Analgesics Aspirin (acetylsalicylic acid) >>ANALGESIC, ANTIPYRETIC, ANTIINFLAMMTORY, ANTIPLATELET MOA- act on peripheral nervous system at the pain

receptor sites by inhibiting prostaglandin synthesis Indication-mild to moderate pain of skeletal muscle & joint CI- children < 12y.o. (Reyes Syndrome) SE: Gastric irritation AE:excess bleeding (2 days menstruation) Nsg Resp: take with food, w/ glass of water, monitor platelet bleeding time, d/c aspirin 7 days prior to surgery NARCOTIC ANALGESICS/OPIOID ANALGESICS Meperidine (Demerol) MOA- binds to opiate receptors in the CNS, reduces stimuli from sensory nerve end, pain threshold is increased Indication-shorter duration of action than morphine potency varies, used narcotic for alleviating post op pain, preferred in pregnancy CI- with resp dysfunction, head injuries, increase ICP, hepatic & renal disease, alcoholism SE: constipation,mod decrease of blood pressure, orthostatic hypotension, AE: hepatotoxicity, Abstinence Syndrome (Tachycardia, Hypertension, Irritability, Restlessness, Diaphoresis, Muscle Twitching) Nsg Resp: not prescribed for long term use, VS should not be RR < 10/ min, BP < 90/60, should not take with alcohol or sedative- hypnotics, I & O, no ambulation, naloxone (Narcan), instruct about deep breathing and coughing exercises Codeine NARCOTIC ANALGESICS/OPIOID ANALGESICS MOA- binds to opiate receptors in the CNS, reduces stimuli from sensory nerve end, pain threshold is increased Indication-not as potent as morphine CI- Respiratory depression, obstructive airway disease, asthma. Acute alcoholism, convulsive disorders, head injuries, comatose patients, raised intracranial pressure. Pregnancy (prolonged use or high doses at term) SE: constipation,mod decrease of blood pressure, orthostatic hypotension, AE: hepatotoxicity, Abstinence Syndrome (Tachycardia, Hypertension, Irritability, Restlessness, Diaphoresis, Muscle Twitching) Nsg Resp: not prescribed for long term use, VS should not be RR < 10/ min, BP < 90/60, should not take with alcohol or sedative- hypnotics, I & O, no ambulation, naloxone (Narcan), instruct about deep breathing and coughing exercises

Acetaminophen (Tylenol, Tempra) >>ANALGESIC, ANTIPYRETIC MOA- weakly inhibits prostaglandin synthesis which decreases pain sensation and heat Indication-analgesic, antipyretic, muscular aches & fever caused by viral infections CI- Severe hepatic/ renal disease, alcoholism, hypersensitivity SE: early symptoms of hepatic damage, abd pain, diarrhea AE: hepatotoxicity Nsg Resp: keep out of childrens reach, no alcohol, self med should not be used more than 10 days for adults and 5 days for children, acetylcysteine (antidote)

NARCOTIC ADDICTED PERSON Morphine Sulfate NARCOTIC ANALGESICS/OPIOID ANALGESICS MOA- binds to opiate receptors in the CNS, reduces stimuli from sensory nerve end, pain threshold is increased Indication-MI, CA, dyspnea-pulmonary edema, severe pain CI- with resp dysfunction, head injuries, increase ICP, hepatic & renal disease, alcoholism SE: trouble breathing, lightheaded or tired, nausea AE: hepatotoxicity, Abstinence Syndrome (Tachycardia, Hypertension, Irritability, Restlessness, Diaphoresis, Muscle Twitching) Nsg Resp: not prescribed for long term use, VS should not be RR < 10/ min, BP < 90/60, should not take with alcohol or sedative- hypnotics, I & O, no ambulation, naloxone (Narcan), instruct about deep breathing and coughing exercises Methadone MOA- a narcotic but causes less dependency that the narcotics it is replacing Indication- for pt addicted to narcotics

NARCOTIC AGONIST-ANTAGONIST Pentazocine (Talwin)

Opioid agonist-antagonist analgesic

NARCOTIC ANTAGONIST naloxone (Narcan) MOA- blocks the receptor & displaces any narcotic that would be at the receptor, thus inhibiting the narcotic action Indication- antidotes for overdoses of narcotic analgesics CI-heart disease; seizures; a history of head injury or brain tumor; or a history of drug or alcohol addiction. SE:chest pain, fast or irregular heartbeats; dry cough, wheezing, feeling short of breath; sweating, severe nausea or vomiting; AE: seizure (convulsions), fainting, slow breathing (breathing may stop) Nsg Resp: VS q 5, q 15, q 30 until stable MOA- added to a narcotic agonist to decrease narcotic abuse, works on the brain and nervous system to decrease pain Indication-moderate to severe pain, pre op, anesthesia CI- allergic to other codeine or morphinerelated medicines SE: dizziness, drowsiness,lightheadedness, redness, swelling, vomiting AE: rash, difficulty of breathing, hives, swelling of the mouth, blurred vision, seizures, trouble sleeping, fainting Nsg Resp: out of reach of children, check if pentazocine contains particles or is discolored, use caution in the elderly because it may cause confusion and more sedation

Butorphanol tartate (Stardol)

Buprenorphine (Buprenex)

Opioid agonist-antagonist analgesic

MOA- added to a narcotic agonist to decrease narcotic abuse, works on the brain and nervous system to decrease pain Indication-Management of pain when use of an opioid analgesic is appropriate (parenteral/nasal); preoperative or preanesthetic medication, as a supplement to balanced anesthesia, and for relief of pain during labor (parenteral). CI- allergic to other codeine or morphinerelated medicines; hypersensitivity or preservative benzethonium chloride SE: headache, dizziness, nausea, vomiting AE: anxiety, euphoria, tremor, nervousness, lethargy, palpitations, pruritus, bronchitis Nsg Resp: IV/IM, take with meals, avoid alcohol, monitor bleeding

