Pharm Final

Angiotensin-Converting Enzyme (ACE) Inhibitors
"PRIL

Reduces the production of Angiotensin ii by blocking the conversion of I to ii: leading to vasodilation
Used to Treat: hypertension, heart failure, MI, Stroke
Watch for: Diuretic use, orthostatic hypotension, dry cough, hyperkalemia, angioedema, and Neutr

Angiotensin II Receptor Blockers (ARB's)
"Sartan's

Block the action of Angiotensin II: leading to vasodilation and excretion of NA+ and water
Treats Hypertension, Heart Failure, Stroke Prevention, Delay of Diabetic effects, used in Patients who can not take Ace Inhibitors
The major difference between ARB'

Aldosterone Antagonists
Eplerenone & Spironolactone

Reduce blood volume by blocking aldosterone in the kidneys, thus promoting excretion of sodium and water and retention of potassium
Treats hypertension & heart failure
Watch for hyperkalemia, hyponatremia, gynecomastia
Contraindicated in patients with hig

Calcium Channel Blockers
Verapamil, Diltiazem, Amlodipine, Felodipine, Dicardipine

Blocks Calcium channels in blood which leads to vasodilation
Reflex tachycardia (administer with beta blocker), peripheral edema (give diuretic)
Verapamil is contraindicated in patients with hypotension, heart block, dig toxicity, severe heart failure, an

Beta Adrenergic blockers
Cardioselective: (heart): Metoprolol, atenolol
Nonselective: (heart & Lungs): Propranolol
Alpha & beta blockers: Carvedilol, lavetalol

Blocks electrical conduction of the heart=decreases contractility, Cardiac output, promotes of excretion of sodium and water
Treat primarily hypertension
Assess BP and HR before administration, bronchospasm (NO hx of asthma)
Notify HCP and hold med if HR

Cardiac glycosides
Digoxin

Increase force of myocardial contraction, decreased heart rate
Second line of treatment for heart failure and Afib
Assess for bradycardia, monitor potassium levels, increase potassium containing foods in diet, monitor dig level 0.5-0.8 ng/ml
Watch for dig

Adrenergic agonists
Catecholamines (epinephrine, dopamine, dobutamine)

Site response: Alpha, Beta1, Beta2, Dopamine
Provide for Continuous Cardiac and blood pressure monitoring, Infuse through central IV line
Avoid use of MAOI's in patients receiving epinephrine, dopamine, dobutamine
Nursing administration: continuous IV inf

Organic nitrates
Nitroglycerin

Dilates veins and decreases venous return which decreases cardiac oxygen demand
Used for chest pain
It can cause a headache, low blood pressure, reflex tachycardia
Contraindicated in patients with severe anemia, glaucoma, THI
Caution with patients on anti

STATins
"Statins

Decrease LDL, increase HDL
Treats high cholesterol and prevents coronary events
Assess for hepatotoxicity (Increase in Aspartate Transaminase-Above 40 U/L)
Assess for Myopathy (muscle aches, pain, and tenderness)
Contraindicated in patients with liver dis

Anticoagulants
Heparin, Enoxaparin

Purpose: prevent clotting
Uses: Heparin treats DIC, prevent/treat DVT, PE
Complications: Hemorrhage (watch for bleeding, VS, petechia, black tarry stools), monitor PTT, platelet count (thrombocytopenia)
Contraindicated: Do not give to patients with low pl

Oral Anticoagulant
Warfarin

Purpose: prevents the synthesis of all 4 coagulation factors
Uses: treatment of venous thrombosis, treatment/prevention of thrombus formation in patients with Afib or prosthetic heart valves, prevention of MI, TIA's, PE, DVT.
Complications: hemorrhage, mo

Antiplatelets
Aspirin, clopidogrel

Purpose: inhibit platelets from clumping
Uses: prevent MI, prevent stroke/TIA, acute coronary syndromes
Complications: GI upset, use with PPI, bleeding, tinnitus
Contraindications: Use cautiously in patients with peptic ulcer disease

Thrombolytic Medications
Alteplase (tPA)

