Key Takeaways
- Check apical pulse for 1 minute before digoxin; hold if HR < 60 in adults
- Warfarin is monitored by PT/INR; heparin is monitored by aPTT
- Rinse mouth after using inhaled corticosteroids to prevent thrush
- Assess respiratory rate before opioids; hold if RR < 12
- Insulin: clear before cloudy when mixing; never mix long-acting insulins
Last updated: January 2026
Common Drug Classifications
Understanding drug classifications, their mechanisms, and nursing implications is essential for safe medication administration. This section covers major drug classes commonly encountered in LPN/VN practice.
Cardiovascular Medications
Antihypertensives
| Class | Examples | Mechanism | Key Nursing Points |
|---|---|---|---|
| ACE Inhibitors (-pril) | Lisinopril, enalapril | Block angiotensin II formation | Monitor for dry cough, hyperkalemia, first-dose hypotension |
| ARBs (-sartan) | Losartan, valsartan | Block angiotensin receptors | Similar to ACE inhibitors but less cough |
| Beta Blockers (-olol) | Metoprolol, atenolol | Decrease HR and contractility | Monitor HR (hold if <60), assess for fatigue, mask hypoglycemia |
| Calcium Channel Blockers (-dipine) | Amlodipine, diltiazem | Vasodilation, decrease contractility | Monitor BP, assess for edema, constipation |
| Diuretics | HCTZ, furosemide | Increase urine output | Monitor electrolytes (K+), I&O, weight |
Cardiac Glycosides
Digoxin:
- Increases cardiac contractility (positive inotrope)
- Decreases heart rate (negative chronotrope)
- Therapeutic range: 0.5-2.0 ng/mL
- Hold if: HR < 60 (adult), < 90-100 (infant)
- Toxicity signs: Anorexia, nausea, visual disturbances (halos), bradycardia, arrhythmias
- Monitor potassium (hypokalemia increases toxicity risk)
Anticoagulants
| Drug | Monitoring | Antidote |
|---|---|---|
| Heparin | aPTT (1.5-2.5× normal) | Protamine sulfate |
| Enoxaparin (Lovenox) | Anti-Xa levels (if monitored) | Protamine sulfate (partial) |
| Warfarin (Coumadin) | PT/INR (2.0-3.0 for most) | Vitamin K, fresh frozen plasma |
Respiratory Medications
| Class | Examples | Purpose | Nursing Points |
|---|---|---|---|
| Short-acting bronchodilators (SABA) | Albuterol | Acute bronchospasm relief | Rapid onset (rescue inhaler), may cause tachycardia |
| Long-acting bronchodilators (LABA) | Salmeterol | Maintenance therapy | Not for acute attacks, use with ICS for asthma |
| Inhaled corticosteroids (ICS) | Fluticasone, budesonide | Reduce inflammation | Rinse mouth after use, prevents thrush |
| Anticholinergics | Ipratropium, tiotropium | Bronchodilation | Dry mouth common, avoid in glaucoma |
Gastrointestinal Medications
| Class | Examples | Purpose | Nursing Points |
|---|---|---|---|
| Proton Pump Inhibitors (PPIs) | Omeprazole, pantoprazole | Reduce acid secretion | Take 30-60 min before meals, long-term use risks |
| H2 Blockers | Famotidine, ranitidine* | Reduce acid | Less potent than PPIs |
| Antacids | Calcium carbonate, aluminum hydroxide | Neutralize acid | Take 1-3 hours after meals, drug interactions |
| Antiemetics | Ondansetron, promethazine | Prevent/treat nausea | May cause drowsiness, ondansetron: check QT |
| Laxatives | Senna, docusate, bisacodyl | Promote bowel movements | Adequate fluids, don't use long-term |
*Note: Ranitidine recalled; famotidine is alternative
Endocrine Medications
Insulins
| Type | Onset | Peak | Duration | Example |
|---|---|---|---|---|
| Rapid-acting | 10-30 min | 30 min-3 hr | 3-5 hr | Lispro (Humalog), Aspart (NovoLog) |
| Short-acting | 30-60 min | 2-4 hr | 5-8 hr | Regular (Humulin R) |
| Intermediate | 1-2 hr | 4-12 hr | 12-18 hr | NPH (Humulin N) |
| Long-acting | 1-2 hr | Minimal/none | 24+ hr | Glargine (Lantus), Detemir (Levemir) |
Insulin Administration:
- Always verify dose with another nurse
- Rotate injection sites within same region
- Clear insulins before cloudy when mixing
- Do NOT mix long-acting with other insulins
- Store open vials at room temp (28 days); unopened in refrigerator
Oral Antidiabetic Agents
| Class | Example | Mechanism | Key Points |
|---|---|---|---|
| Biguanides | Metformin | Decreases glucose production | Hold before contrast dye, no alcohol |
| Sulfonylureas | Glipizide, glyburide | Stimulate insulin release | Risk of hypoglycemia, take with meals |
| DPP-4 Inhibitors | Sitagliptin | Increase incretin levels | Low hypoglycemia risk |
Pain Medications
Opioid Analgesics
| Drug | Equianalgesic Dose | Key Points |
|---|---|---|
| Morphine | 10 mg IV/30 mg PO | Standard for comparison |
| Hydromorphone (Dilaudid) | 1.5 mg IV/7.5 mg PO | 4-5× more potent than morphine |
| Fentanyl | 100 mcg IV | Very potent, rapid onset |
| Oxycodone | 20 mg PO | Oral only, often combined with APAP |
Nursing Considerations:
- Assess respiratory rate before administration (hold if RR <12)
- Monitor sedation level
- Constipation is expected; implement bowel regimen
- Assess pain before and after administration
- Know location of naloxone (Narcan) for reversal
Non-Opioid Analgesics
| Drug | Maximum Daily Dose | Key Points |
|---|---|---|
| Acetaminophen | 3-4 g/day (less with liver disease) | Hepatotoxic in overdose |
| Ibuprofen (NSAID) | 3.2 g/day | GI bleeding risk, renal effects |
| Ketorolac (NSAID) | 5 days max | Very effective, significant GI/renal risks |
Neurological Medications
| Class | Examples | Purpose | Nursing Points |
|---|---|---|---|
| Benzodiazepines | Lorazepam, diazepam | Anxiety, seizures, sedation | Respiratory depression, fall risk, flumazenil reverses |
| Antiepileptics | Phenytoin, valproic acid, levetiracetam | Seizure prevention | Monitor levels (phenytoin: 10-20 mcg/mL), CBC |
| SSRIs | Sertraline, fluoxetine | Depression, anxiety | 2-4 weeks for effect, serotonin syndrome risk |
Test Your Knowledge
Before administering digoxin, what assessment should the LPN/VN perform?
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D
Test Your Knowledge
A patient is taking warfarin. Which laboratory value should the LPN/VN monitor?
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B
C
D
Test Your Knowledge
Which insulin has the longest duration of action?
A
B
C
D