Pharmacology new

short duration: slower acting insulin

Regular insulin (Humulin R, Novolin R)

Mood stabilizing anticonvulsants

Common Drugs: - Clonazepam (Klonopin) - Gabapentin (Neurontin) - Topiramate (Topax)

electrolyte replacement

Common drugs: Isotonic Corrects dehydration and sodium depletion, replaces GI losses, dextrose provides calories Caution in pt with cardiac or renal disease, bc risk for fluid volume overload DO not administer to pt with known or suspected IICP Normal saline (NS) IV therapy of 0.9% NaCl in water crystalloid solution - isotonic Used to as Na+ replacement to treat fluid volume deficit (dehydration) - FOR HYPOVOLEMIC SHOCK Lactated Ringers (LR) - Normal saline with electrolytes and buffer - Isotonic - Normal saline with K+, Ca++ and lactate (buffer) - Often seen with surgery Be careful using for patients with renal failure - Used to treat fluid loss seen with diarrhea and vomiting. Also for imbalances due to burns and trauma - FOR HYPOVOLEMIC SHOCK Dextrose 5% in water - D5W - Isotonic - Used to treat hypoglycemia and hyponatremia Hypotonic Treats intracellular dehydration (diabetic ketoacidosis, Hyperosmolar hyperglycemic state) Monitor for. hypovolemia 1/2 normal saline (NS) - Hypotonic - 0.45 NaCl in crystalloid water solution - Useful for daily maintenance of body fluid - Helpful for establishing renal function - Fluid replacement for clients who do not need extra glucose (diabetics) 2.5 dextrose in water 0.33 NaCl Hypertonic Corrects severe hyponatremia, decreases ICP in patients with cerebral edema Increases serum osmality Dextrose 5% in 0.9% sodium chloride - D5NS - Hypertonic -used like LR but provides calories Dextrose 5% in 0.45% sodium chloride - Hypertonic Used as a maintenance solution with free water Dextrose 10% in water - Hypertonic -D10W Used as free water to raise the fluid volume and treat hypoglycemia Dextrose 50% in water - D50W -Hypertonic -Used as free water to raise the fluid volume and treat hypoglycemia 3% sodium chloride - 3% NaCl Hypertonic Used to treat severe hyponatremia and cerebral edema Potassium (K+) -Essential for maintaining electrical excitability of muscle, conduction of nerve impulses, and regulation of acid/base balance -Normal range 3.5-5.0 mEq/L -Potassium chloride (K-Dur)· - Oral or IV administration· to avoid fatal hyperkalemia - Dilute potassium and give no more than 40 mEq/L per IV to prevent irritation of vein - Administer no faster than 10 mEq/L per IV -Concurrent use with potassium-sparing diuretics or ACE inhibitors can cause hyperkalemia· -Administer Kayexalate for hyperkalemia with serum potassium > 5.0 mEq/L Calcium ( CA2+) -Essential for normal musculoskeletal, neurological, and cardiovascular function -Normal range: 9.0-10.5 mEq/L -Calcium citrate (Citracal)· - Calcium carbonate or calcium acetate -Oral or IV administration - Implement seizure precautions during administration and have emergency equipment on hand Magnesium (MG2+) -Regulates skeletal muscle contraction and blood coagulation - Normal range: 1.3-2.1 mEq/L - Magnesium sulfate -Magnesium gluconate or magnesium hydroxide· - Monitor BP, pulse, and respirations with IV administration -Decreased/absent deep tendon reflexes indicate toxicity· -Have injectable calcium gluconate on hand to counteract toxicity when giving magnesium sulfate via IV Bicarbonate (HCO3-) -Maintains blood pH to prevent metabolic acidosis -Normal pH range: 7.35-7.45 - Sodium bicarbonate· Given orally as an antacid or via IV· - Numerous incompatibilities with IV form

Intermediate duration insulin

NPH insulin (Humulin N, Novolin N) Insulin detemir (levemir)

Loop Diuretics

Uses: Loop diuretics are used in the treatment of edema due to heart failure, liver disease and kidney disease. They may also be used to treat high blood pressure. Common drugs: Bumetanide (Bumex) Ethacrynic acid (Edecrin) Furosemide (Lasix) Torsemide (Demadex) Contraindications/precautions: The salt balance in the bloodstream sometimes being upset, which can cause a low blood level of potassium, sodium, and magnesium, and a high level of calcium. These effects may cause weakness, confusion and, rarely, abnormal heart rhythms to develop. You may be advised to have a blood test to check for these problems. If you have diabetes or gout, these conditions may be made worse by diuretics, An upset stomach, Dizziness on standing - due to too low blood pressure (hypotension). - Other possible adverse reactions include hypochloremic metabolic alkalosis, hyperglycemia, hyperuricemia, and hypomagnesemia. -Rapid parenteral administration of loop diuretics can cause hearing loss and tinnitus. These problems may be reversible if they're recognized and the drug is stopped. High doses can trigger profound diuresis, leading to hypovolemia and cardiovascular collapse. Your patient may develop photosensitivity while taking one of these drugs. - Some loop diuretics may pass into breast milk, so the health care provider should review their appropriateness before prescribing. - Pregnancy or severe renal disease. Use cautiously. - Severe hypersensitivity to sulfonamides. Use cautiously to avoid allergic reactions. -Neonates: Use cautiously. For example, administer the recommended pediatric dose as ordered, but extend dosing intervals. Advanced age: Monitor closely for problems due to drug-induced diuresis. The the patient may need a reduced dosage. Nursing interventions: - Establish baseline vital signs before therapy and monitor for significant changes, especially during rapid diuresis. - Establish baseline values for complete blood cell count, liver function tests, serum electrolytes, magnesium, blood urea nitrogen, and creatinine levels, and review periodically. -Monitor for signs and symptoms of excessive diuresis: hypotension, tachycardia, poor skin turgor, excessive thirst, and dry, cracked mucous membranes. -Monitor your patient for edema, especially in his legs if he's ambulatory and in the sacral area if he's bedridden. -Weigh him each morning after voiding and before breakfast, in similar clothing and on the same scale, to reliably assess his response to diuretic therapy. -Monitor and record his daily intake and output. - Administer diuretics in the morning and avoid giving them after 6 p.m. to prevent nocturia. Keep a urinal or commode readily available. - If your patient is ambulatory, take safety precautions until you know his response to diuretics. -Monitor for signs and symptoms of hypokalemia and administer potassium supplements as ordered. - Administer a lower dosage of the diuretic as ordered if your patient has hepatic dysfunction. - Administer an increased dosage as ordered if he has renal impairment, oliguria, or decreased diuresis. Inadequate urine output can cause circulatory overload, leading to water intoxication, pulmonary edema, and worsening heart failure. - For a patient with diabetes, increase the dosage of insulin or oral hypoglycemic drug as ordered, and reduce the dosage of other antihypertensives. Patient teaching: - Explain the rationale for diuretic therapy and the importance of adherence to the regimen. - Teach your patient to watch for and promptly report adverse reactions, including chest, back, or leg pain; shortness of breath; dyspnea; increased edema or weight; and excess diuresis indicated by a weight loss of more than 2 pounds in 1 day. - Encourage him to eat potassium-rich foods such as tomato products, bananas, and potatoes and to avoid table salt and high-sodium foods such as lunch meats, smoked meats, and processed cheese. -Encourage him to keep his follow-up appointments to monitor the effectiveness of therapy.

Potassium sparing diuretics

Uses: Potassium-sparing diuretics are medicines that increase diuresis (urination) without the loss of potassium. They are generally weak diuretics and work by interfering with the sodium-potassium exchange in the distal convoluted tubule of the kidneys or as an antagonist at the aldosterone receptor. Aldosterone promotes the retention of sodium and water, so if potassium-sparing diuretics are used to block this effect, more sodium and water can pass into the collecting ducts of the kidneys, increasing diuresis. Because potassium-sparing diuretics do not promote the secretion of potassium during diuresis they do not cause hypokalemia (low potassium levels Potassium-sparing diuretics may be used alone or in conjunction with a loop or thiazide diuretics. Common drugs: amiloride triamterene (Dyrenium) spironolactone (Aldactone) eplerenone (Inspra) Contraindications/precautions: Tummy ache or cramp, Dry mouth, Feeling dizzy or faint, especially when getting up from sitting or lying positions (due to too-low blood pressure), Skin rash, Feeling sleepy or confused, Headache, Aches and pains, Muscle cramps, Weakness, Diarrhea or constipation, Potassium levels going too high (hyperkalemia). - There are very few people who are not able to take these medicines. They should not be taken by anyone who has high levels of potassium in their blood, severe kidney problems, or Addison's disease. - In addition, potassium supplements should not be taken with these medicines. Some salt substitutes that you can buy are high in potassium. These should be avoided if you take a potassium-sparing diuretic. -Taking a potassium-sparing diuretic at the same time as an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor antagonist medicine (eg, valsartan, losartan) can also cause very high blood potassium levels. Nursing interventions: - Assess fluid status throughout therapy. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. -Assess patient for anorexia, muscle weakness, numbness, tingling, paresthesia, confusion, and excessive thirst. Notify health care professional promptly if these signs of electrolyte imbalance occur. -Monitor electrolytes (especially potassium), blood glucose, BUN, and serum uric acid levels before and periodically throughout course of therapy. Patient teaching: PATIENT TEACHINGS ARE THE SAME AS THIAZIDE DIURETICS - Instruct patient to notify health care professional of medication regimen before treatment or surgery. - Advise patient to contact health care professional immediately if muscle weakness, cramps, nausea, dizziness, or numbness or tingling of extremities occurs. - Emphasize the importance of routine follow-up. - Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, regular exercise, restricted sodium intake, stress reduction, moderation of alcohol consumption, and cessation of smoking). - Instruct patients with hypertension in the correct technique for monitoring weekly BP.