Purpose: dissolves clots
Uses: treats acute MI, PE, acute ischemic attacks, restores patency to central IV catheters
Given IV only
Complications: bleeding, monitor PT, PTT, Hgb, Hct
Contraindications: hemorrhagic stroke, active bleeding, kidney disorders

Erythropoietic Growth Factors
Epoetin alfa: erythropoietin

Purpose: increase production of RBC's
Uses: anemia related to chronic kidney disease, chemo use, HIV/AIDS
Complications: thrombotic events, hypertension watch Hgb, Hct levels

Blood/Blood Products

Packed RBC (PRBC's)
Purpose: Increases the number of RBC's
Uses: severe anemia (Hgb 6-10)
Fresh Frozen Plasma (FFP)
Replaces coagulation factors
Uses: active bleeding, burns, shock, DIC
Albumin
Expands circulating blood volume
Uses: hypovolemia, burns
Com

Beta2-Adrenergic agonists
Prototype: albuterol, salmeterol

Purpose: Brochodilation
Uses: Prevention of asthma episode, treatment of Bronchospasm, Long-term control of asthma
Complications: Tachycardia, angina, tremors
Use before other inhalers

Methylxanthines
Prototype: theophylline

Purpose: bronchodilation
Uses: long-term control of chronic asthma/copd
Complications: gi distress, restlessness, dysrhythmias, seizures
Nursing: monitor theophylline serum levels (5-15mcg/mL), avoid caffeinated beverages

Inhaled-Anticholinergics
Prototype: ipratropium, tiotropium

Purpose: bronchodilation
Uses: relieve bronchospasm
Complications: Dry mouth
Nursing: sip fluids, suck on sugar-free candy, rinse mouth

Glucocorticoids
Prototype: prednisone, fluticasone

Purpose: prevent inflammation, decrease edema
Uses: prophylaxis of asthma
Complications: increased risk of infection, bone loss, hyperglycemia, Peptic ulcers
Nursing: check adrenal gland function, monitor glucose, weight bearing exercises, avoid use of NS

Leukotriene Modifiers
Prototype: montelukast

Purpose: reduces inflammation, airway edema, mucus production
Uses: long-term therapy of asthma, used in children
Complications: depression, suicidal ideation
Nursing: Assess for changes in mood and behavior

Expectorants
Prototype: guaifenesin

Purpose: increased cough production by thinning mucous secretions
Uses: decrease congestion
Complications: gi upset, drowsiness
Nursing: take with food, increase fluid intake

Mucolytics
Prototype: acetylcysteine

Purpose: thin secretions
Uses: cystic fibrosis, antidote for acetaminophen poisoning
Complications: aspiration, bronchospasm, hypotension, tachycardia, hepatotoxicity
Nursing: smells like rotten eggs, monitor respiratory status, vitals signs, monitor live

Decongestants
Prototype: phenylephrine, ephedrine

Purpose: reduction in inflammation of nasal membranes
Uses: nasal stuffiness, sinusitis, common cold
Complications: rebound congestion, cns stimulation
Nursing: use short-term, taper off, watch for agitation & nervousness

Antihistamines
Prototype: diphenhydramine, Loratadine & cetirizine (H1 antagonists)

Purpose: blocks histamine
Uses: mild allergic reactions, anaphylaxis, insomnia
Complications: sedation, anticholinergic effects, gi discomfort
Nursing: take at night, avoid driving, take sips of water, suck on candy, take with food, cannot take in 3rd tri

Histamine2-receptor Antagonists
Ranitidine, Cimetidine, Famotidine

Purpose: Block H2 receptors
Uses: ulcers, GERD, heartburn, aspiration, indigestion, H. pylori
Complications: androgen blockage in males, CNS effects, GI distress
Contraindications: use cautiously in the elderly, pts with COPD, interfere with warfarin and

Proton pump inhibitor
Omeprazole, Pantoprazole, Lansoprazole, Esomeprazole

Purpose: reduces gastric acid
Uses: ulcers, erosive esophagitis, GERD, hypersecretory conditions
Complications: Short-term~ HA, N/V/D.... Long-term~ Pneumonia, Osteoporosis, Hypomagnesemia
Contraindications: Do not take if lactating, use cautiously in chi

Mucosal protectant
Sucralfate

Purpose: it serves as a protective barrier over an ulcer
Uses: ulcers
Complications: Constipation
Contraindications: interferes with multiple medications

