Exams 1-4 Pharmacology Meds -Complete

Anthelmintic and Antiprotozoal Drugs: Nursing Implications

! Before beginning therapy, perform a thorough health history and medication history, and assess for allergies. ! Be sure to collect specimens before beginning drug therapy. ! Check baseline vital signs. ! Check for conditions that may contraindicate use and for potential drug interactions. ! Some drugs may cause the urine to have an asparagus-like odor or cause an unusual skin odor or a metallic taste; be sure to warn the patient ahead of time. ! Administer all drugs as ordered and for the prescribed length of time. ! Most drugs should be taken with food to reduce GI upset. ! Monitor for adverse effects. - Ensure that patients know the adverse effects that should be reported. - Monitor for therapeutic effects and adverse effects with long-term therapy.

Non-Opioid Analgesics: Nursing Implications

! Before beginning therapy, perform a thorough history of allergies, and use of other medications, including alcohol, health history, and medical history ! Obtain baseline vitals and I&O ! Assess for potential contraindications & drug interactions ! Be sure to medicate PT before the pain becomes severe as to provide adequate analgesia and pain control ! Pain management includes pharmacologic and non-pharmacologic approaches; be sure to include other interventions as indicated ! PT should not take other medications of OTC preparations without checking with physicians ! Instruct PT to notify physician about signs of allergic reactions/ adverse effects

Alkylating Drugs: Examples

- Cisplatin (Platinol): Treat solid tumors - Cyclophosphamide (Cytoxan): Treat bone, lymph, blood, and solid tumors - Mechlorethamine (Mustargen, nitrogen mustard): Hodgkins, Hodgkins lymphoma - Others

Xanthine Derivatives: Nursing Implications

- Contraindications: history of PUD or GI disorders - Cautious use: cardiac disease - Timed-release preparations should not be crushed or chewed (cause gastric irritation). - Report to prescriber: Nausea, Vomiting, Restlessness, Insomnia, Irritability, Tremors - Be aware of drug interactions with cimetidine, oral contraceptives, allopurinol, certain antibiotics, influenza vaccine, and others. - Cigarette smoking enhances xanthine metabolism. - Interacting foods include charcoal-broiled, high-protein, and low-carbohydrate foods.These foods may reduce serum levels of xanthines through various metabolic mechanisms.

Transplant Medications (Cont.)

- Cyclosporine (Sandimmune) - Azathioprine (Imuran) - Muromonab-CD3 (Orthoclone) - Daclizumab (Zenapax) - Sirolimus (Rapamune) - Basiliximab (Simulect) - Glatiramer acetate (Copaxone) - Tacrolimus (Prograf) - Mycophenolate mofetil (CellCept) - Fingolimod (Gilenya)

Women's Health Drugs/Estrogens: Interactions

- Decrease the activity of the oral anticoagulants - Decrease effect of rifampin - St. John's wort - Tricyclic antidepressants - Smoking

Hematopoietic Drug: Mechanism of Action

- Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia - Allow for higher dosages of chemotherapy - Decrease bone marrow recovery time after bone marrow transplantation or irradiation - Stimulate other cells in the immune system to destroy or inhibit the growth of cancer cells, as well as virus- or fungus-infected cells

Antihistamine/ Peripherally Acting

- Developed to eliminate unwanted adverse effects, mainly sedation - Work peripherally to block the actions of histamine; thus, fewer central nervous system (CNS) adverse effects - Longer duration of action (increases compliance) Examples: fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec)

Common Cold Pediatric Concerns

- Difficult to identify whether cause is viral or bacterial - Treatment is "empiric therapy," treating the most likely cause - Antivirals and antibiotics may be used, but a definite viral or bacterial cause may not be easily identified. - Parents are advised to consult their children's pediatricians on the best ways to manage these illnesses. - A 2010 study showed a dramatic decrease in young children's emergency department visits since the 2008 FDA recommendation.

Xanthine Derivatives: Indications

- Dilation of airways in asthmas, chronic bronchitis, and emphysema - Mild to moderate cases of acute asthma - NOT for management of acute asthma attack - Adjunct drug in the management of COPD - Not used as frequently because of potential for drug interactions and variables related to drug levels in the blood

Bronchodilators/Beta- Adrenergic Agonists: Interactions

- Diminished bronchodilation when nonselective beta blockers are used with the beta agonist bronchodilators - Monoamine oxidase inhibitors - Sympathomimetics - Monitor patients with diabetes; an increase in blood glucose levels can occur.

Immunization/ Active Immunizing Drugs

- Diphtheria and tetanus toxoids and acellular pertussis vaccine (adsorbed) - Haemophilus influenzae type B conjugate vaccine

Acid-Controlling Drugs/ Antacids: Mechanism of Action

- Do not prevent the overproduction of acid but instead help to neutralize acid secretions - Promote gastric mucosal defense mechanisms - Stimulate secretion of: Mucus: protective barrier against HCl Bicarbonate: helps buffer acidic properties of HCl Prostaglandins: prevent activation of proton pump

Alkylating Drugs: Adverse Effects

- Dose-limiting adverse effects: Nausea and vomiting, myelosuppression - Alopecia - Nephrotoxicity, peripheral neuropathy, ototoxicity:Hydration can prevent nephrotoxicity. - Extravasation causes tissue damage and necrosis.

Adrenal Drugs: Contraindications

- Drug allergies - Serious infections, including septicemia, systemic fungal infections, and varicella - However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory central nervous system (CNS) damage. - Cautious use in patients with:Gastritis, reflux disease, ulcer disease, Diabetes, Cardiac, renal, or liver dysfunction

Women's Health Drugs/ Estrogens: Contraindications

- Drug allergy - Any estrogen-dependent cancer - Undiagnosed abnormal vaginal bleeding - Pregnancy - Active thromboembolic disorder or history

Nasal Decongestants: Contraindications

- Drug allergy - Narrow-angle glaucoma - Uncontrolled cardiovascular disease, hypertension - Diabetes and hyperthyroidism - History of cerebrovascular accident or transient ischemic attacks - Long-standing asthma - BPH - Diabetes

Antitussives: Contraindications

- Drug allergy - Opioid dependency - Respiratory depression - Others

Corticosteroids/ Inhaled: Contraindications

- Drug allergy - Not intended as sole therapy for acute asthma attacks - Hypersensitivity to glucocorticoids - Patients whose sputum tests positive for Candida organisms - Patients with systemic fungal infection

Corticosteroids/ Inhaled: Drug Interactions

- Drug interactions are more likely to occur with systemic (versus inhaled) corticosteroids. - May increase serum glucose levels, possibly requiring adjustments in dosages of antidiabetic drugs - Cyclosporine and tacrolimus - Itraconazole - Phenytoin, phenobarbital, and rifampin

Expectorants: Background Information

- Drugs that aid in the expectoration (removal) of mucus - Reduce the viscosity of secretions - Disintegrate and thin secretions - Example: guaifenesin

Antineoplastic Medications/ CCS

- Drugs that are cytotoxic during a specific cell-cycle phase - Used to treat a variety of solid or circulating tumors: (Antimetabolites, Mitotic inhibitors, Alkaloid topoisomerase II inhibitors, Topoisomerase I inhibitors, Antineoplastic enzymes)

Immunosuppressant Drugs: Background Information

- Drugs that decrease or prevent an immune response, thus suppressing the immune system - Used to prevent or treat rejection of transplanted organs - Immunosuppressive therapy

Antitussives: Indications

- Drugs used to stop or reduce coughing - Opioid and nonopioid - Used only for nonproductive coughs! - May be used in cases when coughing is harmful - Used to stop the cough reflex when the cough is nonproductive or harmful

Respiratory Drugs: Nursing Implications (General)

- Encourage patients to take measures that promote a generally good state of health so as to prevent, relieve, or decrease symptoms of COPD. - Avoid exposure to conditions that precipitate bronchospasm (allergens, smoking, stress, air pollutants). - Adequate fluid intake - Compliance with medical treatment - Avoid excessive fatigue, heat, extremes in temperature, and caffeine. - Encourage patients to get prompt treatment for flu or other illnesses and to get vaccinated against pneumonia or flu. - Encourage patients to always check with their physicians before taking any other medication, including over-the-counter (OTC) medications.

Biologic Response-Modifying Drugs: Therapeutic Effects

- Enhancement of hematopoietic function - Regulation or enhancement of the immune response, including cytotoxic or cytostatic activity against cancer cells - Inhibition of metastases, prevention of cell division, or inhibition of cell maturation

Biologic Response-Modifying Drugs: Mechanisms of Action

- Enhancement or restoration of the host's immune system defenses against the tumor. - Direct toxic effect on the tumor cells, which causes them to lyse, or rupture - Adverse modification of the tumor's biology, which makes it harder for the tumor cells to survive and reproduce

Leukotriene Receptor Antagonists (LTRAs): Nursing Implications

- Ensure that the drug is being used for chronic management of asthma, not acute asthma. - Teach the patient the purpose of the therapy. - Improvement should be seen in about 1 week. - Advise patients to check with prescriber before taking OTC or prescribed medications to determine drug interactions. - Assess liver function before beginning therapy and throughout. - Teach patients to take medications every night on a continuous schedule even if symptoms improve.

Corticosteroids/ Inhaled: Patient Education

- For any inhaler prescribed, ensure that the patient is able to self-administer the medication. - Provide demonstration and return demonstration. - Ensure that the patient knows the correct time intervals for inhalers. - Provide a spacer if the patient has difficulty coordinating breathing with inhaler activation. - Ensure that the patient knows how to keep track of the number of doses in the inhaler device.

Antihistamines:Nursing Implications

- Gather data about the condition or allergic reaction that required treatment; also assess for drug allergies. - Contraindicated in the presence of acute asthma attacks and lower respiratory diseases, such as pneumonia - Use with caution in patients with increased intraocular pressure, cardiac or renal disease, hypertension, asthma, COPD, peptic ulcer disease, BPH, or pregnancy. - Instruct patients to report excessive sedation, confusion, or hypotension. - Instruct patients to avoid driving or operating heavy machinery; advise against consuming alcohol or other CNS depressants. - Instruct patients not to take these medications with other prescribed or OTC medications without checking with their prescribers - Best tolerated when taken with meals; reduces GI upset - If dry mouth occurs, teach patients to perform frequent mouth care, chew gum, or suck on hard candy (preferably sugarless) to ease discomfort. - Monitor for intended therapeutic effects.

Mitotic Inhibitors: Adverse Effects

- Hair loss, nausea and vomiting, myelosuppression - Liver, kidney, lung toxicities - Convulsions - Extravasation: Several specific antidotes can be used.

Antimetabolites (CCS): Adverse Effects

- Hair loss, nausea and vomiting, myelosuppression - Neurologic, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary, dermatologic, ocular, otic, and metabolic toxicity - Tumor lysis syndrome - Palmar-plantar dysesthesia (also called hand-foot syndrome), Stevens-Johnson syndrome, toxic epidermal necrolysis

Chemotherapy Information (Cont.)

- Harmful to all rapidly growing cells, cancer cells & healthy, normal human cells (ex: Hair follicles, Gastrointestinal (GI) tract cells, bone marrow cells) - Dose-limiting adverse effects: GI tract and bone marrow - Alopecia - Emetic potential - Myelosuppression: Bone marrow suppression (BMS), Bone marrow depression - Nadir - Extravasation - Targeted drug therapy - Special Considerations: Toxicities, Contraindications, Pregnancy, Prepubertal, & Older adults

Biologic Response-Modifying Drugs: Subclasses

- Hematopoietic drugs - IFNs - MABs - IL receptor agonists and antagonists - Disease-modifying antirheumatic drugs (DMARDs) - Miscellaneous drugs

Hematopoietic Drugs: Background Information

- Hematopoietic drugs (HDs) promote the synthesis of various types of major blood components by promoting the growth, or differentiation, and function of their precursor cells in the bone marrow. - Produced by recombinant DNA technology - HDs are used to: Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia, Enable higher doses of chemotherapy to be given, and other uses

Anticholinergics: Mechanism of Action

- Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways. - Anticholinergics bind to the ACh receptors, preventing ACh from binding. - Result: bronchoconstriction is prevented, airways dilate - Ipratropium (Atrovent), tiotropium (Spiriva), and aclidinium (Tudorza) - Indirectly cause airway relaxation and dilation - Help reduce secretions in COPD patients

Adrenal Drugs: Mechanism of Action

- Action of corticosteroids is related to the involvement in the synthesis of certain proteins. - Most corticosteroids exert their effects by modifying enzyme activity. - Glucocorticoids differ in their potency, duration of action, and the extent to which they cause salt and fluid retention. - Glucocorticoids inhibit or help control inflammatory and immune responses.

Antirheumatic Drugs/ Biologic Disease-Modifying

- Adalimumab - Tofacitinib - Anakinra - Certolizumab - Etanercept - Golimumab - Infliximab - Adalimumab - Abatacept - Rituximab - Tocilizumab

Immunization/ Artificial Passive: Background Information

- Administration of serum or concentrated immunoglobulins - Provides the inoculated person the substance needed to fight off the invading microorganism - Bypasses the host's immune system - Example: immunization with tetanus immunoglobulin, hepatitis immunoglobulin, rabies immunoglobulin, and snakebite antivenin

Nasal Decongestants: Adverse Effects

- Adrenergics - Steroids - Nervousness - Local mucosal dryness Insomnia and irritation - Palpitations - Tremors (Systemic effects caused by adrenergic stimulation of the heart, blood vessels, and CNS)

Adrenal Drugs: Indications

- Adrenocortical deficiency - Adrenogenital syndrome - Bacterial meningitis - Cerebral edema - Collagen diseases (e.g., systemic lupus erythematosus) - Dermatologic diseases (e.g., exfoliative dermatitis, pemphigus) - Endocrine disorders (thyroiditis) - Gastrointestinal (GI) diseases (e.g., ulcerative colitis, regional enteritis) - Exacerbations of chronic respiratory illnesses such as asthma and chronic obstructive pulmonary disease - Hematologic disorders (reduce bleeding tendencies) - Ophthalmic disorders (e.g., nonpyogenic inflammations) - Organ transplantation (decrease immune response to prevent organ rejection) - Leukemias and lymphomas (palliative management) - Nephrotic syndrome (remission of proteinuria) - Spinal cord injury

Immunosuppressants:Adverse Effects

- Adverse effects vary according to drugs and may be devastating. - All immunosuppressed patients have a heightened susceptibility to opportunistic infections.

Bronchodilators/Beta- Adrenergic Agonists: Nursing Implications

- Albuterol, if used too frequently, loses its beta2-specific actions at larger doses. - As a result, beta1 receptors are stimulated, causing nausea, increased anxiety, palpitations, tremors, and increased heart rate. - Ensure that patients take medications exactly as prescribed, with no omissions or double doses. - Inform patients to report insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms.

Cytotoxic Antibiotics: Adverse Effects

- All can produce bone marrow suppression, except bleomycin - Hair loss, nausea and vomiting, myelosuppression - Heart failure (daunorubicin) - Acute left ventricular failure (doxorubicin) - Pulmonary fibrosis and pneumonitis (bleomycin) - Liver, kidney, and cardiovascular toxicities - Many others

Immunosuppressant Drugs: Mechanism of Actions

- All suppress certain T-lymphocyte cell lines, thus preventing their involvement in the immune response. - Results in a pharmacologically immunocompromised state - Mechanisms of action vary according to drug.

Biologic Antimicrobial Drugs: Background Information

- Also called biologics - Antitoxins - Antisera - Toxoids and vaccines (immunizing biologics) - Used to prevent, treat, or cure infectious diseases - Toxoids and vaccines are known as immunizing biologics, and they target a particular infectious microorganism.

Men's Health Drugs: Adverse Effects

- Androgens cause fluid retention. - Thromboembolic disorders (DVT, PE) Heart attack - Anabolic steroids - Peliosis of the liver - Hepatic neoplasms (liver cancer) - Cholestatic hepatitis - Jaundice - Abnormal liver function - Priapism: abnormally prolonged penile erection - Relatively uncommon - Possible adverse effect of both the ED drugs and the androgens - Medical emergency that warrants urgent medical attention - Caused by an excessive therapeutic drug response - PDE inhibitors: can cause unexplained visual loss. - Finasteride: loss of libido, loss of erection, ejaculatory dysfunction, hypersensitivity reactions, gynecomastia, severe myopathy, and a 50% decrease in prostate-specific antigen (PSA) concentrations

Acid-Controlling Drug Classes

- Antacids - H2 antagonists - PPIs

Hormonal Drugs for Male-Specific Neoplasms

- Antiandrogens: Bicalutamide, flutamide, nilutamide - Antineoplastic hormone: Estramustine

Biologic Antimicrobial Drugs/ Toxoids: Background Information

- Antigenic (foreign) preparations of bacterial exotoxins Detoxified with chemicals or heat: Weakened or "attenuated" - Cannot revert back to a toxic form - Stimulate one's immune system to produce a specific antibody: Artificial active immune response - These antibodies protect against future exposures. - Example: diphtheria and tetanus caused by toxin-producing bacteria

Corticosteroids (Glucocorticosteroids): Background Information

- Antiinflammatory properties - Used for chronic asthma - Do not relieve symptoms of acute asthma attacks - May be administered IV - Oral or inhaled forms - Inhaled forms reduce systemic effects. - May take several weeks before full effects are seen

Immunization/ Passive: Indications

- Antitoxins, antivenins, immunoglobulins - Minimizes effects of poisoning by the venoms of spiders and certain snakes - Provides quick immunity before a person's own immune system has a chance to make antibodies (such as in cases of exposure to hepatitis B or rabies viruses)

Immunization/ Passive Drugs: Background Information

- Antitoxins: purified antiserum that is usually obtained from horses inoculated with the toxin - Immunoglobulins: concentrated preparation containing predominantly immunoglobulin G and is harvested from a large pool of blood donors - Snake and spider antivenins (antivenom): antiserum containing antibodies against a venom, which is a poison secreted by an animal such as a reptile, insect, or other arthropod (e.g., spider) [Most antivenins are obtained from animals (usually horses) that have been injected with the particular venom, Recombinant technology, Serum contains immunoglobulins that can neutralize the toxic effects of the venom.]

Interleukins: Mechanism of Action

- Antitumor action: IL-2 is produced by activated T cells in response to macrophage-"processed" antigens and secreted IL-1. - IL-2 derivative aldesleukin: stimulates or restores immune response - Aldesleukin: binds to receptor sites on T cells, which stimulates the T cells to multiply - Lymphokine-activated killer cells: recognize and destroy only cancer cells and ignore normal cells

Immunization/ Passive Immunizing Drugs

- Antivenins: Pit viper, coral snake, Black widow spider - Hepatitis B immune globulin - Immunoglobulin, various forms - Rabies immunoglobulin (human) - Rho(D) immune globulin (RhoGAM) - Tetanus immunoglobulin Varicella-zoster immunoglobulin

Immunization/ Active

- Artificial active immunization: body is clinically exposed to a relatively harmless form of an antigen that does not cause an actual infection - Natural active immunization: person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organism

Antineoplastic Enzymes: Nursing Implication

- Assess baseline blood counts before administering antineoplastic drugs. - Follow specific administration guidelines for each antineoplastic drug.

Antineoplastic Medications: Nursing Implications

- Assess baseline blood counts before administering antineoplastic drugs. - Follow specific administration guidelines for each antineoplastic drug. - Monitor closely for anaphylactic reactions. - Keep epinephrine, antihistamines, and antiinflammatory drugs on hand. - Monitor closely for complications associated with bone marrow suppression: Anemia, thrombocytopenia, neutropenia - Cytoprotective drugs may be used to reduce toxicities: IV amifostine to reduce renal toxicity associated with cisplatin & IV or oral allopurinol to reduce hyperuricemia - Monitor for oncologic emergencies: Infections, Pulmonary toxicity, Allergic reactions, Stomatitis with severe ulcerations, Bleeding, Metabolic aberrations, Bowel irritability with diarrhea, Renal, liver, cardiac toxicity

Immunization: Nursing Implications

- Assess the patient's health history, medication history, allergies, and pregnancy status. - Assess previous reactions and responses to immunizations. - Assess for contraindications, including immunosuppression - Before giving any drug, recheck the specific protocols for administration and schedules for administration. - Follow the manufacturer's guidelines for drug storage, administration, routes, and site of administration. - Encourage parents of young children to keep a journal of the child's immunization status, with dates of immunizations and reactions, if any. - If discomfort occurs at the injection site, apply warm compresses and give acetaminophen. - Do not give aspirin to children. - Monitor for therapeutic responses and adverse reactions.

Immunization/ Artificial Active Drugs: Examples

- Bacillus Calmette-Guérin vaccine (tuberculosis) - Diphtheria, tetanus, and pertussis toxoids: several forms - Haemophilus influenzae type B conjugate vaccine - Hepatitis A and B virus vaccines - Measles, mumps, and rubella virus vaccine, live: several forms - Pneumococcal bacterial vaccines - Human papilloma virus vaccine (Gardasil) - Poliovirus vaccine: several forms - Rabies virus vaccine - Smallpox virus vaccine - Tetanus toxoid - Varicella virus vaccine (chickenpox) - Yellow fever virus vaccine - Many others

Corticosteroids/ Inhaled: Examples

- Beclomethasone dipropionate (Beclovent) - Budesonide (Pulmicort Turbuhaler) - Ciclesonide (Omnaris) - Flunisolide (AeroBid) - Fluticasone (Flovent) - Mometasone (Asmanex) - Triamcinolone acetonide (Azmacort)

Antitussives: Adverse Effects

- Benzonatate: Dizziness, headache, sedation, nausea, and others - Dextromethorphan: Dizziness, drowsiness, nausea - Opioids: Sedation, nausea, vomiting, lightheadedness, constipation

Antineoplastics (Misc.)

- Bevacizumab (Avastin), - Hydroxyurea (Hydrea, Droxia), -Imatinib (Gleevec), -Mitotane (Lysodren) - Octreotide (Sandostatin)

Antihistamines: Mechanism of Action

- Block action of histamine at H1 receptor sites - Compete with histamine for binding at unoccupied receptors - Cannot push histamine off the receptor if already bound - The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation: Vasodilation, Increased gastrointestinal (GI) and respiratory secretions, & Increased capillary permeability - More effective in preventing the actions of histamine rather than reversing them - Should be given early in treatment before all the histamine binds to the receptors

Cytotoxic Antibiotics: Mechanism of Action

- CCNS drugs are active in all phases of the cell cycle. - Act by intercalation, resulting in blockade of DNA synthesis

Antimetabolities (CCS): Mechanism of Action

- CCS analogues that work by antagonizing the actions of key cellular metabolites - Antimetabolites work primarily in the S phase of the cell cycle, when DNA synthesis is most active.

Mitotic Inhibitors: Mechanism of Action

- Can work in various phases of the cell cycle (late S phase, throughout G2 phase, and M phase) - All work shortly before or during mitosis and thus retard cell division. - Each different subclass inhibits mitosis in a unique way.

Xanthine Derivatives: Drug Effects

- Cause bronchodilation by relaxing smooth muscle in the airways - Result: relief of bronchospasm and greater airflow into and out of the lungs - Also cause central nervous system (CNS) stimulation - Also cause cardiovascular stimulation: increased force of contraction and increased heart rate, resulting in increased cardiac output and increased blood flow to the kidneys (diuretic effect)

Immunization/ Inactivated Drugs

- Hepatitis B virus vaccine (inactivated) (Recombivax HB, Engerix-B) is a noninfectious viral vaccine containing hepatitis B surface antigen (HBsAg). - Antigenic HBsAg is used to promote active immunity to hepatitis B infection in persons considered at high risk for potential exposure to the hepatitis B virus or HBsAg-positive materials (e.g., blood, plasma, serum). - Recommended: all children (usually started shortly after birth) and adults with diabetes mellitus

Chemotherapy: Nursing Implications (Cont.)

- Implement measures to monitor for and prevent infection in patients with neutropenia or leukopenia. - Implement measures to monitor for and prevent bleeding in patients with thrombocytopenia and anemia. - Keep in mind that anemia may result in severe fatigue. - Monitor for stomatitis (oral inflammation and ulcerations) and implement measures to reduce the effects if it occurs. - Anticipate nausea and vomiting and implement measures to reduce these effects. - Antiemetics often work better if given 30 to 60 minutes before chemotherapy is started. - Women of childbearing age will need to use a nondrug form of contraception during therapy. - In addition to physical measures, keep in mind the need for emotional support during this time for both the patient and family. - Monitor for therapeutic responses to antineoplastic therapies and the many possible adverse effects.

Xanthine Derivatives: Mechanism of Action

- Increase levels of energy-producing cAMP: This is done by competitively inhibiting phosphodiesterase, the enzyme that breaks down cAMP. - Result: Increased cAMP levels, smooth muscle relaxation, bronchodilation, and increased airflow

Women's Health Drugs/ Progestins: Mechanism of Action

- Induction of secretory changes in the endometrium - Increases basal body temperature - Thickening of the vaginal mucosa - Relaxation of uterine smooth muscle - Stimulation of mammary alveolar tissue growth - Feedback inhibition of the release of pituitary gonadotropins

Topoisomerase 1 Inhibitors (Camptothecins) (CCS): Mechanism of Action

- Inhibit proper DNA function in the S phase - Prevent DNA relegation

Acid-Controlling Drugs/Antacids: Contraindications

- Known allergy to a specific drug product - Severe renal failure or electrolyte disturbances: potential toxic accumulation of electrolytes in the antacids themselves - GI obstruction: antacids may stimulate GI motility when they are undesirable because of the presence of an obstructive process requiring surgical intervention

Antihistamines: Contraindications

- Known drug allergy - Narrow-angle glaucoma - Cardiac disease, hypertension - Kidney disease - Bronchial asthma, chronic obstructive pulmonary disease (COPD) - Sole drug therapy during acute asthmatic attacks: Albuterol or epinephrine - Peptic ulcer disease - Seizure disorders - Benign prostatic hyperplasia (BPH) - Pregnancy

Leukotriene Receptor Antagonists (LTRAs): Contraindications

- Known drug allergy - Previous adverse drug reaction - Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives is also important to note because these are inactive ingredients in these drugs.

Bronchodilators/Beta- Adrenergic Agonists: Contraindications

- Known drug allergy - Uncontrolled hypertension - Cardiac dysrhythmias - High risk of stroke (because of the vasoconstrictive drug action)

Acid-Controlling Drugs/Proton Pump Inhibitor (PPIs) Drugs

- Lansoprazole (Prevacid) - Omeprazole (Prilosec) - Rabeprazole (AcipHex) - Pantoprazole (Protonix) - Esomeprazole (Nexium)

Antineoplastics: Extravasation

- Leaking of an antineoplastic drug into surrounding tissues during intravenous (IV) administration - Can result in permanent damage to nerves, tendons, muscles; loss of limbs - Skin grafting or amputation may be necessary. - Prevention is essential. - Continuous monitoring of the IV site is essential. - If suspected, stop the infusion immediately and contact the prescriber but leave the IV catheter in place. - Aspirate any residual drug or blood from the catheter. - Consult guidelines or the pharmacist regarding antidotes, application of hot or cold packs or sterile occlusive dressings, and elevation and rest of the affected limb. - Thoroughly document the extravasation incident. - Consult facility protocol and guidelines.

Non Bronchodilating Respiratory Drugs

- Leukotriene receptor antagonists (montelukast, zafirlukast, and zileuton) - Corticosteroids (beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, ciclesonide, and triamcinolone) - Mast cell stabilizers: rarely used cromolyn and nedocromil, which are sometimes used for exercise-induced asthma

Leukotriene Receptor Antagonists (LTRAs): Mechanism of Action

- Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body. - Leukotrienes cause inflammation, bronchoconstriction, and mucus production. - Result: coughing, wheezing, shortnessof breath - LTRAs prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation. - Inflammation in the lungs is blocked, and asthma symptoms are relieved.

Antirheumatic Drugs/Disease-Modifying: Background Information

- Modify the disease of RA - Exhibit antiinflammatory, antiarthritic, and immunomodulating effects - Inhibit the movement of various cells into an inflamed, damaged area, such as a joint - Slow onset of action of several weeks versus minutes to hours for NSAIDs - Also referred to as slow-acting antirheumatic drugs

Alkylating Drugs: Nursing Implications

- Monitor for expected effects of bone marrow suppression. - Expect nausea, vomiting, diarrhea, and stomatitis. - Hydration is important to prevent nephrotoxicity. - Report ringing or roaring in the ears—possible ototoxicity. - Report tingling, numbness, or pain in the extremities—peripheral neuropathies may occur.

Mitotic Inhibitors

- Natural products obtained from the periwinkle plant: Vinca alkaloids (vinblastine, vincristine, and vinorelbine) - Taxanes: paclitaxel, docetaxel, cabazitaxel (Jevtana), and eribulin (Halaven)

Cytotoxic Antibiotics

- Natural substances produced by the mold Streptomyces - Semisynthetic substances also used - Bone marrow suppression: common toxicity - Bleomycin: instead causes pulmonary toxicity - Daunorubicin: heart failure - Doxorubicin: left ventricular failure

Xanthine Derivatives: Adverse Effects

- Nausea, vomiting, anorexia - Gastroesophageal reflux during sleep - Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias - Transient increased urination - Hyperglycemia

Immunizations/ Influenza Vaccine

- Needs to be given each year before the influenza season begins Single most important influenza control measure - FluMist is given intranasally, whereas the others are given intramuscularly. - CDC: all people older than 6 months of age should receive the influenza vaccine. - Newer formulations of the influenza vaccine: "high-dose" Fluzone, which is specifically indicated for older adults.

Nasal Decongestant/ Inhaled Steroids & Anticholinergics: Background Information

- Not associated with rebound congestion - Often used prophylactically to prevent nasal congestion in patients with chronic upper respiratory tract symptoms

Mitotic Inhibitors: Indications

- Often used in combination therapies - Used to treat a variety of solid tumors and some hematologic malignancies: Testicular, small cell lung, breast, ovarian, non-small cell lung cancers, Kaposi's sarcoma, & Acute leukemia

Antihitamines/ Traditional

- Older - Work both peripherally and centrally - Have anticholinergic effects, making them more effective than nonsedating drugs in some cases Examples: diphenhydramine, brompheniramine, chlorpheniramine, dimenhydrinate, meclizine, promethazine

Nasal Decongestants:Nursing Implications

- Patients should avoid caffeine and caffeine-containing products. - Patients should report a fever, cough, or other symptoms lasting longer than 1 week. - Monitor for intended therapeutic effects.

Anticholinergics: Indication

- Prevention of the bronchospasm associated with chronic bronchitis or emphysema - Not for the management of acute symptoms

Immunization/ Active: Indications

- Prevents infection caused by bacterial toxins or viruses - Provides long-lasting or permanent immunity - "Herd immunity"

Corticosteroids/ Inhaled: Indications

- Primary treatment of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders - Persistent asthma - Often used concurrently with the beta-adrenergic agonists - Systemic corticosteroids are generally used only to treat acute exacerbations, or severe asthma. - IV corticosteroids: acute exacerbation of asthma or other COPD

Nasal Decongestants/ Oral: Background Information

- Prolonged decongestant effects but delayed onset - Effect less potent than topical - No rebound congestion - Exclusively adrenergics Example: pseudoephedrine (Sudafed)

Leukotriene Receptor Antagonists (LTRAs): Indications

- Prophylaxis and long-term treatment and prevention of asthma in adults and children 12 years of age and older - Not meant for management of acute asthmatic attacks - Montelukast is also approved for treatment of allergic rhinitis - Improvement with their use is typically seen in about 1 week.

Immunosuppressant Drugs: Indications

- Rheumatoid arthritis - Systemic lupus erythematosus - Crohn's disease - Multiple sclerosis (MS) - Myasthenia Gravis - Psoriasis, and others

Immunization/ Passive: Background Information

- Serum or concentrated immunoglobulins from humans or animals are injected into a person. - The substances needed to fight off invading microorganisms are given directly to a person. - The immune system is bypassed. - Short-lived compared with active immunization but works faster - Passive immunization lasts only until the injected immunoglobulins are removed from the person's immune system by the reticuloendothelial system.

Nasal Decongestants: Drug Effects

- Shrink engorged nasal mucous membranes - Relieve nasal stuffiness

Antihistamines: Other Effects

- Skin: reduce capillary permeability, wheal-and-flare formation, itching - Anticholinergic: drying effect that reduces nasal, salivary, and lacrimal gland secretions (runny nose, tearing, and itching eyes) - Sedative: some antihistamines cause drowsiness

Biologic Antimicrobial Drugs/ Vaccines: Background Information

- Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms - These slight alterations in the bacteria and viruses prevent the person injected from contracting the disease. - Also stimulate the production of antigens against a specific antibody - Vaccinations with live bacteria or virus provide lifelong immunity. - Vaccinations with killed bacteria or virus provide partial immunity, and booster shots are needed periodically. - Example: influenza and pneumonia vaccines

Antineoplastic Enzymes: Mechanism of Action

- Synthesized using cultures of bacteria and recombinant DNA technology - As a result, an enzyme is produced.

Nasal Decongestants:Interactions

- Systemic sympathomimetic drugs and sympathomimetic nasal decongestants are likely to cause drug toxicity when given together. - Monoamine oxidase inhibitors and sympathomimetic nasal decongestants raise blood pressure. - Methyldopa - Urinary acidifiers and alkalinizers

Dermatologic Drugs/Topical Antipsoriatic drugs

- Tazarotene (Tazorac) - Tar-containing products - Anthralin (Anthra-derm) - Calcipotriene (Dovonex) - Etanercept (Enbrel) - Alefacept (Amevive) - Ustekinumab (Stelara) - Ixekizumab (Taltz)

Corticosteroids/ Inhaled: Nursing Implication

- Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections. - If a beta agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before administration of the corticosteroid. - Teach patients to monitor disease with a peak flow meter. - Encourage use of a spacer device to ensure successful inhalations. - Teach patient how to keep inhalers and nebulizer equipment clean after use.

Immunization/ Artificial Active

- The body is exposed to a relatively harmless form of an antigen. - The immune system is stimulated and "remembers" this antigen if subsequent exposures occur. - Does not cause a full-blown infection

Transplant Medications: Indications

- Therapeutic use varies from drug to drug. - Primarily indicated for the prevention of organ rejection - Muromonab-CD3, mycophenolate, and tacrolimus are indicated for both prevention of rejection and treatment of organ rejection

Topoisomerase 1 Inhibitors (Camptothecins) (CCS): Adverse Effects

- Topotecan: BMS, mild to moderate nausea, vomiting, and diarrhea; headache; rash; muscle weakness; and cough - Irinotecan: causes more severe adverse effects than topotecan (hematologic adverse effects, cholinergic diarrhea, moderate risk of nausea and vomiting)

Monoclonal Antibodies: Background Information

- Treatment of cancer, rheumatoid arthritis (RA), MS, and organ transplantation - Specifically target cancer cells and have minimal effect on healthy cells - Fewer adverse effects than traditional antineoplastic medications

Bronchodilators/Beta- Adrenergic Agonists: Indications

- Used during acute phase of asthmatic attacks - Quickly reduce airway constriction and restore normal airflow - Agonists, or stimulators, of the adrenergic receptors in the sympathetic nervous system - Sympathomimetics - Relief of bronchospasm related to asthma, bronchitis, and other pulmonary diseases - Used in treatment and prevention of acute attacks - Used in hypotension and shock

Antimetabolities (CCS): Indications

- Used in combination with other drugs to treat various types of cancer, such as solid tumors and some hematologic cancers: Acute and chronic lymphocytic leukemias, Leukemias (several types), Colon, rectal, breast, stomach, lung, pancreatic cancers - Oral and topical forms may be used for low-dose maintenance and palliative cancer therapy. - Often used in combination chemotherapy regimens - Methotrexate is also used to treat severe cases of psoriasis and rheumatoid arthritis.

Hematopoietic Drugs: Indications

- Used in patients who have experienced destruction of bone marrow cells as a result of cytotoxic chemotherapy - Decrease the duration of low neutrophil counts, thus reducing the incidence and duration of infections - Enhance the functioning of mature cells of the immune system, resulting in greater ability to kill cancer cells as well as viral- and fungal-infected cells - Also enhance red blood cell and platelet counts in patients with bone marrow suppression resulting from chemotherapy - Allow for higher doses of chemotherapy, resulting in the destruction of a greater number of cancer cells

Topoisomerase 1 Inhibitors (Camptothecins) (CCS): Indications

- Used primarily to treat ovarian and colorectal cancer, small cell cancer, and other tumors - Derived from camptothecin, a substance taken from a Chinese shrub: Topotecan (Hycamtin), Irinotecan (CPT-11, Camptosar)

Hormonal Drugs: Indications

- Used to treat a variety of neoplasms in men and women - Hormonal therapy used to: Oppose effects of hormones & Block the body's sex hormone receptors - Used most commonly as adjuvant and palliative therapy: but may be a drug of first choice for some cancers

Xanthine Derivatives (Caffeine)

- Used without prescription as a CNS stimulant or analeptic to promote alertness (e.g., for long-duration driving or studying) - Cardiac stimulant in infants with bradycardia - Enhancement of respiratory drive in infants

Interferons: Indications

- Viral infections: Genital warts, hepatitis - Cancer: Chronic myelogenous leukemia, follicular lymphoma, hairy-cell leukemia, Kaposi's sarcoma, malignant melanoma - Autoimmune disorders: Multiple sclerosis (MS)

Hormonal Drugs for Female-Specific Neoplasms

-Aromatase inhibitors: Anastrozole, aminoglutethimide -Selective estrogen receptor modulators: Tamoxifen, toremifene - Progestins: Megestrol, medroxyprogesterone - Androgens: Fluoxymesterone, testolactone - Estrogen receptor antagonist: Fulvestrant

Immunization/ Passive

-Artificial passive immunization: administration of serum or concentrated immunoglobulins - The inoculated person is given the substance needed to fight off the invading microorganism. - This type of immunization bypasses the host's immune system. - Natural passive immunization: antibodies are transferred from the mother to her infant in breast milk or through the bloodstream via the placenta during pregnancy

Antirheumatic Drugs: Nursing Implications

-Assess for allergies, specifically allergies to egg proteins, IgG, or neomycin. - Assess for conditions that may be contraindications. - Assess baseline blood counts; perform cardiac, renal, and liver studies. - Assess for presence of infection. - Follow specific guidelines for preparation and administration of drugs. - Monitor the patient's response during therapy. - Teach patients to report signs of infection immediately: Sore throat, Diarrhea, Vomiting, Fever of 100.5°F (38.1°C) or higher - Monitor for therapeutic responses: Decrease in growth of lesion or mass, Improved blood counts, Absence of infection, anemia, and hemorrhage - Monitor for adverse effects.

Immunization: Controversy

- Link between immunizations and autism in children - Cause: thimerosal - Since 2001, thimerosal has no longer been used in the preparation of vaccines. - In 2011, the medical community declared that the original study suggesting a link to autism was fraudulent. - No scientific data to support a link between autism and vaccines - Many parents are still reluctant to vaccinate their children.

Adrenergic Drugs: Five Subcategories

1. Adrenergic neuron blockers (central and peripheral) 2. Alpha2 receptor agonists (central) 3. Alpha1 receptor blockers (peripheral) 4. Beta receptor blockers (peripheral) 5. Combination alpha1 and beta receptor blockers (peropheral)

ACE Inhibitors: Effects (Cardioprotective)

ACE inhibitors decrease SVR (a measure of afterload) and preload. Used to prevent complications after MI Ventricular remodeling: left ventricular hypertrophy, which is sometimes seen after MI ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF. Drugs of choice for hypertensive patients with HF

ACE Inhibitors: Effects (Renal Protective)

ACE inhibitors: reduce glomerular filtration pressure Cardiovascular drugs of choice for patients with diabetes ACE inhibitors reduce proteinuria. Standard therapy for diabetic patients to prevent the progression of diabetic nephropathy

Amphetamines: Indications for use

ADHD, narcolepsy & Obesity

Antidysrhythmics: Adverse Effects

ALL antidysrhythmics can cause dysrhythmias! Other effects: - Hypersensitivity reactions - Nausea, vomiting, and diarrhea - Dizziness - Headache and blurred vision - Prolongation of the QT interval

Angiotensin II Receptor Blockers: Mechanism of Action

ARBs affect primarily vascular smooth muscle and the adrenal gland. Selectively block the binding of AII to the type 1 AII receptors in these tissues ARBs block vasoconstriction and the secretion of aldosterone.