Thiazide diuretics

Uses: Thiazide diuretics are a type of diuretic (a drug that increases urine flow). They act directly on the kidneys and promote diuresis (urine flow) (the functional unit of a kidney). Thiazides decrease sodium reabsorption which increases fluid loss in urine, which in turn decreases extracellular fluid and plasma volume. This reduces cardiac output (how hard the heart has to work to pump blood around the body) and lowers blood pressure. Thiazides also work in other ways to lower blood pressure. Thiazide diuretics are recommended as one of the first drug treatments for high blood pressure. Common drugs: Chlorothiazide (Diuril) Chlorthalidone Hydrochlorothiazide (Microzide) Indapamide Metolazone Contraindications/precautions: Use with caution in patients with renal or hepatic disease. Safety in pregnancy and lactation not established. cross-sensitivity with other sulfonamides. Nursing interventions: Assess fluid status throughout therapy. Monitor daily weight, intake, and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Assess the patient for anorexia, muscle weakness, numbness, tingling, paresthesia, confusion, and excessive thirst. Notify health care professionals promptly if these signs of electrolyte imbalance occur Monitor BP and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension. Monitor neurologic status and intracranial pressure readings in patients receiving osmotic diuretics to decrease cerebral edema. Monitor for persistent or increased eye pain or decreased visual acuity. Monitor blood glucose, BUN, and serum uric acid levels before and periodically throughout the course of therapy. Thiazide and loop diuretics may cause ↑ serum cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride concentrations. Patient teaching: - Instruct patient to take medication exactly as directed. - - Advise patients on an antihypertensive regimen to continue taking medication, even if feeling better. Medication controls but does not cure, hypertension. - Caution patient to make position changes slowly to minimize orthostatic hypotension. Caution patient that the use of alcohol, exercise during hot weather, or standing for long periods during therapy may enhance orthostatic hypotension. - Instruct patient to consult a health care professional regarding dietary potassium guidelines. - Instruct patient to monitor weight weekly and report significant changes. - Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions. - Advise patient to consult health care professional before taking OTC medication concurrently with this therapy. - Instruct patient to notify health care professional of medication regimen before treatment or surgery. -Advise patient to contact health care professional immediately if muscle weakness, cramps, nausea, dizziness, or numbness or tingling of extremities occurs. - Reinforce the need to continue additional therapies for hypertension (weight loss, regular exercise, restricted sodium intake, stress reduction, moderation of alcohol consumption, and cessation of smoking).

Anticholinergics

dilates pupils, causes photophobia, tachycardia, used preoperatively for cataract removal. Paralyzes accommodation, cycloplegia. Allows for eye exam. DO NOT use in glaucoma example) atropine or cyclogel

Other considerations

TCA's increase anticholinergic effects and are detrimental to the elderly. Thorazine should not be used with the elderly due to strong alpha blockage. Orthostatic hypotension is more common than EPS in elderly. FGA antipsychotics should be given in smaller doses. Haldol is commonly used. Atypical antipsychotics should not be used to control agitation due to increased mortality related to cardiac complications and infection. BDZ use (long term or continued use) may cause antegrade amnesia. Lorazepam (Ativan) is often used for acute agitation.

When do you draw the peak?

***The same drug given in two different routes at the same time will have different peaks however two different drugs given at the same time and at the same route will peak together Sublingual- 5-10 minutes after the drug is dissolvedIV-15-30 minutes after the drug is finished (when the bag is empty)IM- 30-60 minutes after you give itSUbq- SEE- See diabetes lecture (insulins)PO- never test PO's because they're all too variable ***The same drug given in two different routes at the same time will have different peaks however two different drugs given at the same time and at the same route will peak together Sublingual- 5-10 minutes after the drug is dissolved IV-15-30 minutes after the drug is finished (when the bag is empty) IM- 30-60 minutes after you give it SUbq- SEE- See diabetes lecture (insulins) PO- never test PO's because they're all too variable

Fluoroquinolones (antibiotics)

-Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin. for: respiratory and urinary tract, Gi tract, bones, joint, skin, and soft tissue infections Teaching: antacids, dairty, vitamins, iron 6 hours before or 2 hours after antibiotic - Monitor for tendon pain, swelling, and inflammation -Wear protective clothing and apply sunscreen

Atropine

-Muscarinic antagonist -Used in bradycardia and for ophthalmic applications -Also used as antidote for cholinesterase inhibitor poisoning -Actions include increase pupil dilation, cycloplegia, decreased airway secretions, decreased acid secretions, decreased gut motility, decreased bladder urgency in cystitis -Toxicity: increased body temp (due to decreased sweating), rapid pulse, dry mouth, dry and flushed skin, cycloplegia, constipation, disorientation; -Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants -See also homatropine and tropicamide Contradicted in those with glaucoma

Lithium toxicity

2 or greater tremors, nausea, and vomiting. metallic taste, severe diarrhea, number one intervention, give fluids, if sweating give electrolytes too When giving pt lithium, must watch for a decrease in sodium

Corticosteroids

2 types: Mineralocorticoids Glucocorticoids

Theophylline toxicity

20 or greater Therapeutic is 10-20 Signs of toxicity include nausea, vomiting (coffee ground emesis), tachycardia, and tremors

Medications for hypertensive crisis

A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or higher — can damage blood vessels. The blood vessels become inflamed and may leak fluid or blood. As a result, the heart may not be able to pump blood effectively. Causes of hypertensive crisis include: Forgetting to take your blood pressure medication Stroke Heart attack Heart failure Kidney failure Rupture of your body's main artery (aorta) Interaction between medications Convulsions during pregnancy (eclampsia) In an URGENT hypertensive crisis, your blood pressure is extremely high, but your doctor doesn't suspect you have any damage to your organs. In an EMERGENCY hypertensive crisis, your blood pressure is extremely high and has caused damage to your organs. An emergency hypertensive crisis can be associated with life-threatening complications. Signs and symptoms of hypertensive crisis: Severe chest pain Severe headache, accompanied by confusion and blurred vision Nausea and vomiting Severe anxiety Shortness of breath Seizures Unresponsiveness Common drugs: Sodium nitroprusside Labetalol (Trandate) Diazoxide (Hyperstat) Fenoldopam (Corlopam) Trimethaphan (Arfonad) Contraindications/precautions: Provide direct vasodilation of veins and arteries and rapid reduction of BP Cyanide poisoning can occur and lead to cardiac arrest Thiocyanate poisoning can lead to altered mental status and psychotic behavior Nitroprusside may be slightly brown, however, solutions that are dark blue, red, or green should be discarded Continuous BP and ECG monitoring should be performed during the administration of these drugs.

nephrotoxic drugs (kidneys!!)

Antibiotics - Gentamicin - Amphotericin B NSAIDS ACE inhibitors Lithium salts Chemotherapy -Cisplatin Radiocontrast media Watch for: Elevated serum creatinine Normal: women: 0.6-1.1 mg/dL Men: 0.7-1.3 mg/dL Elevated BUN normal: 7-20 mg/dL

ototoxic drugs

Antibiotics Ex) gentamicin and tobramycin macrolides Loop diuretics Ex) Furosemide Chemotherapy Ex) cisplatin Carboplatin Never give two of these drug classes together.

Phenytoin

Anticonvulsant: used for tonic−clonic and partial seizures; blocks Na+ channels in neuronal membranes. Serum levels variable due to first−pass metabolism and dose−dependent nonlinear elimination kinetics. Tox: sedation, diplopia, gingival hyperplasia, hirsutism, respiratory depression in overdose, teratogenic potential. Medications that increase levels of phenytoin (can be dangerous) - Alcohol - NSAIDS -Anticonvulsants - Benzodiazepines - Calcium channel blockers - Proton pump inhibitors - Serotonin reuptake inhibitors TEETH AND GUM ISSUES An antiseizure drug without as severe side effects is levetiracetam

hepatotoxic drugs

Antihypertensives - Ace inhibitors Anti-infectives - erythromycin - Fluconazole - Itraconazole Tuberculosis -Rifampin -INH Pain - Acetaminophen - NSAIDs Alcohol Psych - Phenothiazines Watch for: elevated liver enzymes Normal: ALT: 7-56 units/L AST: 10-40 units/L Watch for: fatigue, weakness, loss of appetite, pain in upper abdomen, dark colored urine, and yellowing of skin or eyes

When do you draw trough?

Sublingual- 30 minutes before the next dose IV- 30 minutes before the next dose IM- 30 minutes before the next dose Subq- 30 minutes before the next dose PO- 30 minutes before the next dose

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Common Drugs: Duloxetine (Cymbalta) Venlafaxine (Effexor XR) Desvenlafaxine (Pristiq) Common side effects include weight gain and sexual dysfunction

Herb/Botanical Therapy

Common drugs: ST johns wort reduces depression and anxiety, anti-inflammatory Interacts with CNS depressants and opioids, SSRI, TCAs, and warfarin Can lead to serotonin syndrome. Saw palmetto Can be used to treat benign prostatic hyperplasia symptoms, as a mild diuretic, and an anti-inflammatory. Goji Can be taken orally for hypertension, diabetes, fever, malaria, and cancer. Echinacea: Used to treat the common cold. With chronic use, echinacea can decrease the positive effects of medications for TB, HIV, or cancer. Interactions: amiodarone, anabolic steroids, and methotrexate Ginger root: Used to decrease nausea of morning sickness, motion sickness, and nausea induced by surgery. May also decrease the pain and stiffness of rheumatoid arthritis. These medications suppress platelet aggregation. Should be used cautiously in pregnancy. Ginkgo biloba: Promotes vasodilation and may be used to increase recall ability and mental processes. Used commonly with dementia and Alzheimer's Disease. May also be used for erectile dysfunction in clients who take SSRIs and experience impotence as a side effect. May interact with medications that lower the seizure threshold, such as antihistamines, antidepressants, and antipsychotics. Also interacts with NSAIDS, heparin, and warfarin May interfere with coagulation. Valerian: Increases GABA to prevent insomnia. Promotes sleep with increased effect over time. There is a risk of dependence. May cause drowsiness and depression. Should be used cautiously in clients with mental health disorders. Avoid use in pregnancy or while breastfeeding. Black cohosh: Acts on the female reproductive system as an estrogen substitute. May be used instead of estrogen therapy during menopause. Increases the effects of antihypertensive medications and may increase the effect of estrogen medications. Increases hypoglycemia in clients who are taking insulin or other medications for diabetes. Senna Laxative Milk thistle Used for antitoxin, and protection against liver disease Side effects: diarrhea, bloating, and upset stomach Garlic Used to reduce blood cholesterol and blood pressure, anticoagulation Interacts with NSAIDS, heparin, and warfarin Contraindications/precautions: Supplements contraindicated for pregnancy use : - Saw palmetto - Goldenseal - Dong quai - Ephedra - Black cohosh - Blue cohosh - Pennyroyal