Antacids
Aluminum hydroxide, Magnesium hydroxide, Calcium carbonate

Purpose: neutralize gastric acid
Uses: Peptic ulcer disease, GERD
Complications: Constipation, Diarrhea, Fluid retention, Toxicity
Contraindications: Use caution if patient has bowel perforation/obstruction/abdominal pain

Laxatives
Psyllium, Docusate sodium, Bisacodyl, Senna, Lactulose

Purpose/Uses: Bulk-forming laxative (diarrhea, promote defecation), Surfactant laxative (constipation, straining), Stimulant laxative (colonoscopy prep, constipation r/t opioid use)
Complications: GI irritation, rectal burning, fluid retention
Contraindic

Antidiarrheals
Diphenoxylate + atropine, Loperamide, Paregoric

Purpose: decrease intestinal motility and increase fluid and sodium absorption
Complications: at high doses a patient can experience opioid effects
Contraindications: Paregoric cannot be used in patients with COPD

Iron Preparations
Ferrous sulfate

Purpose: helps with RBC development and the oxygen carrying capacity
Uses: iron-deficiency anemia
Complications: GI distress, teeth staining, iron toxicity in children
Contraindications: Cannot use for other anemias, medication interactions, caffeine, foo

Vitamin B12/Cyanocobalamin
Vitamin B12, Intranasal cyanocobalamin

Purpose: to correct deficiency
Uses: Vitamin B12 deficiency, Megaloblastic anemia
Complications: Hypokalemia

Folic acid
Folic acid

Purpose: production of DNA and erythropoiesis
Uses: treat megaloblastic anemia, prevention of neural tube defects, supplement for alcohol use disorder
Contraindications: medication interactions with methotrexate and phenytoin

Loop Diuretics
Furosemide

Purpose: Block reabsorption of NA and prevent reabsorption of water, leads to extensive diuresis
Uses: Pulmonary edema due to CHF, Edema, HTN
ROUTE: PO, IV, IM
Complications: Dehydration, Hypotension, Hypokalemia, Ototoxicity
Contraindicated: patients who

Thiazide Diuretics
Hydrochlorothiazide

Purpose: Promotes Diuresis when renal function is NOT Impaired
Uses: 1st choice for htn, edema, combination with antihypertensive
Complications: Dehydration, hypokalemia, Hyperglycemia
Contraindicated: Do not use if Pregnant, breastfeeding, or have renal

Potassium-Sparing Diuretics
Spironolactone

Purpose: Blocks Aldosterone which causes K+ Retention
Uses: Combination drug with other Diuretics, CHF, Hyperaldosterone
Complications: Hyperkalemia, Endocrine effects, Drowsiness
Contraindicated: Not used in pts on K+ supplements or have kidney failure

Osmotic Diuretics
Mannitol

Purpose: reduce ICP
Uses: Prevent Kidney failure, ICP, Intraocular pressure, hyponatremia
Complications: Heart failure, Pulmonary edema, F&E imbalances
Contraindicated: cannot use in pts with active brain bleed, anuria, Pulm. Edema, dehydrated, or renal f

Thyroid Hormone
Levothyroxine (Synthroid)

Purpose: Increase metabolism
Uses: Hypothyroidism
Complications: Overmedication, overtreatment
Contraindications: Can not use if patient has thyrotoxicosis, or just had a MI, caution if hx of any cardiac issues
NOT USED TO TREAT OBESITY
Drug Interactions:

Thionamides
Propylthiouracil, Methimazole

Purpose: Blocks thyroid hormones
Uses: treat Graves' Disease, thyrotoxicosis, methimazole (1st line of therapy)
Complications: Hypothyroidism, Agranulocytosis, Liver injury,
Contraindications: Pregnancy
Interactions: Anticoagulants, Digoxin
NURSING: Monit

Radiopharmaceuticals
Radioactive iodine (131I)

Purpose: Destroys thyroid cells
Uses: Hyperthyroidism, Thyroid Cancer
Complications: Radiation sickness, Bone marrow depression, Hypothyroidism
Contraindications: Pregnancy, Childbearing age/intent, Lactating mothers
NURSING: will be radioactive until the