Opioid agonist-antagonist analgesic

MOA- analgesic effect by binding to the muopioid receptors in the CNS. It has a longer duration of analgesic action than morphine. Its partial agonist activity gives it a low level of physical dependence Indication-Management of pain when use of an opioid analgesic is appropriate (parenteral/nasal); preoperative or preanesthetic medication, as a supplement to balanced anesthesia, and for relief of pain during labor (parenteral). CI- Acute alcoholism; convulsive disorders; head injuries; increased intracranial pressure; comatose patients; resp depression and obstructive airway disease; patients on established opioid agonists. SE: headache, dizziness, nausea, vomiting AE: hypoventilation, resp or CNS depression; tachycardia, bradycardia, urinary retention, coma, withdrawal syndrome. Nsg Resp: assist during ambulation,

Nalbuphine HCl (Nubain)

Opioid agonist-antagonist analgesic

MOA- added to a narcotic agonist to decrease narcotic abuse, works on the brain and nervous system to decrease pain Indication: to treat moderate to severe pain. It is also used for treating pain just after surgery or childbirth. CI:asthma or other breathing disorder, liver or kidney disease, gallbladder disease, mental illness, or a history of drug or alcohol addiction. SE:weak or shallow breathing; fast or slow heart rate; headach, cold, clammy skin; AE:hallucinations, unusual thoughts or behavior; severe weakness or dizziness Nsg Resp: Nalbuphine should never be shared with another person, especially someone who has a history of drug abuse or addiction, NONSTEROIDAL ANTI-INFLAMMATORY

Aspirin (Aspergum, Aspirin Lite Coat, Zorprin)

Nonsteroidal anti-inflammatory drugs-Salicylate

MOA- inhibit the synthesis of prostaglandin and other mediators in the process of inflammation and have anti-inflammatory, antipyretic and analgesic properties. Indication-pain, fever, and inflammation, mild to moderate pain, prevent heart attacks, strokes, and angina. CI- should not be given to a child or teenager who has a fever (Reyes Syndrome), recent history of stomach or intestinal bleeding; a bleeding disorder such as hemophilia; SE: black, bloody, or tarry stools; vomiting,

or stomach pain AE: coughing up blood or vomit that looks like coffee grounds; Nsg Resp: should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox, Avoid drinking alcohol,

Indomethacin (Indocin)

Ibuprofen (Advil , Alaxan)

nonsteroidal anti-inflammatory drugs (NSAIDs) non-salicylates

MOA- reducing hormones that cause inflammation and pain in the body. Indication: treat pain or inflammation caused by many conditions such as arthritis, gout, ankylosing spondylitis, bursitis, or tendinitis. CI:allergic to any drugs, or if you have: a history of heart attack, stroke, or blood clot; heart disease, congestive heart failure, high blood pressure; a history of stomach ulcers or bleeding; liver or kidney disease, SE:chest pain, weakness, dizziness, nausea, headache AE:jaundice, skin rash, blurred vision, ringing in the ears Nsg Resp: Store indomethacin at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze.Take indomethacin with food or milk to lessen stomach upset. Do not crush, chew, break, or open an extended-release capsule Phenylbutazone

nonsteroidal anti-inflammatory drugs (NSAIDs) non-calculates Proprionic acid derivatives

MOA- blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced. Indication:mild to moderate pain, fever, and inflammation. Pain, fever, and inflammation CI: SE: diarrhea, constipation, epistaxis, headache, dizziness AE:esophageal ulceration, heart failure, hyperkalemia, renal impairment, confusion, and bronchospasm Nsg Resp: do not share it with others.Laboratory and/or medical tests may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Keep all regular medical and laboratory appointments. Naproxen (Flanax, Skelan)

nonsteroidal anti-inflammatory drugs (NSAIDs) non-salicylates

MOA- reducing hormones that cause inflammation and pain in the body. Indication: rheumatoid arthritis and gout CI: SE:Nausea, vomiting, indigestion, headache AE:gastrointestinal (GI) ulcers, blood dyscrasia, kidney damage, oral lesions, and internal hemorrhage Nsg Resp:Take the drug with meals, milk, or antacids. Do not take any other drugs, including aspirin, while you are taking phenylbutazone without consulting your doctor.

nonsteroidal anti-inflammatory drugs (NSAIDs) non-calculates Proprionic acid derivatives

MOA- blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced. Indication:mild to moderate pain, fever, and inflammation. Pain, fever, and inflammation CI: SE: diarrhea, constipation, epistaxis, headache, dizziness AE:esophageal ulceration, heart failure, hyperkalemia, renal impairment, confusion, and bronchospasm Nsg Resp:Take the drug with meals, milk, or antacids. Monitor bleeding, avoid alcohol,

check hypersensitivity

Meloxicam (Mobic) Mefenamic Acid (Ponstan)

nonsteroidal anti-inflammatory drugs (NSAIDs) non-calculates Oxicam

MOA- Meloxicam blocks the enzymes that make prostaglandins (cyclooxygenase 1 and 2) and reduces the levels of prostaglandins. As a result, inflammation and its accompanying symptoms are reduced. Indication: treat tenderness, swelling and pain caused by the inflammation of osteoarthritis and rheumatoid arthritis. CI:asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. SE:gastrointestinal tract (GI) and include nausea, vomiting, abdominal pain, diarrhea, somnolence, tremors AE: liver disease, seizures, severe dizziness Nsg Resp:Take the drug with meals, milk, or antacids. Monitor bleeding, avoid alcohol, check hypersensitivity

nonsteroidal anti-inflammatory drugs (NSAIDs) non-calculates Fenamates

MOA- blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. Indication: short-term treatment of mild to moderate pain from various conditions. It is also used to decrease pain and blood loss from menstrual periods. CI:asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. SE: GI discomfort, diarrhea, constipation, epistaxis, headache, dizziness, insomnia, malaise, nervousness, paresthesia, somnolence, tremors AE: cystitis, dysuria, hematuria, interstitial nephritis, oliguria/polyuria, proteinuria, renal failure esophageal, ulceration, heart failure, hyperkalemia, renal impairment, confusion, and bronchospasm Nsg Resp:Take the drug with meals, milk, or antacids. Monitor bleeding, avoid alcohol, check hypersensitivity