Psych meds

Common drugs: Antianxiety medications: Include medications such as Alprazolam (Xanax), Buspirone (BuSpar), Diazepam (Valium), and Lorazepam (Ativan). Hint: lams and Pams are Antianxiety medications. Used to treat generalized anxiety disorder and panic disorders. Use cautiously in clients with a history of substance abuse and liver disorder. Buspirone should not be used with MAOIs. SSRIs: These medications include Citalopram (Celexa), Fluoxetine (Prozac), or Sertraline (Zoloft). The client should avoid using St. John's Wort with these medications and should eat a healthy diet while on these medications. Clients should avoid alcohol when on SSRIs and should not stop these medications suddenly. TCAS: tricyclic antidepressants: Amitriptyline (Elavil) is an example. Anticholinergic effects and orthostatic hypotension may occur. Do not administer with an MAOI or St. John's Wort. Sedation is common, and Anticholinergic effects will occur. Hint: Anticholinergic effects cause the client to 'dry up', so they have blurred vision, urinary retention, dry mouth, and decreased bowel movements. MAOI's: Monoamine Oxidase Inhibitors: Phenelzine (Nardil) is an example. Hypertensive crisis may occur with tyramine food ingestion, so care must be taken to avoid these substances. Discuss with the client the importance of contacting the provider about the use of all medication with this class of medication. Interacts with many other meds!!! Atypical antidepressants: Bupropion (Wellbutrin) is the most common example. Appetite suppression is a common side-effect. Headache and dry mouth may be severe and client should notify the provider if this occurs. Atypical antidepressants should not be used with clients with seizure disorders. Serotonin Norepinephrine Reuptake inhibitors: Common SNRIs include Venlafaxine (Effexor) and Duloxetine (Cymbalta). Adverse effects may include nausea, weight gain, and sexual dysfunction. Encourage the client to have a healthy diet to maintain an appropriate body weight. Lithium carbonate (Lithium): Used for bipolar disorder. Fine hand tremors, polyuria, weight gain, and renal toxicity may occur. The therapeutic level for lithium is 0.4-1.0 mEq/L. Sodium levels should be maintained in a constant state, so the client should avoid profound dehydration. Disulfiram (Antabuse): is used to help maintain alcohol abstinence. It works by changing how alcohol is metabolized in the body. Doses of warfarin and phenytoin should be adjusted and therapeutic levels monitored.(10-20) Advise client to not drink during therapy, and all alcohol must be out of blood stream prior to first dose. Contraindications/precautions: Antipsychotic medications are either conventional or atypical. Atypical antipsychotics have fewer side effects. A common conventional Antipsychotic medication is Chlorpromazine (Thorazine). Aripiprazole (Abilify) is an atypical antipsychotic. These medications are used to help treat schizophrenia and psychosis. Antipsychotic medications should be used cautiously in clients with benign prostate hyperplasia and glaucoma because of the Anticholinergic properties. The mnemonic SEA TANS can help remember side and adverse effects of antipsychotic: Side Effects: Sedation EPS Anticholinergic effect Adverse Effects: Tardive dyskinesia Agranulocytosis Neuroleptic malignant syndrome Seizures

Meds to Support Withdrawal / Abstinence from Nicotine

Common drugs: bupropion (Zyban) - decreases nicotine craving and manifestations of withdrawal. To treat drymouth, use sugarless gum. Avoid caffeine and other CNS stimulants. Nicotine gum is not recommended for use longer than 6 mos. Avoid eating and drinking 15 mins prior to chewing the gum. Sprays are not recommended for those with upper respiratory issues. Avoid patch if rash occurs, and remove before MRI. Avoid nicotine if pregnant. nicotine substitutes (Nicorette, Nicotrol) - pharmaceutical products that substitutes for the nicotine in cigarettes or chewing tobacco. varenicline (Chantix) - nicotinic receptor agonist that promotes the release of dopamine to simulate the pleasurable effects of nicotine. Reduces cravings and severity of withdrawal symptoms. Monitor glucose levels and BP. Contraindicated for depressed people. Notify provider if N/V, insomnia or depression occurs.

miotic

Constricts pupil; Timoptic Can cause contact dermatitis ex) Pilocarpine and timolol

endocrine system

Endocrine glands: Pineal gland thyroid parathyroid Pineal body Reproductive glands Hypothalamus Pituitary Hypothalamus- main link between the endocrine and nervous system. Stimulates or suppresses the pituitary gland Releases CRH (corticotropin releasing hormone) Pituitary- Regulates activity of thyroid (TSH), adrenal glands (ACTH), and reproductive glands (FSH/LSH), and the growth hormone (GH) Releases ACTH (adrenocorticotropic hormone) Adrenal gland- located on top of kidney. Releases cortisol and aldosterone Two parts: 1) adrenal medulla- produces catecholamines (epinephrine) 2) adrenal cortex- produces corticosteroids, influences/regulates salt and water balance, stress response, metabolism, immune system, sexual development

Gonadatropins

Gonad-stimulatin hormones produced by the anterior pituitary. Side effects: Hot flashes Gynecomastia (enlargement of males breasts)

Folic Acid Food Sources

Green leafy veggies Liver, meat, and fish Whole grains and yeast Legumes and peanuts Orange juice

Complications of epidural anesthesia

Hypotension Fetal distress, abnormal FHR post dural puncture seizures Vertigo Meningitis Cardiorespiratory arrest Severe headache

Penicillins (antibiotics)

Inhibit cell wall synthesis Group of antibiotics that are often used to treat infections by gram-positive bacteria. phenoxymethylpenicillin, flucloxacillin and amoxicillin. Adverse drug rxs: Nausea, vomiting, diarrhea, rash, and anaphylaxis

Macrolides (antibiotics)

Inhibits protein synthesis Ex: erythromycin, azithromycin, and clarithromycin for: whooping cough, diphtheria, chlamydia Adverse rxs: Gi upset, increased QT interval, headache, insomnia, ototoxicity, metallic taste take w meals to reduce GI upset, but increased absorption on empty stomach Contraindicated in pt with GT prolongation or on verapamil or diltiazem

Long duration insulin

Insulin glargine (Lantus)

Short Duration Rapid Acting Insulin

Insulin lispro (Humalog) Insulin aspart (Novolog) Insulin glulisine (Apidra)

Anticholinergic drugs (neuro drug ) SNS drug so it... Dilates pupil Inhibits salivation Increases HR, BP Dilates broncioles Inhibits digestion Relaxes bladder Inhibits sex organs

Oxybutynin (Ditropan, Gelnique), tolterodine (Detrol), Darifenacin (Enablex), Solifenacin (Vesicare), Trospium (Sanctura), Fesoterodine (Toviaz), benztropine, Atropine, ipratropium, and scopolamine for: COPD. overactive bladder and incontinence. gastrointestinal disorders, such as diarrhea. poisoning due to some insecticides and poisonous mushrooms. symptoms of Parkinson's disease, such as abnormal involuntary muscle movement. asthma. dizziness. also forL IBS, incontinence, asthma, and motion sickess

Tuberculosis drugs

Rifampin- Orange colored body secretions are expected side effect Liver tests will be performed monthly Avoid alcoholic beverages Rifampin reduces the effectiveness of phenytoin Isoniazid Pyrazinamide- Take w food Ethambutolx

Insulin

SHOULD NOT be administered to clients with renal impairments, thyroid disease, or fever

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

Severe hyperglycemia brought on by insulin deficiency Occurs most often in type 2 diabetes Changes can occur 1-2 months before signs and symptoms occur Hyperosmolar- large amount of glucose excreted in urine (and water Severe dehydration

Helpful Mnemonic

THESE DRUGS CAN INTERACT (TDCI) T = Theophylline D = Dilantin C = Coumadin I = ilosone (Erythromycin) EMERGENCY DRUGS TO LEAN ON L = Lidocaine E = Epinephrine A = Atropine sulfate N = Narcan Serious complications of oral birth control pills (ACHES) A = Abdominal pain C = Chest pain H = Headache E = Eye problems S = Severe leg pain Side effects of steroids. the 5 S's Sick- easier to get sick Sad-causes depression Sex-increases libido Salt-retains more and causes weight gain Sugar-raises blood sugar NSAID DRUGS N - Naproxen S - Salicylates A - Advil I- ibuprofen D - Diclofenac S - Sulinclac

Aminoglycosides (antibiotics)

Think: "a mean old mycin" Gentamicin, tobramycin, neomycin, amikacin 3 mycins that are not mean old mycins are: THRO! • Erythromycin• Zipthromycin• Claripthromycin What are the toxic effects? 1) MICE- MYCIN- Mickey Mouse Ears - Ototoxic (ear), monitor hearing, ringing in the ears (tinnitus), and vertigo or dizziness (ear has equilibrium) 2) Human ear- connect the dots and its' shaped like the kidney- nephrotoxicity- MUST monitor CREATININE- the best indicator of kidney or renal function- 24 hour creatnine clearance is better than serum creatnine. 3) HAVE A VISUAL OF THE NUMBER 8- the number 8 drawn inside the ear reminds you of the fact that they are.. Toxic to cranial nerve number 8 which is the EAR Nerve and you... 4) Administer them every 8 hours What is the route? IM or IV, do not give PO because they will not be absorbed monitor peaks and troughs, eat function, creatine balance, BUN, and urine output *** EXCEPT in two cases for oral! 1) Hepatic encephalopathy or hepatic coma- when ammonia levels get too high and you go into a coma... you can die. Treatment is to get the ammonia down and oral mycins do that because it will kill gram negative bacteria in your gut, sterilize your bowel, kill ecoli in your gut which is the number 1 producer of ammonia in your gut, and decreases it. Because these people have liver damage we do not want it going to the liver and its perfect because it goes in and right out the gut. *Makes you have diarrhea that makes you get rid of stuff. 2) Give during preop bowel surgery- to sterilize the bowel, ****will not have otoxicity because it is not absorbed,Both: sterilized bowel without causing ototoxicity because it is not absorbed ***Sargent asks "who can sterilize my bowel?" "Neo Kan!"