Anterior Pituitary Hormones/Growth Hormones
Somatropin

Purpose: Stimulates overall growth
Uses: Treat growth deficiencies, AIDS wasting syndrome
Route: IM, SQ (preferred)
Complications: Hyperglycemia, Renal calculi
Contraindications: Cannot use if severely obese or have respiratory impairment, diabetes, treat

Antidiuretic Hormone
Vasopressin, Desmopressin

Purpose: Promotes reabsorption of water within kidney
Uses: Treat Diabetes Insipidus (DI)
Complications: Reabsorption of too much water, Myocardial ischemia
Contraindications: Do not use in cardiac patients, caution in renal patients
NURSING: Monitor VS,

Adrenal Hormone Replacement
Hydrocortisone, Prednisone, Dexamethasone, Fludrocortisone

Purpose: Mimic effect of natural steroids
Endocrine Uses: treat Addison's disease, adrenal crisis
Complications: Osteoporosis, peptic ulcer, infection, Cushing's Syndrome, sodium & water retention
Contraindications: Do not give if patient has active infec

Benzodiazepines
Alprazolam, Diazepam, Lorazepam

Purpose: Relief from anxiety
Uses: anxiety & panic disorder, PTSD, seizures
Complications: CNS depression, amnesia, toxicity, paradoxical response, N/V
Contraindications: Can not use if pregnant/breastfeeding, have sleep apnea, respiratory depression, cau

Selective serotonin reuptake inhibitors (SSRI antidepressants)
Paroxetine, sertraline, citalopram, escitalopram

Purpose: allows more serotonin, produces CNS stimulation
Uses: anxiety, panic attacks, OCD, depressive disorders (1st line of treatment), social anxiety disorders, sexual dysfunction
Complications: early/late effects, weight changes, GI bleeding, serotoni

Monoamine oxidase inhibitors (Maoi's)
Phenelzine

Purpose: Block MAO, increasing other neurotransmitters, can cause increase in BP
Uses: depression, bulimia, OCD, PTSD, anxiety, panic
Complications: CNS stimulation, hypertensive crisis
Contraindications: can not take if taking SSRIs, heart failure, CVD,

Antiepileptic
Carbamazepine, Valproic acid, Lamotrigine (Bipolar)
Phenobarbital, Phenytoin, Carbamazepine, Valproic Acid (Seizures)

Purpose: suppresses CNS excitation
Uses: Bipolar (manic phases), seizures
Complications: CNS effects, Blood dyscrasias, skin disorders, hepatotoxicity, GI effects
Contraindications: Do not use if pregnant, have liver disorders, bone marrow depression
Inte

Anti-Parkinson's
Levodopa/carbidopa

Purpose: offer relief from s/s of Parkinson's
Uses: help with Parkinson's disease
Complications: N/V, Dyskinesias, orthostatic hypotension, cardiovascular effects, psychosis, dopamine agonist, dopamine releaser
NURSING: avoid taking haloperidol, take with

Muscle Relaxants & Antispasmodics
Diazepam, Dantrolene, Baclofen, Cyclobenzaprine

Purpose: produce sedative effects & depress spasticity of muscles
Uses: Muscle spasm r/t injury
Complications: CNS depression, dependence, GI upset, seizures, hepatic toxicity (Dantrolene)
Contraindications: liver impairment
Interactions: alcohol, opioids

Disease-Modifying Antirheumatic Drugs (DMARD's)
Methotrexate, Infliximab

Purpose: slow joint degeneration & progression of RA
Uses: Analgesia, maintenance, slow/delay disease
Complications: risk of infection, hepatic toxicity, bone marrow suppression, GI ulcerations, congenital abnormalities, renal toxicity, blood dyscrasias,

Antigout
Colchicine, Allopurinol, Febuxostat

Purpose: inflammation caused by gout, inhibit uric acid production
Uses: gout
Complications: GI distress, thrombocytopenia, muscle pain, hypersensitivity reaction, kidney injury, Hepatitis
Contraindications: cannot use in pts with renal, cardiac, hepatic,

