EXAM 3

hydromorphone

7 times stonger than morphine. Also known as Dilaudid.Youll see Constipation respiratory depression

dextroamphetamine

ADHD narcolepsy and somnolence, obesity. High risk for abuse and dependency. Any amphetamines will slow them down if have ADHD, if don't have ADHD this will speed you up (anxious).

olmesartan

ARB (angiotensin receptor blockers) anti hypertensive agent. Angiotensin causes vasoconstriction, by blocking the receptors it is unable to enact its purpose. Commonly used for congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, and to reduce the risk of stroke.

Pseudoephedrine

Adrenergic, nasal decongestant. It can cause rebound nasal congestion. Don't give to pts with hypertension. DONT GIVE WITH MAOIs within 14 days.

Acetaminophen

Analgesic, antipyretic, nonopioid analgesic. NOT AN NSAID. PO/RECTAL: treat mild to moderate pain and fever. IV: treat mild to moderate pain, moderate to severe pain with opioid analgesics, fever. Inhibits synthesis of prostaglandins. NO anti-inflammatory properties or GI toxicity. ADVERSE: CNS: agitation in children, anxiety, headache, fatigue, insomnia. RESP: atelectasis (collapse of lung), dyspnea. CV: hypertension, hypotension. GI: HEPATOTOXICITY, constipation, increased liver enzymes. F AND E: hypokalemia. GU: renal failure. HEMAT: neutropenia, pancytopenia. MS: muscle spasmus, trismus (lock jaw), DERM: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, STEVENS JOHNSON SYNDROME, TOXIC EPIDURAL NECROLYSIS. Assess for rash, blisters, bullae, or other lesions on skin in mucous membranes. ANTIDOTE: acetylcysteine.

donepezil

Anti-Alzheimer agent/cholinergic; cholinesterase inhibitor. Treatment of mild to moderate dementia associated with Alzheimer's disease. Action: improves cholinergic function, which is lacking in clients with Alzheimer's disease, by inhibiting acetylcholinesterase, thus prolonging the effect of acetylcholine (the neurotransmitter of the cholinergic system). ADVERSE: CNS: headache, abnormal dreams, depression, dizzy, drowsy, fatigue, insomnia, syncope. CV: atrial fibrillation, HTN, hypotension, vasodilation. GI: diarrhea, nausea, anorexia, vomiting, PEPTIC ULCERS. GU: frequent urination. DERM: ecchymoses. METAB: hot flashes, weight loss. MS: arthritis, muscle cramps. NOTIFY HCP IF ABDOMINAL PAIN, COFFEE GROUND EMESIS, NAUSEA, DIARRHEA, CHANGES IN COLOR OF STOOL, OR NEW SYMPTOMS OCCUR. This med slows the progression for the disease but does not provide a cure. Increased cholinergic side effects: SLUDGE: salivation, lacrimation, urination, diarrhea, GI distress, emesis. Administer in the evening before going to bed. Cholinesterase inhibitor, increases acetylcholine. Indicated for ppl with alzheimers and dementia related to parkinsons (sometimes parkinsons causes dementia). Drug to drug interaction with anticholinergic drugs and NSAIDS.

levodopa/carbidopa

Anti-Parkinson agent/ dopamine agonist. Treatment of Parkinson's dz. These drugs are not useful for drug induced extrapyramidal reactions. Action: Levodopa is converted to dopamine in the CNS, where is serves as a neurotransmitter. Carbidopa, a decardoxylase inhibitor, prevents peripheral destruction of levodopa. Consequently more levodopa is delivered to the CNS using a smaller dose when used with carbidopa. ADVERSE: CNS: involuntary movements, anxiety, dizziness, hallucinations, memory loss, psychiatric problems. EENT: blurred vision, mydriasis. GI: nausea, vomiting, anorexia, dry mouth, HEPATOTOXICITY. DERM: melanoma. HEMAT: hemolytic anemia, leukopenia. MISC: darkening of urine or sweat. HIGH PROTEIN MEALS MAY IMPAIR THE DRUG'S EFFECTS. Change positions slowly to decrease dizziness. Good oral hygiene for dry mouth. Avoid multivitamins (pyridoxine vitamin B6 and iron may decrease effectiveness). Notify HCP if palpitations, urinary retention, involuntary movement, behavioral changes, severe nausea, and vomiting or new skin lesions occur. Signs of toxicity: involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of tongue, behavioral changes. Treats parkinsons. Carbidopa is unable to pass BBB, levodopa can pass through and it can bring carbidopa with it. Adverse: urinary retention (before catheterize check bladder scan), hypotension, heart palpitations. Can cause nausea and vomiting.

Entacapone

Anti-Parkinson agent/COMT inhibitor. Treatment of Parkinson's dz as an adjunct to levodopa/carbidopa therapy to decrease fluctuation of dopamine (off periods). Inhibits the enzyme that breaks down levodopa, greatly increasing its availability to the CNS. Prolongs duration of response to levodopa without end of dose motor fluctuations. ADVERSE: SEVERE DIARRHEA, HEPATOTOXICITY. Assess LFT periodically. This drug can cause serious liver problems quickly. Do not give concurrently with MAOI type A or B drugs, SSRI, SNRIs, or TCAs. Give with levodopa/carbidopa. Inhibition enzyme COMT. Parkinsons pt increases levodopa time that it can work. Helps decrease weaning off affect. Side effect is urinary discoloration and tarditive dyskinesia.

Midazolam

Antianxiety agent, sedative-hypnotic/benzodiazepines. Promotion of presurgical sedation. Commonly used for conscious sedation. Produce CNS depression. ADVERSE: CNS: agitate, drowsy, excess sedation, headache. EENT: blurry vision. RESP: apnea, LARYNGOSPASM, RESPIRATORY DEPRESSION, bronchospasm, coughing. CV: CARDIAC ARREST, arrhythmias. GI: hiccups, nausea, vomiting. DERM: rash. LOCAL: phlebitis at the IV site, pain at IM site. This medication decreases mental recall of procedure. ANTIDOTE: flumazenil. BENZO. Short acting. Commonly used for sedation and anxiety. All benzo watch resp depression.

Digoxin

Antiarrhythmic agent, inotropic agent/digitalis glycoside. Treats CHF, tachyarrhythmias, atrial fibrillation, atrial flutter, and paroxysmal atrial tachycardia. Contraindicated in ucontrolled ventricular arrhythmias, AV blocks. Watch for hypokalemia, predisposes toxicity. Monitor apical pulse for 1 full minute before administering drug. Monitor BNP. heart failure, afib, flutter. Liver failure pts at increased risk for digoxin toxicity (see halos). First time You receive digitizing dose that's higher than norm to bring you up to therapeutic levels faster (0.5-2) therapeutic level. Antidote is digoxin immunofab

gabapentin

Anticonvulsant. Adjunct treatment for partial seizures. Can be used for mood stabilization and adjunct analgesia (diabetic neuropathy, postthermic neuralgia, and fibromyalgia). Involved in enhancing the activity of GABA. May cause blockage of sodium channels in neurons. ADVERSE: CNS: dizzy, drowsy, nervous, weakness, cognitive impair, confusion, difficulty concentrating, HALLUCINATIONS, headache, mental depression, personality disorder. EENT: abnormal vision, tinnitus. RESP: DYSPNEA, epistaxis. CV: chest pain, edema, HTN, palpitations, syncope, tachycardia. GI: abdominal pain, gingivitis, stomatitis. DERM: alopecia. MS: arthralgia, neck pain. NEURO: ataxia, tremors. MISC: allergic reactions, chills, lymphadenopathy. DO NOT DISCONTINUE ABRUPTLY. Give info on ketogenic diet. For seizure mainentance, pain adjunct, given for neuropathic pain. Inhibits transmission of GABA between neurons at the junction sites.