Carbonic Anhydrase Inhibitors

Treat glaucoma Decreases aqueous humor production Decreases intraocular pressure common side effect: Diuresis Ex) Diamox and acetazolamide

antipsychotic drugs (1st GEN conventional) Typical suffix: Zine

Uses: blocks dopamine (D2), acetylcholine, histamine and norepinephrine (NE) receptors in the brain. Used mainly to control positive symptoms of psychotic behavior. Reserved for violent and aggressive patients. Common Drugs: chlorpromazine (Thorazine) - low potency → Prototype thioridazine - low potency loxapine, medium potency perphenazine, medium potency haloperidol (Haldol), high potency thiothixene (Navane), high potency fluphenazine, high potency trifluoperazine, high potency Contraindications/Precautions: Higher risk for NMS SYNDROME! and tardive dyskinesia, parkinsonism Acute dystonia akathisia

thrombolytic agents

Uses: A drug that is able to dissolve a clot (thrombus) and reopen an artery or vein. Thrombolytic agents may be used to treat a heart attack, stroke, deep vein thrombosis (clot in a deep leg vein), pulmonary embolism, and occlusion of a peripheral artery or indwelling catheter. If the Ghostbusters had a medication class of choice, this would be it! Thrombolytic Agents are. They work QUICKLY to restore circulation. As such, they increase a client's risk for bleeding. Common drugs: Who are you going to call??? Streptokinase (Streptase). Alteplase (Activase) Call right away! These medications must be administered within 4 to 6 hours of the onset of symptoms. Thrombolytic agents dissolve clots that have already been formed. These medications convert plasminogen to plasmin, which destroys fibrinogen and other clotting factors. The goal is to have restoration of circulation, as evidenced by relief of chest pain, and reduction of initial ST-segment injury pattern as shown on ECG. After clot is gone, administer beta-blockers to decrease myocardial oxygen consumption and reduce the incidence and severity of reperfusion arrhythmias Contraindications/precautions: Increased bleeding. These medications should only be given while the client is closely monitored. Baseline platelet and blood counts (aPTT, PT, and INR ) should be carefully assessed. Venipunctures and SQ and IM injections should be limited. Contradicted in those with hypertension

Levothyroxine

Used to treat hypothyroidism Outcome: weight loss, better tolerance to the surrounding environment and elevated heart rate Common adverse effects: Headache, menstrual irregularities, and anxiety, irritability, difficulty sleeping, heat intolerance, Signs of shock: hypotension, low urine output and changes in level consciousness

Vasodilators antihypertensive drug class #6

Uses: improve oxygenation of tissues by dilating or (opening up) the body's vascular system. While several classes of drugs dilate vessels through different mechanisms, the goal is the same — to provide improved circulation of oxygen to the body's tissues. Drug of choice for hypertensive emergencies. Common drugs: nitroprusside, nitroglycerin, and hydralazine. Contraindications/precautions: concurrent use of any of these drugs with other antihypertensive drugs can lead to severe hypotension.

Erectile dysfunction agents Typical suffix: Fil

Uses: act by increasing nitric oxide which opens and relaxes the blood vessels of the penis causing increased blood flow (helping lead to getting and keeping an erection). Common drugs: Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) Notice these end in 'fil'. 'Fil' helps the nitric oxide to 'fil' the penis. Contraindications/precautions: Headache, flushing, back pain and muscle aches (with Levitra), temporary vision changes, including "blue vision" (with Viagra), and not all men can spend time with 'Fil'. Men who have heart problems, uncontrolled blood pressure problems, a history of stroke, or a health problem that can cause priapism can't hang out with 'Fil.'

Angiotensin II Receptor Blockers (ARBs) Typical suffix: Sartan antihypertensive drug class #2 Note: AVOID IN PREGNANCY

Uses: ARBs are used for controlling high blood pressure, treating heart failure, and preventing kidney failure in people with diabetes or high blood pressure. ARBs also may prevent diabetes and reduce the risk of stroke in patients with high blood pressure and an enlarged heart. ARBs also may prevent the recurrence of atrial fibrillation. Since ARB medications have effects that are similar to those of ACE inhibitors, they often are used when ACE inhibitors are not tolerated by patients (for example, due to excessive coughing). Common drugs: Losartan (Cozaar) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Contraindications/precautions: cough, elevated potassium levels in the blood (hyperkalemia), low blood pressure, dizziness, headache, drowsiness, diarrhea, abnormal taste sensation (metallic or salty taste), rash, orthostatic hypotension (low blood pressure upon standing), fatigue, indigestion, increased blood glucose levels, flu-like symptoms, sinusitis (sinus infection), bronchitis, and upper respiratory tract infections. Compared to ACE inhibitors, cough occurs less often with ARBs. kidney failure, liver failure (hepatitis), serious allergic reactions, a decrease in white blood cells, a decrease in blood platelets, and swelling of tissues (angioedema). Fetal injury can result if used by pregnant women during 2nd and 3rd trimester There have been reports of rhabdomyolysis (destruction of skeletal muscle) in patients receiving ARBs. Individuals who have narrowing of both arteries that supply the kidneys or have had a severe reaction to ARBs should avoid them. Like other antihypertensives, ARBs have been associated with sexual dysfunction. Drug interactions: Since ARBs may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase potassium may result in excessive blood potassium levels and cardiac arrhythmias. ARBs may also increase the blood concentration of lithium (Eskalith, Lithobid) and lead to an increase in side effects from lithium. Rifampin (Rifadin) reduces the blood levels of losartan, and fluconazole (Diflucan) reduces the conversion of losartan to its active form. These effects could decrease the effects of losartan ARBs should not be combined with ACE inhibitors because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment. ARBs should not be combined with aliskiren (Tekturna) because such combinations increase the risk of kidney failure, excessive low blood pressure, and hyperkalemia.

Alpha Adrenergic Blockers Typical suffix: Sin antihypertensive drug class #4 (adrenergic blockers) PNS drugs so they... Constrict pupils Increase salivation Decrease HR, Bp Constricts bronchioles Stimulates digestion Contracts bladder Stimulates sex or organs

Uses: Alpha-blockers lower blood pressure by keeping the hormone norepinephrine from tightening the muscles in the walls of smaller arteries and veins. As a result, the vessels remain open and relaxed. This improves blood flow and lowers blood pressure. Because alpha-blockers also relax other muscles throughout the body, these medications also can help improve urine flow in older men with prostate problems. Alpha-blockers are also called alpha-adrenergic blocking agents, alpha-adrenergic antagonists, adrenergic blocking agents, and alpha-blocking agents. Alpha-blockers typically aren't the first treatment option for high blood pressure. Instead, they're used in combination with other drugs, such as diuretics, when your high blood pressure is difficult to control. In addition to high blood pressure, doctors prescribe alpha-blockers to prevent, treat or improve symptoms of an enlarged prostate (benign prostatic hyperplasia) Common drugs: Prazosin (Minipress) Doxazosin (Cardura) Terazosin Norepinephrine Contraindications/precautions: Dilate veins and arteries Potential for 1st dose orthostatic hypotension Concurrent use of prazosin and NSAIDs or clonidine can interfere with reduction of BP Some alpha-blockers might have a "first-dose effect." When you start taking an alpha-blocker, you might develop pronounced low blood pressure and dizziness, which can make you faint when you rise from a sitting or lying position. As a result, the first dose is often taken at bedtime Dizziness, Headache, pounding heartbeat, Weakness, Orthostatic Hypotension, Alpha-blockers may improve total cholesterol. However, some research has found that long-term use of some alpha-blockers can increase the risk of heart failure.

Anticoagulant

Uses: Anticoagulants prevent the formation of blood clots by interfering with the clotting cascade, thereby preventing coagulation Common drugs: Heparin sodium prevents thrombin from converting fibrinogen to fibrin. It is administered IV or SQ. Enoxaparin (Lovenox) is low-molecular-weight heparin. It has the same action as heparin but has a longer half-life. It is administered via subcutaneous injection. Protamine sulfate is the antidote for heparin. Administer heparin when there is the likelihood of clot formation, such as with myocardial infarction or deep-vein thrombosis. The risk for bleeding is the major side effect that clients should be alerted about. Clients should be alerted to monitor for bleeding, including bleeding gums, bruises, hematuria, and petechiae. Coumadin (generic name Warfarin sodium) interferes with coagulation factors by antagonizing vitamin K. Oral administration is typically used. Clients may need continued heparin infusion via IV until the therapeutic effect of Coumadin is experienced (may take3-5 days). Contraindicated in clients with low platelet counts or uncontrolled bleeding. Mephyton (trade name vitamin K) is the antidote for Coumadin. Advise clients to avoid foods that are high in vitamin K, and avoid the use of acetaminophen, glucocorticoids, and aspirin. Clients should wear a medical alert bracelet indicating warfarin use. Doses are typically taken once daily. NR and PT are monitored for clients who are taking Coumadin. Depending on the intent of therapy, PT should be 1.5 to 2 times control and INR should be 2-3. Target INR is 3 to 4.5 for clients with a mechanical heart valve Contraindications/precautions: NO Coumadin for pregnant women! Oral anticoagulants fall into Pregnancy Risk Category X. Heparin may be safely used in pregnancy.