SLE meds
Belimumab

Purpose: disrupts activation of B-lymphocytes
Uses: Lupus
Complications: GI effects, headache, depression, insomnia, infusion reaction, increased risk of infection
Contraindications: Avoid breastfeeding, cannot use if pt has severe renal impairment
Intera

Fibromyalgia Meds
Duloxentine, Pregabalin

Purpose: restores balance of neurotransmitters
Uses: fibromyalgia, neuropathy
Complications: drowsiness, blurred vision, GI upset, headache, hypertension, sexual dysfunction, angioedema
Contraindications: Cannot take if pt has hepatic, renal impairment or

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Aspirin, Ibuprofen, Naproxen, Ketorolac, Celexoxib

Purpose: decrease platelet aggregation, inflammation, fever, pain
Uses: inflammation, analgesia, fever reduction, inhibits platelet aggregation
Complications: GI discomfort, impaired kidney function, salicylate toxicity, Reye syndrome
Contraindications: P

Acetaminophen
Acetaminophen

Purpose: slows production of prostaglandins
Uses: analgesic, antipyretic
Complications: Acute toxicity
Contraindications: alcohol, warfarin
Interactions: alcohol, warfarin
NURSING: do not take for more than 10 days, take with H2O, do not exceed 4g/day for

Opioid Agonists
Morphine, Fentanyl, Meperidine, Methadone, Codeine, Oxycodone, Hydromorphone

Purpose: Act on the mu receptors
Uses: relief of moderate-severe pain, sedation, cough suppression
Complications: respiratory depression, constipation, urinary retention, cough suppression, sedation, biliary colic, n/v, opioid overdose triad
Contraindicat

Opioid Antagonist
Naloxone, Naltrexone

Purpose: interfere with the action of opioids
Uses: treatment of opioid abuse, reversal of effects of opioids
Complications: tachycardia, tachypnea, abstinence syndrome
Contraindications: patients with opioid dependency, acute hepatitis, liver failure
NUR

PENICILLINS
Penicillin, Amoxicillin, Piperacillin tazobactam

Purpose: destroy bacteria by weakening the bacterial wall
Uses: treat infections caused by Streptococcus pneumonia, gram-negative cocci, and provide prophylaxis against bacterial endocarditis in at risk patients.
Complications: anaphylaxis, renal impairme

Cephalosporins
Cephalexin, Cefazolin, Ceftriaxone, Cefepime (most common)

Purpose: similar to penicillins, they destroy bacterial cell wall
Uses: Broad-spectrum antibiotic that treat UTIs, postop infections, pelvic infections, and meningitis
Complications: anaphylaxis, bleeding, thrombophlebitis, renal insufficiency, antibiotic

Carbapenems
Imipenem-cilastatin, Meropenem (more common)

Purpose: beta-lactam antibiotics that will cause destruction of micro-organisms
Uses: serious infections like pneumonia, peritonitis, UTI due to gram + cocci
Complications: Allergy, GI upset, suprainfections
Interactions: Valproic acid (decreases levels t

Vancomycin
Vancomycin (PO or IV)

Purpose: destroys bacterial cell walls, causing destruction of micro-organisms
Uses: treat serious infections due to methicillin-resistant staph (IV), treats antibiotic associated pseudomembranous colitis due to Cdiff (PO)
Complications: ototoxicity, infu

Tetracyclines
Tetracycline, Doxycycline

Purpose: broad-spectrum antibiotics that inhibit micro-organism growth
Uses: acne, periodontal disease, pneumonia, anthrax, lyme disease, GI infections (H. Pylori - peptic ulcer disease)
Complications: GI discomfort, tooth discoloration (do not use in chi

Macrolides
Erythromycin, Azithromycin

Purpose: slows growth of micro-organisms
Uses: treat infections in patients with penicillin allergy
Complications: GI discomfort, prolonged QT intervals, Ototoxicity
Contraindications: cannot use if pt has liver disease or QT prolongation
NURSING: take on

Aminoglycosides
Gentamicin, Tobramycin, Neomycin

Purpose: bactericidal antibiotics that destroy micro-organisms
Uses: treat gram- bacilli (Ecoli), oral neomycin suppresses the normal flora of GI tract (prior to colorectal surgery), treats infections of the eye, ear, and skin
Complications: Ototoxicity,