Laxatives/Hyperosmotic: Adverse Effects

Abdominal bloating Electrolyte imbalances Rectal irritation

Fibric Acid Derivatives: Adverse Effects

Abdominal discomfort, diarrhea, nausea Blurred vision, headache Increased risk of gallstones Prolonged prothrombin time Liver studies may show increased enzyme levels.

Hypoglycemia

Abnormally low blood glucose level (below 50 mg/dL) Mild cases can be treated with diet—higher intake of protein and lower intake of carbohydrates—to prevent rebound postprandial hypoglycemia. Early: Confusion, irritability, tremor, sweating Late: Hypothermia, seizures, coma and death will occur if not treated.

Adrenergic-Blocking drugs/Beta Blockers (Cardioselective)

Acebutolol (Sectral) Atenolol (Tenormin) Betaxolol (Kerlone) Esmolol (Brevibloc) Nebivolol (Bystolic) Metoprolol (Lopressor, Toprol-XL)

Non-Opioid Analgesics

Acetaminophen (NSAIDs) Tremadol Hydrochloride (Ultram)

Ophthalmic Drugs/Cholinergics: Direct-Acting Miotics

Acetylcholine (Miochol-E) is a direct-acting cholinergic drug. Used to produce miosis during ophthalmic surgery Pilocarpine (Pilocar) Used as a miotic in the treatment of glaucoma Pilocarpine ocular insert system (Ocusert Pilo-20): applied once weekly by the patient

Carbonic Anhydrase Inhibitors: Adverse Effects

Acidosis Hypokalemia Drowsiness Anorexia Paresthesias Hematuria Urticaria Photosensitivity Melena (blood in the stool)

Dermatologic Drugs/Antiacne

Acne vulagaris is the most common skin disorder. Acne is caused by Propionibacterium acnes and staphylococcus species. Drugs used to treat acne - Benzoyl peroxide - Erythromycin - Tetracycline - Isotretinoin - Clindamycin - Vitamin A acid: retinoic acid Other drugs used for treatment and prevention of acne - Formulations of the antibiotics minocycline, doxycycline, and tetracycline - Oral contraceptives for female acne patients

Ophthalmic Drugs/ Ocular Antiinflammatory Drugs: Mechanism of Action

Act on various parts of the arachidonic acid metabolic pathway Reduce the production of various inflammatory mediators As a result, pain, erythema, and other inflammatory processes are reduced Used prophylactically after surgery to prevent inflammation and scarring NSAIDs used for symptomatic treatment of seasonal allergic conjunctivitis

Muscle Relaxants: Mechanism of Action

Act to relieve pain associated with skeletal muscle spasms Centrally Acting: (Majority) - CNS is the site of action - Similar in structure and action to other CNS depressants Direct Acting: - Act directly on skeletal muscle - Closely resemble GABA

Thrombolytic Drugs: Mechanism of Action

Activate the fibrinolytic system to break down the clot in the blood vessel quickly Activate plasminogen and convert it to plasmin, which can digest fibrin Reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction

Vitamin C (Ascorbic Acid)

Acts in oxidation-reduction reactions Required for several metabolic activities - Collagen synthesis - Maintenance of connective tissue - Tissue repair - Maintenance of bone, teeth, and capillaries - Folic acid metabolism - Erythropoiesis Enhances absorption of iron Required for the synthesis of: - Lipids - Proteins - Steroids Aids in cellular respiration Aids in resistance to infections Deficiency: Prolonged deficiency results in scurvy. - Gingivitis and bleeding gums - Loss of teeth - Anemia - Subcutaneous hemorrhage - Bone lesions - Delayed healing of soft tissues and bones

Thrombolytic Drugs: Indications

Acute MI Arterial thrombolysis DVT Occlusion of shunts or catheters Pulmonary embolus Acute ischemic stroke

Acid-Controlling Drugs/Antacids: Indications of Use

Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn

Dermatologic Drugs/Topical Antiviral Drugs

Acyclovir (Zovirax) and penciclovir (Denavir) - Both used to treat initial and recurrent herpes simplex 1 and 2 and human papillomavirus infections Do not cure viral skin infections but may reduce healing time and pain Systemic drugs have been shown to be better for controlling viral skin conditions.

Monoclonal Antibodies

Adalimumab Alemtuzumab Bevacizumab Cetuximab Golimumab Ibritumomab- tiuxetan Infliximab Natalizumab Rituximab Trastuzumab

Hyperthyroidism Symptoms

Affects multiple body systems, resulting in an overall increase in metabolism - Diarrhea - Flushing - Increased appetite - Muscle weakness - Sleep disorders - Altered menstrual flow - Fatigue - Palpitations - Nervousness - Heat intolerance - Irritability

Cholinergic-Blocking: Indications of Use (CV)

Affects the heart's conduction system - Low doses: slow the heart rate - High doses: block inhibitory vagal effects on sinoatrial and atrioventricular node pacemaker cells •Results in increased heart rate Atropine - Used primarily for cardiovascular disorders •Diagnosis of sinus node dysfunction •Symptomatic second-degree heart block •Severe sinus bradycardia with hemodynamic compromise (advanced life support)

Insulin (Rapid Acting)

Afrezza - Rapid-acting insulin that is inhaled - Peak of 12 to 15 minutes - Short duration of action of 2 to 3 hours - Administered within 20 minutes before each meal - Must be given in conjunction with long-acting insulins or oral diabetic agents (for type 2 DM) - Side effects: hypoglycemia, cough, and throat pain - Contraindicated: smokers and those with chronic lung diseases - Black box warning regarding the risk of acute bronchospasms

Non-Opioid Analgesics: Adverse Effects

Agitation in Children Anxiety Fatigue Insomnia Hyper/Hypotension Hypokalemia Constipation Dyspnea Headache, Nausea, Vomiting

Opioid Analgesics: Mechanism of Action

Agonists: Bind to opioid pain receptor in the brain and cause an analgesic response (reduction in pain sensation) Agonists-Antagonists: Bind to pain receptor and cause a weaker neurologic response than a full agonist (AKA: partial agonist or mixed agonist) Antagonist (non-analgesic): Reverse the effects of these drugs on pain receptors. Bind to a pain receptor and exert no response (AKA: competitive agonists)

Antipsychotics: Adverse Effects

Agranulocytosis and hemolytic anemia Insulin resistance Weight Gain Changes in serum lipid levels Metabolic Syndrome CNS effects - Drowsiness - Neuroleptic Malignant Syndrome (NMS): potentially life threatening, high fever, Unstable BP, myoglobinemia -Extrapyramidal Symptoms (EPS): involuntary muscle symptoms similar to parkinson's, Akathesia (muscle restlessness), acute dystonia (painful muscle spasms) Treated: Benzotropine - Tardive Dyskinesia: Involuntary contractions of oral and facial muscles; choreoathetosis (wavelike mvmt of extremities), occurs with continuous long term anti-psychotics therapy) Treated: Valbenazine

Anthelmintic Drug List

Albendazole (Albenza) Ivermectin (Stromectol) Praziquantel (Biltricide) Pyrantel (Antiminth)

Colloids

Albumin 5% and 25% (from human donors) Dextran 40, 70, or 75 (a glucose solution) Hetastarch (synthetic, derived from cornstarch)

Interleukins (Misc.)

Aldesleukin (Proleukin) - Treatment of metastatic renal cell carcinoma and metastatic melanoma - Off-label uses include HIV infection and AIDS and non-Hodgkin's lymphoma Anakinra (Kineret) - IL-1 receptor antagonist - Used to control symptoms of RA Tocilizumab (Actemra) - IL-6 antagonist - Used for severe RA Secukinumab (Cosentyx) - IL-17a antagonist - Used to control symptoms of ankylosing spondylitis, plaque psoriasis, psoriatic arthritis

Antibiotics/Penicillin: Adverse Effects

Allergic reactions to the penicillins occur in 0.7% to 4% of treatment courses. - Urticaria, pruritus, angioedema Patients allergic to penicillins have an increased risk of allergy to other beta-lactam antibiotics. Only patients with a history of throat swelling or hives from penicillin should not receive cephalosporins. Common adverse effects - Nausea, vomiting, diarrhea, abdominal pain Other adverse effects are less common.

Antigout Drugs

Allopurinol (Zyloprim) Febuxostat (Uloric) Colchicine (Colcrys) Probenecid (Benemid) Lesinurad (Zurampic) Sulfinpyrazone (Anturane)

Bronchodilators/Beta- Adrenergic Agonists: Adverse Effects

Alpha and beta (epinephrine) - Insomnia - Restlessness - Anorexia - Vascular headache - Hyperglycemia - Tremor - Cardiac stimulation Beta1 and beta2 (metaproterenol) - Cardiac stimulation - Tremor - Anginal pain - Vascular headache - Hypotension Beta2 (albuterol) - Hypotension or hypertension - Vascular headache - Tremor

Adrenergic: Drug Adverse Effects

Alpha-adrenergic: - Headache, restlessness, excitement, insomnia, euphoria - Chest pain, vasoconstriction, reflexive bradycardia, palpitations, dysrhythmias - Anorexia, dry mouth, nausea, vomiting, taste changes Beta-adrenergics: - Mild tremors, headache, nervousness, dizziness - Increased heart rate, palpitations, fluctuations of blood pressure - Sweating, nausea, vomiting, muscle cramps

Anxiolytics (Antianxiety)/ Benzodiazepines

Alprazolam (Xanax) Diazepam (Valium) Lorazepam (Ativan)

Antibiotics/Quinolones

Also called fluoroquinolones Excellent oral absorption Absorption reduced by antacids Effective against gram-negative organisms and some gram-positive organisms

Antidiarrheals/Probiotics: Mechanism of Action

Also known as intestinal flora modifiers and bacterial replacement drugs Bacterial cultures of Lactobacillus organisms work by: - Supplying missing bacteria to the GI tract - Suppressing the growth of diarrhea-causing bacteria Example: Lactobacillus acidophilus (Bacid)

Biologic Response-Modifying Drugs: Background Information

Alter the body's response to diseases such as cancer and autoimmune, inflammatory, and infectious diseases. - Hematopoietic drugs - Immunomodulating drugs: Interferons (IFNs), Monoclonal antibodies (MABs), Interleukin (IL) receptor agonists and antagonists, & Miscellaneous drugs

Immune Response

Antigens (foreign proteins): from an invading organism; specific information is imprinted into a cellular "memory bank" of the immune system; the body can then effectively fight any future invasion by that same organism by mounting an immune response Antibodies: immunoglobulin molecules that have antigen-specific amino acid sequences - Immunoglobulins: glycoprotein molecules synthesized by the humoral immune system for the purpose of destroying all substances that the body recognizes as foreign

Ophthalmic Drugs

Antiglaucoma drugs Antimicrobial Antiinflammatory drugs Topical anesthetics Diagnostic drugs Antiallergic drugs Lubricants and moisturizers

Dermatologic Drugs/Topical Antipruritic Drugs

Antihistamines Corticosteroids - Antiinflammatory effects - Antipruritic effects - Vasoconstrictor actions Adverse effects: acne, allergic contact dermatitis, burning, dryness, skin fragility, purpura, hirsutism, round and swollen face, alopecia

Potassium-Sparing Diuretics

Amiloride (Midamor) Spironolactone (Aldactone) Triamterene (Dyrenium) ALS: Aldosterone-inhibiting diuretics

Nutritional Supplements/Enteral Formulation Group: Altered Amino Acid

Amin-Aid, Hepatic-Aid, Travasorb Renal, Traum-Aid HBC Contain varying amounts of specific amino acids Used for patients with diseases associated with altered metabolism capabilities

Antifibrinolytic Drugs

Aminocaproic acid (Amicar) Tranexamic acid (Cyklokapron) Desmopressin

Ophthalmic Drugs/ Ocular Antibacterial Drugs

Aminoglycosides - Antibacterial - Gentamicin (Garamycin), tobramycin (Tobrex) Macrolides - Antibacterial - Erythromycin, azithromycin, others - Erythromycin also is used for prevention of Neisseria gonorrhoeae eye infections in newborns. - Treatment of neonatal conjunctivitis caused by Chlamydia trachomatis Polypeptides - Bacitracin - Polymyxin B Quinolones - Ciprofloxacin (Ciloxan) - Gatifloxacin (Zymar) - Moxifloxacin (Vigamox) - Levofloxacin (Quixin) - Ofloxacin (Ocuflox) Sulfonamides - Sulfacetamide (Bleph-10) - Sulfisoxazole (Gantrisin)

Antidepressants/ Tricyclic Antidepressants

Amitriptyline (Elavil)

Amphetamines

Amphetamine Atomoxetine Methylphenidate (Ritalin) Modafinil (Provigil) - nonamphetamine

Antidiabetic Drugs (Injectable): Mechanism of Action

Amylin agonist - Mimics the natural hormone amylin - Slows gastric emptying - Suppresses glucagon secretion, reducing hepatic glucose output - Centrally modulates appetite and satiety - Used when other drugs have not achieved adequate glucose control - SQ injection Incretin mimetic - Mimics the incretin hormones - Enhances glucose-driven insulin secretion from beta cells of the pancreas - Only used for type 2 DM - Exenatide: injection pen device

Antidiabetic Drugs (Injectable)

Amylin agonist - Pramlintide (Symlin) Incretin mimetics - Exenatide (Byetta) - Dulaglutide (Trulicity) - Liraglutide (Victoza) - Albiglutide (Tanzeum) - Lixisenatide (Adlyxin) - Combo agent: Soliqua (insulin glargine and lixisenatide) & Xultophy (insulin degludec and liraglutide)

Antidiabetic Drugs (Injectable): Adverse Effects

Amylin agonist - Nausea, vomiting, anorexia, headache Incretin mimetics - Nausea, vomiting, and diarrhea - Rare cases of hemorrhagic or necrotizing pancreatitis - Weight loss

Men's Health Drugs/Androgens

Androgens are the group of male sex hormones (primarily testosterone). Several synthetic derivatives of testosterone are available. Long-term dosage forms can last from 2 to 3 days to 2 to 4 weeks. Oral forms have a high first-pass effect. - Methyltestosterone (Android) - Fluoxymesterone (Halotestin) Transdermal forms available - Patches and gel

Men's Health Drugs: Interactions

Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity. Androgens with cyclosporine increase the risk of cyclosporine toxicity. Sildenafil, vardenafil, tadalafil, and avanafil may cause severe hypotension when given together with nitrates such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate. Alpha blockers: additive hypotension when given with other drugs that lower blood pressure Effects of tamsulosin may be increased when it is taken with azole antifungal drugs, erythromycin and clarithromycin, cardiac drugs such as propranolol and verapamil, and protease inhibitors.

Ophthalmic Drugs/Lubricants and Moisturizers

Artificial tears - Over-the-counter products - Provide lubrication or moisture for dry or irritated eyes - Available in drops or ointment - Brand names include Murine, Nu-Tears, Moisture Drops, Tears Plus, Akwa Tears - Lifitegrast (Xiidra) •Newest agent for treatment of dry eyes •Twice daily administration Restasis - Ophthalmic form of cyclosporine - Immunosuppressant drug - Used to treat keratoconjunctivitis sicca (dry eyes) - It can be used together with artificial tears if the drugs are given 15 minutes apart.

Antiplatelet Drugs

Aspirin Cilostazol (Pletal) Clopidogrel (Plavix) Prasugrel (Effient) Treprostinil (Remodulin) Abciximab (ReoPro) Eptifibatide (Integrilin) Tirofiban (Aggrastat) Anagrelide (Agrylin) Dipyridamole (Persantine)

Vitamins and Minerals: Nursing Implications

Assess nutritional status. Assess baseline lab values (H&H, white blood cell count, RBC count, protein, albumin levels). Assess history and medication history. Assess for contraindications. Follow specific guidelines for administration, especially if parenteral. Provide nutritional counseling about necessary foods to include in the diet. Monitor for therapeutic responses. - Will vary for each vitamin and mineral Monitor for adverse effects.

Antianginal/ Beta Blockers

Atenolol Metoprolol Propranolol Nadolol Mainstay in the treatment of several cardiovascular diseases - Angina, MI, Hypertension, Dysrhythmias

Coagulation Modifier Drugs: Nursing Implications

Aticoagulants Antiplatelets Thrombolytics Antifibrolytic ASSESS: ! Patient history, medication history, allergies ! Contraindications ! Baseline vital signs, laboratory values ! Potential drug interactions ! History of abnormal bleeding conditions

Antiprotozoal Drugs

Atovaquone (Mepron) Metronidazole (Flagyl) Pentamidine (Pentam 300) Paromomycin (Humatin) Several drugs used to treat malaria are also used to treat nonmalarialprotozoal infections

Cholinergic-Blocking drugs

Atropine Dicyclomine (Bentyl) Glycopyrrolate (Robinul) Oxybutynin (Ditropan) Scopolamine (Transderm-Scōp) Tolterodine (Detrol) Mirabegron (Myrbetriq)

Antimalarial Drugs

Attack the parasite during the asexual phase, when it is vulnerable - Erythrocytic phase drugs: chloroquine, hydroxychloroquine, quinine, mefloquine, pyrimethamine - Primaquine: kills parasite in both phases May be used together or with a sulfonamide for synergistic or additive killing power Centers for Disease Control and Prevention (CDC)

Stimulant: Indications of Use

Attention deficit hyperactivity disorder Narcolepsy Obesity treatment

Ophthalmic Drugs/Beta-Adrenergic Blocker Drugs

Betaxolol (Betoptic) Carteolol (Ocupress) Levobunolol (Betagan) Levobetaxolol (Betaxon) Metipranolol (OptiPranolol) Timolol (Timoptic) Reduce IOP by: - Reducing aqueous humor formation - Increasing aqueous humor outflow Do not affect pupil size, accommodation, or night vision

Antidiabetic Drugs (Oral)

Biguanide Sulfonylureas Glinides Thiazolidinediones (glitazones) Alpha-glucosidase inhibitors Dipeptidyl peptidase-IV (DPP-IV) inhibitors (gliptins)

Antianginal/ Beta Blockers: Mechanism of Action

Block beta1 receptors on the heart Decrease heart rate, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart Decrease myocardial contractility, helping to conserve energy or decrease demand After an MI, a high level of circulating catecholamines irritates the heart, causing an imbalance in supply and demand ratio and even leading to life-threatening dysrhythmias. Beta blockers block the harmful effects of catecholamines, thus improving survival after an MI.

Antiemetics and Antinausea Drugs/ Antidopaminergic Drugs: Mechanism of Action and other Indications of Use

Block dopamine receptors in the CTZ Also used for psychotic disorders, intractable hiccups Examples •Prochlorperazine (Compazine) •Promethazine (Phenergan) •Droperidol: Use is controversial because of associated cardiac dysrhythmia

Antiemetics and Antinausea Drugs/Prokinetic Drugs: Mechanism of Action and other Indications of Use

Block dopamine receptors in the CTZ Cause CTZ to be desensitized to impulses it receives from the gastrointestinal (GI) tract Also stimulate peristalsis in GI tract, enhancing emptying of stomach contents Also used for gastroesophageal reflux disease, delayed gastric emptying Metoclopramide (Reglan) •Long-term use may cause irreversible tardive dyskinesia.

Antipsychotics: Mechanism of Action

Block dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion , cognitive function, motor function Dopamine levels in the CNS are decreased Result: tranquilizing effect in the psychotic PTS

Antiemetics and Antinausea Drugs/Serotonin blockers: Mechanism of Action and other Indications of Use

Block serotonin receptors in the GI tract, CTZ, and VC Used for nausea and vomiting in patients receiving chemotherapy and for postoperative nausea and vomiting Examples •Dolasetron (Anzemet) •Granisetron (Kytril) •Ondansetron (Zofran) •Palonosetron (Aloxi)

Men's Health Drugs/Androgens: Receptor Blockers

Block the activity of androgen hormones at target tissue (prostate) receptors Used in the treatment of prostate cancer Flutamide (Eulexin) Nilutamide (Nilandron) Bicalutamide (Casodex)

Men's Health Drugs/Androgens: Inhibitors

Block the effects of naturally occurring (endogenous) androgens 5-Alpha reductase inhibitors Benign prostatic hyperplasia (BPH) treatment Finasteride Dutasteride

Cholinergic-Blocking: Indications of Use (Respiratory)

Blocking the cholinergic stimulation of the PSNS allows unopposed action of the SNS. Results - Decreased secretions from the nose, mouth, pharynx, and bronchi - Relaxed smooth muscles in the bronchi and bronchioles - Decreased airway resistance - Bronchodilation Cholinergic blockers are used to treat: - Exercise-induced bronchospasms - Chronic bronchitis - Asthma - Chronic obstructive pulmonary disease

Atypical Antipsychotics: Adverse Effects

Blood Dyscrasias Potential for agranulocytosis Drug induced (WBC) underproduction Weight gain Changes in serum lipid levels, Metabolic syndrome Dizziness, Drowsiness, Headache, Insomnia Dry mouth, Dyspepsia, Anxiety, Increased appetite

Antidiabetic Drugs (Oral)/Alpha-glucosidase inhibitors

Background: - Acarbose (Precose), miglitol (Glyset) - Indication: type 2 DM - Contraindications: IBS, malabsorption syndromes, or intestinal obstruction Mechanism of Action: - Reversibly inhibit the enzyme alpha glucosidase in the small intestine - Result in delayed absorption of glucose - Must be taken with meals to prevent excessive postprandial blood glucose elevations (with the "first bite" of a meal) Adverse Effects: - Flatulence, diarrhea, abdominal pain - Do not cause hypoglycemia, hyperinsulinemia, or weight gain

Antidiabetic Drugs (Oral)/ Biguanide

Background: - Metformin (Glucophage) - First-line drug and is the most commonly used oral drug for the treatment of type 2 DM - Not used for type 1 DM Mechanism of Action: - Decrease production of glucose by the liver - Decrease intestinal absorption of glucose - Increase uptake of glucose by tissues - Do not increase insulin secretion from the pancreas (does not cause hypoglycemia) Adverse Effects: - Primarily affects gastrointestinal (GI) tract: abdominal bloating, nausea, cramping, diarrhea, feeling of fullness - May also cause metallic taste, reduced vitamin B12levels - Lactic acidosis is rare but lethal if it occurs. - Does not cause hypoglycemia

Antidiabetic Drugs (Oral)/Thiazolidinediones (glitazones)

Background: - Pioglitazone (Actos) - Rosiglitazone (Avandia): Only available through specialized manufacturer programs - Insulin-sensitizing drugs - Indication: type 2 DM Mechanism of Action: - Decrease insulin resistance - "Insulin sensitizing drugs" - Increase glucose uptake and use in skeletal muscle - Inhibit glucose and triglyceride production in the liver Adverse Effects - Black box warning: can cause or exacerbate heart failure and are not recommended for use in patients with symptomatic heart failure. - Peripheral edema and weight gain. - The weight gain may be due to both water retention and an increase in adipose tissue. - Reduced bone mineral density and an increased risk for fractures.

Antidiabetic Drugs (Oral)/Glinides

Background: - Repaglinide (Prandin), nateglinide (Starlix) - Indication: type 2 DM - Action similar to sulfonylureas - Increase insulin secretion from the pancreas Adverse Effects: - Headache, - Hypoglycemic effects - Dizziness - Weight gain - Joint pain - Upper respiratory infection - Flulike symptoms

Antidiabetic Drugs (Oral)/ Sulfonylureas

Background: - Second generation: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta) - Stimulate insulin secretion from the beta cells of the pancreas, thus increasing insulin levels - Beta cell function must be present. - Improve sensitivity to insulin in tissues - Result in lower blood glucose level - Adverse effects: hypoglycemia, hematologic effects, nausea, epigastric fullness, heartburn, many others

Antidiabetic Drugs (Oral)/Dipeptidyl peptidase-IV (DPP-IV) inhibitors (gliptins)

Background: - Sitagliptin (Januvia) - Saxagliptin (Onglyza) - Linagliptin (Tradjenta) - Alogliptin (Nesina) Mechanism of Action: - Delay breakdown of incretin hormones by inhibiting the enzyme DPP-IV. - Incretin hormones increase insulin synthesis and lower glucagon secretion. - Reduce fasting and postprandial glucose concentrations. Adverse Effects: - Upper respiratory tract infection, headache, and diarrhea - Hypoglycemia can occur and is more common if used in conjunction with a sulfonylurea.

Muscle Relaxants

Baclofen Cyclobenzaprine (Flexeril) Dantrolene (Dantrium Metaxalone (Skelaxin) Tizanidine (Zanaflex) Carisoprodol (Soma) Chlorzoxazone (Paraflex) Methocarbamol (Robaxin)

Antibiotics/Quinolones: Mechanism of Action

Bactericidal Alter DNA of bacteria, causing death Do not affect human DNA Used to treat S. aureus, Serratia marcescens, and Mycobacterium fortuitum Bacterial resistance to quinolone antibiotics: - Pseudomonas aeruginosa, S. aureus, Pneumococcus spp., Enterococcus spp., and the broad Enterobacteriaceae family that includes E. coli.

Carbonic Anhydrase Inhibitors: Interactions

Because CAIs can cause hypokalemia, an increase in digoxin toxicity may occur when they are combined with digoxin. Use with corticosteroids may also cause hypokalemia. Increased effects of amphetamines, carbamazepine, cyclosporine, phenytoin, and quinidine with concurrent use of CAIs

Bronchodilators/Beta- Adrenergic Agonists: Mechanism of Action

Begins at the specific receptor stimulated Ends with dilation of the airways: - Activation of beta2 receptors activates cyclic adenosine monophosphate (cAMP), which relaxes smooth muscle in the airway and results in bronchial dilation and increased airflow.

Fibric Acid Derivatives: Mechanism of Action

Believed to work by activating lipase, which breaks down cholesterol Also suppress the release of free fatty acid from adipose tissue, inhibit synthesis of triglycerides in the liver, and increase secretion of cholesterol in the bile

Depressants

Benzodiazepines Barbiturates Marijuana

Anxiolytics (Antianxiety)/ Benzodiazepines: Adverse Effects

Benzodiazepines AE's are an over-expression of their therapeutic effects: - Decreased CNS activity, sedation - Hypotension - Drowsiness, loss of coordination, dizziness, headache - N/V, Dry mouth, constipation

Depressants: Mechanism of Action/ Drug Effects

Benzodiazepines and barbiturates work by increasing the action of GABA. Active ingredient in marijuana is cannabinoids (THC) which bind to and stimulate cannabinoid receptors in CNS.

Antiparkinson Agents/ Anticholinergics

Benzotropine Rasagiline/Selegiline Carbidopa/Levodopa Amantadine Entacapone Tolcapone Bromocriptine Pramipexole Levodopa Ropinirole Safinamide

Adrenergic-Blocking drugs/Beta Blockers: Adverse Effects

Blood: Agranulocytosis, thrombocytopenia CV: AV block, bradycardia, heart failure CNS: Dizziness, depression, unusual, dreams, drowsiness GI: Nausea, vomiting, diarrhea, constipation Other: impotence, alopecia, wheezing, bronchospasm, dry mouth Nonselective beta blockers may interfere with normal responses to hypoglycemia (tremor, tachycardia, nervousness). - May mask signs and symptoms of hypoglycemia - Use with caution in patients with diabetes mellitus

Antibiotics/Sulfonamides: Adverse Effects

Blood: Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia Integumentary: Photosensitivity, exfoliative dermatitis, Steven-Johnson syndrome, epidermal necrolysis GI: Nausea, vomiting, diarrhea, pancreatitis Other: Hepatotoxicity, convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, cough

Antihypertensive Drugs: Miscellaneous (Pulmonary)

Bosentan (Tracleer) - Specifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe HF - Action: blocks receptors of the hormone endothelin Other drugs used to treat pulmonary hypertension - Epoprostenol - Treprostinil - Iloprost - Ambrisentan - Macitentan - Selexipag

Ophthalmic Drugs/Carbonic Anyhydrase Inhibitors

Brinzolamide (Azopt) Dorzolamide (Trusopt) Inhibit the enzyme carbonic anhydrase, which reduces aqueous humor formation in the eye Result is decreased IOP.

Antibiotics/Cephalosporins: (fourth generation)

Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria Uncomplicated and complicated UTI - Cefepime (Maxipime)

Laxatives/Bulk forming: Mechanism of Action

Bulk forming - High fiber - Absorb water to increase bulk - Distend bowel to initiate reflex bowel activity - Examples Psyllium (Metamucil) Methylcellulose (Citrucel)

Laxative types

Bulk forming Emollient (stool softeners, lubricant laxatives) Hyperosmotic Saline Stimulant

Laxatives: Indication of Use

Bulk forming: Acute and chronic constipation, irritable bowel syndrome, diverticulosis Emollient: Acute and chronic constipation, fecal impaction, facilitation of bowel movements in anorectal conditions Hyperosmotic: Chronic constipation, diagnostic and surgical preps Saline: Constipation, diagnostic and surgical preps Stimulant: Acute constipation, diagnostic and surgical preps

Loop Diuretics

Bumetanide (Bumex) Ethacrynic acid (Edecrin) Furosemide (Lasix) Torsemide (Demadex)

Second Generation Antidepressants (SSRI)s

Bupropion Citalopram (Celexa) Duloxetine (Cymbalta)- SSNRI Fluoxetine (Prozac) Mirtazapine (Remeron) Trazodone (Desyrel, Oleptro)

Leukotriene Receptor Antagonists (LTRAs): Drug Effects

By blocking leukotrienes: - Prevent smooth muscle contraction of the bronchial airways - Decrease mucus secretion - Prevent vascular permeability - Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation

Expectorants: Drug Effects

By loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished.

Blood Products: Background information

CLLOIDS: Only class of fluids that are able to carry oxygen Increase tissue oxygenation Increase PV Most expensive and least available fluid because they require human donors

Amphetamines: Drug Effects

CNS Effects: Mood elevation or Euphoria Increased mental alertness & capacity for work Decreased fatigue & drowsiness Prolonged wakefulness Respiratory Effects: Relaxation of bronchial smooth muscle Increased respiration Dilation of Pulmonary arteries

Opioid Analgesics: Adverse Effects

CNS depression (leads to respiratory depression: most serious) - Nausea & Vomiting - Diuresis - Convulsions - Pupil contribution (miosis) Non-CNS - Hypotension - Urinary Retention - Diaphoresis & flushing - Constipation - Itching, Urticria, Pruritus

Stimulants: Adverse Effects

CNS: - Restlessness, syncope, dizziness, tremor, hyperactive reflexes, talkativeness, tenseness, irritability, weakness, insomnia, fever, euphoria - Confusion, aggression, increased libido, anxiety, delirium, paranoid hallucinations, panic states, suicidal, and homicidal tendencies - Fatigue and depression follow CNS stimulation. CV: - Headache, pallor or flushing, palpitations, tachycardia, cardiac dysrhythmias, hypertension or hypotension, excessive sweating, circulatory collapse GI: - Dry mouth, anorexia, nausea, vomiting, diarrhea, abdominal cramps

Potassium-Sparing Diuretics: Adverse Effects

CNS: Dizziness, headache GI: Cramps, nausea, vomiting, diarrhea Other: Urinary frequency, weakness, hyperkalemia Spironolactone (Aldactone): Gynecomastia, Amenorrhea, irregular menses, Postmenopausal bleeding

Thiazide and Thiazide-Like Diuretics: Adverse Effects

CNS: Dizziness, headache, blurred vision GI: Anorexia, nausea, vomiting, diarrhea GU: Impotence Hematologic: Jaundice, leukopenia Integumentary: Urticaria, photosensitivity Metabolic: Hypokalemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis

Loop Diuretics: Adverse Effects

CNS: Dizziness, headache, tinnitus, blurred vision GI: Nausea, vomiting, diarrhea Integumentary: Stevens-Johnson (torsemide) Hematologic: Agranulocytosis, neutropenia, thrombocytopenia Metabolic: Hypokalemia, hyperglycemia, hyperuricemia

Antibiotics/Quinolones: Adverse Effects

CNS: Headache, dizziness, insomnia, insomnia, depression, restlessness, convulsions GI: Nausea, vomiting, diarrhea, constipation, thrush, increased liver function study results Cardiac: Prolonged QT interval Integumentary: Rash, pruritus, urticaria, flushing Other: Ruptured tendons, *tendonitis,* fever, chills, blurred vision, tinnitus *BLACK BOX WARNING: Increased risk of tendonitus and tendon rupture

Antianginal/ Beta Blockers: Adverse Effects

CV: - Bradycardia, hypotension, atrioventricular (AV) block Metabolic: - Hyperglycemia, hypoglycemia, hyperlipidemia CNS: - Dizziness, fatigue, depression, lethargy Other: - Impotence, wheezing, dyspnea

Cholinergic-Blocking: Drug Effects

CV: - Small doses: decrease heart rate - Large doses: increase heart rate CNS: - Small doses: decrease muscle rigidity and tremors - Large doses: drowsiness, disorientation, hallucinations Eye - Dilated pupils (mydriasis) - Decreased accommodation caused by paralysis of ciliary muscles (cycloplegia) GI: - Relax smooth muscle tone of GI tract - Decrease intestinal and gastric secretions - Decrease motility and peristalsis GU: - Relaxed detrusor muscle - Increased constriction of internal sphincter - Result: urinary retention Glandular - Decreased bronchial secretions, salivation, sweating Respiratory - Decreased bronchial secretions - Dilated bronchial airways

Adrenergic: Therapeutic Effects

CV: Decreased edema, Increased urinary output, Return to normal vital signs, Improved skin color and temperature, Increased LOC Asthma: Return to normal respiratory rate, Improved breath sounds, Fewer crackles, Increased air exchange, Decreased cough, Less dyspnea, Improved blood gases, Increased activity tolerance

Cholinergic-Blockings: Adverse Effects

CV: Increased HR, dysrhythmias CNS: CNS excitation, restlessness, irritability, disorientation, hallucinations, delirium Eye: Dilates pupils (causing blurred vision), increased intraocular pressure GI: Decreased salivation, decreased gastric secretions, decreased motility (causing constipation) GU: Urinary retention Glandular: Decreased sweating Respiratory: Decreased bronchial secretions

Adrenergic-Blocking drugs/Alpha Blockers: Adverse Effects

CV: Palpitations, orthostatic hypotension, tachycardia, edema, chest pain CNS: Dizziness, headache, anxiety, depression, weakness, numbness, fatigue GI: Nausea, vomiting, diarrhea, constipation, abdominal pain Other: Incontinence, dry mouth, pharyngitis

Barbiturates: Adverse Effects

CV: Vasodilation & Hypertension CNS: Drowsiness, lethargy, vertigo Resp: Resp. depression, cough GI: N/V, diarrhea, constipation Hematologic: Agranulocytosis, thrombocytopenia Other: Hypersensitivity reactions, Stevens-Johnson syndrome, reduced REM --> agitation, inability to deal with normal dress

Analeptics

Caffeine Doxapram (Dopram)

Vitamin D: Forms

Calcifediol (Calderol) Calcitriol (Rocaltrol) Ergocalciferol (Drisdol)

Women's Health Drugs/Osteoporosis: Drug Therapy for Prevention

Calcium supplements and vitamin D may be recommended for women at high risk for osteoporosis. Current recommendations are that women, especially those older than age 60 years, consider taking calcium and vitamin D supplements for bone health. Bisphosphonates - Alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), zoledronic acid (Reclast) Selective estrogen receptor modifiers (SERMs) - Raloxifene (Evista) - Tamoxifen (Nolvadex) Hormones - Calcitonin (Calcimar) - Teriparatide (Forteo): stimulates bone formation - Denosumab (Prolia): prevents bone resorption Bisphosphonates - Work by inhibiting osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density - Strong clinical evidence indicates the bisphosphonates can reverse lost bone mass and reduce facture risk. Selective estrogen receptor modulators (SERMs) - Stimulate estrogen receptors on bone and increase bone density Calcitonin (Calcimar) - Directly inhibits osteoclastic bone resorption Teriparatide (Forteo) - Only drug that stimulates bone formation - Derivative of parathyroid hormone (PTH) - Action similar to natural PTH Denosumab (Prolia) - Monoclonal antibody that blocks osteoclast activation, thereby preventing bone resorption - It is given as a subcutaneous injection once every 6 months along with daily calcium and vitamin D.

Benzodiazepines: Drug Effects

Calming effect on the CNS Useful in controlling agitation and anxiety Reduce excessive sensory stimulation, inducing sleep Induce skeletal muscle relaxation

Adrenal Drugs: Background Information

Can be either synthetic or natural Many different drugs and forms Glucocorticoids - Topical, systemic, inhaled, nasal Mineralocorticoid - Systemic Adrenal steroid inhibitors - Systemic

Adrenergic Drugs: Interactions

Can cause additive CNS depression with alcohol, benzodiazepines, opioids Always check for specific drug interactions

Interleukins: Adverse Effects

Capillary Leak Syndrome: - Severe toxicity of aldesleukin therapy - Capillaries lose ability to retain vital colloids in the blood; these substances are "leaked" into the surrounding tissues. Result: massive fluid retention - Respiratory distress - Heart failure - Myocardial infarction - Dysrhythmias Reversible after IL therapy is discontinued

ACE Inhibitors (Angiotensin-Converting Enzyme)

Captopril (Capoten) Benazepril (Lotensin) Enalapril (Vasotec) Fosinopril (Monopril) Lisinopril (Prinivil) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik)

Antidiarrheals/Antimotility drugs (opiates): Mechanism of Action

Decrease bowel motility and reduce pain by relief of rectal spasms Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed Examples: paregoric, opium tincture, codeine, over-the-counter (OTC) loperamide, diphenoxylate

Antidiarrheals/Antimotility drugs (anticholinergics): Mechanism of Action

Decrease intestinal muscle tone and peristalsis of GI tract Result: slows the movement of fecal matter through the GI tract Example: belladonna alkaloids Slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract Drying effect Reduce gastric secretions Used in combination with adsorbents and opiates

Neuromuscular Blocking Drugs

Depolarizing: - Succinylcholine Non-Depolarizing: - Rocuronium

Benzodiazepines: Mechanism of Action

Depress CNS activity Affect hypothalamic, thalamic, and limbic systems of the brain Benzodiazepine receptors Gamma-aminobutyric acid (GABA) Do not suppress rapid eye movement (REM) sleep as much as barbiturates do Do not increase metabolism of other drugs

Antidepressants/ Tricyclic Antidepressants: Indications of Use

Depression Childhood enuresis (imipramine) OCDs Adjuctive analgesics for chronic pain conditions - ex: Trigeminal neuralgia Increased appetite is an effect of TCAs; therefore TCAs are sometimes used to treat anorexia nervosa

Second Generation Antidepressants (SSRI)s: Indications of Use

Depression, OCD, panics attacks/disorders, PTSD BPD, Obesity, Eating disorders Premenstural myoclonus Alcoholism/substance abuse

General Anesthetics

Dexmedetomidine Ketamine Nitrous Oxide Propofol Sevoflurane

Vitamins and Minerals/Phosphorus: Adverse Effects

Diarrhea Nausea and vomiting Other GI disturbances Confusion Weakness Breathing difficulties

Benzodiazepines

Diazepam (Valium) Midazolam (Versed) Temazepam (Restoril) Nonbenzodiasepine: Eszopiclone (Lunesta) Amelteon (Rozerem) Zolpidem (Ambien)

Vasodilators

Diazoxide (Hyperstat) Hydralazine (Apresoline) Minoxidil (Rogaine) - For hair regrowth Nitroprusside (Nitropress)

Nutritional Supplements

Dietary products used to provide nutritional support Can be given in a variety of ways Vary in amounts and complexity of carbohydrates, protein, and fat content Electrolytes, vitamins, minerals, and osmolality may also vary. Malnutrition - The body's nutritional needs are not met by nutrient intake. Enteral nutrition - Provision of food or nutrients through the gastrointestinal (GI) tract Parenteral nutrition - Delivery of nutrients directly into the circulation by means of an intravenous (IV) solution

Anemia Drugs/Iron

Dietary sources: meats, certain vegetables, and grains Dietary iron must be converted by gastric juices before it can be absorbed. Some foods enhance iron absorption: - Orange juice - Veal - Fish - Ascorbic acid Some foods impair iron absorption: - Eggs* - Corn - Beans* - Cereal products containing phytates Supplemental iron may be given as a single drug or as part of a multivitamin preparation. Oral iron preparations are available as ferrous salts. - Ferrous fumarate (Femiron), ferrous gluconate, ferrous sulfate (FeSO4) Parenteral - Iron dextran (INFeD) - Iron sucrose (Venofer) - Ferric gluconate (Ferrlecit, Nulecit) - Ferumoxytol (Feraheme)

Vitamin E: Indications of Use

Dietary supplement Antioxidant Treatment of deficiency - Highest risk of deficiency in premature infants

Vitamin B2 (Riboflavin): Indications of Use

Dietary supplement Treatment of deficiency Microcytic anemia Acne Migraine headaches Many other uses

Vitamin D: Indications of Use

Dietary supplement Treatment of vitamin D deficiency Treatment and correction of conditions related to long-term deficiency: rickets, tetany, osteomalacia Prevention of osteoporosis Other uses: treatment of osteodystrophy, hypocalcemia, hypoparathyroidism, pseudohypoparathyroidism, hypophosphatemia

Vitamin A: Indications of Use

Dietary supplement - Infants and pregnant and nursing women Deficiency states - Hyperkeratosis of the skin - Night blindness - Other conditions Skin conditions - Acne, psoriasis, keratosis follicularis - Isotretinoin

Vitamin C (Ascorbic Acid): Indications of Use

Dietary supplement Prevention and treatment of scurvy Urinary acidifier Most large controlled studies have shown that ascorbic acid has little or no value as a prophylactic for the common cold.