Antidotes

Uses: Antidotes are agents given to counteract the effects of poisoning related to toxicity of certain drugs or substances. Antidotes are extremely valuable, however most drugs do not have a specific antidote. Common drugs: Atropine- antidote for muscarinic agonists, cholinesterase inhibitors such as - Bethanechol (Urecholine) - Neostigmine (Prostigmin) Physostigmine (Antilirium)- Antidote for anticholinergic drugs such as atropine Digoxin immune fab (Digibind)- antidote for digoxin, digitoxin Vitamin K- Antidote for warfarin (Coumadin) Protamine sulfate- Antidote for heparin Glucagon- Antidote for insulin-induced hypoglycemia Acetylcysteine (mucomyst)- antidote for acetaminophen (tylenol) Contraindications/precautions:

Antihistamines Typical suffix: Ine

Uses: Antihistamines are drugs that stop histamines from attaching to histamine receptors in the tissues and producing inflammatory and allergic symptoms. Allergens activate mast cells that are the chief controllers of the immune system. They are manufactured in the bone marrow and are present in all tissues of the body. When the mast cells are activated, they release histamine. Antihistamines do no prevent histamine from being released. They block the receptors on the tissues. Common Drugs: diphenhydramine (Benadryl) diphenhydramine (Topical agent) brompheniramine (Dimetapp) fexofenadine (Allegra) loratadine (Claritin) cetirizine hydrochloride (Zyrtec) chlorpheniramine (Chlor-Trimeton) clemastine (Tavist) Contraindications/Precautions: Warm patients not to drive or operate hazardous equipment because these drugs usually cause drowsiness. Check the urine output of patients who have an enlarged prostate gland because a side effect of these drugs is urinary retention. Avoid giving these drugs to patients with glaucoma because the action can increase intraocular pressure. Warn patients that many over the counter sleep aids contain antihistamines and taking these with an antihistamine could lead to overdose. Watch for hyperexcitability and restlessness in children or older adults because they are more likely to have paradoxical reaction to the drug. Tell patients who are breast feeding to avoid brompheniramine because it enters breast milk and will produce side effects in the infant. Warn patients not to take these drugs with sedatives, opioids, anticholinergic drugs, or drugs that cause CNS depression because the CNS side effects will be more severe. Warm patients to take these drugs for 2 weeks or less to avoid tolerance and long- term side effects. Teach patients not to take fexofenadine with grapefruit, orange, or apple juice because these products reduce the effectiveness of the drug. Ask whether the patient has any kidney problems before giving either fexofenadine or levocetirizine because poor kidney function allows the drug to remain in the system longer and can lead to overdose. Give levocetirizine in the evening because it has more sedating effects.

Antiplatelets

Uses: Antiplatelet agents are medicines that reduce the ability of platelets to stick together (called platelet aggregation) and inhibit the formation of blood clots. Antiplatelet agents play a major role in the treatment and prevention of myocardial infarction (heart attacks), stent thrombosis, and ischemic stroke (strokes caused by a blood clot). These medications are used to prevent myocardial infarction and stroke. Low dose therapy (81 mg) is effective for the prevention of strokes and MI. These medications are most commonly taken orally. They may also be administered IV. Common drugs: Antiplatelet agents can be divided into three major types: Glycoprotein platelet inhibitors (abciximab, eptifibatide, tirofiban) Platelet aggregation inhibitors (aspirin, cilostazol, clopidogrel) Protease-activated receptor-1 antagonists (vorapaxar). Aspirin (Ecotrin) Clopidogrel (Plavix) Pentoxifylline (Trental) Contraindications/precautions: WATCH FOR BLEEDING. These medications should be taken with food. These medications should be used cautiously in clients with peptic ulcer disease and in clients with severe renal/hepatic disorders. What do clients who are taking these medications need to know? Observe for signs of weakness, dizziness, and headache and report them if they occur. These may be signs of hemorrhagic stroke. Bleeding time should be assessed carefully. Coffee ground emesis or bloody, tarry stools should be reported. Watch for bruising, petechiae, and bleeding gums. Avoid concurrent use of medications that enhance bleeding, including NSAIDs, heparin, and warfarin. Corticosteroids should be avoided as they may increase aspirin effects. Concurrent use of aspirin may reduce the hypertensive action of beta-blockers.

Antivirals Typical suffix: Vir, and Vine

Uses: Antivirals are a class of medications that are used to treat viral infections. Most viral infections resolve spontaneously in immunocompetent individuals. The aim of antiviral therapy is to minimize symptoms and infectivity as well as to shorten the duration of illness. These drugs act by arresting the viral replication cycle at various stages. Currently, antiviral therapy is available only for a limited number of infections. Most of the antiviral drugs currently available are used to treat infections caused by HIV, herpes viruses, hepatitis B and C viruses, and influenza A and B viruses. Because viruses are obligate, intracellular parasites, it is difficult to find drug targets that interfere with viral replication without also harming the host cells. Unlike other antimicrobials, antiviral drugs do not deactivate or destroy the microbe (in this case, the virus) but act by inhibiting replication. In this way, they prevent the viral load from increasing to a point where it could cause pathogenesis, allowing the body's innate immune mechanisms to neutralize the virus. Common Drugs: Contraindications/Precautions: Before giving these drugs, ask the patient about all other drugs he or she is takes and check with a pharmacist because of the numerous possible drug interactions. Assess patients for fatigue and excessive bruising because these drugs decrease bone marrow production of red blood cells and platelets. Assess urine output and teach patients to stay hydrated because these drugs can damage the kidneys. For patients taking acyclovir or famciclovir, assess for yellowing of the skin and sclera, and elevated liver enzymes because these drugs are liver toxic. Tell families to watch out for confusion or behavior changes because the systemic drugs can affect the CNS. Warm patients that the skin may become red where the topical cream is applied to reduce their anxiety when the symptom appears. Warn patients that excessive use of the topical cream can cause systemic side effects and adverse effects because of skin absorption of the drug. Before giving acyclovir, ask patients whether they have a true milk allergy because this is a contraindication to acyclovir therapy because there is a cross-sensitivity of the antibodies. Don't take with grapefruit or grapefruit juice. Side effects: fatigue and generalized weakness Nausea and vomiting Diarrhea

Benzodiazepines Typical suffix: Lam and Pam

Uses: Benzos are a class of medications that work in the central nervous system and are used for a variety of medical conditions, such as anxiety, seizures, and for alcohol withdrawal. Benzodiazepines appear to work by blocking excessive activity of nerves in the brain and other areas in the central nervous system. As a class, benzodiazepines are similar in how they work in the brain but have different potencies and durations of actions. Because of this, some benzodiazepines work better than others in the treatment of particular conditions. The main effects of benzodiazepines are: sedation, reduced anxiety, alcohol withdrawal treatment, muscle relaxant Common Drugs: alprazolam (Xanax, Xanax XR) clobazam (Onfi) clonazepam (Klonopin) clorazepate (Tranxene) chlordiazepoxide(Librium) diazepam (Valium, Diastat Acudial, Diastat) lorazepam (Ativan) alprazolam (Xanax) Contraindications/Precautions: Drowsiness, sleepiness, or dizziness are the most commonly reported side effects with this drug class. Driving or operating machinery or perform other hazardous tasks can be dangerous while using these drugs. Drinking alcohol in combination with benzodiazepines may heighten these effects. Unusual sleep behaviors and anterograde amnesia may occur with traditional benzodiazepines. Anterograde amnesia is the loss of the ability to create new memories, leading to a partial or complete inability to recall the recent past. Several benzodiazepines are known to have this powerful amnesic effect; triazolam (Halcion) is notorious. Next day drowsiness and "hangover effect" is a concern with benzodiazepines that have long duration, for example, with diazepam or flurazepam. The sedative side effects can carry into the next day and impair driving and other daily activities; this is a particularly concerning risk in the elderly. Combined use of kava and benzodiazepines is not recommended. Combined use of St. John's wort with benzodiazepines may increase side effects such as dizziness, drowsiness, impaired thinking and difficulty concentrating. Grapefruit and grapefruit juice may interact with certain benzodiazepines such as midazolam, triazolam, and alprazolam. Blood levels of these drugs may be increased if taken after drinking grapefruit juice and lead to potentially dangerous side effects. Women who are breastfeeding their infant should not use benzodiazepines unless directed to do so by their physician. Benzodiazepines may accumulate in breast milk and in breastfed infants. In general, benzodiazepines should NOT be used in pregnancy. Antidote: Flumazenil (Romazicon) used for benzodiazepine overdose. (ben is off with the flu).