Diclofenac Na (Voltaren, Cataflam)

nonsteroidal anti-inflammatory drugs (NSAIDs) non-calculates Phenylacetic acid Derivatives

MOA- block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower production of prostaglandins. Indication: treatment of mild to moderate pain, fever, and inflammation CI- heart disease or increased risk for heart disease (due to conditions such as high blood pressure or diabetes) SE:ulcerations, abdominal burning, pain, cramping, nausea, gastritis, and even serious gastrointestinal bleeding and liver toxicity AE: liver disease, seizures, severe dizziness Nsg Resp:Take the drug with meals, milk, or antacids. Monitor bleeding, avoid alcohol,

check hypersensitivity Celecoxib (Celebrex)

nonsteroidal anti-inflammatory drugs (NSAIDs) non-calculates Selevtive COX2 inhibitors

MOA- block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower production of prostaglandins. Indication: treatment of mild to moderate pain, fever, and inflammation CI- severe renal and hepatic deisease, Gi bleed and hypersensitivity SE:ulcerations, abdominal burning, pain, cramping, nausea, gastritis, and even serious gastrointestinal bleeding and liver toxicity AE: hives, unusual bruising or bleeding, swelling Nsg Resp:Take the drug with meals, milk, or antacids. Monitor bleeding, avoid alcohol, check hypersensitivity, Do not take aspirin while you are using Celecoxib unless your doctor tells you to.

Hydrocortisone (Corstitan)

nonsteroidal anti-inflammatory corticosteriods

MOA- block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower production of prostaglandins. Indication:minor skin irritations, itching, and rashes, relieve the discomfort of mouth sores. CI- liver disease (such as cirrhosis); kidney disease; a thyroid disorder; Diabetes SE:drying or cracking of the skin, Acne, Itching, Burning, change in skin color AE: severe skin rash, difficulty breathing or swallowing, Wheezing, skin infection (redness, swelling, or oozing of pus) Nsg Resp:Keep this medication in the container it came in, tightly closed, and out of reach of children, Supplemental calcium and vitamin D are encouraged to slow this process of bone thinning.

STEROIDAL ANTI-INFLAMMATORY CORTICOSTERIODS Cortisone Acetate (Cortisan)

nonsteroidal anti-inflammatory corticosteriods

MOA- block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower production of prostaglandins. Indication:arthritis, colitis, asthma, bronchitis, certain skin rashes, cell cancers blood disease CI- liver disease (such as cirrhosis); kidney disease; a thyroid disorder; Diabetes SE:vision;swelling, rapid weight gain, feeling short of breath; severe depression, unusual thoughts or behavior, seizure (convulsions); AE: growth retardation in children, convulsions, and psychic disturbances. Nsg Resp:Avoid being near people who are sick or have infections, Do not receive a "live" vaccine while using cortisone, Avoid drinking alcohol while you are taking cortisone.

Prednisone (Deltasone)

nonsteroidal anti-inflammatory corticosteriods

MOA- block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower production of prostaglandins. Indication:minor skin irritations, itching, and rashes, relieve the discomfort of mouth sores. CI- liver disease (such as cirrhosis); kidney disease; a thyroid disorder; Diabetes SE:drying or cracking of the skin, Acne, Itching, Burning, change in skin color AE: severe skin rash, difficulty breathing or swallowing, Wheezing, skin infection (redness, swelling, or oozing of pus) Nsg Resp:Keep this medication in the container it came in, tightly closed, and out of reach of children, Supplemental calcium

and vitamin D are encouraged to slow this process of bone thinning. ANTI-GOUT AGENTS Colchicine (Novovolchicine) ANTI-GOUT MOA- inhibits migration of leukocytes at inflamed site Indication:treat gout and gouty arthritis; together with penicillin antibiotics to make them more effective. CI- uric acid kidney stones, a gout attack that has already started, or a blood cell disorder such as anemia, or decreased white blood cells SE:urinating more than usual; mild nausea, vomiting, loss of appetite; headache, dizziness; sore gums; AE:worsening gout symptoms; severe pain in your side or lower back; blood in your urine; Nsg Resp:Drink plenty of water to prevent kidney stones, This medication may affect your body's response to anesthesia, Do not take it in larger amounts or for longer than recommended Probenecid (Benemid) ANTI-GOUT MOA- increase rate of uric acid excretion by inhibiting reabsorption Indication:allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. CI- Do not receive a "live" vaccine while using prednisone, SE:increased sweating; headache, dizziness, spinning sensation; nausea, stomach pain, bloating; oror weakness; AE: dangerously high blood pressure, bloody or tarry stools, coughing up blood; severe depression, unusual thoughts or behavior, seizure (convulsions); Nsg Resp:Take with food if prednisone upsets your stomach, Prednisone can cause unusual results with certain medical tests, Avoid being near people who are sick or have infections Allopurinol (Zyloprim) ANTI-GOUT MOA- reduces the production of uric acid in your body. Uric acid buildup can lead to gout or kidney stones Indication: to treat gout or kidney stones, and to decrease levels of uric acid in people who are receiving cancer treatment CI- allergic to prednisone, or if you have a fungal infection anywhere in your body. SE:mild nausea or vomiting, stomach pain; mild diarrhea, flushed skin & rash, metallic taste, drowsiness AE:muscle pain or weakness;BMD pain or bleeding when you urinate, easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin. Nsg Resp:Take each dose with a full glass of water, Take allopurinol exactly as prescribed by your doctor, Store allopurinol at room temperature away from moisture and heat.

