Routes of Administration EPINEPHRINE

Subcutaneous
(Adrenalin)
Intravenous
Topical
Inhaled
Intracardiac

Classification
Mode of Action
Nonselective Adrenergic Agonist
● Epinephrine works by stimulating both
the alpha and beta adrenergic
receptors, thus why it is called a
sympathomimetic, as it gives a full
sympathetic response.

Samuel McDonald
 What Does it Do?
● Because Epinephrine stimulates both
the alpha and beta adrenergic receptors,
it results in many widespread effects
including:
○ INC Heart Contractility
○ Pupil Dilation
○ Bladder Relaxation
○ Prostate Contraction
○ DEC GI Tone and Motility
○ INC Heart Rate
○ INC Blood Pressure
○ Bronchodilation
○ Uterine Muscle Relaxation
○ INC Blood Sugar
What Does It Treat?
● Epinephrine treats many things, but is
primarily used for the treatment of
severe allergic reactions and
anaphylaxis. The bronchodilation
properties allow for improved airway
patency and the INC contractility of the
heart improves cardiac output of the
heart. It is also used to treat
hypotension due to septic shock, croup,
and is even used as a local anesthetic
block in the operating room.
Nursing Considerations Side Effects
● Epinephrine can increase rigidity and ● Epinephrine side effects are due to the
tremor in patients with Parkinson’s fact that it is a nonselective adrenergic
disease agonist and all 4 receptors are being
● Epinephrine is the drug of choice in activated. Side effects include:
emergency treatment of acute
○ Nervousness
anaphylactic reactions
○ Tremors
● Observe patient closely for adverse
reactions ○ Tachycardia
● If blood pressure increases sharply, ○ Hypertension
give rapid-acting vasodilators such as ○ Dizziness
nitrates and alpha blockers, in order to ○ Sweating
counteract the marked pressor effect ○ Headache
of large doses ○ Anxiety
Patient Teaching
● For patients with acute hypersensitivity
reactions, such as to bee stings or
peanuts, teach self-injection in case of
emergency
● Instruct patient to give autoinjector into
the outer thigh and not into the buttock,
as this area of injection has been shown ● More severe adverse reactions of
to be less effective in life-threatening epinephrine include cerebral
situations hemorrhage, subarachnoid hemorrhage,
● Instruct patient to seek immediate ventricular fibrillation, and shock
medical care for reactions and to never
give more than 2 sequential doses
 Routes of Administration
Fosinopril
Oral
(Monopril)

Mode of Action

● It inhibits ACE which prevents

conversion of ang. 1 to ang. 2, a potent Classification
vasoconstrictor. Less ang. 2 decreases ACE Inhibitor
peripheral arterial resistance, thus (Antihypertensive)
decreasing aldosterone secretion,
reducing sodium and water retention,
lowering blood pressure.

Samuel McDonald
 What Does it Do?
● Fosinopril is from the drug class called
the antihypertensives. It blocks an
enzyme needed to produce a substance
that causes blood vessels to tighten up.
So as a result from taking fosinopril,
blood vessels relax, resulting in a
lowered blood pressure. In addition, it
results in an improved supply of blood
and oxygen to the heart.
Nursing Considerations
● Monitor Blood pressure for drug effect
● Assess renal and hepatic function
before and periodically throughout
therapy
● Can increase the risk for angioedema,
including intestinal angioedema.
Monitor patient for facial swelling,
airway obstruction, and abdominal pain
● Monitor potassium intake and
potassium level. Diabetic patients and
those with impaired renal function may
develop hyperkalemia
Side Effects
● Some side effects that can occur while
taking Fosinopril include:
○ Dizziness
○ Hypotension
○ Irritating Cough
○ Hyperkalemia
○ Peripheral vasodilation
■ Edema
● Although this is used to treat
hypertension, we need to be careful,
because this lowering of the blood
pressure can push us in the opposite
direction, resulting in hypotension.

Patient Teaching

● Tell patient to avoid

What Does It Treat?
● Through relaxing the blood vessels and
lowering the blood pressure, Fosinopril
treats both hypertension and heart
failure. High blood pressure increases
the workload of the heart and can
overtime, cause the heart and arteries to
not work properly. In addition,
hypertension increases the risk for heart
attacks to occur.
potassium-containing salt substitutes,
which may increase the risk of
hyperkalemia
● Instruct patient to contact prescriber if
light-headedness or fainting occurs
● Tell female patients of childbearing
● Some less common side effects
potential to notify the prescriber if
include:
pregnancy occurs. Drug therapy will
○ Runny nose
need to be stopped. ○ Loss of voice
○ Ear congestion
○ Body aches
 Routes of Administration
Phenytoin
Oral
Intravenous

Classification
Hydantoin
Mode of Action (Anticonvulsant)

● Phenytoin works by suppressing

abnormal firing, slowing the synaptic
transmission and inhibiting the neuron
from firing. By blocking the positive
feedback loop, phenytoin causes neural
propagation of high frequency action
potentials, preventing seizures.