bronchodilator drugs Typical suffix: Rol, and ine

Uses: Bronchodilators work by relaxing the muscles in the airways. The relaxation causes the airways to open up and the bronchial tubes to widen. Various types work in slightly different ways. Respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), cause bronchospasm, which is constriction or narrowing of the airways. Narrowed airways make it hard for a person to cough mucus up. It also makes it difficult for them to get air in and out of the lungs. Classifications of bronchodilators include beta 2-agonists, anticholinergics, and xanthine derivatives. These medications open the airways, but they work on different receptors in the body. Common Drugs: Beta-2 antagonists Beta 2-agonists stimulate beta-adrenoceptors in the airway. This class of bronchodilator causes the smooth muscles surrounding the airways to relax. This improves airflow and reduces symptoms, such as shortness of breath. Anticholinergic drugs Anticholinergic bronchodilators block the action of acetylcholine. Acetylcholine is a chemical released by the nerves that can lead to tightening of the bronchial tubes. By blocking the chemical, anticholinergic bronchodilators cause the airways to relax and open. Xanthine derivatives Xanthine derivatives also relax the airway muscles, although doctors do not know precisely how they work. The main xanthine derivative is theophylline. Doctors rarely prescribe theophylline anymore because many people experience significant side effects. However, theophylline is available in capsule, tablet, or liquid form. Short acting: Doctors often call short-acting bronchodilators rescue or fast-acting inhalers because they treat symptoms that come on suddenly, such as wheezing, shortness of breath, and chest tightness. Short-acting bronchodilators work quickly, usually within a few minutes. Although they work fast, the therapeutic effects generally only last 4-5 hours. Short-acting bronchodilators treat sudden symptoms, and people do not need to use them when they are symptom-free. Common short acting: Albuterol Levalbuterol Pirbuterol Long acting: Long-acting bronchodilators do not work as quickly as short-acting bronchodilators and do not treat acute or sudden symptoms. The effects typically last for 12-24 hours, and people take them daily to prevent symptoms from developing. Common long-acting: salmeterol (Serevent) formoterol (Perforomist) aclidinium (Tudorza) tiotropium (Spiriva) umeclidinium (Incruse) Administration methods: Metered dose inhalers: A metered dose inhaler (MDI) is a small, pressurized canister that contains medication. The device releases the medicine when a person presses down on the canister. A propellant in the MDI carries the dose of medicine into the lungs. Nebulizer: A nebulizer uses bronchodilator medication in the form of a liquid and turns it into an aerosol that the person then inhales through a mouthpiece. Dry powder inhaler: A dry powder inhaler does not have a propellant, and the bronchodilator is in powder form. Soft mist inhaler: Some bronchodilators are available in soft mist inhalers. Soft mist inhalers deliver an aerosol cloud into the lungs without a propellant. Contraindications/precautions: Beta-blockers, for example, propranolol (Inderal, Inderal LA), block the effect of beta-adrenergic bronchodilators and may induce bronchospasm in asthmatics. Beta-adrenergic bronchodilators may cause hypokalemia (low potassium). Therefore, combining beta-adrenergic bronchodilators with loop diuretics, for example, furosemide (Lasix), may increase the likelihood of hypokalemia.

Corticosteroids Typical suffix: Sone

Uses: Corticosteroids mimic the effects of hormones your body produces naturally in your adrenal glands, which are small glands that sit on top of your kidneys. When prescribed in doses that exceed your body's usual levels, corticosteroids suppress inflammation. This can reduce the signs and symptoms of inflammatory conditions, such as arthritis and asthma. Corticosteroids also suppress your immune system, which can help control conditions in which your immune system mistakenly attacks its own tissues. Common Drugs: Fludrocortisone- Used for treating adrenal insufficiency in addison's disease and acts as a replacement for cortisone in body. Acts by causing the kidneys to retain sodium, thus balancing salt and water in the body and maintaining blood pressure levels. - Avoid contact w infected persons (reduces immunosuppression) - Report any signs of infection - Immunizations containing live vaccines are prohibited - side effects include hypertension, hypernatremia, hypocalcemia, and hypokalemia - Regularly monitor BP for hypertension - Report weight gain and edema Prednisone prednisolone (Orapred, Prelone) triamcinolone (Aristospan Intra-Articular,) methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol) dexamethasone (Dexamethasone Intensol) hydrocortisone (Cortef) cortisone ethamethasoneb (Celestone) Contraindications/Precautions: Because oral corticosteroids affect your entire body instead of just a particular area, this route of administration is the most likely to cause significant side effects such as; Elevated pressure in the eyes (glaucoma), Fluid retention (causing swelling in your lower legs), High blood pressure, Problems with mood swings, memory and behavior and other psychological effects, such as confusion or delirium, Weight gain, with fat deposits in your abdomen, face and the back of your neck. When taking oral corticosteroids longer term, patient may experience side effects such as; Clouding of the lens in one or both eyes (cataracts), High blood sugar, which can trigger or worsen diabetes, Increased risk of infections, especially with common bacterial, viral and fungal microorganisms, Thinning bones (osteoporosis) and fractures. When using inhaled corticosteroids, some of the drug may deposit in the mouth and throat instead of making it to the lungs. This can cause: Fungal infection in the mouth (oral thrush), Hoarseness. Topical corticosteroids can lead to thin skin, red skin lesions and acne. Injected corticosteroids can cause temporary side effects near the site of the injection, including skin thinning, loss of color in the skin, and intense pain — also known as post- injection flare. Other signs and symptoms may include facial flushing, insomnia and high blood sugar. Corticosteroids should not be stopped suddenly after prolonged use as this can result in adrenal crisis because of the body's inability to secrete enough cortisol to make up for the withdrawal. Nausea, vomiting, and shock are the reported side effects of adrenal crisis. Inhaled corticosteroids can cause fungal infections in the mouth

Diuretics

Uses: Diuretics, also called water pills, are medications designed to increase the amount of water and salt expelled from the body as urine. There are three types of prescription diuretics. They're often prescribed to help treat high blood pressure, but they're used for other conditions as well. The most common condition treated with diuretics is high blood pressure. The drugs reduce the amount of fluid in your blood vessels, and this helps lower your blood pressure. Other conditions are also treated with diuretics. Congestive heart failure, for instance, keeps your heart from pumping blood effectively throughout your body. This leads to a buildup of fluids in your body, which is called edema. Diuretics can help reduce this fluid buildup. Common drugs: The three types of diuretic medications are called thiazide, loop, and potassium-sparing diuretics. All of them make your body excrete more fluids as urine. Each type affects a different part of the kidneys.

Monamine Oxidase Inhibitors (MAOIs)

Uses: blocks MAO in the brain, thereby increasing the amount of norepinephrine, dopamine and serotonin. Increase of these neurotransmitters relieves depression. Not commonly used anymore. Good for bulimia and depression or other unconventional depression but must be aware of interactions. Common Drugs: phenelzine (Nardil) isocarboxazid (Marlplan) tranylcypromine (Parnate) selegiline (Emsam) - transdermal patch Contraindications/Precautions: Interacts with Tyramine (including cheese, alcohol, avocado, fish, figs, chocolate, fermented meats). Mixing with antidepressants can lead to hypertensive crisis. Other Side effect include CNS stimulation (including hypomania, mania, anxiety, agitation), orthostatic hypotension. interacts with many meds!!

Insulins

Uses: Insulins are used to manage diabetes mellitus, a chronic illness that results from an absolute or relative deficiency of insulin. There are various insulins that are available to manage diabetes. . Assessment should occur frequently, but especially during the PEAK of insulin action, as this is when hypoglycemia is most likely to occur. Signs and symptoms of abrupt-onset hypoglycemia include tachycardia, palpitations, diaphoresis, and shakiness. Gradual onset hypoglycemia may manifest with headaches, tremors, or weakness. Common drugs: ***WHEN MIXING, remember clear over cloudy. Rapid-acting insulins: (fastest) Lispro (Humalog) Aspart (Novalog) Onset: Less than 15 minutes. Peak: 30 minutes to 1 hour. Duration: 3 to 4 hours. - Eat within 15 mins, used for rapid reduction of glucose or to prevent nocturnally hyperglycemia. Short-acting insulins: (fast) Regular (humulin R) Onset: 30 minutes to 1 hour Peak: 2 to 3 hours Duration: 5 to 7 hours - Take 20-30 minutes before a meal. May be taken alone or combined, ONLY IV INSULIN!! Intermediate-acting insulins: (Slow) NPH insulin (Humulin N) Onset: 1 to 2 hours Peak: 4 to 12 hours Duration: 18 to 24 hours - Not reliant on food, usually taken 2 times daily Long-acting insulins: (Slowest) Insulin glargine (lantus) Detemir (Levemir) Onset: 1 to 2 hours Peak: None Duration: 10 to 24 hours - Used for basal dose. Can NOT mix. Taken one time daily, time must be consistent. Contraindications/precautions:

Beta blockers Typical suffix : Olol antihypertensive drug class #5

Uses: Making the heart beat slower and less forcefully, which in turn lowers blood pressure. Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta blockers also help open up your veins and arteries to improve blood flow. Common drugs: Metoprolol [Lopressor, Toprol-XL] Propranolol [Inderal LA, InnoPran XL] Bisoprolol [Zebeta] Contraindications/precautions: Avoid in patients with COPD/Asthma, can cause bronchospasms, avoid abrupt cessation Can mask hypoglycemia!!!

Organic nitrates

Uses: Organic nitrate esters have a direct relaxant effect on vascular smooth muscles, and the dilation of coronary vessels improves oxygen supply to the myocardium. The dilation of peripheral veins, and in higher doses peripheral arteries, reduces preload and afterload, and thereby lowers myocardial oxygen consumption. Glyceryl trinitrate, isosorbide dinitrate, and isosorbide-5-mononitrate are organic nitrate esters commonly used in the treatment of angina pectoris, myocardial infarction, and congestive heart failure. Common drugs: Nitroglycerin (Nitrol, Nitrostat) Isosorbide dinitrate (Imdur) Contraindications/precautions: Dilates veins and prevents spasms of coronary arteries Headache is common so client should use with acetaminophen or aspirin Tolerance can occur with prolonged use Concurrent use with sildenafil (Viagra) can lead to life-threatening hypotension Use with alcohol can cause increased hypotension Sublingual tablets, translingual spray, or transmucosal preparations should be used at the first sign of angina Sustained-release capsules, transdermal patches, or topical ointment provide long- term prophylaxis

Proton Pump Inhibitors Typical suffix: Zole

Uses: PPIs decrease stomach acid by inhibiting those gastric proton pumps that make the acid - they stop the acid at the pump! Think of a pump in your stomach just churning out the acid - 'Zole' is the nice guy who shuts off the pump. Common drugs: Omeprazole [Prilosec, Zegerid, Omepral, Omez] Lansoprazole [Prevacid, Zoton, Inhibitol] Dexlansoprazole [Kapidex, Dexilant] Esomeprazole [Nexium, Esotrex] Contraindications/precautions: Can cause vitamin B12 deficiency if he stays around too long (with long-term use).

