry mouth

Nursing Interventions Client Education

Monitor calcium and magnesium levels Add calcium rich foods to diet (dairy products, shellfish, dark
Cardiac monitoring green leafy vegetables)
Seizure precautions Decrease oxalate and zinc-rich foods: nots, legumes, chocolate,
Observe IV tubing for precipitation spinach, soy.
Carefully monitor IV site Avoid immobilization.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Phosphorus
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Phosphate (Phospho Hypercalcemia Hyperphosphatemia PO
Soda, Fleets enema) Hypophosphatemia Appendicitis Rectal
Constipation

Mechanism of Action

Essential in bone and teeth formation and for neuromuscular activity. Assists in energy transfer in cells. Supports acid-base balance.
Phosphorus has an inverse relationship to calcium. So if calcium is high, phosphorus is low.
Advantages/Disadvantages
Side Effects Adverse Effects

Nursing Interventions Client Education

Monitor calcium, magnesium and phosphorus levels.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Electrolyte; Anti-Convulsant
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Magnesium Salts Preeclampsia Hypersensitivity IM 1 hour Increase effect of neuromuscular
(Magnesium sulfate) Eclampsia Heart block IV 30 minutes blockers, antihypertensives,
calcium channel blockers.
Decrease effect of digoxin.
Decrease absorption of
tetracyclines, fluoroquinolones,
nitrofurantoin.

Mechanism of Action

Acts as a CNS depressant. Decreases acetylcholine from motor nerves, which blocks neuromuscular transmission and decreases
incidence of seizures. Secondary effect is reduction in BP as magnesium sulfate relaxes smooth muscles. Secondarily affects
peripheral vascular system with increased uterine blood flow caused by vasodilation. Also inhibits uterine contractions.
Advantages/Disadvantages
Side Effects Adverse Effects

Decreases BP while preventing Muscle weakness Flaccid paralysis

seizures in PIH clients Flushing and warmth Circulatory collapse
Sedation Heart block
Must be closely monitored for Confusion Hypotension
hypermagnesemia. Respiratory depression

Nursing Interventions Client Education

Seizure precautions. Reason for medication. Expected results.

Monitor BP.
Cardiac monitoring.
Monitor for magnesium toxicity (thirst, confusion, decreased
DTRs)
I&O
Hourly urinary outputs

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Cation Exchange Resin
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Sodium polystyrene Hyperkalemia GI obstruction PO Increased risk of
sulfonate (Kayexalate) Rectal hypokalemia when used
with loop diuretics and
cardiac glycosides.
Decrease effect of lithium
and thyroid hormones.

Mechanism of Action

Exchanges potassium for sodium in the large intestine.

Advantages/Disadvantages
Side Effects Adverse Effects

Constipation Fecal impaction

Anorexia Hypernatremia
Nausea/vomiting Hypocalcemia
Hypomagnesemia

Nursing Interventions Client Education

Cardiac monitoring Reason for medication and expected results.

Monitor electrolyte levels Low potassium diet
Assess bowel function daily
Monitor for fecal impaction
I&O
Daily weight

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Electrolyte/Potassium supplements
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Potassium Hypokalemia Renal insufficiency or failure PO 30 minutes Increases serum potassium
(Kaochlor, KCL, Prevention of Addison’s disease IV Rapid levels: ACE inhibitors,
Hypokalemia Potassium sparing diuretics,
Micro K, K Dur) Hyperkalemia
Hypokalemic alkalosis NSAIDS, beta-adrenergic
Severe dehydration blockers, heparin, salt
Potassium Sparing diuretics substitutes. Decreases
serum potassium: loop and
thiazide diuretics, licorice.

Mechanism of Action

Transmits and conducts nerve impulses. Conracts skeletal, smooth, and cardiac muscles.

Advantages/Disadvantages
Side Effects Adverse Effects

Nausea/vomiting Hyperkalemia
Diarrhea Life-threatening dysrhythmias
Abdominal cramps Respiratory distress.
Irritability
IV site phlebitis

Nursing Interventions Client Education

Give oral potassium with at least 3-8 ounces’ fluid and with meals. Drink a full glass of water or juice with potassium supplements.
Always put IV potassium on a pump to infuse. Take with a meal.
Monitor infusion at least hourly. Check IV site for infiltration. Signs/symptoms of hyperkalemia and hypokalemia.
Do not give potassium IVP. Do not give IM. Foods containing potassium.
Assess urine output before and during IV potassium.
Monitor serum potassium, creatinine, BUN, glucose, electrolytes,
ABGs.
Monitor for signs/symptoms of hyperkalemia.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Alkalinizer
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Sodium bicarbonate Severe acidosis Metabolic alkalosis IV 15 minutes Do not infuse epinephrine,
based on ABGs Respiratory alkalosis norepinephrine or
Cardiac arrest dopamine in the same site
Hypocalcemia as sodium bicarbonate as
Hypochloremia they will inactivate by the
sodium bicarbonate.

Mechanism of Action

Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises
blood pH and reverses the clinical manifestations of acidosis.
Advantages/Disadvantages
Side Effects Adverse Effects

Irritability Metabolic alkalosis

Headache Tetany
Confusion Seizures
Not the first line medication during a Irregular pulse Cardiac arrest
cardiac arrest. Edema
Can lead to alkalosis. Flatulence

Nursing Interventions Client Education

Monitor ABGs About medication and expected outcome

Assess respiratory and heart rate
I&O
Daily weight
Monitor electrolytes

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Plasma Volume Expander
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Albumin (Albumarc, Shock Hypersensitivity IV 15 minutes
Albuminar, Burns CHF
Hypoproteinemia
Plasbumin) Severe anemia
ARDS
Nephrotic syndrome Renal insufficiency
Pulmonary edema

Mechanism of Action

Exerts oncotic pressure, which expands volume of circulating blood and maintains cardiac output. When injected intravenously, it will
increase circulating plasma volume by approximately 3.5 times the volume infused within 15 minutes if the client is well hydrated. This
extra fluid reduces hemoconcentration and blood viscosity.
Advantages/Disadvantages
Side Effects Adverse Effects

Fever Fluid volume excess

Chills Pulmonary edema
Flushing Anaphylactic shock
Headache Hypertension
Nausea/Vomiting
Increases salivation

Nursing Interventions Client Education

Assess blood studies: Hgb, Hct. Reason for medication.

Assess vital signs Report signs of hypersensitivity such as rash, itching, confusion,
I&O anxiety
Daily weight
Monitor oxygen saturation
Assess lung sounds, CVP, monitoring for signs of FVE

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Phosphorus Binding Drugs
Agent(s) Common Uses Contraindications Route/Dosage Onset of Action Interactions
Sevelamer (RenaGel), Chronic kidney Pregnancy PO Take Ciprofloxacin
Calcium acetate disease Bowel obstruction at least 2 hours
Hyperphosphatemia before or 6 hours
(PhosLo) Hypersensitivity
Hypercalcemia after sevelamer.

Mechanism of Action

Binding phosphate in the dietary tract and decreasing absorption, thus lowering the phosphate concentration in the serum.

Advantages/Disadvantages
Side Effects Adverse Effects

Nausea/Vomiting Allergic Reaction

Stomach pain
Loss of appetite
Flatulence
Constipation
Dry mouth

Nursing Interventions Client Education

Monitor for reduced vitamins D, E, K and folic acid levels Take with meals
Notify prescriber of severe abdominal pain, worsening
constipation.
Avoid use of calcium supplements including antacids.

References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.

Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis