A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply.
1. Chlordiazepoxide (Librium).
2
An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety.
1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriate
A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective?
1. The client verbalizes that the clonazepam (Klonopin) is to be used for long-te
3. Clonazepam would be used for shortterm treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks.
TEST-TAKING HINT: To answer this question correctly, the test taker must note appropriate teaching needs for clients pres
In which situation would benzodiazepines be prescribed appropriately?
1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and
alcohol withdrawal.
2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and pr
2. Benzodiazepines are prescribed for shortterm treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative
sedation.
TEST-TAKING HINT: The test taker needs to note the words "long-term" and "short-term" in
A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important?
1. Monitor for signs and
2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms
include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile b
Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply.
1. Insomnia.
2. Tremor.
3. Delirium.
4. Dry mouth.
5. Lethargy.
Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increase
From a cognitive theory perspective, which is a possible cause of panic disorder?
1. Inability of the ego to intervene when conflict occurs.
2. Abnormal elevations of blood lactate and increased lactate sensitivity.
3. Increased involvement of the neuroch
4. Distorted thinking patterns that precede
maladaptive behaviors relate to the cognitive
theory perspective of panic disorder
development.
TEST-TAKING HINT: The test taker should note important words in the question, such as "cognitive." Although all of
An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the ___________________ theory of generalized anxiety disorder development.
An overuse or ineffective use of ego defense mechanisms, which results in a maladaptiveresponse to anxiety, is an example of thepsychodynamic theory of generalized anxiety disorder development.
TEST-TAKING HINT: To answer this question correctly, the test
A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective?
1. "I understand that the event I experienced, ho
1. When the client verbalizes understanding
of how the experienced event, individual
traits, and available support systems affect
his or her diagnosis, the client demonstrates
a good understanding of the psychosocial
cause of posttraumatic stress disorder
Counselors have been sent to a location that has experienced a natural disaster to assist the population to deal with the devastation. This is an example of __________________ prevention.
4. Sending counselors to a natural disaster site to assist individuals to deal with the devastation is an example of primary prevention. Primary prevention reduces the incidence of mental disorders, such as posttraumatic stress disorder, within the popula
Which of the following statements explains the etiology of obsessive-compulsive disorder (OCD) from a biological theory perspective?
1. Individuals diagnosed with OCD have weak and underdeveloped egos.
2. Obsessive and compulsive behaviors are a condition
4. The belief that abnormalities in various
regions of the brain cause OCD is an
explanation of OCD etiology from a biological theory perspective.
TEST-TAKING HINT: To answer this question correctly, the test taker must understand the different theories o
After being diagnosed with pyrophobia, the client states, "I believe this started at the age of 7 when I was trapped in a house fire." When examining theories of phobia etiology, this situation would be reflective of ____________ theory.
When examining theories of phobia etiology,
this situation would be reflective of learning
theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of pho
A client diagnosed with social phobia has an outcome that states, "Client will voluntarily participate in group activities with peers by day 3." Which would be an appropriate intrapersonal intervention by the nurse to assist the client to achieve this out
3. Encouraging discussion about fears is an
intrapersonal intervention.
TEST-TAKING HINT: It is important to understand that interventions are based on theories of causation. In this question, the test taker needs to know that intrapersonal theory relates
Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder?
1. Encourage the client to evaluate the power of distorted thinking.
2. Ask the client to include his or her family in scheduled therapy sessio
3. The nurse discussing the overuse of ego
defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder.
TEST-TAKING HINT: When answering this question, the test taker must be able to differentiate am
Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessivecompulsive disorder?
1. Ineffective coping R /T punitive superego.
2. Ineffective coping R /T active avoidance.
3. Ineffective coping R /T alteration in serotonin.
4. In
1. Ineffective coping R /T punitive superego
reflects an intrapersonal theory of the etiology of obsessive-compulsive disorder
(OCD). The punitive superego is a concept contained in Freud's psychosocial theory of personality development.
TEST-TAKING HINT:
The nurse is using an intrapersonal approach to assist a client in dealing with survivor's guilt. Which intervention would be appropriate?
1. Encourage the client to attend a survivor's group.
2. Encourage expression of feelings during one-to-one interact
2. Encouraging expressions of feelings
during one-to-one interactions with the nurse is an intrapersonal approach to interventions that treat survivor's guilt associated with PTSD.
TEST-TAKING HINT: To answer this question correctly, the test taker needs
A client diagnosed with posttraumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing?
1. Denial.
2. Social isolation.
3. Anger.
4. Survivor's guilt.
4. The client in the question is experiencing
survivor's guilt. Survivor's guilt is a common
situation that occurs when an individual
experiences a traumatic event in which
others died and the individual survived.
TEST-TAKING HINT: To answer this question
Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism?
1. Suppression.
2. Repression.
3. Undoing.
4. Denial.
3. Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to
negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would u
Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply.
1. Dissociative events.
2. Intense fear and helplessness.
3. Excessive attachment and dependence toward others.
4. Ful
1. A client diagnosed with posttraumatic
stress disorder (PTSD) may have dissociative events in which the client feels
detached from the situation or feelings.
2. A client diagnosed with PTSD may have
intense fear and feelings of helplessness.
5. A client
When treating individuals with posttraumatic stress disorder, which variables are included in the recovery environment?
1. Degree of ego strength.
2. Availability of social supports.
3. Severity and duration of the stressor.
4. Amount of control over reoc
2. Availability of social supports is part of
environmental variables. Others include
cohesiveness and protectiveness of family
and friends, attitudes of society regarding
the experience, and cultural and subcultural
influences.
TEST-TAKING HINT: To answe
A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess?
1. Recurrent, distressing flashbacks.
2. Intense fear, helplessness, and horror.
3. Diminished participation in significant
3. Diminished participation in significant
activities is a behavioral symptom of
PTSD.
TEST-TAKING HINT: To answer this question correctly, the test taker should take note of the keyword "behavioral," which determines the correct answer. All symptoms may
Which of the following assessment data would support the disorder of acrophobia?
1. A client is fearful of basements because of encountering spiders.
2. A client refuses to go to Europe because of fear of flying.
3. A client is unable to commit to marriag
2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be
unable to fly because of this fear.
TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the definitions of specific commonly diagnosed phobi
In which situation would the nurse suspect a medical diagnosis of social phobia?
1. A client abuses marijuana daily and avoids social situations because of fear of
humiliation.
2. An 8-year-old child isolates from adults because of fear of embarrassment,
4. A student who avoids classes because of
the fear of being scrutinized by others
meets the criteria for a diagnosis of social
phobia.
TEST-TAKING HINT: The test taker must understand the DSM-IV-TR diagnostic criteria for social phobia to answer this que
A client experiencing a panic attack would display which physical symptom?
1. Fear of dying.
2. Sweating and palpitations.
3. Depersonalization.
4. Restlessness and pacing.
2. Sweating and palpitations are physical
symptoms of a panic attack.
TEST-TAKING HINT: The test taker must note important words in the question, such as "physical symptoms." Although all the answers are actual symptoms a client experiences during a panic
A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which behavioral symptom would the nurse expect to assess?
1. The client uses excessive hand washing to relieve anxiety.
2. The client rates anxiety
1. Using excessive hand washing to relieve
anxiety is a behavioral symptom exhibited
by clients diagnosed with obsessivecompulsive disorder (OCD).
TEST-TAKING HINT: To answer this question correctly, the test taker must be able to differentiate various cl
A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed informati
3. Physical problems should be ruled out
before determining a psychological cause
for this client's symptoms.
TEST-TAKING HINT: The test taker needs to remember that although a client may have a history of a psychiatric illness, a complete, thorough evalu
Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply.
1. Chronic obstructive pulmonary disease.
2. Hyperthyroidism.
3. Hypertension.
4. Diverticulosis.
5. Hypoglycemia.
1. Chronic obstructive pulmonary disease
causes shortness of breath. Air deprivation
causes anxiety, sometimes to the point of
panic.
2. Hyperthyroidism (Graves's disease)
involves excess stimulation of the sympathetic nervous system and excessive levels
Which assessment data would support a physician's diagnosis of an anxiety disorder in a client?
1. A client experiences severe levels of anxiety in one area of functioning.
2. A client experiences an increased level of anxiety in one area of functioning f
3. For a client to be diagnosed with an anxiety disorder, the client must experience
symptoms that interfere in a minimum of
two areas, such as social, occupational, or
other important functioning. These symptoms must be experienced for durations of 6 mon
Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply.
1. Excessive worry about items difficult to control.
2. Muscle tension.
3. Hypersomnia.
4. Excessive amounts of energy.
5. Feel
1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control.
2. A client diagnosed with GAD would experience muscle tension.
5. A client diagnosed with GAD would
experience an increased s
A client diagnosed with obsessive-compulsive disorder is newly admitted to an inpatient psychiatric unit. Which cognitive symptom would the nurse expect to assess?
1. Compulsive behaviors that occupy more than 4 hours per day.
2. Excessive worrying about
2. Excessive worrying about germs and illness is a cognitive symptom experienced
by clients diagnosed with OCD.
TEST-TAKING HINT: To answer this question correctly, the test taker must note the keyword "cognitive." Only "2" is a cognitive symptom.
A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority?
1. Posttrauma syndrome R /T a distressing event AEB
4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flashbacks, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioriti
A client leaving home for the first time in a year arrives on the psychiatric in-patient unit wearing a surgical mask and white gloves and crying, "The germs in here are going to kill me." Which nursing diagnosis addresses this client's problem?
1. Social
1. According to the North American Nursing Diagnosis Association (NANDA), the nursing diagnosis format must
contain three essential components:
(1) identification of the health problem, (2) presentation of the etiology (or cause) of the problem, and (3) d
A client seen in an out-patient clinic for ongoing management of panic attacks states, "I have to make myself come to these appointments. It is hard because I don't know when an attack will occur." Which nursing diagnosis takes priority?
1. Ineffective br
3. Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses anticipatory fear of unexpected attacks, which
affects the client's ability to interact with others.
TEST-TAKING HINT: To answer thi
A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which correctly stated nursing diagnosis takes priority?
1. Anxiety R /T obsessive thoughts AEB ritualistic behaviors.
2. Powerlessness R /T ritualis
1. Anxiety is the underlying cause of the diagnosis of obsessive compulsive disorder (OCD), therefore, anxiety R/T obsessive thoughts is the priority nursing diagnosis
for the client newly admitted for the treatment of this disorder.
TEST-TAKING HINT: Whe
During an assessment, a client diagnosed with generalized anxiety disorder rates anxiety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority?
1
4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client
problems.
TEST-TAKING HINT: When looking for a priority nursing diagnosis, th
A hospitalized client diagnosed with posttraumatic stress disorder has a nursing diagnosis of ineffective coping R /T history of rape AEB abusing alcohol. Which is the expected short-term outcome for this client problem?
1. The client will recognize trigg
1. It is a realistic expectation for a client who copes with previous trauma by abusing alcohol to recognize the triggers that precipitate this behavior. This outcome
should be developed mutually early in treatment.
TEST-TAKING HINT: It is important to re
Which client would the charge nurse assign to an agency nurse who is new to a psychiatric setting?
1. A client diagnosed with posttraumatic stress disorder currently experiencing flashbacks.
2. A newly admitted client diagnosed with generalized anxiety di
3. A client admitted 4 days ago with a diagnosis
of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a nurse unfamiliar with psychiatric clients.
TES
A newly admitted client diagnosed with social phobia has a nursing diagnosis of social isolation R/T fear of ridicule. Which outcome is appropriate for this client?
1. The client will participate in two group activities by day 4.
2. The client will use re
1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable
outcome that includes a timeframe.
TEST-TAKING HINT: To express an appropriate out
When a client experiences a panic attack, which outcome takes priority?
1. The client will remain safe throughout the duration of the panic attack.
2. The client will verbalize an anxiety level less than 2/10.
3. The client will use learned coping mechani
1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client.
TEST-TAKING HINT: All outcomes must be appropriate
for the situation described in the question. In the question, the client is experiencing a panic attac
The nurse has received evening report. Which client would the nurse need to assess first?
1. A newly admitted client with a history of panic attacks.
2. A client who slept 2 to 3 hours last night because of flashbacks.
3. A client pacing the halls and sta
3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others.
TEST-TAKING HINT: When the nurse is priorit
A client was admitted to an in-patient psychiatric unit 4 days ago for the treatment of obsessive-compulsive disorder. Which outcome takes priority for this client at this time?
1. The client will use a thought-stopping technique to eliminate obsessive/co
4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current
priority outcome.
TEST-TAKING HINT: The test taker must recognize
the importance of time-wise
A client diagnosed with generalized anxiety disorder has a nursing diagnosis of panic anxiety R/T altered perceptions. Which of the following short-term outcomes is most appropriate for this client?
1. The client will be able to intervene before reaching
1. The client's being able to intervene before reaching panic levels of anxiety by discharge is measurable, relates to the stated nursing diagnosis, has a timeframe, and is an appropriate short-term outcome for this client.
TEST-TAKING HINT: When evaluati
A 10-year-old client diagnosed with nightmare disorder is admitted to an in-patient psychiatric unit. Which of the following interventions would be appropriate for this client's problem? Select all that apply.
1. Involving the family in therapy to decreas
1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate
A client on an in-patient psychiatric unit is experiencing a flashback. Which intervention takes priority?
1. Maintain and reassure the client of his or her safety and security.
2. Encourage the client to express feelings.
3. Decrease extraneous external
1. During a flashback, the client is experiencing
severe-to-panic levels of anxiety; the priority nursing intervention is to maintain and reassure the client of his or
her safety and security. The client's anxiety needs to decrease before other interventi
A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement?
1. Elopement precautions.
2. Suicide precautions.
3. Homicide precautions.
4
2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions.
TEST-TAKING HINT: To answer this question correctly,
the test taker should note the words "hopelessness" and "helplessness," which would be
A client diagnosed with obsessive-compulsive disorder has been hospitalized for the last 4 days. Which intervention would be a priority at this time?
1. Notify the client of the expected limitations on compulsive behaviors.
2. Reinforce the use of learned
2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques
should begin by day 4.
TEST-TAKING HINT: To answer this question correctly, the test
The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessivecompulsive disorder? Select all that apply.
1. Assess previously used coping mechanisms and
1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the
nursing process, and this information needs to be gathered to intervene effectively.
2. Al
A client diagnosed with generalized anxiety disorder complains of feeling out of control and states, "I just can't do this anymore." Which nursing action takes priority at this time?
1. Ask the client, "Are you thinking about harming yourself?"
2. Remove
1. The nurse should recognize the statement, "I can't do this anymore," as evidence of hopelessness and assess further the potential for suicidal ideations.
TEST-TAKING HINT: To answer this question correctly, the test taker should apply the nursing proce
During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority?
1. Teach the client relaxation techniques.
2.
2. It is important for the nurse to ask the client about a potential plan for suicide to intervene in a timely manner. Clients who have developed suicide plans are at higher
risk than clients who may have vague suicidal thoughts.
TEST-TAKING HINT: To answ
A client diagnosed with posttraumatic stress disorder has a nursing diagnosis of disturbed sleep patterns R /T nightmares. Which evaluation would indicate that the stated nursing diagnosis was resolved?
1. The client expresses feelings about the nightmare
3. The client's feeling rested on awakening and denying nightmares are the evaluation data needed to support the fact that the nursing diagnosis of disturbed sleep patterns
R/T nightmares has been resolved.
TEST-TAKING HINT: To answer this question correc
The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which action by the client would indicate that the teaching was successful?
1. The client eliminates anxiety by using the breathing technique.
2. The c
4. A client's ability to maintain an anxiety level of 3/10 without medications indicates that the client is using breathing techniques successfully to reduce
anxiety.
TEST-TAKING HINT: To answer this question correctly, the test taker should understand th
The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which statement by the client would indicate that the intervention has been successful?
1. "I reminded myself that the panic attack would end soon, and it help
1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention.
TEST-TAKING HINT: To answer this
Which of the following medications can be used to treat clients with anxiety disorders? Select all that apply.
1. Clonidine hydrochloride (Catapres).
2. Fluvoxamine maleate (Luvox).
3. Buspirone (BuSpar).
4. Alprazolam (Xanax).
5. Haloperidol (Haldol).
1. Clonidine hydrochloride (Catapres) is used in the treatment of panic disorders and generalized anxiety disorder.
2. Fluvoxamine maleate (Luvox) is used in the treatment of obsessive-compulsive disorder.
3. Buspirone (BuSpar) is used in the treatment of
A client is prescribed alprazolam (Xanax) 2 mg bid and 1.5 mg q6h PRN for agitation. The maximum daily dose of alprazolam is 10 mg/d. The client can receive _____ PRN doses of alprazolam within a 24-hour period.
The client can receive 4 PRN doses.
Medications are given four times in a 24-hour period when the order reads q6h: 1.5 mg x 4 = 6 mg. The test taker must factor in 2 mg bid = 4 mg. These two dosages together add up to 10 mg, the maximum daily dose of alpr
Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid?
1. Encourage the client to avoid drinking alcohol while taking this medication because
of the additive central nervous system depressant effects.
2. Encourage
2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working.
TEST
A client diagnosed with generalized anxiety disorder is prescribed paroxetine (Paxil) 30 mg QHS. Paroxetine is supplied as a 20-mg tablet. The nurse would administer ______tablets.
1.5 tablets
A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maximum daily dose of lorazepam should not exceed 4 mg QD. This client would be able to receive ______ PRN doses as the maximum number of PRN lorazepam doses.
This client should receive 2 PRN doses.
The test taker must recognize that medications are given
three times in a 24-hour period when the order reads q8h: 1 mg x 3 = 3 mg. The test taker must factor in the 0.5 mg qid = 2 mg. These two dosages together add
Bronchodilator
SYMPATHOMIMETIC: dilate the airways of the respiratory tree
METHYLXANTHINES: stimulates the CNS and respiration; dilates coronary and pulmonary vessels; causes diuresis
*A quick relief medication
Bronchodilators are used to treat what
rhinitis, sinusitis, acute bronchospam, acute and chronic asthma, bronchitis, chronic obstructive pulmonary disease(COPD), emphysema
When should bronchodilators be used with caution
HTN, diabetes mellitus, narrow-angle glaucoma
Bronchodilators are contraindicated in individuals with
hypersensitivity, peptic ulcer disease, severe cardiac disease, dysrhythmias, hyperthyroidism, uncontrolled seizure diorder
Theophylline
*increase the risk of digoxin(linoxin: heart med)toxicity and reduces the effect of lithium(psych med) and phenytoin(dilantin: seizure med)
*dysrhythmias may occur if used with B2-adrenergic
*B-blockers cimetidine(tagamet) and erythromycine increase it's
Side effects of bronchodilators are
palpitations and tachycardia, dysrhythmias, restlessness, anorexia, nausea and vomiting, headaches and dizziness, hyperglycemia, decreased clotting time, mouth dryness and throat irritation with inhalers
What should one avoid while using a bronchodilators
caffeinated products
One way to identify a Sympathomimetic bronchodilator is
B2-Adrenergics mainly end with ol. i.e albuterol or salmeterol(COPD)
*the only one that is differented is brethine(also good for pre-term labor)
aAdrenergics mainly end with ium and are only inhaled
Methylxanthine bronchodilator only has kind of medication called a
theophylline(theolair-SR, theo-24, uniphyl)
An inhaler is only empty if it can
float on top of water
What is an inhaled nonsteroidal antiallergy agent(mast-cell stabilizers)
*treat allergic rhinitis, bronchial asthma, exercise induced bronchospasm
caution to be used for renal function problems
Side affects of nonsteroidal antiallergic agent(mast-cell stabilizer)
cough or bronchospasm, nasal sting or sneezing, nasty tatse in mouth
nonsteroidal antiallergic agent(mast-cell stabilizer) med are
Cromolyn Na+ (Intal) and Nedrocromil(Tilade) Both are inhaled
nonsteroidal antiallergic agent important interventions are
DO NOT discontinue medication abruptly because it will a rebound asthmatic attack
What are Leukotriene modifiers
*used in prophylaxis and tx of chronic bronchial asthma.
*NOT used for ACUTE episodes
*contraindicated with breastfeeding moms
*caution to be used in renal function problems
Side affects of Leukotriene modifiers are
Headaches, nausea and vomiting, dyspepsia, diarrhea, generalized pain and myalgia(muscle pain), fever, dizziness
Leukotrienes modifiers important interventions are
*take meds 1 hours before or 2 hours after meals
*increase fluid intake
*NEVER discontinue even in symptom-free periods
Leukotriene Modifier medication usually end with
ast(i.e Montelukast, oral (Singulair), Zafirlukast, oral (Accolate)
Zileuton, oral(Zyflo) ~ Is an leukotriene inhibitor and another medication
Antihistamines
called histamine antagonists or H1 blockers; they compete for receptor sites, thus preventing a histamine response
What are Antihistamines used for
common cold, rhinitis, nausea and vomiting, motion sickness, urticaria, sleep aid
Name 2 prescribed antihistamine
Acrivastne/pseudoephedrine(Semprex-D), Azelastine hydrochloride(Astelin), Brompheniramine(Brovex)
Name some over-the-counter(OTC) antihistamines
Cetirizine hydrchloride(Zyrtec), Chlopheniramine maleate(Aller-Chlor, Chlor-Trimeton), Chlorpheniramine/pseudoephrdrine(allerest Maximum Strength), Clemastine Fumerate(Tavist), Desoratidine(Clarinex), Dimenhydrinate(Dramamine), Diphenhydramine(benadryl),
Caution should be used when using antihistamine in
HTN, Diabetics and Do Not use it in COPD pts
Major side affects of antihistamines are
Urinary retention, wheezing(hence not good for COPD pts), constipation, GI irritation, Hypotension, Hearing issues, Nightmares
Nasal Decongestants
Shrink mucosal membranes and reduces fluid secretion, should not be used for more than 48 hours
Nasal decongestants should be used with EXTREME caution in patients with
HTN, Cardiac disease, hyperthyroidism, and diabetes
What are Glucocorticoids
act as anti-inflammatory agents and reduce edema of the airways
Glucocorticoid medications usually end with
one(i.e: prednisone, prednisolone=these are the only ORAL as well)
What are expectorants
used to loosen bronchial secretions so that they can be eliminated with coughing
What is a mucolytic agent
thins mucous secretions for a more productive cough.
NOTE
If it has dextromethorohen it NOT good for pts with COPD; it suppresses coughs
Some nasal decongestants that can be purchased OTC are
Sudafed(ID needed), Afrin, Neo-Synephrine(good for babies)
Some Nasal meds that are prescribed are
Beconase AQ, Rhinocort Aqua, Nasarel, Flonase, Nasonex, Nasacort(ALL OF THESE ARE TOP DRUGS ON NCLEX!!!)
Side effects of Expectorants and Mucolytics are
GI and Oropharyngeal issues, rashes
What are antitussives
acts on the cough reflex in the medulla to suppress the cough
Some common side effects of antitussives are
dry mouth, constipation, respiratory depression
What are some important interventions for antitussives
*avoid administering to pts with cranial injuries or cranial surgeries
*avoid administering to pts that are taking opiods, sedatives, barbiturates or antidepressant because it can cause CNS depression
Some expectorant meds are
Pulmozyme, humibid, robitussin
A mucolytic med is
mucomyst
Antitussive meds can be
both opioid(i.e: codienes and hydrocodone) or non-opiods(i.e: Benadryl)
Opiod antagonists
reverses respiratory depression in an opioid overdose
Tuberculosis
is treated with a combination of meds which the organism is susceptible.
First-line medications
provide the most effective anti-TB activity
Second-line medications
are used in combination with first-line medications but are more toxic
Isoniazid(INH, Nydrazid)
is bactericidal and is contraindicated in people with liver disease and hypersensitive; cautioned in people with liver disease, alcoholism, or renal impairment or using niacin/nicobid
First and Second line meds
usually end with -in(i.e: Streptomycin)
Side effects of TB
Neurotoxicity, Hepatotoxicity, peripheral neuritis, Vitamin B deficiency, hyperglycemia, hepatitis
TB interventions
assess hepatic dysfunction, dizziness; monitor cbc, blood glucose and liver function tests, numbness and tingling of extremities, visual changes(call PCP),
signs of hepatitis(anorexia, nausea, weakness, dark urine, jaundice) stop meds and call PCP
Major medications
that are used are Rifampin, Ethambutol, Pyrazinamide(PZA), Rifabutin
Interventions for the major TB meds
are to monitor the cbc, blood glucose, liver and uric acid blood tests; hepatotoxic effects; visual changes; no need to eat before taking
The medication that needs to be taken with food
is PZA(Pyrazinamide)
Streptomycin
will cause
*Nephrotoxicity(Kidney)
*Octotoxicity(hearing)
*Thrombotoxicity(Bleeding)
Vaccines
are recommended annually to avoid the flu.
Vaccine side affects
are localized pain and swelling in injection site; body aches and pain or fever; some may even cause flu-like symptoms
Antiviral medications
are used during a flu outbreak
Flu vaccines
inactivated(not live): usually begin with flu(i.e: fluarix)
live(live): Flumist
Antiviral medications
Symmetrel, Tamiflu, Flumadine, Relenza
*Symmetrel usually for parkinson's
*Tamiflu causes insomnia
What is the CNS?
composed of the brain and spinal cord it is the "processing center
What does the PNS do?
receives stimuli from the CNS and and initiates response
What two divisions make up the PNS?
automatic and somatic
The automatic system controls?
visceral system acts on smooth muscle and glands (involuntary).
Heart, respiration, GI, bladder, eyes, & glands
The somatic system controls?
acts on skeletal muscle (voluntary)
What are the two sets of neurons in the Automatic System?
afferent (sensory) and efferent (motor)
The efferent pathway of the autonomic nervous system is divided into what two branches?
sympathetic and parasympathetic
What is another name for the sympathetic system and what is the main neurotransmitter?
adrenergic system
neurtransmitter: norepinephrine
The sympathetic system is associated with what two responses?
fight or flight (dry hot and revved up)
Can'ts (see, pee, poop, spit)
What is the neurotransmitter that controls the parasympathetic system and what is the normal response?
acetylcholine
response: sludge
What is another name for the parasympathetic system?
cholinergic system
Name the specific sympathetic responses
dilates pupils and bronchioles, increases HR, constricts blood vessels, relaxes (GI, bladder and uterine)
Name the specific responses for the parasympathetic system
constrict pupils (miosis) causing increased aqueous humor outflow, constricts bronchioles and bladder, decrease HR causing decreased BP, dilate blood vessels, and increases peristalsis and saliva
Drugs that stimulate the sympathetic system are known as
sympathomimetics (adrenergics, adrenomimetics, or adrenergic agonist)
Drugs that stimulate the parasympathetic system are known as
parasympathomimetics (cholinergics or cholinergic agonist)
Drugs that block the sympathetic system are known as
sympatholytics (adrenergic blockers, adrenolytics, or adrenergic antagonist)
Drugs that block the parasympathetic system are known as
parasympatholytics (anticholinergics, cholinergic antagonist, and antispasmodics)
Sympathomimetics causes a similar response to what group of drugs?
parasympatholytics
Parasympathomimetics causes a similar response to what group of drugs?
sympatholytics
Alpha 1 receptor controls
vasoconstriction that leads to elevated BP, elevated HR, pupil dilation (mydriasis), decrease saliva and urine output
Alpha 2 receptor controls
stops norepinephrine which causes vasodilation leading to decreased BP, HR, and GI motitlity
Beta 1 receptor controls
increases HR and contraction, increased renin secreation causing increase in BP
Beta 2 receptor controls
causes bronchiodilation, promotes blood flow to skeletal muscles, and causes liver to change glucagon into glucose (muscles will recieve more O2 and glucose, needed during fight or flight)
What are the 3 ways to inactivate the neurotransmitters?
1. reuptake of the transmitter back into the nerve cell terminal
2. enzymatic transformation or degradation
3. diffusion away from the receptor
Sympathomimetic drugs are classified which 3 ways?
1. direct acting - directly stimulates the receptor (norepinephrine, epinephrine)
2. indirect acting - stimulates the release of norepinephrine (amphetamine)
3. mixed - stimulates the receptor site and increases norepinephrine (ephedrine)
Is epinephrine (adrenaline) selective or non-selective?
non-selective - acts on multiple receptors equally (Alpha 1 and Beta 1&2)
What does epinephrine do to the body?
it is inotropic so it increases HR
it is a vasoconstrictor so it increases BP
and causes bronchoDILATION
What are uses for epinephrine?
anaphylaxis, bronchospasms, cardiogenic shock and arrest
How can epinephrine be administered?
SC (epi-pen), IV, topically, inhaled, intracardiac (Pulp Fiction), and instillation
NO ORAL ROUTE
What are the contraindications of epinephrine?
Do not give to patients with cardiac dysrhythmias
What are side effects of epinephrine?
tachycardia, HTN, cardiac dysrhythmias, pallor, palpitations, dizziness, decreased renal and urinary output
Use epinephrine cautiously with patients who have?
HTN, hyperthyroidism, diabetes and pregnancy
Albuterol works on which receptor site?
Beta 2, it primarily relaxes bronchiole muscles and causes dilation
Albuterol treats what problems?
bronchospasm, asthma, bronchitis, and COPD
Use albuterol cautiously with patients who have?
sever cardiac disease, HTN, hyperthyroidism, diabetes (can become hyperglycemia), and pregnancy
What do Alpha 1 BLOCKERS cause?
vasodilation which decreases BP (If BP drops too low, tachycardia can occur).
relax bladder and prostate
What are Alpha 1 blockers commonly used to treat?
Peripheral Vascular Disease (PVD) and Enlarged Prostate (BPH)
Why are Beta blockers preferred to treat HTN versus Alpha 1 Blockers?
Alpha 1 blockers can cause orthostatic hypotension and tachycardia
What do Beta 1 BLOCKERS do?
Reduces HR which will reduce BP
What do Beta 2 BLOCKERS do?
bronchoCONSTRICTION and inhibit the liver from turning glucagon into glucose (causes hypoglycemia)
What type of beta blocker is propranolol?
It is non-selective (blocks both beta 1 & 2)
What is the beta blocker propranolol used for?
HTN, heart failure, prophylaxis for migrains and thyroid storm
What are the contraindications of the beta blocker propranolol?
don't use if the patient has COPD or asthma bc it will cause bronchoCONSTRICTION
Metoprolol and Atenolol are what type of beta blockers?
They are selective, only acting on beta 1
Selective beta blockers are used for what treatment?
HTN and angina bc they have fewer side effects then non-selective beta bloackers
What are some side effects of selective beta blockers
bradycardia, hypotension, dizziness, fatigue and hypoglycemia
Do not use beta blockers with what drugs?
NSAIDs and sulfonyureas
What are the two cholinergic receptors?
muscarinic and nicotinic
What does the muscarinic receptor control?
stimulates smooth muscle and slows HR
What does the nicotinic receptor control?
stimulate the striated skeletal muscle, giving strength and tone.
What does SLUDGE stand for?
slavitation
lacrimination
urination
diaphoresis
GI peristalsis
edema
What do direct acting cholinergic agonist do?
they act on muscarinic receptors
What does the direct acting cholinergic drug metoclopramide do?
it reduces N/V by increasing gastric emptying
What does the direct acting cholinergic drug pilocarpine do?
decreases ocular pressure by causing miosis (pupil constriction)
What does the direct acting cholinergic drug bethanechol chloride (urecholine) do?
increases urination either for post op or due to a neurological disorder. It is administer SC or PO
What are the side effects of the direct acting cholinergic drug bethanechol chloride?
bradycardia, hypotension, sweating, increased saliva, N/V, diarrhea, abdominal cramps, bronchoCONSTRICTION, hypersecreation of gastric acid
What is the antidote for direct acting cholinergics?
atropine
What is the nursing intervention for direct acting cholinergics?
record I&O, give 1 hr before or 2 hrs after meal, check amylase AST and bilirubin serum for increase, listen for decreased bowel sounds and reprt them, ausculate for rales and rhonchi, have antidote ready, linens may need to be changed due to sweating
ACE Inhibitors, - pril suffix, ex Captopril,
Prevent the synthesis of angiotensin II by "inhibiting" angiotensin-converting enzyme, a potent vasoconstrictior; decrease afterload and preload in heart failure; used to treat HTN, CHF;Interacts with: NSAID, Diuretics, sulfameth/trimethoprim, side effect
Ascetylcholinesterase Inhibitors -ine suffix-ex rivastigmine, memantine, galantmine, different suffix -Aricept(donepezil)
(AChe inhibitor) an enzyme to break down AChe-Promote the accumulation of actylcholine in neuron receptors, resulting in prolonged cholinergic, improves cognition in Alzheimer's pt's side effects: Nausea, vomiting, diarrhea, dizziness, decreased appetite
Alpha Adrenergic blockers -zosin suffix, ex prazosin(Minipress), dozazosin(Cardura)
Decreases peripheral vascular resistance and lowers blood pressure by selectively blocking receptors in the vascular smooth muscle, Used for HTN, side effects: 1st dose Hypotension, dizziness, lightheadedness, faint, interacts with:NSAIDS, clonidine NRSG-
Aldosterone Receptor antagonists
Block stimulation of mineralocorticoid receptors by aldosterone, thus reducing high blood pressure by preventing sodium reabsorption; interacts with: side effects:
Aminoglycosides
Gentamicin, Tobramycin, and related antibiotics; particularly effective against gram-negative microorganisms; noted for potentially dangerous toxicity; interacts with: side effects:
Analgesics, ex's- acetaminophen, aspirin, Morphine sulfate, Demerol, fentanyl
Narcotic and nonnarcotic; relieve pain without producing loss of consciousness or reflex activity; interacts with:ALCOHOL, ASA-coumadin side effects:Acute toxicity to liver(tylenol) or kidneys
Androgens
These steroid hormones produce masculinizing effects; interacts with: side effects:
Angiotensin II receptor antagonists - tan suffix, ex irbesartan, Valsartan
Also known as ARBs (a very potent vasoconstrictor) from binding to receptor sites is vascular smooth mucle, brain, heart, kidneys, and adrenal gland, thus blocking the blood pressure-elevating and sodium-retaining effects of angiotensin II; interacts with
Anesthetics
For example, local anesthesia, general anesthesia; cause a loss of sensation with or without a loss of consciousness; interacts with: side effects:
Antacids
Reduce the acidity of the gastric contents; interacts with: side effects:
Antianginals
Used to prevent or treat attacks of angina pectoris; interacts with: side effects:
Antianxiety
Used to prevent anxiety symptoms or disorders; also known as minor tranquilizers or anxiolytics, although the term tranquilizer is avoided today to prevent the misperception that the patient is being tranquilized
Antiarrhythmics
Used to correct cardiac arrhythmias (any heart rate or rhythm other than normal sinus rhythm); interacts with: side effects:
Antibiotics
Used to treat infections caused by pathogenic microbes; the term in often used interchangeably with antimicrobial agents; interacts with: side effects:
Anticholinergic
Block the action of acetylcholine in the parasympathetic nervous system; also known as cholinergic blocking agents, antispasmodics, and parasympatholytic agents; interacts with: side effects:
Anticoagulants-Parenteral -Heparin, enoxaprin (lovanoxn
Do not dissolve existing blood clots, but so prevent enlargement or extension of blood clots; interacts with: side effects:
Anticonvulsants
Suppress abnormal neuronal activity in the CNS, preventing seizures; interacts with: side effects:
Antidepressants
Relieve depression; interacts with: side effects:
Antidiabetics
Also known as hypoglycemics; include insulin (used to treat type 1 diabetes mellitus) and oral hypoglycemic agents (used in the treatment of type 2 diabetes mellitus); interacts with: side effects:
Antidiarrheals
Relieve or control the symtoms of acute or chronic diarrhea; interacts with: side effects:
Antiemetics
Used to prevent or treat nausea and vomiting; interacts with: side effects:
Antifungals
Used to treat fungal infections; interacts with: side effects:
Antiglaucoma
Used to reduce intraocular pressure; interacts with: side effects:
Antigout
Used in the treatment of active gout attacks or to prevent future attacks; interacts with: side effects:
Antihypertensives
Used to treat elevated blood pressure (hypertension); interacts with: side effects:
Antilipemics-Statins -statin, ex's simvastatin(Zocor), lovastatin(mevacor)
Supresses cholesterol synthesis in the liver. Can increase HDL and decrease LDL, promotes vasodilation, decreases plaque site inflammation, decreases risk of thromboembolism.Uses to reduce serum cholesterol and/or triglycerides in hypercholesterolemia, pr
Antimicrobials
Chemicals that eliminate living microorganisms pathogenic to the patient; also called antibiotics or antiinfectives; interacts with: side effects:
Antineoplastics
Also called chemotherapy agents; used alone or in combination with other treatment modalities such as radiation, surgery, or biologic response modifiers for the treatment of cancer; interacts with: side effects:
Antiparkinson's
Used in the treatment of Parkinson syndrome and other dyskinesias; interacts with: side effects:
Antiplatelets
Prevent paltelet clumpling (aggregation), thereby preventing an essential step in formation of a blood clot; interacts with: side effects:
Antipsychotics
Used in the treatment of severe mental illnesses; also known as major tranquilizers or neuroleptics, although the term tranquilizer is avoided today to prevent the misperception that the patient is being tranquilized; interacts with: side effects:
Antipyretics
Used to reduce fevers associated with a variety of conditions; interacts with: side effects:
Antispasmodics
Actually anticholinergic agents; interacts with: side effects:
Antithyroid
Used to treat the symptoms of hyperthyroidism; also known as thyroid hormones antagonists; interacts with: side effects:
Antituberculins
Used to prevent or treat an infection caused by Mycobacterium tuberculosis
Antitussive
Used to suppress a cough by acting on the souch center of the brain
Antiulcer agents
These drugs, such as histamine-2 antagonist, decrease the volume and increase the pH of gastric secretions; interacts with: side effects:
Antivirals
Used to treat infections caused by pathogenic viruses; interacts with: side effects:
Bronchodilators
Stimulate receptors within the tracheobronchial tree to relax and dilate the airway passages, allowing a greater volume of air to be exchanged and improving oxygenation; interacts with: side effects:
Beta andrenergic blockers -lol suffix, metoprolol, atenolol, popranolol
Inhibit the acivity of sympathetic transmitters, norepinephrine, and epinephrine; used to treat angina, arrhythmias, hypertension, and glaucoma; Used for: Angina,HTN,Cardiac dysrrhythmias,MI,CHF,interacts with: Calcium channel blockers,(verapamil, diltiaz
Calcium channel blockers -pine suffix ex amlodipine(Norvasc) felodipine(Plendil), also, diltiazem (Cardizem) verapamil (Calan)
Also called calcium ion antagonists, inhibit the entry of calcium ions in heart muscle cells, causing a slowing of the heart rate, lessening the demand for oxygen and nutrients, and relaxing of the smooth muscle cells causing vasodilation; Use: prevent or
Carbapenems
Antiboitics (imipenen, ertapenem, meropenerm) that have a broad spectrum ot activity against gram-positive and gram-negative bacteria; they act by inhibiting cell wall synthesis; interacts with: side effects:
Carbonic anhydrase inhibitors
Interfere with the production of aque humor, thereby reducing intraocular pressure associated with glaucoma; interacts with: side effects:
Cell-stimulating agents
Improve immune function by stimulating the activity of various immune cells; interacts with: side effects:
Cholinergic
Also known as parasympathomimetics; produce effects similar to those of acetylcholine; interacts with: side effects:
Cholinesterase inhibitors
These enzymes destroy acetylcholine, the cholinergic neurotransmitter; interacts with: side effects:
Coating agent
This drug, sucralfate, forms a complex that adheres to the carter of an ulcer, protecting it from aggravation by gastric secretions; interacts with: side effects:
Colony-stimulating factors
Stimulate progenitor cells in bone marrow to increase numbers of leukocytes, thereby improving immune function; interacts with: side effects:
Corticosteroids
These hormones are secreted by the adrenal cortex the adrenal gland; interacts with: side effects:
Cycloplegics
Anticholinergic agents that paralyze accommodation of the iris of the eye; interacts ; interacts with: side effects:with: side effects:
Cytotoxics
Agents that cause direct cell death; often used for cancer chemotherapy; interacts with: side effects:
Decongentants
Reduce swelling in the nasal passages caused by common cold or allergic rhinitis; interacts with: side effects:
Digestants
Combination products containing digestive enzymes used to treat various digestive disorders and to supplement deficiencies of natural digestive enzymes; interacts with: side effects:
Digitalis glycosides
A class of drugs, also konwn as cardia glycosides, that increase the force of contraction and slow the heart rate, thereby improving cardiac output; interacts with: side effects:
Diuretics
Act to increase the flow of urine; interacts with: side effects:
Emetics
Used to induce vomiting; interacts with: side effects:
Estrogens
Steroids that cause feminizing effects; interacts with: side effects:
Expectorants
Liquefy mucus by stimulating the natural lubricant fluids from the bronchial glands; interacts with: side effects:
Fluoroquinolones
Ciprofloxacin and related agents; widely used broad-spectrum antibiotics; interacts with: side effects:
Gastric stimulants
Used to increase stomach contractions, relax the pyloric valve, and increase peristalsis in the gastrointestinal tract; result in a decrease in gastric transit time and more rapid emptying of the interstinal tract; interacts with: side effects:
Glucocorticoids
Also known as adrenocorticosteroids; are used to regulate carbohydrate, fat, and protein metabolism
Gonadal hormones
Hormones produced by the testes in the male and ovaries in the female; interacts with: side effects:
Herbals
Plant products usually sold as food supplements; may have pharmacologic effects that are not evaluated or regulated by the FDA; interacts with: side effects:
Histamine (H2) antagonists
Decrease the volume and increase the pH of gastric secretions both during the day and the night; interacts with: side effects:
HMG-CoA reductase enzyme inhibitors
Also known as the statins: antilipemic agents that inhibit hydroxymethyl-glutaryl coenzyme A (HMG-CoA) thus reduce potential for atherosclesrosis; interacts with: side effects:
Hyperuricemics
Used to decrease the production or increase the excretion of uric acid; interacts with: side effects:
Immunizations
Produces antibodies that provide active immunity, prevents childhood infectious diseases
Immune Globullin-ex's Gamma globulin, Immunoglobulin G (IgG) Route: deep IM
Provides passive immunity and provide antibodies, interacts with: Live virus, side effects:local reaction, systemic allergy,
Immunostimulants-ex's Interferon alfa, Interleukin 2 Route: SQ or IM
enhance immune responses & decrease proliferation of cancer cells; interacts with: Antihypertensives,Theo-dur, Zydovudine(Retrovir) side effects:Cardiotoxicity, Hypotension, flu-like symptoms(fever, headaches,fatigue,chills,myalgias) Bone marrow suppressi
immunosuppressants-ex's cyclosporine(Sandimmune, Gengraf,Neoral)
Act on T lymphocytes to suppress production of immune response components, supresses B cells Cytotoxic T's; interacts with: Phentoin, phenobarbitol,rifampin,tegretol, causing decrease in cyclosporine effects; Grapefruit juice,Ketoconizole, erythromycin, A
Antihistamines ex's-1st gen H1antagonists-Diphenhydramine, promethazine, dramamine, 2nd gen H1 antagonists-loratadine (claritin) cetirizine(Zyrtec), fexofenadine(allegra)
Antihistamne action is on the H1 receptor results in blocking histamine relase in small blood vessels, nerves during allergic reactions. ; Used to treat allergy symptoms; may also be used to treat motion sickness, insomnia, and other nonallergic reactions
NSAIDs-Nonsteroidal Anti-Inflammatory ex's-1st gen-COX & COX 2 inhibitors-Aspirin, 2nd gen-selective Cox 2 inhibitors-Celebrex. 1st gen Ibuprofen, naproxen, ketorolac, 2nd gen-valdecoxib(Bextra)
Inhibits cyclooxygenase (inhibits COX 2 reducing inflammation, pain, fever. Inhibits COX 1 reducing platelet aggregation; interacts with: Warfarin increases bleeding times, glucocorticoids-increasing GI bleed risk, ALCOHOL- risk of bleeding, Ibuprofen-dec
Alpha 2 Agonist -ine suffix, ex clonidine (Catapress)
Act within the CNS to decrease sympathetic outflow resulting in decreased stimulation to the adrenergic receptors (both alpha & beta) of the heart and peripheral vascular system. Results in vasodilation,bradycardia & decreased cardiac output. Used for: HT
Hypertensive Crisis Medications/treatment -no common suffix, labetalol (Trandate), diazoxide(Hyperstat),fenoldopam(Corlopam), trimethaphan(arfonad), IV sodium nitroprusside(Nitropress)
Hypertensive emergencies are severe elevations in BP, often higher than 220/140 mm Hg, complicated by clinical evidence of progressive target organ dysfunction. A potentially life-threatening syndrome that results when an individual taking MAOIs eats a pr
Organic Nitrates -Nitroglycerin ex's Nitrol, Nitrostat, Isosorbide dinitrate(Imdur)
in stable angina-decreases cardiac 02 demand by dilating veins and decreasing venous return(preload), in variant angina-relaxes or prevents spasm in coronary arteries, increasing 02 supply. Uses:Acute attack & prophylaxsis in stable angina,variant angina,
Cardiac Glycosides - only med is digoxin(Lanoxin,Lanoxicaps,Digitek)
positive inotropic effect=increased force and efficiency of myocardial contraction improving pumping of heart, Stroke Volume(SV), and Cardiac Output(CO). Negative chronotropic effect=decreased heart rate, at therapeutic levels it slows rate of SA node dep
Antilipemics-Fibrates -gemfibrizol(Lopid), fenofibrate(Tricor,Lofibra)
Decreases triglyceride levels-very low density lipoproteins(VLDL) by increasing the rate of VLDL excretion by inhibiting absorption of cholesterol secreted by the bile and from food. Increases HDL levels by promoting production of presursors to HDL's. Use
Antilipemics-Bile acid sequestrants - cholesteryamine(Questran), colestipol(Colestid)
Increases LDL receptor sites on liver cells resulting in increased uptake of serum cholesterol lowering LDL levels. Used in adjunct therapy with atorvastatin and dietary changes to lower cholesterol levels. SE's-constipation, Interacts wtih: Digoxin, Warf
Norepinephrine/ Epinephrine
Vasoconstrictor, increases BP and cardiac output
S/E: Palpitations, TISSUE NECROSIS with extravasation
Dopamine
Low dose- dilates renal & coronary arteries, high-dose- vasoconstrictor
S/E: Incr ocular pressure, tachycardia, decr urinary output
Headache- sign of drug excess
Benadryl
Blocks effect of histamines (allergic rx)
S/E: DROWSINESS, confusion
Antianxiety Meds
S/E: Sedation, lethargy, depression, dry mouth, constipation, bradycardia, elev of liver enzymes, urinary retention
**
starred have potential for abuse
** Do NOT dc abruptly, avoid alcohol
Valium, Librium
Antianxiety, ***
S/E: lethargy, respiratory depression
Ativan, Xanax
Antianxiety, ***
S/E: CONFUSION
Check renal/hepatic function
Versed
Antianxiety- used preop and pre-procedures
S/E: RETROGRADE AMNESIA, hypotension
BuSpar
Antianxiety
S/E: Confusion, hypotension
Requires 3 wks to be effective, not PRN
Avoid alcohol/grapefruit juice
Antacid Meds
S/E: Constipation, diarrhea, metabolic acidosis
Absorp of other meds may be decr if given together
Give with fluids
Maalox
Antacid
S/E: LAXATIVE effect
Milk of Magnesia
Antacid, ***
S/E: when excessive- nau, vom, diarrhea
Antidysrhythmic Meds
Monitor blood pressure (for hypotension), heart rate, QT intervals
Lidocaine
Antidysrhythmic Meds
S/E: Slurred speech, confusion, bradycardia
Propanolol
Antidysrhythmic Meds
S/E: BRONCHOSPASM
Contraindicated for asthma, COPD
Amiodarone
Antidysrhythmic Meds
S/E: Liver toxicity
Verapamil
Antidysrhythmic Meds
S/E: Orthostatic hypertension
Gentamicin, Neomycin
Aminoglycosides
S/E: Ototoxicity, nephrotoxicity
Encourage fluids, small frequent meals
Cephalexin, Ceftriaxone
Cephalosporins
S/E: Incr risk of bleeding, superinfections, thrombophlebitis IV
Take with food, avoid alcohol, CROSS ALLERGY: penicillins
Ciprofloxacin, Levofloxacin
Fluoroquinolones
S/E: Superinfections, hepatotoxicity
Take on empty stomach, monitor liver function
Penicllin G
Penicillins
S/E: Gastritis, diarrhea, allergy
Sulfamethoxazole, Trimethoprim
Sulfonamides
S/E: Peripheral neuropathy, crystalluria, photosensitivity
Take on empty stomach, push fluids, protect from light
Doxycycline
Tetracyclines
S/E: Glossitis, phototoxic rx, decr oral contraceptives effectiveness
Take on empty stomach, protect from sunlight, monitor renal
Bacitracin ointment
Antibacterial ointment
S/E: Nephrotoxicity, ototoxicity
Silver sulfadiazine cream
Tx for burns
S/E: Neutropenia, burning
CROSS-ALLERGY: sulfonamides
Pyridium
Genitourinary med, antispasmodic & analgesic
S/E: Bright orange urine
Ditropan
Genitourinary med, tx, incontinence, antispasmodic
S/E: Drowsiness, blurred vision, dry mouth
Increase fluids and fiber in diet
Viagra
Tx of ED
S/E: Flushing, hypotension, priapism
DO NOT USE WITH NITRATES- fatal hypotension
Do not drink grapefruit juice
Proscar
Tx of BPH
S/E: Decr libido, impotence
Pregnant women should avoid contact with drug or pts semen
Atropine sulfate
Tx of bradycardia
S/E: Headache, dry mouth, urinary retention
Check for hx of glaucoma, asthma, HTN
Anticholinergic medications
Competes with acetylcholine at receptor sites in ANS for a variety of effects
S/E: Blurred vision, dry mouth, urinary retention, change in HR
Atrovent
Used for longterm tx of bronchospasm, asthma
S/E: Dry mouth
Cogentin
Used for Parkinson's Disease to reduce symptoms
S/E: Anticholinergic eff, orthostatic hypotension
Taper before d/c
Anticoagulant Medications
S/E: Alopecia, hemorrhage, bleeding
Soft toothbrush, electric razor, report black tarry stools, monitor platelet counts
Heparin
Anticoagulant
S/E: thrombocytopenia, anemia
Monitor PTT at 1.5 to 2.0 x control
Antidote: Protamine sulfate
Coumadin
S/E: Diarrhea, rash
Monitor PT at 1.5 to 2.0 x control, avoid diet high in vit K
Antidote: Vitamin K
Anticonvulsant Medications
S/E: Cardiac depression, resp depression, agranulocytosis, aplastic anemia, ataxia
Tolerance with longterm use, don't dc abruptly
Tegretol
Anticonvulsant
S/E: Myelosuppression, diplopia
Monitor CBC, wear sun protectant
Klonopin
Anticonvulsant, Benzodiazepine
S/E: Confusion, drowsiness
Topamax
Anticonvulsant
S/E: Vision problems, renal calculi
Valium
Anticonvulsant, ***
S/E: Hypotension, tachycardia
Alcohol incr CNS depression
Keppra
Anticonvulsant
S/E: Dizziness, suicidal ideation
Avoid alcohol
Dilantin
Anticonvulsant
S/E: Hirsutism, GI upset, gingival hypertrophy
Urine/sweat may turn red/brown, incr exposure to sunlight
Phenobarbital
Anticonvulsant, ***
S/E: Drowsiness, initially constricts pupils
Magnesium sulfate
Anticonvulsant, used for pre-eclampsia
S/E: Flushing, extreme thirst, hypotension
Monitor intake and output, check knee jerks before each dose
Depakote
Anticonvulsant
S/E: Sedation, tremors, prolonged bleeding time
Monitor platelets, bleeding time, liver functions
Nardil, Marplan
Antidepressive, MAOi
S/E: Hypertensive crisis when taken with foods containing tyramine, photosensitivity, sexual dysfunction
Do not take with SSRIs, avoid other CNS depressants, monitor for urinary retention
Prozac, Zoloft
Antidepressive, SSRI
S/E: Dry mouth, sexual dysfunction, weight gain
Take in AM, 4 full weeks for full effect, do not give with MAOi, monitor for thrombocytopenia, leukopenia, and anemia
Elavil
Antidepressive, Tricyclic
S/E: Photosensitivity, anticholinergic effs, bone marrow depression
Therapeutic eff in 1-3 wks, give at night, S/E decr over time, do not abruptly stop, avoid alcohol, avoid exposure to sunlight
Humalog
Rapid-acting Insulin, used in insulin pumps
Onset: 5-15 min, peak: 1 hr, duration: 3hr
Humalin R
Short-acting insulin
Onset: 30-60 min, peak: 2-3 hr, duration: 4-6hr
NPH
Intermediate-acting insulin
Onset: 2-4hr, peak: 6-12 hr, 16-20 hr
Lantus
Very long acting insulin
Onset: 1 hr, peak: none (continuous), duration: 24 hr
Insulin
S/E: Hypoglycemia
Have pts rotate sites, only reg insulin given IV, all others SQ
-when mixing insulin in one syringe, draw up regular (clear) before Lantus (cloudy)
Glucophage
Oral hypoglycemic
S/E: Diarrhea, abdominal discomfort, hypoglycemia
Avoid alcohol
Glucagon
Oral hyperglycemic
S/E: Nausea, vomiting, bronchospasm, hypotension
May repeat q15 mins
Antidiarrheal Meds
S/E: Drowsiness, constipation, anticholinergic effs
Monitor for urinary retention
Pepto-Bismol
Antidiarrheal
S/E: Darkening of stools and tongue, constipation
Give 2 hr before and 3 hr after other meds, do not give for more than 48hr
Lomotil
Antidiarrheal
S/E: Sedation, tachycardia, dizziness
Decr peristalsis, onset 45-60 min
Compazine
Antiemetic med
S/E: Orthostatic hypotension, diplopia, photosensitivity
Antiemetic Meds
S/E: Drowsiness, sedation, anticholinergic effs
Check CBC and liver func with prolonged use
Reglan
Antiemtic med
S/E: Restlessness, extrapyramidal symptoms, dystonic rx
Take before meals, use with tube feedings to decr asp
Amphotericin B
Antifungal med
S/E: GI upset, hypokalemia, seizures, hematological, cardiac, and hepatic abnorms
Protect med from sunlight
Questran
Antilipemic med
S/E: Constipation, rash, fat-soluble vitamin deficiency
Sprinkle powder in beverage or wet food
Lisinopril
AntiHTN, ACE inhibitor
S/E: Tachycardia, MI, persistent dry cough
Small, freq meals, change position slowly
Propanolol
AntiHTN, Beta Blocker
S/E: Bradycardia, cardiac dysrhythmias, impotence, bronchospasm
Do not dc abruptly, provide rest periods, take with meals.
Cardizem
AntiHTN, Calcium Channel Blocker
S/E: Peripheral edema, angina, flushing, rash, impotence
Do not chew sustained-release tabs, avoid grapefruit juice, monitor VS
Losartan
AntiHTN, Ace Receptor Blockers
S/E: Angioedema, renal failure, orthostatic HTN
Monitor for edema.
Methyldopa
AntiHTN
S/E: Drowsiness, orthostatic hypotension, CHF
Don't dc abruptly
Hydralazine
AntiHTN
Lithium
Bipolar med, mood stabilizer
S/E: Fine hand tremors, reversible leukocytosis
Monitor blood levels, norm = 1-1.5meQ/L
Intoxication signs: Vom, diarrhea, drowsiness, ataxia
Have good fluid and salt intake
Tegretol
Bipolar med, mood stabilizer
S/E: Drowsiness, ataxia, CHF, thombocytopenia
Check CBC, BUN, LFTs, basic urinalysis
Drowsiness disappears in 3-4 days
Cisplatin platinol-AQ, Methotrexate, Bleomycin
Antineoplastic med
S/E: Bone marrow suppression, alopecia, renal toxicity
Check hematopoietic func weekly, encourage fluids
Levodopa
Antiparkinsonian med
S/E: Mental status changes, twitching, anorexia
Admin in long, prolonged doses, give with food
Sinemet
Antiparkinsonian med, Levodopa plus Carbidopa
S/E: Hemolytic anemia, dystonic movements, dry mouth
Plavix
Antiplatelet med
S/E: Hemorrhage, bleeding
Check for bleeding gums, check before OTC meds
Aspirin
Antiplatelet med
S/E: GI bleeding, metabolic acidosis, tinnitus
Observe for bleeding gums, give with milk, water, food
Antipsychotic S/E
EPS--> Pseudoparkinsonism, dystonia (muscle spasm), acute dystonic reaction (tightening of jaw, oculogyric crisis), akathisia (inability to sit or stand still), tardive dyskinesia (abnorm involuntary movements)
Tx: IM benadryl
More: Neuroleptic malignant
Haldol
Antipsychotic, high potency
S/E: Low sedative effect, high incidence of EPS
Thorazine
Antipsychotic, low potency
S/E: High sedative effect, hypotension
Patient has incr sensitivity to sunlight, no potential for abuse
Risperdal
Antipsychotic, atypical
S/E: Orthostatic hypotension, significant weight gain, moderate sedation, mild EPS
Acetaminophen
S/E: Uncommon GI effects, liver dysfunction
Prophylthiouracil (PTU)
Antithyroid
S/E: Leukopenia, fever, jaundice
Check CBC and hepatic function
Synthroid
Thyroid Replacement
S/E: Nervousness, palpitations, insomnia
Take in morning, monitor weight, tell pt to report chest pain, sweating, obtain baseline VS
Isoniazid
Antitubercular
S/E: hepatitis, peripheral neuritis, fever
Give B6 as prophylaxis for neuritis, check LFTs, avoid alcohol, give before meals, do not combine with Dilantin
Rifampin
Antitubercular
S/E: Hepatitis, fever
Orange urine, tears, saliva, check LFTs, take with food
Dextromethorphan
Antitussive
S/E: Drowsiness, dizziness
Monitor cough type and frequency
Guaifenesin
Expectorant
S/E: Dizziness, headache, nau/vom
Take with glass of water
Acyclovir
Antiviral
S/E: Headache, seizures, diarrhea
Slows progression of symptoms, does not prevent transmission, check LFTs and renal test
AZT
Antiviral, used with AIDS
S/E: Anemia, paresthesias, agranulocytosis
Teach pts to strictly comply with dosing schedule
Ritalin
Tx for ADHD
S/E: nervousness, tachycardia, weight loss
Monitor CBC, platelet counts, give at least 6 hr ac bedtime
Fosamax
Tx/prevention of osteoporosis
S/E: Arthralgia, esophagitis
Take meds in morning with water and remain upright for 30 min, monitor bone density tests
Aminophylline
Bronchodilators
S/E: Nervousness, dizziness, tachycardia
Albuterol
Bronchodilator, short-acting
S/E: Nervousness, hyperactivity, TACHYCARDIA
Digoxin
Cardiac glycoside
S/E: Bradycardia, visual disturbances, abdom pain
Monitor renal func, take apical pulse before admin dose
Norm level: 0.125-0.5mg IV
Toxic S/E: Halos around dark objects, heart block, dysrhythmias
Hydrochlorothiazide
Diuretics
S/E: Hypokalemia, hyperlycemia, hypotension
Don't give at bedtime, weigh patient daily, encourage K+ foods
Spironlactone
Diuretics
S/E: Hyperkalemia, hyponatremia, hepatic/renal damage
Avoid salt substitutes, give with meals
Furosemide
Diuretics
S/E: Hypokalemia, hyperglycemia, hypotension
Monitor BP, potassium. Weigh pt daily, don't give at bedtime, encourage K+ foods
Os-Cal
Calcium supplement
S/E: Dysrhythmias, constipation
Monitor EKG
Magnesium chloride
Magnesium supplement
S/E: Weak or absent deep tendon reflexes, hypotension, resp paralysis
Monitor respirations, test knee-jerk reflexes before each dose
Potassium chloride
Potassium supplement
S/E: Dysrythmias, cardiac arrest, resp paralysis
Monitor EKG, take after meals with full glass of water
Feosol
Iron supplement
S/E: Nau, constipation, black stools
Use straw to avoid staining teeth, monitor Hgb, NO milk for liq preparations
Dexamethasone
Glucocorticoids
S/E: Edema, osteoporosis, hyperglycemia
Do not abruptly dc, check weight, protect from fractures
Laxatives/Stool Softeners
S/E: Diarrhea, dependence
Bisacodyl
Stimulant
S/E: Mild cramps, nausea, diarrhea
Do not take with milk, eff in 6-12 hr
Docusate
Stool softener
S/E: Abdom cramps
Metamucil
Stool bulk-forming
S/E: Obstruction of GI tract
Take with a full glass of water.
Morphine sulfate
Opioid, ***
S/E: Sedation, resp depression, constipation
Monitor VS, bowel patterns, observe for dependence
Dilaudid
Opioid, ***
S/E: Sedation, hypotension, urine retention
Keep naloxone available, monitor bowel patterns
Oxycodone
Opioid, ***
S/E: Lightheadedness, sedation, constipation
Admin with milk after meals
Nitroglycerin
Antianginal
S/E: Flushing, hypotension, tachycardia
Subling q 5 min x 3, protect drug from light, do not dc abruptly
Ibuprofen
NSAIDs
S/E: GI upset, dizziness, headache
Use cautiously with aspirin allergy
Cimetedine
Anti-ulcer
S/E: Diarrhea, confusion
Dose at bedtime.
Levonorgestrel / Ethinyl Estradiol (BCP)
Birth Control Pill
S/E: Chance of DVT, nausea, breakthrough bleeding
Take at same time daily, no smoking
Flomax
Decr urinary urgency, hesitancy, nocturia in BPH
S/E: Dizziness, headache, orthostatic HTN
Change position slowly, admin at bedtime, admin 30 min after same meal each day
-afil
phosphodiesterase (PDE) inhibitor
-asone
corticosteroid
-bicin
antineoplastic; cytotoxic agent
-bital
barbiturate (sedative)
-caine
local anesthetic
cef-, ceph-
cephalosporin antibiotic
-cillin
penicillin antibiotic
cort
corticosteroid
-cycline
tetracycline antibiotic
-dazole
anthelmintic; antibiotic; antibacterial
-dipine
calcium channel blocker
-dronate
bisphosphonate; bone resorption inhibitor
-eprazole
proton pump inhibitor (PPI)
-fenac
nonsteroidal anti-inflammatory drug (NSAID)
-floxacin
quinolone antibiotic
-gliptin
antidiabetic; inhibitor of the DPP-4 enzyme
-glitazone
antidiabetic; thiazolidinedione
-iramine
antihistamine
-lamide
carbonic anhydrase inhibitor
-mab
monoclonal antibody
-mustine
alkylating agent (antineoplastic)
-mycin
antibiotic; antibacterial
-nacin
muscarinic antagonist (anticholinergic)
-nazole
antifungal
-olol
beta blocker
-olone
corticosteroid; anabolic steroid
-onide
corticosteroid
-oprazole
proton pump inhibitor (PPI)
parin; -parin
antithrombotic; anticoagulant (blood thinner)
-phylline
xanthine derivative (bronchodilator)
-pramine
tricyclic antidepressant (TCA)
pred; pred-
corticosteroid
-pril
ACE inhibitor
-profen
nonsteroidal anti-inflammatory drug (NSAID)
-sartan
angiotensin II receptor blocker; ARB
-semide
loop diuretic (water pill)
-setron
serotonin 5-HT3 receptor antagonist; antiemetic and antinauseant
-statin
HMG-CoA reductase inhibitor; statins
sulfa-
antibiotic; anti-infective; anti-inflammatory
-tadine
antihistamine; antiviral; anti-influenza-A
-terol
beta agonist; bronchodilator
-thiazide
thiazide diuretic (water pill)
-tinib
antineoplastic (kinase inhibitor)
-trel
female hormone (progestin)
tretin-; tretin; -tretin
retinoid; dermatologic agent; form of vitamin A
-triptan
antimigraine; selective 5-HT receptor agonist
-tyline
tricyclic antidepressant (TCA)
vir; -vir
antiviral; (anti-HIV, anti-hepatitis, anti-herpes, anti-cytomegalovirus (CMV), anti-flu)
-vudine
antiviral; nucleoside analogues
-zepam
benzodiazepine
-zolam
benzodiazepine
-zosin
alpha blocker
-ase
thrombolytic (clot buster)
enzymes (wound debridement)
-azepam
benzodiazepine (anxiety, insomnia, seizures, alcohol withdrawal)
-azine
phenothiazine (psychosis, antihistamine)
-azole
proton pump inhibitor (ulcers, acid secretion)
antifungal (fungal infection)
-barbital
barbiturate (sedation, anesthesia, insomnia, seizures)
cef-
cephalosporins (anti-infectives)
-caine
anesthetic
-cillin
penicillins (anti-infectives)
-cycline
antibiotic
-dipine
calcium channel blocker
EXCEPTIONS:
diltiazem
verapimil
-floxacin
flouraquinolones (anti-infectives)
-pramine, -ptyline
tricyclic antidepressants (depression)
-lone, -sone
corticosteroids (metabolism, inflammation, electolytes, water)
-mab
monoclonal antibodies (cancer)
-micin, -mycin, -kasin
aminoglycosides (anti-infectives)
-navir
antiviral, protease inhibitors (HIV, Hep C)
-olol
beta blocker (post MI, HTN, dysrhythmias)
-oxin
cardiac glycoside (CHF, dysrhythmias)
-osin
alpha blockers (BPH, HTN)
-parin
anticoagulant (prevent DVT, PE, MI, stroke)
-pril
ACE inhibitor (diurese for HTN, CHF)
-statin
HMG-COA reductase inhibitors (high cholestorol)
-sartan
ARB angiotensin II blocker (diurese for HTN, CHF)
-terol and -terenol
beta 2 agonist / sympathomimetic (asthma, COPD)
-thiazide
thiazide diuretics (HTN, edema)
-tidine
H2 antagoinst (ulcers, acid secretion)
-tropin
pituitary hormone
-vir-
anti-viral (HIV, Hep C)
protease inhibitors (HIV, Hep C)
-zolam
benzodiazepine (anxiety, insomnia, seizures, alcohol withdrawal)
-izine
H1 antagonist (n/v)
-lukast
leukotriene antagoinst (asthma, bronchitis)
-zoline, -edrine
decongestent (nasal congestion)
-pressin
pituitary hormone (vasoconstriction, Na in, K out)
-calc- or -calci-
parathyroid hormone (effect calcium levels)
-cort-
corticosteroids (metabolism, inflammation, electolytes, water)
-zolamide
carbonic anhydrase inhibitors (glaucoma, seizures, altitude sickness, ulcers, osteoperosis)
-setron
HT3 antagonist (n/v)
-ine
beta-adrenergic agonists (bronchodilate, increase vasc resist)
ex: norepinephrine (Levophed), dopamine (Inotropin)
used cardiac arrest, COPD
adfx: anticholinergic, dysrhythmias
-pam
benzodiazepine
adfx: depression, CNS depression, addictive. d/c slowly
caffeine and nicotine decreases effectiveness
-lol
beta blocker
adfx: bronchospasm
antibiotics general
allergic reaction (after 1st time), superinfection, liver kidney toxic
do C&S, encourage fluids, toxic when expired
peak level about an hour after IV, trough just after it's hung
-mycin (micin)
aminoglycosides-inhibit protein synthesis gram neg
adfx:oto and nephrotoxic
check cranial nerve 8 (ear)
ceph (cef)
cephalosporin-tonsillitis, prophylaxis, meningitis-bacterial wall inhibitor
adfx: bone marrow depression, GI upset, cross allergy w/pcn, protein/glucose in urine
do not drink etoh, take with food
-floaxcin
fluoroquinalones- dna inhibitor
anthrax tx, e. coli
adfx: decreased WBC, hct. elevated liver enzymes
don't take with food
-thromycin
macrolide-cell membrane binder
used in pcn allergy. used for dental prophylaxis in valve disorders
adfx: confusion, increases effects of coumadin, theophylline
take without food
-cillin
penicillin-inhibits synthesis of cell wall
severe infx-syphillis, lyme disease...
adfx: stomatitis, allergy
take without food
sulf, zulf, bactrim
sulfonamide-antagonizes folic acid synth
UC, crohn's, uri
adfx: peripheral neuropathy, photosensitive, crystalluria, stomatitis
take with food, encourage fluids, mouth care
-cycline
tetracycline-prevents protein synthesis
baby eye drops, acne
adfx: discoloration of primary teeth in utero or in early childhood, phototoxic, toxic when expired
take without food
uti meds
furadantin-anti-infective adfx: asthma attack, take with food and cranberry juice
pyridian-urinary tract analgesic adfx: HA, vertigo, turns pee orange, take with meals
anti-impotence drugs adfx: HA, hypotn, priaprism
grapefruit juice interaction
lipitor, viagra, ...
anticholinergic
block parasymp nerve
dilate pupil, bronchodilation, decrease secretions, decrease GI motility and secretions
uses: eye exams, motion sickness
adfx:urinary retention, dry mouth, hypotn and inc HR
probanthine, atropine, -bromide, ium
not with meals or paral
-arin
anticoagulant
adfx: bleeding, hematuria
heparin blocks conversion of prothrombin to thrombin, used in PE, venous thrombosis, after acute MI. PTT: 30-75?
antidote for heparin: protamine sulfate
warfarin interferes with vit k clotting factors. used in PE, v
anticonvulsant
adfx: gingival hypertrophy, resp depression, aplastic anemia
turn urine pink or reddish brown
Dilantin: can cause cardiac arrest if pushed too fast CANNOT BE MIXED WITH ANOTHER MED
no carbonation with depakote
mARplan, pARnate, nARdil (trade names)
MAOI antidepressant-4 wk to effectiveness
adfx: Hypertensive crisis with tyramine foods: aged cheese, liver, yogurt, beer, wine, pickled foods, herring, bologna, salami, bananas.
potentiate alcohol, interactions with CNS stimulants or cold meds
-etine, -aline
SSRI antidepressant- 4 weeks for effect
adfx: anxiety, urinary/bowel retention, insomnia at hs, pink urine
suicide risk on upswing
tricyclic antidepressant
used also for sleep apnea
amitryptalin (Elavil), imipramine (Tofranil), desipramine (Norpramin)
adfx: postural hypotension, confusion, urinary retention
suicide risk
take at hs
2-6 weeks for effectiveness
wean off
no alcohol, care in sun
heterocyclic antidepressant
Wellbutrin, trazadone
used also for smoking cessation
adfx: wellbutrin- agitation and insomnia. trazadone- sedation
wean slowly, no alcohol
-ase
antidiabetic (also Dymelor) for type II only
adfx: skin reaction, hypoglycemia
take prior to eating- EAT. alcohol, aspirin, sulfonamides, oral birth control, maois affect action
glucagon
used to reverse hypoglycemia
change glycogen to glucose and release it to the body
adfx: hypotn, bronchospasm. may repeat in 15 minutes. once alert, give longer acting carbohydrates
-ylate
antidiarrheals (also immodium)
adfx: anticholinergic, constipation
cxn in unknown abd pain
antiemetics
trimethobenzamide (Tigan), procorperazine (Compazine), metoclopramide (Reglan), meclizine (Antivert)
block dopamine, increase GI motility
adfx: anticholinergic, sedation
prophylaxis for chemotherapy as well
may cause Reye's used during viral infx
antifungals
fungizone (Amphotericin), mycostatin (Nystatin)
impair cell membrane
adfx: liver dysfunction, thrombocytopenia, leukopenia, pruritis
take with food
anti-gout
cholsalide (Colchicine), benemid (Probenecid), Zyloprim (Allopurinol)
decreases uric acid
Probenecid increases action of Cipro
Colchicine used only in acute gout syndrome
Probenecid for chronic
adfx: agranulocytosis, renal calculi-flush kidneys at treatme
Antihistamine
chlor-trimeton, diphenhydramine (Benadryl), promethazine (Phenergan)
adfx: drowsiness, anticholinergic, photosensitivity, bronchospasm
hard candy for dry mouth
-statin
antihyperlipidemia- statins block synthesis of cholesterol and triglycerides
(sequestrans-Questran-blocks absorption)
adfx: constipation, fat-soluble vitamin deficiency
take hs or at least 30 minutes before meals. assess diet
cannot take with other meds
-pril
antihypertensives
ACE Inhibitors-affect arteries-vasodilation in whole body
use for HTN and CHF
adfx: lethargy initially, orthostatic hypotension
take without food
-lol
antihypertensives
beta adrenergic blockers- decreases excitability of heart, decreases oxygen consumption
use: angina, SVT, HTN
adfx: bronchospasm, HR changes
take with food, taper off to avoid rebound HTN
-ipine
antihypertensives
also diltiazem, verapamil
calcium channel blocker-inhibit calcium influx across cell membrane to slow conduction and dilate coronary vessels and decrease HR
uses: angina, HTN, interstitial cystitis
adfx: hypotn, GI upset
SR-do not chew,
-artan
antihypertensives
angiotensin II-receptors
uses: HTN, heart failure, MI, neuropathy, stroke prophylaxis
adfx: dizziness, GI distress
SR-do not chew, crush, open
-azosin
antihypertensive
alpha 1-adrenergic blockers in peripheral vasculature
use: HTN, BPH
adfx: orthostatic hypotn, reflex tachycardia, Nasal Congestion, periph edema
first dose at HS-causes fainting initially
centrally acting alpha-adrenergic
antihypertensive
centrally acting alpha-adrenergic-decrease rate and force of contraction
Catapres, Aldomet
uses: HTN
adfx: orthostatic hypotn, Sedation
taper off
direct acting vasodilators
minoxidil, hydralazine (Apresoline)-relax smooth muscle
uses: HTN
minoxidil topical is Rogaine
adfx: ortho hypotn, tachycardia (may use with B-blocker to prevent), increased hair
check pulse when taking med
meds for bipolar disorder
lithium, Tegretol, Depakote
block catecholamines
Lithium salt is dangerous: tight therapeutic range. blood drawn 2-3 weeks. 3000 mL water/day. evaluated q2-3 wk
Tegretol, Depakote: antipsychotic/convulsant watch kidney and liver
adfx: GI upset, Tremors, p
alkylating agents
anti-neoplastic- interferes with rapid DNA replication
used: leukemia, multiple myeloma
Csplatin, busulfan (Mylerin), cyclophosphamide (Cytoxin)
adfx: very hepatotoxic, basic chemo adfx: bone marrow suppression, decreased WBC, platelets, RBCs, bleeding, G
antimetabolites
anti-neoplastic-inhibit DNA polymerase
fluorouracil (5-FU), Methotrexate
used: ALL, CA of breast, colon, pancreas
adfx: basic- GI-N/V, ulcers, decreased RBC, WBC, plt
CA -mycin (trade name)
anti-tumor antineoplastic-interfere with DNA and RNA synthesis.
ex:Adriamycin
use: CA
adfx: basic chemo: stomatitis, alopecia, bone marrow suppression
hormonal agents
antineoplastic- block hormone input into CA cells
ex: tomoxifen, testosterone
use: hormone-sensitive CA
adfx: leukopenia, bone pain, hypercalcemia, effects of individual hormone
vin-
Vinca-alkyloid antineoplastic. derived from periwinkle. interferes with cell division
ex: vinblastine
use: CA- affects every rapid producing cell in body
adfx: CNA Depression, stomatitis, alopecia, bone marrow suppression
check reflexes, give with Zylopri
-dopa
antiparkinson. essentially replace dopamine
(also parlodil)
adfx: ataxia, anticholinergic, dizziness
B6 can reverse effects, avoid CNS depressants
-azine
antipsychotic-block dopamine receptors
adfx: akasthesia, dyskinesia, dystonia, parkinsonian, tardive dyskinesia, leukopenia, can stunt growth in kids
avoid etoh and caffeine
-cyclovir
antiviral, inhibits DNA and RNA (includes non -cyclovirs too)
use in herpes, HIV
adfx: HA, dizziness, GI
doesn't cure.
-dronate
biophosphenates- antiosteoporosis inhibit bone resorption
adfx: esophagitis, arthralgia
-tropium, -ol, -phylline
bronchodilators
uses:COPD, asthma (terbutaline for preterm labor)
adfx: tachycardia, dysrhythmias, palpitations, anticholinergic
take bronchodilator first
-zolamide
anti-glaucoma, decreases production of aqueous humor
adfx: blurred vision, lethargy, depression, anorexia, decrease potassium
-oxin
cardiac glycoside-increase force of myocardial contraction, slow HR
Left heart failure
adfx: bradycardias, N/V, visual disturbance
hold if pulse <60 in adult, <70 in older kids, <90 in infants, young kids
check K+ levels- low potassium increases risk of t
-fate
cytoprotective agents
form barrier on duodenal ulcers
adfx: constipation, vertigo, flatulance
take without food
-sone
glucocorticoids
uses: asthma, COPD, some leukemias, Addison's, Crohn's
adfx: infxn, mask s/s of infxn, insomnia, hypoglycemia, hypokalemia, psychosis, depression, stunted growth
wean over time
ACE Inhibitors
Antihypertensive
Acetaminophen
Non Opioid Analgesic & Antipyretic
Acyclovir
Antiviral
Albuterol
Bronchodilator
Aldactone
Diuretic
Allopurinol
Antigout Agent & Antihyperuricemic
Ambien
Sedative/Hypnotic
Aminophylline
Bronchodilator
Amiodarone
Antiarrhythmic
Amphotericin
Antifungal
Ampicillin
Anti-infective
Antacids
Antiulcer
Antabuse
Alcohol Abuse Therapy Adjunct
Aspirin
Non Opiod Analgesic & Antipyretic
Atenolol
Antianginal & antihypertensive
Atropine
Antiarrhythmic
AZT
Antiretroviral
Benadryl
Allergy & Cough & Cold
Beta Blockers
Antihypertensive
Calcium Channel Blocker
Antihypertensive
Captopril
Antihypertensive
Cialis
Erectile Dysfunction Agent
Ciprofloxacin
Anti-infective
Clozaril
Antipsychotic
Codeine
Allergy, Cough & Cold, Antitussive & Opioid Analgesic
Coumadin
Anticoagulant
Cyclosporine
Immunosuppressant & Antirheumatic
Digoxin
Antiarrythmic & Inotropic
Dilatin
Antiarryhmic & Anticonvulsant
Evista
Bone Reabsorbtion Inhibitor
Fentanyl
Opioid Analgesic
Flagyl
Antiprotozoas, Anti-infective & Antiulcer
Gentamicin
Anti-infective
Glucophage
Antidiabetic
Haloperidol
Antipsychotic
Heparin
Anticoagulant
Imitrex
Vascular Headache Suppressant
Insulin
Antidiabetic Hormone
Kayexalate
Hypokalemic & Electrolyte Modifiers
Keflex
Anti-infective
Lactulose
Laxitive
Lasix
Diurectic
Levodopa
Antiparkinson
Lidocaine
Anesthetic
Lipitor
Lipid Lowering Agent
Lithium
Mood Stabilizer
Magnesium Sulfate
Mineral & Electrolyte Replacement
Mannitol
Diuretic
MAO
Inhibitor Anti-depressant
Morphine
Opioid Analgesic
Morphine
Opioid Analgesic
Narcan
Antidote
Neomycin
Anti-infective
Neostigmine
Antimyasthenics
Neupogen
Colony Stimulating Factor
Neurontin
Analgesic Adjunct, Anticonvulsant & mood stabilizer for chronic pain or bipolar
Nitroglycerin
Antianginal
Pitocin
Hormone, induces labor
Plaquenil
Antimalaria & antirheumatic
Procrit
Antianemic
Pronestyl
Antiarrhythmic
Protonix
Antiulcer Agent
Questran
Lipid Lowering Agent
Reglan
Antiemetic
Remicade
Antirheumatic
Restoril
Sedative & Hypnotic
Rifampin
Antitubercular
Ritalin
CNS Stimulant
Steroids (Prednisone)
Anti-asthmatic & Corticosteroid
Synthroid
Hormone for Thyroid
Tagamet
Antiulcer Agent
Tetracycline
Anti-infective
Thorazine
Antiemetic & Antipsychotic
Tofranil
Antidepressant
Isotonic Fluids
0.9% Nacl
RInger's Solution
Lactated Ringer's
Hypotonic Fluids
D5W
0.45% NaCl
Hypertonic Fluids
10-15% DW
3% NaCl
Insertion of IV catheter
Tourniquet 8-10" above site,
BP cuff filled to diastolic pressure
Catheter bevel up at 15-20 degrees
Triple-lumen Central Catheter
Distal: Infuse or draw blood
Middle: TPN infusion
Proximal:infuse or draw blood, admin Meds
6 Rights of Med Admin
Right med
Right dosage
Right route
Right time
Right client
Right charting
Aloe: Action
Topical: Skin ailments
Oral: Constipation SE: diarrhea
Aloe: Drug interaction
None with topical
Black Cohosh: Action
Acute symptoms of: menopause & PMS
SE: minor upset stomach
Black Cohosh: Drug Interaction
May potentiate hypotensive actions of antihypertensives, Hypoglycemic actions or insulin and oral hypoglycemics
Echinacea: Action
Stimulate immune functions, suppress inflammation, for colds, flue, UTI, wounds, SE:unpleasant taste, fever, N&V, tingling of tongue,
Echinacea: Drug Interaction
oppose effects of immunosuppresants, Avoid if allergic to ragweed or daisies
Feverfew: Action
migraines, fever, stimulates menstruation and suppresses inflammation
Feverfew: Drug Interaction
suppress platelet aggregation, risk for bleeding with anticoagulants (Aspirin, Warfarin, heparin)
Garlic: Action
Reduces triglycerides, chlesterol, and atherosclerotic plaque formation, Antimicrobial, antithrombolic, antitumore, anti-inflammatory
Garlic: SE
Flatulence, Heartburn, irritation of mouth, esophagus, and stomach, allergic reaction
Potentiates: insulin, Antihypertensives,
Garlic, Ginger, Ginkgo: Drug interaction
Increase risk for bleeding with anticoagulants: (aspirin, warfarin, heparin)
Ginger root: Action
For N&V caused by motion sickness, nausea from chemotherapy
Ginkgo biloba: Action
increase circulation, memory, clear thinking, and impotence. SE: stomach upset, dose-related HA
Goldseal: Action
Bacterial, fungal, and protozoal infection of mucous membranes in resp, GI, Gu tracts. Inflammation of gallbladder. SE toxic in high doses
Goldseal: Interactions
Contraindication in pregnancy
Kava: Action
relieve anxiety, promote sleep, relax muscle. long-term and high dose cause CNS depression, skin problems, liver damage.
Kava: Drug Interactions
Intensifies the effects of CNS depressants. Alcohol is contraindicated.
Ma Huang (ephedra): Action
reduces appetite, increases energy, relieves bronchospasm. Increases BP and HR. SE: dangerous for CV with long-term and/or high doses.
Ma Huang (ephedra): Drug Interactions
Potentiates the effects of CNS stimulants; can counteract the effects of antihypertensives
St. John's wort: Action
Depression
St. John's wort: Drug interactions
Interferes with oral contraceptives, reduces effect of warfarin, cyclosporine. Caustion with other antidepressants
Saw palmetto: Action
Urinary symptoms relate to BPH. SE false-negatives on PSA test.
Saw palmetto: Drug interactions
Not to be used with finasteride (Proscar), avoid with pregnancy
Valerian: Action
sedative to promote sleep and reduce restlessness. SE: daytime drowsiness, long-term/High doses: HA, neurvousness, cardiac abnormalities.
Antianxiety Agents
Benzodiazepine, Nonbenzodiazepine, Herbal meds
Benzodiazepine: Names
Common: suffix -pam,
Librium, Valium, Xanax, Klonopin, Ativan, Serax, Versed
Nonbenzodiazepine: Names
BuSpar, Vistaril, atarax
Herbal Antianxiety: Names
Kava, melatonin
Antianxiety: Indications
Anxiety disorders, insomnia, petit mal, panic attack, acute manic
Antianxiety: SE
Sedation, depression, confusion, Anger, hostility, HA, Dry mouth, Constipation, Bradicardia, elevations in LDL, AST, ALT(Hepatic dysfunction), urinary retention
Antianxiety: NI
Monitor liver function, therapeutic blood levels, avoid alcohol, activities in alertness (driving), possible addiction/OD
Antacid: Names
Maalox, MoM, Titralac, Amphojel
Antacid: Action
Neutralizes gastic acids, raises gastric pH, inactivates pepsin
Antacid: Indications
Peptic ulcers, indigestion, GERD, prevent stress ulcers
Antacid: SE
constipation, diarrhea, acid rebound between doses, metabolic acidosis
Antacid: NI
Sodium cautiously for cardiac and renal disease. Reduces absorption of : tetracycline, quinolones, phenothiazides, iron, isoniazid. decreases effectiveness of oral contraceptives and salicylates
Antidysrhythmics: Class IA: Names
Procainamide, Disopyramine
Antidysrhythmics: Class IA: SE
Hypotension, HF
Antidysrhythmics: Class IA: NI
Monitor BP, for widening PR, QRS, QT, Toxic SE's, Limited use
Antidysrhythmics: Class IB: Names
Lidocaine, Mexiletine, Tocainide
Antidysrhythmics: Class IB: SE
CNS:slurred speech, confusion, drowsiness, seizure
Hypotension, bradycardia
Antidysrhythmics: Class IB: NI
Monitor CNS, BP, HR, heart rhythm
Antidysrhythmics: Class IC: Names
Flecainide, Rhythmol
Antidysrhythmics: Class IC: SE
Bradycardia, Hypotension, Dyshythmias,
CNS: anxiety, insomnia, confusion, seizures
Antidysrhythmics: Class IC: NI
Monitor dysrhythmias, HR, BP, CNS
Antidysrhythmics: Class II: Names
Propanol, Acebutolol, Esmolol, Sotalol
Antidysrhythmics: Class II: SE
Bradycardia, hypotension, bronchospasm, increase HF, fatigue, Sleep distrubance
Antidysrhythmics: Class II: NI
Monitor AP (1 min), rhythm, BP, Assess: SOB, wheezing, fatigue, sleep
Antidysrhythmics: Class III: Names
Amiodarone, Ibutilide, Defetilide
Antidysrhythmics: Class III: SE
Hypotension, Bradycardia, AV block, Muscle weakness, tremors, photosensitivity And photophobia, liver toxicity
Antidysrhythmics: Class III: NI
continuous monitoring of cardiac rhythm during IV admin, QT, HR, BP, Wear sunglasses, sunscreen
Antidysrhythmics: Class IV: Names
Verapamil, Diltiazem
Antidysrhythmics: Class IV: SE
Bradycardia, Hypotension, Dizziness, Orthostatic hypotension, HF
Aminoglycosides: Names
Suffix: -micin
Gentamicin, Neomycin, streptomycin, tobramycin, amikacin
Aminoglycosides: Action
Antibiotics: Gram-negative, Pseudomonas, E.coli
Aminoglycosides: SE
ototoxicity, nephrotoxicity, anorexia, N&V, diarrhea
Aminoglycosides: NI
Check CN VIII, Renal function, 7-10 days, encourage fluids (2500-3000 mL), small, frequent meals
Cephalosporins: Names
Keflex, Ceclor, Rocephin, Maxipime
Common: ceph/cef
Cephalosporins: Action
Antibiotics: Tonsillitis, otitis media, peri-op, prophylaxis, meningitis
Cephalosporins: SE
Abd pain, N&V, diarrhea, Increased bleeding risk, hypoprothromvinemia, rash, superinfections, Thrombophlebitis (IV),
Cephalosporins: NI
Given with food, cross allergy PCN, avoid alcohol, C&S
IV Tube Change
72 Hours
IV Bag Changes
24 hours
IV Infiltrations Assessment
Cool skin, swelling, pain, decreased flow rate
IV Infiltration Implementation
Discontinue IV, warm compresses, elevated arm, new IV proximal to site
IV Extravasation
medication or IV fluid that causes blisters or tissue sloughing
IV Vasicants
Gentamicin, Penicillin, Vancomycin, Dilantin, antineoplastics, Calcium, Potassium, Epinephrine
IV Extravasation Assessment
Pain, Burning, Edema, Blanching at site, coolness
IV Extravastion Precautions
Lager veins, Assess patency before admin, Stop IV, aspirate
IV Phlebitis, Thrombophlebitis Assessment
Redness, warm, tender, swelling, leukocytosis
IV Phlebitis, Thrombophlebitis Implementations
discontinue IV, warm, moist compressions, new IV proximal to site
IV Hematoma Assessment
ecchymosis, swelling, leakage of blood
IV Hematoma Implementations
discontinue IV, apply pressure, Ice bag 24 hrs, restart IV in opposite extremity
IV Clotting Assessment
Decreased flow rate, back flow of blood into tubing,
IV Clotting implementations
Discontinue, do not irrigate, do not milk, do not increase flow rate or hang solution higher, do not aspirate cannula, inject urokinase
PICC Complications
Pneumothorax, dysrhythmias, thrombophlebitis, nerve, tendon damage, resp distress, embolism
Central Line Implementations
Change dressing 2-3x/Week (when wet or nonocclusive)
Flush with 2ml NS, 5 ml Heparin (100 u/ml)
Tubing Change q24hrs, Low fowlers for dressing change
Central Line Insertion Implementations
Place in supine, head-low position
head away from the procedure
Valsalva
Antibiotic ointment, transparent dressings,
X-ray
Adrenergics: Names
Levophed (norepinephrine)
Intropin (dopanime)
Adrenalin (epinephrine)
Adrenergics: Indications
Cardiac Arrest, COPD
Adrenergics: SE
Dysrhythmias, Tremors, AntiCholinergic effects,
Adrenergics: NI
Monitor BP, HR, Output
General Antibiotics: SE
Allergic reactions
Super infection
Organ Toxicity
General Antibiotics: NI
ABC's, Benadryl, Epinephrine, Bronchodialators
General Antibiotics: Teaching
Take until gone, C&S first encourage fluids(2500-3000 mL), check expiration dates
Fluoroquinolones: Names
Cipro (ciprofloxin), levofloxacin (levaquine), norfloxacin (noroxin)
Common suffix: -floxacin
Fluoroquinolones: Action
Antibiotic: DNA replication: G-: E.coli, Pseudomonas, S. aureus, Anthrax
Fluroquinolenes: SE
diarrhea, decreased WBC & Hct, elevated Liver enzymes, elevated alkaline phosphatase
Fluroquinolenes: NI
C&S, Encourage fluids (2500-3000 mL), 1h ac or 2 h pc,
Microlide: Names
erythromycin, clindamycin, azethromycin
Suffix:- thromycin
Microlide: Action
Antibiotic: Acne, URI, Prophylaxis for dental w/PCN allergy
Microlide SE
Confusion, Diarrhea, hepatotoxixity, superinfection
Microlide: NI
1 h ac or 2-3 h pc
monitor liver function
Full glass of water (not juice)
increases effect of warferin, theophaline
Penicillins (PCN): name
Amoxcillin, Ampicillin, Augmentin (amoxicillin/clavulanate)
Suffix: -cillin
Penicillins: Action
Antibiotic: moderate to severe infections, syphilis, gonococcus infections, lyme disease
Penicillins: SE
Stomatitis, diarrhea, allergic reactions, renal and hepatic changes
Penicillins: NI
Check for hypersensitivity: Good Hx
1-2 h ac or 2-3 pc
Cross allergy with cephalosporins
Glycopeptides: Names
Vancomycin
Glycopeptides: Action
Antibitic: resistance staph
Glycopeptides: SE
Thrombophlebitis, Abscess formation, nephrotoxicity, ototoxicity
Glycopeptides: NI
IV admin: peak 5 min, 12-24 h duration
avoid and monitor extravasation
antihistamine with "red man syndrome": decreased BP, flushing of face and neck
Contact clinician if S/S superinfection, sore throat, fever, fatigue
Sulfonamides: Names
Gentrisin (acetyl sulfisoxazole)
Bactim (co-trimoxazole)
azulfidine (sulfasalazine)
Sulfonamides: Action
Antibiotic: Ulceratice colitis, Crohn's, Otitis media, UTIs
Sulfonamides: SE
peripheral neuropathy, crystalluria, photosensitivity, GI upset, stomatitis
Sulfonamides: NI
Take with meals or food, encourage fluids (2500-3000 mL), good mouth care
Tetracyclines: names
Vibramycin (doxycycline),
Panmycin (tetracycline)
Tetracyclines: Action
Antibiotic: infections, acne, prophylaxis for ophthalmia neonatorum
Tetracyclines: SE
Discoloration of primary teeth if taken during pregnancy, glossitis, rash, phototoxic reaction
Tetracyclines: NI
1 h ac or 2-3 h pc,
do not take with antacid, milk, iron
monitor renal function, avoid sunlight
Note expiration date
Furadantin: Name
Nitrofurantoin
Furadantin: Action
Antibiotic: UTIs
Furadantin: SE
Asthma attacks, diarrhea
Furadantin: NI
Anti-infective, give with food or milk, give with cranberry juice, monitor pulmonary status,
Pyridium: name
phenazopyridine
Pyridium: Action
Urinary tract analgesic
Pyridium: SE
HA, vertigo
Pyridium: NI
Urine will be orange
Anti-impotence: names
Suffix: -afil
Viagra (sildenafil)
Levitra (Vardenafil)
Cialis (Tadalafil)
Anti-impotence: SE
HA, hypotension, priapism
Contraindications: Nitrates, alpha blockers
Anti-impotence: NI
cannot take with grapefruit juice, call PCP if erection last longer than 4 hrs
Anticholinergics: names
Pro-Banthine (propanthekine), Atropine, Scopace (scopolamine), Atrovent, Spiriva, Cogentin, Artane
Anticholinergics: Action
dialates pupils, causes bronchodilation, decreases secretions, decreases GI & GU mobility
Uses: ophthalmic exam, Motion sickness, pre-op
Anticholinergics: SE
Urinary retiention, Dry mouth, blurred vision, changes in HR
Anticholinergics: NI
Monitor output, contraindicated with glaucoma, paralytic ileus, BPH
Give 30 min ac, or 2 h pc
Heparin: Action
Blocks conversion of prothrombin to thrombin
uses: PE, venous thrombosis, prophylaxis after acute MI
Heparin: SE
Hematuria, tissue irritation
Heparin: NI
Monitor aPTT (normal 20-45 secs)
antagonist: protamine sulfate
SQ or IV admin
Warfarin (Coumadin): Action
Interferes with synthesis or vitamin K-dependent clotting factors
uses: PE, venous thrombosis, prophylaxis after acute MI
Warfarin (Coumadin): SE
hemorrhage, alopecia, hematuria
Warfarin (Coumadin): NI
Monitor PT (9-12 secs)
Antagonist: Vitamin K (aquaMEPHYTON)
Monitor bleeding
PO admin
limit Vit C and Vit E
Anticoagulants: NI
Avoid: use of ASA with other Anticoag
Avoid: Garlic, ginger, ginkgo
Large does of anise will interfere,
Chamomile may interfere
Ginseng and alfalfa decrease
Black haw increases
Anticonvulsants: Names
Dilantin (phenytoin), Luminal (phenobarbital), Depakote (divalproex sodium), Tegretol (carbamazepine), Klonopin (clonazepam)
Anticonvulsants: Action
decreases flow of CA++ and NA+ across neuronal membranes
Uses: seizures
Anticonvulsants: SE
resp depression, aplastic anemia, gigival hypertrophy, ataxia, drowsiness
Anticonvulsants: NI
Don't DC abruptly, I&Os, caution with meds that lower seizure threshold (MAOI, antipsychotics)
Dilantin: NI
Extravasation precaution, Fast IV admin may cause cardiac arrest, do not mix with other meds or Dextrose
PO admin with at least 1/2 glass of water, avoid alcohol
Depakote: NI
Avoid carbonated beverages
take with food
MAO inhibitors: Names
Marplan (isocarboxazid), Parnate (tranylcypromine), Nardil (phenelzine)
MAO inhibitors: Action
Antidepressants: Causes increased concentration of neurotransmitters, used for chronic pain
MAO inhibitors: SE
hypertensive crisis w/tyramine foods, photosensitivity, weight gain, sexual dysfunction, orthostatic hypotension
MAO inhibitors: NI
Avoid tyramine foods: (aged cheese, bologna, pepperoni, salami, bananas, raisins, beer, figs, chianti red wine, sour cream, pickled foods)
Monitor output, 4 weeks to work
Avoid: ephedrine and pseudoephedrine
SSRI: Names
Prozac (fluoxetiner)
Paxil (paroxetine hydrocloride),
Zoloft (sertraline)
SSRI: Action
antidepressants: inhibits CNS uptake of serotonin, used w/ obsessive compulsice disorder, bulimia
SSRI: SE
anxiety, GI upset, Changes in appetitie and bowl function, Urinary retention (pink urine)
SSRI: NI
suicide precautions (2-3 weeks after tx)
takes 4 weeks for full effectiveness
take in AM
Tricyclines: Names
Elavil (amitriptyline)
Tofranil (imipramine)
Norpramin (desipramine)
Tricyclines: Action
Antidepressant: inhibits reuptake of neurotransmitters, used w/sleep apnea
Tricyclines: SE
sedation, anticholinergic effects, confusion, postural hypotension, urinary retention
Tricyclines: NI
Monitor for suicide
Take 2-6 weeks to work
Take at hs
monitor VS
Avoid: sunlight, sleep aids
Heterocyclines: Names
Wellbutrin (bupropion)
Desyrel (Trazadone)
Heterocyclines: Action
Antidepressant: alter serotonin in CNS, used w/smoking cessation
Heterocyclines: SE
Wellbutrin: agitation, insomnia
desyrel: sedation
Heterocyclines: NI
Avoid alcohol, CNS depressants, wean off slowly
Rapid-acting: Names
lispro (Humalog)
Aspart (NovoLog)
Rapid-acting: Onset
5=15 mins
Rapid-acting: Peak
40 min - 1 h
Rapid-acting: Duration
4-6 h
Rapid-acting: Time of adverse reaction
midmorning
Rapid-acting: NI
eat withing 5-15 mins, used in pumps
Short acting: Names
Regular: Humulin R, Novolin R, Iletin II regular
Short-acting: Onset
30-60 mins
Short-acting: peak
2-3 hr
Short-acting duration
4-6 h
Short-acting: time of adverse reaction
midmorning, midafternoon
Short-acting: NI
clear solution: given 20-30 mins before meal, can be given alone or with other insulins
Intermediate-acting: Names
Isophane (NPH), lente
Intermediate-acting: Onset
2-4 h
Intermediate-acting: Peak
6-12 hrs
Intermediate-acting: duration
16-20 hrs
Intermediate-acting: time of adverse reaction
early evening
Intermediate-acting: NI
white and cloudy solution, can be given after meals
Long-acting: Names
ultralente, Humulin U
Long-acting: Onset
1 h
Long-acting: Peak
12-16 h
Long-acting: duration
20-30 h
Long-acting: time of adverse reaction
early morning
Long-acting: NI
used to control fasting BG levels
Very Long Acting: Names
Glargine (lantus)
Very Long Acting: Onset
1 h
Very Long-acting: Peak
Peakless
Very Long-acting: duration
>24 h
Very Long-acting: NI
maintains BG levels regardless of meals, cannot be mixed, given hs
Insulin: SE
hypoglycemia
Insulin: NI
Rotate SQ site to prevent lipohypertrophy, fibrofatty masses, (do not inject these masses), only Regular can be given IV
Insulin: Herbal interactions
Bee pollen, ginkgo, glucosamine may increase blood glucose
Basil, bay leaf, chrominum, echinacea, garlic, ginseng may decrease blood glucose
Antidiabetics: Names
Diabinese, Orinase, Dymelor, Micronase
Antidiabetics: Actions
Stimulates insulin release from beta cells
Use: Type 2 diabetes
Antidiabetics: SE
hypoglycemia, allergic skin ractions, GI upset
Antidiabetics: NI
Taken before breakfast, monitor BG, avoid alcohol, ASA, MAOI, Oral contraceptives
Hypoglycemics: Names
GlucaGen (glucagon)
Hypoglycemics: Action
Stimulates liver to change glycogen to glucose, used for hypoglycemia (when unconscious)
Hypoglycemics: SE
Hypotension, bronchospasm
Hypoglycemics: NI
May repeat in 15 mins,
may be given oral carbs to prevent secondary hypoglycemic reactions
Antidiarreheals: Names
Kaopectate: (bismuth subsaliculate)
Lomotil (diaphenoxylate/atropine)
Imodium (loperamide)
Paregoric (tincure of opium)
Antidiarreheals: Action
Slows peristalsis, increases tone of sphincters
antidiarreheals: SE
Constipation, anticholinergic effects
Antidiarreheals: NI
Do not use with abd pain
monitor urinary retention
2 h before or 3 h after other meds
Antiemetics: Names
Tigan (trimethobenzamide)
Compazine (prochlorperazine)
Reglan (metoclopramide)
Antiver (meclizine)
Zofran (ondansetron)
Dramamine (dimenhydrinate)
Antiemetics: Action
Increase GI motility, clocks effects of dopamine, uses: vomiting
Antiemetics: SE
sedation, anticholinergic effects
Antiemetics: NI
used before chemotherapy
used with viral infections may cause Rye's syndrome
Antifungals: Names
Amphotericin B (fungizone),
Nystatin (mycostatin)
Flucanozal (diflucan)
Antifungals: Action
impairs fungal cell membranes, uses: candidiasis, oral thrush, histoplasmosis
Antifungals: SE
Hepatoxicity, thrombocytopenia, leukopenia, pruritus
Antifungals: NI
give with food
monitor liver functions
Good oral hygiene
Antigout: Names
Cochicine (colsalide)
Probenecid (benemid)
Allopurinol (zyloprim)
Antigout: Action
decreases production and resorption of uric acid, uses: gout
Antigout: SE
Agranulocytosis, GI upset, renal calculi
Antigout: NI
Probenecid increases actions cephalosporins
Monitor for renal calculi
Encourage fluids (2500-3000 mL)
Give with milk, food, and antacids
Antihistamine: Names
Benadryl (Diphenhydramine HCL)
Chlor-trimeton
Phenergan (promethazine)
Claritin (Loratadine)
Allegra (fexofenadine)
Zyrtec(Cetirizine)
Suffix: -ine
Antihistamine: Action
Blocks effects of histamine, uses: allergic rhinitis, allergic reactions to blood
Antihistamine: SE
Drowsiness, dry mouth, photosensitivity, bronchospasm, urinary retention
Antihistamine: NI
Give with food, use sunscreen, avoid alcohol, assess respiration, mouth care, hard candy
Antilipemic: Names
Lipitor (atrovastin)
Questran (cholestyramine)
Niacin (Niaspan)
Crestor (rosuvastatin)
Tricor (fenofibrate)
Antilipemic: Action
inhibits cholesterol and triglyceride synthesis, uses: tx elevated cholesterol, reduce incidence of CV diseas
Antilipemic: SE
Constipation, fat-soluble vitamin deficiency
Antilepemic: NI
Take hs or 30 min ac
1 h before or 4-6 h other meds
ACE Inhibitors: Names
Suffix: ~pril
Vasotec (enalapril)
Zestril (lisinopril)
Capoten (captopril)
ACE Inhibitors: Action
Antihypertensives: blocks ACE in lungs, uses: hypertension, CHF
ACE inhibitors: SE
GI upset, orthostatic hypotension, dizziness
ACE inhibitors: NI
1 h ac or 3 h pc
change position slowly
monitor VS
may cause fatigue
Beta Blockers: Names
suffix: ~ lol
Lopressor (metoprolol)
Coreg (carvedilol)
Tenormin (atenolol),
Corgard (nadolol)
Inderal (propranolol)
Beta Blockers: Action
decreases excitability of heart, decreases cardiac workload: Uses: Hypertension, angina, SVT
Beta Blockers: SE
Changes in HR, Hypotension, bronchospasm!
Beta Blockers: NI
Mask signs of shock and hypoglycemia, take with meals, do not DC abruptly
Calcium-channel Blockers: Name
Procardia (nifedipine),
Calan (verapamil)
Cardizem (diltiazem)
Common suffix: -ipine
Calcium channel Blockers: Action
Inhibits movement of calcium across cell membranes, Uses: angina, hypertension, interstitial cystitis
Calcium-channel Blockers: SE
orthostatic hypotension, renal failure, angioedema
Calcium- Channel Blockers: NI
caution about position changes, monitor for edema, facial swelling, SOB
Sustain release (cannot be chewed, or broken)
Angiotensin II Blockers: Names
Cardesartan (Atacand)
Losartan (Cozaar)
Angiotensin II Blockers: Action
Blocks vasoconstriction and aldosterone effects of angiotensin II, Uses: hypertension, HF, MI, diabetic neuropathy, stroke prevention
Angiotensin II: SE
hypotension, dizziness, GI distress
Angiotensin II: NI
Monitor VS,
Sustained Release (cannot be chewed or broken)
Alpha Blockers: Names
Doxazosin (cardura), Prazosin (minipress)
Alpha Blockers: Action
Selective blockade of alpha-1 reception in peripheral blood vessels, Uses: hypertension, BPH, reflex tachycardia
Alpha Blockers: SE
reflex tachycardia, orthostatic hypotension, nasal congestion
Alpha Blockers: NI
Administer first dose HS to avoid fainting, monitor BUN, weight and edema, change positions slowly
Centrally Acting A-andrenergics: Names
Aldomet
Catapres
Centrally Acting A-andrenergics: Action
Antihypertension: Stimulates alpha receptors in medulla
Centrally Acting A-andrenergics: SE
Sedation, orthostatic hypotension
Centrally Acting A-andrenergics: NI
Do not DC abruptly, monitor fluid retention, Change positions slowly
Direct-acting Vasodilators: Names
Apresoline (hydralazine),
Minoxidil
Direct-acting Vasodilators: Action
antihypertensive: Relaxes smooth muscle
Direct-acting Vasodilators: SE
Tachycardia, incrase in body hair
Direct-acting Vasodilators: NI
Teach patient to check pulse
Antibipolar: Name
Lithium, Tegretol (carbamazepine), Depakote (divalproex)
Antibipolar: Action
Reduces catecholamine release: Uses: manic episodes
Antibipolar: SE
GI Upset, tremors, Polydipsia, polyuria
Antibipolar: NI
Monitor serum levels, give with meals, increase fluid intake (2500-3000 mL)
Lithium: SE
Dizziness, HA, Impaired vision, Fine hand tremors, Reversible leukocytosis
Lithium: NI
Therapeutic level: 1-1.5 mEq/L
Serum check 2-3x per week (AM per dose)
2,500-3,000 mL/day &adequate salt intake
Lithium: Intoxication
vomiting, diarrhea, drowsiness, muscular weakness, ataxia
Alkylating Agents: Names
Cisplatin
Myleran (buslfan)
Cytoxan (Cyclophosphamide)
Alkylating Agents: Action
Antineoplastic: Interferes with rapidly reproducing DNA, Uses: leukemia, multiple myeloma
Alkylating Agents: SE
Hepatotoxicity, bone marrow suppresion
Alkylating Agents: NI
Check hematopoitic function, Force fluids (2500-3000 mL), good mouth care,
Antimetabolites: Names
5-FU (fluoroucil), Methotrexate,
Antimetabolites: Actions
Antineoplastic: Inhibits DNA, Uses: ALL, Colon, breast, pancreatic cancers
Antimetabolites: SE
N&V, oral ulceration, bone marrow suppression, alopecia
Antimetabolites: NI
Monitor hematopoitic functions, Good mouth care, discuss body image changes
Antitumor: Names
Adrimycin, bleomycin, Anctinomycin D
Antitumor: Action
Antineoplastic: Interferes with DNA and RNA synthesis
Antitumor: SE
Bone marrow suppression, alopecia, stomatitis
Antitumor: NI
Monitor VS, antiemetic meds
Hormonal Antineoplastic: Names
Nolvadex (tamoxifen), testosterone, Leuprolide (Lupron)
Hormonal Antineoplastic: Action
Antineoplastic: Changes hormone input into sensitive cells
Hormonal Antineoplastic: SE
leukopenia, bone pain, hypercalcemia, fluid retention, increasing appetite, body hair growth, mood changes,
Hormonal Antineoplastic: NI
Check CBC, Monitor serum calcium, therapeutic communication for changes in body image
General Antineoplastic: SE
Hepatotoxicity, bone marrow suppression, GI alterations, Alopecia, Nail loss, Infertility
General Antineoplastic: NI
Check hematopoietic function, Force fluids, good mouth care, Thrombocytopenia, Neutropenic, leukopenic precautions, anemia precautions
Vinca Alkaloids: Names
Prefix:~vin
Velban (vinblastine)
Oncovin (vincristine)
VInca Alkaloids: Action
Antineoplastic: Interferes with cell division
Vinca Alkaloids: SE
Stomatitis, Alopecia, loss of DTR, bone marrow suppression
Vinca Alkaloids: NI
Antiemetics, check reflexes, given with Zyloprim (decreases uric acid), Extravasation precaution
Topoisomerase: Name
Irinotecan (Camptosar)
Topotecan (Hycamtin)
Topoisomerase: Action
Antineoplastic: binds to enzyme that breaks DNA strands
Topoisomerase: SE
Bone marrow suppresion, Diarrhea, N&V, Hepatotoxicity
Antiparkinson: Names
Artane,
Cogentin
L-Dopa (Levodopa)
Parlodel
SInemet (carbidopa-levodopa)
Antiparkinson: Action
converted dopamine, stimulates postsynaptic dopamine receptors
Antiparkinson: SE
Dizziness, ataxia, atropine-like effects
Antiparkinson: NI
monitor urinary retention, Large doses of Vitamin B6 will reverse effects, avoid use of CNS depressants (Alcohol, sedatives)
Antiplatelet: Names
ASA, Persantine (dipyridamole), Plavix (copidrogel),
Antiplatelet: Action
Interferes with platelet aggregation, uses: venous thrombosis, PE
Antiplatelet: SE
hemorrhage, thrombocytopenia
Antiplatelet: NI
Check for bleeding, give with food or milk
High Traditional: Antipsychotics: Names
Haldol (haloperidol), Prolixin (Fluphenazine)
General Antipsychotics: Action
Blocks dopamine receptors in basal ganglia, Acute and chronic psychoses
High Traditional: Antipsychotics: SE
Low Sedation, low incidence of hypotension, high incidence or extrapyramidal effects
High Traditional: Antipsychotics: NI
high dose for assultive patients,
Medium Traditional: Antipsychotics: Names
Trilafone (perphenazine)
Medium Traditional: Antipsychotics: SE
Orthostatic hypotension, dry mouth, constipation
Medium Traditional: Antipsychotics: NI
can help control severe vomitting
Low Traditional: Antipsychotics: Names
Thorazine (chlorpromazine)
Low Traditional: Antipsychotics: SE
High sedation, high incidence of hypotension
Low Traditional: Antipsychotics: NI
Photosentitivity, no tolerance or potential for abuse
Atypical: Antipsychotics: Names
Abilify (aripiprazole),
Risperdal (risperidone),
Clozaril (clozarpine)
Atypical Antipsychotics: Action
interferes with binding of dopamine in the brain
Atypical Antipsychotics: SE
extrapyramidal effects, anticholinergic effects, sedative, orthostatic hypotension
Atypical Antipsychotics: NI
Monitor Blood, Monitor airway,
Change position slowly, use sunscreen,
Do not DC abruptly
Antipyretics: Names
Tylenol (APAP)
ASA
Antipyretics: Action
Antiprostagladin activity in hypothalamus
Antipyretics: SE
GI irritation, liver dysfunction
Antipyretics: NI
Monitor liver function, ASA is contratindicated for younger than 21 yrs because of Rye's syndrome
Antithyroid: Names
Tapazole (methimazole)
SSKI
PTU (propylthioracil)
Antithyroid: Action
Reduce vascularity of thyroid, inhibits release of thyroid into circulation, Uses: myxedema, hyperthyroidism
Antithyroid: SE
Leukopenia, rash, thrombocytopenia
Antithyroid: NI
Bitter taste: Burning in mouth, Give with meals, Check CBC, use straw to prevent staining of teeth
Thyroid replacement: Names
Synthroid (levothyroxine),
Cytomel (liothyronine)
Thyroid replacement: Action
Increases metabolic rate
uses: hypothyroidism, Grave's disease
Thyroid replacement: SE
nervousness, tachycardia, weight loss
Thyroid replacement: NI
Monitor weight, take in AM, monitor HR, BP, Enhances effects of coumadin & antidepressants, decrease effects of digoxin and insulin
Antitubercular: Names
INH (isoniazid), Rifampin, Ethambutol, Streptomycin, PAS (para-amino-salicyclic acid), PZA (pyrazinamide)
Antitubercular: Action
Inhibits cell and protein synthesis,
Antitubercular: SE
Hepatitis, peripheral neuritis,
Antitubercular: NI
Check liver function, Admin B6 for peripheral neutitis, used in combination, avoid alcohol,
General Antipsychotic: SE
akathisia, dyskinesia, dystonias, pakinson's syndrome, tardive dyskinesias, leukopenia
General Antipsychotic: NI
Monitor VS, Avoid alcohol and caffeine
Antitussive/Expectorants: Names
Benylin DM, Robitussin
Antitussive/Expectorans: Action
Suppress cough reflex in medulla, decrease viscosity or secretions. Uses: coughs due to URI, COPD
Antitussive/Expectorans: SE
Bradycardia, respiratory depression, drowsiness, dizziness, anticholinergic effects
Antitussive/Expectorans: NI
Monitor cough, avoid alcohol, monitor respiratory status
Antivirals: Names
Zoviraz, AZT, VIdex, Famvir, Cytovene, Tamiflu, HIVID
Antivirals: Action
Inhibits DNA & RNA replication, uses: revurrent HSV, HIV infectiosn
Antivirals: SE
HA, dizziness, Gi symptoms
Antivirals: NI
Encourage Fluids (2500-3000 mL), not a cure, but relieves symptoms
ADHD Meds: Names
Ritalin (methylphenidate), Dexedrine (dextroamphetamine)
ADHD Med: Action
Increases level of catecholamines, uses: ADD, narcolepsy
ADHD Med: SE
restlessness, insomnia, tachycardia, palpitations
ADHD: NI
monitor growth rate, liver enzymes, give in AM, monitor progress of Tx (including parents)
Biophosphonates: Name
Fosamax (alendronate), Boniva (ibandronate), Actonel (Risedronate)
Biophosphonates: Action
Inhibits bone calcium reabsorption, Uses: prevent and Tx for osteosporosis,
Biophosphonates: SE
Esophagitis, Arthralgia, Nausea, diarrhea
Biophosphonates: NI
Take in AM, with 6-8 oz of water before eating, remain upright for 3 mins. Bone density test
Bronchodilators/Resp Med: Names
Truphylline (Aminophylline), Atrovent (ipratropium), Albuterol (Proventil), Singulair (Montelukast), Mucomyst (Acetylcyteine)
Bronchodilators/Reps Med: SE
Nervousness, Tremors, Tachycardia, Pulmonary edema, Seizure, Anticholinergic effects
Bronchodilators/Reps Med: NI
May aggravate diabetes because them cause hyperglycemia, Monitor BP
Carbonic Anhydrase Inhibitor: Names
Diamox (Acetazolamine)
Carbonic Anhydrase Inhibitor: Action
Decreases production of aqueous humor in ciliary body
Carbonic Anhydrase Inhibitor: SE
Blurred vision, lacrimation, pulmonary edema
Carbonic Anhydrase Inhibitor: NI
Monitor client for systemic effects
Cardiac Glycoside: Names
Lanoxin (digoxin)
Cardiac Glycoside: Action
Inotropic effects
Cardiac Glycoside: SE
Tachycardia, bradycardia, heart block, anorexia, N&V, halos, blurred vision
Cardiac Glycoside: NI
Instruct clients to eat high potassium foods, Monitor for digitalis toxicity, potassium, toxicity risk with hypokalemia
Immunosuppressants: Names
Sandimmune (cyclosporine)
Immunosuppressants: Action
Prevents production of T cells and their response to interleukin-2, uses: Organ transplants
Immunosuppressants: SE
hepatotoxicity, nephrotoxicity, leikopenia, thrombocytopenia
immunosuppressants: NI
take once daily in am, used with corticosteroids, monitor renal and liver function, can be taken with milk or juice
Laxatives/Stool Softeners: Names
Cascara, Dulcolax, Colace, Milk of Mag
Laxatives/Stool Softeners: Action
Absorbs water increasing buld, lubricate surface of stool, stimulate peristalsis, Uses: constipation, and pre-op
Laxatives/Stool Softeners: SE
DIarrhea, dependence, abd cramps, hypermagnesemia
Laxatives/Stool Softeners: NI
Contraindicated with s/s of acute abdomen, monitor fluid and electrolyte levels, Chronic uses may cause hypokalemia, Encourage fluids (2500-3000 mL)
MIotic Eye Med: Names
Isopto-Carpine, Eserine, Carbacel
Miotic Eye Med: Action
Causes constriction of sphincter muscles of iris: uses: ocular surgery, open-angle glaucoma
Miotic Eye Med: SE
HA, Photophobia, hypotention, bronchoconstriction
Miotic Eye Med: NI
Apply pressure on lacrimal sac for 1 min, avoid sunlight, may experience transient brow pain and myopia, Monitor Resp status
Musculoskeletal Med: Names
Fosamax (Alendronate), Mestinon (Pyridostigmine), Tensilon (edrophonium), Glucosamine
Musculoskeletal Med: Action
Inhibits destruction of acetylcholine released from parasympathetic and somatic efferent nerves
Musculoskeletal Med: SE
Bronchoconstriction, Diarrhea, Respiratory paralysis, respiratory paralysis, muscle cramps
Musculoskeletal Med: NI
Give with milk or food, Admin exactly as ordered and on time, Doses vary with patient activity levels, monitor VS (especially Resp)
Mydriatic Eye Med: Names
Atropine Sulfate, Cyclogyl
Mydriatic Eye Med: Action
Anticholinergic actions leaves pupil under unopposed adrenergic influence. Uses: Dx exams, acute iritis, uveitis
Mydriatic Eye med: SE
Tachycardia, blurred vision, photophobia, dry mouth
Mydriatic Eye med: NI
Contraindicated with glaucoma, apply pressure on lacrimal sac for 1 min, wear dark glasses
Narcotics: Names
Morphine, Codeine, Darvon, Demerol, Dilaudid, Vicodin, Percodan
Narcotics: Action
Acts on CNS receptors, uses: moderate to severe pain
Narcotics: SE
dizziness, sedation, resp depression, hypotension, constipation
Narcotics: NI
Safety precautions, avoid alcohol, monitor VS, Narcan: Opioid antagonis, Monitor Resp status,
Antianginals: Names
Nitroglycerine, Isordil (isosorbide)
Antianginals: Action
Relaxes smooth muscle, decreases venour return: Uses: angina, peri-op HTN, HF
Antianginals: SE
hypotension, tachycardia, HA, dizziness
Antianginals: NI
Check expiration date, teach when to take med, may take q 5 mins x 3 doses, wet with saliva and place under tongue, do not DC abruply
NSAIDs: Names
ibuprofen, indocin, Naproxen, Celebrex, Tarodol
NSAIDs: Action
Inhibit prostagladin sysnthesis, Uses: arthritis, mild to moderate pain, fever
NSAIDs: SE
GI upsets, dizziness, HA, bleeding, fluid retention
NSAIDs: NI
Take with food or after meals, monitor liver and renal function, use cautiously w/ ASA allergy, check for bleeding
Thrombolytics: Names
Streptokinase, Urokinase,t-PA, Activase, retavase
Thrombolytics: Action
Dissolves or lyses blood clots, Uses: acute PE, Thrombosis, MI
Thrombolytics: SE
bleeding, bradycardia, dysrhythmias,
Thrombolytics: NI
Contraindications: Hemophilia, Active CVA, Trauma (<2 months), >75yrs, Heparin, coumadin
Accurate and full Hx
Monitor bleeding, have amino caproic acid, Check HR, color, sensation of extremities, , monitor EKG, Neuro checks, Monitor for Hematuria, occult
PPI: Names
Tagamet (Cimetidine)
Zantec (Ranitidine)
Pepcid (Famotidine)
Axid (Nizatidine)
PPI: Action
Inhibits action of histamine and gastric acid secretion, Uses: GI ulcers, GERD
PPI: SE
dizziness, confusion, hypotension, impotence
PPI: NI
take with meals and hs,
Smoking decreases effectiveness, monitor liver function and CBC
Vitamins: Names
Cynocobalamin (B12), Folic Acid
Vitamins: Action
Coenzyme that speeds up metabolic processes, Uses: deficiencies
Vitamins: SE
Anaphylaxis, uraticaria (B12), bronchospasm, Malaise (folic acid)
Vitamins: NI
Monitor levels, do not mix with other meds
Oral Contraceptives: Action
Prevent pregnancy, hormone control
Oral Contraceptives: SE
HA, Dizziness, nausea, breakthrough bleeding, weight gain, hormonal mood swings
Oral Contraceptives: Ni
No smoking, condom use for STD, if missed dose take as soon as possible & use protection, same time each day
Estrogens: Names
Estrace (estradiol), Premarin (estrogen)
Estrogens: Action
Hormone replacement: tx menopausal symptomes, cancers, osteoporosis
Estrogens: SE
Nausea, gynecomastia, contact lens difficulty
Estrogens: NI
Call PCP brest lumps, vaginal bleeding, edema, dark urine, blurred vision, chest pain
Alpha1 Blockers: Names
Terazosin (hytrin), Tamsulosin (Flomax)
Alpha1 Blockers: Action
Decrease urinary urgency, hesitancy nocturia, prostatic hyperplasia
Alpha1 Blockers: SE
HA, dizziness, orthostatic hypotension
Alpha1 Blockers: NI
Watch position changes, avoid alcohol, CNS, depressants, give at bedtime
Anaphylaxis: S/S
Hives, rash, difficulty breathing, diaphoresis
Anaphylaxis: NI
Epinephrine 0.3 ml of 1:1000 solution SQ, massage site, may repeat in 15-20 mins
Delayed Allergic Reaction: S/S
Rash, hives, swollen joints
Delayed Allergic Reaction: NI
DC med, Topical antihistamines, corticosteroids, comfort measures
Dermatologic Reaction: S/S
hives, exfoliative dermatitis, erythema multiform excidativum, hepatic involvement
Dermatologic Reaction: NI
Good skin care, antihistamines, topical corticosteroids
Stomatitis: S/S
swollen gums and tongues, difficulty swallowing, bad breath, mouth pain
Stomatitis: NI
Good mouth care, small feedings, antifungals, local anesthetics, non-spicy foods
Superinfections: S/s
fever, diarrhea, black hairy tongue, glossitis, vaginal itching and discharge
Superinfections: NI
Good mouth care, and skin care, antifungals
Bone marrow Depression: S/S
Fever, chills, sore throat, back pain, dark urine, anemia, thrombocytopenia, leukopenia
Bone Marrow Depression: NI
Monitor CBC, Protect from infections, Avoid injury
Liver impairment: S/s
Fever, malaise, jaundice, light stools and dark urine, abd pain, elevated AST and ALT, altered PTT
Liver impairment: NI
Good skin care, comfort measures, rest
Renal impairment: S/s
Elevated BUN and Creatinine, decreased Hct, altered electrolytes, fatigue, edema
Renal Impairment: NI
Diet and fluid restrictions, electrolyte replacement, dialysis, rest
Ocular Impairments: S/S
blurred vision, color vision changes, blindness
Ocular impairment: NI
monitor vision, exposure to light
Auditory Impairment: S/s
dizziness, ringing in ears, loss of hearing, loss of balance
Auditory Impairment: NI
Monitor hearing, safety measures to prevent falls
CNS Impairment: S/S
Confussion, insomnia, drowsiness, hallucinations
CNS impairment: NI
safety measures, avoid activities that require alertness, orient to surroundings
Cholinergic Effects: S/s
dry mouth, dysphagia, urinary retention, impotence, nasal congestion
Cholinergic Effects: NI
sugarless lozenges, good mouth care, void before taking med
Pakinson's-like Effects: S/s
Akinesia, tremors, drooling, changes in gait, rigidity, akathisia, dyskinesia
Pakinson's-like Effects: NI
Anticholinergic and antiparkinson medications, safety measures for gait
Cytoprotective: Names
Carafare (Sucralfate)
Cytoprotective: Action
Adheres to and protects ulcer's surface by forming a barrier
Cytoprotective: SE
Constipation, Vertigo, Flatulence
Cytoprotective: NI
Actions last up to 6 h, 2 h before or after most meds
Loop Diuretics: Names
Lasix (Furosemide), Bumex (bumetamide)
Loop Diuretics: Action
Increases the excretion of Potassium in the loop on henle
Loop Diuretics: SE
Hypotension, Hypokalemia, Hyperglycemia, GI upset, weakness
Loop Diuretics: NI
Monitor BP, HR, I&O, Monitor serum potassium, Dont give hs, encourage food with high potassium
Thiazide Diuretics: Names
Hydrodiuril (Hydrochlorothiazide)
Thiazide Diuretics: Action
Inhibit sodium reabsorption
Thiazide Diuretics: SE
Hypokalemia, Hyperglycemia, Blurred vision, Dry mouth, Hypotension
Thiazide Diuretics: NI
Monitor electrolytes, Monitor potassium, I&O, Monitor BUN and Creatinine, Dont give hs
Potassium-sparring Diuretics: Names
Aldactone (Spirolactone), Amiloride
Potassium-Sparring Diuretics: Action
Inhibits Aldosterone function
Potassium-Sparring Diuretics: SE
Hyperkalemia, Hyponatremia, Hepatic and renal damage, Tinnitus, Rash
Potassium-Sparring Diuretics: NI
Used with other diuretics, give with meals, avoid salt substitutes (w/K+), monitor serum potassium levels, I&O
Osmotic Diuretics: Names
Mannitol
Osmotic Diuretics: Action
Pulls fluid from tissues due to hypertonic effect, uses: increased ICP
Osmotic Diuretics: SE
Dry mouth, Thirst
Osmotic Diuretics: NI
I&O, VS, Electrolyte imbalances.
Iron Preparations: Names
Feosol (Ferrous sulfate), Imferon (iron dextran)
Iron Preparations: Actions
Iron salts increase availability of iron for hemoglobin. Uses: Iron-deficiency anemia
Iron Preparations: SE
Constipation, diarrhea, Dark stools, tooth enamel stains, seizures, flushing, hypotention, Tachycardia
Iron Preparations: NI
Take on an empty stomach, Avoid taking with Antacids, coffee, tea, mild, eggs, tetracyclines. Vit C increases absorption, Vit E delays response to Tx
Glucocorticoids: Names
Suffix: ~sone
Sul-cortef (Hydrocortisone), Decadron (Dexamethasone), Deltrasone (Prednisone), Pulmicort (Budesonide)
Glucocorticoids: Action
Stimulates gluconeogenisis, decreases use of glucose by body cells, increases formation and storage of fat in muscle tissue, alters normal immune respose, Uses: Addison's disease, Crohn's, COPD, Lupus, leukemias
Glucocorticoids: SE
Psychoses, depression, Weight gain, hypokalemia, Hypocalcemia, stunted growth in children, petechiae, buffalo hump
Glucocorticoids: NI
Monitor fluids and electrolyte balance, Don't DC abruptly, Monitor S/s of infections
Digitalis Toxicity: S/s
Confusion, irritation, irregular pulse, loss of appetite, N&V, diarrhea, palpitation, Visual changes (blind spots, blurred vision, changes in color perception, Halos or rings of light)
SIADH
Syndrome of inappropriate antidiuretic hormone
SIDS
sudden infant death syndrome
SL
sublingual
SLE
systemic lupus erythematosus
SOB
short of breath
sol
solution
SMBG
self-monitoring blood glucose
SMR
submucous resection
sp gr
specific gravity
spec.
specimen
ss
one half
SS
soapsuds
SSKI
saturated solution of potassium iodide
stat
immediately
STI
sexually transmitted infection
subcut, SubQ
subcutaneous
sx
symptoms
Syr.
syrup
T
temperature, thoracic to be followed by the number designating specific thoracic vertebra
T&A
tonsillectomy and adenoidectomy
tabs
tablets
TB
tuberculosis
T&C
type and crossmatch
TED
antiembolic stockings
temp
temperature
TENS
transcutaneous electrical nerve stimulation
TIA
transient ischemic attack
TIBC
total iron binding capacity
tid
three times a day
tinct, or tr.
tincture
TMJ
temporomandibular joint
t-pa, TPA
tissue plasminogen activator
TPN
total parental nutrition
TPR
temperature, pulse, respiration
TQM
total quality management
TSE
testicular self-examination
TSH
thyroid-stimulating hormone
tsp
teaspoon
TSS
toxic shock syndrome
TURP
transurethral prostatectomy
UA
urinalysis
ung
ointment
URI
upper respiratory tract infection
UTI
urinary tract infection
VAD
venous access device
VDRL
Venereal Disease Research Laboratory (test for syphilis)
VF, Vfib
ventricular fibrillation
VPC
ventricular premature complexes
VS, vs
vital signs
VSD
ventricular septal defect
VT
ventricular tachycardia
WBC
white blood cell or count
WHO
World Health Organization
wt
weight
nystatin aka
Mycostatin
nystatin
dermatologicals; antifungals, topical
nystatin side effects
GI distress, hypersensitivity; irritation (with topical use)
nystatin N considerations
treatment of Candida infections; discontinue if redness, swelling, irritation occurs; encourage good oral/vaginal/skin hygiene; do not mix oral suspension with food; Rx; Preg Cat C (oral); Preg Cat A (vaginal)
fluocinonide aka
Lidex
fluocinonide
dermatologicals; anti-inflammatories, topical
fluocinonide side effects
acne; atrophy; epidermal thinning; purpura; striae; burning; allergic dermatitis
fluocinonide N considerations
topical glucocorticoid used to treat severe dermatoses not responding to less potent meds: psoriasis, eczema, contact dermatitis, pruritus; apply only to affected areas, do not get in eyes; leave site uncovered or lightly covered; occlusive dresing is not
triamcinolone acetonide aka
Kenalog
triamcinolone acetonide
dermatologicals; anti-inflammatories topical
triamcinolone acetonide side effects
acne; atrophy; epidermal thinning; purpura; striae; allergic contact dermatitis; hypopigmentation
triamcinolone acetonide N considerations
topical glucocorticoid used to treat severe dermatoses not responding to less potent meds: psoriasis, eczema, contact dermatitis, pruritus; apply only to affected areas, do not get in eyes; leave site uncovered or lightly covered; occlusive dressing is no
acarbose aka
Precose
acarbose
diabetic meds; hypoglycemic agents, oral
acarbose side effects
abdominal pain; diarrhea; flatulence; rash
acarbose N considerations
management of diabetes by non-insulin-dependent diabetics; used alone or in combination with a sulfonylurea or insulin; PO: take with first bite of each meal, med blood level peaks in 1 hour; recognize signs of hypoglycemia: weakness, hunger, dizziness, t
glimepride aka
Amaryl
glimepride
diabetic meds; hypoglycemic agents, oral
glimepride side effects
headache; weakness, dizziness; drowsiness; dyspnea; fall in BP; shock
glimepride N considerations
management of stable type 2 diabetes mellitus; do not drink alcohol since it may produce a disulfiram rxn: N, headache, cramps, flushing, hypoglycemia; assess for symptoms of cholestatic jaundice: dark urine, pruritus, yellow sclera (rare); take at breakf
glipizide aka
Glucotrol
glipizide
diabetic meds; hypoglycemic agents, oral
glipizide side effects
headache; weakness; dizziness; drowsiness
glipizide N considerations
management of adults with type 2 diabetes mellitus; do not drink alcohol since it can produce a disulfiram rxn: N, headache, cramps, flushing, hypoglycemia; assess for symptoms of cholestatic jaundice: dark urine, pruritus, yellow sclera (rare); take at b
glyburide aka
DiaBeta
glyburide
diabetic meds; hypoglycemic agents, oral
glyburide side effects
headache; weakness, dizziness; GI disturbances; allergic skin rxns
glyburide N considerations
management of adult type 2 diabetes mellitus; assess for symptoms of cholestatic jaundice: dark urine, pruritus, yellow sclera (rare); take at breakfast, onset is in 2-4 hours, peak in 4 hours, duration 24 hours; have a quick source of sugar or a glucagon
metformin HCl aka
Glucophage
metformin HCl
diabetic meds; hypoglycemia agents, oral
metformin HCl side effects
headache; weakness, dizziness, drowsiness; agitation; N, V, diarrhea; lactic acidosis; flatulence
metformin HCl N considerations
management of adult type 2 diabetes mellitus; PO: twice a day with meals to decrease GI upset and provide best absorption; may also be taken as one dose; can crush tablets and mix with juice or soft foods for ease of swallowing; do not crush/chew/break ex
pioglitazone hydrochloride aka
Actos
pioglitazone hydrochloride
diabetic meds; hypoglycemia agents, oral
pioglitazone hydrochloride side effects
cold symptoms; headache; sinusitus; respiratory infection; muscle pain; tooth disorder
pioglitazone hydrochloride N considerations
treatment for type 2 diabetes; take around the same time each day, once daily, with or without food; full therapeutic effects may require 2 or more weeks; used in conjunction with diet and exercise regimen; may exacerbate CHF, monitor for edema and lung s
repaglinide aka
Prandin
repaglinide
diabetic meds; hypoglycemic agents, oral
repaglinide side effects
hypoglycemia; respiratory infectoin; headache; N/V, diarrhea; sinusitus, constipation; arthralgia; back pain
repaglinide N considerations
used to lower blood glucose levels in type 2 diabetes in adults; used in conjunction with diet and exercise regimen; some antifungals may inhibit metabolism; medication should be taken immediately before a meal; dose should be skipped if meal is skipped;
rosiglitazone maleate aka
Avandia
rosiglitazone maleate
diabetic meds; hypoglycemic agents, oral
rosiglitazone maleate side effects
upper respiratory infection; headache; back pain; hyperglycemia; fatigue; bone fracture, especially in women
rosiglitazone maleate N considerations
used in conjunction with diet and exercise to control blood glucose levels in patients with type 2 diabetes; seldom used in type 1 diabetes b/c of the need for insulin to be present; may be taken at any time of day without regard to meals; patient should
insulin aspart aka
NovoLog
insulin aspart
diabetic meds; insulin
insulin aspart side effects
hypoglycemia; lipodystrophy; hypokalemia; allergic rxns; headache; weight gain; edema
insulin aspart N considerations
management of diabetes in adults; the only insulin analog approved for use in external pump systems for continuous subQ insulin infusion; onset 15 minutes, peak 1-3 hours, duration 3-5 hours; may be given IV under medical supervision with close blood-suga
insulin glargine
Lantus
insulin glargine
diabetic meds; insulin
insulin glargine side effects
hypoglycemia; lipodystrophy; allergic rxns; pruritus; rash
insulin glargine N considerations
management of diabetes in type 1 diabetics or adults with type 2 requiring a long-acting insulin to control hyperglycemia; onset 1.1 hours, peak 5 hours, duration 24 hours; not the drug of choice for diabetic ketoacidosis (use a short-acting insulin); hig
insulin, isophane suspension (NPH) aka
Humulin N, Novolin N
insulin, isophane suspension (NPH)
diabetic meds; insulin
insulin, isophane suspension (NPH) side effects
hypoglycemia; lipodystrophy; alergic rxns
insulin, isophane suspension (NPH) N considerations
management of diabetes; comes in 100 units per milliliter vial, as well as in combination with regular insulin in a 50/50 proportion and 75/25 proportion; SubQ: onset 1-1.5 hours, peak 4-12 hours, duration 18-24 hours; read administration instructions car
insulin lispro aka
Humalog
insulin lispro
Diabetic meds; insulin
insulin lispro side effects
hypoglycemia; lipodystrophy; allergic rxns
insulin lispro N considerations
management of type 1 diabetes and in combination with sulfonylureas for type 2 diabetes; take within 15 minutes of eating and immediately after mixing, with combined therapy; may be used in children in combination with sulfonylureas; onset rapid, peak 30-
insulin, regular aka
Humulin R
insulin, regular
diabetic meds; insulin
insulin, regular side effects
hypoglycemia; lipodystrophy; allergic rxn; hypokalemia
insulin, regular N considerations
management of diabetic coma, diabetic acidosis, or other emergency conditions; esp. suitable for labile diabetes; comes in 100 units/milliliter vial; only insulin that can be given IV; SubQ: onset 30-60 minutes, peak 10-30 minutes, duration 30-60 minutes;
glucagon aka
GlucaGen
glucagon
diabetic meds; reversal of hypoglycemia
glucagon side effects
N/V
glucagon N considerations
acute management of severe hypoglycemia, facilitation of GI x-rays; IM for hypoglycemia: onset within 10 minutes, peak 30 minutes, duration 30-60 minutes; IV for hypoglycemia: onset within 10 minutes, peak 5 minutes, duration 60-90 minutes; subQ for hypog
aluminum hydroxide gel aka
Amphojel
aluminum hydroxide gel
GI meds; antacids
aluminum hydroxide gel side effects
constipation that may lead to impaction; phosphate depletion
aluminum hydroxide gel N considerations
antacid with duration of effect of 20-180 minutes; aluminum antacid compounds interfere with tetracycline absorption; contact clinician if signs of GI bleeding: tarry stools or coffee-grounds vomitus; shake suspension well and follow with small amount of
hydroxymagnesium aluminate aka
Riopan
hydroxymagnesium aluminate
GI meds; antacids
hydroxymagnesium aluminate side effects
mild constipation; increased urine pH levels; diarrhea; hypophosphatemia
hydroxymagnesium aluminate N considerations
symptomatic relief of GERD, indigestion, and GI distress; antacid with onset in 20 minutes and duration of 20-180 minutes; may decrease effect of antibiotics and other drugs, such as digoxin, phenothiazines, quinidine, salicylates due to impaired absorpti
calcium carbonate aka
Tums
calcium carbonate
GI meds; antacids
calcium carbonate side effects
N, anorexia, constipation, dry mouth, possible allergic rxn
calcium carbonate N considerations
used as antacid and calcium supplement; may decrease effect of some antibiotics and other drugs due to impaired absorption, so separate administration times by 2 hours; do not use if ventricular fibrillation or hypercalcemia; use caution if taking cardiac
dicyclomine HCl aka
Bentyl
dicyclomine HCl
GI meds; anticholinergics
dicyclomine HCl side effects
drowsiness; blurred vision; dyspnea; dry mouth; rash; urinary hesitancy; tachycardia; headache
dicyclomine HCl N considerations
used for treatment of irritable bowel syndrome;
hyoscyamine aka
Anaspaz, Gastrosed
hyoscyamine
GI meds; anticholinergics
hyoscyamine side effects
confusion; stimulation in elderly; dry mouth, constipation; urinary retention, hesitancy; palpitations; blurred vision; tachycardia; rash; headache; drowsiness
hyoscyamine N considerations
treatment of peptic ulcer, other GI disorders, other spastic disorders, urinary incontinence; PO: onset 20-30 minutes, duration 4-6 hours; IM/IV/SubQ: onset 2-3 minutes, duration 4-6 hours; avoid activities requiring alertness until stabilized on med; avo
loperamide HCl aka
Imodium
loperamide HCl
GI meds; antidiarrheals
loperamide HCl side effects
N/V, abdominal pain/distention, dizziness, drowsiness, dry mouth
loperamide HCl N considerations
used for control of diarrhea, including diarrhea in travelers; take with a full glass of water; encourage 6-8 glasses of fluid per day; use caution with potentially hazardous activities; if abdominal distention in acute ulcerative colitis, stop med; avoid
meclizine aka
Antivert, Bonine
meclizine
GI meds; antiemetics
meclizine side effects
drowsiness, dizziness
meclizine N considerations
management of vertigo, motion sickness; duration 8-14 hours; take 1 hour before traveling; avoid activities requiring alertness; avoid alcohol, CNS depressants; OTC, Rx; Preg Cat B
metoclopramide HCl aka
Reglan
metoclopramide HCl
GI meds; antiemetics
metoclopramide HCl side effects
drowsiness, restlessness, lassitude, headache, sleeplessness, dry mouth, anxiety
metoclopramide HCl N considerations
prevention of N, Vomiting induced by chemotherapy, radiation, delayed gastric emptying, GERD; used with tube feeding to decrease residual and risk of aspiration; PO: take 30-60 minutes before meals or procedures; IV: inject slowly over 1-2 minutes, infuse
prochlorperazine aka
Compro
prochlorperazine
GI meds; antiemetics
prochlorperazine side effects
orthostatic hypotension, blurred vision, dry eyes, dry mouth; constipation; drowsiness; photosensitivity
prochlorperazine N considerations
management of N/V, psychotic disorders; monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, sweating, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder co
promethazine aka
Phenergan
promethazine
GI meds; antiemetics
promethazine side effects
drowsiness; dizziness; constipation; urinary retention; dry mouth; hyperglycemia
promethazine N considerations
management of motion sickness, rhinitis, allergy symptoms, sedation, N, pre- and postoperative sedation; PO: onset 20 minutes, duration 4-6 hours; take 30-60 minutes before traveling; avoid activities requiring alertness; avoid alcohol, CNS depressants; m
simethicone
GI meds; antiemetics
simethicone side effects
belching; rectal flatus
simethicone N considerations
helps disperse gas pockets in GI system, does not decrease gas production; take after meals, at bedtime; shake suspension well before pouring; tablets must be chewed; OTC; Rx; Preg Cat C
esomeprazole magnesium aka
Nexium
esomeprazole magnesium
GI meds; antisecretory
esomeprazole magnesium side effects
headache; diarrhea; N, flatulence; dry mouth
esomeprazole magnesium N considerations
short-term treatment of erosive esophagitis; used to treat GERD; take at least 60 minutes before meals; swallow capsules whole, do not chew; may be taken in conjunction with antacids; Rx; Preg Cat B
omeprazole aka
Prilosec
omeprazole
GI meds; antisecretory
omeprazole side effects
headache; N/V, diarrhea; flatulence
omeprazole N considerations
treatment of active duodenal ulcers; treatment of GERD in patients over age 2 years; take 30 minutes before eating; may be taken at the same time as antacids; OTC, Rx; Preg Cat C
cimetidine aka
Tagamet
cimetidine
GI meds; antiulcer meds
cimetidine side effects
diarrhea; confusion (esp. in elderly with large doses); headache; dysrhythmias
cimetidine N considerations
treatment of chronic warts in children; reduces gastric acid secretions by 50-80%; may be taken without regard to meals; avoid antacids 1 hour before or after dose; do not use OTC for more than 2 weeks unless medically supervised; monitor liver enzymes an
famotidine aka
Pepcid
famotidine
GI meds; antiulcer meds
famotidine side effects
headache; blood dyscrasias; hepatitis; dizziness; constipation
famotidine N considerations
treatment of duodenal and gastric ulcres, GERD, heartburn; PO: onset 30-60 minutes, peak 1-3 hours, duration 6-12 hours; IV: onset immediate, peak 30-60 minutes, duration 8-15 hours; signs of blood dyscrasia: bleeding, bruising, fatigue, malaise, poor hea
lansoprazole aka
Prevacid
lansoprazole
GI meds; antiulcer meds
lansoprazole side effects
dizziness; diarrhea; abdominal pain
lansoprazole N considerations
used for treatment of GERD and ulcers, erosive esophagitis; PO: take no more than 30 minutes before meals, capsules may be opened and sprinkled on food (applesauc, pudding, cottage cheese, yogurt) and swallowed immediately; can use with antacids; do not c
misoprostol aka
Cytotec
misoprostol
GI meds; antiulcer meds
misoprostol side effects
abdominal pain; diarrhea; miscarriage; N; headache
misoprostol N considerations
prevention of gastric ulcers during NSAID therapy; take with meals and at bedtime; avoid taking magnesium antacids within 2 hours; notify clinician if diarrhea lasts more than 1 week; notify clinician if black, tarry stools or severe abdominal pain; Rx; P
rabeprazole aka
AcipHex
rabeprazole
GI meds; antiulcer meds
rabeprazole side effects
headache; dizziness; N/V, diarrhea; constipation, flatulence; rash; back pain
rabeprazole N considerations
used for treatment of GERD and duodenal ulcers; take on an empty stomach before eating; swallow tablets whole, do not crush/chew/split tablets; avoid alcohol, NSAIDs, and ASA, may increase gastric upset; Rx; Preg Cat B
ranitidine aka
Zantac
ranitidine
GI meds; antiulcer meds
ranitidine side effects
dizziness (esp. in elderly); drowsiness; headache
ranitidine N considerations
used to inhibit gastric acid secretion, ulcers (GI); take with or immediately following meals; do not take antacids within 1 hour before or after; do not smoke, it interferes with healing and drug's effectiveness; avoid alcohol, ASA, and caffeine, which i
sucralfate aka
Carafate
sucralfate
GI meds; antiulcer meds
sucralfate side effects
constipation; hypersensitivity
sucralfate N considerations
short-term treatment (less than 8 weeks) of duodenal ulcers; PO: 1 hour before meals or 2 hours after meals and at bedtime with full glass of water; do not chew tablets; do not use antacids within 30 minutes of med; encourage 8-10 glasses of fluid per day
sulfasalazine aka
Azulfidine
sulfasalazine; sulfasalazine side effects/ N considerations
GI meds; antiulcer meds
headache; anorexia; N/V; diarrhea; rashes; fever; oligospermia; hepatotoxicity
used for treatment of inflammatory bowel diseases and arthritis; PO: take with food to decrease GI upset; encourage fluids to decrease crystallization i
phentermine aka
Ionamin
phentermine
GI meds; appetite suppressants
phentermine side effects
CNS stimulation; hypertension; changes in libido; palpitations; drowsiness
phentermine N considerations
short-term treatment of obesity; PO: hydrochloride form duration is 4 hours, resin complex form duration is 12-14 hours; take 30 minutes beofre meals or as a single dose before breakfast or 10-14 hours before bedtime; avoid activities requiring alertness
sibutramine aka
Meridia
sibutramine
GI meds; appetite suppressants
sibutramine side effects
headache; dry mouth; anorexia; constipation; insomnia; rhinitis; back pain; hypertension; tachycardia; migraine
sibutramine N considerations
used to manage weight loss and maintenance in obesity; should be used with a reduced-calorie diet; regular heart rate and BP monitoring is important; avoid used with MAOIs; should not be used in patients with cardiac disease; Rx C-IV; Preg Cat C
lactulose syrup aka
Enulose
lactulose syrup
GI meds; laxatives
lactulose syrup side effects
N/V; abdominal cramps
lactulose syrup N considerations
used for chronic constipation, prevention and treatment of portal-systemic encephalotic including hepatic precoma and coma; PO: take with water or fruit juice to counteract sweet taste; use with caution in diabetics; monitor blood sugar; Rx; Preg Cat B
pancreatin
GI meds; pancreatic enzymes
pancreatin side effects
anorexia; N/V, diarrhea; constipation; hives
pancreatin N considerations
do not crush or break enteric-coated capsules; do not use if sensitive or allergy to pork; OTC, Rx; Preg Cat C
pancrelipase aka
Pancrease, Viokase
pancrelipase
GI meds; pancreatic enzymes
pancrelipase side effects
abdominal pain (high doses only); N, diarrhea; stomach cramps; flatulence; abnormal feces; fatigue
pancrealipase N considerations
used to replace or supplement naturally occurring enzymes, contains lipase, amylase, and protease lost due to cystic fibrosis; take with 8 ounces of water and food, swallow right away, sit up when taking; do not crush or break enteric-coated capsules; do
tamsulosin hydrochloride aka
Flomax
tamsulosin hydrochloride
genitourinary meds; alpha-adrenoceptor antagonist
tamsulosin hydrochloride side effects
sleepiness, difficulty falling or staying asleep; weakness; back pain; N/V, diarrhea; UTI; cold symptoms, including pain or pressure in the face; blurred vision; abnormal ejaculation; dizziness; headache; increased cough; chest pain; priapism
tamsulosin hydrochloride N considerations
treatment of benign prostatic hyperplasia; take the same time daily, once a day, 30 minutes after a meal; avoid changing positions (lying, sitting, standing) rapidly; use caution in potentially hazardous activities; may have cross-allergy with sulfa drugs
oxybutynin chloride aka
Ditropan
oxybutynin chloride
genitourinary meds; anticholinergics
oxybutynin chloride side effects
anxiety, restlessness; dizziness; convulsions; palpitations, tachycardia; drowsiness, blurred vision; N/V; anorexia; dry mouth; mydriasis; constipation
oxybutynin chloride N considerations
antispasmodic treatment of neurogenic bladder; take on an empty stomach; avoid alcohol, CNS depressants; avoid activities requiring alertness until med response is known; decreased ability to perspire, avoid strenuous activity in warm weather; wear sungla
tolterodine tartate aka
Detrol, Detrol LA
tolterodine tartate
genitourinary meds; anticholingerics
tolterodine tartate side effects
dry mouth; dizziness; constipation; dyspepsia; somnolence; blurred vision
tolterodine tartate N considerations
used to treat patients with overactive bladder; effective with frequency, urgency, or incontinence symptoms; patients should avoid alcohol during treatment with tolterodine; missed doses should be skipped, return to normal schedule; Rx; Preg Cat C
sildenafil citrate aka
Viagra
sildenafil citrate
genitourinary meds; erectile dysfunction agents
sildenafil citrate side effects
headache, flushing; dizziness; upset stomach; nasal congestion; UTI; abnormal vision; rash; tinnitus, hearing loss; visual disturbances
sildenafil citrate N considerations
treatment of erectile dysfunction; take approximately 1 hour before sexual activity; do not use more than once a day; tablets may be split; high-fat meal will reduce absorption, better absorption on empty stomach; never use with nitrates, could have fatal
tadalafil aka
Cialis
tadalafil
genitourinary meds; erectile dysfunction agents
tadalafil side effects
headache; dyspepsia; back pain; tinnitus, hearing loss; myalgia; nasal congestion
tadalafil N considerations
used to treat erectile dysfunction; patients with severe hepatic impairment should not take this; contraindicated in patients taking nitrates or alpha-adrenergic blockers; this does not protect against STDs; alert physician if erection lasts more than 4 h
vardenafil aka
Levitra
vardenafil
genitourinary meds; erectile dysfunction agents
vardenafil side effects
headache; nasal congestion; flushing; dyspepsia; tinnitus, hearing loss
vardenafil N considerations
used to treat erectile dysfunction; contraindicated in patients taking organic nitrates; contact physician if erection lasts over 4 hours; plasma levels peak in 30 minutes to 2 hours; stop med if hearing or visual disturbances occur; alpha blocker used wi
finasteride aka
Proscar, Propecia
finasteride
genitourinary meds; testosterone inhibitors
finasteride side effects
decreased libido; decreased volume of ejaculate; testicular pain; impotence; breast tenderness and enlargement; angioedema
finasteride N considerations
treatment of BPH by Proscar, male hair loss by Propecia; may be taken without regard for food; pregnant women should avoid contact with crushed drug or patient's semen, may adversely affect developing male fetus; full therapeutic effect: Propecia may requ
phenazopyridine HCl aka
Pyridium
phenazopyridine HCl
genitourinary meds; urinary analgesics
phenazopyridine HCl side effects
GI upset; kidney and liver toxicity; rash; headache
phenazopyridine HCl N considerations
treatment of urinary tract irritation, often paired with urinary anti-infective; do not crush tablets, can take with food or milk to decrease GI upset; inform patient that urine will be bright orange/red; monitor for signs of hepatotoxicity: dark urine, c
nitrofurantoin aka
Furadantin, Macrobid, Macrodantin
nitrofurantoin
genitourinary meds; urinary anti-infectives
nitrofurantoin side effects
dizziness; N/V, diarrhea; abdominal pain; tooth staining; hypersensitivity
nitrofurantoin N considerations
treatment of UTIs; take with food/milk; avoid alcohol; two daily doses if urine output is high or patient has diabetes; drug may turn urine rust-yellow to brown; may cause false positive glucose in urine; may increase AST and ALT; Rx; Preg Cat B
alendronate aka
Fosamax
alendronate
hormones/synthetic substitutes/modifiers; bone resorption inhibitors
alendronate side effects
esophageal ulceration; GI distress; musculoskeletal pain
alendronate N considerations
treatment of osteoporosis in postmenopausal women and Paget disease in men; onset: 1 month, peak 3-6 months, duration 3 weeks to 7 months; take in A.M. before food or other meds with full glass of water, remain upright for 30 minutes; if dose missed, skip
risedronate aka
Actonel
risedronate
hormones/synthetic substitutes/modifiers; bone resorption inhibitors
risedronate side effects
weakness; diarrhea, abdominal pain; bone pain; back pain; joint pain; dyspepsia; hypersensitivity; eye inflammation
risedronate N considerations
treatment of osteoporosis in postmenopausal women and for Paget disease; onset: within days, peak 30 days, duration up to 16 months; take in A.M. before food or other meds with full glass of water, remain upright for 30 minutes; take with calcium and vitD
etidronate aka
Didronel
etidronate
hormones/synthetic substitutes/modifiers; parathyroid agents (calcium regulators)
etidronate side effects
N, diarrhea; bone pain and tenderness; myalgia; hypersensitivity; headache; arthralgia
etidronate N considerations
treatment of Paget disease, used with total hip replacement and spinal cord injury, hyperkalemia of cancer; PO: onset 1 month, duration 1 year; IV: onset 24 hours, peak 3 days, duration 11 days; take on empty stomach with calcium and vitD, but not within
thyroid, desiccated aka
Armour Thyroid
thyroid, desiccated
hormones/synthetic substitutes/modifiers; thyroid hormones
thyroid, desiccated side effects
weight loss; palpitation; diarrhea; tachycardia; sweating
thyroid, desiccated N considerations
used to treat adult hypothyroidism; side effects are rare and generally associated with overdosing; dosed at 15-30 mg initially and titrated up every 2-3 weeks until optimum results are present; thyroid levels should be checked every 6 months after patien
levothyroxine (T4) aka
Synthroid, Levothroid
levothyroxine (T4)
hormones/synthetic substitutes/modifiers; thyroid hormones
levothyroxine (T4) side effects
weight loss; arrhythmias, tachycardia; insomnia, irritability; nervousness; heat intolerance; menstrual irregularities
levothyroxine (T4) N considerations
management of hypothyroidism, myxedema coma, thyroid hormone replacement; PO: peak 1-3 weeks, duration 1-3 weeks; IV: onset 6-8 hours, peak 24 hours; PO: take at same time daily to maintain blood level, take on empty stomach; do not switch brands unless d
alprazolam aka
Xanax
alprazolam
mental health meds; antianxiety agents
alprazolam side effects
dizziness, drowsiness; orthostatic hypotension; blurred vision
alprazolam N considerations
management of anxiety, panic disorders, premenstrual dysphoric disorders; onset 30 minutes, peak 1-2 hours, duration 4-6 hours; full therapeutic response takes 2-3 days; may be taken with food; may be habit-forming, do not take for longer than 4 months un
buspirone aka
BuSpar
buspirone
mental health meds; antianxiety agents
buspirone side effects
dizziness, headache; stimulation, insomnia, nervousness; light-headedness, numbness; N, diarrhea, constipation; tachycardia, palpitations
buspirone N considerations
management of anxiety disorders; onset 7-10 days, optimum effect may take 3-4 weeks; use caution with activities requiring alertness until response to med is known; avoid alcohol, CNS depressants, and large amounts of grapefruit juice; use caution when ch
chlordiazepoxide aka
Librium
chlordiazepoxide
mental health meds; antianxiety agents
chlordiazepoxide side effects
dizziness, drowsiness, pain at IM site, ataxia, disorientation
chlordiaepoxide N considerations
management of anxiety and treatment of alcohol withdrawal, IBS; PO: onset 1-2 hours, peak 30 minutes to 4 hours; IM: onset 15-30 minutes, slow, erratic absorption; IV: onset 1-5 minutes, duration 15-60 minutes; use caution with activities requiring alertn
diazepam aka
Valium
diazepam
mental health meds; antianxiety agents
diazepam side effects
drowsiness, fatigue, ataxia; hypotension; paradoxic anxiety, esp. in elderly; orthostatic hypotension; blurred vision
diazepam N considerations
treatment of anxiety, acute alcohol withdrawal, seizures, preoperative and skeletal muscle relaxant; PO: may be taken with food, onset 30 minutes; IM: inject deep, slowly into large muscle mass, onset 15-30 minutes, duration 60-90 minutes, slw and erratic
lorazepam aka
Ativan
lorazepam
mental health meds; antianxiety agents
lorazepam side effects
dizziness, drowsiness; orthostatic hypotension; blurred vision; weakness; disorientation; visual disturbance
lorazepam N considerations
management of anxiety, irritability in psychiatric or organic disorders, preoperatively, insomina, adjunct in endoscopic procedures; PO: onset 30 minutes, peak 1-6 hours; IM: onset 15-30 minutes, peak 60-90 minutes; IV: onset 5-15 minutes, peak unknown; m
citalopram aka
Celexa
citalopram
mental health meds; antidepressants, SSRIs
citalopram side effects
palpitations, tachycardia; N/V, diarrhea; decreased appetite; nervousness, insomnia; drowsiness; hyponatremia
citalopram N considerations
treatment of major depression; take in AM to avoid insomnia; can potentiate effects of digoxin, warfarin, and diazepam; avoid use with alcohol, CNS depressants for up to 1 week after end of therapy; use caution in potentially hazardous activities; avoid c
escitalopram oxalate aka
Lexapro
escitalopram oxalate
mental health meds; antidepressants, SSRIs
escitalopram oxalate side effects
N, diarrhea, constipation; insomnia; fatigue, drowsiness; decreased libido, sexual dysfunction; increased sweating; increased appetite, heartburn, stomach pain; flulike symptoms, runny nose, sneezing; dry mouth; dizziness; labile blood sugar; hypokalemia;
escitalopram oxalate N considerations
treatment of major depression, anxiety; take consistently at same time of day, full therapeutic effect may require 4 weeks; may require gradual reduction before stopping; can potentiate effects of digoxin, warfarin, diazepam; use caution in potentially ha
fluoxetine HCl aka
Prozac
fluoxetine HCl
mental health meds; antidepressants, SSRIs
fluoxetine HCl side effects
palpitations; N, diarrhea, constipation; decreased appetite with significant weight loss; nervousness, insomnia; urinary retention; drowsiness; rash, pruritus, excessive sweating; fatigue
fluoxetine HCl N considerations
treatment of depression/OCD, bulimia, PMDD; take consistently at same time of day, full therapeutic effects may require 4 weeks; can potentiate effects of digoxin, warfarin, diazepam, NSAID, and aspirin; used for anorexia, not suicidal or homicidal emotio
paroxetine HCl aka
Paxil
paroxetine HCl
mental health meds; antidepressants, SSRIs
paroxetine HCl side effects
palpitations; N/V, diarrhea, constipation; hyponatremia; decreased appetite; nervousness, insomnia
paroxetine HCl N considerations
treatment of anxiety, depression, OCD and social anxiety disorder, panic disorder, PTSD; take consistently at same time of day, therapeutic effects in up to 4 weeks; do not chew or crush; may increase risk of suicidal thoughts or behavior or bleeding; avo
sertraline HCl aka
Zoloft
sertraline HCl
mental health meds; antidepresants, SSRIs
sertraline HCl side effects
headache; dizziness; tremor; N, diarrhea; insomnia; dry mouth; male sexual dysfunction
sertraline HCl N considerations
treatment of depression, OCD, panic disorder with or without agoraphobia, PTSD, PMDD, and social phobia; take consistently at same time of day, therapeutic effects take up to 4 weeks; can potentiate effects of digoxin, warfarin, diazepam, aspirin, and NSA
amitriptyline
mental health meds; antidepressants, tricyclic
amitriptyline side effects
sedation/drowsiness; blurred vision, dry mouth, diaphoresis; postural hypotension, palpitations; N/V, diarrhea; constipation, urinary retention; increased appetite; sexual dysfunction; confusion; cardiac dysrhythmias
amitriptyline N considerations
treatment of major depression; suicide risk high after 10-14 days due to increased energy; avoid use with alcohol; sunblock required; increase fluid intake; take dose at bedtime due to sedative effects; heavy smokers may require a larger dose; use safety
doxepin
mental health meds; tricyclic antidepressants
doxepin side effects
sedation/drowsiness; blurred vision, dry mouth, diaphoresis; postural hypotension, palpitations; N/V, diarrhea; constipation, urinary retention; anorexia; sexual dysfunction
doxepin N considerations
psychoneurotic patient with depression and or anxiety, hyponotic for insomnia; avoid use with alcohol; suicide risk high after 10-14 day due to increased energy; increase fluid intake; take dose at bedtime due to sedative effect; heavy smokers may require
imipramine aka
Tofranil
imipramine
mental health meds; antidepressants, tricyclic
imipramine side effects
sedation/drowsiness; dry mouth; postural hypotension, palpitations; diarrhea; urinary retention; anorexia; confusion
imipramine N considerations
psychoneurotic patient with depression and anxiety, hypnotic for insomnia; full therapeutic effect may take 2-3 weeks; drug is dispensed in small amounts at beginning of treatment due to suicide potential; use safety precautions with hazardous activity; a
nortriptyline aka
Pamelor
nortriptyline
mental health meds; antidepressants, tricyclic
nortriptyline side effects
sedation/drowsiness; blurred vision, dry mouth, diaphoresis; postural hypotension, palpitations; N/V, diarrhea;constipation, urinary retention; increased appetite; sexual dysfunction
nortriptyline N considerations
treatment of major depression; avoid use with alcohol, CNS depressants; suicide risk high after 10-14 days due to increased energy; increase fluid intake; take dose at bedtime due to sedative effect; heavy smokers may require a larger dose; use safety pre
bupropion HCl aka
Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban
bupropion HCl
metnal health meds; other antidepressants
bupropion HCl side effects
agitation; N/V; headache; dry mouth; tremor; hypertension; insomnia; nervousness
bupropion HCl N considerations
treatment of depression and smoking cessation; if missed dose for depression, take ASAP and space remaining doses at not less than 4-hour intervals; if missed dose for smoking cessation, omit dose; may require gradual reduction before stopping;avoid use w
duloxetine hydrochloride aka
Cymbalta
duloxetine hydrochloride
mental health meds; other antidepressants
duloxetine hydrochloride side effects
N/V, diarrhea, constipation; decreased appetite, stomach pain; heartburn; dry mouth; increased urination, difficulty urinating; dizziness, headache; tiredness, weakness, drowsiness; muscle pain or cramps; increased sweating, night sweats; sexual dysfuncti
duloxetine hydrochloride N considerations
treatment of depression, anxiety, diabetic neuropathy, and fibromyalgia; take the same time daily, once or twice a day for depression, once a day for anxiety, diabetic neuropathy, or fibromyalgia, full therapeutic effects may require 4 weeks; may require
mirtazapine aka
Remeron
mirtazapine
mental health meds; other antidepressants
mirtazapine side effects
drowsiness, dizziness; increased appetite, weight gain; constipation; dry mouth; somnolence
mirtazapine N considerations
treatment of depression; do not use within 14 days of MAOI; may require gradual reduction before stopping; check with clinician before taking OTC cold remedy; avoid use with alcohol, CNS depressants for up to 1 week after end of therapy; use caution in po
trazodone
mental health meds; other antidepressants
trazodone side effects
drowsiness; hypotension; dry mouth; N; dizziness; priapism; hyponatremia; somnolence; blurred vision; constipation
trazodone N considerations
treatment of major depression; take with or immediately after meals to lessen GI upset; if dose is missed, take immediately, unless within 4 hours of next dose; may require gradual reduction before stopping; avoid use with alcohol, CNS depressants for up
venlafaxine aka
Effexor, Effexor XR
venlafaxine
mental health meds; other antidepressants
venlafaxine side effects
abnormal dreams, insomnia; anxiety, nervouseness; dizziness, weakness; headache; abdominal pain; N/V, diarrhea; anorexia, weight loss; sexual dysfunction; sedation; mydriasis; hypertension; serotonin syndrome
venlafaxine N considerations
treatment of major depression or relapse, generalized anxiety disorder; take with food, extended-release tablets should be swallowed whole; if dose is missed, take immediately unless time for next dose; may require gradual reduction before stopping if tak
haloperidol aka
Haldol
haloperidol
mental health meds; antipsychotics
haloperidol side effects
drowsiness; dizziness; hallucinations; tardive dyskinesia; tachycardia; hypotension; confusion; hypertension; dystonia; hyperpyrexia; schizophrenia
haloperidol N considerations
treatment of Tourette syndrome, schizophrenia; PO concentrate: dilute with water, not coffee or tea; PO: take with food or full glass of water/milk; IM: inject slowly, deep into UOQ of buttock, have patient lie down for 30 minutes, do not give IV; avoid a
olanzapine aka
Zyprexa
olanzapine
mental health meds; antipsychotics
olanzapine side effects
somnolence; agitation; hostility; dizziness; rhinitis; nervousness; joint pain; dry mouth; headache; insomnia; increase appetite and weight gain; fatigue
olanzapine N considerations
useful in schizophrenia and bipolar I disorder; has been used successfully in manic episodes associated with bipolar I; use caution when rising due to postural hypotension possiblity; dosage should be managed tightly when established; use caution when ope
risperidone aka
Risperdal
risperidone
mental health meds; antipsychotics
risperidone side effects
drowsiness; tardive dyskinesia; dizziness; constipation; hypersensitivity; NMS; hyperglycemia; dysphagia; priapism
risperidone N considerations
treatment of schizophrenia and bipolar I disorder, autistic disorder; avoid use with alcohol, CNS depressants; use caution in potentially hazardous activities; avoid changing positions (lying/sitting/standing) rapidly; notify clinician if fever, sore thro
quetiapine aka
Seroquel
quetiapine
mental health meds; antipsychotics
quetiapine side effects
drowsiness; dizziness; hyperglycemia; hypertension; dry mouth; somnolence; dyspepsia; weight gain
quetiapine N considerations
used in treatment of schizophrenia, bipolar I disorder; avoid use with alcohol, CNS depressants; use caution in potentially hazardous activities; avoid changing positions rapidly; notify clinician if fever, sore throat, bruising/bleeding, tics/spasms, tre
ziprasidone HCl aka
Geodon
ziprasidone HCl
mental health meds; antipsychotics
ziprasidone HCl side effects
drowsiness; tardive dyskinesia; dizziness; constipation;somnolence; abnormal vision; V; headache; hyperglycemia; NMS
ziprasidone HCl N considerations
used in treatment of schizophrenia, bipolar I disorder; avoid use with alcohol, CNS depressants; use caution in potentially hazardous activities; avoid changing positions (lying/sitting/standing) rapidly; notify clinician if fever, sore throat, bruising/b
methylphenidate HCl aka
Concerta, Ritalin
methylphenidate HCl
mental health meds; Attention deficit disorder agents
methylphenidate HCl side effects
headache; resp. infections; hyperhidrosis; decreased appetite; visual disturbance; abdominal pain; cough; N; insomnia; restlessness
methylphenidate N considerations
used to treat ADD/ADHD in children over 6 years old and depression in elderly, narcolepsy; Concerta is time-released and should be swallowed whole, not chewed; this prescription cannot be refilled; dosage is adjusted in 18-mg increments to a maximum of 54
carbamazepine aka
Tegretol, Tegretol XR
carbamazepine
mental health meds; bipolar agents
carbamazepine side effects
myelosuppression; dizziness, drowsiness; ataxia; diplopia, rash; photosensitivity; N/V
carbamazepine N considerations
management of bipolar disorder, seizures, trigeminal neuralgia, diabetic neuropathy; avoid driving and other activities requiring alertness for the first 3 days; monitor blood levels, CBC regularly, espeially during first 2 months, periodic eye exams; tak
divalproex sodium aka
Depakote
divalproex sodium
mental health meds; bipolar agents
divalproex sodium side effects
sedation, drowsiness, dizziness; mental status and behavioral changes; N/V, constipation, diarrhea, heartburn; prolonged bleeding time; teratogenicity; pancreatitis; hepatotoxicity
divalproex sodium N considerations
management of seizures, manic episodes assoc. with bipolar disorder (delayed-release only), migraine prophylaxis (delayed- and extended-release only); take with or immediately after meals to lessen GI upset; swallow tablets or capsules whole (no crushing,
lithium aka
Lithobid
lithium
mental health meds; bipolar agents
lithium side effects
dizziness; impaired vision;fine hand tremors; reversible leukocytosis; signs of intoxication: V, diarrhea, drowsiness, muscular weakness, ataxia
lithium N considerations
controls manic episodes in manic-depressive individuals, mood stabilizer; use caution in potentially hazardous activities; check serum levels 2 times weekly during treatment, q 2-3 months on maintenance, draw blood in AM prior to dose; target serum levels
temazepam aka
Restoril
temazepam
mental health meds; hypnotics
temazepam side effects
drowsiness; dizziness; lethargy; weakness; euphoria; anorexia; headache; fatigue
temazepam N considerations
used for short-term (7-10 days) treatment of insomnia; should be avoided in patients under the age of 18; avoid alcohol while taking this drug; not intended for use for more than 10 days; when used with CNS depressants, the CNS depression is increased; "s
zaleplon aka
Sonata
zaleplon
mental health meds; hyponotics
zaleplon side effects
headache; myalgia; dizziness; asthenia; dyspepsia; eye pain
zaleplon N considerations
used in short-term insomnia treatment; Zalepion does not prolong sleep time or decrease awakenings; elderly patients generally benefit the most; because of rapid onset, patients should take immeiately before bedtime; avoid alcohol while using this med; ma
zolpidem tartrate aka
Ambien
zolpidem tartrate
mental health meds; hyponotics
zolpidem tartrate side effects
headache; drowsiness; influenza-like symptoms; dizziness; N; "drugged" feeling
zolpidem tartrate N considerations
short-term treatment of insomnia; dosage may need to be adjusted down if patient is using a CNS depressant to avoid an addictive effect; side effects increase with prolonged usage; may cause "sleep driving"; may worsen depression; monitor for suicidal tho
allopurinol aka
Aloprim, Zyloprim
allopurinol
musculoskeletal meds; antigout agents
allopurinol side effects
GI upset; headache, drowsiness; rash
allopurinol N considerations
treatment of gout, uric acid neuropathy, uric acid stone formation; encourage 10-12 glasses water/day; check CBC and renal function tests; take with food, don't take vitC or iron; initial therapy can increase attacks of gout; avoid use of alcohol, eating
colchicine aka
Colcrys
colchicine
musculoskeletal meds; antigout agents
colchicine side effects
N/V, diarrhea; sign of toxicity, abdominal cramp; agranulocytosis; pharyngolaryngeal pain
colchicine N considerations
treatment and prevention of acute gout attacks, familial Mediterranean fever; has analgesic, anti-inflammatory effects; may be taken without regard to meals; IV: slowly, do not administer IM/subQ; encourage 10-12 glases water/day; avoid use of alcohol, ea
probenecid aka
Probalan
probenecid
musculoskeletal meds; antigout agents
probenecid side effects
N; sore gums, anorexia; hypersensitivity; skin rash; hemolytic anemia
probenecid N considerations
treatment of hyperuricemia associated with gout, gouty arthritis; check BUN, renal function tests; encourage 8-10 glasses water/day; give with milk, food, and antacids; avoid use of alcohol, eating organ meats, gravy, legumes; may also be used with penici
diclofenac Na aka
Voltaren
diclofenac Na
musculoskeletal meds; nonsalicylate NSAIDs, antirheumatics
diclofenac Na side effects
N; sore gums, anorexia; hypersensitivity; skin rash; hemolytic anemia
diclofenac Na N considerations
used in arthritic conditions, dysmenorrhea; ophthalmic: reduce inflammation after cataract extraction; PO: take with full glass of water and food and remain upright for 30 minutes; if dose missed, take within 2 hours; use sunscreen to prevent photosensiti
etodolac
musculoskeletal meds; nonsalicylate NSAIDs, antirheumatics
etodolac side effects
nephrotoxicity; N; blood dyscrasias; anorexia; dizziness; hypertension; hypersensitivity
etodolac N considerations
reduces pain of osteoarthritis, rheumatoid arthritis; monitor for signs of toxicity, blurred vision, ringing or roaring in ears; full therapeutic effect may take up to 1 month; avoid concurrent use of ASA, NSAIDs, acetaminophen, alcohol; may increase risk
ibuprofen aka
Advil, Motrin IB
ibuprofen
musculoskeletal meds; nonsalicylate NSAIDs, antirheumatics
ibuprofen side effects
N/V, diarrhea, constipation; headache, dizziness; fluid retention; GI bleeding; hives; rash
ibuprofen N considerations
treatment of rheumatoid arthritis/osteoarthritis, relief of mild/moderate, antipyretic; take with milk/food; use cautiously with aspirin allergy; monitor for visual disturbances, tinnitus; monitor for increased weight gain, edema, fever, hematuria, arthra
indomethacin aka
Indocin
indomethacin
musculoskeletal meds; nonsalicylate NSAIDs, antirheumatics
indomethacin side effects
peptic ulcer; dizziness
indomethacin N considerations
treatment of rheumatoid arthritis/osteoarthritis, acute gout, acute painful shoulder; observe for bleeding problems; PO: take with food/milk, encourage upright position for 15-30 minutes; use caution with potentially hazardous activities; avoid use with a
naproxen Na aka
Aleve, Anaprox, Naprosyn
naproxen Na
musculoskeletal meds; nonsalicylate NSAIDs, antirheumatics
naproxen Na side effects
N; dizziness; headache; asthma; GI bleeding; hives
naproxen Na N considerations
for mild to moderate pain, treatment of arthritis, primary dysmenorrhea; PO: with food to decrease GI upset, on empty stomach to increase absorption; monitor for signs of toxicity, blurred vision, ringing or roaring in ears; full therapeutic effect may ta
piroxicam aka
Feldene
piroxicam
musculoskeletal meds; nonsalicylate NSAIDs, antirheumatics
piroxicam side effects
drowsiness; headache; hypertension; hypersensitivity; GI disturbances, bleeding or ulcer
piroxicam N considerations
for mild to moderate pain, osteoarthritis, rheumatoid arthritis; PO: with food to decrease GI upset, on empty stomach to increase absorption; take at same time every day; monitor for signs of toxicity: blurred vision, ringing or roaring in ears, jaundice;
salsalate aka
Disalcid
salsalate
musculoskeletal meds; salicylates, antirheumatics
salsalate side effects
N/V, GI bleeding; vertigo; heartburn; rash; tinnitus
salsalate N considerations
for mild to moderate pain, rheumatoid arthritis, and osteoarthritis; PO: can be crushed or taken whole, take with food or milk to derease GI upset; full therapeutic effect may take 2 weeks; read label on OTC meds, may contain ASA; monitor for signs of tox
baclofen aka
Lioresal
baclofen
musculoskeletal meds; skeletal muscle relaxants
baclofen side effects
drowsiness; dizziness; weakness, fatigue; confusion; N/V; headache; seizures
baclofen N considerations
used to reduce spasticity in multiple sclerosis, spinal cord injury, flexor spasms, and muscular rigidity; take with food; avoid alcohol, CNS depressants; increase risk of seizures in patients with seizure disorder; withdraw gradually over 1 to 2 weeks, u
carisoprodol aka
Soma
carisoprodol
musculoskeletal meds; skeletal muscle relaxants
carisoprodol side effects
drowsiness; light-headedness; headache; dizziness; N
carisoprodol N considerations
relief of pain, stiffness associated with musculoskeletal conditions; PO: onset 30 minutes, peak 4 hours, duration 4-6 hours; avoid alcohol, CNS depressants, including OTC cold or allergy meds; avoid activities requiring alertness until effects of med are
cyclobenzaprine aka
Flexeril
cyclobenzaprine
musculoskeletal meds; skeletal muscle relaxants
cyclobenzaprine side effects
drowsiness; dizziness; fatigue; dry mouth; constipation; headache
cyclobenzaprine N considerations
relieves muscle spasms from acute conditions; avoid alcohol, CNS depressants, including OTC cold or allergy meds; avoid activities requiring alertness until effects of med are known; Rx; Preg Cat B
metaxalone aka
Skelaxin
metaxalone
musculoskeletal meds; skeletal muscle relaxants
metaxalone side effects
drowsiness; GI pains; nervousness; dizziness; headache; irritability
metaxalone N considerations
used to relieve painful musculoskeletal injuries; should be an adjnct to rest and physicial therapy; avoid alcohol while using this drug; use caution when operating machinery; use cautiously in patients with known liver impairment; may cause false positiv
methocarbamol aka
Robaxin
methocarbamol
musculoskeletal meds; skeletal muscle relaxants
methocarbamol side effects
drowsiness; light-headedness; dizziness; N
methocarbamol N considerations
relieves muscle spasms from acute conditions, tetanus management; IM: inject deep into UOQ of buttock, rotate sites; NG tube: crush tablets into fluid; PO: take with food/milk; metallic taste may develop urine may turn green, black, or brown; avoid alcoho
benztropine aka
Cogentin
benztropine
neurological meds
benztropine side effects
dry mouth; constipation; anhidrosis; weakness; tardive dyskinesia
benztropine N considerations
treatment of Parkinson symptoms, EPS associated with neuroleptic drugs, acute dystonic rxns; IM/IV: onset 15 minutes, duration 6-10 hours; PO: onset 1 hour, duration 6-10 hours; tablets may be crushed and mixed with food; taper med over a week, or withdra
caffeine/ergotamine aka
Cafergot
caffeine/ergotamine
neurological meds
caffeine/ergotamine side effects
headache; tremors, convulsions; blood vessel contraction, with decreased circulation, esp. in limbs; toxic erotism: N/V, diarrhea, dizzines headache, mental confusion
caffeine/ergotamine N considerations
treatment of vascular headache; take at onset of pain/during prodromal stage to abort headache; lie down in darkened quiet room for several hours; Rx; Preg Cat X
carbidopa/levodopa aka
Sinemet
carbidopa/levodopa
neurological meds
carbidopa/levodopa side effects
twitching; headache, dizzines; mental changes: confusion, agitation, mood alterations; dark urine/sweat; cardiac arrhythmias
carbidopa/levodopa N considerations
treatment for Parkinson disease and syndrome; replacement dopaminergic agent; change positions slowly; take with food, decreased effects with liver, pork, wheat germ, and vitB6; full therapeutic effect may take several months; monitor for melanoma; may ca
donepezil aka
Aricept
donepezil
neurological meds
donepezil side effects
N/V, diarrhea; headache, dizziness; fatigue; twitching; cardiac arrhythmias;insomnia; seizures; rash; dark urine/sweat; mental changes: confusion, agitation, mood alterations
donepezil N considerations
used in treatment of mild to moderate Alzheimer's disease; drug does not cure, but stabilizes or relieves symptoms; take at regular intervals; take b/w meals or may be given with meals to decrease GI upset; may increase BUN, SGOT, GPT; Rx; Preg Cat C
eletriptan hydrobromide aka
Relpax
eletriptan hydrobromide
neurological meds
eletriptan hydrobromide side effects
coronary artery vasospasm; transient myocardial ischemia; MI; ventricular tachycardia; ventricular fibrillation; asthenia; N; dizziness; somnolence; hypertension; diaphoresis; seizure
eletriptain hydrobromide N considerations
indicated for treatment of migraine headaches with and without aura; may be taken with or without food; teach patient to call physician or seek immediate medical help for chest pain or SOB; teach patient to call physician or seek immediate medical help fo
methylphenidate aka
Concerta; Ritalin
methylphenidate
neurological meds
methylphenidate side effects
hyperactivity, insomnia; restlessness; talkativeness; palpitations, tachycardia; hyperhidrosis; anorexia; visual disturbance; N; abdominal pain; cough
methylphenidate N considerations
management of ADHD, narcolepsy, depression in elderly; onset 30 minutes, duration 4-6 hours; take at least 6 hours before bedtime (regular-release) or 10 hours before bedtime (sustained-release, extended-release); taper med over several weeks or depressio
selegiline aka
Eldepryl
selegiline
neurological meds
selegiline side effects
dizziness; cardiac dysrhythmias; rhinitis; N; pain; headache; back pain; dyspepsia; insomnia
selegiline N considerations
indirect-acting dopaminergic agent; used in management of Parkinson disease with levodopa/carbidopa; do not use with tricyclics or opioids, do not use with meperidine; monitor for signs of toxicity: twitching, eye spasms; do not stop abruptly, parkinsonia
zolmitriptan aka
Zomig
zolmitriptan
neurological meds
zolmitriptan side effects
weakness, neck stiffness; tingling, hot sensation, burning, feeling of pressure, tightnes; numbness, dizziness, sedation; hypertension; dyspepsia; dry mouth
zolmitriptan N considerations
used for treatment of acute migraine with or without aura; take as soon as symptoms occur; PO: tablet may be split; avoid foods high in tyramine: cheese, pickled products, alcohol, large amounts of caffeine; may cause serotonin syndrome when used with ant
dorzolamide HCl aka
Trusopt
dorzolamide HCl
ophthalmics; antiglaucoma meds
dorzolamide HCl side effects
ocular burning, stinging, discomfort; blurred vision, tearing, or dryness; photophobia; bitter taste in mouth
dorzolamide HCl N considerations
treatment of glaucoma and ocular hypertension; wash hands beofre and after instillation; do not touch tip of dropper to eye or body; do not wear contact lens during instillation; drug is sulfonamide, although given topically, it can be absorbed systemical
desired effect
aka therapeutic effect
action for which drug is prescribed
adverse effects
harmful unintended reactions
toxic effect
serious adverse effect that occurs when plasma concentrations of drug reach dangerous, life threatening levels
side effect
response that is unrelated to desired action of drug
cumulative action
when repeated dose of drug accumulates in the body and exerts greater biologic effect than the initial dose
drug dependence
physical or psychological reliance on chemical agent resulting from continued use,abuse or addiction
idiosyncratic response
individuals unique, unpredictable response
paradoxical reaction
response that contrasts sharply with the usual, expected response
tolerance
ability to endure ordinarily injurious amounts of drug or decreasing efects obtained from established dose.
requires increasing dose to possibly toxic levels to acquire the same effect
hypersensitivity
excessive allergic reaction to an exogenous agent
therapeutic index
ratio between lethal dose and therapeutic dose.
a guide to safe dosing.
a high TI is preferable to a low TI (narrow margin of safety)
peak level
highest concentration of drug.
1 to 2 hours after oral.
1 hour after IM.
30 minutes after IV.
trough (residual) level
lowest concentration of drug.
preferably within 15 minutes of next scheduled dose.
opioid analgesics fxn
bind to opiate receptors in CNS.
result in diminished transmission and perception of pain impulse.
opioid analgesics examples
morphine (MS Contin), codeine, meperidine (Demerol), hydromorphone (Dilaudid), fentanyl, tapentadol, hydrocodone
opioid analgesics side effects
respiratory depression (major)
constipation (most common)
lethargy, mental cloudiness, N & V, hypotension, urinary retention, euphoria, allergy, pruritis
opioid antagonist
reverses effect of opioid analgesic in case of overdose or sign of adverse effects.
ex: naloxone (Narcan) , naltrexone (Vivitrol)
NSAIDS fxn
act on peripheral nerve endings and decrease inflammatory mediators by prostaglandin synthesis.
have analgesic, antinflammatory and antipyretic effects.