Statins Typical suffix: Statin

Uses: Statins are used to treat primary hypercholesterolemia, for prevention of coronary events (primary and secondary), for protection against MI and stroke for clients with diabetes, and to help increase HDL levels in clients with primary hypercholesterolemia. Remember LDL is the 'bad' cholesterol and HDL is the 'good' cholesterol (HDL helps keep the 'bad' cholesterol from building up in artery walls). You want your LOW (LDL) LOW and your HIGH (HDL) HIGH. Common drugs: Atorvastatin (Lipitor) Simvastatin (Zocor) Lovastatin (Mevacor) Pravastatin (Pravachol) Rosuvastatin (Crestor) Fluvastatin (Lescol) Contraindications/precautions: When you think 'statins' think that we need to protect the liver and muscles stat. Don't take with grapefruit juice! There is a risk of hepatotoxicity. It is important to obtain a baseline liver function and to monitor liver function tests after 12 weeks and then every 6 months and to avoid alcohol. There is also a risk of myopathy and peripheral neuropathy. Clients should be told to report tingling and tenderness. CK levels will be monitored periodically during treatment as well.

ACE inhibitors Typical suffix: PRIL antihypertensive drug class #1. Note: AVOID IN PREGNANCY

Uses: Treating heart failure, hypertension, myocardial infarction, and diabetic or non-diabetic nephropathy. Common drugs: Enalapril [Vasotec] Lisinopril [Prinivil, Zestril] Quinapril [Accupril] Benaxepril [Lotensin] Captopril (Capoten) Contradictions/precautions: Clients taking captopril (Capoten) should be instructed to take meds at least 1 hour before meals; all other ACE inhibitors are not affected by food. Should be stopped if the client experiences cough, rash, altered taste, angioedema, or signs of infections. Can cause hyperkalemia so must monitor serum potassium levels. Concurrent use with potassium supplements or potassium-sparing diuretics can cause hyperkalemia. Concurrent use with lithium can lead to lithium toxicity . for clients unable to handle ace inhbitors, take ARBS

Antagonists

Uses: Treatment of opioids overdose, reversal of effects of opioids, or reversal of respiratory depression in an infant. Example: a postoperative client receiving morphine sulfate for pain control experiences respiratory depression and is treated with naloxone (Narcan) Common drugs: Contraindications/precautions: Monitor for side/adverse effects Tachycardia and tachypnea Abstinence syndrome in clients who are physically dependent on opioid agonists Monitor for symptoms to include cramping, hypertension, and vomiting Administer naloxone by IV, IM, or subcutaneous routes, not orally Be prepared to address client's pain because naloxone will immediately stop the analgesic effect of the opioid the client had taken When used for respiratory depression, monitor for return to normal respiratory rate (16-20/min for adults; 40-60/min for newborns)

Selective Serotonin Reuptake Inhibitors (SSRIs)

Uses: blocks reuptake of serotonin in the synaptic space, thereby intensifying the effects of serotonin. Less side effects and less anticholinergic effect. SE, abdominal pain, anxiety, hyperreflexia, serotonin syndrome (stop right away if occurs), hyponatremia (so take caution when taking diuretic). First line therapy for most types of depression. Effective if depression is accompanied with anxiety or psychomotor agitation. Low lethality risk so can be given 30-day supply. Takes 2-4 weeks. Common Drugs: fluoxetine (Prozac) citalopram (Celexa) escitalopram (Lexapro) paroxetine (Paxil) - good alternative to Ativan Sertraline (Zoloft)vilazodone (Viibryd)Trazodone (Desyrel) - used at night due to drowsy side effect. Can be used as a sleep aid. Serotonin syndrome: Agitation or restlessness. Confusion. Rapid heart rate and high blood pressure. Dilated pupils. Loss of muscle coordination or twitching muscles. Muscle rigidity. Heavy sweating. Diarrhea. SSRI and MAO can not be combined, increases risk of serotonin syndrome. (if the drug doesn't have an x or z, it doesn't belong in this class)

atypical antipsychotics (2nd GEN)

Uses: blocks serotonin, and to a lesser degree, dopamine receptors. Medication of choice because of less side effects. Treats both positive and negative symptoms. Fewer EPS and Anticholinergic effects Common Drugs: risperidone (Risperdal) → Prototype aripiprazole (Abilify) asenapine (Saphris) iloperidone (Fanapt) lurasidone (Latuda) olanzapine (Zyprexa) paliperidone (Invega) quetiapine (Seroquel) ziprasidone (Geodon) clozapine (Clozaril) - a second gen atypical antipsychotic drug that, unlike other second gen drugs, has a high anticholinergic effect & blood dyscrasia or agranulocytosis. Risk for NMS!!!

Calcium Channel Blockers Typical suffix: dipine and amil antihypertensive drug class #3

Uses: calcium channel blockers are like valium for your heart calms your heart given when heart is tachycardic, pt is having tachyarrhythmias, had a heart attack and need to rest heart never give to stimulate heart negative inotropic, chronotropic and dromotropic- its like valium for your heart- relax your heart and calm it down Treat: A) Antihypertensives- relax your heart blood vessels and blood pressure goes down AA) Antiangina- relax your heart, uses less oxygen, and decreases oxygen demand because it relaxes the heart- worst thing that can happen to person with angina is if their heart speeds up so we want to slow it down AAA) Anti Atrial Arrhythmias- (will not treat ventricular tachycardia) treats atrial flutter, atrial fibrillation, premature atrial contractions TRICK: supraventricular tachycardia- supra means above, and the atria is above the ventricle. Common drugs: Nifedipine [Procardia] Nisoldipine [Sular] Amlodipine [Norvasc] - Amlodipine has very little effect on the heart rate and contraction. Therefore, amlodipine is not used for treating abnormal heart rhythm, but it is preferred when heart failure is present, and dilation of arteries is desired. Diltiazem [Cardizem, Tiazac]- IV DRIP Felodipine (Plendil) Nicardipine (Cardene) Verapamil (Calan) - Verampil reduces the strength and rate of the heart's contraction and are used in treating abnormal heart rhythms Contradictions/precautions: **think H&HH) headache - vessels dilate in the brain causing migraine H) hypotension- relaxes heart and blood vessels *headache is great choice for SATA most times Vasodilation is the result of blocking calcium channels in blood vessels. Risk of reflex tachycardia, peripheral edema, and acute toxicity with nifedipine. Risk of orthostatic hypotension, peripheral edema, constipation, bradycardia, dysrhythmias, and acute toxicity with verapamil and diltiazem. Drinking grapefruit juice can lead to toxicity. Concurrent use of digoxin with verapamil can lead to digoxin toxicity. ***Vital signs needed to measured before giving a calcium channel blocker, ex. Blood pressure because pt will be at risk for hypotension hold the calcium channel blocker if the systolic is under 100, l

Meds to Support Withdrawal / Abstinence from alcohol

Uses: decrease the intensity of withdrawal manifestations. Should be administered round the clock or PRN. Obtain baseline vitals and monitor neuro status on ongoing basis, and provide seizure precautions. Common drugs: Detoxification: Benzodiazepines chlordiazepoxide (Librium) diazepam (Valium) lorazepam (Ativan) oxazepam (Serax) Abstinence maintenance (following detox): disulfiram (Antabuse) - causes withdrawal symptoms for aversion therapy. Risk for acetaldehyde syndrome (Diarrhea, N/V, tachycardia, hypotension, & flushing). naltrexone (Vivitrol) - suppresses cravings and pleasurable effects of alcohol. acamprosate (Campral) - reduces cravings for alcohol.

Benzodiazepine sedative hypnotic anxiolytics

Uses: enhances the inhibitory effects of GABA. Relief from anxiety occurs rapidly. Common Drugs: alprazolam (Xanax) diazepam (Valium) lorazepam (Ativan) chlordiazepoxide (Librium) clorazepate (Tranxene) oxazepam (Serax) clonazepam (Klonopin)

Alpha 2 Adrenergic Agonists

Uses: exact MOA is not fully understood; however, they are known to activate presynaptic alpha 2 adrenergic receptors in the brain. Good for ADHD. Common drugs: guanfacine (Intuniv) clonidine (Kapway)

atypical/nonbarbiturate anxiolytic

Uses: exact MOA is unknown, but, it does bind to serotonin and dopamine receptors. Less dependency than other anxiolytics. Use of buspirone does not result in sedation or potentiate the effects of other CNS depressants. Common Drugs: buspirone (BuSpar)

Antianemics

Uses: increases the number of red blood cells or the amount of hemoglobin (an oxygen-carrying protein) in the blood, deficiencies of which characterize the disorder known as anemia. The red cell and hemoglobin reductions associated with anemia result in tissue oxygen deficiencies that can lead to symptoms such as fainting, dizziness, and shortness of breath. Common drugs: epoetin alfa (Epogen) Ferrous sulfate (Feosol) Contraindications/precautions: Iron can cause teeth staining (liquid form). Discuss with clients the importance of diluting liquid iron with water or juice (Orange juice), drink with a straw, and rinse mouth after swallowing. Iron can cause staining of the skin and other tissues with IM injections. If the IM route must be used, give IM doses deep IM using the Z track technique. Iron also has several drug interactions - co-administration of antacids or tetracyclines reduces the absorption of iron. Separate use by at least 2 hr. Vitamin C increases absorption but also increases the incidence of GI complications. Avoid vitamin C intake when taking medication. Instruct clients to take iron on an empty stomach such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. However, iron can cause GI distress (nausea, constipation, heartburn). If intolerable, iron can be administered with food to increase compliance with therapy but this does reduce absorption. Instruct clients to space doses at approximately equal intervals throughout the day to most efficiently increase red blood cell production. Inform clients to anticipate a harmless dark green or black color of stool. Instruct clients to increase water and fiber intake (unless contraindicated), and to maintain an exercise program to counter the constipation effects. Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks, muscle meats, yeast).