before swallowing them; do not give milk products Antacids Aluminum Hydroxide (Mylanta, Novaluzid, Amphogel) ANTACID MOA- neutralizes gastric acid secretions and raises the gastric pH of the stomach Indication: increased stomach acid, such as heartburn, upset stomach, sour stomach, or acid indigestion; reduce phosphate levels in people with certain kidney conditions. CI:dehydration, constipation, diarrhea(may change the dose) SE:extreme drowsiness; or tired feeling, loss of appetite, and muscle weakness. AE:severe stomach pain or constipation; bloody, black, or tarry stools; coughing up blood that looks like coffee grounds;pain when you urinate; Nsg Resp:Shake the oral suspension (liquid) well just before you measure a dose, Do not take aluminum hydroxide for longer than 2 weeks without your doctor's advice. Store aluminum hydroxide at room temperature away from moisture, heat, and light.; do not give milk products Calcium Carbonate (Alka-mints, Tums) ANTACID MOA- neutralizes gastric acid secretions and raises the gastric pH of the stomach Indication: increased stomach acid, such as heartburn, upset stomach, sour stomach, or acid indigestion; reduce phosphate levels in people with certain kidney conditions. CI:dehydration, constipation, diarrhea(may change the dose) SE:extreme drowsiness; or tired feeling, loss of appetite, and muscle weakness. AE:severe stomach pain or constipation; bloody, black, or tarry stools; coughing up blood that looks like coffee grounds;pain when you urinate; Nsg Resp:Shake the oral suspension (liquid) well just before you measure a dose, Do not take aluminum hydroxide for longer than 2 weeks without your doctor's advice. Store aluminum hydroxide at room temperature away from moisture, heat, and light.; do not give milk products, Keep using colchicine as directed, even if you feel well.

Magnesium Hydroxide (Simeco) ANTACID MOA- neutralizes gastric acid secretions and raises the gastric pH of the stomach; reduces stomach acid, and increases water in the intestines which may induce defecation. Indication: relieve indigestion, sour stomach, and heartburn. CI:dehydration, constipation, diarrhea(may change the dose); (abdominal) pain, nausea, or vomiting SE:extreme drowsiness; or tired feeling, loss of appetite, and muscle weakness. AE:severe stomach pain or constipation; bloody, black, or tarry stools; coughing up blood that looks like coffee grounds;pain when you urinate; Nsg Resp:should not be used for longer than one week; Take the tablets and capsules with a full glass of water. Chew the chewable tablets thoroughly

Histamine-2 Receptor Antagonist Anticholinergic agents/ anti-spasmodic Cimetidine (Tagamet) HISTAMINE-2 RECEPTOR ANTAGONIST MOA- block the H2 receptors of the parietal cells of the stomach, thus reducing gastric secretions and concentration; decreasing the amount of acid your stomach produces. Indication: ulcer, and to treat conditions that cause the stomach to produce too much acid. Cimetidine is also used to treat gastroesophageal reflux disease (GERD), when stomach acid backs up into the esophagus and causes heartburn. CI:dehydration, constipation, diarrhea(may change the dose) SE:headache, nausea, diarrhea, abd pain AE:severe bradycardia, anemia Nsg Resp:Administer before meals, do not administer the same time with antacids Atropine Sulfate ANTICHOLINERGIC/ ANTI-SPASMODIC MOA- decreases acetylcholine by blocking the cholinergic receptors Indication: colitis, spastic bladder, diverticulitis, infant colic, renal and biliary colic, peptic ulcer, and irritable bowel syndrome. CI:kidney disease; a blockage of your urinary tract (difficulty urinating); a blockage in your intestines, severe ulcerative colitis, or ulcerative colitis complicated by toxic megacolon; SE:headache, dizziness or lightheadedness; weakness or nervousness AE:an allergic reaction (swelling of your lips, tongue, or face, difficulty breathing, closing of your throat, or hives); an irregular or fast heart rate; rash or flushing Nsg Resp: Take before meals, monitor bowel elimination. Give antacids 2 hours after ant cholinergic

Ranitidine (Taladine, Zantac) HISTAMINE-2 RECEPTOR ANTAGONIST MOA- block the H2 receptors of the parietal cells of the stomach, thus reducing gastric secretions and concentration; decreasing the amount of acid your stomach produces. Indication: ulcers in the stomach and intestines. It also treats conditions in which the stomach produces too much acid, such as Zollinger-Ellison syndrome. Ranitidine also treats gastroesophageal reflux disease (GERD) and other conditions in which acid backs up from the stomach into the esophagus, causing heartburn. CI:dehydration, constipation, diarrhea(may change the dose) SE:headache (may be severe); drowsiness, dizziness; sleep problems (insomnia); AE:severe bradycardia, anemia, sleep problems (insomnia); decreased sex drive, impotence, or difficulty having an orgasm; swollen or tender breasts (in men); Nsg Resp:Administer before meals, do not administer the same time with antacids; relaxation technique; eat rich in Vit B12 to prevent deficiency as a result of drug therapy