NSAIDS examples
aspirin (Ecotrin), ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve)
NSAIDS side effects
GI ulceration and bleeding (most common)
Tarry stool (melena), kidney or liver impairment, N & V, constipation, diarrhea, impaired coag, visual disturbance, headache, confusion, seizures, htn, fluid retention
Tinnitus WITH ASPIRIN
NSAID Administration
Preferably with food and a full glass of water
Nonopioid analgesics fxn
analgesic effect caused by inhibition of CNS prostaglandin synthesis.
no effect on peripheral prostaglandin synthesis therefore no antiinflammatory action.
Nonopioid analgesic example
acetaminophen (Tylenol)
non opioid analgesic side effects
Few if therapy short term.
Hemolytic anemia, hepatotoxicity, seizure, coma, death.
avoid exceeding 4 g daily
Killed vaccines
Antigenic preparations containing killed microbes
Killed vaccines examples
Pertussis and typhoid
Live vaccines
Antigenic preparations containing weakened (attenuated) microbes; typically such vaccines are more antigenic than killed preparations
Live vaccines examples
Measles
Toxoid vaccines
Antigenic preparations composed of inactivated bacterial toxins
Toxoid vaccines examples
Tetanus and diptheria
Bactericidal effect
Destroys bacteria at low concentrations
Bacteriostatic effect
Slows reproduction of bacteria
Superinfection
AKA secondary infection.
Emergence of microorganism growth when natural protective flora are destroyed by an anti infective drug.
Common Signs of Superinfection
Vaginal itching
Diarrhea
Change in cough or sputum
White plaques in mouth
Bacterial resistance
Natural or acquired characteristic of an organism that prevents destruction by a drug to which it was previously susceptible
Antibiotics fxn
Destroy bacteria or inhibit bacterial reproduction to control infection. Do so by interfering with or inhibiting cell wall synthesis of RNA or DNA of pathogen.
Available in oral, parenteral, and topical forms.
Antibiotic Major Side Effects
Depressed appetite (altered taste)
Normal flora imbalance: N & V, diarrhea, suppressed nutrient absorption, inc excretion of water soluble vitamins and minerals, superinfection
Allergic rxn
Nephrotoxicity
Effect of Antibiotics on Oral Contraceptives
Render them ineffective (don't work)
Antibiotic Administration
Administer most preparations 1 hour before meals or 2 hours after meals for best absorption
Classes and Examples of Antibiotics
Penicillins
Cephalosporins
Erythromycin
Tetracyclines
Aminoglycosides
Quinolones
Polymyxin group
Glycopeptides
Penicillin examples
amoxicillin & clavulanate (Augmentin)
ampicillin and sulbactam (Unasyn)
piperacillin and tazobactam (Zosyn)
*Penicillins combined to prevent resistance
Cephalosporin examples
cefazolin (Ancef
cephalexin (Keflex)
Erythromycin examples
clindamycin HCl (Cleocin HCl)
azithromycin (Zithromax)
erythromycin (Ery-tab, Eryc)
Tetracycline examples
doxycycline (Vibramycin)
tetracycline (Sumycin)
Tetracycline Specific Side Effects
Hepatotoxicity
Phototoxicity
Hyperuricemia (impaired kidneys)
Enamel hypoplasia, dental caries and bone defects in children younger than 8 due to drug binding to calcium in tissue
Tetracycline Teaching
Explain why they are contraindicated during last half of pregnancy or children younger than 8 years of age.
Assess for potentiation if currently receiving oral anticoagulants.
Teach to avoid direct sunlight.
Advise to avoid dairy products, antacids or iro
Aminoglycoside examples
gentamicin
neomycin
streptomycin
Aminoglycoside Specific Side Effects
Ototoxicity (affects 8th cranial nerve)
Leukopenia
Thrombocytopenia
Neurotoxicity: headache, confusion, peripheral neuropathy
Nephrotoxicity
Respiratory paralysis
Aminoglycosides Teaching
Assess for potentiation if client is receiving neuromuscular blocking agents, general anesthetic or parenteral Mg.
Monitor renal and neurologic fxn.
Quinonolones examples
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
Polymyxin group example
Polymyxin B
Glycopeptide example
vancomycin (Vancocin)
Vancomycin Specific Side Effects
Ototoxicity (hearing loss)
Nephrotoxicity
Vancomycin Nursing Care
Assess peak and trough blood levels because these drugs have a narrow therapeutic range.
Incompatible with heparin.
Antivirals fxn
Prevent entrance of virus into host cells.
Provide prophylaxis after exposure to a person with a viral infection.
Available in oral, intravenous and topical preparations.
Antivirals examples
acyclovir (Zovirax)
amantadine (Symmetrel)
zanamivir (Relenza)
oseltamivir (Tamiflu)
Antivirals Major Side Effects
CNS stimulations
Depressed cardiovascular system: Orthostatic hypotension, dizziness
Constipation
Nephrotoxicity
Local irritation
Antiviral Nursing Care
Encourage intake of foods rich in immune stimulating nutrients.
Encourage intake of high fiber foods to prevent constipation.
Sulfonamides
Substitute a false metabolite for PABA, required in bacterial synthesis of folic acid.
Mainly used to treat urinary tract infections.
Available in oral , parenteral (IM & IV) and topical preparations.
Sulfonamide example
sulfisoxazole
combination products such as sulfamethoxazole and trimethoprim (Bactrim, Septra)
Sulfonamide Major Side Effects
N & V
Hypersensitivity: Skin rash, photosensitivity, allergic response, anaphylaxis
Decreased blood cells: Malaise, blood dyscrasias
Crystalluria (if acidic urine)
Stomatitis (inflamed oral mucosa)
Headache
Sulfonamide Nursing Care
Promote increased fluid intake.
Caution to avoid direct sunlight.
Maintain alkaline urine.
Check peak and trough levels.
Monitor blood work due to potential of megaloblastic anemia caused by folacin deficiency.
Monitor for dysuria and urinary output.
Antifungals fxn
Destroy fungal cells (fungicidal) or inhibit reproduction of fungal cells (fungistatic).
Can treat systemic and localized fungal infections.
Available in oral, IV, topical, vaginal and intrathecal preparations.
Antifungals Examples
amphotericin B (Fungizone) and nystatin (Mycostatin, Nilstat): disrupt fungal cell membrane permeability
fluconazole (Diflucan): disrupts fungal cell membrane fxn
griseofulvin (Gris-PEG): disrupts fungal nucleic acid synthesis
Antifungals Major Side Effects
N & V
Neurotoxicity: Headache and parasthesia
Blood dyscrasias
Amphotericin B Specific Nursing Care
Use infusion control device for IV.
Protect solution from light.
Monitor blood work - can cause hypokalemia and inc urinary excretion of Mg
Premedicate with antipyretics, corticosteroids, antihistamines and antiemetics before administering.
Griseofulvin Specific Nursing Care
Assess for antagonistic effect if concurrently taking oral anticoagulants
Instruct to avoid direct exposure to sunlight
Antiparasitics fxn
Interfere with parasite metabolism and reproduction.
Treat parasitic diseases.
Available in oral, parenteral, vaginal and rectal preparations.
Antiparasitic examples
anthelmintics: mebendazole
amebicides: chloroquine phosphate (Aralen) and metronidazole (Flagyl)
Antimalarials: chloroquine phosphate (Aralen), hydroxychloroquine (Plaquenil), quinine (Qualaquin)
Antiprotozoals: pentamidine (NebuPent, Pentam 300)
Anthelmintics Major Side Effects
GI irritation: N & V, diarrhea
CNS disturbances
skin rash
Amebicides Major side effects
GI irritation: N & V, diarrhea
Blood dyscrasias
Skin rash
Headache
Dizziness
Antimalarials Major Side Effects
N & V
Blood dyscrasias
Visual disturbances : impaired accomodation, retinal and corneal changes. MOST COMMON
Antiparasitic Nursing Care
Administer with meals to decrease GI irritation
Monitor blood work for dyscrasias
Instruct regarding hygiene practices
Ensure safety if CNS effects
For antimalarials encourage frequent visual examinations!
Instruct to report unusual bruising or bleeding.
Solute
dissolved substance
Solvent
Substance in which solute is dissolved
Solution
Substances that dissolve in other substances form solutions
Hypotonic
aka dilute
Small amount of solute in a relatively large amount of solvent
Cells swell so there is more fluid vs solute
Hypotonic fluid example
0.45% NaCl
Hypertonic
aka concentrated
Large amount of solute in a relatively small amount of solvent
Hypertonic fluid example
5% dextrose in NS
Isotonic
when osmotic pressures of two liquids are equal, flow of solvent equalizes and the two solutions are said to be isotonic to each other
Isotonic fluid example
0.9% sodium chloride
Dextrose in Water IV Fluids
Provides fluid and limited calories. Can result in negative nitrogen balance if client is not eating.
Corrects dehydration, ketosis and hypernatremia.
1 L of 5% dextrose = 170 calories
Dextrose in NaCl IV Fluid
Corrects fluid loss from excessive perspiration or vomiting
Prevents alkalosis
NaCL IV Fluid
Manages alkalosis, fluid loss, and adrenal cortical insufficiency
Ringer's Solution IV Fluid
Contains sodium, chloride, potassium and calcium.
Corrects dehydration from vomiting, diarrhea or inadequate intake
Lactated Ringer's Solution IV Fluid
Contains sodium, chloride, potassium, calcium and lactate.
Lactate is metabolized by the liver and forms bicarbonate.
Corrects extracellular fluid shifts and moderates metabolic acidosis.
Plasma expander IV fluids
Increase blood volume in clients with burns or traumatic injuries.
Examples of Plasma Expanders
Albumin
Plasma
Plasma protein fraction (Plasmanate)
Dextran (Gentran 40)
Hetastarch (Hespan)
General Anesthetics
Used in combination to produce varying levels of loss of consciousness, amnesia, anesthesia, analgesia and or skeletal muscle relaxation.
Depresses CNS through progressive sequence
Four phases of anesthesia induction
1) Client becomes drowsy and loses consciousness
2) Stage of excitement - muscles become tense, breathing irregular
3) Vital signs and reflexes are depressed; operation begins
4) Respiratory depression is complete
Anesthetics available in...
IV, IM or inhalation preparations
Neuromuscular Blocking Agents
Inhibit transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine.
Neuromuscular blocking agent examples
Pancuronium (Pavulon)
Succinylcholine (Anectine)
Major side effects of neuromuscular blocking agents
Hypotension
Respiratory depression
Dysrhythmias
Inhalation anesthetic examples
halothane (Fluothane)
Nitrous oxide
Major side effects of inhalation anesthetics
Excitement and restlessness during induction
N & V (stimulation of chemoreceptor trigger zone in medullary vomiting center)
Respiratory distress
Affinity for adipose tissue -- prolonged effects
Malignant hyperthermia
Malignant hyperthermia
Rare life threatening condition, associated with muscle rigidity, pyrexia and tachycardia.
Susceptibility linked to autosomal dominant disorder.
Barbiturates in Anesthesia
Ultra short acting IV barbiturates are used in induction of anesthesia because they quickly penetrate the blood brain barrier
High lipoid affinity promptly affects cerebral tissue
IV barbiturate examples
Methohexital (Brevital)
Thiopental (Pentothal)
Major side effects of IV barbiturates
Respiratory depression
Hypotension and tachycardia
Laryngospasm
IV and IM nonbarbiturates in Anesthesia
IV and IM nonbarbiturates produce special type of anesthesia in which client appears to be awake but dissociated from environment, resulting in amnesia.
Induce cataleptic state.
IV and IM nonbarbiturates examples
Midazolam (Versed)
Combination product: fentanyl (Sublimaze) and droperidol (Innovar)
Major side effects of IV and IM nonbarbiturates
Respiratory failure
Changes in BP: hyper or hypo
Rigidity of muscles
Psychic disturbance during recovery
Conscious sedation
IV or nasal routes of sedation to depress consciousness but maintains airway and ventilations
Conscious sedation examples
midazolam (Versed)
ketamine (Ketalar)
fentanyl (Sublimaze)
Local anesthetics
Block nerve impulse conductino in sensory, motor and autonomic nerve cells by decreasing nerve membrane permeability to sodium ion influx; used for pain control without loss of consciousness
Local anesthetic uses
Used for obstetric, dental and minor surgical procedures.
Can also be used for postoperative pain control when administered subcutaneously on a continuous basis.
Local anesthetic available in...
Topical, spinal, regional and nerve block preparations.
Use of epinephrine with local anesthetic
May be added to local anesthetic to enhance duration of local anesthetic effect and to decrease regional bleeding
Topical local anesthetic site and examples
Local infiltration of tissue
benzocaine (Solarcaine)
lidocaine (Xylocaine)
tetracaine (Pontocaine) - nerve block for spinal anesthesia
Spinal local anesthetic site and examples
Injected into subarachnoid space
lidocaine (Xylocaine)
procaine (Novocain) - nerve block also
Epidural local anesthetic site and examples
Injected into epidural space of spinal column
lidocaine (Xylocaine)
bupivacaine (Marcaine)
Nerve block local anesthetic site and examples
Injected at perineural site distant from desired anesthesia site
bupivacaine (Marcaine)
chloroprocaine (Nesacaine)
mepivacaine (Carbocaine)
ropivacaine (Naropin)
Major side effects of local anesthetic
Allergic reactions, anaphylaxis
Respiratory arrest
Dysrhythmias, cardiac arrest
Seizures (depression of CNS)
Hypotension
Sedatives/Hypnotics
Used for short term treatment of clients with situational anxiety and insomnia
Depress CNS; produce sedation in small dosages and sleep in larger dosages
Available in oral, parenteral (IV and IM) and rectal preparations
Sedatives/Hypnotics Classes
Benzodiazepenes
Barbiturates
Nonbarbiturates
Benzodiazepenes
Act on many levels of CNS to produce short term sedation, anxyiolysis, and amnesia
Used for conscious sedation during diagnostic procedures
Benzodiazepene examples
midazolam (Versed)
diazepam (Valium)
temazepam (Restoril)
Barbiturates
Depress CNS starting with diencephalon
Barbiturate example
thiopental (Pentothal)
Nonbarbiturates
Depress CNS and relax skeletal muscles
Nonbarbiturate examples
propofol (Diprivan)
chloral hydrate (Noctec)
hydroxyzine (Vistaril)
Major Side Effects of Sedatives/Hypnotics
Drowsiness
Hypotension
Dizziness
GI irritation
Skin rash
Blood disorders
Drug dependence
Major Side of Effects of Barbiturates specifically
Hangover
Photosensitivity
Excitement in children and older adults (paradoxic)
Neoplastic Medications
Destroy malignant cells by interfering with the reproduction of the cancer cell
Act at specific points in cycle of cell division or at any phase in cycle of cell division (Specific vs Nonspecific)
Affect any rapidly dividing cell within body thus has pote
Neoplastic Medication Classes
Alkylating agents
Vinca alkaloids
Antibiotics
Antimetabolites
Hormones
Monoclonal Antibodies
Neoplastic Medications - Alkylating Agents fxn and ex
Cell cycle non specific; attack DNA of rapidly dividing cells
Nitrosourea: carmustine (BiCNU)
Nitrogren mustard: chlorambucil (Leukeran) and cyclophosphamide (Cytoxan)
Inorganic heavy metal: cisplatin (Platinol - AQ) and carboplatin (Paraplatin)
Neoplastic Medications - Vinca Alkaloids fxn and ex
Cell cycle specific, work during "M" phase, interfere with mitosis
vincristine
Neoplastic Medications - Antibiotics fxn and ex
Cell cycle nonspecific, inhibit DNA and RNA synthesis of rapidly dividing tissue
mitomycin (Mutamycin) and Doxorubicin
Neoplastic Medications - Antimetabolites
Cell cycle specific, inhibit protein synthesis in rapidly dividing cells during S phase.
fluorouracil/5 FU (Carac, Efudex, Fluoroplex)
hydroxyurea (Hydrea)
methotrexate (Trexall)
Neoplastic Medications - Hormones
Tissue specific, inhibit RNA and protein synthesis in tissues that are dependent on opposite sex hormone for development
androgens, estrogens
progestins
steroids (prednisone)
hormone antagonists
cortisol antagonist
estrogen antagonist
luteinizing hormone
Neoplastic Medications - Monoclonal Antibodies
Exogenous antibodies produced in lab by combining specific cancer cells with antibody producing B cells derived from different sources (mouse, human)
rituximab (Rituxan) - non Hodgkins
trastuzumab (Herceptin) - breast cancer
gemtuzumab ozogamicin (Mylotar
Monoclonal antibodies ending
-mab
Neoplastic Medications - Other Immune Agents
Introduction of noncancerous antigens or other agents into body to stimulate production of lymphocytes and antibodies
Bacille Calmette-Guerin (BCG) vaccine - immunity
Interferon alfa-2a (Roferon - A) or interferon alfa - 2b (intron A) - suppresses cell pr
Neoplastic Medications - Miscellaneous
Leucovorin calcium: reduced form of folic acid; acts as antidote to folic acid antagonists
Paclitaxel (Taxol): inhibits reorganization of microtubule network that is needed for interphase and mitotic cellular functions
Major Side Effects of Neoplastic Medications
Anorexia
N & V
stomatitis (irritation of GI tract)
Diarrhea
Bone marrow depression and blood dyscrasias
Aloepecia
CNS disturbance
Hepatic disturbance
Tumor lysis syndrome
Acute renal failure
Cardiomyopathy
Metabolic abnormalities (inc Ca and uric acid)
al
Tumor lysis syndrome
Release of large quantities of breakdown products causing hyperkalemia, hyperuricemia, hyperphosphatemia, and acute renal failure
Anticoagulants fxn
Prevent fibrin formation by interfering with production of various clotting factors in the coagulation process.
Prevent platelet aggregation and clot extension.
Available in oral, parenteral (Sub Q and IV). Can be given together until oral medication reac
What are anticoagulants used to treat?
Used for prevention and treatment of thrombus and embolus
Anticoagulant examples
Heparin sodium (IV or SubQ)
Low molecular weight heparin (SubQ) - enoxaparin (Lovenox), dalteparin (Fragmin), fondaparinux (Arixtra)
Dabigatran (Pradaxa) - direct thrombin inhibitor
Lepirudin (Refludan) (IV) - for clients with heparin induced thrombocytop
Benefit of Dabigatran (Pradaxa)
Direct thrombin inhibiter
Benefit is routine blood coagulation studies are unnecessary
Antiplatelet drugs
given orally
ASA (aspirin)
ticlopidine (Ticlid)
clopidogrel (Plavix)
Specific side effect of ASA (aspirin)
May cause tinnitus and hearing loss
Antiplatelet drug prefix
-clopi found in the name
Major Side Effects of Anticoagulants
Fever
Chills
Bronchospasm and skin rash (hypersensitivity)
petechiae
burising
hemorrhage
diarrhea
thrombocytopenia and other blood dyscrasias
Anticoagulant Monitoring
Monitor blood work when pt receiving warfarin (Coumadin: check platelets, and INR
Monitor blood work when client receiving heparin derivatives: check platelets, PT, and aPTT
Monitor blood work if surgery can't be delayed when client on dabigatran (Pradaxa
INR value
Therapeutic range = 2.0 - 3.5
Normally 1 - 2
Change in drug regimen requires more frequent INRS because many drugs have interactive effects
PT value and aPTT value
Therapeutic value = 1.5 to 2 times normal value
For aPTT for when given as a continuous drip
SubQ Heparin Administration
Administer in the abdomen
Do no aspirate or massage the area
Antidote for Anticoagulants
Vitamin K for warfarin
Protamine suflate for heparin
Anticoagulant Nursing Care
Avoid IM injection and salicylates with administration of anticoagulants to prevent bleeding.
Assess for signs of bleeding.
Instruct to carry a medical alert card.
Avoid alcohol and medications containing aspirin.
Avoid interacting herbal supplements.
Avo
Thrombolytics fxn
Convert plasminogen to plasmin, which initiates local fibrinolysis.
Dissolve occluding thrombi.
Administered IV or intraarterial.
Thrombolytics Admin. Instructions
Initial loading dose is administered concomitantly with heparin.
Therapy must be instituted within hours of the onset of myocardial infarction, PE, or acute ischemic brain attack.
Thrombolytics examples
streptokinase (Streptase)
tissue plasminogen activator such as alteplase (Activase)
Major Side Effects of Thrombolytics
Bleeding (especially GI if hx of peptic ulcer dx or cerebral if hx of uncontrolled hypertension)
allergic reactions
low grade fever
reperfusion dysrhythmias
Thrombolytics Nursing Care
Screen clients for contraindications and complete all venipuncture procedures before starting therapy.
Assess for signs of bleeding.
Monitor VS and neuro status.
Assess for signs of allergic reaction.
Antidote for Thrombolytics
Keep aminocaproic acid (Amicar), a fibrinolysis inhibitor, available.
Procedure after Thrombolytic Admin
Maintain continuous IV infusion of heparin afterwards
Antianemics fxn
Promote RBC production.
Colony stimulating factors stimulate red blood cell production; iron containing compounds and vitamin replacements needed for the formation of RBCs.
Available in oral and parenteral (IM, IV, SubQ) preparations.
Antianemics Classes
Colony stimulating factors
Iron compounds
Vitamin replacements
What do Antianemics treat?
Effective in treatment of anemia caused by chronic kidney disease or chemotherapy, iron deficiency anemia and inadequate nutrition.
Antianemics Examples - Colony stimulating factors
Colony stimulating factors -
epoetin (Epogen, Procrit)
administerd subQ or IV three times a week
Antianemics Examples - Iron compounds
oral - ferrous gluconate, ferrous sulfate
parenteral - iron dextran
Antianemics Examples - Vitamin replacements
cyanocobalamin - vitamin B12, folic acid
vitamin B9
Major Side Effects of Antianemics - Epoetin
Seizures
Hypertension
Thrombotic events
Major Side Effects of Antianemics - Iron Replacements
N & V
Constipation
Black stool (presence of unabsorbed iron in stool)
Stained teeth (liquid preparations)
Tissue staining (injectable preparations that leak iron)
Major Side Effects of Antianemics - Vitamin replacements
local irritation
allergic reactions, anaphylaxis
diarrhea
Nursing Care of Epoetin
Monitor Bp, hematocri and patency of dialysis shunt if present
Institute seizure precautions if there is a precipitous rise in hematocrit level
Do not shake vial, can inactivate drug
Nursing Care of Iron Replacements
Inform about side effects
Encourage intake of foods high in iron, vitamin B 12 and folic acid; increase high fiber foods to reduce potential of constipation
Instructions on taking Liquid Iron Preparations
Dilute with water or fruit juice.
Drink through a straw on an empty stomach.
For optimum absorption take ascorbic acid (vitamin C) concurrently because it increases iron absorption
Encourage oral hygiene after iron administration to prevent staining of te
Antidote for Iron Toxicity
deferoxamine (Desferal)
Nursing Care of Vitamin Replacements
For vitamin B12 inform that cannot be taken orally. Use Z track method for IM injection. Therapy is lifelong for pernicious anemia.
For folic acid instruct about dietary sources of folic acid.
Antilipidemics fxn
Improve lipid profile by reducing cholesterol or triglyceride synthesis and or increasing HDL level
Used to attain recommended goals for LDL levels
Antilipidemics classes
HMG-CoA reductase inhibitors (statins): lower levels of total cholesterol, LDL, and triglycerides, increase HDLs
Fibrates: decrease levels of total cholesterol, LDL and triglycerides
Bile acid sequestrants: bind with intestinal bile, preventing absorption
Antilipidemics : statins examples
pravastatin (Pravachol)
lovastatin (Mevacor)
simvastatin (Zocor)
atorvastatin (Lipitor)
Statins suffix
-statin
Antilipidemics: fibrates examples
gefibrozil (Lopid)
fenofibrate (Tricor)
Antilipidemics: bile acid sequestrants
cholestyramine (Questran)
colestipol (Colestid)
Major Side Effects of Antilipidemics
N & V, diarrhea
Musculoskeletal disturbances
Hepatic disturbances
Reduced absorption of fat and fat soluble vitamins and B12 and iron
Specific Side Effect of Statins
Nursing Care
rhabdomyolysis: potentially fatal skeletal muscle disease
Instruct to report muscle pain, fever and dark urine which are signs of rhabdomyolysis.
Monitor creatine kinase level.
Specific Side Effect of Bile acid sequestrants
Nursing Care
Constipation
Mix with full glass off liquid; incorporate measures to prevent constipation
Specific Side Effect Nicotinic acid (niacin)
facial flushing
Nursing Care of Antilipidemics
Encourage diet: low cholesterol, low fat, replace vegetable oils with those high in monounsaturated fatty acid, eat fish high in omega 3, increase intake of high fiber foods
Provide schedule for monitoring blood work.
Antilipidemics Admin Instructions
Take medications with meals to reduce GI irritation
Take statins at hour of sleep to increase effectiveness
Simvastatin (Zocor) Nursing Care
Lovastatin and gemifibrozil Nursing Care
teratogenic
Asssess for visual disturbances with prolonged use
Phosphodiesterase Inhibitors
Inhibit cyclic adenosine monophosphate phosphodiesterase, leading to increased levels of adenosine monophosphate within the cells.
Increases cardiac contractility and cardiac output.
Cause vasodilation, decreasing peripheral vascular resistance, preload a
What do phosphodiesterase inhibitors treat?
Short term treatment of heart failure, administered IV
Examples of Phosphodiesterase inhibitors
inamrinone (Inocor)
milrinone (Primacor)
Suffix of Phosphodiesterase Inhibitors
-rinone
Major Side Effects of Phosphodiesterase Inhibitors
Hypotension
dysrhythmia
nephrogenic diabetes insipidus
hepatotoxicity
anorexia
abdominal cramps
thrombocytopenia
Nursing Care of Phosphodiesterase Inhibitors
Monitor for therapeutic effects: decreased pulmonary capillary wedge pressure, resolution of clinical indicators of heart failure
Monitor BP and cardiac rhythm
Use infusion control pump to administer; consult with health care provider for titration based
Blood Transfusion fxn
Restores blood volume after hemorrhage
Maintains hemoglobin levels in clients with severe anemia
Replaces blood components
Sources of Blood for Transfusion
Homologous - random collection by donors/volunteers
Autologous - donation of client's own blood before hospitalization; possible if Hgb > 11. Donations saved for 5 wks.
Directed donation - donation by a donor for specific client
Blood salvage - client's b
Blood components
Whole blood
Packed RBCs
Platelets
Fresh frozen plasma
Cryoprecipitate
Albumin
Plasma Protein factor
IV gamma globulin
Whole blood use
volume replacement for blood loss
Packed RBCs use
increase RBC mass
Platelets use
increase platelets to prevent bleeding related to thrombocytopenia
Fresh frozen plasma use
contains plasma, antibodies, clotting factors
Cryoprecipitate use
contains factor VIII, fibrinogen, and factor XIII to treat hemophilia
Albumin use
volume expander to treat hypoproteinemia
Plasma protein factor use
to treat some types of hemophilia
IV gamma globulin
contains immunoglobulin G (IgG) antibodies to treat immunodeficiency
Stage 1 Hypertension medications
Thiazide diuretic (most common)
ACE inhibitors
ARBs
Calcium Channel blockers
Beta blockers
Stage 2 Hypertension medications
Add a second antihypertensive to the thiazide diuretic prescription
Med that is not good for hypertensive patients to take
NSAIDs.
Make patients aware that it could cause hypertension due to vasoconstrictive action
Pharmacologic management for prevention of MI
Nitrates
Beta blockers
Ca Channel blockers
Antilipidemics
Antiplatelet agents
ACE inhibitors
Pharmacologic management of acute MI
Administer aspirin immediately
Beta blockers or ARBs for left ventricular systolic dysfxn
Thrombolytic therapy within 30 minutes; anticoagulant
IV nitroglycerin
ACE inhibitors
Antidysrhythmics
PCI within 90 minutes of arrival at ED
Intraaortic balloon pum
Meds prescribed at discharge of MI patient
Aspirin, beta blocker, and possible antilipidemic
Meds to Promote Comfort and Rest of MI patient
Analgesics (IV morphine) to reduce pain, anxiety, and cardiac workload
Heart Failure Medications to dec cardiac workload
Diuretics
Vasodilators
ACE inhibitors
ARBs
beta blockers
phosphodiesterase inhibitors
nesiritide (Natrecor)
Heart Failure Medications to inc pump performance
Digitalis
dobutamine (Dobutrex)
Heart Failure Medications to prevent dig toxicity
Potassium supplements
Shock Meds - Vasoconstrictors
To increase BP
norepinephrine (Levophed)
Dopamine (Inotropin)
vasopressin (Pitrecin)
Shock meds - Inotropic agents
Increase contractility
Dobutamine (Dobutrex)
Dopamine (Inotropin)
epinephrine (Adrenalin)
milrinone (Primacor)
Shock meds - Vasodilators
To reduce myocardial workload and ischemia
nitroglycerin (Tridil)
nitroprusside (Nitropress)
Anaphylactic Shock meds
Antihistamines - diphenhydramine (Benadryl)
Steroids
(to reduce inflammation)
Septic shock meds
Antibiotics based on blood cultures.
Drotrecogin alfa (Xigris) to interfere with coagulation cascade and decrease mortality from septic shock
What medication could anemics take that would stimulate bone marrow function?
Epoetin (Epogen, Procrit)
What medication could be given to a polycythemia vera patient to suppress the bone marrow?
hydroxyurea (Droxia, Hydrea)
Colony Stimulating Factors
Epoeitin alfa (Epogen) for RBCs
filgrastim (Neupogen) for WBCs
Antidiabetic Agents
Used to treat diabetes mellitus
2 types: insulin for parenteral use and oral antidiabetics
Antidiabetic Agents - Insulin
Acts to facilitate transport of glucose and amino acids across cell membrane; promotes glycogenesis and protein synthesis
3 types - human, pork and beef (not in US)
Human is least antigenic and most common
Insulin Availability
rapid acting
short acting
intermediate acting
long acting
Mixing of Insulin
Rapid or short acting can be premixed with intermediate acting
Administration of Insulin
syringe
pen
pump
IV (only regular/short acting)
Examples of rapid acting insulin
lispro (Humalog)
aspart (Novolog)
glulisine (Apidra)
Onset, Peak and Duration of rapid acting insulin
10 minutes
1 - 2 hours
3 - 4 hours
Examples of short acting insulin
regular (Novolin R)
regular (Humulin R)
Onset, Peak and Duration of short acting insulin
30 minutes - 1 hour
2 - 3 hours
6 - 8 hours
When should patient take short acting injection?
Only take within 45 minutes of eating.
Strict scheduling is necessary.
Examples of Intermediate Acting insulin
NPH (N)
Novolin N
Humulin N
Onset, Peak and Duration of intermediate acting insulin
1 - 4 hours
6 - 12 hours
18 - 24 hours
Why do you need to mix intermediate acting insulin?