Vitamin K: Indications of Use

Dietary supplementation Treatment of deficiency states (rare) - Antibiotic therapy - Malabsorption Given prophylactically to newborn infants Reverses the effects of certain anticoagulants (warfarin) Patient becomes unresponsive to warfarin for approximately 1 week after vitamin K administration.

Pituitary Drugs: Mechanism of Action

Differs depending on the drug - Either augments or antagonizes the natural effects of the pituitary hormones

Cardiac Glycosides: Adverse Effects

Digoxin (Lanoxin) - Very narrow therapeutic window - Drug levels must be monitored.(0.5 to 2 ng/mL) - Low potassium levels increase its toxicity. - Electrolyte levels must be monitored. CV: dysrhythmias, including bradycardia or tachycardia CNS: headaches, fatigue, malaise, confusion, convulsions Eyes: colored vision (seeing green, yellow, purple), halo vision, flickering lights GI: anorexia, nausea, vomiting, diarrhea

Digoxin Toxicity

Digoxin immune Fab (Digibind) therapy - Hyperkalemia (serum potassium greater than 5 mEq/L) in a digitalis-toxic patient - Life-threatening cardiac dysrhythmias - Life-threatening digoxin overdose Conditions That Predispose to Digoxin Toxicity: - Hypokalemia - Use of cardiac pacemaker - Hepatic dysfunction - Hypercalcemia - Dysrhythmias - Hypothyroid, respiratory, or renal disease - Advanced age

Ophthalmic Drugs/Intraocular Pressure Reducers

Direct-acting cholinergics Indirect-acting cholinergics Adrenergics: sympathomimetics Anti-adrenergics: beta blockers Carbonic anhydrase inhibitors Osmotic diuretics Prostaglandin agonists

Cholinergics

Direct-acting drugs: Bethanechol Cevimeline Succinylcholine Indirect-acting drugs: Physostigmine Pyridostigmine Indirect-acting anticholinesterase drugs: Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon)

Vasodilators: Mechanism of Action

Directly relax arteriolar or venous smooth muscle (or both) Results in: - Decreased SVR - Decreased afterload - Peripheral vasodilation

Antipsychotics

Conventional (1st Gen) or 2nd Gen Phenothiazines- 1st Gen Haloperidol (Haldol) - Butyrophenones

Vitamin B2 (Riboflavin): Functions

Converted into enzymes essential for tissue respiration Required to activate vitamin B6 (pyridoxine) Converts tryptophan into niacin Maintains erythrocyte integrity Needed for normal respiratory functions

Osmotic Diuretics: Adverse Effects

Convulsions Thrombophlebitis Pulmonary congestion

Ophthalmic Drugs/Osmotic Diuretics

Create ocular hypotension by producing an osmotic gradient Water is forced from the aqueous and vitreous humors into the bloodstream. Result is reduced volume of intraocular fluid and thus reduced IOP. Administered intravenously, orally, or topically Glycerin usually tried first - Can cause hyperglycemia Mannitol used if glycerin is unsuccessful Isosorbide and urea may also be used. Indications - Acute glaucoma episodes - Before and after ocular surgery to reduce IOP Adverse effects - Nausea, vomiting, headache - May cause fluid and electrolyte imbalance

Diuretic Drugs: Types

Carbonic anhydrase inhibitors (CAIs) Loop diuretics Osmotic diuretics Potassium-sparing diuretics Thiazide and thiazide-like diuretics

Thyroid Replacement Drugs: Adverse Effects

Cardiac dysrhythmia is the most significant adverse effect. May also cause: - Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, sweating, heat intolerance, fever, others

Cytotoxic Antibiotics: Adverse Effects (Cont.)

Cardiomyopathy is associated with large amounts of doxorubicin. - Routine monitoring of cardiac ejection fraction with multiple-gated acquisition (MUGA) scans - Cumulative dose limitations - Cytoprotective drugs such as dexrazoxane can decrease the incidence of this devastating toxicity.

Heart Failure/ Beta Blockers: Mechanism of Action

Cardioprotective quality of beta blockers: prevent catecholamine-mediated actions on the heart by reducing or blocking sympathetic nervous system stimulation to the heart and the heart's conduction system - Intended effects: reduced heart rate, delayed AV node conduction, reduced myocardial contractility, decreased myocardial automaticity Examples: Metoprolol, Carvedilol (Coreg)

Histamine vs. Antihistamine Effects

Cardiovascular (small blood vessels) - Histamine effects: dilation and increased permeability (allowing substances to leak into tissues) - Antihistamine effects: Reduce dilation of blood vessels & reduce increased permeability of blood vessels Smooth muscle (on exocrine glands) - Histamine effects: stimulate salivary, gastric, lacrimal, and bronchial secretions - Antihistamine effects: reduce salivary, gastric, lacrimal, and bronchial secretions Immune system (release of substances commonly associated with allergic reactions) - Histamine effects: mast cells release histamine and other substances, resulting in allergic reactions - Antihistamine effects: bind to histamine receptors, thus preventing histamine from causing a response

ACE Inhibitors: Effects (Primary)

Cardiovascular and renal BP: reduce BP by decreasing SVR HF - Prevent sodium and water resorption by inhibiting aldosterone secretion - Diuresis: decreases blood volume and return to the heart - Decreases preload, or the left ventricular end-diastolic volume - Decreases work required of the heart

Adrenergic Drugs/ Dual-Action Alpha1 and Beta Receptor Blockers

Carvedilol (Coreg)

Adrenergic-Blocking drugs/Beta Blockers (Nonselective)

Carvedilol (Coreg, Coreg CR) Labetalol (Normodyne, Trandate) Nadolol (Corgard) Penbutolol (Levatol) Pindolol (Visken) Propranolol (Inderal) Sotalol (Betapace) Timolol (Blocadren, Timoptic)

Adrenergic-Blocking drugs/Alpha Blockers: Mechanism of Action

Cause both arterial and venous dilation, reducing peripheral vascular resistance and blood pressure (BP) Used to treat hypertension Effect on receptors on prostate gland and bladder decreases resistance to urinary outflow, thus reducing urinary obstruction and relieving effects of benign prostatic hyperplasia (BPH).

Antianginal /Calcium Channel Blockers: Mechanism of Action

Cause coronary artery vasodilation Cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance Reduce the workload of the heart Result: - Decreased myocardial oxygen demand - Dysrhythmias: depression of the automaticity of and conduction through the sinoatrial and AV nodes

Adrenergic-Blocking drugs/Beta Blockers: Mechanism of Action (Nonselective, beta 1 & beta 2)

Cause same effects on heart as cardioselective beta blockers Constrict bronchioles, resulting in narrowing of airways and shortness of breath Produce vasoconstriction of blood vessels Other effects

Antibiotics/Aminoglycosides: Adverse Effects

Cause serious toxicities - Nephrotoxicity (renal damage) - Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve]) Must monitor drug levels to prevent toxicities Minimum inhibitory concentration (MIC) Therapeutic drug monitoring Ototoxicity and nephrotoxicity are the most significant Headache Paresthesia Fever Superinfections Vertigo Skin rash Dizziness

Nitrates and Nitrites: Mechanism of Action

Cause vasodilation because of relaxation of smooth muscles Potent dilating effect on coronary arteries

Hyperthyroidism Information

Caused by several diseases - Graves' disease - Multinodular disease - Plummer's disease (rare): also called toxic nodular disease - Thyroid storm (induced by stress or infection): severe and potentially life threatening

Antibiotics/Cephalosporins: (fifth generation)

Ceftolozane (Zerbaxa) - Contains beta-lactamase inhibitor - Enhances gram negative activity Ceftaroline (Teflaro) - Broader spectrum of antibacterial activity - Effective against a wide variety of organisms •MRSA

Antineoplastic Medications (CCNS)

Cell cycle-nonspecific (CCNS) antineoplastic drugs - Alkylating drugs: Classic alkylators (nitrogen mustards), Nitrosoureas & Miscellaneous alkylators - Cytotoxic antibiotics

Immunization: Indication

Centers for Disease Control and Prevention (CDC)/Department of Health and Human Services recommendations for adult and pediatric immunizations (USA) - Provide specific dosages and intervals for immunizations - Refer to the CDC's website for current recommendations

Vitamins and Minerals/Calcium: Drug Interactions

Chelation - Calcium salts will bind (chelate) with tetracyclines to produce an insoluble complex. If hypercalcemia is present in patients taking digoxin, serious cardiac dysrhythmias can occur

Carbonic Anhydrase Inhibitors (CAIs)

Chemical derivative of sulfonamide antibiotics Inhibit the activity of the enzyme carbonic anhydrase - Found in kidneys, eyes, and other parts of the body Acetazolamide (Diamox) - Most commonly used CAI

Antimalarial Drug List

Chloroquine Hydroxychloroquine Quinine Quinidine Mefloquine Diaminopyrimidine (pyrimethamine and trimethoprim) Primaquine Sulfonamides Tetracyclines Clindamycin

Bile Acid Sequestrants

Cholestyramine (Questran) Colestipol (Colestid): Tablet form Colesevelam (Welchol) AKA: Bile acid-binding resins and ion-exchange resins Powdered form may not be convenient or well tolerated

Ophthalmic Drugs/Sympathomimetics: Indication of Use

Chronic, open-angle glaucoma (to reduce IOP) Reduction of perioperative IOP Reduction of ocular hypertension

Acid-Controlling Drugs/Histamine 2 (H2) Antagonists: Drug Interactions

Cimetidine (Tagamet) - Binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels - All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption. - Because of its potential to cause drug interactions, cimetidine has been largely replaced by ranitidine and famotidine. - Cimetidine is still used to treat certain allergic reactions. Smoking has been shown to decrease the effectiveness of H2 blockers. For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids.

Antibiotics/Quinolones Drugs

Ciprofloxacin (Cipro) Norfloxacin (Noroxin) Levofloxacin (Levaquin) Moxifloxacin (Avelox) Gemifloxacin (Factive) Delafloxacin (Baxdela)

Vaughan Williams Classification

Class I - Class Ia: Procainamide (Pronestyl), Quinidine (Quinidex) - Class Ib: Lidocaine (Xylocaine), Propafenone (Rythmol) - Class Ic: Flecainide (Tambocor) Class II - ex: Atenolol (Tenormin), Metoprolol (Lopressor), Amiodarone (Cordarone, Pacerone) Class III -ex: Ibutilide (Corvert), Dofetilide (Tikosyn), Sotalol (Betapace) Class IV - ex: Diltiazem (Cardizem, Others), Verapamil (Calan)

Vaughan Williams Class II: Mechanism of Action/ Indications

Class II: beta blockers - Reduce or block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart's conduction system - Depress Phase 4 depolarization Used for: General myocardial depressants for both supraventricular and ventricular dysrhythmias Also used as antianginal and antihypertensive drugs

Vaughan Williams Class III: Mechanism of Action/ Indications

Class III: amiodarone, dronedarone, dofetilide, sotalol, ibutilide - Increase APD - Prolong repolarization in Phase 3 Used for: Dysrhythmias that are difficult to treat (Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter that is resistant to other drugs)

Vaughan Williams Class IV: Mechanism of Action/ Indications

Class IV: Calcium channel blockers - Inhibit slow-channel (calcium-dependent) pathways - Depress Phase 4 depolarization - Reduce AV node conduction Used for: Paroxysmal supraventricular tachycardia (PSVT); Rate control for atrial fibrillation and flutter

Vaughan Williams Class Ia: Mechanism of Action/ Indications

Class Ia: procainamide, quinidine, and disopyramide - Block sodium (fast) channels - Delay repolarization Increase APD Used for: Atrial fibrillation Premature atrial contractions Premature ventricular contractions Ventricular tachycardia Wolff-Parkinson-White syndrome

Vaughan Williams Class Ib: Mechanism of Action/ Indications

Class Ib: phenytoin, lidocaine - Block sodium channels - Accelerate repolarization - Increase or decrease APD Used for: - Lidocaine: ventricular dysrhythmias only - Phenytoin: Atrial and ventricular tachydysrhythmias caused by digitalis toxicity or long QT syndrome.

Vaughan Williams Class Ic: Mechanism of Action/ Indications

Class Ic: flecainide, propafenone - Block sodium channels (more pronounced effect) - Little effect on APD or repolarization - Used for severe ventricular dysrhythmias May be used: Atrial fibrillation or flutter Wolff-Parkinson-White syndrome Supraventricular tachycardia dysrhythmias

Hypothyroidism Classification

Classified also by when it occurs in the lifespan: Congenital hypothyroidism (Cretinism) - Hyposecretion of thyroid hormone during youth - Low metabolic rate, retarded growth and sexual development, possible mental retardation Myxedema - Hyposecretion of thyroid hormone during adulthood - Decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair, firm edema, yellow dullness of the skin

Antibiotics: Miscellaneous

Clindamycin (Cleocin) Linezolid (Zyvox) Metronidazole (Flagyl) Nitrofurantoin (Macrodantin, Furadantin) Quinupristin-dalfopristin (Synercid) Daptomycin (Cubicin) Vancomycin (Vancocin, Vancoled) Colistimethate (Coly-Mycin) Telavancin (Vibativ)

Adrenergic Drugs/ Alpha2-Adrenergic Receptor Stimulators (Agonists)

Clonidine and Methyldopa Not typically prescribed as first-line antihypertensive drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness Adjunct drugs to treat hypertension after other drugs have failed Used in conjunction with other antihypertensives such as diuretics

Adrenergic Drugs: Centrally Acting

Clonidine and methyldopa - Stimulate alpha2-adrenergic receptors in the brain - Decrease sympathetic outflow from the central nervous system - Decrease norepinephrine production - Stimulate alpha2-adrenergic receptors, thus reducing renin activity in the kidneys - Result in decreased BP

Dermatologic Drugs/Topical Antifungal Drugs

Clotrimazole (Lotrimin, Mycelex-G) - Lozenge for oral candidiasis (thrush) - Vaginal suppository or cream for yeast infections - Other forms used for other fungal infections Miconazole (Monistat) - Topical cream - Vaginal suppository or cream

Atypical Antipsychotics

Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega) Iloperidone (Fanapt) Asenapine (Saphris) Lurasidone (Latuda) Brexpiprazole (Rexulti)

Antidiarrheals/Adsorbents: Mechanism of Action

Coat the walls of the gastrointestinal (GI) tract Bind to the causative bacteria or toxin, which is then eliminated through the stool Examples: bismuth subsalicylate (Pepto-Bismol), activated charcoal, and antilipemic drugs colestipol and cholestyramine

Opioid Analgesics

Codeine Sulfate Fentanyl Hydromorphone (Dilaudid) Meperidine Meperodone hydrochloride (Dolophine) Methadone hydrochloride Morphine sulfate Oxycodone hydrochloride Naloxone hydrochloride (Narcan)

Hypothyroidism Symptoms

Common symptoms - Thickened skin - Hair loss - Constipation - Lethargy - Anorexia

Acid-Controlling Drugs/Antacids: Magnesium Salts

Commonly cause diarrhea; usually used with other drugs to counteract this effect Dangerous when used with renal failure; the failing kidney cannot excrete extra magnesium, resulting in accumulation Examples - Hydroxide salt: magnesium hydroxide (Milk of Magnesia) - Carbonate salt: Gaviscon (also a combination product) - Combination products such as Maalox, Mylanta (aluminum and magnesium)

Cholinergic-Blocking: Mechanism of Action

Competitive antagonists Compete with ACh for binding at muscarinic receptors in the PNS - As a result, ACh is unable to bind to thereceptor site and cause a cholinergic effect. When these drugs bind to receptors, they inhibit nerve transmission at these receptors.

Acid-Controlling Drugs/ Histamine 2 (H2) Antagonists: Mechanism of Action

Competitively block the H2 receptor of acid-producing parietal cells Reduced hydrogen ion secretion from the parietal cells Increase in the pH of the stomach Relief of many of the symptoms associated with hyperacidity-related conditions

Nutritional Supplements/Enteral Formulation Group: Polymeric

Complete, Ensure, Ensure Plus, Isocal, Osmolite, Portagen, Jevity, Sustacal Preferred over elemental formulations for patients with fully functional GI tracts and few specialized nutrient requirements; cause fewer GI problems Most closely resemble normal dietary intake

Crystalloids/Sodium Chloride: Concentrations

Concentrations: - 0.9%: physiologically normal concentration of sodium chloride (isotonic), and it is referred to as NS. - 0.45% ("half-normal") - 0.25% ("quarter-normal") - 3% (hypertonic saline) - 5% (hypertonic saline)

Insulin

Function as a substitute for the endogenous hormone Effects are the same as normal endogenous insulin. Restores the diabetic patient's ability to: - Metabolize carbohydrates, fats, and proteins - Store glucose in the liver - Convert glycogen to fat stores Human insulin: - Derived using recombinant DNA technologies - Recombinant insulin produced by bacteria and yeast Goal: tight glucose control - To reduce the incidence of long-term complications

Acid-Controlling Drugs/Proton Pump Inhibitors (PPIs): Indications of Use

GERD Erosive esophagitis Short-term treatment of active duodenal and benign gastric ulcers Zollinger-Ellison syndrome Nonsteroidal antiinflammatory drug (NSAID)-induced ulcers Stress ulcer prophylaxis Treatment of H. pylori-induced ulcers - Given with an antibiotic

Antibiotics/Macrolides: Adverse Effects

GI effects, primarily with erythromycin - Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia Azithromycin and clarithromycin: fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration

Nutritional Supplements/Enteral Nutrition: Adverse Effects

GI intolerance: diarrhea Dumping syndrome Aspiration pneumonia

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS): Adverse Effects

GI: heartburn to severe GI bleeding Acute renal failure Noncardiogenic pulmonary edema Increased risk of MI and stroke Altered hemostasis Hepatotoxicity Skin eruption, sensitivity reaction Tinnitus, hearing loss

Acid-Controlling Drugs/Histamine 2 (H2) Antagonists: Indications of Use

Gastroesophageal reflux disease (GERD) PUD Erosive esophagitis Adjunct therapy to control upper GI bleeding Zollinger-Ellison syndrome

Antibiotics/Aminoglycosides Drugs

Gentamicin Neomycin (Neo-Fradin) Tobramycin (TOBI) Amikacin

Nutritional Supplements/Enteral Formulation Group: Impaired Glucose Tolerance

Glucerna - Contains proteins, carbohydrates, fat, sodium, potassium - Used in patients with impaired glucose tolerance (e.g., diabetes)

Antibiotics/Quinolones: Indications of Use

Gram-negative bacteria such as Pseudomonas spp. Complicated urinary tract, respiratory, bone and joint, GI, skin, and sexually transmitted infections Anthrax (ciprofloxacin)

Antihistamines/ Histamine Agonists

H1 antagonists (also called H1 blockers) Examples: chlorpheniramine, fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec), diphenhydramine (Benadryl) Antihistamines have several properties - Antihistaminic - Anticholinergic - Sedative

Acid-Controlling Drugs/Antacids: Aluminum Salts

Have constipating effects Often used with magnesium to counteract constipation Often recommended for patients with renal disease (more easily excreted) Examples: - Aluminum carbonate: Basaljel - Hydroxide salt: AlternaGEL - Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel

Antidepressants/ MAO-B Inhibitor: Adverse Drug effects

Headache, Dizziness, Nausea Insomnia, Confusion Hypotension Rash Weight loss, Diarrhea, Stomatitis Dyskinesia, Back pain Somnolence Impulse control disorders

Nitrates: Adverse Effects

Headaches - Usually diminish in intensity and frequency with continued use Reflex tachycardia Postural hypotension Skin irritation with topical application Tolerance may develop: - Occurs in patients taking nitrates around the clock or with long-acting forms - Prevented by allowing a regular nitrate-free period to allow enzyme pathways to replenish - Transdermal forms: remove patch at bedtime for 8 hours, then apply a new patch in the morning

Adrenergic Drugs/ Alpha1 Blockers

Doxazosin (Cardura) Prazosin (Minipress) Tamsulosin (Flomax)* Terazosin (Hytrin)

Adrenergic Drugs: Peripherally Acting Alpha1 Blockers

Doxazosin, prazosin, and terazosin - Block alpha1-adrenergic receptors - When alpha1-adrenergic receptors are blocked, BP is decreased. - Dilate arteries and veins - Alpha1 blockers also increase urinary flow rates and decrease outflow obstruction by preventing smooth muscle contractions in the bladder neck and urethra. Use: benign prostatic hyperplasia (BPH)

Women's Health Drugs/Contraceptive Drugs: Adverse Effects

Drawbacks to the use of these drugs include: - Hypertension - Thromboembolism, possible PE, myocardial infarction (MI), stroke - Alterations in lipid and carbohydrate metabolism - Increases in serum hormone concentrations These effects are caused by the estrogen component. May also cause: - Edema, dizziness, headache, depression, nausea, vomiting, diarrhea, increased appetite, increased weight, breast changes, many others Improve menstrual cycle regularity Decrease blood loss during menstruation Decrease incidence of functional ovarian cysts and ectopic pregnancies

Antidiarrheals/Opiates: Adverse Effects

Drowsiness, dizziness, lethargy Nausea, vomiting, constipation Respiratory depression Hypotension Urinary retention Flushing

Anticoagulants: Contraindications

Drug allergy Any acute bleeding process or high risk for such an occurrence. Warfarin is strongly contraindicated in pregnancy. Other anticoagulants are rated in lower pregnancy categories (B or C). LMWHs are contraindicated in patients with an indwelling epidural catheter risk of epidural hematoma.

Antimalarial Drugs: Contraindications

Drug allergy Tinnitus (ear ringing) Pregnancy (quinine) Severe renal, hepatic, or hematologic dysfunction

Women's Health Drugs/Uterine Relaxants: Tocolytics

Drug for Preterm Labor Management Used to stop labor that begins before term to prevent premature birth Generally used after the 20th week of gestation Uterine contractions that occur between the 20th and 37th weeks of gestation are considered premature labor. Nonpharmacologic measures - Bed rest, sedation, hydration

Antiparkinson Agents/ Anticholinergics: Mechanism of Action

Drug therapies are aimed at increasing levels of dopamine or antagonizing the effects of Ach. Dompamine Modulator: Causes release of dopamine from storage sites in presynaptic fibers that have not yet been destroyed. Indirect acting: Cause an increase in levels of dopaminergic stimulation in the CNS Direct acting: Direct stimulation of presynaptic and/or postsynaptic dopamine receptors of the brain. Anticholinergics: Block the effects of Ach

Thromolytic Drugs

Drugs that break down, or lyse, preformed clots Older drugs: - Streptokinase - Urokinase Current drugs: - Alteplase (Activase, Cathflo Activase) - Reteplase (Retavase) - Tenecteplase (TNKase)

Women's Health Drugs/Contraceptive Drugs: Interactions

Drugs that decrease effectiveness of oral contraceptive drugs - Antibiotics (especially penicillins and cephalosporins) - Barbiturates - Isoniazid - Rifampin Drugs that may have reduced effectiveness if given with oral contraceptives - Beta blockers, warfarin, tricyclic antidepressants, vitamins, hypnotics, anticonvulsants, theophylline, and antidiabetic drugs

Loop Diuretics: Indications

Edema associated with HF or hepatic or renal disease To control hypertension To increase renal excretion of calcium in patients with hypercalcemia In cases of HF resulting from diastolic dysfunction

Antibiotics/Sulfonamides: Indications of use

Effective against both gram-positive and gram-negative bacteria Treatment of urinary tract infections (UTIs) caused by susceptible strains of: - Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Proteus vulgaris, Staphylococcus aureus Pneumocystis jiroveci pneumonia - Co-trimoxazole Upper respiratory tract infections SMX-TMP is commonly used for outpatient Staphylococcus infections because of the high rate of community-acquired MRSA infections.

Niacin: Indications

Effective in lowering triglyceride, total serum cholesterol, and LDL levels Increases HDL levels Effective in the treatment of types IIa, IIb, III, IV, and V hyperlipidemias

Men's Health Drugs/Androgens: Mechanism of Action

Effects are similar to the body's endogenous androgens. - Stimulate normal growth and development of the male sex organs - Development and maintenance of male secondary sex characteristics - Stimulate increased synthesis of body proteins, aiding in the formation of muscular and skeletal proteins - Enhanced erythropoiesis

Anthelmintic Drugs: Adverse Effects

Effects vary with each drug. Common adverse effects: - Nausea - Vomiting - Diarrhea - Dizziness - Headache

Anticoagulants: Drug Interactions

Enzyme inhibition of metabolism Displacement of the drug from inactive protein-binding sites Decrease in vitamin K absorption or synthesis by the bacterial flora of the large intestines Alteration in the platelet count or activity

Antihypertensive Drugs: Miscellaneous

Eplerenone (Inspra) - New class of drugs called selective aldosterone blockers - Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain - Indications: routine treatment of hypertension and for post-MI HF Sildenafil and Tadalafil - Commonly used for erectile dysfunction - Also used for pulmonary hypertension but with different trade names (Sildenafil: Revatio & Tadalafil: Adcirca) Treprostinil (Remodulin) - Lowers blood pressure through a combined mechanism of action - Dilating pulmonary and systemic blood vessels - Inhibiting platelet aggregation - Used for treatment of pulmonary artery hypertension

Anemia Drugs: Erythropoiesis Stimulating Agent:

Epoetin alfa (Epogen) - Longer acting form of epoetin called darbepoetin (Aranesp) - Contraindications: drug allergy, uncontrolled hypertension, hemoglobin levels are above 10 g/dL for cancer patients and 11 g/dL for renal patients, head and neck cancers, risk of thrombosis. - Most frequent adverse effects: hypertension, fever, headache, pruritus, rash, nausea, vomiting, arthralgia, and injection site reaction

Women's Health Drugs/Osteoporosis: Risk Factors

European or Asian descent Slender body build Early estrogen deficiency Smoking Alcohol consumption Low-calcium diet Sedentary lifestyle Family history

Thyroid Crisis (Thyroid Storm)

Exacerbation of hyperthyroidism and is potentially life threatening Assess for precipitating causes - Stress - Infection Assess for drug interactions

Antiepileptics: Mechanism of Action

Exact MOA is unknown. Reduced nerve's ability to be stimulated. Suppress transmission of impulses from one nerve ti the next. Decreased speed of nerve impulses conduction within a neuron.

Electrolytes/Potassium: Background Information (Cont.)

Excessive potassium loss (rather than poor dietary intake) - Alkalosis, Corticosteroids, Diarrhea, Ketoacidosis, Laxative misuse, Hyperaldosteronism, Increased secretion of mineralocorticoids, Burns, Thiazide, thiazide-like, and loop diuretics, Vomiting, Malabsorption, & others Potassium is responsible for: - Muscle contraction - Transmission of nerve impulses - Regulation of heartbeat - Maintenance of acid-base balance - Isotonicity

Muscle Relaxants: Adverse Effects

Extension of effects on CNS and skeletal muscles Euphoria Lightheadedness Dizziness Drowsiness Fatigue Muscle weakness, others

Antilipemic Drugs: Miscellaneous

Ezetimibe (Zetia) - Inhibits absorption of cholesterol and related sterols from the small intestine - Results in reduced total cholesterol, LDL, and triglyceride levels - Also increases HDL levels - Often combined with a statin drug - Can be used as monotherapy PSCK-9 Inhibitors - Proprotein convertase subtilisin kein (PCSK9) - Serine protease produced in the liver that leads to an increased low-density lipoprotein cholesterol level - Shown to significantly lower LDL-C levels - Alirocumab (Praluent) - Evolocumab (Repatha)

Vitamin D

Fat soluble "Sunshine vitamin" Responsible for proper utilization of calcium and phosphorus Vitamin D2 (ergocalciferol) - Plant vitamin D - Obtained through dietary sources Vitamin D3 (cholecalciferol) - Produced in the skin by ultraviolet irradiation Vitamin D2-containing foods - Fish liver oils, saltwater fish - Fortified foods: milk, orange juice, cereals - Animal livers, eggs, butter, dairy products Endogenous synthesis in the skin

Vitamin E

Fat soluble Four forms: alpha, beta, gamma, and delta tocopherol Dietary plant sources - Fruits, grains, fortified cereals, vegetable oils, wheat germ, nuts Animal sources - Eggs, chicken, meats, fish

Vitamin K

Fat soluble Three types: phytonadione (vitamin K1), menaquinone (vitamin K2), and menadione (vitamin K3) Body does not store large amounts of vitamin K. Vitamin K2 is synthesized by the intestinal flora. Dietary sources of K1 - Green leafy vegetables (broccoli, cabbage, spinach, kale), cheese, soybean oils

Vitamin A

Fat soluble Vitamin A (retinol) food sources: liver, fish, dairy products, egg yolks, dark green leafy vegetables, and yellow-orange vegetables and fruits Vitamin A comes from carotenes, which are found in plants (green and yellow vegetables and yellow fruits). Retinol, retinyl palmitate, and retinyl acetate Vitamin A (Aquasol A), also known as retinol, retinyl palmitate, and retinyl acetate

ACE Inhibitors: Adverse Effects

Fatigue Dizziness Headache Mood changes Impaired taste term-35 Possible hyperkalemia Dry, nonproductive cough, which reverses when therapy is stopped Angioedema: rare but potentially fatal Note: First-dose hypotensive effect may occur

Diuretics: Mechanism of Action

First-line antihypertensives in the JNC 8 guidelines for the treatment of hypertension Decrease plasma and extracellular fluid volumes Results - Decreased preload - Decreased CO - Decreased total peripheral resistance Overall effect - Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for hypertension.

Antitubercular Drugs List

First-line drugs : - INH: primary drug used - Rifapentine - Ethambutol - Rifabutin - Pyrazinamide (PZA) - Rifampin - Streptomycin Second-line drugs: - Capreomycin - Cycloserine - Levofloxacin - Ethionamide - Ofloxacin - Kanamycin - Para-aminosalicylic acid (PAS)

Antifibrinolytic Drugs: Mechanism of Action

Hemostatic Drugs: Promote coagulation Prevent the lysis of fibrin Result in promoting clot formation

Anticoagulants: Nursing Implications

Heparin ! IV doses are usually double checked with another nurse. ! Ensure that subcutaneous doses are given subcutaneously, not intramuscularly. ! Subcutaneous doses should be given in areas of deep subcutaneous fat and sites rotated. ! Do not give subcutaneous doses within 2 inches of:The umbilicus, abdominal incisions, open wounds, scars, drainage tubes, or stomas ! Do not aspirate subcutaneous injections or massage the injection site ! May cause hematoma formation ! IV doses may be given by bolus or IV infusions. ! Anticoagulant effects are seen immediately. ! Laboratory values are done daily to monitor coagulation effects (aPTT). ! Protamine sulfate can be given as an antidote in case of excessive anticoagulation.

Antiretroviral Drugs

Highly active antiretroviral therapy - Includes at least three medications - These medications work in different ways to reduce the viral load. Reverse transcriptase inhibitors (RTIs) - Block activity of the enzyme reverse transcriptase, preventing production of new viral DNA PIs - Inhibit the protease retroviral enzyme, preventing viral replication Fusion inhibitors - Inhibit viral fusion, preventing viral replication Entry inhibitor: CCR5 coreceptor antagonists HIV integrase strand transfer inhibitors

Acid-Controlling Drugs/Antacids: Sodium Bicarbonate

Highly soluble Buffers the acidic properties of HCl Quick onset but short duration May cause metabolic alkalosis Sodium content may cause problems in patients with heart failure (HF), hypertension, or renal insufficiency.

Insulin (Fixed Combination)

Humulin 70/30 Humulin 50/50 Novolin 70/30 Humalog Mix 75/25 Humalog 50/50 NovoLog 70/30 Each contains two different insulins, fixed combinations - One intermediate-acting type - Either one rapid-acting type (Humalog, NovoLog) or one short-acting type (Humulin)

Vasodilators: Specific Uses

Hydralazine - Orally: routine cases of essential hypertension - Injectable: hypertensive emergencies - BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients Nitroprusside: - Used in the intensive care setting for severe hypertensive emergencies; titrated to effect by IV infusion - Contraindications: known hypersensitivity to the drug, severe HF, and known inadequate cerebral perfusion (especially during neurosurgical procedures)

Thiazide and Thiazide-Like Diuretics: Indications

Hypertension (one of the most prescribed group of drugs for this) Edematous states Idiopathic hypercalciuria Diabetes insipidus HF caused by diastolic dysfunction Adjunct drugs in treatment of edema related to HF, hepatic cirrhosis, or corticosteroid or estrogen therapy

Interferons: Effects

Immune System: - Restore the immune system's function if it is impaired. - Augment the immune system's ability to function as the body's defense. - Inhibit the immune system from working: Helpful in autoimmune disorders

Transplant Medications

Immunosuppresants: Major class to prevent organ rejection - Glucocorticoids: inhibit all stages of T-cell activation and are used for induction, maintenance immunosuppression, and acute rejection - Calcineurin inhibitors: inhibit the phosphate required for interleukin-2 production - Antimetabolites: inhibit cell proliferation - Biologics: inhibit cytotoxic T killer cell function

Laxatives/Bulk forming: Adverse Effects

Impaction Fluid overload Electrolyte imbalances Esophageal blockage

Antineoplastic Enzymes: Adverse Effects

Impaired pancreatic function, which can lead to hyperglycemia and severe or fatal pancreatitis, dermatologic, hepatic, genitourinary, neurologic, musculoskeletal, GI, and cardiovascular effects

Ophthalmic Drugs/Ocular Antifungal Drugs

Natamycin (Natacyn) - Used topically to treat: •Blepharitis •Conjunctivitis •Keratitis

Blood Products: Adverse Effects

Incompatibility with recipient's immune system Crossmatch testing Transfusion reaction Anaphylaxis Transmission of pathogens to recipient (hepatitis, human immunodeficiency virus)

Cholinergics: Indications of Use (Indirect-acting drugs)

Increase ACh concentrations at the receptor sites, which leads to stimulation of the effector cells Cause skeletal muscle contractions Used for diagnosis and treatment of myasthenia gravis Used to reverse neuromuscular blocking drugs Used to reverse anticholinergic poisoning (antidote) •Examples: physostigmine pyridostigmine

Blood Products: Mechanism of Action

Increase colloid osmotic pressure and PV - Pull fluid from extravascular space into intravascular space (plasma expanders) - Red blood cell products also carry oxygen. - Increase body's supply of various products (e.g., clotting factors, hemoglobin)

Laxatives/Hyperosmotic: Mechanism of Action

Increase fecal water content Results in bowel distention, increased peristalsis, and evacuation Examples - Polyethylene glycol (PEG) - Sorbitol, glycerin - Lactulose (also used to reduce elevated serum ammonia levels)

Cardiac Glycosides: Mechanism of Action

Increase myocardial contractility Change electrical conduction properties of the heart - Decrease rate of electrical conduction - Prolong the refractory period (Area between SA node & AV node)

Antibiotics/Tetracyclines

Natural and semisynthetic Obtained from cultures of Streptomyces Bacteriostatic: inhibit bacterial growth Inhibit protein synthesis Stop many essential functions of the bacteria

Laxatives/Saline: Mechanism of Action

Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines Results in bowel distention, increased peristalsis, and evacuation Examples - Magnesium hydroxide (Milk of Magnesia) - Magnesium citrate (Citroma)

Acid-Controlling Drugs/Proton Pump Inhibitors (PPIs): Drug Interactions

Increase serum levels of diazepam and phenytoin Warfarin: increased chance of bleeding Absorption of ketoconazole, ampicillin, iron salts, and digoxin Clopidogrel Sucralfate: may delay the absorption of PPIs Food may decrease absorption of the PPIs.

Antibiotics/Aminoglycosides

Natural and semisynthetic Produced from Streptomyces spp. Poor oral absorption; no oral forms (exception: neomycin) Very potent antibiotics with serious toxicities Bactericidal; prevent protein synthesis Kill mostly gram-negative bacteria; some gram-positive bacteria

Interleukins: Background Information

Natural part of the immune system: classified as lymphokines Beneficial antitumor action IL receptor agonists and antagonists: - Aldesleukin (IL-2) - Oprelvekin (IL-11)* - Tocilizumab (IL-6) - Anakinra (IL-1) - Secukinumab (IL-17a)

Antibiotics/Penicillin

Natural penicillins - Penicillin G - Penicillin V Penicillinase-resistant drugs - Nafcillin - Cloxacillin - Oxacillin - Dicloxacillin Aminopenicillins - Amoxicillin - Ampicillin Extended-spectrum drugs - Carbenicillin - Piperacillin - Ticarcillin - Piperacillin/tazobactam

Adrenergic Drugs/ Beta Receptor Blocker

Nebivolol (Bystolic)

Vitamin B6 (Pyridoxine): Function

Necessary for many metabolic functions - Protein, lipid, and carbohydrate utilization - Conversion of tryptophan to niacin Necessary for integrity of peripheral nerves, skin, mucous membranes, hematopoietic system Deficiency s/s: - Sideroblastic anemia - Neurologic disturbances - Seborrheic dermatitis - Cheilosis (chapped, fissured lips) - Glossitis, stomatitis - Epileptiform convulsions - Hypochromic microcytic anemia Causes of Deficiency: Inadequate intake Poor absorption Uremia, alcoholism, cirrhosis, hyperthyroidism, malabsorption, heart failure Drug induced (isoniazid, hydralazine, others)

Antidiarrheals/ Adsorbents: Adverse Effects

Increased bleeding time Constipation, dark stools Confusion Tinnitus Metallic taste Blue tongue

Antidepressants/ Tricyclic Antidepressants: Mechanism of Action

Increased levels of neurotransmitter concentration in CNS --> thought to correct abnormally low levels taht lead to depression Block reuptake of neurotransmitters, cause accumulation at the nerve endings

Cardiac Glycosides: Drug Effects (General)

Increased stroke volume Reduction in heart size during diastole Decrease in venous BP and vein engorgement Increase in coronary circulation Decrease in exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis Improved symptom control, quality of life, and exercise tolerance No apparent reduction in mortality

Osmotic Diuretics: Drug Effects

Increases glomerular filtration rate and renal plasma flow; helps to prevent kidney damage during ARF Reduces intracranial pressure or cerebral edema associated with head trauma Reduces excessive intraocular pressure

Laxatives/Stimulant: Mechanism of Action

Increases peristalsis via intestinal nerve stimulation Examples - Senna (Senokot) - Bisacodyl (Dulcolax)

Antidepressants (General): Indication of Use

Indicated for major depressive disorders Other indications: - Dysthymia (chronic low-grade depression) - As adjunct for schizophrenia - Eating disorders - Personality disorders Various medical conditions: Migraine headaches, Chronic pain/sleep disorders, Premenstrual syndrome, Hot flashes associated with menopause

Antiplatelet Drugs: Adverse Effects & Indication

Indications: Antithrombotic effects Adverse effects: Vary according to drug

Adrenergic Drugs: Indications/Contraindications

Indications: - All used to treat hypertension - Glaucoma - BPH: doxazosin, prazosin, and terazosin - Management of severe heart failure (HF) when used with cardiac glycosides and diuretics Contraindications: - Acute HF - MOAIs - Peptic ulcers - Severe liver/kidney disease - Asthma (with beta blockers)

Women's Health Drugs/Uterine Relaxants

Indomethacin - Nonsteroidal antiinflammatory agent - Inhibits prostaglandin activity Nifedipine - Calcium channel blocker - Inhibits myometrial activity by blocking calcium influx When indomethacin and nifedipine are ineffective and delivery is proceeding, corticosteroids (betamethasone or dexamethasone) are administered to the mother to promote lung maturity in the fetus between 24 and 34 weeks of gestation.