Belladonna alkaloids ANTICHOLINERGIC/ ANTI-SPASMODIC MOA- decreases acetylcholine by blocking the cholinergic receptors Indication: colitis, spastic bladder, diverticulitis, infant colic, renal and biliary colic, peptic ulcer, and irritable bowel syndrome. CI:kidney disease; a blockage of your urinary tract (difficulty urinating); blockage in your intestines, severe ulcerative colitis, or ulcerative colitis complicated by toxic megacolon; glaucoma; or myasthenia gravis. SE:headache, dizziness, or lightheadedness; weakness or nervousness AE:an allergic reaction (swelling of your lips, tongue, or face, difficulty breathing, closing of your throat, or hives); an irregular or fast heart rate; a rash or flushing; or eye pain. Nsg Resp: Take before meals, monitor bowel elimination. Give antacids 2 hours

after ant cholinergic PROTON PUMP INHIBITOR Omeprazole (Losec) PROTON PUMP INHIBITOR MOA- suppresses the final step of gastric production by inhibiting hydrogenpotassium ATPase enzyme Indication: symptoms of gastroesophageal reflux disease (GERD) and other conditions caused by excess stomach acid. It is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid). CI:kidney disease; a blockage of your urinary tract (difficulty urinating); blockage in your intestines, severe ulcerative colitis, or ulcerative colitis complicated by toxic megacolon; glaucoma; or myasthenia gravis. SE: fast heartbeat, nausea, vomiting, sweating, headache, or dry mouth. AE:dizziness, confusion; fast or uneven heart rate; jerking muscle movements; feeling jittery; Nsg Resp: Take before meals, emphasize the importance of only remaining pantoprazole for a maximum of 16 weeks Omeprazole up to 8 weeks; regular medical Check-up Pantoprazole (Pantoloc) PROTON PUMP INHIBITOR MOA- suppresses the final step of gastric production by inhibiting hydrogenpotassium ATPase enzyme; decreases the amount of acid produced in the stomach. Indication: treat erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid such as Zollinger-Ellison syndrome. CI:kidney disease; a blockage of your urinary tract (difficulty urinating); blockage in your intestines, severe ulcerative colitis, or ulcerative colitis complicated by toxic megacolon; glaucoma; or myasthenia gravis. SE: weight changes; nausea, vomiting, diarrhea; gas, stomach pain; AE:seizure (convulsions), jerking muscle movements; feeling jittery; muscle cramps, Nsg Resp: Take before meals, emphasize the importance of only remaining pantoprazole for a maximum of 16 weeks; regular medical check-up

Pantoprazole (Pantoloc) PROTON PUMP INHIBITOR MOA- suppresses the final step of gastric production by inhibiting hydrogenpotassium ATPase enzyme; decreases the amount of acid produced in the stomach. Indication: treat erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excess stomach acid such as Zollinger-Ellison syndrome. CI:kidney disease; a blockage of your urinary tract (difficulty urinating); blockage in your intestines, severe ulcerative colitis, or ulcerative colitis complicated by toxic megacolon; glaucoma; or myasthenia gravis. SE: weight changes; nausea, vomiting, diarrhea; gas, stomach pain; AE:seizure (convulsions), jerking muscle movements; feeling jittery; muscle cramps,

Nsg Resp: Take before meals, emphasize the importance of only remaining pantoprazole for a maximum of 16 weeks; regular medical Take each dose with a full glass (8 ounces) of water. PROSTAGLANDIN ANALOGUE Misoprostol (Cytotec) PROSTAGLANDIN ANALOGUE MOA- decreases vagal activity; inhibits gastric acid secretion and protects the mucosa; promotes secretion of sodium bicarbonate and cytoprotection mucus Indication:ulcer, ripening of the cervix CI:pregnant women. SE: diarrhea, abdominal pain AE:abortion, Nsg Resp: Take before meals, no alcohol, NSAIDs aspirin, smoking ANTI-FLATULENTS Simethicone (Kremil-S, Simeco) ANTI-FLATULANTS MOA- aids in breaking up gas bubbles trapped in the intestines; increases gastric emptying, It acts in the stomach and intestines to change the surface tension of gas bubbles, enabling their breakdown and the formation of larger bubbles. Indication: post operative patients, children with colic, abdominal pain due to excessive gas in the digestive tract; patients undergoing upper abdominal ultrasound imaging. SE: constipation, dry mouth, abdominal cramps, nausea, vomiting, and headache AE: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. Nsg Resp: increase OFI, high fiber diet, ambulation, auscultate bowel sounds, avoid gas forming foods, Take this product by mouth, usually after meals and at bedtime or as directed by your doctor. Swallow the capsules whole. Do not crush or chew the capsules.

Domperidone (Motilium) ANTI-FLATULANTS MOA- aids in breaking up gas bubbles trapped in the intestines; increases gastric emptying Indication: post operative patients, children with colic; relieve painful pressure caused by excess gas in the stomach and intestines. CI:history of breast cancer, allergies, pregnant women SE: constipation, dry mouth, abdominal cramps,Headache, dizziness, dry mouth, nervousness, flushing AE: swelling of the feet or ankles, difficulty urinating, swelling of the breasts or discharge from the nipple in men or women, menstrual changes, sexual difficulties. Nsg Resp: increase OFI, increase OFI, high fiber diet, ambulation, auscultate bowel sounds, avoid gas forming foods; Simethicone works best if you take it after meals and at bedtime, ANTI-EMETICS Promethazine (Phenergan) ANTI-EMETICS PHENOTHIAZINE MOA- decrease response to chemoreceptor trigger zone (CTZ) by inhibiting domaninergic receptors Indication:severe nausea, vomiting, before and after chemotherapy, motion sickness CI:pregnant women during 1st trimester SE: drowsiness, orthostatic hypotension AE: Parkinsons symptoms, anticholinergic effects