duloxetine

Antidepressant, antianxiety/serotonin and norepinephrine reuptake inhibitor (SNRI). Treatment of major depressive illnesses or relapse, often in conjunction with psychotherapy. Treatment of generalized anxiety disorder and social anxiety disorder. Inhibits serotonin and norepinephrine reuptake in the CNS. ADVERSE: CNS: SEIZURES, abnormal dreams, anxiety, dizziness, headache, insomnia, nervousness, weakness, abnormal thinking, agitation, confusion, depersonalization, worsening depression. EENT: rhinitis, visual disturbances, tinnitus. CV: abdominal pain, altered taste, anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting, weight loss. GU: sexual dysfunction, urinary frequency, urinary retention. DERM: echymoses, itching, photosensitivity, skin rash. NEURO: paresthesia, twitching. MISC: chills, yawning. REPORT SUICIDAL THOUGHTS IMMEDIATELY. The risk for serotonin syndrome increases with use of MAOIs, St. John's wort, or SAMe. Assess suicidal tendencies especially in early treatment. Monitor CBC, LFT, RFT, and electrolyte levels. SNRI: for depression, anxiety, fibromyalgia, peripheral neuropathy. ALL SNRI, SSRI, MAOI have a lot of drug to drug interactions. All interact with alcohol.

fluoxetine (same as Citalopram)

Antidepressant/ selective serotonin reuptake inhibitor (SSRI). Treatment of various forms of depression, OCD, social phobias, bulimia, anorexia nervosa, and panic disorder. Selectively inhibits the reuptake of serotonin from the neural synapse. ADVERSE: CNS: SEIZURES, anxiety, drowsy, headache, insomnia, nercous, abnormal dreams, dizzy, fatigue, hypomania, mania, weakness. EENT: stuffy nose, visual disturbances. RESP: cough. CV: chest pain, palpitations. GI: diarrhea, abdominal pain, abnormal taste, anorexia, constipation, dry mouth, dyspepsia, nausea, vomiting, weight loss. GU: sexual dysfunction, urinary frequency. DERM: Excessive sweating, pruritis, erythema nodosum, flushing, rashes. ENDO: dysmenorrhea. MS: arthralgia, back pain, myalgia. NEURO: tremor. MISC: allergic reaction, fever, flu like syndrome, hot flashes, sensitivity reaction. The medication may cause decreased libido. REPORT CHEST DISCOMFORT, PALPITATIONS, or SUICIDAL THOUGHTS IMMEDIATELY. Monitor appetite and nutrition intake. Monitor CBC, LFT, and RFT. Prototypical SSRI for depression, OCB, panic disorder, and PMS. Drug to drug interactions. SSRI: increase serotonin and neurepinephrine in the body.

Lidocaine

Antidysrhythmic. Increases electrical stimulation threshold of ventricle and His-purkinje system, which stabilizes cardiac membrane and decreases automaticity. (Decreases myocardial excitability). Treats: ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, MI, digoxin toxicity, cardiac catheterization. CONTRA: hypersens to amides, severe heart block, supraventricular dysrhythmias, Adams Stokes syndrome, Wolff-Parkinson-White syndrome. CAUTION: CHF, respiratory depression, malignant hyperthermia, myasthenia gravis. ADVERSE: CNS: headache, dizzy, involuntary movement, confusion, tremor, drowsiness, euphoria, SEIZURS, shivering. CV: hypotension, bradycardia, HEART BLOCK, CARDIOVASCULAR COLLAPSE, ARREST. EENT: tinnitus, blurred vision. GI: Nausea, vomiting, anorexia. HEMA: MEthemoglobinemia. INTEG: rash, urticarial, edema, swelling, petechiae, pruritis. MISC: fibrile response, phlebitis at injection site. RESP: dyspnea, RESPIRATORY DEPRESSION. Monitor ECG continuously. THERAPEUTIC EFFECTS: decreased BP/dysrhythmias, decreased HR, normal sinus rhythm. Reversal: O2, artificial ventilation, ECG, DOPAMINE (circulatory depression), DIAZEPAM (seizures)spo Local anesthetic. Topical injectable, nebulizer. If IV its not for anesthetic its used for arrhythmias. If injected with Epinephrine it will vasoconstict stop blood flow. Toxicity is life threatening.

metoclopramide

Antiemetic, gastric stimulant. Prevents emesis r/t chemotherapy and surgery. Reduce GERD. Prevents micro aspiration in clients with enteral (tube) feedings. Unlabeled use = treatment of hiccups. Action: blocks dopamine receptors in the chemoreceptor trigger zone of CNS. Stimulates motility of upper GI tract and accelerates gastric emptying. ADVERSE: CNS: drowsy, NEUROLEPTIC MALIGNANT SYNDROME.Stimulates digestive tract. Treats GERD. Blocks dopamine to speed up emptying and movement of stomac and intestines. At risk for tarditive dyskinesia (lip smacking). Don't give to any parkinsons pts bc it blocks dopamine and theres not enough dopamine in these pts.

propranolol

Antihypertensive, antianginal, antidysarrhythmic, beta blocker. Has inotropic, chronotropic, dromotropic properties. Therapeutic effect:decreased BP and HR. Used for MI, heart failure, Migraines. Increases Blood flow. If it works: decreased BP and hypertension, decreased tremors, absense of dysrhytmias, decreased migraine headaches. Lots of drug to drug interactions. Don't give to asthma or pregnant pts. Taper off drug 1-2 weeks will cause bad BP.

pyridostigmine

Antimyasthenic/anticholinesterase; cholinergics. Diagnosis of myasthenia gravis. Assessment of adequacy of anticholinesterase therapy in myasthenia gravis. Differentiating myasthenic from cholinergic crisis. Reversal of muscle paralysis from nondepolarizing neuromuscular blocking agents. Other agents in this class increase muscle strength in symptomatic treatment of myasthenia gravis and prevent and treat postoperative bladder distention/ urinary retention of ileus. Action: inhibits the breakdown of acetycholine by acetylcholinesterase in the neural synapse, resulting in prolonged effect. Causes muscular contraction. ADVERESE: CNS: SEIZURES, dizzy, dysphasia, dysphonia, weakness. EENT: diplopia, lacrimation, miosis. RESP: bronchospasm, excess secretions. CV: bradycardia, hypotension. GI: abdominal cramps, diarrhea, dysphagia, excessive salivation, vomiting, nausea. GU: incontinence, urinary frequency. DERM: sweating, rashes. MS: fasciculation (spontaneous contraction). Lifelong treatment will be required. Space activities to avoid fatigue. To differentiate myasthenic from cholinergic crisis, assess for increased cholinergic symptoms (SLUDGE- salivation, lacrimation (tears), urination, diarrhea, GI distress, emesis). Give exactly when ordered. Atropine (anticholinergic) may be used for treatment of cholinergic symptoms. Cholinergic drug myasthenia gravis first line 30 min before activity. Improves muscle strength. Secondary use for reducing effects of nondepolarizing neuromuscular drugs. Antidote for tricyclic antidepressants overdose.