Vitamin A: Toxicity

Ingestion of excessive amounts causes toxicity: - Irritability, drowsiness, vertigo, delirium, vomiting, other symptoms - Increased intracranial pressure in infants - Generalized peeling of the skin and erythema over several weeks

ACE Inhibitors: Mechanism of Action

Inhibit ACE - ACE: converts angiotensin I (AI) (formed through the action of renin) to angiotensin II (AII) AII: potent vasoconstrictors that induce aldosterone secretion by the adrenal glands - Aldosterone: stimulates sodium and water resorption, which can raise BP - Renin-angiotensin-aldosterone system - ACE inhibitors thus lower BP. Large group of safe and effective drugs - Currently are 10 ACE inhibitors Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic or CCB

Antiemetics and Antinausea Drugs/Antihistamine Drugs: Mechanism of Action and other Indications of Use

Inhibit ACh by binding to H1 receptors Prevent cholinergic stimulation in vestibular and reticular areas, thus preventing nausea and vomiting Also used for motion sickness, nonproductive cough, allergy symptoms, sedation Examples •Dimenhydrinate (Dramamine) •Diphenhydramine (Benadryl) •Meclizine (Antivert)

HMG-CoA Reductase Inhibitors: Mechanism of Action

Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol Lower the rate of cholesterol production

Heart Failure/ ACE Inhibitors: Mechanism of Action

Inhibit angiotensin-converting enzyme. Responsible for converting angiotensin I to angiotensin II Prevent sodium and water resorption by inhibiting aldosterone secretion. Diuresis results, which decreases preload, or the left ventricular end-volume, and the work of the heart Examples: lisinopril, enalapril, fosinopril, quinapril, captopril, ramipril, trandolapril, and perindopril

Antiplatelets Drugs: Mechanism of Action

Inhibit platelet aggregation Prevent platelet plugs Prevent platelet adhesion

Antiemetics and Antinausea Drugs/Neurokinin receptor antagonists: Mechanism of Action and other Indications of Use

Inhibit substance P/neurokinin 1 receptors in the brainstem Used in conjunction with serotonin blockers and glucocorticoids Use augments the serotonin blockers and glucocorticoids to inhibit acute and delayed phases of chemotherapy-induced emesis. Examples •Aprepitant •Fosaprepitant

Antidepressants/ MAO-B Inhibitor: Mechanism of Action

Inhibit the MAO enzyme system in the CNS; therefore dopamine, serotonin, and norepinephrine are not broken down; and therefore, higher levels of these substances occur

Anticoagulants: Mechanism of Action

Inhibit the action or formation of clotting factors; Prevent clot formation AKA: antithrombotic drugs Have no direct effect on a blood clot that is already formed Prevent intravascular thrombosis by decreasing blood coagulability Used prophylactically to prevent - Clot formation (thrombus) - An embolus (dislodged clot)

Thiazide and Thiazide-Like Diuretics: Mechanism of Action

Inhibit tubular resorption of sodium, chloride, and potassium ions Action primarily in the distal convoluted tubule Result: water, sodium, and chloride are excreted Potassium is also excreted to a lesser extent. Dilate the arterioles by direct relaxation

Second Generation Antidepressants (SSRI)s: Mechanism of Action

Inhibition of serotonin reuptake and possible effects on norepinephrine and dopamine reuptake

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS): Mechanism of Action

Inhibition of the leukotriene pathway, the prostaglandin pathway, or both Blocking the chemical activity of the enzyme COX - COX-1: has a role in maintaining the gastrointestinal (GI) mucosa - COX-2

Second Generation Antidepressants (SSRI)s: Adverse Effects

Insomnia (partly cause by reduced REM sleep), weight gain, sexual dysfunction Serotonin Syndrome: - Common Symptoms: Delirium, Agitation, Tachycardia, Sweating, Myoclonus (muscle spasms), Hyperreflexia, Shivering, Course tremors, Extensor plantar muscles (sole of foot) response - More severe symptoms: Hyperthermia, Seizures, Rhabdomyolysis, Renal failure, Cardiac dysrhythmias, Disseminated intravascular coagulation

Antidiabetic Drugs: Types

Insulins Oral hypoglycemic drugs - Both aim to produce normal blood glucose states Some new injectable hypoglycemic drugs may be used in addition to insulin or antidiabetic drugs.

Local Anesthetics: Mechanism of Action

Interfere with nerve impulse transmission to specific areas of the body but do not cause loss of consciousness; Render a specific portion of the body insensitive to pain. (AKA: Regional anesthetics) 2 Kinds: Topical & Parenteral (IV/Injection to CNS)

Insulin (Immediate Acting)

Intermediate acting: Insulin isophane suspension (also called NPH) - Cloudy appearance - Often combined with regular insulin - Onset—1 to 2 hours - Peak—4 to 8 hours - Duration—10 to 18 hours

Dermatologic Drugs/Skin Preparation Drugs

Isopropyl alcohol Povidone-iodine (Betadine) Chlorhexidine (Hibiclens) Benzalkonium chloride (Zephiran)

Mood Stabilizing Drugs (Lithium): Mechanism of Action

Its mechanism of action is poorly understood Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine + dopamine Potentiates serotonergic neurotransmission

Antimalarial Drugs: Drug Effects

Kill parasitic organisms Hydroxychloroquine - Has antiinflammatory effects - Sometimes used in the treatment of rheumatoid arthritis and systemic lupus erythematosus Quinine and quinidine - Decrease the excitability of both cardiac and skeletal muscles - Quinidine is still currently used to treat certain types of cardiac dysrhythmias.

Men's Health Drugs: Contraindications

Known androgen-responsive tumors Sildenafil, vardenafil, tadalafil, and avanafil: contraindicated in men with major cardiovascular disorders, especially if they use nitrate medications such as nitroglycerin Use of finasteride is contraindicated in women (especially pregnant women) and children.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS): Contraindications

Known drug allergy Patients with documented aspirin allergy must not receive NSAIDs. Conditions that place the patient at risk for bleeding: - Vitamin K deficiency - Peptic ulcer disease

Antidyrhythnmic Drugs: Contraindications

Known drug allergy 2n or 3rd degree AV block, bundle branch block, cardiogenic shock, sick sinus syndrome, and any other ECG changes depending on the clinical judgment of a cardiologist. Other antidysrhythmic drugs

Antianginal /Calcium Channel Blockers: Contraindications

Known drug allergy Acute MI 2nd or 3rd degree AV block (unless the patient has a pacemaker) Hypotension

Carbonic Anhydrase Inhibitors: Contraindications

Known drug allergy Hyponatremia Hypokalemia Severe renal or hepatic dysfunction Adrenal gland insufficiency Cirrhosis

Nitrates: Contraindications

Known drug allergy Severe anemia Closed-angle glaucoma Hypotension Severe head injury Use of the erectile dysfunction drugs sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)

Fibric Acid Derivatives: Contraindications

Known drug allergy Severe liver or kidney disease Cirrhosis Gallbladder disease

Women's Health Drugs/Contraceptive Drugs: Contraindications

Known drug allergy to a specific product Pregnancy Known high risk for or history of thromboembolic events such as MI, venous thrombosis, PE, or stroke

ACE Inhibitors: Nursing Implications

LAB VALUES: ! ACE inhibitors can cause renal impairment, which can be identified with serum creatinine. ! ACE inhibitors can also cause hyperkalemia, so potassium levels need to be monitored.

Anticoagulants: Nursing Implications (Cont.)

LMWH: ! Given subcutaneously in the abdomen ! Rotate injection sites. ! Protamine sulfate can be given as an antidote in case of excessive anticoagulation. Coumadin (Warfarin): ! May be started while the patient is still on heparin until PT/INR levels indicate adequate anticoagulation ! Full therapeutic effect takes several days. ! Monitor PT/INR regularly; keep follow-up appointments. ! Antidote is vitamin K. ! Many herbal products have potential interactions; increased bleeding may occur: Capsicum pepper, Garlic, Ginger, Ginkgo, St. John's wort, Feverfew

Adrenergic Drugs: Dual-Action Alpha1 & Beta Receptor

Labetalol and carvedilol - Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade)

Nonsteroidal Anti-inflammatory Drugs (NSAIDS)

Large and chemically diverse group of drugs with the following properties: - Analgesic - Antiinflammatory - Antipyretic - Aspirin-platelet inhibition

Loop Diuretics: Interactions

Neurotoxic Nephrotoxic Increase serum levels of uric acid, glucose, alanine aminotransferase, and aspartate aminotransferase. Thiazide (metolazone): sequential nephron blockade Nonsteroidal antiinflammatory drugs (NSAIDs)

Antithyroid Drugs: Adverse Effects

Liver and bone marrow toxicity is the most damaging or serious adverse effect.

Women's Health Drugs/Progestins: Adverse Effects

Liver dysfunction: cholestatic jaundice Thrombophlebitis, thromboembolic disorders, such as pulmonary embolism (PE) Nausea, vomiting Amenorrhea, spotting Edema, weight gain or loss

Antifungal Drugs: Contraindications

Liver failure Renal failure Porphyria (griseofulvin) Drug allergy Most common: drug allergy, liver failure, kidney failure, and porphyria (for griseofulvin) Itraconazole: contraindicated treatment of onychomycoses in patients with severe cardiac problems Voriconazole can cause fetal harm in pregnant women.

Insulin (Long Acting)

Long acting: Insulin glargine (Lantus) - Clear, colorless solution - Constant level of insulin in the body - Usually dosed once daily - Can be dosed every 12 hours - Referred to as basal insulin - Onset: 1 to 2 hours - Peak: none - Duration: 24 hours - Toujeo: more concentrated U-300 Insulin detemir (Levemir) - Duration of action is dose dependent. - Lower doses require twice-daily dosing. - Higher doses may be given once daily. Insulin glargine (Basaglar) - Biosimilar insulin - U100 Insulin degludec (Tresiba) - Ultra long acting - Once daily - U100 or U200

Vitamin D: Toxicity

Long-term ingestion of excessive amounts causes toxicity: - Hypertension, weakness, fatigue, headache - Anorexia, dry mouth, metallic taste, nausea, vomiting, abdominal cramps - Ataxia and bone pain - Can progress to impairment of renal

Angiotensin II Receptor Blockers

Losartan (Cozaar) Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) Also referred to as angiotensin II blockers Well tolerated Do not cause a dry cough that is common with ACE inhibitors

Women's Health Drugs/ Osteoporosis

Low bone mass Increased risk of fractures Primarily affects women - 40% of women over 50 years of age will develop osteoporotic fracture. 20% with this condition are men.

Thiazide and Thiazide-Like Diuretics: Drug Effects

Lowered peripheral vascular resistance Depletion of sodium and water (and potassium) Thiazides should not be used if creatinine clearance is less than 30 to 50 mL/min (normal is 125 mL/min). Metolazone remains effective to a creatinine clearance of 10 mL/min.

Antibiotics/Penicillin: Interactions

MANY interactions! - Nonsteroidal anti-inflammatory drugs - Oral contraceptives - Warfarin

Laxatives/Saline: Adverse Effects

Magnesium toxicity (with renal insufficiency) Cramping Electrolyte imbalances Diarrhea Increased thirst

NMBD: Indications of Use

Main Use: Facilitating controlled ventilation during surgical procedure, Endotracheal intubation (short acting), to reduce muscle contraction in an area that needs surgery, diagnostic drugs for Myasthenia Gravis.

Electrolytes/ Potassium: Indications

Main indication: - Treatment or prevention of potassium depletion when dietary means are inadequate Other therapeutic uses: - Stop irregular heartbeats - Management of tachydysrhythmias that can occur after cardiac surgery

Anxiolytics (Antianxiety)/ Benzodiazepines: Indication of Use

Main use: Anxiety, Symptoms of anxiety Also Used: alcohol withdrawl symptoms, insomnia, and muscle spasms as well as an adjunct for depresession

Opioid Analgesics: Indications of use

Main use: to alleviate moderate to severe pain. Often given with an adjuvant analgesic drug to assist primary drugs with pain relief . Also used for: cough center suppression, treatment of diarrhea, balanced anesthesia, certain drugs are used to treat opioid dependance

Antidepressants/ MAO-B Inhibitor: Indication of Use

Major depression

Antifungal Drugs: Interactions

Many antifungal drugs are metabolized by the cytochrome P-450 enzyme system. Co-administration of two drugs that are metabolized by this system may result in competition for these enzymes and thus higher levels of one of the drugs.

Antiemetics and Antinausea Drugs: Mechanism of Action

Many different mechanisms of action Most work by blocking one of the vomiting pathways, thus blocking the stimulus that induces vomiting.

Acid-Controlling Drugs/Antacids: Calcium Salts

Many forms but carbonate is most common May cause constipation, kidney stones Also not recommended for patients with renal disease—may accumulate to toxic levels Long duration of acid action—may cause increased gastric acid secretion (hyperacidity rebound) Often advertised as an extra source of dietary calcium Example: Tums (calcium carbonate)

Crystalloids: Adverse effects

May cause edema, especially peripheral or pulmonary May dilute plasma proteins, reducing COP Effects may be short-lived. Prolonged infusions may worsen alkalosis or acidosis.

Antiemetics and Antinausea Drugs/ Ginger: Drug Interactions

May increase absorption of oral medications Increase bleeding risk with anticoagulants

Women's Health Drugs/Uterine Stimulants

Medications used to alter uterine contractions Used to: - Promote labor - Prevent the start or progression of labor - Postpartum use: reduce the risk of postpartum hemorrhage Also called oxytocics - Oxytocin (hormonal drug) - Prostaglandins - Ergot derivatives - Progesterone antagonist mifepristone (RU-486)

Women's Health Drugs/Contraceptive Drugs

Medications used to prevent pregnancy Oral contraceptive medications - Monophasic, biphasic, and triphasic forms •Triphasic form most closely duplicates the normal hormonal levels of the female cycle. - Newest extended-cycle products - Most contain estrogen-progestin combinations Other contraceptive forms available - Long-acting injectable form of medroxyprogesterone - Transdermal contraceptive patch - Intravaginal contraceptive ring - Implantable rods

Antithyroid Drugs/ Thioamide Derivatives

Methimazole (Tapazole) Propylthiouracil Radioactive iodine (iodine 131) Potassium iodine

Antithyroid Drugs: Mechanism of Action

Methimazole and propylthiouracil Inhibits the incorporation of iodine molecules into the amino acid tyrosine, required to make the precursors of T3 and T4 - Impedes formation of thyroid hormone - Propylthiouracil also inhibits the conversion of T4 to T3in the peripheral circulation.

Benzodiazepines: Adverse Effects

Mild & Infrequent: - Headache - Drowsiness/ Dizziness/ Vertigo - Cognitive Impairment - Lethargy - Fall hazard in older adults - "Hangover" effect or daytime sleepiness

Non-Opioid Analgesics: Indications of Use

Mild to moderate pain, fever, Alternative to those who can not take aspirin products (little to no inflammatory effects) - Available OTC & in combination with opioids

HMG-CoA Reductase Inhibitors: Adverse Effects

Mild, transient gastrointestinal (GI) disturbances Rash Headache Elevations in liver enzymes or liver disease Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis - Breakdown of muscle protein - Myoglobinuria: urinary elimination of the muscle protein myoglobin - Can lead to acute renal failure and even death - When recognized reasonably early, rhabdomyolysis is usually reversible with discontinuation of the statin drug. - Instruct patients to immediately report any signs of toxicity, including muscle soreness or changes in urine color.

PDIs (Phosphodiesterase inhibitors)

Milrinone Only available phosphodiesterase inhibitor Only in injectable form. Adverse effects: cardiac dysrhythmias, headache, hypokalemia, tremor, thrombocytopenia, and elevated liver enzyme levels Interactions: diuretics (additive hypotensive effects) and digoxin (additive inotropic effects)

Ophthalmic Drugs/Cholinergics

Mimic the parasympathetic nervous system neurotransmitter acetylcholine Also called miotics, cholinergics Direct-acting and indirect-acting drugs Cause pupillary constriction (miosis), which leads to reduced IOP caused by increased outflow of aqueous humor Direct-acting cholinergic drugs - Acetylcholine (Miochol-E) - Carbachol (Carboptic) - Pilocarpine (Pilocar) (also ocular insert form) Indirect-acting cholinergic drugs Echothiophate (Phospholine Iodide)

Ophthalmic Drugs/Sympathomimetics

Mimic the sympathetic neurotransmitters epinephrine and norepinephrine Stimulate the dilator muscle to contract - Result is increased pupil size (mydriasis). - Enhance aqueous humor outflow through the canal of Schlemm IOP is reduced. Drugs: Apraclonidine (Iopidine) Brimonidine (Alphagan P) Dipivefrin (Propine) - Prodrug of epinephrine - When applied topically: •Hydrolyzed to epinephrine •Penetrates tissues better

Adrenal/Fludrocortisone (Florinef): Background Information

Mineralocorticoid Indications: Addison's disease and treatment of salt-losing adrenogenital syndrome Adverse effects: - Generally relate to water retention - Heart failure, hypertension, and elevated intracerebral pressure - Skin rash, peptic ulcers, hyperglycemia, hypokalemia - Muscle pain, weakness, compression bone fractures

Acid-Controlling Drugs/Antacids: Adverse Effects

Minimal and depend on the compound used - Overuse: metabolic alkalosis - Aluminum and calcium: constipation - Magnesium: diarrhea - Calcium: kidney stones, rebound hyperacidity - Calcium carbonate: produces gas and belching; often combined with simethicone

Antianginal Drugs: Therapeutic Objectives

Minimize the frequency of attacks and decrease the duration and intensity of anginal pain. Improve the patient's functional capacity with as few adverse effects as possible. Prevent or delay the worst possible outcome: MI.

Dermatologic Drugs/Antibacterials

Most common bacteria are Streptococcus pyogenes and Staphylococcus aureus - Folliculitis - Impetigo - Furuncles - Carbuncles - Cellulitis - Pustules - Vesicles - Papules Most common drugs - Bacitracin - Neomycin - Polymyxin - Neomycin and polymyxin B (Neosporin) - Mupirocin (Bactroban) •Unfortunately, because of the high incidence of infection with methicillin-resistant S. aureus (MRSA), mupirocin is now becoming resistant.

Vitamins and Minerals/Iron: Adverse Effects

Most common cause of pediatric poisoning deaths Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain Causes black, tarry stools Liquid oral preparations may stain teeth. Injectable forms cause pain upon injection.

Women's Health Drugs/Progestins

Most commonly used - Hydroxyprogesterone (Hylutin) - Levonorgestrel (Plan B) - Medroxyprogesterone (Provera, Depo-Provera) - Megestrol (Megace) - Norethindrone acetate (Aygestin) - Norgestrel (Ovrette, Ovral) - Progesterone (Prometrium) - Etonogestrel implant (Implanon)

Adrenal/Methylprednisone (Solu-Medrol): Background Information

Most commonly used injectable glucocorticoid drug Primary use: antiinflammatory or immunosuppressant drug Usually administered intravenously Available in a long-acting (depot) formulation Most injectable formulations contain a preservative (benzyl alcohol) that cannot be given to children younger than 28 days of age.

Adrenal/Prednisone: Background Information

Most commonly used oral glucocorticoid for antiinflammatory or immunosuppressant purposes Also used to treat exacerbations of chronic respiratory illnesses Inadequate for the management of adrenocortical insufficiency (Addison's disease)

Vitamins and Minerals/Ferrous Sulfate

Most frequently used oral iron 300 mg BID or TID for adults Each tablet contains 65 mg of elemental iron.

Ophthalmic Drugs/Cholinergics: Adverse Effects

Most limited to local effects If sufficient amounts enter the bloodstream, systemic effect may occur (most likely with indirect-acting agents): - Hypotension, bradycardia, or tachycardia - Headache, nausea, vomiting, diarrhea, abdominal cramps, asthma attacks

Antiviral Drugs (Non-HIV): Mechanism of Action

Most of the current antiviral drugs work by blocking the activity of a polymerase enzyme that normally stimulates the synthesis of new viral genomes. Used to treat non-HIV viral infections - Influenza viruses - HSV, VZV - CMV - Hepatitis

Antilipemics/ HMG-CoA Reductase Inhibitors (Statins)

Most potent LDL reducers - Lovastatin (Mevacor) - Pravastatin (Pravachol) - Simvastatin (Zocor) - Atorvastatin (Lipitor) - Fluvastatin (Lescol) - Rosuvastatin (Crestor) - Pitavastatin (Livalo)

Antibiotics/Cephalosporins: (third generation)

Most potent group against gram-negative bacteria Less active against gram-positive bacteria Examples: - Cefotaxime (Claforan) - Ceftazidime (Fortaz) - Cefdinir (Omnicef) - Ceftizoxime (Cefizox) - Ceftriaxone (Rocephin) - Cefpodoxime - Ceftibuten (Cedax) Ceftriaxone (Rocephin) - IV and IM, long half-life, once-a-day dosing - Elimination is primarily hepatic. - Easily passes meninges and diffused into cerebrospinal fluid to treat central nervous system infections. Ceftazidime (Ceptaz, Fortaz, Tazidime) - IV and IM forms - Excellent gram-negative coverage - Used for difficult-to-treat organisms such as Pseudomonas spp. - Excellent spectrum of coverage - Resistance is limiting usefulness.

Mood Stabilizing Drugs (Lithium): Adverse Effects

Most serious adverse effect is cardiac dysrhythmia. Other effects: drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension Long-term treatment may cause hypothyroidism.

Adrenal Drugs: Interactions

Multiple drug interactions, including: - Non-potassium-sparing diuretics (e.g., thiazides, loop diuretics) can lead to severe hypocalcemia and hypokalemia. - Aspirin, other nonsteroidal antiinflammatory drugs (NSAIDs), and other ulcerogenic drugs produce additive GI effects and an increased chance of gastric ulcer development. - Anticholinesterase drugs produce weakness in patients with myasthenia gravis. - Immunizing biologics inhibit the immune response to the biologic. - Antidiabetic drugs may reduce the hypoglycemic effects of the latter and result in elevated blood glucose levels. - Others

Ophthalmic Drugs: Drugs That Affect the Eye

Mydriatics (apraclonidine) - Dilate the pupil Miotics (acetylcholine, pilocarpine) - Constrict the pupil Cycloplegics (atropine, cyclopentolate) - Paralyze the ciliary body - Have mydriatic properties - Cycloplegia: paralysis of accommodation

Antiepileptics: Adverse Effects

Numerous adverse effects; vary per drug and often necessitate a change in medication BLACK BOX WARNING: Suicidal thoughts and behavior Long term therapy with phenytoin (Dilatin) may cause gingival hyperplasia. acne, hirsutism, and Dilatin faces

Antiretroviral Drugs: Adverse Effects

Numerous and vary with each drug Drug therapy may need to be modified because of adverse effects Goal is to find the regimen that will best control the infection with a tolerable adverse effect profile Medication regimens change during the course of the illness

Laxatives/Stimulant: Adverse Effects

Nutrient malabsorption Skin rashes Gastric irritation Electrolyte imbalances Discolored urine Rectal irritation *All laxatives can cause electrolyte imbalances

Vitamins and Minerals/Magnesium: Indications of Use

Nutritional supplement Treatment of magnesium deficiency - Anticonvulsant in magnesium deficiency - Preeclampsia and eclampsia - Tocolytic drug for inhibition of uterine contractions in premature labor - Pediatric acute nephropathy - Cardiac dysrhythmias - Short-term treatment of constipation

Pituitary Drugs (Specific): Nursing Implications

Octreotide (Sandostatin) ! May impair gallbladder function; instruct patient to report abdominal pain. ! Use with caution in patients with renal impairment. ! Monitor glucose levels in patients with diabetes and even in those who do not have diabetes. ! Can be given intravenously, intramuscularly, or subcutaneously

Otic Drugs/Antibacterial and Antifungal Drugs

Often combined with steroids for antiinflammatory, antipruritic, and antiallergic drug effects Treat outer and middle ear infections Middle ear infections generally require systemically administered antibiotics. Antibiotics - Neomycin and polymyxin B plus hydrocortisone combination (Cortisporin Otic) = Others containing ciprofloxacin and dexamethasone (Ciprodex) - Fluoroquinolone: Ofloxacin Antifungals - Cortic (combination of antifungal drugs and hydrocortisone) - Acetasol HC (hydrocortisone, local anesthetic, antiseptic antifungal, emulsifier, and antiseptic preservative)

Monoclonal Antibody Antiasthmatic

Omalizumab (Xolair), mepolizumab (Nucala), reslizumab (Cinqair) - Selectively binds to the immunoglobulin E, which in turn limits the release of mediators of the allergic response - Given by injection - Potential for producing anaphylaxis - Monitor closely for hypersensitivity reactions.

Vitamin B3 (Niacin): Functions

Once ingested, converted to nicotinamide Nicotinamide is converted to two coenzymes. These enzymes are required for: - Glycogenolysis, tissue respiration - Lipid, protein, and purine metabolism

Cardiac Glycosides: Background Information

One of the oldest groups of cardiac drugs No longer used as first-line treatment Not been shown to reduce mortality in HF patients Originally obtained from Digitalis plant, foxglove Digoxin is the prototype. Used in HF and to control ventricular response to atrial fibrillation

Vitamins and Minerals/Magnesium

One of the principal cations of intracellular fluid Essential for enzyme systems associated with energy metabolism Required for: - Nerve physiology Muscle contraction Dietary sources - Green, leafy vegetables - Meats, seafood, milk, cheese, yogurt - Bran cereal, nuts Required in higher amounts for those with diets high in protein-rich foods, calcium, and phosphorus

Ophthalmic Drugs/Cholinergics: Indications of Use

Open-angle glaucoma Angle-closure glaucoma Ocular surgery Convergent strabismus ("cross-eye") Ophthalmologic exams

Ophthalmic Drugs/Antiallergic Drugs

Ophthalmic antihistamines - Used to treat symptoms of allergic conjunctivitis ("hay fever") - Azelastine (Optivar) - Olopatadine (Patanol) - Emedastine (Emadine) - Ketotifen (Zaditor) Epinastine (Elestat) Used for seasonal allergy symptoms - Mast cell stabilizers •Cromolyn sodium (Crolom) •Pemirolast (Alamast) •Nedocromil (Alocril) •Lodoxamide (Alomide) - Decongestants •Tetrahydrozoline •Phenylephrine (Neo-Synephrine) •Oxymetazoline (Visine LR) Naphazoline (Clear Eyes)

Antitussives: Mechanism of Action

Opioids - Suppress the cough reflex by direct action on the cough center in the medulla - Analgesia, drying effect on the mucosa of the respiratory tract, increased viscosity of respiratory secretions, reduction of runny nose and postnasal drip - Examples: Codeine & Hydrocodone Nonopioids - Dextromethorphan: works in the same way - Not an opioid - No analgesic properties - No CNS depression - Benzonatate - Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and prevent reflex stimulation of the medullary cough center

Vitamin B12 (Cyanocobalamin): Oral Absorption

Oral absorption of vitamin B12 (extrinsic factor) requires presence of the intrinsic factor. The intrinsic factor is a glycoprotein secreted from the gastric parietal cells. Oral absorption of cyanocobalamin requires the presence of intrinsic factor, which is secreted by gastric parietal cells.

Electrolytes/Sodium: Adverse Effects

Oral administration - Nausea, vomiting, cramps IV administration - Venous phlebitis

HMG-CoA Reductase Inhibitors: Interactions

Oral anticoagulants Drugs metabolized by CYP3A4 - Erythromycin - Azole antifungals - Verapamil - Diltiazem - Human immunodeficiency virus protease inhibitors - Amiodarone - Grapefruit juice

Fibric Acid Derivatives: Interactions

Oral anticoagulants Statins - Risk of myositis, myalgias, and rhabdomyolysis is increased. Laboratory test reactions - Decreased hemoglobin level, hematocrit value, and white blood cell count - Increased activated clotting time, lactate dehydrogenase level, and bilirubin level

Ophthalmic Drugs/Carbonic Anyhydrase Inhibitors: Adverse Effects

Oral forms can produce systemic effects: - Drowsiness, confusion - Transient myopia, tinnitus - Anorexia, vomiting, diarrhea - Several others Patients with sulfa allergies may develop cross-sensitivities.

Glucose Elevating Drugs

Oral forms of concentrated glucose - Buccal tablets, semisolid gel 50% dextrose in water (D50W) Glucagon

Electrolytes/Potassium: Adverse Effects

Oral preparations - Diarrhea, nausea, vomiting, GI bleeding, ulceration IV administration - Pain at injection site - Phlebitis - Rate of administration Excessive administration - Hyperkalemia - Toxic effects

Antibiotics/Quinolones: Interactions

Oral quinolones: antacids, calcium, magnesium, iron, zinc preparations, or sucralfate Patients need to take the interacting drugs at least 1 hour before or after taking quinolones. Dairy products Enteral tube feedings Probenecid Nitrofurantoin Oral anticoagulants

Antibiotics (Multidrug-Resistant Organisms)

Organisms that are resistant to one or more classes of antimicrobial drugs Methicillin-resistant Staphylococcus aureus (MRSA) Vancomycin-resistant Enterococcus (VRE) Organisms producing extended-spectrum beta-lactamases (ESBLs) Carbapenem-resistant Enterobacteriaceae (CRE)

Antibiotics (Multidrug-Resistant Organisms): ESBL

Organisms that produce ESBL are resistant to all beta-lactam antibiotics and aztreonam. Can be treated only with carbapenems or sometimes quinolones Use of carbapenems: resistance occurred; production of carbapenemase, which renders all carbapenems ineffective Tigecycline and colistimethate

Acid-Controlling Drugs/Antacids: Forms available

Over-the-counter (OTC) formulations available as: - Capsules and tablets - Powders - Chewable tablets - Suspensions - Effervescent granules and tablets Used alone or in combination - Aluminum salts - Magnesium salts - Calcium salts Sodium bicarbonate

Otic Drugs/External and Middle Ear Disorder Drugs

Over-the-counter agents Antibacterials Antifungals Antiinflammatories Local analgesics Local anesthetics Corticosteroids Earwax emulsifiers

Acid-Controlling Drugs/Histamine 2 (H2) Antagonists: Adverse Effects

Overall, very few adverse effects Central nervous system adverse effects in elderly patients include confusion and disorientation. Cimetidine may induce impotence and gynecomastia. Thrombocytopenia has been reported with ranitidine and famotidine.

Bile Acid Sequestrants: Considerations

Overdose can cause obstruction because the bile acid sequestrants are not absorbed. Treatment of overdose includes restoring gut motility. Drug interactions - All drugs must be taken at least 1 hour before or 4 to 6 hours after the administration of bile acid sequestrants. - High doses of a bile acid sequestrant decrease the absorption of fat-soluble vitamins (A, D, E, and K).

Depressants: Adverse Effects

Overexpression of their therapeutic effects CNS: Drowsiness, sedation, lack of coordination, dizziness, blurred vision, headaches, paradoxical reactions GI: Nausea, vomiting, constipation, dry mouth, abdominal cramping Misc: Chronic respiratory symptoms for marijuana smokers; memory and attention deficit problems; chronic depressive amotivational syndrome

Adrenocortical Hormones

Oversecretion leads to Cushing's syndrome. - "Moon face," "hump back," hirsutism, ecchymosis, hypertension, hypokalemia, hypernatremia, abnormal glucose tolerance, muscle atrophy Undersecretion leads to Addison's disease. - Decreased blood sodium and glucose levels, increased potassium levels, dehydration, weight loss

Nitrates and Nitrites: Drug Effects

Oxygen to ischemic myocardial tissue Used for prevention and treatment of angina

Acid-Controlling Drugs/Proton Pump Inhibitors (PPIs): Adverse Effects

PPIs are generally well tolerated. Possible predisposition to GI tract infections: Clostridium difficile Osteoporosis and risk of wrist, hip, and spine fractures in long-term users Pneumonia Depletion of magnesium Link between PPIs and dementia as well as development of lupus erythematous

Local Anesthetics: Drug effects

Paralysis - First, autonomic activity is lost. Then pain and other sensory functions are lost.Last, motor activity is lost. - As local drugs wear off, recovery occurs in reverse order (motor, sensory, then autonomic activity are restored).

Antibiotics (Beta-Lactam)

Penicillins Cephalosporins Carbapenems Monobactams

Antibiotics/Penicillin: Mechanism of Action

Penicillins enter the bacteria via the cell wall. Inside the cell, they bind to penicillin-binding protein. Once bound, normal cell wall synthesis is disrupted. Result: Bacteria cells die from cell lysis. Penicillins do not kill other cells in the body.

Barbiturates

Pentobarbital (Nembutal) Phenobarbital

Nutritional Supplements/Enteral Formulation Group: Elemental

Peptamen, Vital HN, Vivonex Plus, Vivonex TEN Minimal digestion needed; residual is minimal. Used for malabsorption, partial bowel obstruction, irritable bowel disease, other conditions Hyperosmolarity of formulas may cause GI problems.

Heart Failure/ Angiotensin Receptor-Neprilysin Inhibitors (ARNI): Mechanism of Action

Newer class of drugs: Valsartan/sacubitril (Entresto) Blocks the degradation of vasoactive peptides by inhibiting the neprilysin enzyme Common adverse effects: hypotension, hyperkalemia, increased serum creatinine

Ophthalmic Drugs/Prostaglandin Agonsists

Newest class of drugs for glaucoma - Xalatan (latanoprost) - Lumigan (bimatoprost) - Travatan Z (Travoprost) - Zioptan (tafluprost) - Vyzult (latanoprostene bunod) Reduce IOP by increasing the outflow of aqueous fluid Increase uveoscleral outflow of fluid Used in the treatment of glaucoma Most drugs allow for single daily dosing because of effects lasting for 20 to 24 hours. Effects on eye color - In some persons with hazel, green, or blue/brown eyes, eye color will change permanently to brown. - Color change occurs even if the medication is stopped.

Antianginal Drugs: Classifications

Nitrates or nitrites Beta blockers Calcium channel blockers (CCBs)

Leukotriene Receptor Antagonists (LTRAs): Background Information

NonbronchodilatingNewer class of asthma medications Currently available drugs: - Montelukast (Singulair) - Zafirlukast (Accolate) - Zileuton (Zyflo)

Ophthalmic Drugs/ Ocular Antiinflammatory Drugs

Nonsteroidal antiinflammatory drugs (NSAIDs) - Ketorolac (Acular) - Flurbiprofen (Ocufen) - Bromfenac (Xibrom) - Diclofenac (Voltaren) Corticosteroids - Dexamethasone (Decadron) - Fluocinonide (Retisert) - Fluorometholone (Fluor-Op, others) - Loteprednol (Lotemax, others) - Medrysone (HMS) - Prednisolone (Pred Forte, others) - Rimexolone (Vexol)

Crystalloids

Normal saline (NS; 0.9% sodium chloride) Half NS (0.45% sodium chloride) Hypertonic saline (3% sodium chloride) Lactated Ringer's solution Dextrose 5% in water (D5W)

Cholinergic: Indications of Use (Memantine (Namenda))

Not a cholinergic drug Also used in the treatment of Alzheimer's disease

Heart Failure Drugs

Positive inotropic drugs: increase the force of myocardial contraction Positive chronotropic drugs: increase heart rate Positive dromotropic drugs: accelerate cardiac conduction Phosphodiesterase inhibitors Cardiac glycosides Sinoatrial modulators Angiotensin receptor-neprilysin inhibitors ACE Inhibitors Angiotensin receptor blockers (ARBs) Beta blockers Diuretics

Cardiac Glycosides: Drug Effects (Specific)

Positive inotropic effect - Increased force and velocity of myocardial contraction (without an increase in oxygen consumption) Negative chronotropic effect - Reduced heart rate Negative dromotropic effect - Decreased automaticity at SA node, decreased AV nodal conduction, and other effects

Loop Diuretics: Mechanism of Action

Possess renal, cardiovascular, and metabolic effects Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption Increase renal prostaglandins, resulting in the dilation of blood vessels and reduced peripheral vascular resistance Useful in treatment of edema

Anorexiants: Adverse Effects

Possible elevated blood pressure and heart palpitations Anxiety Agitation Dizziness Headache Orlistat: fecal incontinence with oily stools

Loop Diuretics: Drug Effects

Potent diuresis and subsequent loss of fluid Decreased fluid volume causes a reduction in - Blood pressure - Pulmonary vascular resistance - Systemic vascular resistance - Central venous pressure - Left ventricular end-diastolic pressure - Potassium and sodium depletion

Immunosuppressants: Nursing Implications

Perform a thorough assessment before administering immunosuppressants: - Renal, liver, and cardiovascular function studies - Central nervous system baseline function - Respiratory assessment - Baseline vital signs - Baseline laboratory studies, including hemoglobin, hematocrit, white blood cell (WBC) count, and platelet count - Assess for contraindications, drug allergies, and drug interactions. - Monitor WBC counts throughout therapy; if the count drops below normal range, contact the prescriber. - Oral immunosuppressants should be taken with food to minimize gastrointestinal upset. - Oral forms are used when possible to decrease the risk of infection that may occur with parenteral injections. - Note that there are several possible drug interactions. - Grapefruit juice also interacts with some of these drugs.

Nutritional Supplements/Parenteral Nutrition Types

Peripheral TPN - Temporary, short term (less than 2 weeks) - Dextrose concentration generally less than 10% Central TPN - Long-term use (over 2 weeks) - Dextrose concentrations may be 10% to 50%, but are commonly 25% to 35%.

Immunization/ Natural Active

Person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organism.

Adrenergic Drugs: Beta Blockers

Propranolol, metoprolol, and atenolol - Reduction of the heart rate through beta1 receptor blockade - Cause reduced secretion of renin - Long-term use causes reduced peripheral vascular resistance.

Colloids: Background Information

Protein substances Increase COP Move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)

Inteferons: Background Information

Proteins with three basic properties 1. Antiviral 2. Antitumor 3. Immunomodulating - Used to treat certain viral infections and cancer: Alpha, beta, and gamma IFNs - Recombinantly manufactured substances that are identical to the IFN cytokines that are naturally present in the human body IFNs - Protect human cells from virus attack - Prevent cancer cells from dividing and replicating - Increase the activity of other cells in the immune system, such as macrophages, neutrophils, and NK cells - Recombinantly made IFNs are identical to the IFNs that are present within the human body and have the same properties. - IFNs protect human cells from viruses and prevent cancer cells from dividing and replicating.

Nutritional Supplements/Enteral Formulation Groups

Provide basic building blocks for anabolism Supply complete dietary needs through the GI tract by oral route or by feeding tube - Elemental Polymeric - Modular •Carbohydrate formulations •Fat formulations •Protein formulations - Altered amino acid formulations - Impaired glucose tolerance

Antipsychotics: Indications of Use

Psychotic illness, most commonly schizophrenia Anxiety & mood disorders Prochlorperazine: Antiemetics

Stimulants

Racemic amphetamine Dextroamphetamine Methamphetamine ("Ecstasy") Cocaine Methylphenidate Phenmetrazine

Hyperthyroidism Treatment

Radioactive iodine (I131) works by destroying the thyroid gland Surgery to remove all or part of the thyroid gland - Lifelong thyroid hormone replacement will be needed.

Women's Health Drugs/Osteoporosis: Drug Therapy: Indications of Use

Raloxifene - Primary use: prevention of postmenopausal osteoporosis Bisphosphonates: prevention and treatment of osteoporosis Teriparatide: subset of osteoporosis patients at highest risk of fracture (e.g., those with prior fracture) Calcitonin: treatment of osteoporosis

Antianginal Drugs: Miscellaneous

Ranolazine (Ranexa) - Mechanism of action is unknown. - Known to prolong the QT interval on the electrocardiogram - Reserved for patients who have failed to benefit from other antianginal drug therapy - Contraindications: pre-existing QT prolongation or hepatic impairment, in those taking other QT-prolonging drugs - Drug interactions

Insulin (Cont.)

Rapid-acting treatment for types 1 and 2 DM - Most rapid onset of action (5 to 15 minutes) - Peak: 1 to 2 hours - Duration: 3 to 5 hours - Patient must eat a meal after injection. - Insulin lispro (Humalog): similar action to endogenous insulin - Insulin aspart (NovoLog) - Insulin glulisine (Apidra) - May be given subcutaneously (SQ) or via continuous SQ infusion pump (but not intravenously [IV])

Adrenal Drugs: Adverse Effects

Potent effects on all body systems—part 1 - CV: heart failure, cardiac edema, hypertension—all caused by electrolyte imbalances (hypokalemia, hypernatremia) - CNS: convulsions, headache, vertigo, mood swings, nervousness, insomnia - Endocrine: growth suppression, Cushing's syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, hypothalamic-pituitary-adrenal axis suppression - GI: peptic ulcers, pancreatitis, ulcerative esophagitis, abdominal distension - Integumentary: fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria - Musculoskeletal: muscle weakness, loss of muscle mass, osteoporosis - Ocular: increased intraocular pressure, glaucoma, cataracts - Other: weight gain

Heart Failure/ Angiotensin II Receptor Blockers (ARBs): Mechanism of Action

Potent vasodilators; decrease systemic vascular resistance (afterload) Used alone or in combination with other drugs such as diuretics in the treatment of hypertension or HF Examples: valsartan (Diovan), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), olmesartan (Benicar), and losartan (Cozaar)

Adrenergic-Blocking drugs/Beta Blockers: Mechanism of Action (Cardioselective, beta 1)

Reduce SNS stimulation of the heart Decrease heart rate Prolong sinoatrial (SA) node recovery Slow conduction rate through the AV node Decrease myocardial contractility, thus reducing myocardial oxygen demand

Acid-Controlling Drugs/ Histamine 2 (H2) Antagonists

Reduce acid secretion All available OTC in lower dosage forms Most popular drugs for treatment of acid-related disorders - Cimetidine (Tagamet) - Nizatidine (Axid) - Famotidine (Pepcid) - Ranitidine (Zantac)

Cholinergics: Indications of Use (Direct-acting drugs)

Reduce intraocular pressure Useful for glaucoma and intraocular surgery •Echothiophate •Carbachol •Pilocarpine Topical application because of poor oral absorption

Anxiolytics (Antianxiety)/ Benzodiazepines: Mechanism of Action

Reduces anxiety by reducing overactivity in the CNS Benzodiazepines: Depress activity in the brainstem and limbic system

Ophthalmic Drugs/Beta-Adrenergic Blockers: Indications

Reduction of elevated IOP - Chronic open-angle glaucoma - Ocular hypertension Treatment of some forms of angle-closure glaucoma Administration of systemic beta blockers with high doses of ophthalmic beta blockers may result in additive effects.

Acid-Controlling Drugs/Antacids: Drug Effects

Reduction of pain associated with acid-related disorders > Raising the gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid. > Reducing acidity reduces pain as a result of: •Base-mediated inhibition of the protein-digesting ability of pepsin •Increase in the resistance of the stomach lining to irritation •Increase in the tone of the cardiac sphincter

Cholinergic-Blocking: Indications of Use (GU)

Reflex neurogenic bladder Incontinence

Expectorants: Mechanisms of Action

Reflex stimulation - Drug causes irritation of the GI tract. - Loosening and thinning of respiratory tract secretions occur in response to this irritation. Direct stimulation - The secretory glands are stimulated directly to increase their production of respiratory tract fluids. Final result: thinner mucus that is easier to remove

Electrolytes: Control

Renin-angiotensin-aldosterone system Antidiuretic hormone system Sympathetic nervous system

Vitamin A: Functions

Required for growth and development of bones and teeth (morphogenesis) Essential for night and normal vision (rhodopsin) Necessary for other processes: - Reproduction - Integrity of mucosal and epithelial surfaces - Cholesterol and steroid synthesis

Vitamins and Minerals/Phosphorus: Functions

Required precursor for the synthesis of essential body chemicals Building block for body structures Required for the synthesis of: - Nucleic acid - Adenosine diphosphate - Adenosine monophosphate - Adenosine triphosphate Responsible for cellular energy transfer Necessary for the development and maintenance of the skeletal system and teeth Several other functions Deficiency: Deficiency caused by nondietary causes - Malabsorption - Extensive diarrhea or vomiting - Hyperthyroidism - Long-term use of aluminum or calcium antacids - Hepatic disease

Insulin Dosing (Basal-Bolus)

Preferred method of treatment for hospitalized patients with DM Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus Basal insulin is a long-acting insulin (insulin glargine). Bolus insulin (insulin lispro or insulin aspart)

Vitamin B12 (Cyanocobalamin): Function

Present as two different coenzymes Required for many metabolic pathways - Fat and carbohydrate metabolism - Protein synthesis - Growth, cell replication - Hematopoiesis - Nucleoprotein and myelin synthesis Cyanocobalamin is a required coenzyme for many body processes. Deficiency: The most common manifestation of untreated cyanocobalamin deficiency is pernicious anemia. Deficiency leads to: - Neurologic damage - Megaloblastic anemia Deficiency states caused by: - Malabsorption - Poor dietary intake (vegetarians)

Vitamin B6 (Pyridoxine): Indications of Use

Prevent and treat vitamin B6 deficiency. Seizures that are unresponsive to usual therapy Morning sickness during pregnancy Patients with various metabolic disorders may respond to pyridoxine therapy.

NMBD: Mechanism of Action

Prevent nerve transmission in skeletal smooth muscle, resulting in muscle paralysis. Also paralyze the skeletal muscles required for breathing (the intercostal muscles and diaphragm) can be Depolarizing or Non-Depolarizing

Women's Health Drugs/Contraceptive Drugs: Mechanism of Action

Prevent ovulation by inhibiting the release of gonadotropins and increasing uterine mucus viscosity, resulting in: - Decreased sperm movement and fertilization of the ovum - Possible inhibition of implantation of a fertilized egg (zygote)

Potassium-Sparing Diuretics: Drug Effects

Prevent potassium from being pumped into the tubule, thus preventing its secretion. Competitively block aldosterone receptors and inhibit their action. Promote the excretion of sodium and water.

Antibiotics/Macrolides: Mechanism of Action

Prevent protein synthesis within bacterial cells Considered bacteriostatic Bacteria will eventually die In high enough concentrations, may also be bactericidal

Antibiotics/Penicillins: Indication of Use

Prevention and treatment of infections caused by susceptible bacteria, such as: - Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., Staphylococcus spp.

Vitamins and Minerals/Iron: Indications of Use

Prevention and treatment of iron-deficiency syndromes Administration of iron alleviates the symptoms of iron-deficiency anemia, but the underlying cause of the anemia should be corrected.

Vitamin B3 (Niacin): Indications of Use

Prevention and treatment of pellagra Antihyperlipidemic drug - Lowers serum cholesterol and triglyceride levels by reducing very-low-density lipoprotein synthesis - Doses required for this effect are higher than those required for its nutritional and metabolic effects. Niacin, once in the body, is converted to nicotinamide adenosine dinucleotide (NAD) and nicotinamide adenosine dinucleotide (NADP), which are coenzymes needed for many metabolic processes. Deficiency: Pellagra: niacin deficiency - Mental: various psychotic symptoms - Neurologic: neurasthenic syndrome - Cutaneous: crusting, erythema - Inflammation of mucous membranes: oral, vaginal, and urethral lesions; glossitis GI: diarrhea or bloody diarrhea

Antiepileptics: Indications of Use

Prevention or control of seizure activity Long term maintenance therapy fro chronic, recurring seizures Acute treatment of convulsions and status epilepticus

Fibric Acid Derivatives

Primarily affect the triglyceride levels but may also lower the total cholesterol and LDL levels and raise the HDL AKA: Fibrates - Gemfibrozil (Lopid) - Fenofibrate (Tricor)

Ophthalmic Drugs/Sympathomimetics: Adverse Effects

Primarily limited to ocular effects - Burning - Eye pain - Lacrimation Rare systemic effects - Hypertension - Tachycardia - Extrasystoles - Headache - Faintness

Ophthalmic Drugs/Beta-Adrenergic Blockers: Adverse Effects

Primarily ocular effects - Transient burning and discomfort - Blurred vision - Pain - Photophobia - Others Limited systemic effects - Headache - Dizziness - Cardiac irregularities - Bronchospasm

Women's Health Drugs/Contraceptive Drugs: Indications of Use

Primarily used to prevent pregnancy Other uses - Treatment of endometriosis and hypermenorrhea - Production of cyclic withdrawal bleeding - Postcoital emergency contraception

Calcium Channel Blockers: Mechanism of Action

Primary use: HTN and angina Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: - Decreased peripheral smooth muscle tone - Decreased SVR - Decreased BP

Men's Health Drugs: Indications of Use

Primary use: replacement therapy Other uses vary with the specific drug.

Analeptics: Indication of Use

Respiratory depression; Neonatal apnea; Narcolepsy

Hypothyroidism Information

Primary: abnormality in the thyroid gland itself Secondary: results when the pituitary gland is dysfunctional and does not secrete thyroid-stimulating hormone (TSH) Tertiary: results when the hypothalamus gland does not secrete thyrotropin-releasing hormone, which stimulates the release of TSH Goiter - Enlargement of the thyroid gland - Results from overstimulation by elevated levels of TSH - TSH is elevated because there is little or no thyroid hormone in circulation.

Electrolytes

Principal ECF electrolytes - Sodium cations (Na+) - Chloride anions (Cl−) Principal ICF electrolyte - Potassium (K+) Others: - Calcium, magnesium, phosphorus

Otic Drugs/Earwax Emulsifiers

Products that soften and help eliminate ear wax Carbamide peroxide (Debrox) - Combined with other drugs, such as glycerin, to loosen and help remove cerumen Ear canal irrigation with water may be needed.

Adrenergic: Indications of Use

Respiratory: Bronchodilators: drugs that stimulate beta2-adrenergic receptors of bronchial smooth muscles, causing relaxation, resulting in bronchodilation Examples: albuterol, ephedrine, epinephrine, formoterol, levalbuterol, metaproterenol, pirbuterol, and salmeterol Nasal: Intranasal (topical) application causes constriction of dilated arterioles and reduction of nasal blood flow, thus decreasing congestion. Alpha1-adrenergic receptors Examples: ephedrine, naphazoline, oxymetazoline, phenylephrine, and tetrahydrozoline Opthalmic: Temporary relief of conjunctival congestion (eyes) (Alpha-adrenergic receptors); Reduction of intraocular pressure and dilation of pupils: treatment of open-angle glaucoma (Alpha-adrenergic) receptors Examples: epinephrine, naphazoline, phenylephrine, tetrahydrozoline; Examples: epinephrine and dipivefrin Overactive Bladder: Relaxes the detrusor muscle during the storage phase of the bladder fill cycle. Increases bladder storage capacity Ex: Mirabegron (Myrbetriq) CV: (Pressors, Inotropes) (cardioselective sympathomimetics) Used to support the heart during cardiac failure or shock; various alpha and beta receptors affected

Serotonin Agonists (Triptans)

Sumatriptan Ergotamine (Ergot Alakaloid)

Anorexiants: Mechanism of Action

Suppress appetite control centers in the brain Increase the body's basal metabolic rate Mobilization of adipose tissue stores Enhanced cellular glucose uptake Reduce dietary fat absorption

Acid-Controlling Drugs/Histamine 2 (H2) Antagonists: Drug Effect

Suppressed acid secretion in the stomach

Local Anesthetics: Indications for Use

Surgical, dental, and diagnostic procedure. Treatment of certain types of chronic pain. Spinal Anesthesia: to control pain during surgical procedures and childbirth.

Vitamins and Minerals/Iron: Toxicity

Symptomatic and supportive measures - Suction and maintenance of the airway; correction of acidosis; control of shock and dehydration with IV fluids or blood, oxygen, and vasopressors In patients with severe symptoms of iron intoxication, such as coma, shock, or seizures, chelation therapy with deferoxamine is initiated. Deferiprone is used in iron overload.

Anticoagulants/Heparin: Toxic Effects & Treatment

Symptoms: -Hematuria, melena (blood in the stool), petechiae, ecchymoses, and gum or mucous membrane bleeding Stop drug immediately. - Intravenous (IV) protamine sulfate: 1 mg of protamine can reverse the effects of 100 units of heparin. Treatment: - Discontinue the warfarin. - May take 36 to 42 hours before the liver can resynthesize enough clotting factors to reverse the warfarin effects - Vitamin K1 (phytonadione) can hasten the return to normal coagulation. - High doses of vitamin K (10 mg) given IV will reverse the anticoagulation within 6 hours. - Caution: when vitamin K is given, warfarin resistance will occur for up to 7 days. - Severe bleeding: transfusions of human plasma or clotting factor concentrates. - Life-threatening bleeding from warfarin: Kcentra and Profiline - IV vitamin K: risk of anaphylaxis. Risk is diminished by diluting it and giving it over 30 minutes.

Antifungal Drugs: Indications of Use

Systemic and topical fungal infections Drug of choice for the treatment of many severe systemic fungal infections is amphotericin B. Choice of drug depends on type and location of infection Fluconazole: passes into the cerebrospinal fluid and inhibit the growth of cryptococcal fungi, effective in the treatment of cryptococcal meningitis

Adrenal/Corticosteroids: Background Information

Systemic corticosteroids consist of 13 chemically different but pharmacologically similar hormones. Pregnancy category C drugs Steroids must not be stopped abruptly: can lead to adrenal suppression

Antianginal/ Beta Blockers: Contraindications

Systolic HF Serious conduction disturbances Caution: bronchial asthma because any level of blockade of beta2 receptors can promote bronchoconstriction Diabetes mellitus: can mask hypoglycemia-induced tachycardia Peripheral vascular disease: may further compromise cerebral or peripheral blood flow

Phosphodiesterase-4 Inhibitor

Roflumilast (Daliresp) - Indicated to prevent coughing and excess mucus from worsening and to decrease the frequency of life-threatening COPD exacerbations - Adverse effects include nausea, diarrhea, headache, insomnia, dizziness, weight loss, and psychiatric symptoms.

Women's Health Drugs/Osteoporosis: Drug Therapy: Adverse Effects

SERMs - Hot flashes, leg cramps - Increased risk of venous thromboembolism - Teratogenic - Leukopenia Bisphosphonates - Headache, gastrointestinal (GI) upset, joint pain - Risk of esophageal burns if medication lodges in esophagus before reaching the stomach - Risk of osteonecrosis of the jaw - Possible severe (incapacitating) bone, joint, or muscle pain Calcitonin: - Flushing of the face, nausea, diarrhea, and reduced appetite Teriparatide: - Chest pain, dizziness, hypercalcemia, nausea, and arthralgia Denosumab: - Infections

Insulin Dosing (Sliding Scale)

SQ rapid-acting (lispro or aspart) or short-acting (regular) insulins are adjusted according to blood glucose test results. Typically used in hospitalized diabetic patients or those on total parenteral nutrition or enteral tube feedings SQ insulin is ordered in an amount that increases as the blood glucose increases. Disadvantage: delays insulin administration until hyperglycemia occurs; results in large swings in glucose control

HMG-CoA Reductase Inhibitors: Indications

STATINS: - Patients with clinical atherosclerotic cardiovascular disease (CVD) - Patients with LDL cholesterol levels >190 mg/dL - Patients with diabetes age 40 to 75 years with LDL levels of 70 to 189 mg/dL and without evidence of CVD - Patients without evidence of CVD or diabetes but who have LDL levels between 70 and 189 mg/dL and a 10-year risk of CVD > 7.5% First-line drug therapy for hypercholesterolemia Treatment of types IIa and IIb hyperlipidemias - Reduces LDL levels by up to 50% - Increases HDL levels by 2% to 15% - Reduces triglycerides by 10% to 30%

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) List

Salicylates - Aspirin - Diflunisal (Dolobid) - Salsalate (Salistab) - Choline salicylate (Arthropan) Acetic acid derivatives - Diclofenac sodium (Voltaren) - Indomethacin (Indocin) - Sulindac (Clinoril) - Tolmetin (Tolectin) - Etodolac (Lodine) - Ketorolac (Toradol) - Meclofenamate (generic only) - Mefenamic acid (Ponstel) Cyclooxygenase-2 (COX-2) inhibitors - Celecoxib (Celebrex) Enolic acid derivatives - Nabumetone (Relafen) - Meloxicam (Mobic) - Piroxicam (Feldene) Propionic acid derivatives - Fenoprofen (Nalfon) - Flurbiprofen (Ansaid) - Ibuprofen (Motrin, Advil, others) - Ketoprofen (Orudis KT) - Naproxen (Naprosyn, Aleve) - Oxaprozin (Daypro)

Atypical Antipsychotics: Indications of Use

Schizophrenia & negative symptoms Bipolar disorder & major depressive disorder Agitation associated with autistic disorder

Thyroid Gland

Secretes three hormones essential for proper regulation of metabolism - Thyroxine (T4) - Triiodothyronine (T3) - Calcitonin Located near the parathyroid gland, which is responsible for maintaining adequate levels of calcium in the extracellular fluid

Antidepressants/ Tricyclic Antidepressants: Adverse Effects

Sedation Impotence Orthostatic Hypotension (Older PT: Dizziness, postural hypotension, constipation, delayed micturition, edema, muscle tremors)

Benzodiazepines: Indications of Use

Sedation, Sleep induction Skeletal muscle relaxation, Anxiety relief, Anxiety-related depression Treatment of acute seizure disorders, Alcohol withdrawal, Agitation relief Balanced anesthesia, Moderate or conscious sedation

Antidepressants/ MAO-B Inhibitor

Selegiline Transdermal Patch (Emsam) - Selective

Women's Health Drugs/Fertility Drugs: Adverse Effects

Tachycardia, hypovolemia, DVT Dizziness, headache, flushing, depression, restlessness, anxiety, nervousness, fatigue Nausea, bloating, constipation, vomiting, anorexia Urticaria, ovarian hyperstimulation, multiple pregnancy, blurred vision, diplopia, photosensitivity, breast pain

Ophthalmic Drugs/Topical Anesthetics

Tetracaine Proparacaine Used to prevent eye pain during: - Surgery - Ophthalmic examinations - Removal of foreign bodies or sutures - Diagnostic testing and procedures Short-term use only Not for self-administration

Cholinergic-Blocking: Indications of Use (GI)

The PNS controls gastric secretions and smooth muscles that produce gastric motility. Blockade of PNS results in: - Decreased secretions - Relaxation of smooth muscle - Decreased GI motility and peristalsis GI drugs are used to treat: - Irritable bowel disease - GI hypersecretory states

Carbonic Anhydrase Inhibitors: Mechanism of Action

The enzyme carbonic anhydrase helps to make H+ ions available for exchange with sodium and water in the proximal tubules. CAIs block the action of carbonic anhydrase, thus preventing the exchange of H+ ions with Na & H2O nhibition of carbonic anhydrase reduces H+ ion concentration in renal tubules. As a result, there is increased excretion of bicarbonate, sodium, water, and potassium. Resorption of water is decreased, and urine volume is increased.

Vitamin E: Functions

The exact biologic function of vitamin E is unknown. Believed to act as an antioxidant Unproved theory that vitamin E has beneficial effects for patients with cancer, heart disease, premenstrual syndrome, and sexual dysfunction American Heart Association no longer recommends the use of high-dose vitamin E to prevent heart disease.

Men's Health Drugs/Herbal Products: Saw Palmetto

Serenoa repens, Sabal serrulata Used for treatment of BPH and alopecia Adverse effects - Gastrointestinal upset - Headache - Back pain - Dysuria

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS): Interactions

Serious interactions can occur when given with - Anticoagulants - Aspirin - Corticosteroids and other ulcerogenic drugs - Protein bound drugs - Diuretics and ACE inhibitors

Antibiotics/Aminoglycosides: Therapeutic Drug Monitoring

Serum levels measured to prevent toxicity Serum level needs to be at least eight times higher than the MIC. Time-dependent killing Concentration-dependent killing Peak: highest drug levels for once-daily regimens Trough: lowest to ensure adequate renal clearance of the drug and avoid toxicity Postantibiotic effects Resistance Drug interactions

Insulin (Short Acting)

Short acting - Regular insulin (Humulin R) - Routes of administration: IV bolus, IV infusion, intramuscular (IM), SQ - Onset (SQ route): 30 to 60 minutes - Peak (SQ route): 2.5 hours - Duration (SQ route): 6 to 10 hours

Bronchodilators/Beta- Adrenergic Agonists: Background Information

Short-acting beta agonist (SABA) inhalers - Albuterol (Ventolin, ProAir) - Levalbuterol (Xopenex) - Pirbuterol (Maxair) - Terbutaline (Brethine) - Metaproterenol (Alupent) Long-acting beta agonist (LABA) inhalers - Arformoterol (Brovana) - Formoterol (Foradil, Perforomist) - Salmeterol (Serevent) - Indacaterol (Arcapta Neohaler) - Vilanterol in conjunction with fluticasone (Breo Ellipta) - Vilanterol in conjunction with the anticholinergic, umeclidinium (Anoro Ellipta) - The term Ellipta refers to a new delivery system.

PDIs: Indications

Short-term management of HF for patients in the intensive care unit (ICU) AHA and ACC advise against long-term infusions

Antibiotics/Cephalosporins: Adverse Effects

Similar to penicillins - Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema Potential cross-sensitivity with penicillins if allergies exist

Non-Opioid Analgesics: Mechanism of Action

Similar to salicylates; Blocks pain impulses peripherally by inhibiting prostaglandin synthesis

Nasal Decongestant: Mechanism of Action

Site of action: blood vessels surrounding nasal sinuses Adrenergics - Constrict small blood vessels that supply upper respiratory tract structures - As a result, these tissues shrink, and nasal secretions in the swollen mucous membranes are better able to drain. Nasal steroids - Antiinflammatory effect - Work to turn off the immune system cells involved in the inflammatory response - Decreased inflammation results in decreased congestion.

Barbiturates: Mechanism of Action

Site of action: brainstem (reticular formation) By potentiating the action of GABA, nerve impulses traveling in the cerebral cortex are inhibited.

Laxatives/Emollient: Adverse Effects

Skin rashes Decreased absorption of vitamins Electrolyte imbalances Lipid pneumonia

Electrolytes/Sodium: Hypernatremia

Sodium excess; serum levels over 145 mEq/L Symptoms: - Water retention (edema), hypertension - Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased urine output Causes: - Poor renal excretion stemming from kidney malfunction; inadequate water consumption and dehydration

Electrolytes/Sodium: Hyponatremia

Sodium loss or deficiency; serum levels below 135 mEq/L Symptoms: - Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures Causes: - Same causes as hypokalemia; also excessive perspiration (during hot weather or physical work), prolonged diarrhea or vomiting, or renal disorders

Crystalloids: Mechanism of Action

Solutions containing fluids and electrolytes that are normally found in the body Maintains the osmotic gradient between extravascular and intravascular compartments Do not contain proteins (colloids) No risk for viral transmission, anaphylaxis, or alteration in coagulation profile Better for treating dehydration rather than expanding PV

Antiemetics and Antinausea Drugs: Indications of Use

Specific indications vary per class of antiemetics. General use for each type: prevention and reduction of nausea and vomiting

Pituitary Drugs: Adverse Effects

Specific to the individual drug

Potassium-Sparing Diuretics: Indications

Spironolactone and triamterene - Hyperaldosteronis - Hypertension - Reversing potassium loss caused by potassium-losing drugs - Certain cases of HF: prevention of remodeling Amiloride - Similar as spironolactone and triamterene, but amiloride is less effective in the long term

Women's Health Drugs/ Exogenous Estrogenic Drugs: Synthetic

Steroidal - Conjugated estrogens, estradiol transdermal, estropipate, many others Nonsteroidal - Diethylstilbestrol - No longer available in the United States

Analeptics: Mechanism of Action

Stimulate areas of CNS that control respiration Methylxanthines: Inhibit phosphodiesterase, leading to buildup of cyclic adenosine monophosphate (cAMP) Caffeine: Antagonizes adenosine receptors

Amphetamines: Mechanism of Action

Stimulate areas of the brain associated with mental alertness in CNS & Respiratory System

Cholinergic: Drug Effects

Stimulate intestine and bladder - Increased gastric secretions - Increased gastrointestinal motility - Increased urinary frequency Stimulate pupils - Constriction (miosis) - Reduced intraocular pressure Increased salivation and sweating Cardiovascular effects - Decreased heart rate - Vasodilation Respiratory effects - Bronchial constriction, narrowed airways At recommended doses, cholinergics primarily affect muscarinic receptors. At high doses, cholinergics stimulate nicotinic receptors. Desired effects are from muscarinic receptor stimulation. Many undesirable effects are caused by stimulation of nicotinic receptors.

Cholinergic: Mechanism of Action

Stimulate the parasympathetic nervous system (PNS) Mimic effects of the PSNS neurotransmitter acetylcholine (ACh) Direct-acting cholinergic agonists - Bind to cholinergic receptors, activating them Indirect-acting cholinergic agonists - Also known as cholinesterase inhibitors - Inhibit the enzyme acetylcholinesterase, which breaks down ACh - Results in more ACh available at the receptors Effects seen when PSNS is stimulated After binding, permeability of the cell changes allowing flow of calcium and sodium into the cells. Results in depolarization of cell membrane and stimulation of the effector organ The PNS is the "rest and digest" system. Sympathetic nervous system: "flight or fight"

Adrenergic: Mechanism of Action

Stimulate the sympathetic nervous system (SNS) AKA: Adrenergic agonists or Sympathomimetics Mimic the effects of SNS neurotransmitters (catecholamines): Norepinephrine (NE), Epinephrine (EPI), Dopamine Direct acting sympathomimetic: binds directly to the receptor and causes a physiologic response Indirect acting sympathomimetic: causes release of catecholamine from storage sites(vesicles) in nerve endings; catecholamines then bind to receptors and causes a physiologic response Mixed-acting sympathomimetic: directly stimulates the receptor by binding to it and indirectly stimulates the receptor causing the release of stored neurotransmitters from vesicles in the nerve ending

Antibiotics/Tetracyclines: Adverse Effects

Strong affinity for calcium - Discoloration of permanent teeth and tooth enamel in fetuses and children or nursing infants if taken by the mother - May retard fetal skeletal development if taken during pregnancy Alteration in intestinal flora may result in: - Superinfection (overgrowth of nonsusceptible organisms such as Candida spp.) - Diarrhea - Pseudomembranous colitis May also cause: - Vaginal candidiasis - Gastric upset - Enterocolitis - Maculopapular rash

Acid-Controlling Drugs/Proton Pump Inhibitors (PPIs)

The parietal cells release positive hydrogen ions (protons) during HCl production. This process is called the proton pump. H2 blockers and antihistamines do not stop the action of this pump.

Antiparkinson Agents/ Anticholinergics: Indication of Use

To slow down the disease process of Parkinson's; Anticholinergics: used to treat muscle rigidity associated with PD

Nasal Decongestant/ Topical Nasal: Background Information

Topical adrenergics - Prompt onset - Potent - Sustained use over several days causes rebound congestion, making the condition worse. - Ephedrine, oxymetazoline, phenylephrine, and tetrahydrozoline

Ophthalmic Drugs/Ocular Antimicrobial Drugs

Topical and systemic administration - Antibacterial - Antiviral - Antifungal Topical application may cause transient and local inflammation, burning, and stinging. Use of ophthalmic antibiotics with corticosteroids may make it more difficult to rid the eye of infection.

Thiazide and Thiazide-Like Diuretics

Thiazide diuretics: - Hydrochlorothiazide (Esidrix, HydroDIURIL) - Chlorothiazide (Diuril) Thiazide-like diuretics: - Metolazone (Mykrox, Zaroxolyn) - Chlorthalidone (Hydone, Thalitone) -Indapamide (Lozol)

Antithyroid Drugs

Thioamide antithyroid 2 weeks of therapy may be necessary before symptoms improve.

Niacin: Mechanism of Action

Thought to increase activity of lipase, which breaks down lipids Reduces the metabolism or catabolism of cholesterol and triglycerides

Antibiotics (Multidrug-Resistant Organisms): MRSA

Threat of MRSA becoming resistant to all antibiotics currently available No longer seen just in hospitals; it has spread to the community setting, and approximately 50% of staphylococcal infections contracted in the community involve MRSA

Antitubercular Drug: Mechanisms of Action

Three groups: - Protein wall synthesis inhibitors: streptomycin, kanamycin, capreomycin, rifampin, rifabutin, others - Cell wall synthesis inhibitors: cycloserine, ethionamide, INH - Other mechanisms of action: ethambutol, INH, PAS, ethionamide

Women's Health Drugs/Estrogens

Three major endogenous estrogens - Estradiol (principal and most active) - Estrone - Estriol Synthesized from cholesterol in ovarian follicles Basic chemical structure of a steroid Responsible for: - Development and maintenance of the female reproductive system - Development of female secondary sex characteristics - Shaping of body contours and development of the skeleton Indicated for the treatment of many clinical conditions, primarily those resulting from estrogen deficiency Smallest dosage of estrogen that relieves the symptoms or prevents the condition is used

Nutritional Supplements/Enteral Formulation Group: Modular

Three types - Carbohydrate: Moducal, Polycose - Fat: MCT Oil, Microlipid - Protein: Casec, ProMod, Propac, Stresstein Single nutrient formulas Intended for use with monomeric or polymeric formulations

Dermatologic Drugs/Other Topical Dermatologic Drugs

Topical hair growth drug - Minoxidil (Rogaine) - For men and women Systemic hair growth drug - Finasteride (Propecia) - Finasteride is classified as a pregnancy category X drug. - Women are not to handle this drug without gloves or crush this drug, thereby making it airborne. Sunscreens - Rated by sun protection factor (SPF), which is a number ranging from 2 to 50 (or higher) in order of increasing potency of UV protection - Only those with SPF of 15 or greater may state they reduce the risk of skin cancer and early skin aging. Topical antineoplastics - Fluorouracil (Efudex) •Basal cell carcinoma •Actinic keratosis Immunomodulators - Pimecrolimus (Elidel) •Treats atopic dermatitis - Imiquimod (Aldara) •Treats actinic keratosis, basal cell carcinoma, and anogenital warts

Nutritional Supplements/Parenteral Nutrition

Totally digested nutrients are given intravenously, directly into the circulatory system. The entire GI system is bypassed, eliminating the need for absorption, metabolism, or bowel elimination. Hyperalimentation Total parenteral nutrition (TPN) Formulations vary according to individual patient nutritional needs. - Amino acids - Carbohydrates - Fats - Trace elements - Vitamins - Minerals

Vitamin B6 (Pyridoxine): Toxicity

Toxic effects occur with large doses, especially neurotoxicity. Will subsided when discontinued Central nervous: Paresthesias, flushing, warmth, headache, lethargy

Vitamin E: Toxicity and Management of Overdose

Toxicity is primarily limited to use in the newborn. - Hemolysis of red blood cells (RBCs) can occur. - Infants with low levels of glucose-6-phosphate dehydrogenase. - Blood products may be indicated.

Vitamins and Minerals/Zinc

Trace element Essential in metabolic reactions of proteins and carbohydrates Important for normal tissue growth and repair, especially wound repair Found in: - Red meats, liver, oysters, milk products, eggs, beans, nuts, whole grains, fortified cereals, certain seafoods

Antihistamine: Types

Traditional: brompheniramine, chlorpheniramine, dimenhydrinate, diphenhydramine, meclizine, and promethazine Nonsedating: loratadine, cetirizine, and fexofenadine

Antithyroid Drugs: Indications

Treat hyperthyroidism Prevent surge in thyroid hormones after surgical treatment or during radioactive iodine therapy

Dermatologic Drugs/ Topical Ectoparasiticidal Drugs

Treat pediculosis (Phthirus pubis, Pediculus humanus corporis, Pediculus humanus capitis) and scabies (Sarcoptes scabiei) - Permethrin (Elimite) - Malathion (Ovide) - Crotamiton (Eurax) - Benzyl alcohol 5% (Ulesfia) - Spinosad (Natroba) Ivermectin

Nitrates and Nitrites: Indications

Treat stable, unstable, and vasospastic angina Rapid-acting forms: - Used to treat acute anginal attacks - Sublingual tablets; IV infusion Long-acting forms: - Used to PREVENT anginal episodes

Antineoplastic Enzymes: Indications

Treatment of acute lymphocytic leukemia This enzyme is isolated and purified for clinical use. - Asparaginase (Elspar): used to treat acute lymphocytic leukemia - Pegaspargase (Oncaspar) - Erwinia asparaginase: available only by special request from the National Cancer Institute for patients who have developed allergic reactions to Escherichia coli-based asparaginase

Mood Stabilizing Drugs (Lithium): Indications

Treatment of acute mania and mixed episodes associated with bipolar 1 disorder. Maintenance treatment of bipolar 1 disorder.

Vitamins and Minerals/Phosphorus: Indications of Use

Treatment of deficiency states Dietary supplement

Women's Health Drugs/Progestins: Indications of Use

Treatment of functional uterine bleeding caused by: - Hormonal imbalance - Fibroids - Uterine cancer Treatment of primary and secondary amenorrhea Adjunctive and palliative treatment of some cancers and endometriosis Alone or in combination with estrogens to prevent conception Prevention of threatened miscarriage Alleviation of premenstrual syndrome symptoms

Ophthalmic Drugs/Carbonic Anyhydrase Inhibitors: Indications of Use

Treatment of glaucoma - Open angle - Angle closure Preoperatively to reduce IOP

Vasodilators: Indications

Treatment of hypertension May be used in combination with other drugs Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies.

Osmotic Diuretics: Indications

Treatment of patients in the early, oliguric phase of acute renal failure (ARF) To promote excretion of toxic substances To reduce intracranial pressure Treatment of cerebral edema

Vitamin B1 (Thiamine): Indications of Use

Treatment of thiamine deficiency - Beriberi - Wernicke's encephalopathy - Peripheral neuritis associated with pellagra - Neuritis of pregnancy Metabolic disorders Malabsorption Management of poor appetite, ulcerative colitis, chronic diarrhea, and cerebellar syndrome or ataxia Oral insect repellent

Fibric Acid Derivatives: Indications

Treatment of type III, IV, and V hyperlipidemias The fibric acid derivatives gemfibrozil and fenofibrate decrease the triglyceride level and increase the HDL cholesterol level by as much as 25%.

Women's Health Drugs/ Estrogens: Indications

Treatment or prevention of disorders that result from estrogen deficiency - Atrophic vaginitis - Hypogonadism - Oral contraception (given with a progestin) - Uterine bleeding - Vasomotor spasms of menopause ("hot flashes") - Osteoporosis (treatment and prophylaxis) - Breast or prostate cancer (palliative treatment) - Ovarian failure or castration (or removal of ovaries)

Electrolytes/Sodium: Indication

Treatment or prevention of sodium depletion when dietary measures are inadequate Mild - Treated with oral sodium chloride and/or fluid restriction Severe - Treated with IV NS or lactated Ringer's solution

Ophthalmic Drugs/Ocular Antiviral Drugs

Trifluridine (Viroptic) Ganciclovir (Vitrasert) Fomivirsen (Vitravene)

Serotonin Agonists: Adverse Effects

Triptans: - Vasoconstriction - Irritation @ injection site - Tingling & flushing Ergot Alkaloids: - N/V, Dizziness - Cold or clammy hands & feet - Muscle pain

Serotonin Agonists: Mechanism of Action

Triptans: Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms; Reduce production of inflammatory neuropeptides; Abortive therapy for migraines Ergot Alkaloids: Narrow or constrict blood vessels in the brain

Antitubercular Drugs

Tuberculosis (TB) - Caused by Mycobacterium tuberculosis Antitubercular drugs treat all forms of Mycobacterium (MTB). TB is most commonly characterized by granulomas in the lungs: nodular accumulations of inflammatory cells (e.g., macrophages, lymphocytes) that are delimited ("walled off" with clear boundaries) and have a center that has a cheesy or caseated consistency.

Anti-Diabetes Treatments

Type 1: - Insulin therapy Type 2: - Lifestyle changes - Oral drug therapy - Insulin when the above no longer provide glycemic control

Anti-Diabetes Non-pharmacological Treatment Interventions

Type 1: Always requires insulin therapy Type 2 - Weight loss - Improved dietary habits - Smoking cessation - Reduced alcohol consumption - Regular physical exercise

Bile Acid Sequestrants: Indications

Type II hyperlipoproteinemia Relief of pruritus associated with partial biliary obstruction (cholestyramine) May be used along with statins

Insulin Dosing

U100: Standard for most (100 units/mL) U200: Insulin pen U300: Insulin pen U500: Newer concentration for those patients needing very high doses of insulin (500 units/mL)

Barbiturates: Indications of Use

Ultrashort Acting: - Anesthesia for short surgical procedure; induction - Control of seizures -Reduction of inter-cranial pressure in neurologic PTs Short & Intermediate Acting: - Sedation and control of seizures Long Acting: - Seizure prophylaxis

Antifibrinolytic Drugs:Adverse Effects

Uncommon and mild Rare reports of thrombotic events Others include: - Dysrhythmia, orthostatic hypotension, bradycardia, headache, dizziness, fatigue, nausea, vomiting, abdominal cramps, diarrhea, others

Antidiarrheals/Anticholinergics

Urinary retention, impotence Headache, dizziness, confusion, anxiety, drowsiness Dry skin, flushing Blurred vision Hypotension Tachycardia

Blood Products: Indications

Use depends on the specific indication Cryoprecipitate and plasma protein factors - Management of acute bleeding (greater than 50% slow blood loss or 20% acutely) Fresh-frozen plasma (FFP) - Increase clotting factor levels in patients with demonstrated deficiency Packed red blood cells (PRBCs) - To increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume Whole blood - Same as for PRBCs except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma - Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues

Antidiabetic Drugs (Oral): Indications

Used alone or in combination with other drugs and/or diet and lifestyle changes to lower the blood glucose levels in patients with type 2 DM

Crystalloids: Indications

Used as maintenance fluids to: - Compensate for insensible fluid losses - Replace fluids - Manage specific fluid and electrolyte disturbances - Promote urinary flow Other Indications Include: - Acute liver failure - Acute nephrosis - Adult respiratory distress syndrome - Burns - Cardiopulmonary bypass - Hypoproteinemia - Renal dialysis - Reduction of the risk for deep vein thrombosis - Shock

General Anesthetics: Indications

Used during surgical procedures to produce: - Unconsciousness - Skeletal muscular relaxation - Visceral smooth muscle relaxation Rapid onset; quickly metabolized Also Used: in electroconvulsive therapy treatments for depression

Antiemetics and Antinausea Drugs/ Ginger: Indications of Use

Used for nausea and vomiting, including that caused by chemotherapy, morning sickness, and motion sickness

Antifibrinolytic Drugs: Indications

Used for prevention and treatment of excessive bleeding resulting from hyperfibrinolysis or surgical complications Treatment of hemophilia or von Willebrand's disease

Men's Health Drugs/Androgens: Alpha 1-Adrenergic Blockers

Used for symptomatic relief of obstruction caused by BPH These drugs have clinical effects of prostate shrinkage immediately. 5-Alpha reductase inhibitors may take up to 6 months of continual therapy for clinical effects of prostate shrinkage. Drugs: Doxazosin (Cardura) Tamsulosin (Flomax) Terazosin (Hytrin) Alfuzosin (Uroxatral) Silodosin (Rapaflo)

Expectorants: Indications

Used for the relief of productive coughs associated with: - Common cold - Bronchitis - Laryngitis - Pharyngitis - Coughs caused by chronic paranasal sinusitis - Pertussis - Influenza - Measles

Cholinergics: Indications of Use (Indirect-acting anticholinesterase drugs)

Used for treatment of mild to moderate Alzheimer's disease •Donepezil (Aricept) •Galantamine (Razadyne) •Rivastigmine (Exelon)

Antidiebetic Drugs (Oral): Background Information

Used for type 2 DM Effective treatment involves several elements. - Careful monitoring of blood glucose levels - Therapy with one or more drugs - Treatment of associated comorbid conditions such as high cholesterol and high blood pressure 2013 American Diabetes Association guidelines New-onset type 2 DM treatment - Lifestyle interventions - Oral biguanide drug metformin - If lifestyle modifications and the maximum tolerated metformin dose do not achieve the recommended HbA1C goals after 3 to 6 months, additional treatment should be given with a second oral agent, GLP-1 agonist (liraglutide, exenatide, albiglutide, lixisenatide) or insulin.