Nsg Resp: avoid alcohol, increase OFI, caution the patient about sedative effects

chlorpromazine (Thorazine) ANTI-EMETICS PHENOTHIAZINE MOA- decrease response to chemoreceptor trigger zone (CTZ) by inhibiting domaninergic receptors Indication:severe nausea, vomiting, before and after chemotherapy, motion sickness CI:pregnant women during 1st trimester SE: drowsiness, orthostatic hypotension AE: Parkinsons symptoms, anticholinergic effects Nsg Resp: avoid alcohol, increase OFI, caution the patient about sedative effects

dimenhydramine (Dramamine, Dimenhydrinate) ANTI-EMETICS ANTI-HISTAMINES MOA- blocks the action of acetylcholine in the brain to decrease nausea and vomiting Indication:severe nausea, vomiting, before and after chemotherapy, motion sickness CI:pregnant women during 1st trimester SE: Dizziness; drowsiness; dry mouth, throat, and nose; thickening of mucus in nose or throat. AE: Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; convulsions; decreased alertness Nsg Resp: avoid alcohol, increase OFI, caution the patient about sedative effects

Diphenhydramine Hcl (Benadryl) ANTI-EMETICS ANTI-HISTAMINES MOA- blocks the action of acetylcholine in the brain to decrease nausea and vomiting;histamine is released by the body during several types of allergic reactions and--to a lesser extent--during some viral infections, such as the common cold. When histamine binds to its receptors on cells, it stimulates changes within the cells that lead to sneezing, itching, and increased mucus production Indication:relief of nasal and non-nasal symptoms of various allergic conditions such as seasonal allergic rhinitis. It is also used to alleviate cold symptoms and chronic urticaria (hives); to prevent or treat active motion sickness, and for mild cases of Parkinsonism, CI:alcoholism, Patients over the age of 60 years are especially sensitive to the sedating and anticholinergic effects of diphenhydramine, and the dose should be reduced., nursing mothers SE: drowsiness, orthostatic hypotension AE: blurred vision, double vision, tremor Nsg Resp: avoid alcohol, increase OFI, caution the patient about sedative effects

Hydrolyzing pamoate (Vistaril, Atarax) ANTI-EMETICS ANTI-HISTAMINES MOA- blocks the action of acetylcholine in the brain to decrease nausea and vomiting Indication:relief of pruritus (itching) caused by various allergic conditions. Hydroxyzine is also used for treating anxiety and tension, and inducing sedation prior to or after anesthesia. CI:pregnant women, hyperthyroidism, cardio dse,asthma, hypertension, SE: Dizziness; drowsiness; dry mouth, throat, and nose; thickening of mucus in

nose or throat. AE: blurred vision, double vision, tremor Nsg Resp: avoid alcohol, increase OFI, caution the patient about sedative effects, Ztrack route/Deep IM EMETICS

an increased risk of aspiration of vomitus, such as:Decreased patient alertness, Depressed gag reflex, Seizures, Unconsciousness (risk of aspiration pneumonia)

LAXATIVES/ CATHARTICS Ipecac Syrup EMETICS MOA- irritates the stomach and stimulates the CTZ and vomiting center in the medulla Indication:overdose, accidental poisoning CI: poisoning involving strong acids or alkalies, unconscious, semicomatose or severely inebriated patients, patients experiencing convulsions and patients who have lost the gag reflex. SE: Dizziness; drowsiness; AE: convulsions, loss of consciousness, toxicity. Protracted or prolonged vomiting, diarrhea and lethargy may occasionally occur. Nsg Resp: Ipecac should not be used to cause vomiting as a means of losing weight. If used regularly for this purpose, serious heart problems or even death may occur, If vomiting has not occurred within 15 to 20 minutes, the dose may be repeated once in adults and children over 12 years.

Apomorphine HCl EMETICS MOA- irritates the stomach and stimulates the CTZ and vomiting center in the medulla, Apomorphine also depresses medullary centers that control respiration and vasomotor tone and stimulates salivation. It increases plasma concentrations of human growth hormone and decreases serum prolactin concentrations by stimulating dopamine receptors. Indication:overdose, accidental poisoning CI: children, sensitive to morphine, patients experiencing convulsions and patients who have lost the gag reflex. SE: Dizziness; drowsiness; AE: convulsions, loss of consciousness, toxicity. Protracted or prolonged vomiting, diarrhea and lethargy may occasionally occur. Nsg Resp: Any condition in which there is

Cephulac (Lactulose, Dufalac) LAXATIVES- OSMOTIC MOA- pull water into the colon and increases water in the feces to increase bulk which stimulates peristalsis; type of sugar. It is broken down in the large intestine into mild acids that draw water into the colon, which helps soften the stools. Indication: treat chronic constipation. CI: elderly SE: Dizziness; drowsiness; vomiting, stomach pain, bloating, gas, diarrhea AE: Fluid and electrolyte disturbances, hypovolemia, hypokalemia, and hypernatremia, especially in elderly or acutely ill patients. Nsg Resp: special diet low in galactose (milk sugar);Lactulose powder should be mixed with at least 4 ounces of water. You may also use fruit juice or milk to make the medication better; it may take up to 48 hours before you have a bowel movement after taking lactulose