Carbapenems (Antibiotic)

inhibit cell wall synthesis Ex: Meropenem, ertapenem Adverse rxns: nausea, vomiting, diarrhea, seizures, pruritus often used as last resort for life threatening reactions or diseases

neurocognitive disorders

Uses: inhibits anticholinesterase, thereby increasing acetylcholine at the cholinergic synapses. Used to slowdown cognitive deterioration of Alzheimer's disease in the mild to moderate stages. Also used for other neurocognitive disorders such as Parkinson and Huntington's diseases. Common drugs: donepezil (Aricept) - long half-life, give once daily at bedtime, available in orally disintegrating tablet. rivastigmine (Exelon) galantamine (Razadyne) Contraindications/Precautions: SE includes nausea, diarrhea and bradycardia. Contraindicated for asthma and COPD patients. Do not use concurrently or take caution if using NSAIDs, antihistamines, TCA and 1st gen antipsychotics (conventional antipsychotics). memantine (Namenda) - only med approved for moderate to severe Alzheimer's. Blocks entry of calcium into nerve cells, thus slowing down brain- cell death. estrogen - estrogen therapy for women may prevent Alzheimer's but is not useful in existing conditions. ginko biloba - may enhance memory in some patients.

Atypical Antidepressants

Uses: inhibits dopamine uptake. Alternative to SSRIs for patients who cant tolerate the sexual dysfunction side effects. Also used to aid smoking cessation and seasonal depression. Common Drugs: bupropion (Wellbutrin) Venlafaxine (Effexor) Duloxetine (Cymbalta) Desvenlafaxine (Pristiq) Mirtazapine (Remeron) Reboxetine (Edronax) Trazodone (Desyrel) Contraindications/Precautions: Appetite suppression is a common side-effect. Headache and dry mouth may be severe, and client should notify the provider if this occurs. Atypical antidepressants should not be used with clients with seizure disorders. Trazodone is used at night due to drowsy side effect. Can be used as a sleep aid.

Mood stabilizing antiepileptic drugs (AEDS)

Uses: works through various mechanisms, including slowing the entrance of sodium and calcium back into the neuron, potentiating the effects of GABA, and inhibiting glutamate, which in turn suppresses CNS excitation. Common Drugs: valproic acid (Depakote) - therapeutic level 50 to 125 mcg/mL. Check AST and ALT. carbamazepine (Tegretol) - therapeutic level 4 to 12 mg/L. Check AST and ALT& blood dycrasis . lamotrigine (Lamictal) - therapeutic level 2.5 to 15 mcg/mL. May cause blurred vision and Stevens Johnson syndrome. Contraindications/Precautions:

NSRIs

Uses: block reuptake of norepinephrine in the CNS. This med is a non-stimulant. Good foterm-46r ADHD. Common Drugs: atomoxetine (Strattera)

tricyclic antidepressants

Uses: good for depression, autism, ADHD, panic and anxiety disorders, school phobia, and OCD. Common Drugs: amitriptyline (Elavil) imipramine (Tofranil) doxepin (Sinequan) nortriptyline (Aventyl, Pamelor) amoxapine (Asendin) trimipramine (Surmontil) desipramine (Norpramin) protriptyline (Vivactil) Contraindications/Precautions More SE than SSRIs, so get a baseline before starting. Also has high OD risk, so give no more than 1 week's dose. Drug names usually contain "TRIPTYLINE" or "PRAMINE." Takes 14 days to take effect. Initial dose should always be low and increased gradually. Has anticholinergic effect. Risky for older adults and those with cardiac issues, so get full cardiac workup. Don't mix with MAOIs. Contraindicated for clients with a history of heart block, heart attack, or dysrhythmia Contradicted for clients with use of CNS depressants or alcohol use

mood stabilizers

Uses: produces neurochemical changes in the brain, including serotonin receptor blockade. There is evidence that lithium decreases neural atrophy and/or increase neural growth. Common Drugs: Lithium- therapeutic level 0.8 to 1.4 mEq/L. Interacts with sodium and potassium, so watch for BUN, CREAT, electrolytes and pregos. Usually taken twice a day.

Glycopeptide (antibiotics)

Vancomycin and Teicoplanin Adverse rx: Hypotension, flushing, rash, drug fever, local phlebitis, reversible neutropenia, red man syndrome, ototoxicity, renal failure

digital toxicity

Yellow/green halos around lights when blood level exceeds 2.0 ng/dl Earliest sign is nausea and vomiting with headache

Signs of digoxin toxicity

You will see yellow spots, nausea, vomiting, and abdominal pain. If these pt is toxic give activated charcoal or digiband Blurred vision, dysrhythmias, and anorexia. Nausea, vomiting

Rilutek (Riluzole)

amyotrophic lateral sclerosis (Lou Gehrig's disease) FOR ALS treatment (slows progression)

Cephalosporins (antibiotics)

inhibit cell wall synthesis Examples: cephalexin, cefprozil, ceftazidime Adverse rxs: rash, nausea, diarrhea, allergic rxns, cytopenia All lack coverage to LAME: Listeria, atypicals, Mrsa, and enterococci If allergic to penicillins (anaphylaxis), do not use. If allergic to penicillins (rash/hive) can use.

hypothalamic dysfunction

caused by damage resulting from malnutrition; genetic disorders, surgery, trauma; affects body temp., mood, metabolism Corticosteroids should not be stopped abruptly Fever is normal Give acetaminophen for fever

mydriatic

dilation of the pupil Side effects: Tachycardia, photophobia DO NOT use in glaucoma Example) neosynephrine or atropine

Antidysrhythmic Drugs

drugs used to treat abnormal heart rhythms Class 1: Sodium channel blockers Prevent depolarization, slow the movement of the action potential across the myocardium, and suppress ectopic pacemakers Class 2: Beta Blockers Block the effects of the sympathetic nervous system, slow heart rate, and slow conduction through the AV node Class 3: Potassium channel blockers Delay repolarization and prolong the refractory period Class 4: Calcium channel blockers Decrease heart rate, slow conduction through the AV node, and prolong the refractory period Miscellaneous antidysrhythmics: Medications from other classes, such as adenosine and digoxin

Tetracyclines (antibiotics)

inhibition of protein synthesis Ex: doxycycline, minocycline, tetracycline for: pneumonia, lyme disease, acne, SSTI Adverse Rx: GI upset, vaginal candidiasis, tooth discoloration, photosensitivity Drink w full glass of water and sit upright for 30 min after taking dose to prevent esophageal ulceration Avoid in children less than 9 years old with severe hepatic or renal impairment. Avoid doxycycline in myasthenia gravis.

Parental routes of administration (outside Gi tract)

intradermal, subcutaneous, intramuscular, intravenous

teratogenic

known to have potential to cause developmental defects in the embryo or fetus Drugs: phenytoin Lithium Valproate Isotretinoin Methotrexate Ace inhibitors Warfarin

Pregnancy and medications

local anesthetic generally OK; minimize vasoconstrictors; avoid aspirin and NSAIDs; avoid antibiotics tetracycline and sulfas. Drugs that are okay: Metronidazole, clindamycin.

Meds to Support Withdrawal / Abstinence from Opioids

methadone (Dolophine) - methadone substitution replaces the opioid to which the client is addicted. Prevents abstinence syndrome from occurring. Used for long term maintenance. Dependence is transferred from opioid to methadone. clonidine (Catapress) - assists with withdrawal effects related to autonomic hyperactivity (diarrhea, nausea, vomiting), but does not reduce cravings. For dry mouth, suck on candies or ice. buprenorphine (Subutex) - agonist-antagonist opioid used for both detox and maintenance. Decreases the feelings of craving and may be effective in maintaining compliance. Administered sublingually in approved treatment centers.

SSRIs

selective serotonin reuptake inhibitors Common Drugs: fluoxetine (Prozac) escitalopram (Lexapro) paroxetine (Paxil) - good alternative to Ativan sertraline (Zoloft) fluvoxamine (Luvox)

Cholinergic medications PNS drugs so they... Constrict pupils Increase salivation Decrease HR, Bp Constricts bronchioles Stimulates digestion Contracts bladder Stimulates sex or organs

stimulate contraction of detrusor muscle, producing urination bethanechol Pilocarpine physostigmine

Cholinergic medications PNS drugs so they... Constrict pupils Increase salivation Decrease HR, Bp Constricts bronchioles Stimulates digestion Contracts bladder Stimulates sex or organs

stimulate contraction of detrusor muscles, producing urination examples: Bethanechol Pilocarpine Physostigmine

Antifolates (antibiotic)

sulfamethoxazole, trimethoprim for: UTI, SSTI, acne Adverse rxs: Nausea, vomiting, photosensitivity, rash, increase in serum creatinine, hyperkalemia, hyponatramia, and allergy

Cytotoxic drugs

used for both immunosuppression and chemotherapy Major toxicities of cancer chemotherapy: Gastrointestinal - Digestive tract injury - Stomatitis - Nausea/vomiting - Diarrhea Bone marrow suppression Causes a decrease in the number of: Neutrophils (leukopenia) Thrombocytes (thrombocytopenia) Erythrocytes (anemia) No gardening, no raw meat, stay away from anything that could contaminate. Use electric razor