Dermatologic Drugs/Herbal Products: Aloe

Used for wound healing Adverse effects - Diarrhea - Abdominal pain - Dermatitis Drug interactions - Digoxin - Antidysrhythmics - Diuretics

Cytotoxic Antibiotics: Indications

Used in combination chemotherapy regimens Used to treat a variety of solid tumors and some hematologic malignancies: - Leukemia, ovarian, breast, bone, others - Squamous cell carcinomas - AIDS-related Kaposi's sarcoma (when intolerant to other treatments)

Alkylating Drugs: Indications

Used in combination with other drugs to treat various types of cancer, such as: - Recurrent ovarian cancer - Brain tumors - Lymphomas - Leukemias - Breast cancer - Bladder cancer - Others

Women's Health Drugs/Fertility Drugs: Indications of Use

Used primarily to induce ovulation in anovulatory patients Also may be used to promote spermatogenesis in infertile men

Adrenergic-Blocking drugs/Alpha Blockers: Indications of Use

Used to control and prevent hypertension in patients with pheochromocytoma Raynaud's disease, acrocyanosis, and frostbite Phentolamine - Quickly reverses the potent vasoconstrictive effects of extravasated vasopressors such as norepinephrine or epinephrine - Restores blood flow and prevents tissue necrosis

Antimalarial Drugs: Indications of Use

Used to kill Plasmodium organisms, the parasites that cause malaria The drugs have varying effectiveness on the different malaria organisms. Some drugs are used for prophylaxis against malaria.

Antibiotics/Aminoglycosides: Indications of Use

Used to kill gram-negative bacteria, such as Pseudomonas spp., Escherichia coli, Proteus spp., Klebsiella spp., Serratia spp. Often used in combination with other antibiotics for synergistic effects (beta-lactams or vancomycin) Used for certain gram-positive infections that are resistant to other antibiotics Aminoglycosides are poorly absorbed through the gastrointestinal (GI) tract and are given parenterally. Can also be given via inhalation for treatment of lung infections Exception: neomycin - Given orally to decontaminate the GI tract before surgical procedures - Also used as an enema for this purpose - Used to treat hepatic encephalopathy

Anticoagulants: Indications

Used to prevent clot formation in certain settings in which clot formation is likely - MI - Unstable angina - Atrial fibrillation - Indwelling devices (ex: mechanical heart valves) - Major orthopedic surgery

Nutritional Supplements/Peripheral Total Parenteral Nutrition

Used to provide nutrients to patients who need more nutrients than present oral intake can provide. Indicated for: - Procedures that restrict oral feedings - Anorexia caused by chemotherapy or radiation treatments - GI illnesses that prevent oral food intake - Postsurgical patients - When nutrition deficits are minimal but oral nutrition will not be started for more than 5 days

Dermatologic Drugs/Topical Anesthetic Drugs

Used to reduce pain or pruritus associated with: - Insect bites - Sunburn - Poison ivy exposure Also used to numb the skin before a painful injection Ointments, creams, sprays, liquids, jellies - EMLA: lidocaine-prilocaine combination - Ela-max: lidocaine

Antithyroid Drugs: Background Information

Used to treat hyperthyroidism and to prevent the surge in thyroid hormones that occurs after surgical treatment or during radioactive iodine treatment for hyperthyroidism

Serotonin Agonists: Indication of Use

Used to treat migraine headaches Relief from moderate to severe migraines within 2 hours in vast majority of PT Available in oral, sublingual, subQ self injections & nasal sprays

Anorexiants: Indication of Use

Used to treat obesity along with behavior modifications (diet & excercise); Most often used in higher risk PTs

Men's Health Drugs/Gonadotropin-Releasing Hormone Analogues

Used to treat prostate cancer Action: inhibit the secretion of pituitary gonadotropin, which eventually leads to a decrease in testosterone production - Goserelin (Zoladex) - Leuprolide (Lupron) - Triptorelin (Trelstar)

Alkaloid Topoisomerase II Inhibitors: Indications

Used to treat small cell lung cancer and testicular cancer (Not used as much now because of significant toxicities without therapeutic benefit)

Colloids: Indications

Used to treat wide variety of conditions when patient requires plasma volume expansion Shock Burns

Heart Failure/ Aldosterone Agonists: Mechanism of Action

Useful in severe stages of HF - Action: activation of the renin-angiotensin-aldosterone system causes increased levels of aldosterone, which causes retention of sodium and water, leading to edema that can worsen HF. Spironolactone (Aldactone): potassium-sparing diuretic and aldosterone antagonist shown to reduce the symptoms of HF\ Eplerenone (Inspra): selective aldosterone blocker, blocking aldosterone at its receptors in the kidney, heart, blood vessels, and brain

Local Anesthetics: Adverse effects

Usually limited - Spinal Headache Effects will result if: - Inadvertent intravascular injection - Excessive dose or rate fo injection - Slow metabolic breakdown - Injection into highly vascular tissue - Allergy (Genrally limited; most common with "ester type" anesthetics)

Colloids: Adverse Effects

Usually safe May cause altered coagulation, resulting in bleeding Have no clotting factors or oxygen-carrying capacity Rarely, dextran therapy causes anaphylaxis or renal failure.

Antibiotics/Penicillin: Contraindications

Usually safe and well-tolerated medications Contraindicated: known drug allergy Type of reaction that occurs in patients who state they are allergic to penicillins Not all end in "cillin" (e.g., Zosyn, Augmentin) Many medication errors have occurred when a penicillin drug called by its trade name is given to a patient with a penicillin allergy.

Antibiotics (Multidrug-Resistant Organisms): VRE

Usually seen in urinary tract infections (UTIs) Newer antibiotics have been developed to successfully treat VRE and MRSA.

General Anesthetics: Mechanism of Action

Varies according to drug/ lipid solubility Fat (Lipid) soluable > Water soluable Classical "stages" of anesthesia Overall effect: -Orderly and systematic reduction of sensory and motor CNS functions -Progressive depression of cerebral and spinal cord function

Women's Health Drugs/Fertility Drugs

Various medical techniques used to treat infertility - Includes in vitro fertilization and medication therapy (ovulation stimulation) Clomiphene (Clomid, Serophene) Menotropins (Pergonal) Chorionic gonadotropin alfa (Ovidrel)

Nutritional Supplements/Enteral Nutrition: Interactions

Various nutrients can interact with drugs to produce significant food-drug interactions. Enteral nutrition can delay absorption of some medications (phenytoin). Enteral nutrition may inactivate some medications (e.g., tetracycline and nutrient formulations that contain calcium). Corticosteroids or vitamins A and D: an increased absorption rate resulting in increased therapeutic effects

Antiemetics and Antinausea Drugs: Adverse Effects

Vary according to drug used Stem from their nonselective blockade of various receptors

General Anesthetics: Adverse Effects

Vary according to the dosage & drug used Site primarily effected: - Heart, peripheral circulation, liver, kidneys, respiratory tract Myocardial depression: Cradiac & respiratory arrest Malignant Hyperthermia - Sudden elevation in body temp (>104 deg. F) - After volatile inhaled anesthesia or use of NMBD - Tachypnea, tachycardia, muscle rigidity - Life threatening emergency - Treated with cardiorespiratory supportive care & dantrolene (Skeletal muscle relaxant)

Antiviral Drugs (Non-HIV): Adverse Effects

Vary with each drug Healthy cells are often killed also, resulting in serious toxicities.

Pituitary Drugs (Posterior)

Vasopressin & Desmopressin - Mimic the action of antidiuretic hormone - Increase water resorption in the distal tubules and collecting ducts of the nephrons, and they concentrate urine, reducing water excretion by up to 90% - Used in the treatment of diabetes insipidus Vassopressin - Potent vasoconstrictor - Hypotensive emergencies such as vasodilatory shock (septic shock) - Advanced Cardiac Life Support (ACLS): pulseless cardiac arrest - Vasopressin is also used to stop bleeding of esophageal varices. Desmopressin - Dose-dependent increase in the plasma levels of factor VIII (antihemophilic factor), von Willebrand factor (acts closely with factor VIII), and tissue plasminogen activator - Management of nocturnal enuresis

Antidysrhythmics

Vaughan Williams Classification Drugs

Monoclonal Antibodies: Contrindications

Very Few

Vitamin E: Adverse Effects

Very few acute adverse effects - Gastrointestinal (GI) tract - Central nervous system (CNS) effects

Vitamins: Water-Soluble Vitamins

Vitamin B complex - Thiamine (B1) - Riboflavin (B2) - Niacin (B3) - Pantothenic acid (B5) - Pyridoxine (B6) - Folic acid (B9) - Cyanocobalamin (B12) Vitamin C - Ascorbic acid

Niacin (Nicotinic Acid)

Vitamin B3 Lipid-lowering properties require much higher doses than when used as a vitamin. Effective, inexpensive, often used in combination with other lipid-lowering drugs

Dermatologic Drugs/Wound Care Drugs

Vitamin C (ascorbic acid) Zinc Topical wound care drugs Sodium hypochlorite (Dakin's solution) Cadexomer iodine (Iodosorb) Collagenase (Santyl) Biafine topical emulsion Acetic acid (vinegar)

Vitamin K: Forms

Vitamin K1 (phytonadione, AquaMEPHYTON) Vitamin K3 (menadione)

Vitamin B1 (Thiamine)

Water soluble Food sources - Enriched whole grain breads and cereals, liver, beans, yeast Deficiencies - Beriberi - Wernicke's encephalopathy Causes of Deficiencies: - Poor diet - Extended fever - Hyperthyroidism - Liver disease - Alcoholism - Malabsorption - Pregnancy and breastfeeding

Vitamin B2 (Riboflavin)

Water soluble Food sources - Green, leafy vegetables - Eggs, dairy products - Nuts, legumes - Meats, liver - Yeast, enriched whole-grain products Deficiency results in: - Cutaneous, oral, and corneal changes •Cheilosis (chapped or fissured lips) •Seborrheic dermatitis •Keratitis Causes of Deficiency: Alcoholism is a major cause. Deficiency also caused by: - Intestinal malabsorption - Long-term infections - Liver disease - Malignancy - Probenecid therapy

Vitamin B3 (Niacin)

Water soluble Food sources - Beans, turkey, tuna, liver, yeast - Enriched whole-grain breads and cereals, wheat germ Also synthesized from tryptophan (an essential amino acid obtained from protein digestion)

Vitamin C (Ascoribic Acid)

Water soluble Natural sources - Citrus fruits and juices, strawberries - Tomatoes, potatoes - Broccoli, spinach, brussels sprouts - Cabbage, green peppers - Liver Can also be synthesized

Vitamin B6 (Pyridoxine)

Water soluble Sources - Whole grains, wheat germ, yeast - Fish, organ meats, poultry, meats, eggs - Peanuts, nuts, vegetables, bananas Composed of three compounds - Pyridoxine - Pyridoxal - Pyridoxamine

Vitamin B12 (Cyanocobalamin)

Water soluble Synthesized by microorganisms present in the body Food sources - Liver, kidney, fish, shellfish, poultry, milk - Eggs, blue cheese, fortified cereals Contained in minimal amounts in plants

Vitamins and Minerals/Folic Acid (Folate)

Water-soluble, B-complex vitamin Essential for erythropoiesis Primary uses - Folic acid deficiency - During pregnancy to prevent neural tube defects Malabsorption syndromes are the most common causes of deficiency. Should not be used until actual cause of anemia is determined May mask symptoms of pernicious anemia, which requires treatment other than folic acid Untreated pernicious anemia progresses to neurologic damage.

Leukotriene Receptor Antagonists (LTRAs): Adverse Effects

Zileuton: Headache, nausea, dizziness, insomnia Zafirlukast and montelukast: Headache, nausea, diarrhea

Sodium Glucose Cotransporter (SGLT2) Inhibitors

nhibition of SGLT2 leads to a decrease in blood glucose caused by an increase in renal glucose excretion. SGLT2 inhibitors: new class of oral drugs for the treatment of type 2 DM Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) Action: work independently of insulin to prevent glucose reabsorption from the glomerular filtrate, resulting in a reduced renal threshold for glucose and glycosuria Other effects: may increase insulin sensitivity and glucose uptake in the muscle cells and decrease gluconeogenesis Results: improved glycemic control, weight loss, and a low risk of hypoglycemia

Women's Health Drugs/Progestins: Contraindications

similar to estrogens

Women's Health Drugs/Progestins: Interactions

may increase the effects of benzodiazepines and voriconazole. Barbiturates, carbamazepine, phenytoin, rifampin, and St. John's wort, which are all enzyme inducers, may decrease the effectiveness of progestin.

Vitamin B3 (Niacin): Adverse Effects

Adverse effects seen when higher doses are used in the treatment of hyperlipidemia - Flushing - Pruritus - GI distress

Antimalarial Drugs: Adverse Effects

Many adverse effects for the various drugs Primarily gastrointestinal (GI) - Nausea - Vomiting - Diarrhea - Anorexia - Abdominal pain

Angiotensin II Receptor Blockers: Adverse Effects

Most common adverse effects of ARBs: - Chest pain - Fatigue - Hypoglycemia - Diarrhea - Urinary tract infection - Anemia - Weakness - Hyperkalemia and cough are less likely to occur than with the ACE inhibitors.

Antibiotics/Tetracyclines: Nursing Implications

! Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug-binding that occur. ! Take all medications with 6 to 8 oz of fluid, preferably water. ! Because of photosensitivity, avoid sunlight and tanning beds.

Stimulant: Nursing Implications

! Monitor BP, pulse, and respiration before administering and periodically during therapy ! Obtain a history (including assessment of family history of sudden death or ventricular arrhythmia), physical exam to assess cardiac disease, and further evaluation (ECG and echocardiogram), if indicated. ! If exertional chest pain, unexplained syncope, or other cardiac symptoms occur, evaluate promptly

Anesthetics & NMBD: Nursing Implications

! Always assess past history of surgeries and response to anesthesia. Assess past history, allergies, and medication, and use of alcohol, illicit drugs, and opioids. ! Assessment during preoperative, intraoperative, and postoperative phases of vital signs, Baseline lab work, ECG, O2 sat, ABCs, ! Monitor all body systems while under anesthesia. ! Watch for sudden elevations in body temperature, which may indicate malignant hyperthermia. ! During recovery, monitor for cardiovascular depression, respiratory depression, and complications of anesthesia. ! Implement safety measures during recovery, especially if motor or sensory loss occurs because of local anesthesia. Reorient patient to his or her surroundings. Teach the patient about postoperative turning, coughing, and deep breathing.

Antimalarial Drugs: Nurse Implications

! Assess for presence of malarial symptoms. ! When used for prophylaxis, these drugs should be started 1 to 2 weeks before potential exposure to malaria and for 4 to 8 weeks after leaving the area. ! Medications are taken weekly with 8 oz of water. ! Instruct patient to notify prescriber immediately if ringing in the ears, hearing decrease, visual difficulties, nausea, vomiting, profuse diarrhea, or abdominal pain occurs. ! Alert patient to the possible recurrence of the symptoms of malaria so that he or she will know to seek immediate treatment.

Colloids: Nursing Implications

! Administer colloids slowly. ! Monitor for fluid overload and possible heart failure. ! For blood products, follow administration procedures closely. ! Monitor closely for signs of transfusion reactions. ! Monitor for therapeutic response - Normal lab values: Red blood cells, white blood cells, electrolyte levels - Improved fluid volume status - Increased tolerance to activities ! Monitor for adverse effects.

Antidiabetic Drugs (Oral): Nursing Implications

! Always check blood glucose levels before giving ! Usually given 30 minutes before meals ! Alpha-glucosidase inhibitors are given with the first bite of each main meal. ! Metformin is taken with meals to reduce GI effects. ! Metformin will need to be discontinued if the patient is to undergo studies with contrast dye because of possible renal effects; check with the prescriber. ! Assess for signs of hypoglycemia. ! If hypoglycemia occurs: - Administer oral form of glucose if the patient is conscious. - Give the patient glucose tablets or gel, corn syrup, honey, fruit juice, or nondiet soft drink or have the patient eat a small snack, such as crackers or a half sandwich. - Deliver D50W or glucagon IV if the patient is unconscious. - Monitor blood glucose levels. ! Monitor for therapeutic response: - Decrease in blood glucose levels to the level prescribed by physician. - Measure HbA1C to monitor long-term compliance with diet and drug therapy. - Monitor for hypoglycemia and hyperglycemia.

Antiparkinson Agents/ Anticholinergics: Nursing Implications

! Assesment: nursing history, med history, Qs about CNS, GI, GU, psychological and emotional status. Assess for symptoms of PD: masklike expression, speech problems, dysphagia, rigidity of arms, legs, and neck. Contraindications ! Administer drugs as directed by manufacturer. ! Provide PT education regarding PD and the medication therapy ! Inform patient not to take other medications with PD drugs unless he or she checks with physician ! When starting dopaminergic drugs, assist patient with walking because dizziness may occur. ! Administer oral doses with food to minimize GI upset. ! Encourage patient to force fluids to at least3000 mL/day (unless contraindicated). ! Taking levodopa with MAOIs may result in hypertensive crisis. ! Patient should be taught not to discontinue antiparkinson drugs suddenly. ! Teach patient about expected therapeutic and adverse effects with antiparkinson drug therapy. ! Entacapone may darken the patient's urine and sweat. ! Therapeutic effects of COMT inhibitors may be noticed within a few days; it may take weeks with other drugs. ! Monitor for response to drug therapy: Improved sense of well-being and mental status, Increased appetite, Increased ability to perform ADLs, to concentrate, and to think clearly, Less intense parkinsonian manifestations, such as less tremor, shuffling gait, muscle rigidity, and involuntary movements

Electrolytes: Nursing Implications

! Assess baseline fluid volume and electrolyte status, vital signs, skin, mucous membranes, daily weights, and input and output. ! Before giving potassium, assess ECG. ! Assess for contraindications to therapy & transfusion history. ! Establish venous access as needed. ! Monitor serum electrolyte levels during therapy. ! Monitor infusion rate, appearance of fluid or solution, and infusion site. ! Observe for infiltration and other complications of IV therapy.

Otic Drugs: Nursing Implications

! Assess baseline hearing or auditory status. ! Evaluate the patient's symptoms. ! Assess drug and food allergies. ! Assess for contraindications. ! Assess knowledge of eardrop administration. ! Keep in mind that perforated eardrum(s) may be a contraindication to these drugs. - Ciprofloxacin and ofloxacin can be used with perforated eardrums. ! If necessary or if ordered, remove cerumen by irrigation before instilling eardrops. ! Cleanse the outer ear thoroughly. ! Warm eardrops to approximately body temperature before instillation. ! Allow refrigerated solutions to warm to room temperature. ! Keep in mind that cold eardrops may cause vomiting and dizziness. ! When administering eardrops to adults: - Hold the pinna up and back. ! When administering eardrops to children younger than 3 years: - Hold the pinna down and back. ! Allow time for eardrops to flow down into the ear canal. ! Have patients lie on the side opposite to the side of the affected ear for about 5 minutes after instilling eardrops. ! A small cotton ball may be gently inserted into the ear canal to keep the drug in but do not force the cotton into the ear canal. ! Gently massage the tragus of the ear to encourage flow of medication.

Women's Health Drugs: Nursing Implications

! Assess baseline vital signs, weight, blood glucose levels, and renal and liver function study results. ! Assess whether the patient smokes. ! Assess history and medication history. ! Assess contraindications, including potential pregnancy. ! Before giving any uterine stimulants, assess the mother's vital signs and fetal heart rate. ! Uterine relaxants are used when premature labor occurs between the 20th and 37th weeks of gestation. ! For bisphosphonates, ensure that patients have no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose. ! Estrogens and progestins - Take the smallest dose needed. - Give intramuscular doses deep in large muscle masses, and rotate sites. - Give oral doses with meals to reduce GI problems. - Teach patients about correct self-administration and what to do if a dose is missed. - Increased susceptibility to sunburn may occur; advise patients to wear sunscreen or avoid sunlight. - Instruct patients to report weight gain. - Advise patients to complete annual follow-up examinations, including Pap smears and breast examinations. ! Follow specific administration guidelines carefully for administration of uterine relaxants or stimulants. ! Monitor the patient's vital signs and fetal condition during therapy. ! Instruct patients taking fertility drugs to take the medication as ordered. ! Advise patients to keep a journal while taking fertility drugs. ! Bisphosphonates - Instruct patients to take medication upon rising in the morning, with a full glass of water, and 30 minutes before eating. - Emphasize that patients should sit upright for at least 30 minutes after taking the medication. ! SERMs - Instruct patients that the medication will need to be discontinued 72 hours before and during any prolonged immobility (e.g., surgery or a long trip). ! Monitor for therapeutic responses. ! Monitor for adverse effects.

Stimulant: Nursing Implications (ADHD)

! Assess children for attention span, impulse control, and interaction with others. ! Therapy may be interrupted at intervals to determine whether symptoms are sufficient to continue therapy

Antiemetics and Antinausea Drugs: Nursing Implications

! Assess complete nausea and vomiting history, including precipitating factors. ! Assess current medications. ! Assess for contraindications and potential drug interactions. ! Many of these drugs cause severe drowsiness; warn patients about driving or performing any hazardous tasks. ! Taking antiemetics with alcohol may cause severe central nervous system depression. ! Teach patients to change positions slowly to avoid hypotensive effects. ! For chemotherapy, antiemetics are often given 30 to 60 minutes before chemotherapy begins. ! Monitor for therapeutic effects. ! Monitor for adverse effects.

Antibiotics: Nursing implications (part 3)

! Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge ! For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings. ! Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored.

Analeptics: Nursing Implications

! Assess for: contraindications, interactions, abnormal cardiac rhythms, seizures, palpitations, liver problems, height & weight ! Pay close attention to the ABCs because of the patient's diminished sensorium. ! Observe for Therapeutic responses: Decrease in frequency, duration, and severity of migraines

Adrenergic-Blocking Drugs: Nursing Implications

! Assess for allergies and history of COPD, hypotension, cardiac dysrhythmias, bradycardia, heart failure, and other cardiovascular problems. - Any pre-existing condition that might be exacerbated by the use of these drugs might be a contraindication to their use. ! Remember that alpha blockers may precipitate hypotension. ! Remember that some beta blockers may precipitate bradycardia, hypotension, heart block, heart failure, and bronchoconstriction. ! Avoid over-the-counter medications because of possible interactions. ! Possible drug interactions may occur with - Antacids (aluminum hydroxide type) - Antimuscarinics or anticholinergics - Diuretics and cardiovascular drugs - Neuromuscular blocking drugs - Oral hypoglycemic drugs ! Encourage patients to take medications as prescribed. ! Instruct patients that these medications should never be stopped abruptly. ! Inform patients to report constipation or the development of urinary hesitancy or bladder distention ! Teach patients to change positions slowly to prevent or minimize postural hypotension. ! Instruct patients to avoid caffeine (excessive irritability). ! Instruct patients to avoid alcohol ingestion and hazardous activities until blood levels become stable. ! Instruct patients to notify their physicians if palpitations, dyspnea, nausea, or vomiting occurs. ! Monitor for adverse effects. ! Monitor for therapeutic effects. - Decreased chest pain in patients with angina - Return to normal BP and heart rate - Other specific effects, depending on the use

Acid-Controlling Drugs/Proton Pump Inhibitors (PPIs): Nursing Implications

! Assess for allergies and history of liver disease. ! Not all are available for parenteral administration. ! May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin ! The granules of pantoprazole capsules may be given via NG tubes, but the NG tube must be at least 16 gauge or the tube may become clogged. ! Capsule contents may be opened and mixed with apple juice but do not chew or crush delayed-release granules.

Acid-Controlling Drugs/Histamine (H2) Antagonists: Nursing Implications

! Assess for allergies and impaired renal or liver function. ! Use with caution in patients who are confused, disoriented, or older. ! Take 1 to 2 hours before antacids. ! For intravenous doses, follow administration guidelines.

Acid-Controlling Drugs/Antacids: Nursing Implications

! Assess for allergies and preexisting conditions that may restrict the use of antacids, such as: - Fluid imbalances - Renal disease - GI obstruction - HF - Pregnancy ! Patients with HF or hypertension should not use antacids with high sodium content. ! Use with caution with other medications because of the many drug interactions. ! Most medications should be administered 1 to 2 hours after an antacid. ! Antacids may cause premature dissolving of enteric-coated medications, resulting in stomach upset. ! Be sure that chewable tablets are chewed thoroughly and liquid forms are shaken well before giving. ! Administer with at least 8 oz of water to enhance absorption (except for "rapid-dissolve" forms). ! Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as malignancy or bleeding ulcers. ! If symptoms remain ongoing, the patient should seek medical evaluation. ! Monitor for adverse effects: - Nausea, vomiting, abdominal pain, diarrhea - With calcium-containing products: constipation, acid rebound ! Monitor for therapeutic response: - Notify the health care provider if symptoms are not relieved.

Adrenergic: Nursing Implications (Assessment)

! Assess for allergies, asthma, and history of hypertension, cardiac dysrhythmias, and other cardiovascular disease. ! Assess renal, hepatic, and cardiac function before treatment. ! Perform baseline assessment of vital signs, peripheral pulses, skin color, temperature, and capillary refill; include postural blood pressure and pulse. - Follow administration guidelines carefully.

Thyroid Replacement/Antithyroid Drugs: Nursing Implications

! Assess for drug allergies, contraindications, and potential drug interactions. ! Obtain baseline vital signs and weight. ! Cautious use is advised for those with cardiac disease or hypertension and for pregnant women. ! During pregnancy, treatment for hypothyroidism should continue. ! Fetal growth may be retarded if maternal hypothyroidism is untreated during pregnancy. - Adjust dosage every 4 weeks to keep TSH at the lower end of the normal range. ! Teach patients to take thyroid drugs once daily in the morning to decrease the likelihood of insomnia if taken later in the day. ! Teach patients to take the medications at the same time every day and not to switch brands without primary care provider approval. ! Teach patients to report any unusual symptoms, chest pain, or heart palpitations. ! Teach patients not to take over-the-counter medications without primary care provider approval. ! Teach patients that therapeutic effects may take several weeks to occur. ! Monitor for therapeutic response. - Thyroid drugs: decreased symptoms of hypothyroidism, improved energy levels, improved mental and physical stamina - Antithyroid drugs: no evidence of hyperthyroidism ! Monitor for adverse effects. - Thyroid drugs: cardiac dysrhythmia - Antithyroid drugs: leukopenia (manifested as fever, sore throat, lesions)

Antibiotics/Cephalosporins: Nursing Implications

! Assess for penicillin allergy; may have cross-allergy. ! Give orally administered forms with food to decrease GI upset even though this will delay absorption. ! Some of these drugs may cause a disulfiram (Antabuse)-like reaction when taken with alcohol.

Dermatologic Drugs: Nursing Implications

! Assess for presence of contraindications, especially drug allergies. ! Do not apply antiinfective drugs until culture and sensitivity testing (if ordered) are completed. ! For isotretinoin (Amnesteem) - Ensure that strict guidelines are in place for monthly pregnancy testing and prescription renewal. - Monitor liver function before and during therapy. ! Assess area affected thoroughly before applying medication. ! Keep in mind that systemic absorption is higher in very young and very old patients because their skin may be more permeable. ! Follow the specific manufacturer's guidelines for administration techniques. ! Cleanse the area thoroughly to remove debris and residual medication; follow specific recommendations. ! Wear gloves when applying topical drugs. ! Apply dressings (e.g., wet, wet-to-dry, occlusive) as prescribed. ! Document - Site of application - Drainage (color, amount) - Swelling, temperature - Odor, color, pain, or other sensations - Type of treatment given - Patient's response ! Protect affected area from sunlight. ! Do not double up on dose if a dose is missed. ! Ensure proper disposal of contaminated dressings. ! Provide patient and family teaching as necessary for self-care. ! Monitor for therapeutic responses. ! Monitor for adverse effects.

Heart Failure Drugs: Nursing Implications

! Assess history, drug allergies, and contraindications. ! Assess clinical parameters, including:BP, Apical pulse for 1 full minute, Heart & breath sounds, Weight, Input & output measures, Electrocardiogram, Serum labs: potassium, sodium, magnesium, calcium, renal, and liver function studies ! Before giving any dose, count apical pulse for 1 full minute. ! For an apical pulse less than 60 or greater than 100 beats/min: Hold dose & notify prescriber. ! Hold dose and notify prescriber if the patient experiences signs or symptoms of toxicity: Anorexia, nausea, vomiting, diarrhea, Visual disturbances (blurred vision, seeing green or yellow halos around objects) ! Check dosage forms carefully and follow instructions for administering. ! Avoid giving digoxin with high-fiber foods (fiber binds with digitalis). ! Patients should immediately report a weight gain of 2 lb or more in 1 day or 5 lb or more in 1 week. ! Nesiritide or milrinone: Use an infusion pump & monitor input and output, heart rate and rhythm, BP, daily weights, respirations ! Monitor for therapeutic effects: Increased urinary output, Decreased edema, shortness of breath, dyspnea, crackles, fatigue, Resolution of paroxysmal nocturnal dyspnea, Improved peripheral pulses, skin color, temperature, ! Monitor for adverse effects.

Vitamins and Minerals: Nursing Implications

! Assess patient history and medication history, including drug allergies. ! Assess for potential contraindications. ! Assess baseline laboratory values, especially hemoglobin, hematocrit, reticulocytes, and others. ! Obtain nutritional assessment. ! Ferrous salts are contraindicated in patients with ulcerative colitis, peptic ulcer disease, liver disease, and other gastrointestinal (GI) disorders. ! Keep away from children because oral forms may look like candy. ! Iron dextran is contraindicated in all anemias except for iron-deficiency anemia. ! For liquid iron preparations, follow the manufacturer's guidelines on dilution and administration. ! Instruct the patient to take liquid iron preparations through a straw to avoid staining tooth enamel. ! Oral forms of iron should be taken between meals for maximum absorption, but may be taken with meals if GI distress occurs. ! Oral forms should be given with juice but not with milk or antacids. ! Patients should remain upright for 15 to 30 minutes after oral iron doses to avoid esophageal corrosion. ! Patients should be encouraged to eat foods high in iron and folic acid. ! For iron dextran, a small test dose should be given. - After 1 hour, if no reaction, the remainder of the dose can be given. - Administer deeply into a large muscle mass using the Z-track method. ! For IV doses of iron dextran, give carefully according to the manufacturer's instructions. ! Have resuscitative equipment available in case of an anaphylactic reaction. ! Determine the cause of anemia before administering folic acid. ! Administer oral folic acid with food. ! Folic acid may also be given IV and added to total parenteral nutrition solutions. ! Monitor for therapeutic responses: - Improved nutritional status - Increased weight, activity tolerance, well-being - Absence of fatigue Monitor for adverse effects.

Ophthalmic Drugs: Nursing Implications

! Assess the patient's history, including medication history. ! Assess the patient's baseline vital signs and visual acuity and perform a physical assessment of the eye and surrounding structures. ! Assess for contraindications to specific drugs. ! Follow specific guidelines for administration of ophthalmic drugs. ! Avoid touching the eye with the tip of the dropper or container. ! Apply ointments as a thin layer in the conjunctival sac. ! When applying eyedrops, have the patient look up to the ceiling and place the drop in the conjunctival sac. ! Pressure may be applied to the inner canthus for at least 1 minute to reduce systemic absorption of the drug. ! If more than one eye medication is ordered, clarify the correct order and intervals for administration. ! If the patient wears contact lenses, check to see if they should be removed during therapy with eye medications. ! Provide patient and family education on correct procedures for administration of eye medications. ! Monitor for adverse effects. ! Monitor for therapeutic response to therapy.

Men's Health Drugs: Nursing Implications

! Assessment should include complete history, including medication history, urinary elimination problems, and potential contraindications. ! Obtain baseline vital signs, weight, height, and serum electrolyte levels. ! Assess renal and liver function. ! Assess PSA level and perform digital rectal examination before beginning any drugs for treatment of prostate disease. ! Assess current medications for potential interactions. ! Follow exact instructions for sublingual, buccal, and oral forms. ! Transdermal Testoderm patches are applied to the scrotal skin. ! Transdermal Androderm patches are applied to the skin on the body, never to scrotal skin. ! Pregnant women should not touch crushed or broken hormone drugs. ! Educate patients on proper administration techniques for each drug. ! Monitor for therapeutic responses. ! Monitor for adverse effects.

Antiepileptic: Nursing Implications

! Assessment: Health history, current med, allergies, liver function, baseline vitals ! Oral drugs: take regularly, same time each day. Take with meals to reduce GI upset. Do not crush, chew or open extended release forms. If PT is NPO for procedure, contact prescriber regarding AED dosage ! IV Forms: follow manufacturer's recommendation for deliver (usually slow). Monitor VS, avoid extravasation of fluid. Use only normal saline with IV phenytoin (Dilatin) ! Be careful with drug names! When using trade names, Cerebyx and Celebrex sound and look very much alike ... but they are quite different! Use both trade and generic names when ordering medications. ! Teach patients to keep a journal to monitor: Response to AED, Seizure occurrence and descriptions, Adverse effects ! Instruct patients to wear a medical alert tag or ID. AEDs should not be discontinued abruptly. Follow driving recommendations. ! Teach patients that therapy is long term and possibly lifelong (not a cure). ! Monitor for therapeutic effects:Decreased or absent seizure activity ! Monitor for adverse effects: Mental status changes, mood changes, changes in level of consciousness or sensorium, Eye problems, visual disorders, Sore throat, fever (blood dycrasias may occur with hydantoins)

Abused Substances: Nursing Implications

! Assessments should include nonjudgmental and open-ended questions about substance abuse. ! Be observant for clues to substance abuse so as to avoid withdrawal symptoms. ! The most dangerous substances in terms of withdrawal are CNS depressants such as barbiturates, benzodiazepines, and alcohol. ! Establish therapeutic rapport and use empathy toward the patient. ! Patient safety is of utmost importance at all times during patient care but especially when the patient is experiencing the signs and symptoms of withdrawal. ! Provide monitoring and support as needed throughout the withdrawal process. ! Educate the patient and family members or significant others about the recovery process. ! Emphasize that recovery is lifelong.

Antibiotics: Nursing Implications (part 1)

! Before beginning therapy, assess drug allergies; renal, liver, and cardiac function; and other lab studies. ! Be sure to obtain thorough patient health history, including immune status. ! Assess for conditions that may be contraindications to antibiotic use or that may indicate cautious use. ! Assess for potential drug interactions. !It is essential to obtain cultures from appropriate sites before beginning antibiotic therapy. ! Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early because they feel better. ! Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge ! For safety reasons, check the name of the medication carefully because there are many drugs that sound alike or have similar spellings.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS): Nursing implications

! Before beginning therapy, assess for conditions that may be contraindications to therapy, especially: - GI lesions or peptic ulcer disease - Bleeding disorders ! Assess for conditions that require cautious use. ! Perform laboratory studies as indicated (cardiac, renal, and liver function studies; complete blood count; platelet count). ! Perform a medication history to assess for potential drug interactions. ! Several serious drug interactions exist. ! Do not give salicylates to children and teenagers because of the risk of Reye's syndrome ! Because these drugs generally cause GI distress, they are often better tolerated if taken with food, milk, or an antacid to avoid irritation. ! Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks. ! Educate patients about the various adverse effects of NSAIDs and inform them to notify their prescribers if these effects become severe or if bleeding or GI pain occurs. ! Inform patients to watch closely for the occurrence of any unusual bleeding, such as in the stool. ! Advise patients that enteric-coated tablets should not be crushed or chewed. ! Monitor for therapeutic effects, which vary according to the condition being treated. - Decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area ** Black Box Warning: - All NSAIDs (except aspirin) share a black box warning regarding an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke. - NSAIDs may counteract the cardioprotective effects of aspirin.

Antifungal Drugs: Nursing Implications

! Before beginning therapy, assess for hypersensitivity, possible contraindications, and conditions that require cautious use. ! Obtain baseline vital signs, complete blood count, liver and renal function studies, and electrocardiography. ! Assess for other medications used (prescribed and over the counter) to avoid drug interactions. ! Follow the manufacturer's directions carefully for reconstitution and administration. ! Monitor vital signs of patients receiving intravenous (IV) infusions every 15 to 30 minutes. ! During IV infusions, monitor input and output to identify adverse effects. ! Some oral forms should be given with meals to decrease GI upset; others require an empty stomach—be sure to check. ! Monitor for therapeutic effects. - Easing of symptoms of infection - Improved energy levels - Normal vital signs, including temperature ! Monitor carefully for adverse effects.

Psychotherapeutic: Nursing Implications

! Before beginning therapy, assess the physical and emotional status of patients.Obtain baseline vital signs, including postural BP readings. Obtain liver and renal function tests.Complete Suicide Assessment Scale ! Assess for possible contraindications to therapy, cautious use, and potential drug interactions, LOC, mental alertness, and potential for injury to self and others. ! Check the patient's mouth to make sure oral doses are swallowed. ! Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected. ! Advise patients to avoid abrupt withdrawal. Advise patients to change positions slowly to avoid postural hypotension and possible injury. ! The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquire more effective coping skills. ! Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts. ! Simultaneous use of these drugs with alcohol or other CNS depressants can be fatal. ! Monitor for therapeutic effects: mental alertness, cognition, affect, mood, ability to carry out activities of daily living, appetite, and sleep patterns. ! Monitor potential for self-injury during the delay between the start of therapy and symptomatic improvement.

Antilipemics: Nursing Implications

! Before beginning therapy, obtain a thorough health and medication history. ! Assess dietary patterns, exercise level, weight, height, vital signs, tobacco and alcohol use, and family history. ! Assess for contraindications, conditions that require cautious use, and drug interactions. ! Contraindications: Biliary obstruction, liver dysfunction, and active liver disease. ! Obtain baseline liver function studies. ! Patients on long-term therapy may need supplemental fat-soluble vitamins (A, D, K). ! Refer to guidelines regarding administration times and meals. ! Counsel patient concerning diet and nutrition on an ongoing basis. ! Instruct patient on proper procedure for taking the medications.