7 days; rectal bleeding; or itchy skin rash. Nsg Resp: help lower cholesterol when used together with a diet low in cholesterol and saturated fat. Senna (Senokot) LAXATIVES-CONTACT LAXATIVES MOA- increase peristalsis by irritating the nerve endings in the intestinal mucosa Indication: Short-term treatment of constipation; preoperative and preradiographic bowel evacuation for procedures involving GI tract. CI: Nausea, vomiting, or other symptoms of appendicitis; acute surgical abdomen; fecal impaction; intestinal obstruction; undiagnosed abdominal pain. SE: Dizziness; drowsiness; vomiting, stomach pain, bloating, gas, diarrhea AE: Fluid and electrolyte disturbances, hypovolemia, hypokalemia, and hypernatremia, especially in elderly or acutely ill patients. Nsg Resp: Administer at bedtime on empty stomach. Shake liquid solution before administering. Dissolve granules before administering. Give oral dosages with full glass of water or juice. Administer suppository with patient lying on left side. Ducosate sodium (Colace) LAXATIVES-EMOLLIENTS MOA- increase peristalsis by irritating the nerve endings in the intestinal mucosa Indication: Short-term treatment of constipation; preoperative and preradiographic bowel evacuation for procedures involving GI tract. CI: Nausea, vomiting, or other symptoms of appendicitis; acute surgical abdomen; fecal impaction; intestinal obstruction; undiagnosed abdominal pain. SE: Dizziness; drowsiness; vomiting, stomach pain, bloating, gas, diarrhea AE: Fluid and electrolyte disturbances, hypovolemia, hypokalemia, and hypernatremia, especially in elderly or acutely ill patients. Nsg Resp: Administer at bedtime on empty stomach. Shake liquid solution before administering. Dissolve granules before administering. Give oral dosages with full glass of water or juice. Administer suppository with patient lying on left side. Ducosate Sodium (Colace) LAXATIVES-EMOLLIENTS MOA- lubricants to prevent constipation, decrease straining during defecation Indication: constipation, and to reduce pain or rectal damage caused by hard stools or by straining during bowel movements. CI: nausea, vomiting, or stomach pain. SE: mild diarrhea; or mild nausea. AE: rectal bleeding or irritation; numbness or a rash around your rectum; severe diarrhea or stomach cramps; or continued constipation. Nsg Resp: Take docusate tablets or capsules with a full glass of water. After using docusate, you should have a bowel movement within 12 to 72 hours. Call your doctor if you have not had a bowel movement within 1 to 3 days.

Psyllium (Metamucil) LAXATIVES-BULK FORMING MOA- orks by absorbing liquid in the intestines and swelling to create a softer, bulky stool that is easier to pass. Indication: treat occasional constipation or bowel irregularity. Psyllium may also be used to treat diarrhea and may help lower cholesterol CI: trouble swallowing; a sudden change in bowel habits that lasts longer than 2 weeks; severe nausea, vomiting, or stomach pain; or if you have ever had a skin rash while taking psyllium. SE: bloating; or minor change in your bowel habits. AE: choking or trouble swallowing; severe stomach pain, cramping, nausea or vomiting; constipation that lasts longer than

Mineral oil (Fleet) LAXATIVES-LUBRICANTS MOA- slowing the absorption of water from the bowel, which softens the stool. Indication: Relieving occasional constipation or fecal impaction (severe constipation). It may also be used to cleanse and remove residue from the bowel in certain situations CI: you are allergic to any ingredient in; Mineral Oil Enema; you have appendicitis or a blockage in your intestines; you are bedridden SE: Bloating; diarrhea; gas; nausea; stomach cramps. AE: Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue) Nsg Resp: lie on your left side with your knee bent and your arms resting comfortably. You may also kneel, then lower your head and chest forward until the left side of your face is resting on the surface with your left arm folded comfortably. Do not use or any laxative for more than 1 week unless directed to do so by your health care provider.

ANTI-DIARRHEALS

Activated charcoal (Optimum Charcoal) ANTI-DIARRHEALS-ABSORBENTS MOA-removes toxins by binding with them and forms a coating over the mucosa Indication: stomach pain caused by excess gas, diarrhea, or indigestion. to relieve itching related to kidney dialysis treatment and to treat poisoning or drug overdose. CI: liver disease; kidney disease; or any type of serious illness. SE: dizziness; drowsiness, tired feeling; constipation; mild stomach pain AE: allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Nsg Resp:Take this medicine with a full glass (8 ounces) of water. Do not crush, break, or chew a charcoal tablet or capsule. Swallow the pill whole. Charcoal is usually taken after meals or at the first sign of stomach discomfort.

Nsg Resp: 30 mins before meal and at bedtime, breast-feeding is not recommended for mothers who are taking domperidone. unsuitable for patients with lactose intolerance, galactosaemia or glucose/galactose malabsorption. loperamide (Imodium) ANTI-DIARRHEALS-OPIATES MOA-slows the rhythm of digestion so that the small intestines have more time to absorb fluid and nutrients from the foods you eat. Indication: treat diarrhea. Loperamide is also used to reduce the amount of stool in people who have an ileostomy (re-routing of the bowel through a surgical opening in the stomach). CI: stools that are bloody, black, or tarry; or if you have diarrhea that is caused by taking an antibiotic. SE: dizziness; drowsiness, tired feeling; constipation; mild stomach pain AE: stomach pain or bloating; ongoing or worsening diarrhea; diarrhea that is watery or bloody; or severe skin reaction Nsg Resp: Shake the oral suspension (liquid) well just before you measure a dose; It may take up to 48 hours before your symptoms improve. Take loperamide with a full glass of water. Drink extra water while you are taking this medication to keep from getting dehydrated. metaclopramide (Plasil, Reglan) GASTROINTESTINAL STIMULANTS MOA-increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines. Indication:short-term to treat heartburn caused by gastroesophageal reflux; treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals. CI: allergic to metoclopramide, or if you have bleeding or blockage in your stomach or intestines, epilepsy or other seizure disorder, or an adrenal gland tumor. SE: restlessness, drowsiness, dizziness, headache, insomnia AE: tremors, or restless muscle movements in your eyes, tongue, jaw, neck, arms, or legs;mask-like appearance of the face; fluid retention Nsg Resp: no alcohol, Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Take metoclopramide 30 minutes before eating.