Addition of protamine. This delays onset, peak and duration so you have basal insulin coverage.
Causes a cloudy appearance. Can become a suspension. Needs to be rolled gently between hands to be mixed.
Examples of long acting insulin
glargine (Lantus)
detemir (Levemir)
Onset, Peak and Duration of long acting insulin
1 hour
No peak, steadily delivered
24 hours
Major side effects of parenteral insulin
Hypoglycemia (irritability, tachycardia, huner, moist skin, tremor, headache, confusion, seizures)
lipodystrophy
Oral antidiabetics
Require some functioning beta cells
Lower serum glucose level in variety of ways depending on drug
Oral antidiabetics - Sulfonylureas
Stimulate beta cells to produce insulin
Examples of Sulfonylureas
glipizide (Glucotrol)
glyburide
glimepiride (Amaryl)
Oral antidiabetics - Biguanides
Reduce rate of endogenous glucose production by liver
Increase use of glucose and muscle and fat cells
Examples of Biguanide
glucophage (Metformin)
Oral antidiabetics - Thiazolidinediones
Improve insulin sensitivity, thus improving peripheral glucose uptake
Examples of Thiazolidinediones
rosiglitazone (Avandia)
pioglitazone (Actos)
Suffix of thiazolidinediones
-glitazone
Oral antidiabetics - Meglitinides
Stimulate quick release of insulin by beta cells
Examples of Meglitinides
repaglinide (Prandin)
nateglinide (Starlix)
Suffix of meglitinides
-glinide
Oral antidiabetics - Alpha glucosidase inhibitors
Block digestion of ingested carbohydrates and slow absorption of glucose
Examples of alpha glucosidase inhibitors
acarbose (Precose)
miglitol (Glyset)
Oral antidiabetics - Dipeptidyl peptidase 4 inhibitor
prevents breakdown of glucagon like peptide which reduces blood glucose level in the body
Examples of dipeptidyl peptidase inhibitor
sitagliptin (Januvia)
saxagliptin (Onglyza)
Oral antidiabetic - synthetic analog of human amylin
decreases gastric emptying
Example of synthetic analog
pramlintide (Symlin)
Oral antidiabetic - incretin mimetic
stimulates insulin production in type 2 diabetes
injectable med for typ 2
Example of incretin mimetic
exenatide (Byetta)
liraglutide (Victoza)
Oral antidiabetics - combination examples
glyburide/metoformin (Glucovance)
sitagliptin/metformin (Janumet)
pioglitazone/metformin (Actoplus Met)
Major Side Effects of Oral antidiabetics
hypoglycemia,
skin rash, allergic reaction, pruritis
jaundice (hepatic)
thrombocytopenia
lactic acidosis
vitamin B12 deficient
Specific Side Effects - Acarbose (Precose) and Miglitol (Glyset)
Alpha glucosidase inhibitors
boating, gas pains, diarrhea
Specific Side Effects - Rosiglitazone (Avandia)
Thiazolidinediones
hepatotoxicity, increased risk of fractures
Metformin (Glucophage) Contraindication
Not for clients with heart failure
Avoid alcohol
Nursing Care for Antidiabetic Agents
Assess clinical findings of hypoglycemia
Instruct client to use proper med administration procedure and carry medical alert card
Adhere to diet
Avoid alcohol
Perform self monitoring blood glucose and regular lab tests
Offer emotional support
Instruct to p
Care for Hypoglycemic Incident
Administer rapid acting glucose - glucose gel or capsule
Follow with complex carb and protein - cheese and crackers to stabilize blood glucose level
Specific Care for Metformin (Glucophage)
Withhold drug before and 48 hours after diagnostic studies requiring iodinated contrast media
Increased risk of hypoglycemia when given concurrently with allopurinol
Administration of Insulin
Administer all Sub Q because insulin destroyed by gastric juices if taken by mouth
Rapid acting can be used in infusion devices
Dosage adjustment necessary when taking nothing by mouth and when ill
Mixed insulins
If you need to mix, draw up rapid/short acting insulin first then the NPH. Remember to gently roll NPH in hands.
Don't need to rotate sites with mixed insulin. Abdomen is preferred site.
Thyroid Enhancers
Regulate metabolic rate of body cells; aid in growth and development of bones and teeth
Affect protein, carb and fat metabolism
Replace thyroid hormone when there is a reduction in or absence of thyroid gland fxn
Examples of Thyroid Enhancers
levothyroxine (Synthroid)
liothyronine (Cytomel)
liotrix (Thyrolar)
Major Side Effects of Thyroid Enhancers
increased metabolism (inc T3 and T4)
hyperactivity (inc metabolism)
cardiac stimulation
Nursing Care for Thyroid Enhancers
Report occurrence of side effects
Take med at scheduled time daily, do not stop abruptly
Take HR, notify if greater than 100
Carry medical alert card
Continue medical supervision
Assess for potentiation of anticoagulants
Offer emotional support
Assess for
Thyroid Inhibitors
Interfere with synthesis and release of thyroid hormone; inhibit oxidation of iodides to prevent their combination with tyrosine in formation of thyroxine
Treats hyperthyroidism
Examples of Thyroid Inhibitors
propylthiouracil (PTU)
methimazole (Tapazole)
Antithyroid - iodine (potssium iodide, SSKI) used to dec vascularity of thyroid gland
Major Side Effects of Thyroid Inhibitors
agranulocytosis (dec WBC)
skin disturbance
nausea and vomiting
dec metabolism (dec T3 and T4)
Specific Effects of Iodine
bitter taste
stains teeth - local oral effect on mucosa and teeth
Nursing Care of Thyroid Inhibitors
Report side effects especially sore throat, jaundice and fever
Avoid crowded places and potentially infectious situations
Assess for signs of hypothyroidism
Administer liquid iodine preparations diluted in beverage with straw to avoid staining teeth
Adrenocorticoids
Interfere with release of factors important in producing inflammatory and immune responses (immunosuppression)
Remove fluid accumulation from brain thereby decreasing cerebral edema
Increase glucose and fat formation and promote protein breakdown
Used for
Examples of Adrenocorticoids
Glucocorticoids
Mineralcorticoids: fludrocortisone
Glucocorticoids - Long acting
dexamethasone
Glucocorticoids - intermediate acting
methylprednisolone (Medrol, Solumedrol)
Glucocorticoids - short acting
hydrocortisone (Solu-Cortef)
Major Side Effects of Adrenocorticoids
Cushingoid clinical findings
Hypertension - sodium and water retention
Hyperglycemia - gluconeogenesis
Mood changes
GI irritation and ulcer formation - take with food
Cataracts - from hyperglycemia
Hypokalemia - potassium excretion
Dec wound healing - leu
Cushingoid Clinical Findings
increased glucocorticoid activity causing facial edema and fluid retention
Nursing Care for Adrenocorticoids
Administer oral preparations with food, milk or antacids
Monitor weight, blood pressure, and serum electrolytes
Assess for GI bleeding
Monitor blood glucose level
Instruct client to avoid exposure to infection
Avoid using salt, encourage foods high in pot
Antidiuretic Hormone (med)
Promotes water reabsorption by distal renal tubules and causes vasoconstriction and increased muscle tone of bladder, GI tract, uterus and blood vessels
Treatment for diabetes insipidus
Example of ADH med
desmopressin (DDAVP)
Major Side Effects of ADH med
Transient headache, drowsiness, listlessness
Nausea, heartburn, milkd abdominal cramps
Nasal irritation, congestion, rhinitis
Shortness of breath, facial flushing, pain and swelling at injection site
Nursing Care for ADH med
Monitor I & O and electrolytes
Assess for side effects
Pediculicides/Scabicides
Act at the parasites nerve cell membrane to produce death of the organism. Used to destroy parasitic arthopods such as lice
Available in topical preparations only
Examples of Pediculicides/Scabicides
permethrin (Nix)
pyrethrum extract/piperonyl butoxide (RID)
lindane (Kwell)
Major Side Effects of Pediculicides/Scabicides
Skin irritation
Contact dermatitis
Hepatotoxicity or nephrotoxicity
Nursing Care of Pediculicides/Scabicides
Inspect skin, particularly scalp for scabies nad pediculosis before and after treatment; assess for skin irritation
Use gown, gloves and hair covering to prevent spread of parasitic arthropods because scabies and lice are highly contagious
Keep linen of i
Antiinfectives for Skin use
Have bactericidal effect on bacterial cell wall or later cellular function
Available in topical preparation
Examples of Topical Antiinfectives
mafenide (Sulfamylon)
silver nitrate 0.5% solution
silver sulfadiazine (Silvadene)
Major side effects of silver sulfadiazene
skin irritation
hemolysis in clients with G-6-PD deficiency
may not be used in presence of renal failure
Major side effects of Mafenide
metabolic acidosis; burning sensation when first applied
Major side effect of silver nitrate
electrolyte imbalance
brownish black discoloration of skin
Nursing Care for Topical Antiinfectives
Use strict surgical asepsis
Cleanse and ensure debridement before application
Silver sulfadiazine - apply thin layer, monitor g-6-pd level before
Mafenide - assess for acidosis
Silvernitrate - apply dressings soaked ins ilver nitrate, protect self from co
Antipruritics for Skin
Inhibit sensory nerve impulse conduction at local site; exert local anesthetic effect
Relieve itching; promote comfort
Available in topical preparations
Examples of Antipruritics
benzocaine (Anbesol, Solarcaine)
tetracaine (Pontocaine)
Suffix of Antipruritics
-caine
Major side effects of antipruritics
skin irritation
contact dermatitis
Nursing Care of Antipruritics
Assess lesion for location, size and irritation
Discourage scratching, keep nails trimmed, avoid contact with open wounds
Advise medical follow up
Prevent contamination of topical agent container
Antiinflammatory Agents for Skin
Reduce clinical findings of inflammation
Produce vasoconstriction, which decrease swelling and pruritis
Available in topical preparations
Examples of Antiinflammatory Agents
triamcinolone (Kenalog, Triderm)
Nursing Care for Antiinflammatory Agents for Skin
Assess lesions for color, location and size
Protect skin from scratching or rubbing
Avoid contact with eyes
Cleanse skin before applying and reapplying
Assess for clinical findings of sensitivity
Avoid occlusive dressings
Prevent contamination of topical
Dermal Agents
Inhibit keratinization and sebaceous gland function to improve cystic acne and reduce sebum excretion
Available in oral and topical
Examples of Dermal Agents
isotretinoin (Accu-tane, Claravis, Amnesteem, Sotret)
vitamin A acid (Retin - A)
Major Side Effects
Visual disturbances such as corneal opacities, dec night vision (vit A toxicity)
papilledema, headache, hepatic dysfunction, pruritis, skin fragility (dryness), hypertriglyceridemia
Nursing Care of Dermal Agents
Assess visual and hepatic status before admin.
Monitor levels of blood lipids before and during therapy
Avoid pregnancy during and for 1 month after therapy (teratogenic)
Avoid vitamin A supplements
Side effects reversible after stopping of therapy
Asess
Antimalarials
Used in treatment of SLE to alleviate fatigue, joint pian, skin rashes and lung inflammation
Examples of Antimalarials
hydroxychloroquine sulfate (Plaquenil)
chloroquine (Aralen)
Major Side Effects of Antimalarials
A potential serious side effect of antimalarial drug is damage to the retina
GI, CNS, dermatologic, hematologic
Administration of Antimalarials
Before or after meals at the same time each day to maintain drug levels
Anticonvulsants
AKA Antiseizure, antiepileptic medications
Modify bioelectric activity at subcortical and cortical sites by stabilizing nerve cell membranes and or raising seizure threshold
Dec. occurrence, frequency or severity of seizures
Examples of Anticonvulsants - Hydantoins
Used for tonic clonic (grand mal) and psychomotor seizures
Ex - phenytoin (Dilantin), fosphenytoin
Examples of Anticonvulsants - Barbiturates
Used for tonic clonic and partial seizures
Ex - phenobarbital, primidone (Mysoline)
Examples of Anticonvulsants - Benzodiazepenes
Used as anticonvulsant and antianxiety agents; for status epilepticus
Ex - diazepam (Valum), lorazepam (Ativan),
for absence (petit mal) clonazepam (Klonopin)
Suffix for Benzos
-pam
Examples of Anticonvulsants - Succinimides
Used for absence seizures
Ex - ethosuximide (Zarontin), methsuximide (Celontin)
Suffix for Succinimides
-suximide
Examples of Anticonvulsants - GABA analogs
Used for partial seizures. Also to control pain of herpes zoster and other neuro disorders
Ex - Gabapentin (Neurontin), pregabalin (Lyrica)
Root of GABA analogs
-gaba
Examples of Anticonvulsants - Carboxamides
Used for tonic clonic and psychomotor seizures. To control pain of trigeminal neuralgia and other neuro disorders.
Ex - carbamazepine (Tegretol), oxcarbazepine (Trileptal)
Examples of Anticonvulsants - Valproates
Used for absence seizures
Ex - valproic acid (Depakene), divalproex sodium (Depakote)
Meds for Absence (petit mal) Seizures
valproates and succinimides
Meds for tonic clonic (grand mal) seizures
hydantoins
barbiturates
benzos
carboxamides
Meds for partial seizures
Barbitrates
GABA analogs
Major Side Effects of Anticonvulsants
Dizziness, drowsiness, paresthesia
N & V
Skin rash
blood dyscrasias
hepatotoxicity
Specific Side Effects for Phenytoin
ataxia (neurotoxicity)
gingival hyperplasia
hirsutism
hypotension
reddish brown urine
Nursing Care for Anticonvulsants
Administer with food to reduce GI irriation
Instruct client to avoid alcohol and other CNS depressants
Notify HCP if fever, sore throat, skin rash, unusal bleeding, loss of balance or seizure occur
Carry med alert card
Dose must be tapered! Do not abruptl
Specific Care for Phenytoin
Avoid mixing with other IV infusions
Incompatible with 5% dextrose
Provide oral hygiene, inspect oral mucosa for infection and gingival hyperplasia
Assess for initial potentiation of anticoagulant effect followed by inhibition
Assess urine, drug may disco
Phenytoin and Other Med Interactions
Inc metabolism of oral contraceptives and anticoagulants
Gingko biloba may dec phenytoin effectiveness
Osmotic Diuretics
Reduce cerebral edema and intraocular pressure by increasing osmotic pressure within vasculature
Causes fluid to leave tissues and be excreted in urine
Only IV
Example of Osmotic Diuretic
mannitol (Osmitrol)
Major Side Effects of Osmotic Diuretics
Headache (dehydration)
Nausea, chills, rebound edema when discontinued (F & E imbalance)
F & E imbalance (dec Na and dec K)
Nursing Care of Osmotic Diuretics
Administer intravenously through a filter
Monitor I & O, daily weight and serum electrolytes
Question prescription if client has heart failure or impaired renal fxn
Elevate HOB during therapy
Assess for signs of inc ICP (dec HR, wide pulse pressure, inc s
Calcium Enhancers - Calcium Ion Replacement
Calcium ion replacement directly increases serum Calcium concentration
Ex: calcium carbonate (Os-Cal), calcium chloride, calcium gluconate (Kalcinate)
Calcium Enhancers - Vitamin D Replacement
Vitamin D replacement improves absorption of calcium from intestines
Ex: calcitriol (Rocaltrol), cholecalciferol (Calciferol)
Calcium Enhancers - Biphosphonates
Absorb calcium phosphate crystals in bone, inhibit resorption of bone by osteoclast. May dec risk of invasive breast cancer. Prescribed weekly, daily, monthly or yearly.
Oral = alendronate (Fosamax), risendronate (Actonel), ibandronate (Boniva)
IV drugs =
Biphosphonates Suffix
-dronate
Calcium Enhancers - Parathyroid Agent
Decrease bone resorption
Ex: nasal spray or injection - calcitonin (Miacalcin), Sub q - teriparatide (Forteo)
Major Side Effects of Calcium Enhancers
N & V, renal calculi, muscle flaccidity (hypercalcemia)
Constipation (inc calcium delays passage of stool)
Specific Side Effects - Calcium prep
cardiac disturbances (stimulation of cardiac conduction)
Specific Side Effects - Vitamin D
dry mouth, metallic taste
Specific Side Effects - Biphosphonates
bone pain, headache, abdominal pain, nausea
Specific Side Effects - Parathyroid Agents
diarrhea, urinary frequency, headache, chest pressure and dyspnea
Nursing Care for Calcium Enhancers
Assess for signs of hypercalcemia and tetany
Monitor levels of serum electrolytes during course of therapy
Encourage inc fluid intake to reduce potential of renal calculi and constipation
Stress vitamin D rich foods
Limit milk, fruits and veggies
For calc
Antiparkinson agents - Anticholinergics
Decrease the activity of acetylcholine instead of acting on the dopaminergic system.
Anticholinergic drugs act at central sites to inhibit cerebral motor impulses and block efferent impulses that cause muscular rigidity.
Can be helpful for tremor and may
Examples of Anticholinergics
trihexyphenydil (Artane)
benztropine mesylate (Cogentin)
Dopamine Agonists
Drugs that stimulate the part of the brain influenced by dopamine
Can be taken alone or in combination with pills with levodopa
Examples of Dopamine Agonists
pramipexole (Mirapex)
ropinirole (Requip)
bromocriptine (Parlodel)
Antiparkinson agents - Dopaminergic agents
Supply or cause release of dopamine required for norepinephrine synthesis and maintenance of neurohormonal balance at sites that control motor function.
Stimulates part of brain that needs dopamine.
Examples of Dopaminergics
carbidopa - levodopa (Sinemet)
carbidopa - levodopa - entacapone (Stalevo)
Carbidopa/Levodopa (Sinemet)
Levodopa is converted to dopamine. Mixed with carbidopa to prevent N & V. Carbidopa also increases the amount of levodopa in the system that can go to the brain.
Prolonged use of Levodopa
Patients will experience dyskinesias (spontaneous, involuntary movements) and on - off periods where the medication will suddenly stop or start working
Antiparkinson Agents - COMT inhibitors
Prolong effect of levodopa by deterring its metabolism and preventing enzyme from breaking it down
Newest class
Examples of COMT inhibitors
entacapone (Comtan)
tolcapone (Tasmar)
Suffix of COMT inhibitors
-capone
MAO-B inhibitor
Block enzyme in the brain that trys to break down levodopa.
Example of MAO-B Inhibitor
selegiline (Eldepryl)
Antiviral agent
potentiates action of dopamine
Example of Antiviral agent
amantadine
Major Side Effects of Antiparkinsons
Orthostatic hypotension
Ataxia, involuntary movements, bepharospasm (neurotoxicity)
CNS disturbances and emotional (suicide)
N & V
Bone marrow depression
Specific Side Effects of Anticholinergics
Dry mouth
Blurred vision (CI with narrow angle glaucoma)
Constipation
Urinary retention
Specific Side Effects of Dopaminergics
Neuroleptic malignant syndrome = muscle rigidity, fever, mental status changes, unstable blood pressure
Nursing Care for Antiparkinsons Agents
Avoid discontinuing drug suddenly. Continue health supervision.
Take COMT inhibitors with levodopa or they will be ineffective.
Offer emotional support
Encourage diet in nutrient rich foods
Nursing Care for Patients Taking Anticholinergics
Suggest sugar free chewing gum and hard candy to inc salivation
Teach to avoid hazardous activities because of drug's CNS effects
Teach to increase fluids, roughage, and activity to prevent constipation
Monitor for urinary retention
Nursing Care for Patients taking Sinemet
Monitor CBC, renal and hepatic fxn
Teach to eliminate or limit Vitamin b6 (pork, veal, lamb, potatoes, legumes, oatmeal, wheat germ) from diet because it dec effectiveness of drug
Instruct client to monitor for extrapyramidal effects - unsteady gait, invo
Nursing Care for Patients taking MAO i (Eldepryl)
Inform that selegiline may be started early in the course of the disease because neuroprotective actions are expected
Teach safety precautions because it can cause orthostatic hypotension
Instruct to avoid foods containing tyramine (wine, cheese and choco
Cholinesterase Inhibitors
Prevent enzymatic breakdown of acetylcholine at nerve endings, thus allowing accumulation of the neurotransmitter
Improve strength of contraction in all muscles including respiratory
Used to diagnose/treat myasthenia gravis
Examples of Cholinesterase Inhibitors
edrophonium (Enlong, Tensilon) - used for diagnostic purposes, short acting (Tensilon test)
neostigmine (Prostigmin)
pyridostigmine (Mestinon)
ambenonium (Mytelase)
Major Side Effects of Cholinesterase Inhibitors
N & V
Abdominal cramps, diarrhea, hypersalivation, hypotension, bradycardia, miosis (inc PNS stimulation)
Muscle cramps (inc contractions)
Seizures
Contraindication for Cholinesterase Inhibitors
Do not give morphine to clients receiving cholinesterase inhibitors, these drugs potentiate effects of morphine and can cause respiratory depression
Acute Toxicity of Cholinesterase Inhibitors
Cholinergic Crisis = profound muscle weakness, pulmonary edema, bronchial constriction and respiratory failure
Must be differentiated from myasthenia crisis with edrophonium test
Nursing Care of Cholinesterase Inhibitors
Administer on time exactly as prescribed
Give with food
Carry medical alert card
Take medication before meals to improve chewing and swallowing
Encourage diet rich in nutrient dense foods
Report resp distress immediately
Antedote for Overdose of Cholinesterase Inhibitors
Atropine sulfate
Skeletal Muscle Relaxants
Relieve muscle spasms
Central agents = depress CNS to promote relaxation of voluntary muscles
Peripheral agents = block nerve impulse conduction at myoneural junction
Examples of Skeletal Muscle Relaxants
carisoprodol (Soma)
cyclobenzaprine (Flexeril)
diazepam (Valium)
Methocarbamol
baclofen (Lioresal)
Major Side Effects of Skeletal Muscle Relaxants
Dizziness, drowsiness
Nausea
Headache
Tachycardia
Nursing Care of Skeletal Muscle Relaxants
Encourage diet rich in nutrient dense foods
Teach to use safety precautions and avoid engaging in hazardous activities or ingesting alcohol
NSAIDs
Interfere with prostaglandin synthesis
Alleviate inflammation and subsequent discomfort of rheumatoid conditions
NSAID Examples
ibuprofen (Advil, Motrin)
Naproxen (Aleve, Naprosyn)
salicylates (aspirin)
ketorolac (Toradol)
diclfenac (Voltaren)
etodolac (Lodine)
COX 2 inhibitors
Same function as NSAIDs,
Decreased risk of peptic ulcers.
COX 2 inhibitors examples
celecoxib (Celebrex)
nabumetone (Relafen)
Major Side Effects of NSAIDs
GI ulceration, tarry stools (melena)
Skin rash
Blood dyscrasias
CNS and GU disturbances
Inc liver enzymes
Specific Side Effect of COX 2
Cand cause potentially fatal CV thrombolytic event with increased duration of use
Nursing Care for NSAIDS
Administer with meals to reduce GI irritation
Avoid alcohol and smoking
Monitor coagulation and liver profiles
Assess VS, inc BP
Report SE such as bleeding or hearing disturbance
Encourage diet rich in nutrient dense foods
Limit sodium to reduce fluid ret
Aspirin toxicity
Can affect cranial nerve 8 and cause tinnitus
Antigout Agents
Dec uric acid formation and inc its excretion
Prevent and arrest gout attacks caused by high levels of uric acid in the blood
Examples of Antigout agents
Allopurinol (Zyloprim): blocks formation of uric acid
Colchicine (Colsalide, Colcrys): dec uric acid crystal deposits by inhibiting lactic acid production. Good for acute attacks.
Probenecid (Benemid): prevents formation of tophi by inhibiting reabsorptio
Major Side Effects of Antigout Agents
N & V, diarrhea
Blood dyscrasias
Liver damage
Skin rash
Nursing Care for Antigout Agents
Administer prescribed antiinflammatory drugs to work in concert with antigout medications during acute attack
Inc fluids to discourage formation of renal calculi
Encourage weight reduction if overweight
Monitor serum blood uric acid level
Administer with
Opthalmic Agents
Prodcue a variety of actions that help to diagnose and treat conditions affecting eyes.
Available in topical, systemic acting are available in oral and parenteral.
Opthalmic Agents - Miotics
constrict pupil, improves outflow of aquous humor.
Treats chronic open angle glaucoma.
Examples of Miotics
Beta blocker = betaxolol (Betoptic), timolol (Timoptic, Cosopt)
Cholinergic miotics = carbachol (Miostat)
Major Side Effects of Miotics
Twitching eye lids, brow ache
headache
Conjuncitval pain
Contact dermatitis
Opthalmic Agents - Mydriatics
dilate pupil by contracting dilator muscle of iris, lessens effects on accomodation
Examples of Mydriatics
Anticholinergics (relax ciliary muscle) and cycloplegic agents (paralyze accomodations) = are used to facilitate eye exams and surgery
Atropine, tropicamide (Mydriacyl, Tropiacacyl), cyclopentolate (Cyclogyl), dipivefrine (Propine)
Major Side Effects of Mydriatics
Dry mouth
Flushing, fever, ataxia
Blurrred vision, photophobia
Skin rash
Tachycardia
Opthalmic Agents - Carbonic anhydrase inhibitors
Dec production of aqueous humor to control intraocular pressure
Carbonic Anhydrase Inhibitor Examples
acetazolamide (Diamox(
brinzolamide (Azopt)
dorzolamide (Trusopt)
Major Side Effects of Carbonic Anhydrase Inhibitors
Diuresis
Metabolic Acidosis
Paresthesia
Bone marrow depression
CNS disturbance
Suffix of CA inhibitor
-zolamide
Opthalmic Agents - Osmotic Agents
Systemically to inc blood osmolality which mobilizes fluid from eye to reduce volume o fintraocular fluid; dec intraocular pressure in glaucoma and corneal edema
Example of Osmotic Agents
mannitol (Osmitrol)
Major Side Effects of Osmotic Agents
Headache
N & V
Opthalmic Agents - Corticosteroids
Administered topically to dec inflammatory response.
Example of Corticosteroids
Dexamethasone (Decadron)
prednisolone (AK-Pred, Blephamide)
Major Side Effects of Corticosteroids
Blurred vision
inc intraocular pressure
Nursing Care for Opthalmic Agents
Instruct on admin technique
Hand hygiene before doing drops. Place med on conjunctival sac. Apply pressure on lacrimal duct to prevent systemic absorption. Wipe from inner to outer canthus.
Assess for side effects
Care for mydriatics - vision blurred temp
HAART
Highly active antiretroviral thearpy involves drug combinations used to fight HIV and AIDS.
Combinations and order in which they are given influence effectiveness. 3 or more drugs from at least 2 different classes fight HIV at different stages of replicat
HAART - Nuceloside analogue reverse transcriptase inhibitors
Interfere with DNA chain.
Ex: lamivudine (Epivir), emtricitabine (Emtriva), abacavir (Ziagen), zidovudine (Retrovir)
Side Effects: lactic acidosis, hepatomegaly, peripheral neuropathy, rash
HAART - Protease inhibitors
Disables protease, the prtein that HIV needs to reproduce
Examples: all end in avir
Side Effects: N & V, diarrhea, abdominal pain, anorexia, hyperglycemia, peripheral paresthesias, headache, renal calculi, inc liver enzymes
Avoid alcohol, drink 8 to 10 gl
HAART - Nonnucloside reverse transcriptase inhibitors
Bind to reverse transcriptase and block RNA and DNA replication
Ex: nevirapine (Viramune), etravirine (Intelence), efavirenz (Sustiva), delaviridine (Rescriptor)
Side Effects: transient rash, nausea, diarrhea, hepatotoxicity, nephrotoxicity
HAART - Fusion inhibitor
Stops HIV from entering CDF cells by inhibiting fusion of viral and cellular membranes
Ex: maraviroc (Selzentry), enfuvirtide (Fuzeon)
HAART - Integrase inhibitors
Interfere with integrase enzyme which HIV needs to insert its genes into CD4 cells
Ex: raltegravir (Isentress)
HARRT - Antiviral
Dec HIV levels in blood and genital secretions, also used for herpes
Ex: valacylovir
Combinations of HARRT drugs
Raltegravir + tenofovir/emtricitabine
Efavirenz/tenofovir/emtricitabine
Ritonavir-boosted atazanavir plus tenofovir/emtricitabine
Ritonavir - boosted darunavir plus tenofovir/emtricitabine
Meds for AIDS related Opportunistic Infections - P jiroveci
trimethoprim sulfamethoxazole (Bactrim)
pentamidine (Pentam)
Meds for AIDS related Opportunistic Infections - Tuberculosis
isoniazid (INH)
rifampin (Rifadin)
ethambutol (Myambutol)
Meds for AIDS related Opportunistic Infections - Fungal
nystatin (Mycostatin)
amphotericin B (Fungizone)
ketoconazole (Nizoral)
Meds for AIDS related Opportunistic Infections - Viral
acyclovir (Zithromax)
Kidney Specific Antiinfectives
Antibacterial effect on renal tissue, ureters and bladder
Used to treat local UTIs
Example of Kidney Specific Antiinfectives
nitrofurnatoin (Macrobid, Macrodantin)
Major Side Effects of Kidney Specific Antiinfectives
anorexia, N &V, pseudomembranous colitis; photosensitivity, peripheral neuropathy, blood dyscrasias, hemolytic anemia, hypersensitivity, pneumonitis, chest pain
Nursing Care for Kidney Specific Antiinfectives
Administer with meals to reduce GI irritaiton
Monitor blood work, cultures, and urine output
Encourage inc fluid intake to promote drug excretion
Dilute oral suspensions in milk or juice to prevent staining of teeth, urine will appear brown
Urinary Spasmolytics
Affect smooth muscle of urinary tract, used for symptomatic relief of incontinence
Examples of Urinary Spasmolytics
flavoxate, oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), darifenacin (Enablex)
Major Side Effects of Urinary Spasmolytics
anticholinergic effects: tachycardia, palpitations, dry mouth, constipation, drowsiness, blurred vision, urinary retention, allergic reaction
Nursing Care of Urinary Spasmolytics
Do not administer if GI obstruction present
Administer cautiously to clients with glaucoma
Advise to avoid driving and other hazardous activities, avoid hot environments
Monitor urine output
Androgens
Hormones that promote secondary sex characteristics in men; have anabolic properties; stimulate building and repair of body tissue.
Used in debilitating conditions and inoperable breast cancer; restore hormone levels in males, fibrocystic breast disease,
Examples of Androgens
Fluoxymesterone
Danazole
Major Side Effects
weight gain, edema, changes in libido, hoarseness, deep voice, gastroenteritis, emotional lability
Nursing Care of Androgens
Assess for virilization in females and gynecomastia in men
Encourage diet high in calories and proteins to aid in building body tissues and low in sodium to limit edema.
Administer with meals to reduce GI irritation.
Monitor BP.
Assess for potentiation of