Antihypertensive Drugs: Nursing Implications

! Before beginning therapy, obtain a thorough health history and head-to-toe physical examination. ! Assess for contraindications to specific antihypertensive drugs. ! Assess for conditions that require cautious use of these drugs. ! Educate patients about the importance of not missing a dose and taking the medications exactly as prescribed. ! Instruct patients to check with their physicians for instructions on what to do if a dose is missed; patients should never double up on doses if a dose is missed. ! Monitor BP during therapy; instruct patients to keep a journal of regular BP checks. ! Instruct patients that these drugs should not be stopped abruptly because this may cause a rebound hypertensive crisis and perhaps lead to stroke. ! Oral forms should be given with meals so that absorption is more gradual and effective. ! Administer IV forms with extreme caution and use an IV pump. ! Remind patients that medication is only part of therapy. Encourage patients to watch their diet, stress level, weight, and alcohol intake. ! Instruct patients to avoid smoking and eating foods high in sodium. ! Encourage supervised exercise. ! Teach patients to change positions slowly to avoid syncope from postural hypotension. ! Instruct patients to report unusual shortness of breath; difficulty breathing; swelling of the feet, ankles, face, or around the eyes; weight gain or loss; chest pain; palpitations; and excessive fatigue. ! Male patients who take these drugs may not be aware that impotence is an expected effect, and this may influence compliance with drug therapy. ! If patients are experiencing serious adverse effects or if they believe the dose or medication needs to be changed, they should contact their physicians immediately. ! Hot tubs, showers, or baths; hot weather; prolonged sitting or standing; physical exercise; and alcohol ingestion may aggravate low BP, leading to fainting and injury; patients should sit or lie down until symptoms subside. ! Patients should not take any other medications, including over-the-counter drugs, without first getting the approval of their physicians ! Educate patients about lifestyle changes that may be needed: Weight loss, Stress management, Supervised exercise, Dietary measures ! Monitor for adverse effects (dizziness, orthostatic hypotension, fatigue) and for toxic effects. ! Monitor for therapeutic effects.

Antiretroviral Drug: Nursing Implications

! Before beginning therapy, thoroughly assess underlying disease and medical history, including allergies. ! Assess baseline vital signs and nutritional status. ! Assess for contraindications, conditions that may indicate cautious use, and potential drug interactions. ! Be sure to teach proper application technique for ointments, aerosol powders, and so on. ! Emphasize handwashing before and after administration of medications to prevent site contamination and spread of infection. ! Instruct patients to wear a glove or finger cot when applying ointments or solutions to affected areas. ! Instruct patients to consult their prescribers before taking any other medication, including over-the-counter medications. ! Emphasize the importance of good hygiene. ! Inform patients that antiviral drugs are not cures but do help to manage symptoms. ! Instruct patients on the importance of taking these medications exactly as prescribed and for the full course of treatment. ! Instruct patients to start therapy with antiviral drugs at the earliest sign of recurrent episodes of genital herpes or herpes zoster.

Glucose Modifying Drugs: Nursing Implications

! Before giving drugs that alter glucose levels, obtain and document: - A thorough history - Vital signs - Blood glucose level, HbA1C level - Potential complications and drug interactions ! Before giving drugs that alter glucose levels ! Assess the patient's ability to consume food ! Assess for nausea or vomiting ! Hypoglycemia may be a problem if antidiabetic drugs are given and the patient does not eat. ! If a patient is NPO for a test or procedure, consult the primary care provider to clarify orders for antidiabetic drug therapy. ! Keep in mind that overall concerns for any patient with DM increase when the patient: Is under stress, has an infection, has an illness or trauma, is pregnant or lactating ! Thorough patient education is essential regarding: Disease process, Diet and exercise recommendations, Self-administration of insulin or oral drugs, Potential complications

Abused Substances: Nursing Implications (Assessment tools for substance abuse)

! CAGE Alcoholism Screening Test Adapted to Include Drugs (CAGE-AID) ! Substance Abuse Subtle Screening Inventory (SASSI) ! Michigan Alcoholism Screening Test Geriatric version (MAST-G) ! Problem Oriented Screening Instrument for Teenagers (POSIT)

Adrenergic: Nursing Implications (IV)

! Check IV site often for infiltration, Use clear IV solutions, Use an infusion pump, Infuse drug slowly to avoid dangerous cardiovascular effects, Monitor cardiac rhythm

Antiplatelet Drugs: Nursing Implications

! Concerns and teaching tips same as for anticoagulants ! Drug-drug interactions ! Adverse reactions to report ! Monitoring for abnormal bleeding

Antianginal Calcium Channel Blockers: Nursing Implications

! Constipation is a common problem; instruct patients to take in adequate fluids and eat high-fiber foods.

Cholinergic-Blocking: Nursing Implications (Continued)

! Dry mouth may occur; can be handled by chewing gum, frequent mouth care, and hard candy. ! Patients should check with the physician before taking any other medication, including over-the-counter medications. ! Antidote for atropine overdose is physostigmine. ! Anticholinergics taken by older adult patients may lead to higher risk for heatstroke because of the effects on heat-regulating mechanisms. ! Teach patients to limit physical exertion and avoid high temperatures and strenuous exercise. ! Emphasize the importance of adequate fluid and salt intake. ! Patients should report the following symptoms to their physician: urinary hesitancy or retention, constipation, tachycardia, palpitations, tremors, confusion, sedation, hallucinations, and decreased sweating (leading to hot, dry skin). ! Monitor for therapeutic effects. - For patients with Parkinson's disease: fewer tremors and decreased salivation and drooling - For patients with urologic problems: improved urinary patterns, less hypermotility, increased time between voiding ! Monitor for adverse effects.

Antibiotics: Nursing Implications (part 2)

! Each class of antibiotics has specific adverse effects and drug interactions that must be carefully assessed and monitored. ! The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea. ! All oral antibiotics are absorbed better if taken with at least 6 to 8 oz of water. ! Monitor for therapeutic effects: - Improvement of signs and symptoms of infection - Return to normal vital signs - Negative culture and sensitivity tests - Disappearance of fever, lethargy, drainage, and redness ! Monitor for adverse reactions.

Nutritional Supplements: Nursing Implications

! Ensure that a complete nutritional assessment is taken, including a dietary history, weekly and daily food intakes, and weight and height measurements. ! Consult with a registered dietitian. ! Assess baseline laboratory studies, such as total protein, albumin, blood urea nitrogen, red blood cell count, white blood cell count, and cholesterol. ! Collect anthropometric data. ! Assess for allergies to components of enteral nutritional supplements (e.g., whey, egg whites). ! Assess for lactose intolerance. ! If administering enteral nutrition by tube feedings, follow facility policy for ensuring proper tube placement and for checking residual volumes before administering a feeding. ! Follow procedures for flushing tubing to prevent clogging the feeding tube with formula. ! Carefully monitor how the patient is tolerating enteral feedings. ! Keep in mind that most enteral feedings are started slowly, and the rate is increased gradually. ! Monitor for signs of lactose intolerance: - Cramping - Diarrhea - Abdominal bloating - Flatulence ! Follow facility policies and procedures for care and maintenance of TPN IV lines, including tubing and dressing changes. ! Monitor patient's temperature; report any increase immediately. ! Monitor blood glucose levels with a glucometer. ! Monitor for hyperglycemia: - Headache, dehydration, weakness - Monitor for hypoglycemia: - Cold, clammy skin, dizziness, tachycardia, tingling of the extremities ! While on TPN, the pancreas provides increased amounts of insulin to cover the increased glucose levels. ! If TPN is discontinued abruptly, rebound hypoglycemia may occur until the pancreas has time to adjust to changing glucose levels. ! If TPN must be discontinued abruptly, then infuse 5% to 10% glucose to prevent hypoglycemia, according to facility policy. ! Monitor for fluid overload while on TPN: - Weak pulse Hypertension - Tachycardia - Confusion - Decreased urine output - Pitting edema Monitor daily weights and intake and output volumes. Monitor for therapeutic responses to nutritional supplementation: - Improved well-being, energy, strength, and performance of activities of daily living - Increased weight - Laboratory studies that reflect a more positive nutritional status

Anorexiants: Nursing Implications

! Follow instructions for diet and exercise ! Take in the morning ! Avoid caffeine ! Fat-soluble vitamin supplementation may be needed ! Observe for Therapeutic responses: appetite control & weight loss

Thrombolytic Drugs: Nursing Implications

! Follow strict manufacturer's guidelines for preparation and administration. ! Monitor IV sites for bleeding, redness, and pain. ! Monitor for bleeding from gums, mucous membranes, nose, and injection sites. ! Observe for signs of internal bleeding (decreased blood pressure, restlessness, increased pulse).

Benzodiazepines, Barbiturates, & Muscle Relaxants: Nursing Implications

! Give hypnotics 30 to 60 minutes before bedtime for maximum effectiveness in inducing sleep (depends on drug's onset). ! Most benzodiazepines cause REM rebound and a tired feeling the next day; use with caution in older adults. ! Instruct patients to avoid alcohol and other CNS depressants. ! Check with the prescriber before taking any other medications, including over-the-counter medications. ! Rebound insomnia may occur for a few nights after a 3- to 4-week regimen has been discontinued. ! Safety is important: Keep side rails up or use bed alarms. Do not permit smoking.Assist patient with ambulation (especially older adults). Keep call light within reach. Monitor for adverse effects. Age-appropriate considerations ! Monitor for therapeutic effects: - Increased ability to sleep at night - Fewer awakenings - Shorter sleep-induction time - Few adverse effects, such as "hangover" effects - Improved sense of well-being because of improved sleep - For muscle relaxants: decreased spasticity, decreased rigidity

Mood Stabilizing Drugs (Lithium): Nursing Implications

! Give with caution and daily monitoring of serum lithium levels to patients with renal or CV disease, debilitation, or dehydration or life-threatening psychiatric disorders. ! Give drug with food or milk or after meals. ! BLACK BOX WARNING: Monitor clinical status closely, especially during initial stages of therapy; monitor for therapeutic serum levels of 0.6-1.2 mEq/L; toxicity is closely related to serum levels. ! Advise patient that this drug may cause serious fetal harm and cannot be used during pregnancy; urge use of barrier contraceptives. ! Decrease dosage after the acute manic episode is controlled; lithium tolerance is greater during the acute manic phase and decreases when manic symptoms subside. ! WARNING: Ensure that patient maintains adequate intake of salt and adequate intake of fluid (2,500-3,000 mL/day). ! Monitor Therapeutic Effects: Less mania, serum levels of 0.6 to 1.2 mEq/L

Anticoagulants: Patient Education

! Importance of regular laboratory testing ! Signs of abnormal bleeding ! Measures to prevent bruising, bleeding, and tissue injury ! Wearing a medical alert bracelet ! Avoiding foods high in vitamin K (tomatoes, dark leafy green vegetables) ! Consulting physician before taking other drugs or over-the-counter products, including herbals

Adrenergic: Nursing Implication (Chronic Lung Disease)

! Instruct patients to avoid factors that exacerbate their condition. ! Encourage fluid intake (up to 3000 mL/day) if permitted. ! Educate patients about proper dosing, use of equipment (metered-dose inhaler, spacer, nebulizer), and equipment care. ! Educate on appropriate use of inhalers (rescue versus maintenance).

Antipsychotics: Nursing Implication

! Instruct patients to wear sunscreen because of photosensitivity. ! Tell patients to avoid taking antacids or antidiarrheal preparations within 1 hour of a dose. ! Inform patients to avoid alcohol and other CNS depressants with these medications. ! Long-term haloperidol therapy may result in tremors, nausea, vomiting, or uncontrollable shaking of small muscle groups; report these symptoms to the physician ! Oral forms may be taken with meals to decrease GI upset. ! These drugs may cause drowsiness, dizziness, or fainting; instruct patients to change positions slowly. ! Monitor for therapeutic effects: Improved mood and affect, Alleviation of psychotic symptoms and episodes, Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope

Cholinergic-Blocking: Nursing Implications

! Keep in mind that these drugs block the action of ACh in the PSNS. ! Assess for allergies, presence of BPH, urinary retention, glaucoma, tachycardia, myocardial infarction, heart failure, hiatal hernia, and GI or GU obstruction. ! Perform baseline assessment of vital signs and systems overview. ! Medications should be taken exactly as prescribed to have the maximum therapeutic effect. ! Overdosing can cause life-threatening problems. ! Blurred vision will cause problems with driving or operating machinery. ! Patients may experience sensitivity to light and may want to wear dark glasses or sunglasses. ! When giving ophthalmic solutions, apply pressure to the inner canthus to prevent systemic absorption.

Amphetamines: Nursing Implications

! Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia. ! Take on an empty stomach 30 to 45 minutes before meals. ! Drug "holidays" may be ordered. ! Instruct parents to keep a journal to monitor the child's response to therapy. ! Monitor the child for continued physical growth, including height and weight. ! Observe for Therapeutic responses: Decrease in hyperactivity, increased attention span & concentration

Antidepressants (General): Nursing Implications

! Many cautions, contraindications, and interactions exist pertaining to the use of antidepressants. ! Inform patients that it may take several weeks to see therapeutic effects. ! Monitor patients closely during this time, assess for suicidal tendencies, and provide support. ! Assist older adult and weakened patients with ambulation and other activities because falls may occur because of drowsiness or postural hypotension. ! Tricyclics may need to be weaned and discontinued before undergoing surgery to avoid interactions with anesthetic drugs. ! Monitor for adverse effects and discuss with patients. ! Encourage patients to wear medication ID badges naming the drugs being taken. ! Caffeine and cigarette smoking may decrease effectiveness of medication therapy. ! With MAOIs, instruct patients and family regarding tyramine-containing foods and signs and symptoms of hypertensive crisis. ! Monitor Therapeutic effects: Improved sleep patterns and nutrition, Increased feelings of self-esteem, Decreased feelings of hopelessness, Increased interest in self and appearance, Increased interest in daily activities, Fewer depressive manifestations or suicidal thoughts or ideations

Anxiolytics (Antianxiety)/ Benzodiazepines: Nursing Implications

! Monitor BP, pulse, and resp. status frequently throughout IV administration ! Prolonged high dose therapy may lead to psychological or physical dependance. Restrict the amount of drug available to PT, especially if PT is depressed, suicidal, or has history of addiction ! Assess: degree of anxiety and level of sedation (ataxia, dizziness, slurred speech) before and periodically throughout therapy ! May cause daytime drowsiness, caution PT to avoid driving and other activities requiring alertness until response to medication is known ! Avoid alcohol, and other CNS depressants concurrently ! Advise PT to inform health care professional is pregnancy is planned or suspected ! In elderly patients, monitor closely for over-sedation and profound CNS depression. ! Monitor Therapeutic effects: improved mental alertness, cognition, and mood, Fewer anxiety and panic attacks, Improved sleep patterns and appetite, Less tension and irritability; fewer feelings of fear, impending doom, and stress, More interest in self and others

Antidysrhythmics: Nursing Implications (Cont.)

! Monitor ECG for prolonged QT interval with use of antidysrhythmics, including amiodarone, procainamide, quinidine, dofetilide, bepridil, sotalol, and flecainide. ! Administer IV infusions with an IV pump. ! Solutions of lidocaine that contain epinephrine should not be given IV; they are to be used ONLY as local anesthetics. ! Ensure that the patient knows to notify health care provider of any worsening of dysrhythmia or toxic effects: SOB, Edema, Dizziness, Syncope, Chest pain, GI distress, Blurred vision ! each patients taking beta blockers, digoxin, and other drugs how to take their own radial pulse for 1 full minute and to notify their physicians before taking the next dose if the pulse is less than 60 beats/min. ! Monitor for therapeutic response: Decreased BP in hypertensive patients, Decreased edema, Decreased fatigue, Regular pulse rate, Pulse rate without major irregularities, Improved regularity of rhythm, Improved cardiac output

Cholinergic: Nursing Implications

! Note that these drugs will stimulate the PNS and mimic the action of ACh. ! Assess for allergies, presence of GI or GU obstructions, asthma, peptic ulcer disease, and coronary artery disease. ! Perform baseline assessment of vital signs and systems overview. ! Medications should be taken as ordered and not abruptly stopped. ! Doses should be spread evenly apart to optimize the effects of the medication. ! Overdosing can cause life-threatening problems. Patients should not adjust dosages unless directed by their health care provider. ! Encourage patients with myasthenia gravis to take medication 30 minutes before eating to help improve chewing and swallowing. ! When cholinergic drugs are prescribed for Alzheimer's disease, be honest with caregivers and patients that the drugs are for management of symptoms (not a cure). ! Therapeutic effects of anti-Alzheimer's drugs may not occur for up to 6 weeks. ! Atropine is the antidote for cholinergics, and it should be available in the patient's room for immediate use if needed. ! Patients should notify their physicians if they experience muscle weakness, abdominal cramps, diarrhea, or difficulty breathing. ! Monitor for therapeutic effects - Alleviated signs and symptoms of myasthenia gravis - In postoperative patients with decreased GI peristalsis, monitor for: •Increased bowel sounds •Passage of flatus •Occurrence of bowel movements

Stimulant: Nursing Implications (Narcolepsy)

! Observe and document frequency of episodes

Antidysrhythmics: Nursing Implications

! Obtain a thorough drug and medical history. ! Measure baseline blood pressure (BP), pulse, input and output, and cardiac rhythm. ! Measure serum potassium levels before initiating therapy. ! Assess for conditions that may be contraindications for use of specific drugs & potential drug interactions. ! Instruct patients to report dosing schedules and adverse effects to physician. ! During therapy, monitor cardiac rhythm, heart rate, BP, general well-being, skin color, temperature, and heart and lung sounds. ! Assess plasma drug levels as indicated. ! Monitor for toxic effects. ! Instruct patients to take medications as scheduled and not to skip doses or double up for missed doses. ! Instruct patients to contact their physicians for instructions if a dose is missed. ! Instruct patients not to crush or chew oral sustained-release preparations.

Laxatives: Nursing Implications

! Obtain a thorough history of presenting symptoms, elimination patterns, and allergies. ! Assess fluid and electrolytes before initiating therapy. ! Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, or abdominal pain. ! A healthy, high-fiber diet and increased fluid intake should be encouraged as an alternative to laxative use. ! Long-term use of laxatives often results in decreased bowel tone and may lead to dependency. ! All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated. ! Patients should take all laxative tablets with 6 to 8 oz of water. ! Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 oz) of water. ! Give bisacodyl with water because of interactions with milk, antacids, and juices. ! Inform patients to contact their prescribers if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible fluid or electrolyte loss. ! Monitor for therapeutic effect.

Antitubercular Drug: Nursing Implications

! Obtain a thorough medical history and assessment. ! Perform liver function studies in patients who are to receive INH or rifampin (especially in older patients and those who use alcohol daily). ! Assess for contraindications to the various drugs, conditions for cautious use, and potential drug interactions. ! Patient education is critical. ! Therapy may last for up to 24 months. ! Take medications exactly as ordered at the same time every day. ! Emphasize the importance of strict adherence to regimen for improvement of condition or cure ! Remind patients that they are contagious during the initial period of their illness—instruct in proper hygiene and prevention of the spread of infected droplets. ! Teach patients to take care of themselves, including getting adequate nutrition and rest. ! Patients should not consume alcohol while taking these medications or take other medications, including over-the-counter medications, unless they check with their prescribers. ! Rifampin causes oral contraceptives to become ineffective; another form of birth control is needed. ! Patients who are taking rifampin should be told that their urine, stool, saliva, sputum, sweat, or tears may become reddish orange; even contact lenses may be stained. ! Pyridoxine may be needed to combat neurologic adverse effects associated with INH therapy. ! Oral preparations may be given with meals to reduce gastrointestinal upset even though recommendations are to take them 1 hour before or 2 hours after meals. ! Monitor for adverse effects. - Instruct patients on the adverse effects that should be reported to the prescriber immediately. - These include fatigue, nausea, vomiting, numbness and tingling of the extremities, fever, loss of appetite, depression, and jaundice. ! Monitor for therapeutic effects. - Decrease in symptoms of TB, such as cough and fever - Laboratory study results (culture and sensitivity tests) and chest radiographs should confirm clinical findings. - Watch for lack of clinical response to therapy, indicating possible drug resistance.

Antidiarrheals: Nursing Implications

! Obtain thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for allergies. ! Do not give bismuth subsalicylate to children or teenagers with chickenpox or influenza because of the risk of Reye's syndrome. ! Use adsorbents carefully in older patients and those with decreased bleeding time, clotting disorders, recent bowel surgery, or confusion. ! Do not administer anticholinergics to patients with a history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, or toxic megacolon. ! Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes. ! Assess fluid volume status, input and output, and mucous membranes before, during, and after initiation of treatment. ! Teach patients to notify their prescribers immediately if symptoms persist. ! Monitor for therapeutic effect.

Pituitary Drugs: Nursing Implications

! Obtain thorough nursing assessment and medication history. ! Assess and document height, weight, VS. ! Assess for contraindications specific to each drug. ! Assess medication history for possible interactions. ! Assess diagnostic lab values (e.g., glucose levels, liver, and kidney function). ! Provide specific instructions for nasal spray forms of vasopressin. ! Rotate injection sites. ! Do not discontinue drugs abruptly. ! Do not take over-the-counter products without checking with health care provider. ! Parents of children who are receiving GHs should keep a journal reflecting the child's growth. ! Monitor for therapeutic responses. - Somatropin should increase growth in children. - Desmopressin and vasopressin should reduce severe thirst and decrease urinary output. - Octreotide should reduce symptoms of carcinoid crisis. ! Monitor for adverse effects.

Opioid Analgesics: Nursing Implications

! Oral forms should be taken with food to minimize gastric upset ! Ensure safety measures, such as keeping side rails up, to prevent injury ! Withhold dose and contact physician if there is a decline in the patients condition or if vital signs are abnormal, especially if respiratory rate is less than 10 to 12 breaths/ min ! Check dosages carefully. - Follow proper administration guidelines for IM injections including site rotation. - Follow proper guidelines for IV administration including dilution, rate, and so on. ! Constipation is a common adverse effect and may be prevented with adequate fluid and fiber intake ! Instruct patients to follow directions for administration carefully and to keep a record of their pain experience and response to treatments ! Patients should be instructed to change positions slowly to prevent possible orthostatic hypotension ! Monitor for adverse effects: -Contact physician immediately if vital signs change, patients condition declines, or pain continues -Respiratory depression may be manifested by respiratory rate of less than 10 breaths/min, dyspnea, diminished breath sounds, or shallow breathing ! Monitor for Therapeutic effects: - Decreased complaints of pain - Decreased severity of pain - Increased periods of comfort - Improved activities of daily living, appetite, and sense of well being

Adrenergic: Nursing Implications (General)

! Overuse of nasal decongestants may cause rebound nasal congestion or ulcerations. ! Avoid over-the-counter and other medications because of possible interactions. ! Administering two adrenergic drugs together may precipitate severe cardiovascular effects such as tachycardia or hypertension

Electrolytes/Potassium: Nursing Implications

! Parenteral infusions of potassium must be monitored closely. ! IV potassium must not be given at a rate faster than 10 mEq/hour to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mEq/hour or more may be used. ! Never give as an IV bolus or undiluted ! Oral forms of potassium: Must be diluted in water or fruit juice to minimize GI distress or irritation ! Monitor for complaints of nausea, vomiting, GI pain, and GI bleeding

Antianginal Drugs: Nursing Implications

! Patients should not take any medications, including over-the-counter medications, without checking with their physicians. ! Patients should be encouraged to limit caffeine intake. ! Patients should report: Blurred vision, Persistent headache, Dry mouth, Edema, Fainting episodes, Weight gain of 2 lb in 1 day or 5 lb in 1 week, Pulse rate less than 60 beats/min, Dyspnea ! Alcohol consumption and spending time in hot baths or whirlpools, hot tubs, or saunas will result in vasodilation, hypotension, and the possibility of fainting. ! Teach patients to change positions slowly to avoid postural BP changes. ! Encourage patients to keep a record of their anginal attacks, including precipitating factors, number of pills taken, and therapeutic effects. ! Monitor for adverse reactions: allergic reactions, headache, lightheadedness, hypotension, dizziness. ! Monitor for therapeutic effects: relief of angina, decreased BP, or both.

Antianginal/ Beta Blockers: Nursing Implications

! Patients taking beta blockers should monitor their pulse rates daily and report any rate lower than 60 beats/min or symptoms of relative bradycardia. ! Instruct patients to report dizziness or fainting. ! Inform patients that these medications should never be abruptly discontinued. ! Inform patients that these medications are for long-term prevention of angina, not for immediate relief.

Adrenal Drugs: Nursing Implications

! Perform a physical assessment to determine baseline weight, height, intake and output status, vital signs (especially blood pressure), hydration and nutritional status, and immune status. ! Obtain baseline laboratory studies. ! Assess for edema and electrolyte imbalances. ! Assess skin condition. ! Assess for contraindications to adrenal drugs, especially the presence of peptic ulcer disease. ! Assess for drug allergies and potential drug interactions (prescription and over-the-counter drugs). ! Be aware that these drugs may alter serum glucose and electrolyte levels. ! Systemic forms may be given by oral, intramuscular, intravenous, or rectal routes (notsubcutaneous) ! Prepare and administer according to manufacturer's directions. ! Oral forms should be given with food or milk to minimize GI upset. ! For topical applications, follow instructions about use and type of dressing, if any, to apply. ! Clear nasal passages before giving a nasal corticosteroid. ! After using an orally inhaled corticosteroid, instruct patients to rinse their mouths to prevent possible oral fungal infections. ! Teach patients taking corticosteroids to avoid contact with people with infections and to report any fever, increased weakness, lethargy, or sore throat. ! Patients should be taught to take all adrenal medications at the same time every day, usually in the morning, with meals or food. ! Patients should not take adrenal medications with alcohol, aspirin, or NSAIDs. ! Sudden discontinuation of these drugs can precipitate an adrenal crisis caused by a sudden drop in serum levels of cortisone. ! Doses are usually tapered before the drug is discontinued. ! Monitor for therapeutic responses. ! Monitor for adverse effects.

Diuretic Drugs: Nursing Implications

! Perform a thorough patient history and physical examination. ! Assess baseline fluid volume status, intake and output, serum electrolyte values, weight, and vital signs (especially postural blood pressure). ! Assess for disorders that may contraindicate or necessitate cautious use of these drugs. ! Instruct patients to take the medication in the morning if possible to avoid interference with sleep patterns. ! Monitor serum potassium levels during therapy. ! Teach patients to maintain proper nutritional and fluid volume status. ! Teach patients to eat more potassium-rich foods when taking any but the potassium-sparing drugs. ! Foods high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish, and legumes. ! Patients taking diuretics along with a digitalis preparation should be taught to monitor for digitalis toxicity. ! Patients with diabetes mellitus who are taking thiazide or loop diuretics should be told to monitor blood glucose and watch for elevated levels.

Antilipemics: Nursing Implications (Cont)

! Powder forms must be taken with a liquid, mixed thoroughly but not stirred, and never taken dry. ! Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption. ! To minimize adverse effects of niacin, start on low initial dose and gradually increase it, and take with meals. ! Small doses of aspirin or NSAIDs may be taken 30 minutes before niacin to minimize cutaneous flushing. ! Provide teaching regarding use of NSAIDs and aspirin. ! Inform patients that these drugs may take several weeks to show effectiveness. ! Instruct patients to report persistent GI upset, constipation, abnormal or unusual bleeding, and yellow discoloration of the skin. ! Monitor for adverse effects, including increased liver enzyme studies. ! Monitor for therapeutic effects: Reduced cholesterol and triglyceride levels

Serotonin Antagonists: Nursing Implications

! Provide specific teaching about correct administration of: dissolvable wafers, nasal spray, and self-injectable forms ! Instruct patients to keep a journal to monitor response to therapy. ! Observe for Therapeutic responses: Decrease in frequency, duration, and severity of migraines

Adrenergic-Blocking drugs/Beta Blockers: Nursing Implications

! Rebound hypertension or chest pain may occur if this medication is discontinued abruptly. ! Instruct patients to notify their physicians if they become ill and unable to take medication. ! Inform patients that they may notice a decrease in tolerance for exercise (dizziness and fainting may occur with increased activity) and have patients notify their physicians if these problems occur. ! Inform patients to report the following to their physicians. - Weight gain of more than 2 lb in 1 day or 5 lb in 1 week - Edema of the feet or ankles - Shortness of breath - Excessive fatigue or weakness - Syncope or dizziness

Antibiotics/Penicillin: Nursing Implications

! Take oral doses with water (not juices) because acidic fluids may nullify the drug's antibacterial action. ! Monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration.

Antibiotics/Sulfonamides: Nursing Implications

! Take with 2000 to 3000 mL of fluid/24 hour. ! Assess red blood cell count before beginning therapy. ! Take oral doses with food.

Antithyroid Drugs: Nursing Implications

! Teach patients the importance of alerting health care providers of thyroid medication use. - May enhance activity of anticoagulants - Patients with diabetes may need increased dosages of hypoglycemic medications. - May decrease serum digoxin levels ! Better tolerated when given with food ! Give at the same time each day to maintain consistent blood levels. ! Never stop these medications abruptly. ! Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt).

Diuretic Drugs: Nursing Implications (Cont.)

! Teach patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness and fainting related to orthostatic hypotension. ! Encourage patients to keep a log of their daily weight. ! Remind patients to return for follow-up visits and lab work. ! Patients who have been ill with nausea, vomiting, or diarrhea should notify their primary care providers because fluid and electrolyte imbalances can result. ! Signs and symptoms of hypokalemia include muscle weakness, constipation, irregular pulse rate, and overall feeling of lethargy. ! Instruct patients to notify their primary care providers immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss). ! Excessive consumption of licorice can lead to additive hypokalemia in patients taking thiazides. ! Monitor for adverse effects: Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness ! Monitor for hyperkalemia with potassium-sparing diuretics. ! Monitor for therapeutic effects: - Reduction of edema - Reduction of fluid volume overload - Improvement in manifestations of HF - Reduction of hypertension - Return to normal intraocular pressures

Antibiotics/Macrolides: Nursing Implications

! These drugs are highly protein bound and will cause severe interactions with other protein-bound drugs. ! The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset, many drugs are taken after a meal or snack.

Insulin: Nursing Implication

! When insulin is ordered, ensure: Correct route, Correct type of insulin, Timing of the dose, Correct dosage ! Insulin order and prepared dosages are second checked with another nurse. ! Check blood glucose level before giving insulin. ! Roll vials between hands instead of shaking them to mix suspensions. ! Ensure correct storage of insulin vials. ! Only use insulin syringes, calibrated in units, to measure and give insulin. ! Ensure correct timing of insulin dose with meals. ! When drawing up two types of insulin in one syringe, always withdraw the regular or rapid-acting insulin first. ! Provide thorough patient education regarding self-administration of insulin injections, including timing of doses, monitoring blood glucose levels, and injection site rotations.

Antihypertensives Drug: Classes

* Diuretics * Adrenergic drugs Vasodilators * Angiotensin-converting enzyme (ACE) inhibitors * Angiotensin II receptor blockers (ARBs) * Calcium channel blockers (CCBs) Direct renin inhibitors

Hematopoietic Drugs: Adverse Effects

* Usually mild * Most common include: - Fever - Muscle aches - Bone pain - Flushing

Cytotoxic Antibiotics: Nursing Implication

- Expect bone marrow suppression, nausea, vomiting, diarrhea, and stomatitis. - Monitor pulmonary status because pulmonary fibrosis may occur. - Monitor for nephrotoxicity and liver toxicity. - Monitor cardiovascular status. - Daunorubicin may turn the urine a reddish color.

Expectorants: Nursing Implications

- Expectorants should be used with caution in older adults and patients with asthma or respiratory insufficiency. - Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions. - Report a fever, cough, or other symptoms lasting longer than 1 week. Monitor for intended therapeutic effect

Interferons: Adverse Effects

- Flulike effects: Fever, chills, headache, myalgia - Dose-limiting adverse effect is fatigue. - Other adverse effects: Anorexia, Dizziness, Nausea, Vomiting, & Diarrhea

Common Cold Treatments

- Involves combined use of antihistamines, nasal decongestants, antitussives, and expectorants - Treatment is symptomatic only, not curative. - Symptomatic treatment does not eliminate the causative pathogen. - Difficult to identify whether cause is viral or bacterial - Treatment is "empiric therapy," treating the most likely cause - Antivirals and antibiotics may be used, but a definite viral or bacterial cause may not be easily identified. - Supplements: Vitamin C, Echinacea, Goldenseal

Immunization/ Other Vaccines

- Measles, mumps, and rubella virus vaccine (live) - Meningococcal vaccine - Pneumococcal vaccine, polyvalent and 13-valent - Poliovirus vaccine (inactivated) - Rabies virus vaccine - Human papillomavirus vaccine - Herpes zoster vaccine - Varicella virus vaccine

Immunization/ Antibody Titer: Background Information

- Measure of how many antibodies to a given antigen are present in the blood and is used to assess whether enough antibodies are present to protect the body effectively against the particular pathogen - Sometimes the antibody levels decline over time. - Booster shot: another dose of the vaccine is given to restore the antibody titers to a level that can protect the person against the infection

Immunomodulation Drugs: Background Information

- Medications that therapeutically alter a patient's immune response to malignant tumor cells - Drugs that modify the body's own immune response so that it can destroy various viruses and cancerous cells - Fourth part of cancer therapy, in addition to: Surgery, Chemotherapy, Radiation - Also used for other diseases: Autoimmune, Inflammatory, & Infectious

Antirheumatic Drugs/ Nonbiologic Disease-Modifying

- Methotrexate - Leflunomide - Hydroxychloroquine - Sulfasalazine

Immunosuppressants: Nursing Implications (Cont.)

- Oral antifungal drugs are usually given with these drugs to treat oral candidiasis that may occur. - Assess the oral cavity often for white patches on the tongue, mucous membranes, and oral pharynx. - Mix oral cyclosporine solution in a glass container. - Do not use Styrofoam containers because the drug adheres to the inside wall of the container. - Follow guidelines for parenteral administration carefully. - Inform patients that lifelong therapy with immunosuppressants is indicated with organ transplantation. - Patients taking immunosuppressants should be encouraged to take measures to reduce the risk of infection: Avoid crowds, & Avoid people with colds or other infections. - Inform patients to immediately report fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection. - Monitor for therapeutic responses. - Monitor for adverse effects and signs of drug toxicity.

Respiratory Drugs: Nursing Implications (General) (Cont.)

- Perform a thorough assessment before beginning therapy, including: Skin color Baseline vital signs Respirations (should be between 12 and 24 breaths/min) Respiratory assessment, including pulse oximetry Sputum production Allergies History of respiratory problems Other medications Smoking history - Teach patients to take bronchodilators exactly as prescribed. - Ensure that patients know how to use inhalers and MDIs and have patients demonstrate use of the devices. - Monitor for adverse effects. - Monitor for therapeutic effects: Decreased dyspnea, Decreased wheezing, restlessness, and anxiety, Improved respiratory patterns with return to normal rate and quality, Improved activity tolerance, Decreased symptoms and increased ease of breathing

Antitussives: Nursing Implications

- Perform respiratory and cough assessment and assess for allergies. - Instruct patients to avoid driving or operating heavy equipment because of possible sedation, drowsiness, or dizziness. - Report any of the following symptoms to the caregiver: Cough that lasts more than 1 week, Persistent headache, Fever, & Rash - Antitussive drugs are for nonproductive coughs. - Monitor for intended therapeutic effects.

Chemotherapy Information

- Pharmacologic treatment of cancer - Antineoplastic drugs - Divided into two groups based on where in the cellular life cycle they work: Cell cycle-nonspecific (CCNS) & Cell cycle-specific (CCS) - Some drugs have characteristics of both. - Drugs have a narrow therapeutic index. - Combination of drugs is usually more effective than single-drug therapy. - Drug resistance - Nearly all drugs cause adverse effects. - Dose-limiting adverse effects

Corticosteroids/ Inhaled: Adverse Effects

- Pharyngeal irritation - Coughing - Dry mouth - Oral fungal infections - Systemic effects are rare because low doses are used for inhalation therapy.

Xanthine Derivatives: Background Information

- Plant alkaloids: caffeine, theobromine, and theophylline - Only theophylline is used as a bronchodilator. - Synthetic xanthines: aminophylline and dyphylline

Immunization: Adverse Effects

- Range from mild and transient to very serious or life threatening - Minor effects: Fever, minor rash, soreness at injection site, itching, adenopathy - Severe effects: Fever higher than 103°F, encephalitis, convulsions, anaphylactic reaction, dyspnea, others - Minor reactions: Treated with acetaminophen and rest Serious or unusual reactions: Serum sickness [Report serious or unusual reactions to the Vaccine Adverse Event Reporting System (VAERS)]

Chemotherapy: Nursing Implications

- Remember that all rapidly dividing cells (both normal and cancer cells) are affected: Mucous membranes, Hair follicles, Bone marrow component - Monitor for effects on these tissues or complications. - Monitor for complications: GI mucous membranes: stomatitis, altered bowel function with high risk for poor appetite, nausea, vomiting, diarrhea, and inflammation and possible ulcerations of GI mucosa - Monitor for complications: Hair follicles: loss of hair (alopecia), Bone marrow components: dangerously low (life-threatening) blood cell counts - Monitor for adverse effects specific to the type of antineoplastic drug given.

Thyroid Replacement Drugs: Indications

- Replace what the thyroid gland itself cannot produce to achieve euthyroid condition (Levothyroxine) - Diagnosis of suspected hyperthyroidism (as in a TSH-suppression test) - Prevention or treatment of various types of goiters - Replacement hormonal therapy in patients whose thyroid glands have been surgically removed or destroyed by radioactive iodine in the treatment of thyroid cancer or hyperthyroidism - Hypothyroidism of pregnancy

Corticosteroids (Glucocorticosteroids): Mechanism of Action

- Stabilize membranes of cells that release harmful bronchoconstricting substances: These cells are called leukocytes, or white blood cells. - Increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation - Dual effect of both reducing inflammation and enhancing the activity of beta agonists - Corticosteroids have also been shown to restore or increase the responsiveness of bronchial smooth muscle to beta-adrenergic receptor stimulation, which results in more pronounced stimulation of the beta2 receptors by beta agonist drugs such as albuterol.

Women's Health Drugs/ Estrogens: Adverse Effects

- Thrombolytic events: most serious - Nausea: most common - Hypertension, thrombophlebitis, edema - Vomiting, diarrhea, constipation, abdominal pain - May cause photosensitivity, chloasma - Amenorrhea, breakthrough uterine bleeding - Tender breasts, fluid retention, headaches

Thyroid Replacement Drugs: Mechanism of Action

- Thyroid preparations are given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid). - Thyroid drugs work the same way as endogenous thyroid hormones.

Alkylating Drugs: Mechanism of Action

- Work by preventing cancer cells from reproducing - Alter the chemical structure of the cells' deoxyribonucleic acid (DNA) - Bifunctional or polyfunctional

Nasal Decongestant: Types

3 main types are used: 1. Adrenergics - Largest group - Sympathomimetics 2. Anticholinergics - Less commonly used - Parasympatholytics 3. Corticosteroids - Topical, intranasal steroids 2 dosage forms 1. Oral 2. Inhaled or topically applied to the nasal membranes

Bronchodilators/Beta- Adrenergic Agonists: Types

3 types 1. Nonselective adrenergics - Stimulate alpha, beta1 (cardiac), and beta2 (respiratory) receptors - Example: epinephrine (EpiPen) 2. Nonselective beta-adrenergics - Stimulate both beta1 and beta2 receptors - Example: metaproterenol 3. Selective beta2 drugs - Stimulate only beta2 receptors - Example: albuterol

Antidysrhythmics: Miscellaneous

Adenosine (Adenocard) - Slows conduction through the AV node - Used to convert PSVT to sinus rhythm - Very short half-life—less than 10 seconds - Only administered as fast intravenous (IV) push - May cause asystole for a few seconds - Other adverse effects are minimal.

Carbonic Anhydrase Inhibitors: Indications

Adjunct drugs in the long-term management of open-angle glaucoma Used with miotics to lower intraocular pressure before ocular surgery in certain cases Also useful in the treatment of: - Edema - High-altitude sickness

Vitamins and Minerals/Magnesium: Adverse Effects

Adverse effects caused by hypermagnesemia - Tendon reflex loss - Difficult bowel movements - CNS depression - Respiratory distress - Heart block - Hypothermia

Decongestant/ Topical Nasal: Examples

Adrenergics - Ephedrine, oxymetazoline Intranasal steroids - Beclomethasone dipropionate (Beconase), budesonide (Rhinocort), flunisolide (Nasalide), fluticasone (Flonase), triamcinolone (Nasacort), ciclesonide (Omnaris) Intranasal anticholinergic - Ipratropium (Atrovent)

Antidiarrheal Drug Classes

Adsorbents Antimotility drugs (anticholinergics and opiates) Probiotics (also known as intestinal flora modifiers and bacterial replacement drugs)

Antidiarrheals: Interactions

Adsorbents decrease the absorption of many drugs, including digoxin, quinidine, and hypoglycemic drugs. Adsorbents cause increased bleeding time and bruising when given with anticoagulants (warfarin). Toxic effects of methotrexate are more likely when given with adsorbents.