Samuel McDonald
 What Does it Do?
● Phenytoin is the primary hydantoin that
is used, from a family of drugs known
as anticonvulsants. Phenytoin does not
prevent all types of seizures, but the
ones that it does, it does so by slowing
down impulses in the brain that cause
seizures to occur. In addition to this, it
also helps keep the neurons in the brain
from becoming too active, which also
helps to prevent seizures.
What Does It Treat?
● Phenytoin is used to control and
prevent seizures, more specifically
tonic-clonic seizures (also known as
grand mal seizures) and complex
partial seizures for people with
epilepsy.
Nursing Considerations Side Effects
● Don’t stop drug suddenly because this ● Some side effects that phenyotin can
may worsen seizures result in include
● Because of the risks of cardiac and ○ Gingival hyperplasia
local toxicity with parenteral ○ Nystagmus
○ Headache
phenytoin, use oral form when possible
○ Diplopia
● Watch for gingival hyperplasia,
○ Dizziness
especially in children ○ Slurred speech
● If a rash appears, you must stop the ○ DEC coordination
drug. If the rash is scarlatiniform or ○ Alopecia
morbilliform, resume drug after rash ○ Thrombocytopenia
appears. If a rash reappears, stop ○ Stevens-Johnson Syndrome
therapy. If rash is exfoliative, purpuric,
or bullous, don’t resume drug.
Patient Teaching
● Advise patient to avoid driving and
other potentially hazardous activities
that require mental alertness until
drug’s CNS effects are known
● Advise patient to avoid alcohol
● Stress importance of good oral hygeine ● Some more serious side effects may
and regular dental exams. Surgical include:
removal of excess gum tissue may be ○ Itchiness
needed periodically if dental hygiene is ○ Skin blistering
poor. ○ Panic attacks
● Advise patient that drug may cause an ○ Suicidal thoughts
○ Severe muscle pain
INC in blood glucose levels.
 Routes of Administration
Aminophylline
Oral
Intravenous

Classification
Bronchodilator (Xanthine derivative)
(Lower respiratory tract drug)

Mode of Action

● Theophylline is released from

aminophylline. Theophylline
competitively inhibits type III and
type IV phosphodiesterase, the
enzyme responsible for breaking
down cyclic AMP in smooth muscle
cells, possibly resulting in
bronchodilation.
Samuel McDonald

What Does it Do?
● Aminophylline is used in order to relax
the smooth muscles of the bronchial
airways as well as the pulmonary blood
vessels, resulting in bronchodilation
which allows for improved airway
patency and gas exchange.
What Does It Treat?
● Aminophylline is primarily used for the
maintenance treatment of asthma.
Although it may seem like it can be
used for many things, it can not be used
to treat bronchospasm or respiratory
distress. Can also be used to treat
symptoms of chronic bronchitis and
emphysema.
Nursing Considerations Side Effects
● Only administer to pregnant patients ● Some common side effects that can
when very clearly needed, such as with result from taking aminophylline
neonatal tachycardia, jitteriness, or include:
from withdrawal apnea as a result of ○ Upset stomach
xanthines up until delivery ○ Diarrhea
● Give immediate release, liquid dosage ○ Headache
forms with food if GI effects occur ○ Restlessness
● Monitor results of serum theophylline ○ Insomnia
levels carefully, and arrange for ○ Irritability
reduced dosage if serum levels exceed
the therapeutic range of 10-20 mcg/mL
Patient Teaching
● Teach patients, if on a timed-release
product, to follow the prescription
exactly, to take it on an empty stomach,
and take it 1 hour before meals or 2
hours after meals.
● Teach patients not to chew or crush
timed release medications. ● Some serious side effects that can occur
● Teach patients to avoid excessive include:
intake of coffee, tea, cocoa, cola ○ Vomiting
beverages, and chocolate because they ○ Rapid Heart rate
can INC the theophylline CNS ○ Irregular heartbeat
stimulation effect. ○ Seizures
○ Rash
 Routes of Administration
Heparin
Intravenous
Subcutaneous

Classification
Mode of Action
Anticoagulant

● Heparin accelerates formation of

antithrombin III-thrombin complex and
deactivates thrombin, thus preventing
the conversion of fibrinogen to fibrin,
thus preventing blood clotting. The
inactivation of thrombin leads to a
cascade that ends with the inability for
blood clotting.

Samuel McDonald
 What Does it Do? Nursing Considerations Side Effects

● Heparin is an anticoagulant, meaning
that in some way, it prevents the
coagulation, or clotting of blood. Some
call it a blood thinner, but it in fact does
not thin the blood. In the process of all
this, Heparin also reduces the rate of
the rise of systolic blood pressure.
● Elderly patients should be started on a
lower dose than others
● Monitor your patients for hyperkalemia
during therapy
● Avoid Intramuscular injections of other
drugs to prevent or minimize
hematoma
● Abrupt withdrawal may cause INC
coagulability; warfarin therapy usually
overlaps heparin therapy for
continuation of prophylaxis or
treatment
● Some side effects that can occur with
heparin therapy include:
○ Bruising more easily
○ Bleeding
○ Bleeding that takes longer to
stop
○ redness/irritation at injection
site
○ INC liver enzymes on liver
function test
○ Thrombocytopenia
○ Prolonged clotting time

Patient Teaching

● Advise patient to watch for and

What Does It Treat?
● Heparin has multiple uses. It is used to
prevent and treat certain blood vessel,
heart, and lung conditions. Heparin is
used to produce a rapid
anticoagulation effect for
thromboembolism treatment, and even
prophylaxis.
immediately report any signs of
bleeding such as abdominal pain or
red/black vomit or stool
● Advise patients to talk to prescriber
before starting any type of herbal
therapy because many herbs have
anticoagulant, antiplatelet, or ● Some more serious side effects include
fibrinolytic properties. ○ Severe bleeding
● Tel patients to avoid over the counter ○ Coughing up blood
drugs containing aspirin or other ○ Dark, tarry stool
○ Dizziness
salicylates as they may interact with
heparin ○ Pink or brown urine