Clopidogrel

Antiplatelet agent/platelet aggregation inhibitor. Reduction of atherosclerotic events in clients at risk for such events, including those with recent MI, acute coronary syndrome (unstable angina/non Q wave MI), stroke, PVD/PAD. Action: Decreases blood viscocity by inhibiting platelet aggregation and decreasing fibrinogen. Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. ADVERSE: BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIA PURPURA. Notify HCP if fever, chills, sore throat, or unusual bleeding or bruising occurs. Prolonged bleeding time is expected. Monitor CBC with differential and platelet count periodically during therapy. Monitor LFT, lipid panel, and uric acid level. Contraindicated in idiopathic thrombocytopenic purpura. antiplatelet, stroke, and cardiac disease. Never give to pt with active bleed.

chlorpromazine

Antipsychotic agent/phenothiazine (older antipsychotic agent). Treatment of acute and chronic psychoses, particularly when accompanied by increased psychomotoractivity. Treatment of nausea and vomiting. Treatment of intractable hiccups. Alters the effects of dopamine in the CNS. Has significant anticholinergic/alpha-adrenergic blocking activity. ADVERSE: CNS: NEUROLEPTIC MALIGNANT SYNDROME, sedation, extrapyramidal reactions, tardive dyskinesia. EENT: blurred vision, dry eyes, lens opacities. CV: hypotension (increased with IV and IM), tachycardia. GI: constipation, dry mouth anorexia, hepatitis, ileus. GU: urinary retention. DERM: photosensitivity, pigment changes, rashes. ENDO: galactorrhea. HEMAT: AGRANULOCYTOSIS, LEUKOPENIA. METAB: hyperthermia. Report any abnormal muscle movement or twitches immediately. Extremes of temperature should be avoided. Monitor for orthostatic hypotension. MONITOR FOR DEVELOPMENT OF NEUROLEPTIC MALIGNANT SYNDROME. Monitor CBC, LFT, and ocular acuity. Antipsychotic. Can cause nausea vomiting and hiccups. BLACK BOX; don't give to dementia pts results in psychosis.

Naproxen (SIMILAR TO KETOROLAC)

Antirheumatic (disease causes joint pain), analgesic, NSAID. Treat mild to moderate musculoskeletal pain or dysmenorrhea. Treat inflammatory disorders including those in the eye. Treat fever and pain in adults and children. Used IV for ductus arteriosus patency. Inhibits prostaglandin synthesis. ADVERSE: CNS: headache, dizzy, drowsy, psychic disturbances. EENT: amblyopia, blurred vision, tinnitus. CV: arrhythmias, edema, MI, CVA. GI: GI BLEEDING, HEPATITIS, constipation, dyspepsia, nausea, vomiting, abdominal discomfort. GU: cystitis, hematuria, renal faiure. DERM: EXFOLIATIVE DERMATITIS, STEVENS JOHNSON SYNDROME, TOXIC EPIDERMAL NECOLYSIS, rashes. HEMAT: blood dyscrasias, prolonged bleeding time. MISC: allergic reactions, ANAPHYLAXIS. Take with food and mild and remain upright for 30 min to decrease irritation to lower esophagus. Alcohol increases stomach irritation. Report abdominal/stomach pain or black/red odorous stool. Monitor: BUN, serum creatinine, CBC with differential, electrolytes, bleeding time, and LFT periodically.

atomoxetine

Attention Deficit Disorder agent/selective norepinephrine reuptake inhibitor. Treatment of ADHD. Selectively inhibits the presynaptic transporter of norepinephrine. ADVERSE: CNS: dizzy, fatigue, mood swings, insomnia. CV: HTN, orthostatic hypotension, tachycardia. GI: dyspepsia, SEVERE LIVER INJURY (rare), nausea, vomiting, dry mouth, constipation. DERM: rash, urticaria. GU: dysmenorrhea, ejaculatory problems, decreased libido, erectile dysfunction, urinary hesitation, urinary retention. METAB: decreased appetite, weight/growth loss. MISC: allergic reactions including ANGIONEUROTIC EDEMA. Avoid pregnancy or breastfeeding. CONTRAINDICATED WHEN USED CONCURRENTLY WITH OR WITHIN 2 WEEKS OF MAOIS. CONTRAINDICATED IN CLIENTS WITH NARROW ANGLE GLUACOMA OR CV HISTORY. THIS MED MAY INCREASE THE RISK OF SUICIDE. CONCURRENT ALBUTEROL OR VASOPRESSOR USE INCREASES RISK OF ADVERSE CV REACTIONS. Monitor BP, pulse, and LFT. ADHD narcolepsy, somnolence. Don't give to depression or suicidal pts

Atenolol

BETA BLOCKER MIGRAINES AND HEADACHES. BLACK BOX IS ABRUPT CESSATION. TAPER OFF FOR 1-2 WEEKS.

Alendronate

Bone resorption inhibitor, inhibits osteoclast activity. Theapeutic effects: reduces symptoms of osteoporosis, Paget's dz. helps with osteoporosis, prevents bone breaks. Give with lots of water and have pt sit upright for 30 min to prevent esophageal burn. Osteoclast formation. ADVERSE: angioedema, Steven Johnson's syndrome, toxic epidural necrolysis, atrial fibrillation.

caffeine

CNS stimulant. Bronchodilate other decreases in sympathetic nervous system, HR, Bp, sweating. is contraindicated in peptic ulcers. Can cause cardiac dysrhythmias. Past heart attack don't take these.

modafinil

CNS stimulant. Improvement of wakefulness in clients with excessive daytime drowsiness due to narcolepsy, obstructive sleep apnea, or shift work sleep disorder. Produces CNS stimulation by weak dopaminergic activity, alpha 1 receptor adrenergic agonism, and decrease is GABA transmission. ADVERSE: CNS: headache, amnesia, anxiety, cataplexy, confusion, depression, dizzy, insomnia, nervous. EENT: rhinitis, abnormal vision, amblyopia, epistaxis, pharyngitis. RESP: dyspnea, lung disorder. CV: ARRHYTHMIAS, CHEST PAIN, HTN, hypotension, syncope, vasodilation. GI: nausea, abnormal liver function, anorexia, diarrhea, gingivitis, mouth ulcers, thirst, vomiting. GU: abnormal ejaculation, albuminuria, urinary retention. DERM: dry skin, herpes simplex. ENDO: hyperglycemia. HEMAT: eosinophilia. MS: joint disorder, neck pain. NEURO: ataxia, dyskinesia, hypertonia, paresthesia, tremor. MISC: infection. This med may impair judgement. NOTIFY HCP IF RASH HIVES OR OTHER ALLERGIC REACTIONS OCCUR. ... CONTRAINDICATED IN PATIENTS WITH CV PROBLEMS. MAY CAUSE ELEVATED LIVER ENZYMES SO MONITOR LFT. Administer a single dose in the morning 1 hour before the start of work shift for clients with shift work sleep disorder. Narcolepsy, somnolence, and sleep apnea.

Tramadol

Centrally acting analgesic/opioid Treats mod to severe pain. Inhibits reuptake of serotonin and norepinephrine in the CNS, which decreases stimulation of nociceptors. Active metabolite, liver function is necessary for it to work. Can cause constipation, respiratory depression and seizures. Pt population at risk are tricyclic antideprressants, SSRI, MAOIs.

Depression

Disease. Depression meds don't discontinue abruptly bc worsens. Symptoms: disconnected with self, appetite changes. Watch cheese effect (tyromine) antidepressants causes HTN

propofol

General anesthetic. Induction of general anesthesia in children older than 3 yr and adults. Maintenance of balanced anesthesia when used with other agents in children older than 2 mo and adults. Initiation and maintenance of monitored anesthesia care (MAC). Sedation of intubated, mechanically ventilated clients in intensive care units. Short and rapid acting (40-sec) sedative hypnotic. Produces amnesia but has no analgesic properties. ADVERSE: CNS: dizzy, headache. RESP: Apnea, cough. CV: bradycardia, hypotension, hypertension. GI: abdominal cramping, hiccups, nausea, vomiting. DERM: flushing. LOCAL: burning, pain, stinging, coldness, numbness, tingling at IV site. MS: involuntary muscle movements, perioperative myoclonia. GU: discoloration or urine (GREEN), MISC: fever. This medication decreases and eliminates mental recall of the procedure. This med will STING AND BURN WHEN ADMINISTERED... ASSESS RESPIRATORY STATUS, PULSE, AND BP CONTINUOUSLY THROUGHOUTT THERAPY. FREQUENTLY CASUES APNEA. MAINTAIN PATENT AIRWAY, APPLY NASAL CANNULA, AND MAINTAIN ADEQUATE VENTILATION. ENDOTRACHEAL INTUBATION TRAY AND RESCUCITATION EQUIPMENT SHOULD BE READILY AVAILABLE. Make sure patient has maintained NPO status prior to procedure. May be administered as an intermittent or continuous infusion for clients on mechanical ventilation. Anesthetic sedative, still need pain med. Lipid based, BBB fast. Don't give if increased lipid levels. Only Short term use for kids. Decrease BP, HR, and cardiac output. Vecuronium: neuromuscular blocking agent. Pt needs to be intubated immediately, it paralyzes but can still hear and see things, can still feel things too. Still need pain med.

Ketamine

General anesthetic. anesthetic commonly abused. Lipid soluble can cross through the blood brain barrier makes it work faster. Hallucinations common side effect. Pair with BENZO it decerases hallucinations.

Nalbuphine

IOB opioid, can be anesthetic adjunct has to be combined. High black box warning of abuse.

Cholestyramine

Lipid lowering agent/bile acid sequestrant. Management of primary hypercholesterolemia. Treatment of pruritus associated with elevated levels of bile acids. Binds bile acids in the GI tract, forming an insoluble complex. The liver must use more cholesterol to make more bile acids. Result is increased clearance of cholesterol. Watch A, D, K, E deficiency. Notify HCP if unusual bleeding or bruising, petechiae, or black tarry stool occurs. Treatment with vitamin K may be necessary. Assess for constipation and presence of bowel sounds. Administer before meals and spaced 1-2 hours apart from other drugs (may bind with them). never give to anyone with PKU or biliary obstruction. Used for constipation effects. Nursing mothers be careful bc interferes with fat soluble vitamins baby wont get vitamins it needs

Phenelzine

MAOI last resort. It can worsen depression and suicide. Can cause hypertension crisis. ALL MAOI don't eat tyromine based foods (wine, pickles, cheese, yogurt, dairy).

calcium carbonate

Mineral and electrolyte replacement or supplemet; acid buffer/electrolyte (calcium salts). Treatment of osteoporosis. Antacid treatment of gastritis. Treatment of electrolyte imbalance. Acts as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle. Essential for bone formation and blood coagulation. Buffers acidity. ADVERSE; CARDIAC ARREST, REBOUND ACIDITY. Vitamin D must be taken in adequate amounts. Watch for signs of deficiency (paresthesias, Chvostek's sign, tremors). Excess use may result in arrhythmias and decrease effectiveness of calcium channel blockers. Avoid high oxalate foods, and report any kidney discomfort or passage of sediment or dtones. MONITOR BP, PULSE, AND ECG FREQUENTLY THROUGHOUT PARENTERNAL THERAPY. MAY CAUSE VASODILATION WITH RESULTING HYPOTENSION, BRADYCARDIA, ARRHYTHMIAS, AND CARDIAC ARREST. pregnancy to prevent gi upset.

lithium

Mood stabilizer. Treatment of bipolar affective disorder (treatment of acute manic episodes and prophylaxis against recurrence). Alters cation transport in nerve and muscle. Influences reuptake of neurotransmitters. ADVERSE: CNS: SEIZURES, fatigue, headache, ipaired memory, ataxia, confusion, dizzy, drowsy, psychomotor retardation, restlessness, stupor. EENT: aphasia, blurred vision, dysarthria, tinnitus. CV: ARRYTHMIAS, ECG CHANGES, edema, hypotension. GI: abdominal, pain, anorexia, bloating, diarrhea, nausea, dry mouth, metallic taste. GU: polyuria, glycosuria, nephrogenic diabetes insipidus, renal toxic. DERM: acne, folliculitis, alopecia, diminished sensation, pruritis. ENDO: hypothyroidism, goiter, hyperglycemia, hyperthyroidism. F and E: hyponatremia. HEMAT: leukocytosis. METAB: weight gaun. MS: muscle weakness, hyperirritability, rigidity. NEURO: tremors. Bipolar disorder, watch metal toxicity. CAN BE TOXIC TO KIDNEYS. High salt concentration, can be very dehydrating. Educate on drinking a lot of water. Narrow therapeutic range. Can be very toxic.

Ketorolac (SIMILAR TO NAPROXEN)

Nonsteroidal anti-inflammatory (NSAID), nonopioid analgesic, (COX-1 inhibitor) Inhibits prostaglandin synthesis. INDICATIONS: treatment of mild to moderate musculoskeletal pain or dysmenorrhea. Treatment of inflammatory disorders, including those of the eye. Treatment of fever and pain in adults and children. Used IV for ductus arteriosus patency. ADVERSE: CNS: headache, dizziness, drowsiness, psychic disturbances. EENT: amblyopia, blurred vision, tinnitus. CV: arrhythmias, edema, MI, CVA. GI: GI BLEEDING, HEPATITIS, constipation, dyspepsia, nausea, vomiting, abdominal discomfort. GU: cystitis, hematuria, renal failure. DERM: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rashes. HEMAT: blood dyscrasias, prolonged bleeding time, ANAPHYLAXIS. Teach pt: take with food or milk and remain upright for 30 min to decrease irritation of lower esophagus. Alcohol increases the potential for stomach irritation. Report abdominal/stomach pain or black-red odorous stool. Assess for rhinitis, asthma, and urticaria. Monitor VS and pain, monitor BUN, serum creatinine, CBC with differential, electrolytes, bleeding time, AST, ALT, and LFT periodically. THERAPEUTIC EFFECTS: decreased pain, decreased inflammatory response, increased mobility, decreased ocular itching. Synthetic opioid .1 mg IV push is sane as 10 mg morphine IV PUSH. Can be given in patches. Replace every 72 hours. STRONG. NSAID: GI bleeding and gastric upset. VERY STRONG. Maternity common.

Codeine

Opiate. Depresses pain impulse at the spinal cord level; decreases DRY cough reflex, GI motility. (Mild to moderate pain relief, decreased non productive cough, decreased diarrhea). Contraindicated: respiratory depression, increased intracranial pressure, seizure, and breastfeeding. Precautions: Pregnancy C (may harm child), geriatric, cardiac dysrhythmias, prostatic hypertrophy, bowel impaction. DO NOT USE ON PRODUCTIVE COUGH. Slowly withdraw after long term use to avoid withdrawal symptoms use stool softener, laxative for constipation. Store in light resistant container at room temp. Do not give if cloudy or precipitates have formed. ADVERSE: CNS: drowsy, sedation, dizzy, SEIZURES. CV: bradycardia, palpitations, orthostatic hypotension, tachycardia, CIRCULATORY COLLAPSE. GI: nausea, vomiting, constipation, DRY MOUTH. GU: urinary retention. INTEG: flushing, rash, urticarial, pruritis. RESP: RESPIRATORY DEPRESSION, RESPIRATORY PARALYSIS. DRUG/LAB test: amylase, lipase. REVERSAL: Naloxone (NARCAN) Opioid for cough can be addictive. OPIOIDS Watch respiratory depression, constipation, decreased BP and HR (CHILLLLLL YOU OUTTT). DON'T GIVE INRCEASED ICP, RESP ISSUES OR SEIZURE DISORDER. Need prescription. BLACK BOX: Child tonsillectomy adenoidectomy

Oxycodone

Opiate/Analgesic. Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception. DECREASES moderate to severe PAIN. CONTRA: asthma, ileus. CAUTION: pregnancy B, breastfeeding, increased ICP (intracranial pressure), MI, severe heart dz, renal.hepatic dz, bowel impaction. IMPLEMENT: should be titrated. Store in light resistant place at room temp. Can give with food or milk to reduce GI upset. ADVERSE: CNS: drowsy, dizzy, confused, headache, sedation, euphoria. CV: palpitations, bradycardia, change in BP. EENT: tinnitus, blurry vision, miosis (excess constriction of pupil), diplopia (double vision). GI: nausea, vomiting, anorexia, constipation, cramps, gastritis, dyspepsia, biliary spasm. GU: increased urinary output, dysuria, urinary retention. INTEG: rash, urticaria, bruising, flushing, diaphoresis, pruritis. RESP: RESPIRATORY DEPRESSION. INTERACTIONS: alcohol (increased respiratory depression, hypotension, sedation) MAOI: increased toxicity. St. John's Wort: increased sedative effect. DRUG/LAB test: amylase, lipase. BLACK BOX: respiratory depression. REVERSAL: Naloxone (NARCAN), IV fluids, vasopressors. Commonly combined with acetaminophen or aspirin. Watch respiratory depression, decreased bp and hr.

Naloxone

Opioid Antagonist (ANTIDOTE). Reversal of CNS depression and respiratory depression bc of suspectedopioid overdose and alcohol abuse. Naloxogel: used for opioid induced constipation. Other uses include narcotic induced pruritis. ADVERSE: CV: HTN, hypotension, VENTRICULAR FIBRILLATION, VT. GI: nausea and vomiting. KEEP IN MIND: these medications reverse the affects of analgesia. ANTIDOTE FOR OPIOID. Give every 2-3 min until opioid is out of system. They will awaken abruptly can cause seizure. Temporary fix still need to go to emergency DEPT

Meperidine

Opioid/Analgesic. Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors. Relief of moderate to severe pain, preoperatively, postoperatively, general anesthesia maintenance, sedation induction. CONTRAINDICATIONS: RESPIRATORY DEPRESSION. CAUTION: breastfeeding, children, geriatric, increased intracranial pressure, seizure disorder, adrenal insufficiency, alcoholism, angina, anticoagulant therapy, asthma, atrial flutter, biliary tract dz, bladder obstruction, heart failure, hypotension, hypothyroidism, ileus, IBS, myxedema thrombocytopenia, MAOI therapy. IMPLEMENTATION: light resistant area at room temp may be given with food or milk to reduce GI irritation. Do not give if cloudy or if precipitate has formed, patient should remain recumbent (lying down) 1 hour after administration. IM is preferred route for multiple injections. Syringe incompatibilities: heparin, morphine, PENTObarbital. ADVERSE: CNS: drowsy, dizzy, confusion, headache, sedation, euphoria, INCREASED ICP, SEIZURES, serotonin syndrome (high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.) CV: palpitations, bradycardia, hypotension, change in BP, tachycardia (IV). EENT: tinnitus, blurred vision, miosis, diplopia, depressed corneal reflex. GI: nausea, vomiting, anorexia, constipation, cramps, biliary spasm, paralytic ileus. GU: urinary retention, dysuria. INTEG: rash, urticaria, bruising, flushing, diaphoresis, pruritis. RESP: RESPIRATORY DEPRESSION. ANAPHYLAXIS. INTERACTIONS: alcohol (increased respiratory depression, hypotension, sedation. Phenytoin: decreased meperidine effect. Procarbazine: fatal reaction, do not use together. SSRIs, SNRIs, serotonin receptor agonists; increased serotonin syndrome, increased neuroleptic malignant syndrome, MAOIs: do not use for 2 weeks before taking meperidine; may cause fatal reaction. Protease inhibitor antiretrovirals: increased adverse reactions. St. John's wort; increased CNS depression. DRUG LAB TEST: increased amylase, lipase. Assess renal function before therapy. REVERSAL: Naloxone (NARCAN), IV fluids, O2, vasopressors. Postop shivering and migraines. NOT commonly used bc elderly and kidney issues it causes.

Fentanyl

Opioid/Analgesic. Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception by binding to opiate receptors. (good supplement to anesthesia). Controls moderate to severe pain; preoperatively and postoperatively; adjunct to general/regional anesthetic. Conscious sedation. CONTRA: myasthenia gravis. CAUTION: pregnancy C, breastfeeding, geriatric, increased intracranial pressure, seizure disorders, cardiac dysrhythmias, severe respiratory disorders. IMPLEMENTATION: store in light-resistant area at room temp. ADVERSE: CNS: dizzy, delirium, euphoria, sedation, confusion, weakness. CV: BRADYCARDIA, CARDIAC ARREST, hypo/hypertension. EENT: blurred vision, miosis (constriction of pupils). GI: Nausea, vomiting, constipation. GU: Urinary retention. INTEG: rash, diaphoresis. MS: muscle rigidity. RESP: RESPIRATORY DEPRESSION, ARREST LARYNGOSPASM. INTERACTIONS: Alcohol (increased respiratory depression, hypotension, increased sedation). Diazepam (increases CV depression), Droperidol (Increased hypotension). St. John's wort: increased fentanyl action. Echinacea: decreased effect of fentanyl. DRUG/LAB TESTS: increased amylase, lipase. BLACK BOX: headache, migraine, apnea, respiratory arrest in opioid native patients, ambient temperature increase (excessive heat may increase absorption) POSITIVE THERAPEUTIC EFFECT: maintenance of anesthesia, decreased breakthrough cancer pain, general pain relief. REVERSAL: Naloxone (NARCAN), IV fluids, vasopressors.

pancrelipase

Pancreatic enzyme needed for breakdown of substances released from pancreas. Therapeutic outcome: increases protein, fat, carbohydrate digestion. Used for pts with exocrine pancreatic secretion insufficiency, cystic fibrosis, steorrhea, pancreatic enzyme deficiency. digestive enzyme, take with meals.Don't let pts just take powder in capsules, can trigger asthma attacks bc irritates the bronchioles.

venlafaxine

SNRI for diff anxiety disorders and depression. Helps restore balalnc of serotonin and neurepinephrine. Don't increase levels that's what SSRIs, SNRIs just move the levels to diff parts of body. More energy and better mood. Can worsen angle closure glaucoma.

trazodone

SSRI antidepressant. Decreases symptoms of depression after 2-3 weeks of use. TAKE with food. ADVERSE: suicide in children and adolescents, hypertension, paralytic ileus, hepatitis, acute renal failure, priapism, agranulocytosis, thrombocytopenia, eosinophilia, leukopenia. INTERACT: Fluoxetine, nefazodone: increases levels, increased toxicity, serotonin syndrome. St. JOhn WOrt: increases serotonin syndrome. ASSESS ECG for flattening T wave, bundle branch block, AV block, dysrhythmias in cardiac pts. to prevent kidney failure in patients with high blood pressure or diabetes, and to reduce the risk of stroke.

Citalopram (same as Fluoxetine)

SSRI treats depression. Don't want to use if breastfeeding. Anythin that has serotonin in it, if you're taking more than one you are at risk for serotonin syndrome.

Dantrolene

Skeletal muscle relaxant (direct acting). PO treatment of spasticity associated with spinal cord inury, stroke, cerebral palsy, and multiple sclerosis. Prophylaxis of malignant hyperthermia. IV EMERGENCY TREATMENT OF MALIGNANT HYPERTHERMIA. Works by decreasing calcium release from sarcoplasmic reticulum in muscle cells. ADVERSE: CNS: drowsy, muscle weakness, confusion, dizzy, headache, insomnia, malaise, nervousness. EENT: excessive lacrimation, visual disturbances. RESP: pleural effusions. CV: changes in BP, tachycardia. GI:HEPATOTOXICITY, diarrhea, anorexia, cramps, dysphagia. GI bleeding, vomiting. GU: crystalluria, dysuria, frequency impotence, incontinence, nocturia. DERM: pruritis, sweating, urticuria. HEMAT: eosinophilia. Local: irritation at IV site, phlebitis. MS: myalgia. MISC: chills, drooling, fever. (assess gag reflex and have client swallow to see the rise of larynx prior to giving food). Muscle relaxant. Treat malignant hyperthermia. When used for muscle relax it can make drowsy. Not drive, can cause photosensotovyt.

norepinephrine

THINK BLOOD PRESSURE. Adrenergic. Increases BP with stabilization, adequate tissue perfusion. Used for acute hypotension and shock. ADVERSE: cerebral hemorrhage, gangrene, anaphylaxis. INTERACTIONS: Guanethidine, methyldopa: do not use with this drug within 2 weeks of using these drugs bc hypertensive crisis. INTERACTIONS: antihistamines, ergots, MAOIs, oxytocics, tricyclics: dotn use within 2 weeks of this drug bc hypertensive crisis. Assess SULFITE SENSITIVITY. IF IT WORKS: increased BP with stabilization, adequate tissue perfusion.

Epinephrine

THINK HEART RATE. Bronchodilator, nonselective adrenergic agonist, cardiac stimulant, vasopressor. Therapeutic effect: vasoconstrictor, cardiac stimulator, bronchodilator, decreased aqueous humor. Uses: acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, cardiac arrest, adjunct anesthesia, shock. AVOID extravasation during parenteral administration; if extravasation occurs, infiltrate the affected area with PHENTOLAMINE diluted in NS. ADVERSE: cerebral hemorrhage, paradoxical bronchospasm (inhalation). IF IT WORKED: absence of dyspnea and wheezing, improved airway exchange, improved ABGS, decreased aqueous humor, stabilization of heart rate and cardiac stabilization. If pt has Stridor. Emergency drug anaphylaxis and HR. increase BP and HR. ANTIDOTE: administer a beta 2 adrenergic blocker, vasodilators, alpha blocker.

Alteplase

TPA, digests clots. Never give with hemorrhagic stroke bc it makes it worse. Only use for ischemic or thrombolytic stroke. Really strong, makes you bleed quick. Don't give Ivs or prick the placement after you give it. Wait 5 min at least best if its all done before administer.

Baclofen, Carisoprodol, Cyclobenzapine

Therapeutic: skeletal muscle relaxants (centrally acting). Manages acute, painful MS conditions associated with muscle spas. Unlabeled use: management of fibromyalgia. One in this class may also be used for treatment of reversible spasticity due to multiple sclerosis or spinal cord lesion and PO to treat pain in trigeminal neuralgia. Reduces tonic somatic muscle activity at the level of the brainstem. Structurally similar to tricyclic antidepressants. One in this class inhibits reflexes at the spinal level. ADVERSE: CNS: dizzy, drowsy, confused, fatigue, headache, nervousness. EENT: dry mouth, blurred vision. CV: arrhythmias. GI: constipation, dyspepsia, nausea, unpleasant taste. GU: urinary retention. NEURO: ataxia (loss of full control of bodily movements), seizures (IV).METAB: hyperglycemia, weight gain. MISC: hypersensitivity reactions, sweating. Avoid activities requiring alertness. Increase fluid intake and bulk in diet to decrease likelihood of constipation. Report symptoms of urinary retention. Good oral hygiene and gum for dry mouth. Do not discontinue abruptly. Almost all drugs used for MS illnesses are GI irritants. Muscle and bladder relax CNS depressant. Commonly for MS pts.

caffeine and methylphenidate

This combination is used for ADHD, can help with narcolepsy, PARKINSONS, high risk for dependency. Caffeine will increase focus.

LAST phenomenon

When local anesthetic becomes systemic can cause systemic vasoconstriction. SYSTEMIC CNS DEPRESSION. RANDOM REACTION.

Bethanechol

acute postop, postpartum nonobstructive urinary retention. Also for neurogenic bladder with someone MS. Don't give to Parkinsons, drug interaction with acetylcholenesterase inhibitors. Can cause hypotension, reflexive tachycardia, never give to pt with asthma .

Fenofibrate

affects triglyceride levels, lowers total cholesterol, lowers LDL and rasies HDLs. Adverse:Gallstones, impotence, drowsy vertigo

caffeine and sodium benzoate

anesthetic adjunct, can help with migraines. Caffeine increases blood flow to brain. Also bronchodilator. Cam cause hallucinations and angina.

edrophonium

anesthetic adjunt, cant be by itself. Myasthenia gravis, help muscles work better, they usually have muscle weakness. Take before anyh activites at least 30 min.

lorazepam (SAME AS DIAZEPAM)

antianxiety agent, sedative-hypnotic agent/BENZODIAEPINE. Treats anxiety; also centrally acting muscle relaxant and adjunctive analgesic. ADVERSE: CNS: dizzy, drowsy, lethargy, confusion, hangover, headache, mental depression, paradoxical excitement. EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting,. DERM: rashes. MISC: physical dependence, psychological dependence, tolerance. Older clients may have an increased "HANGOVER EFFECT" in the morning and are at increased risk for falls. Avoid GRAPEFRUIT JUICE during therapy. Kava, valerian, and chamomile can increase CNS depression. Monitor CBC with differential, liver, and renal function. BENZO: give if having active seizure bc its short acting.

diazepam (SAME AS LORAZEPAM)

antianxiety agent, sedative-hypnotic agent/BENZODIAEPINE. Treats anxiety; also centrally acting muscle relaxant and adjunctive analgesic. Diazepam is used for treatment of stiff-man syndrome and in conscious sedation. ADVERSE: CNS: dizzy, drowsy, lethargy, confusion, hangover, headache, mental depression, paradoxical excitement. EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting,. DERM: rashes. MISC: physical dependence, psychological dependence, tolerance. Older clients may have an increased "HANGOVER EFFECT" in the morning and are at increased risk for falls. Avoid GRAPEFRUIT JUICE during therapy. Kava, valerian, and chamomile can increase CNS depression. Monitor CBC with differential, liver, and renal function. BENZO used to stop seizures second choice bc longer acting.

Atropine

antiarrhythmic/anticholinergic; antimuscarinic. Given preop to decrease oral and respiratory secretions (IM). Treatment of sinus bradycardia, heart block, reversal of adverse muscarinic effects of anticholinesterase agents or anticholinesterase poisoning (IV, IM). Used in inhalation form to treat exercise induced bronchospasm. Action: inhibits the action of acetylcholine at postganglionic sites locates in the smooth muscle, secretory glands, and the CNS (antimuscarinic activity). ADVERSE: CNS: drowsy, confused, hyperpyrexia. EENT: blurred vision, cycloplegia, photophobia, dry eyes, mydriasis. CV: TACHYCARDIA, PALPITATIONS, ARRYTHMIAS. GI: dry mouth, constipation, impaired GI motility. GU: urinary hesitancy, retention, erectile dysfunction. RESP: tachypnea, PULMONARY EDEMA. MISC: Flushing, decreased sweating. Frequent oral hygiene may help with dry mouth. This med impairs heat regulation. Strenuous activity in a hot environment may cause heat stroke. Males with BPH should report changes in urinary stream. SIDE EFFECTS INCLUDE "HOT AS HARE, DRY AS BONE, RED AS BEET, MAD AS HATTER, AND BLIND AS BAT." Assess VS and ECG tracings during IV drug therapy. Monitor I and O and bowel sounds. PHYSOSTIGMINE IS THE ANTIDOTE. Cardiac and eyes. Can be used as anesthetic adjunct. Causes profound bradycardia, heart monitor. Half life is 3-5 min. Also gives anticholinergic effect. Give to babies before intubation (gets rid of phagyl response). Reversal for cholinergics.

caffeine and cefoxitin

antibiotic, affects on BP and HR._______ causes constipation so caffeine will relieve this.

Heparin

anticoagulant. 3-7 watch unfractionated heparin levels. Other wise at risk for HIT (decrease in thrombocyte) heparin induced thrombocytopenia more common in Iv but anyone can get this. Normal pt don't give Iv bc causes severe hypertension.

Imipramine

antidepressant/ tricyclic antidepressant (TCA). Treatment of depression, often in conjunction with psychotherapy. Potentiates the effect of serotonin and norepinephrine in the CNS. Produces significant anticholinergic side effects. ADVERSE: CNS: lethargy, sedation. EENT: blurry vision, dry eyes, dry mouth. CV: ARRHYTHMIAS, hypotension, ECG changes. GI: constipation, hepatitis, paralytic ileus. GU: urinary retention. DERM: photosensitivity. ENDO: changes in the blood glucose, gynecomastia. HEMAT: blood dyscrasias. MISC: increased appetite, weight gain. Medication is best when taken at bedtime bc of sedating effects. NOTIFY HCP IMMEDIATELY IF HAVING SUICIDAL THOUGHTS. Appears on BEERS, may be inappropriate for older adults. Increases risk for falls (may increase risk for suicide attempt/ideation, especially during early treatment. Serotonin syndrome may occur when medication is combined with SAMe or St. John's Wort. Anticholinergic effects are "hot as hare, dry as bone, red as beet, mad as hatter, and blind as bat." Monitor CBC, LFT, RFT, serum glucose, and serum alkaline phosphatase. Tricyclic antidepressant for depression. Can take up to 3 wks to see effects. Increased risk for worsened depression and suicide ideations.

Flumazenil

antidote for BENZOS.

acetazolamide

antigluacoma agent, diuretic, ocular hypotensive agent (reduce pressure), anticonvulsant/carbonic anhydrase inhibitor. Lowers intraocular pressure in the treatment of glaucoma (nerve damage bc of increased pressure). Inhibition of carbonic anhydrase (helps transition into CO2) in the eye results in decreased secretion of aqueous humor. Inhibition of renal carbonic anhydrase results in self-limiting urinary excretion of sodium, potassium, bicarb, and water. CNS inhibition of carbonic anhydrase and resultant diuresis may lower abnormal neuronal firing. Alkaline diuresis prevents precipitation of uric acid or cysteine in the urinary tract. ADVERSE: CNS: depression, tiredness, weakness, drowsiness. EENT: transient nearsightedness. GI: anorexia, metallic taste, nausea, vomiting, melena (dark sticky stool representing partially digested blood). GU: crystalluria, renal calculi. DERM: STEVEN JOHNSON'S SYNDROME, rash. ENDO: hyperglycemia. F AND E: hypercholermic acidosis, hypokalemia, growth retardation in children, HEMAT: APLASTIC ANEMIA, HEMOLYTIC ANEMIA, LEUKOPENIA. METAB: weight loss, hyperuricemia. NEURO: paresthesis. MISC: anaphylaxis. Take PO form with food. REPORT ANY RASH IMMEDIATELY. Assess cross sensitivity to sulfonamides. Assess tonometry readings when used for glaucoma (NORM IOP is 10-20 mm HG) Monitor serum electrolytes, CBC, glucose levels, and LFT. Assess ABG FOR METABOLIC ACIDOSIS. CAI diuretic, don't give to pt with kidney or liver issues, low potassium or sodium, acidosis, adrenal failure, can cause hypokalemia.

Olanzapine

antipsychotic; mood stabilizer/thienobenzodiazepine. Acute therapy of manic or mixed episodes associated with bipolar I disorder (as monotherapy or with lithium or valproate) and maintenance therapy of bipolar I disorder. Treatment of acute agitation due to schizophrenia or bipolar I mania(IM), depressive episodes associated with bipolar I disorder, and treatment resistant depression. Unlabeled use: anorexia nervosa and emesis associated with chemotherapy. Action: antagonizes dopamine and serotonin type 2 in the CNS and has anticholinergic, antihistamine, and anti alpha 1 adrenergic effects. ADVERSE: CNS: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, SUICIDAL THOUGHTS, agitation, delirium, dizzy, headache, restlessness, sedation, weakness, dystonia, insomnia, mood changes, personality disorder, speech impairment, tardive dyskinesia. EENT: amblyopia, rhinitis, increased salivation. RESP: cough, dyspnea. CV: bradycardia, chest pain, orthostatic hypotension, tachycardia. GI: constipation, dry mouth, increased liver enzymes, weight loss or gain, abdominal pain, increased appetite, nausea, thirst. GU: impotence, decreased lipido, urinary incontinence. HEMAT: AGRANULOCYTOSIS, leukopenia, neutropenia. Report abnormal muscle movements or seizure to HCP immediately. Monitor mental status, BP, ECG, CBC, and LFT. MONITOR FOR DEVELOPMENT OF NEUROLEPTIC MALIGNANT SYNDROME. Common second gen antipsychotic for schizophrenia and bipolar disorder. Interacts with a lot of parkinsons meds. Can cause sleepiness, hyperglycemia. Will dry pt out bc cholinergic effects.

Delirium

can cause high mortality in elderly. Receive drug that increases dopamine. Acute confusion: Comes on rapidly and disappears rapidly unlike dementia (develops slowly)

Estazolam

controlled substance for insomnia. Don't use for long periods of time. Only 1-2 weeks at a time. BENZO

Clonidine

decreases BP, used in opioid withdrawal, don't discontinue abruptly bc causes rebound hypertension.

Schizophrenia

diagnosed age 20. Out of touch with world, hears voices. No signs or symptoms.

pentoxifylline

early antiplatelet drug. Much less common.

Filgrastim

enhances WBC after chemotherapy. Opposite of immunosuppressant

Capsaicin

herbal replacement for joint pain like rheumatoid arthritis. If pt cant have NSAID.

epoetin alfa

increases RBCS. Stop taking if hemoglobin is 12 or above. Wont work if low in iron. If taking iron supplement use with meals. Orange juice helps iron absorb. Its working if increased activity

isoflurane

inhaled anesthetic general anesthesia. Rapid acting. Watch for shallow breathing. Low bp, abnormal HR, perioperative hyperkalemia, malignant hyperthermia.

NPH

intermediate acting insulin

nitrous oxide

laughing gas. Dental procedures. Not used as Pain relief. Longer you use the more at risk for nausea and vomiting. Still need pain med

glargine

long acting insulin

Sumatriptan

migraines (cluster migraines). Constricts cranial blood vessels to relieve pain when given with ondansetron it helps with side effects of migraine (nausea, vomiting).

acetylsalicylic acid

migraines and inflammation. Incteased risk for GI bleed, heart event, hard on the kidneys bc filtered here. Aspirin makes platelets slippery, doesn't thin the blood but makes more viscous. Reduces risk of clots forming. Don't give to children. Antipyretic, antiinflamm. Increased risk for GI bleeds.

Butorphanol

mixed opioid/analgesic with ceiling effect, once you give certain dose doesn't have increased effects. Reverse effects of opioids, not recommended. AVOID MAOIS. Watch respiratory depression and bradycardia.

Cyclobenzaprine

muscle relax common for back pain. First time will make you super sleepy, don't drive first time you take it.Therapeutic: skeletal muscle relaxants (centrally acting). Manages acute, painful MS conditions associated with muscle spas. Unlabeled use: management of fibromyalgia. One in this class may also be used for treatment of reversible spasticity due to multiple sclerosis or spinal cord lesion and PO to treat pain in trigeminal neuralgia. Reduces tonic somatic muscle activity at the level of the brainstem. Structurally similar to tricyclic antidepressants. One in this class inhibits reflexes at the spinal level. ADVERSE: CNS: dizzy, drowsy, confused, fatigue, headache, nervousness. EENT: dry mouth, blurred vision. CV: arrhythmias. GI: constipation, dyspepsia, nausea, unpleasant taste. GU: urinary retention. NEURO: ataxia (loss of full control of bodily movements), seizures (IV).METAB: hyperglycemia, weight gain. MISC: hypersensitivity reactions, sweating. Avoid activities requiring alertness. Increase fluid intake and bulk in diet to decrease likelihood of constipation. Report symptoms of urinary retention. Good oral hygiene and gum for dry mouth. Do not discontinue abruptly. Almost all drugs used for MS illnesses are GI irritants. Muscle and bladder relax CNS depressant. Commonly for MS pts.

Carisoprodol

muscle relax only short term, don't stop abruptly headaches stom cramps and trouble sleeping. Therapeutic: skeletal muscle relaxants (centrally acting). Manages acute, painful MS conditions associated with muscle spas. Unlabeled use: management of fibromyalgia. One in this class may also be used for treatment of reversible spasticity due to multiple sclerosis or spinal cord lesion and PO to treat pain in trigeminal neuralgia. Reduces tonic somatic muscle activity at the level of the brainstem. Structurally similar to tricyclic antidepressants. One in this class inhibits reflexes at the spinal level. ADVERSE: CNS: dizzy, drowsy, confused, fatigue, headache, nervousness. EENT: dry mouth, blurred vision. CV: arrhythmias. GI: constipation, dyspepsia, nausea, unpleasant taste. GU: urinary retention. NEURO: ataxia (loss of full control of bodily movements), seizures (IV).METAB: hyperglycemia, weight gain. MISC: hypersensitivity reactions, sweating. Avoid activities requiring alertness. Increase fluid intake and bulk in diet to decrease likelihood of constipation. Report symptoms of urinary retention. Good oral hygiene and gum for dry mouth. Do not discontinue abruptly. Almost all drugs used for MS illnesses are GI irritants. Muscle and bladder relax CNS depressant. Commonly for MS pts.

guarana

natural herb, alternative for ADHD med. Increases focus like caffeine. Can increase HR.

Serotonin

natural hormone, neurotransmitter. Regulates mood. Helps with obesity, headaches, parkinson's, depression. Too much can cause serotonin syndrome: sweating, muscle rigidity, diarrhea, headaches, increased HR.

Succinylcholine

neuromuscular blocking agent. Therapeutic effect is the paralysis of skeletal muscles. Used for facilitation of endeotracheal intubation, skeletal muscle relaxation during orthopedic manipulations. Metabolized slow, acts fast. Need intubation immed. Don't give pt with high potassium, children under 12 or renal failure. Need a defasiculating dose. Feels like getting hit by bus. Need this dose otherwise will be contraindicated and create that horrible feeling. WATCH: hyperkalemia, myopathy, rhabdomyolysis. ANTIDOTE: edrophonium, neostigmine, atropine.

Dextromethorphan

nonopioid antitussive. High risk for abuse.

1-3, 4-12, 10-18

onset, peak, duration intermediate acting insulin

1-3, peakless, 22-24

onset, peak, duration of long acting insulin

15, 1-2, 3-5

onset, peak, duration of rapid acting insulin.

30-60, 2-4, 6-8

onset, peak, duration short acting insulin

Disulfiram

ppl with ETOH alcoholics trying to recover. Cant drink 3-4 days after stopping drug very sick...Chest pain, pounding headaches, vomiting, blurred vision, difficulty breathing, sweating. (acetylalide syndrome after consume alcohol and get these symptoms)

Methadone

prescribed, a lot of drug users use this bc no ceiling affect. Can still use to get high. Use is for weaning off opioid addiction. (suboxone= ceiling affect, given with opioid causes super sick)

Aspart, lispro, glulisine

rapid acting insulin

vitamin K

reversal for warfarin. This takes a really long time, so administer with ffp (fresh froz plasma) bc it will replace clotting factors.

Delusions

seeing things that aren't there. UTIs cause these

regular

short acting insulin

vitamin D

treatment of rickets or tetany. Body needs this to properly use calcium or phosphorus otherwise wont absorb

Methyldopa

treats gestational hTN. Side effects orthostatic hypotension, fatigue, dizzy.

Amitriptyline

tricyclic antidepressant. Commonly used for neuropathic pain, insomnia, and depression. Don't give if pregnant or has had a heart attack. Has anticholinergic effects, dries pt out: dry mouth, urinary retention, constipation. Only give to pt with wet cough not dry cough.

interferon alfa-2b

use if hep c, hep b, hairy cell leukemia, myelogenis leukemia, melanoma, aids related carposki sarcoma (viruses)

caffeine and sodium bicarbonate

used for metabolic acidosis and dyspepsia. Relaxes the stomach.