Antidiarrheals: Indications of Use

Adsorbents: milder cases Anticholinergics and opiates: more severe cases Probiotics: antibiotic-induced diarrhea

Acid-Controlling Drugs/Antacids: Drug Interactions

Adsorption of other drugs to antacids - Reduces the ability of the other drug to be absorbed into the body Chelation - Chemical binding, or inactivation, of another drug - Produces insoluble complexes - Result: reduced drug absorption Increased stomach pH - Increased absorption of basic drugs - Decreased absorption of acidic drugs Increased urinary pH - Increased excretion of acidic drugs - Decreased excretion of basic drugs

Vitamins and Minerals/Calcium: Indications of Use

Adult osteomalacia Hypoparathyroidism Infantile rickets or tetany Muscle cramps Osteoporosis Renal insufficiency Pregnancy and lactation Renal failure Steatorrhea Vitamin D deficiency

Atypical Antipsychotics: Mechanism of Action

Advantageous properties over conventional drugs Block specific dopamine receptors: dopamine-2 (D2) receptors Also block specific serotonin receptors: serotonin 2 (5-HT2) receptors - This is responsible for their improved efficacy and safety profiles

Cholinergic: Adverse Effects

Adverse effects are a result of overstimulation of the PSNS. CV: Bradycardia, hypotension, syncope, conduction abnormalities (AV block and cardiac arrest) CNS: Headache, dizziness, convulsions, ataxia GI: Abdominal cramps, increased secretions, nausea, vomiting Respiratory: Increased bronchial secretions, bronchospasms Other: Lacrimation, sweating, salivation, miosis

Adrenergic-Blocking drugs/Beta Blockers: Indications of Use

Angina - Decreases demand for myocardial oxygen Cardioprotective - Inhibits stimulation from circulating catecholamines - Used in patients who have had a MI Dysrhythmias - Class II antidysrhythmic Migraine headache - Lipophilicity allows entry into CNS. Antihypertensive - Ability to reduce SNS stimulation of the heart, reducing heart rate and force of myocardial contraction Heart failure Glaucoma (topical use)

Antianginal/ Beta Blockers: Indications

Angina Antihypertensive Cardiac dysrhythmias Cardioprotective effects (especially after MI) Some used for migraine headaches, essential tremors, and stage fright

Antianginal /Calcium Channel Blockers: Indications

Angina Hypertension Supraventricular tachycardia Coronary artery spasms (Prinzmetal angina) Short-term management of atrial fibrillation and flutter Migraine headaches Raynaud's disease Nimodipine: cerebral artery spasms associated with aneurysm rupture

Calcium Channel Blockers: Indications

Angina Hypertension: amlodipine (Norvasc) Dysrhythmias Migraine headaches Raynaud's disease Prevent the cerebral artery spasms after subarachnoid hemorrhage: nimodipine

Antiemetics and Antinausea Drugs/ Ginger: Adverse Effects

Anorexia, nausea and vomiting, skin reactions

Antihistamines: Adverse Effects

Anticholinergic (drying) effects: most common - Dry mouth - Difficulty urinating - Constipation - Changes in vision - Drowsiness: Mild drowsiness to deep sleep

Antiemetics and Antinausea Drugs

Anticholinergic drugs Antihistamines (histamine 1 [H1] receptor blockers) Antidopaminergic drugs Neurokinin antagonists Prokinetic drugs Serotonin blockers Tetrahydrocannabinoids

Dermatologic Drugs/Topical Antimicrobial Drugs

Antibacterial drugs Antifungal drugs Antiviral drugs

Immunization/ Natural Passive: Background Information

Antibodies are transferred: - From mother to fetus through the placenta - From mother to infant through breast milk - Naturally acquired passive immunity

Dermatologic Drugs/Topical

Antimicrobial drugs - Antibacterial drugs - Antifungal drugs - Antiviral drugs Antiinflammatory drugs Antineoplastic drugs Antipruritic drugs (for itching) Burn drugs Emollients (soften skin) Keratolytics (cause softening and peeling of the stratum corneum) Local anesthetics Topical vasodilators Débriding drugs (promote wound healing) Sunscreens

Antiviral Drug Therapy

Antiviral drugs kill or suppress the virus by destroying virions or inhibiting the ability of viruses to replicate; controlled by current antiviral therapy. Immunoglobulins are concentrated antibodies that can attack and destroy viruses. Viruses controlled by current antiviral therapy - Cytomegalovirus (CMV) - Hepatitis viruses - Herpesviruses - HIV - Influenza viruses (the "flu") - Respiratory syncytial virus (RSV) Key characteristics of antiviral drugs - Able to enter the cells infected with virus - Interfere with viral nucleic acid synthesis, regulation, or both - Some drugs interfere with ability of virus to bind to cells. - Some drugs stimulate the body's immune system.

Psychotherapeutic Drugs

Anxiolytics (Antianxiety)/ Benzodiazepines Mood Stabilizing Drugs Antidepressants Antipsychotics

Antibiotics/Tetracyclines: Mechanism of Action

Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines. Should not be used in children younger than age 8 years or in pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth

Antiemetics and Antinausea Drugs/Anticholinergics: Mechanism of Action and other Indications of Use

Bind to and block ACh receptors in the inner ear labyrinth Block transmission of nauseating stimuli to CTZ Also block transmission of nauseating stimuli from the reticular formation to the VC Scopolamine (Transderm-Scōp, Scopace)

Antibiotics (Beta-lactamase) inhibitors

Bind with beta-lactamase enzyme to prevent break down of penicillin molecule: - Clavulanic acid (clavulanate) - Tazobactam - Sulbactam - Avibactam

Women's Health Drugs/Osteoporosis: Drug Therapy: Contraindications

Bisphosphonates: drug allergy, hypocalcemia, esophageal dysfunction, and the inability to sit or stand upright for at least 30 minutes after taking the medication SERMs: women with known allergy to these drugs, who are or may become pregnant, with a venous thromboembolic disorder, including deep vein thrombosis (DVT), PE, and retinal vein thrombosis or with a history of such a disorder Calcitonin: drug allergy or allergy to salmon Teriparatide: drug allergy Denosumab: hypocalcemia, renal impairment or failure, and infection

Thrombolytic Drugs: Adverse Effects

Bleeding - Internal - Intracranial - Superficial Other effects - Nausea, vomiting, hypotension, anaphylactoid reactions - Cardiac dysrhythmias; can be dangerous

Anticoagulants: Adverse Effects

Bleeding -Risk increases with increased dosages -May be localized or systemic May also cause: Nausea, vomiting, abdominal cramps, thrombocytopenia, others Heparin-induced thrombocytopenia - Type I: Gradual reduction in platelets; Heparin therapy can generally be continued. - Type II: Acute fall in the number of platelets (more than 50% reduction from baseline); Discontinue heparin.

Women's Health Drugs/ Estrogenic Drugs

Conjugated estrogens (Premarin) Esterified estrogens (Estratab) Estradiol transdermal (Estraderm, Climara, Vivelle) Estradiol cypionate (Depo-Estradiol, DepoGen) Estradiol valerate (Delestrogen) Ethinyl estradiol (Estinyl) Estradiol vaginal dosage forms (Vagifem, Estrace Vaginal Cream) Estrone (Estrone Aqueous) Estropipate (Ogen, Ortho-Est)

Bile Acid Sequestrants: Mechanism of Action

Considered second line choice after statins Prevent resorption of bile acids from small intestine Bile acids are necessary for absorption of cholesterol.

Bile Acid Sequestrants: Adverse Effects

Constipation Heartburn, nausea, belching, bloating These adverse effects tend to disappear over time. Increasing dietary fiber intake or taking a fiber supplement such as psyllium (Metamucil and others), as well as increasing fluid intake, may relieve constipation and bloating. May also cause mild increases in triglyceride levels

Vitamins and Minerals/Ferrous Fumarate (Femiron)

Contains largest amount of iron per gram of salt consumed 33% elemental iron Oral use only

Pituitary Drugs (Anterior)

Cosyntropin - Stimulates release of cortisol from adrenal cortex - Anti inflammatory effect - Diagnosis of adrenocortical insufficiency - Wasting associated with human immunodeficiency virus infection - Promotes renal retention of sodium, which can result in edema and hypertension Somatropin - Recombinantly made growth hormone (GH) - Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism Octreotide - Carcinoid tumors secrete VIP (vasoactive intestinal polypeptide). - VIP causes profuse, watery diarrhea. - Octreotide reduces this severe diarrhea, flushing, and potentially life-threatening hypotension that may occur with a carcinoid crisis.

Antidysrhythmics: Drug Interactions

Coumadin: monitor international normalized ratio Grapefruit juice: amiodarone, disopyramide, and quinidine

Ophthalmic Drugs/Diagnostic Drugs

Cycloplegic mydriatics - Atropine sulfate (Isopto Atropine) •Results in: Mydriasis Cycloplegia •Used for: - Ophthalmic examinations - Uveitis (which benefits from pupillary dilation) Cycloplegic mydriatics (Cont.) - Cyclopentolate (Cyclogyl) •Causes mydriasis and cycloplegia •Used for diagnostic examinations •Not used for uveitis Other cycloplegic mydriatics - Scopolamine (Isopto Hyoscine) - Homatropine (Isopto Homatropine) - Tropicamide (Mydriacyl) Ophthalmic dye ØFluorescein (AK-Fluor) •Diagnostic dye used to identify corneal defects and to locate foreign objects in the eye •Used in fitting hard contact lenses •Various defects are highlighted in either bright green or yellow-orange, and foreign objects have a green halo around them.

Antineoplastic Medications/ CCNS

Cytotoxic during any cell-cycle stage

Cholinergic-Blocking: Indications of Use (CNS)

Decreasing muscle rigidity and muscle tremors - Parkinson's disease - Drug-induced extrapyramidal reactions such as those associated with antipsychotic drugs

Nutritional Supplements/Central Total Parenteral Nutrition

Delivered through a large central vein - Subclavian - Internal jugular Long-term use (more than 7 to 10 days) Disadvantages are the risks associated with central line insertion, use, and maintenance. Higher risk for infection, catheter-induced trauma, metabolic alterations Delivers total dietary nutrients to patients who require nutritional supplementation - Patients with large nutritional requirements (metabolic stress or hypermetabolism) - Patients who need nutritional support for more than 7 to 10 days Patients who are unable to tolerate large fluid loads

Antibiotics/Tetracycline drugs

Demeclocycline (Declomycin) Oxytetracycline (Terramycin) Tetracycline Doxycycline (Doryx, Vibramycin) Minocycline (Minocin) Tigecycline (Tygacil)

Adrenergic - Cardioselective Sympathomimetics

Dobutamine Ephedrine Fenoldopam (Corlopam) Midodrine (Proamatine) Dopamine Epinephrine Phenylephrine (Neo-Synephrine) Norepinephrine (Levophed) Mirabegron (Myrbetriq)

Antihistamines: Background Information

Drugs that directly compete with histamine for specific receptor sites Two histamine receptors - H1 (histamine 1) - H2 (histamine 2) Anaphylaxis: Release of excessive amounts of histamine can lead to: - Constriction of smooth muscle, especially in the stomach and lungs - Increase in body secretions - Vasodilatation and increased capillary permeability, movement of fluid out of the blood vessels and into the tissues, and drop in blood pressure and edema Histamine: Major inflammatory mediator in many allergic disorders - Allergic rhinitis (e.g., hay fever and mold, dust allergies) - Anaphylaxis - Angioedema - Drug fevers - Insect bite reactions - Urticaria (itching) H2 blockers or H2 antagonists - Used to reduce gastric acid in peptic ulcer disease Ex: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid)

Antifungal Drugs

Drugs used to treat infections caused by fungi Systemic - Amphotericin B, caspofungin, fluconazole, flucytosine, griseofulvin, itraconazole, ketoconazole, micafungin, nystatin, terbinafine, posaconazole, anidulafungin, and voriconazole Topical Ophthalmic: natamycin Broken down into major groups based on their chemical structure - Synthetic triazoles: fluconazole, itraconazole, voriconazole - Echinocandins: caspofungin - Synthetic allylamine: terbinafine - Polyenes: amphotericin B, Amphotec (B), Abelcet (B), AmBisome (B), nystatin

Anthelmintic Drugs

Drugs used to treat parasitic worm infections: helminthic infections Unlike protozoa, helminths are large and have complex cellular structures. Drug treatment is very specific to the organism. It is very important to identify the causative worm. Done by finding the parasite ova or larvae in feces, urine, blood, sputum, or tissue - Cestodes (tapeworms) - Nematodes (roundworms) - Trematodes (flukes) - Platyhelminthes (flatworms)

Antiparkinson Agents/ Anticholinergics: Adverse Effects

Dry mouth or decreased salivation Urinary retention Decreased GI motility (constipation) Dilated pupils (mydriasis) Smooth muscle relaxation Cardiac Dysrhythmias Confusion Hypotension Dyskinesias

Anticholinergics: Adverse Effects

Dry mouth or throat Nasal congestion Heart palpitations Gastrointestinal (GI) distress Headache Coughing Anxiety

Antianginal /Calcium Channel Blockers

For Chronic Stable Angina: Amlodipine Diltiazem Nicardipine Nifedipine Verapamil

Antibiotics/Macrolides drugs

Erythromycin (E-mycin, E.E.S, others) Azithromycin (Zithromax) Clarithromycin (Biaxin) Fidaxomicin (Dificid, Dificlir)

Hematopoietic Drugs

Erythropoietic drugs - Epoetin alfa - Darbepoetin alfa Colony-stimulating factors (CSFs): Filgrastim: -Granulocyte colony-stimulating factor (G-CSF), - Stimulates precursor cells for the type of white blood cells known as granulocytes (including basophils, eosinophils, and neutrophils) - Administered before patient develops infection Pegfilgrastim: Longer acting form of filgrastim Sargramostim - Granulocyte-macrophage colony-stimulating factor (GM-CSF) - Stimulates bone marrow precursor cells that make both granulocytes and phagocytic (cell-eating) cells; known as monocytes - Indicated for promoting bone marrow recovery after autologous (own marrow) or allogenic (donor marrow) bone marrow transplantation in patients with leukemia and lymphoma Platelet-promoting drugs: Oprelvekin - Both a hematopoietic drug and one of the ILs (IL-11) - Enhances synthesis of platelets - Indicated for the prevention of chemotherapy-induced severe thrombocytopenia and avoidance of the need for platelet transfusions - Stimulates the bone marrow cells, specifically megakaryocytes that eventually give rise to platelets Romiplostim: CSF used to stimulate platelet production

Vitamins and Minerals/Calcium: Function

Essential for normal maintenance and function of: - Nervous, muscular, skeletal systems - Cell membrane and capillary permeability Catalyst in many enzymatic reactions Essential in many physiologic processes - Transmission of nerve impulses - Contraction of cardiac, smooth, and skeletal muscles - Renal function, respiration, and blood coagulation Deficiency: Hypocalcemia - Infantile rickets - Adult osteomalacia - Osteoporosis - Many other conditions associated with calcium deficiency Causes of Deficiency: - Inadequate intake of calcium or vitamin D - Hypoparathyroidism - Malabsorption syndrome - Many other causes

Vitamin K: Functions

Essential for synthesis of blood coagulation factors in the liver Vitamin K-dependent clotting factors - Factor II (prothrombin) - Factor VII (proconvertin) - Factor IX (Christmas factor) - Factor X (Stuart-Prower factor)

Vitamin B1 (Thiamine): Functions

Essential for: - Carbohydrate metabolism - Many metabolic pathways, including Krebs cycle Maintains integrity of: - Peripheral nervous system - Cardiovascular system - GI tract

Antifungal Drugs: Mechanisms of Action

Flucytosine - Also known as 5-fluorocytosine (5-FC), (antimetabolite) - Taken up by fungal cells and interferes with DNA synthesis - Result: fungal cell death - Older drug; newer drugs are more commonly used Griseofulvin - Disrupts cell division - Result: inhibited fungal mitosis (cell division) - Older drug; newer drugs are more commonly used Polyenes: amphotericin B and nystatin - Bind to sterols in cell membrane lining - Result: fungal cell death - Do not bind to human cell membranes or kill human cells Imidazoles and triazoles: ketoconazole, fluconazole, itraconazole, voriconazole - Inhibit fungal cell cytochrome P-450 enzymes, resulting in cell membrane leaking - Result: altered cellular metabolism and fungal cell death Echinocandins: caspofungin, micafungin, and anidulafungin - Prevent the synthesis of glucans (essential components of fungal cell walls) - Result: fungal cell death

Monoclonal Antibodies: Adverse Effects

Flulike Symptoms

Niacin: Adverse Effects

Flushing (caused by histamine release) - Small dose aspirin or NSAIDS 30 minutes before Niacin may help cutaneous flushing Pruritus GI distress

Heart Failure Drugs (Early Treatment)

Focus on reducing effects of the renin-angiotensin-aldosterone system and the sympathetic nervous system - ACE inhibitors (lisinopril, enalapril, captopril, and others) - ARBs (valsartan, candesartan, losartan, and others) - Certain beta blockers (metoprolol, a cardioselective beta blocker; carvedilol, a nonspecific beta blocker) - Loop diuretics (furosemide) are used to reduce the symptoms of HF secondary to fluid overload. - Aldosterone inhibitors (spironolactone, eplerenone) are added as the HF progresses. Only after these drugs are used is digoxin added.

Antimetabolities (CCS)

Folate (folic acid) antagonists: Interferes with the use of folic acid, as a result, DNA is not produced, and the cell dies. (Methotrexate (MTX), pemetrexed, pralatrexate) Purine antagonists: Interrupts metabolic pathways of purine nucleotides, results in interruption of DNA and RNA synthesis, and tumor lysis syndrome (Fludarabine (F-AMP), mercaptopurine (6-MP), thioguanine (6-TG), cladribine, pentostatin) Pyrimidine antagonists: Interrupts metabolic pathways of pyrimidine bases, results in interruption of DNA and RNA synthesis (Fluorouracil (5-FU), cytarabine (ara-C), capecitabine, floxuridine (FUDR), gemcitabine)

Vitamins and Minerals/Folic Acid (Folate): Mechanism of Action

Folic acid is converted in the body to tetrahydrofolic acid which is used for erythropoiesis and for synthesis of nucleic acids. Not active in the ingested form and must be converted for reactions to occur

Anticoagulants Factor Xa Drugs

Fondaparinux (Arixtra) Rivaroxaban (Xarelto) Apixaban (Eliquis) Edoxaban (Savaysa) Betrixaban (Bevyxxa) Inhibits thrombosis by its specific action against factor Xa

Adrenal Drugs Types

Glucocorticoids - Adrenocorticotropic hormone - Betamethasone - Cortisone - Dexamethasone - Hydrocortisone - Methylprednisolone - Prednisolone - Triamcinolone Mineralocorticoids - Aldosterone - Desoxycorticosterone - Fludrocortisone Catecholamines - Epinephrine - Norepinephrine Adrenal steroid inhibitor - Aminoglutethimide

Adrenal Drugs: Administration

Glucocorticoids administration - By inhalation for control of steroid-responsive bronchospastic states - Nasally for rhinitis and to prevent the recurrence of polyps after surgical removal - Topically for inflammations of the eye, ear, and skin

Antibiotics/Cephalosporins: (second generation)

Good gram-positive coverage Better gram-negative coverage than first generation Examples: - Cefaclor (Ceclor) - Cefprozil (Cefzil) - Cefoxitin (Mefoxin) - Cefuroxime (Zinacef) - Cefotetan (Cefotan) Cefoxitin (Mefoxin): IV and IM - Used prophylactically for abdominal or colorectal surgeries - Also kills anaerobes Cefuroxime - Zinacef is parenteral form; Ceftin is PO. - Surgical prophylaxis - Does not kill anaerobes

Antibiotics/Cephalosporins: (first generation)

Good gram-positive coverage Poor gram-negative coverage Parenteral and oral (PO) forms Examples - Cefadroxil (Duricef, Ultracef) - Cephradine (Velosef) - Cefazolin (Ancef) - Cephalexin (Keflex) Used for surgical prophylaxis and for susceptible staphylococcal infections - Cefazolin (Ancef and Kefzol): intravenous (IV) or intramuscular (IM) - Cephalexin (Keflex): PO

Anticoagulants Types

Heparin: Inhibit clotting factors IIa (thrombin) and Xa - Unfractionated heparin: "heparin" [Relatively large molecule that is derived from animal sources; Frequent laboratory monitoring for bleeding times such as aPTT; Heparin for catheter flush (10 to 100 units/mL): no monitoring is needed] - Low-molecular-weight heparins (LMWHs): Enoxaparin (Lovenox) & Dalteparin (Fragmin) [Synthetic smaller molecular structure; More predictable anticoagulant response; Frequent laboratory monitoring of bleeding times using tests such as aPTT not needed] Coumarins: Inhibit vitamin K-dependent clotting factors II, VII, IX, and X - Warfarin (Coumandin) [Inhibits vitamin K synthesis by bacteria in the gastrointestinal tract; Inhibits production of vitamin K-dependent clotting factors II, VII, IX, and X, which are normally synthesized in the liver; Final effect prevention of clot formation] Direct Thrombin Inhibitors: Inhibit thrombin (factor IIa) - Human antithrombin III (Thrombate) - Lepirudin (Refludan) - Argatroban (Argatroban) - Bivalirudin (Angiomax) - Dabigatran (Pradaxa)

Immunization/ Passive Immunizing Drugs (Cont.): Examples

Hepatitis B immunoglobulin Immunoglobulin Rh0(D) immunoglobulin Rabies immunoglobulin Tetanus immunoglobulin Varicella-zoster immunoglobulin

Adrenergic Drugs: Adverse Effects

High incidence of orthostatic hypotension First-dose syncope Most common: -Bradycardia with reflex tachycardia - Dry mouth - Drowsiness, sedation - Constipation - Depression - Edema - Sexual dysfunction Other - Headaches - Sleep disturbances - Nausea - Rash - Rebound hypertension with abrupt discontinuation

Heart Failure Drugs: Miscellaneous

Hydralazine/isosorbide dinitrate (BiDil) - First drug approved for a specific ethnic group, namely African Americans Dobutamine - positive inotropic drug - Beta1-selective vasoactive adrenergic drug - Structurally similar to dopamine Ivabradine (Corlanor) - Sinoatrial node modulator - Inhibits f-channels within the SA node which ultimately results in reduced heart rate - Used in stable, symptomatic HF with ejection fraction of =/< 35% - Increase risk of atrial fibrillation, bradycardia, and conduction disturbances - Avoid grapefruit juice Nesiritide (Natrecor) - Synthetic version of human B-type natriuretic peptide - Vasodilating effects on both arteries and veins - Used in ICU as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications - Effects: Diuresis (urinary fluid loss), Natriuresis (urinary sodium loss), Vasodilation, Indirect increase in cardiac output and suppression of neurohormonal systems such as the renin-angiotensin system - Adverse Effects: Hypotension, Dysrhythmia, Headache, Abdominal pain, Insomnia

Vasodilators: Adverse Effects

Hydralazine: dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, vitamin B6 deficiency, and rash Minoxidil: T-wave electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash, and thrombocytopenia Sodium nitroprusside: bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and (rarely) cyanide toxicity

Vitamins and Minerals/Calcium: Toxicity

Hypercalcemia may occur with therapy: - Anorexia - Nausea - Vomiting - Constipation Severe hypercalcemia can cause: - Cardiac irregularities - Delirium - Coma

Electrolytes/Potassium: Hyperkalemia

Hyperkalemia: excessive serum potassium;serum potassium level over 5.5 mEq/L: - Potassium supplements, ACE inhibitors, Renal failure, Excessive loss from cells, Potassium-sparing diuretics, Burns, Trauma, Metabolic acidosis, Infections Manifestations: - Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest) Treatment (Severe): - IV sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin - Sodium polystyrene sulfonate (Kayexalate) or hemodialysis to remove excess potassium

Angiotensin II Receptor Blockers: Indications

Hypertension Adjunctive drugs for the treatment of HF May be used alone or with other drugs such as diuretics - Evidence that ARBs are better tolerated and are associated with lower mortality after MI than ACE inhibitors - Not yet clear whether ARBs are as effective as ACE inhibitors in treating HF (cardioprotective effects) or in protecting the kidneys, as in diabetes

ACE Inhibitors: Indications

Hypertension HF (either alone or in combination with diuretics or other drugs) Slow progression of left ventricular hypertrophy after myocardial infarction (MI) (cardioprotective) Renal protective effects in patients with diabetes

Electrolytes/Potassium: Hypokalemia

Hypokalemia, in the presence of digoxin therapy, can cause digoxin toxicity, resulting in serious ventricular dysrhythmias.

Vitamins and Minerals/Magnesium: Causes of Deficiency

Hypomagnesemia - Malabsorption - Alcoholism - Long-term intravenous feedings - Diuretics and proton pump inhibitors - Metabolic disorders (hyperthyroidism, diabetic ketoacidosis)

Women's Health Drugs/Uterine Stimulants: Adverse Effects

Hypotension or hypertension, chest pain Headache, dizziness, fainting Nausea, vomiting, diarrhea Vaginitis, vaginal pain, cramping Leg cramps, joint swelling, chills, fever, weakness, blurred vision

Pituitary Hormones: Locations

Hypothalamus: Part of the central nervous system Pituitary gland: - Anterior pituitary (adenohypophysis) - Posterior pituitary (neurohypophysis) Together they govern all bodily functions. - Hormones - Negative feedback loop

Interferons

IFN alpha products: "leukocyte IFNs"—produced from human leukocytes - IFN alfa-2a (Roferon-A) - IFN alfa-2b (Intron-A) - IFN alfa-n3 (Alferon-N) - IFN alfacon-1 (Infergen) - Peginterferon alfa-2a (Pegasys) - Peginterferon alfa-2b (PEG-Intron) IFN beta products - IFN beta-1a (Avonex, Rebif) - IFN beta-1b (Actimmune) IFN gamma products - IFN gamma-1b (Actimmune)

Antitubercular Drug: Adverse Effects

INH: peripheral neuropathy, hepatotoxicity Ethambutol: retrobulbar neuritis, blindness Rifampin: hepatitis; discoloration of urine, stools, and other body fluids

Mood Stabilizing Drugs

Lithium (1.0-1.5 mEq/L - Acute Mania) (0.6-1.2 mEq/L - Maintenance) (1.5-2.5 mEq/L - Toxicity)

Vitamins and Minerals/Parenteral Iron

Iron dextran (INFeD, Dexferrum) - May cause anaphylactic reactions, including major orthostatic hypotension and fatal anaphylaxis - A test dose of 25 mg of iron dextran is administered before injection of the full dose, and then the remainder of dose is given after 1 hour. - Used less frequently now; replaced by newer products ferric gluconate and iron sucrose Ferric gluconate (Ferrlecit) - Indicated for repletion of total body iron content in patients with iron-deficiency anemia who are undergoing hemodialysis - Risk of anaphylaxis is much less than with iron dextran, and a test dose is not required. - Doses higher than 125 mg are associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching. **Newer Parenteral Iron Ferumoxytol (Feraheme) Can be given undiluted IV push over 1 minute

Acid-Controlling Drugs/Proton Pump Inhibitors (PPIs): Mechanism of Action

Irreversibly bind to H+/K+ ATPase enzyme This bond prevents the movement of hydrogen ions from the parietal cell into the stomach. Results in achlorhydria—all gastric acid secretion is temporarily blocked. - To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase.

Thyroid Replacement Drugs

Levothyroxine (Synthroid, Levoxyl) - Synthetic thyroid hormone T4 - Most commonly prescribed synthetic thyroid hormone - Chemically pure ...100% T4 (thyroxine) - Daily dose - Best at 0600 on an empty stomach - Dosed in micrograms (mcg) Liothyronine (Cytomel) - Synthetic thyroid hormone T3 Liotrix (Thyrolar) - Synthetic thyroid hormone T3 and T4 combined

Local Anesthetics

Lidocaine Bupivacaine Chloroprocaine Mepivacaine Prilocaine Procaine Propoxycaine Ropivacaine Tetracaine

Antianginal /Calcium Channel Blockers: Adverse Effects

Limited Primarily relate to overexpression of their therapeutic effects May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea, other adverse effects

Potassium-Sparing Diuretics: Interactions

Lithium Angiotensin-converting enzyme inhibitors Potassium supplements NSAIDs

Antitubercular Drug Therapy Considerations

Major effects of drug therapy: reduction of cough and, therefore, reduction of the infectiousness of the patient Normally occurs within 2 weeks of the initiation of drug therapy if TB strain is drug sensitive Most cases of TB can be cured. Successful treatment: several antibiotic drugs for at least 6 months and sometimes for as long as 12 months Perform drug-susceptibility testing on the first Mycobacterium spp. that is isolated from a patient specimen to prevent the development of MDR-TB. Even before the results of susceptibility tests are known, begin a regimen with multiple antitubercular drugs (to reduce the chances of development of resistance). Adjust drug regimen after the results of susceptibility testing are known. Monitor patient compliance closely during therapy. Problems with successful therapy occur because of patient nonadherence to drug therapy and the increased incidence of drug-resistant organisms.

Antiemetics and Antinausea Drugs/Tetrahydrocannabinoids: Mechanism of Action and other Indications of Use

Major psychoactive substance in marijuana Inhibitory effects on reticular formation, thalamus, cerebral cortex Alter mood and body's perception of its surroundings, which may help relieve nausea and vomiting Dronabinol (Marinol) Used for nausea and vomiting associated with chemotherapy and for anorexia associated with weight loss in AIDS patients

Antihistamines: Indications

Management of: - Nasal allergies - Seasonal or perennial allergic rhinitis (hay fever) - Allergic reactions - Motion sickness - Parkinson's disease Also used to relieve symptoms associated with the common cold - Sneezing, runny nose - Palliative treatment; not curative

Osmotic Diuretics

Mannitol (Osmitrol): Most used osmotic diuretic Urea Organic acids Glucose

Vitamin C (Ascorbic Acid): Megadoses

Megadoses may cause: - Nausea, vomiting, headache, abdominal cramps - Acidified urine, with possible stone formation Discontinuing megadoses may result in scurvy-like symptoms.

Vaughan Williams Class I: Mechanism of Action

Membrane-stabilizing drugs Fast sodium channel blockers Divided into Ia, Ib, and Ic drugs, according to effects

Nutritional Supplements/Central Total Parenteral Nutrition: Adverse Effects

Most common are those surrounding the use of the central line for the delivery of TPN - Infection - Catheter-induced trauma Greater chance for hyperglycemia because of the larger and more concentrated volumes given

Electrolytes/Potassium: Background Information

Most abundant positively charged electrolyte inside cells 95% of body's potassium is intracellular. Potassium content outside of cells ranges from 3.5 to 5 mEq/L. Potassium levels are critical to normal body function. Potassium obtained from foods: - Fruit and fruit juices (bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes), meats, fish, wheat bread, and legumes Excess dietary potassium excreted via kidneys: - Impaired kidney function leads to higher serum levels, possibly toxicity. - Hypokalemia: deficiency of potassium; serum potassium level less than 3.5 mEq/L

Electrolytes/Sodium: Background Information

Most abundant positively charged electrolyte outside cells Normal concentration outside cells is 135 to 145 mEq/L Maintained through dietary intake of sodium chloride: - Salt, fish, meats, foods flavored or preserved with salt Sodium is responsible for: - Control of water distribution - Fluid and electrolyte balance - Osmotic pressure of body fluids - Participation in acid-base balance

Nitrates: Nursing Implications

Nitroglycerin ! Instruct patients in proper technique and guidelines for taking sublingual nitroglycerin for anginal pain. ! Instruct patients never to chew or swallow the sublingual form. ! Instruct patients that a burning sensation felt with sublingual forms indicates that the drug is still potent. ! Instruct patients to keep a fresh supply of sublingual medication on hand; potency is lost in about 3 months after the bottle has been opened. ! To preserve potency, medications should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler. ! Instruct patients in the proper application of nitrate topical ointments and transdermal forms, including site rotation and removal of old medication. ! To reduce tolerance, the patient may be instructed to remove topical forms at bedtime and apply new doses in the morning, allowing for a nitrate-free period. ! Instruct patients to take as-needed nitrates at the first hint of anginal pain. ! Monitor vital signs frequently during acute exacerbations of angina and during IV administration. ! If experiencing chest pain, the patient taking sublingual nitroglycerin should lie down to prevent or decrease dizziness and fainting that may occur because of hypotension. ! If anginal pain occurs: 1. Stop activity and sit or lie down and take a sublingual tablet. 2. If there is no relief in 5 minutes, call 911 or emergency services immediately and take a second sublingual tablet. 3. If there is no relief in 5 minutes, take a third sublingual tablet. 4. Do not try to drive to the hospital. ! IV forms of nitroglycerin must be given with special non-PVC tubing and bags. ! Discard parenteral solution that is blue, green, or dark red. ! Follow specific manufacturer's instructions for IV administration.

Nitrates & Nitrites

Nitroglycerin (both rapid and long acting) Isosorbide dinitrate (both rapid and long acting) Isosorbide mononitrate (primarily long acting) Available forms: - Sublingual* - Chewable tablets - Oral capsules/tablets - Intravenous (IV) solutions* - Transdermal patches* - Ointments - Translingual sprays*

Vitamin B2 (Riboflavin): Adverse Effects

No adverse or toxic effects Large doses discolor urine to a yellow-orange

Adrenergic-Blocking drugs/ Alpha Blockers

Phenoxybenzamine HCl (Dibenzyline) Phentolamine (Generic) Prazosin (Minipress) Terazosin (Hytrin) Alfuzosin (Uroxatral) Tamsulosin (Flomax) Doxazosin (Cardura)

Anorexiants

Phentermine (Lonamin) Orlistat (Xenical)

Antiepileptics/Anticonvulsants

Phenytoin (Dilantin) Fosphenytoin (Cerebyx) Carbamazepine (Tegretol) Oxycarbazepine (Trieptal) Ethosuximide (Zarontin) Gabapentin (Neurontin) Lamotrigine (Lamictal) Felbamate (Felbatol) Levetiracetam (Keppra) Pregabalin (Lyrica) Tiagabine (Gabitril) Topiramate (Topamax) Valproic acid Zonisamide (Zonegran) Perampanel (Fycompa)

Nutritional Supplements/Peripheral Total Parenteral Nutrition: Adverse Effects

Phlebitis is the most devastating adverse effect. - Can lead to loss of a limb Fluid overload

Men's Health Drugs/Erectile Dysfunction: Treatment Drugs

Phosphodiesterase (PDE) inhibitors are used in the treatment of erectile dysfunction (ED). Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) Avanafil (Stendra) Similar to sildenafil (Viagra) but longer duration of action Sildenafil and tadalafil are also used to treat pulmonary hypertension. Alprostadil (Caverject) Prostaglandin - Administered by injecting it directly into the erectile tissue of the penis or pushing a suppository form of the drug into the urethra

Women's Health Drugs/Herbal Products: Soy

Relief of menopausal symptoms, osteoporosis prevention Estrasorb, applied as a lotion Adverse effects - Nausea - Diarrhea - Abdominal pain - Estrasorb remains on skin for 8 hours.

Nasal Decongestants: Indications

Relief of nasal congestion associated with: - Acute or chronic rhinitis - Common cold - Sinusitis - Hay fever - Other allergies May also be used to reduce swelling of the nasal passage and facilitate visualization of the nasal or pharyngeal membranes before surgery or diagnostic procedures

Muscle Relaxants: Indication of Use

Relief of painful musculoskeletal conditions - Muscle spasms - Management of spasticity of severe chronic disorders (MS, & Cerebral Palsy) Work best when used along with physical therapy

Depressants: Indication of Use

Relieve anxiety, irritability, and tension when used as intended. Also used to treat seizure disorders and induce anesthesia

Adrenergic: Drug Effects

Stimulation of alpha-adrenergic receptors on smooth muscles results in: - Vasoconstriction of blood vessels - Relaxation of GI smooth muscles (decreased motility) - Constriction of bladder sphincter - Contraction of uterus - Male ejaculation - Contraction of pupillary muscles of the eye (dilated pupils) Stimulation of beta1-adrenergic receptors on the myocardium, atrioventricular (AV) node, and sinoatrial (SA) node results in cardiac stimulation - Increased force of contraction (positive inotropiceffect) - Increased heart rate (positive chronotropic effect) - Increased conduction through AV node (positive dromotropic effect) Stimulation of beta2-adrenergic receptors on the airways results in - Bronchodilation (relaxation of the bronchi) Other effects of beta2-adrenergic stimulation - Uterine relaxation - Glycogenolysis in the liver - Increased renin secretion in the kidneys - Relaxation of GI smooth muscles (decreased motility)

Laxatives/Emollient: Mechanism of Action

Stool softeners and lubricants Promote more water and fat in the stools Lubricate the fecal material and intestinal walls Examples •Stool softeners: docusate salts (Colace, Surfak) •Lubricants: mineral oil

Antibiotics/Macrolides: Indications of Use

Strep infections - Streptococcus pyogenes (group A beta-hemolytic streptococci) Mild to moderate upper and lower respiratory tract infections - Haemophilus influenzae Spirochetal infections - Syphilis and Lyme disease Gonorrhea, Chlamydia, Mycoplasma Fidaxomicin (Dificid): newest macrolide - The most common adverse effects are nausea, vomiting, and GI bleed. - Indicated only for the treatment of C. difficile-associated diarrhea - Pregnancy category B - Minimal absorption

Analeptics: Adverse Effects

Vagal: Stimulation of gastric secretions, diarrhea, and reflex tachycardia Vasomotor: Flushing, sweating Respiratory: Elevated respiratory rate Musculoskeletal: Muscular tension and tremors

Amphetamines: Adverse Effects

Wide range; dose related Tend to "speed up" body systems Common adverse effects include: - Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others

Antibiotics/Tetracyclines: Indications of Use

Wide spectrum - Gram-negative and gram-positive organisms, protozoa, Mycoplasma spp., Rickettsia spp., Chlamydia, syphilis, Lyme disease, acne, others Demeclocycline is also used to treat syndrome of inappropriate antidiuretic hormone (ADH) secretion by inhibiting the action of ADH

Vitamins and Minerals/Phosphorus

Widely distributed in foods - Milk - Yogurt - Cheese - Peas - Meat - Fish - Eggs Dietary deficiency is rare.

PDIs: Mechanism of Action

Work by inhibiting the enzyme phosphodiesterase Inodilators- (inotropics and dilators) Result in: - Intracellular increase in cAMP - Positive inotropic response - Vasodilation - Increase in calcium for myocardial muscle contraction.

Stimulant: Mechanism of Action

Work by releasing biogenic amine, norepinephrine from its storage sites Results in CNS stimulation as well as cardiovascular stimulation - Increases blood pressure, heart rate - Possible cardiac dysrhythmias Smooth muscle effects - Contraction of urinary sphincter

Potassium-Sparing Diuretics: Mechanism of Action

Work in collecting ducts and distal convoluted tubules. Interfere with sodium-potassium exchange. Competitively bind to aldosterone receptors. Block resorption of sodium and water usually induced by aldosterone.

Osmotic Diuretics: Mechanism of Action

Work mostly in the proximal tubule. Nonabsorbable, producing an osmotic effect Pull water into the renal tubules from the surrounding tissues. Inhibit tubular resorption of water and solutes, thus producing rapid diuresis.

Vitamin D: Functions

Works with parathyroid hormone to regulate absorption of and use of calcium and phosphorus Necessary for normal calcification of bone and teeth