GASTROINTESTINAL STIMULANTS domperidone (motilium) GASTROINTESTINAL STIMULANTS MOA-stimulates motility of the upper GI tract and increase the rate of gastric emptying w/o stimulating gastric, biliary or pancreatic secretions Indication:gastro esophageal reflux, treat urinary retention & abdominal distention CI: mechanical obstruction, perforation, GI hemmorhage SE: restlessness, drowsiness, dizziness, headache, insomnia AE: LBM, increase lung secretions, decrease BP, CR

tongue). Nsg Resp:Take care not to let your blood sugar get too low. Low blood sugar (hypoglycemia) can occur if you skip a meal, exercise too long, drink alcohol, or are under stress INSULIN Glimepiride (Amaryl) ORAL ANTIDIABETIC DRUGSULFONYLUREAS-2nd GEN MOA- helps your pancreas produce insulin.increase the ability of the cells to bind insulin for glucose metabolism Indication: Diabetes Mellitus Type 2 CI: you are allergic to any ingredient in Insulin, heart disease, liver disease, kidney disease SE: Redness, swelling, or itching at injection sites.pale skin, easy bruising or bleeding, fever, unusual weakness; numbness or tingly feeling; trouble breathing; AE: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).diarrhea; increased skin sensitivity to sunlight Nsg Resp:Take care not to let your blood sugar get too low. Low blood sugar (hypoglycemia) can occur if you skip a meal, exercise too long, drink alcohol, or are under stress; Carry hard candy or glucose tablets with you in case you have low blood sugar. Other sugar sources include orange juice and milk. Be sure your family and close friends know how to help you in an emergency.

Insulin (Terumo, BD) INSULIN MOA-primarily acts in the liver muscle and adipose attaching to the receptors on cellular membranes facilitating the passage of glucose, potassium and magnesium Indication: Diabetes Mellitus type 1 CI: you are allergic to any ingredient in Insulin SE: Redness, swelling, or itching at injection sites. AE: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue). Nsg Resp: Insulin can be injected into the abdomen, buttocks, thighs, and arms. First clean the skin at the injection site with an alcohol pad or rubbing alcohol. Pinch a fold of skin at the injection site with your fingers

ORAL ANTIDIABETIC DRUG tolbutamide (Orinase) ORAL ANTIDIABETIC DRUGSULFONYLUREAS-1st GEN MOA- helps your pancreas produce insulin.increase the ability of the cells to bind insulin for glucose metabolism Indication: Diabetes Mellitus Type 2 CI: you are allergic to any ingredient in Insulin SE: Redness, swelling, or itching at injection sites. AE: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or

Nsg Resp:If you take acarbose with insulin or other diabetes medications, your blood sugar could get too low. Low blood sugar (hypoglycemia) can occur if you skip a meal, exercise too long, drink alcohol, or are under stress. biguanides (Metformin) ORAL ANTIDIABETIC DRUGNONSULFONYLUREAS MOA- decrease hepatic production of glucose from stored glycogen Indication: Diabetes Mellitus Type 2 CI: you are allergic to any ingredient in Insulin, liver disease; a history of heart disease. SE: headache; muscle pain; weakness; or mild nausea, vomiting, diarrhea, gas, stomach pain. AE: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue). Nsg Resp:If you need to have any type of xray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin. Some people develop lactic acidosis while taking metformin.Check your blood sugar carefully during a time of stress or illness, if you travel, exercise more than usual, drink alcohol, or skip meals. These things can affect your glucose levels and your dose needs may also change. Sitagliptin phosphate (Galvuz) ORAL ANTIDIABETIC DRUG- INCRETIN MODIFIER MOA- oral diabetes medicine that helps control blood sugar levels. It works by regulating the levels of insulin your body produces after eating. Indication: Diabetes Mellitus Type 2; used in combination with insulin or other diabetes medications you take by mouth. CI: you are allergic to any ingredient in Insulin, liver disease; a history of heart disease, kidney disease (or if you are on dialysis); a history of pancreatitis. SE: runny, stuffy nose, sore throat; headache; or nausea, stomach pain, diarrhea. AE: pancreatitis - severe pain in your upper stomach spreading to your back, nausea and vomiting, loss of appetite, fast heart rate; Nsg Resp:Take care not to let your blood sugar get too low. Low blood sugar (hypoglycemia) can occur if you skip a meal, exercise too long, drink alcohol, or are under stress.

acarbose (Precose) ORAL ANTIDIABETIC DRUG-ALPHAGLUCOSIDASE INHIBITOR MOA- slows the digestion of carbohydrates in the body, which helps control blood sugar levels. Indication: Diabetes Mellitus Type 2; used in combination with insulin or other diabetes medications you take by mouth. CI: you are allergic to any ingredient in Insulin, liver disease; a history of heart disease. SE: headache; muscle pain; weakness; or mild nausea, vomiting, diarrhea, gas, stomach pain. AE: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).

for 9 months. If the patient is HIV-positive, therapy should be continued for at least 9 months, or for 6 months beyond culture conversion. Longer duration of therapy should be considered for silico-, bone, and meningeal tuberculosis. ANTI-TB DRUGS Pyrazinamide ANTITUBERCULOSIS AGENT MOA- bactericidal & bacteriostatic Indication: treat and to prevent tuberculosis CI: ever had an allergic reaction to pyrazinamide, liver disease, gout, kidney disease, or diabetes mellitus. SE:excess uric acid level(gout/hepatitis), Headache; drowsiness; fatigue; dizziness AE:difficult or painful urination; painful or swollen joints; worsening gout; or a rash, yellowing of your skin or eyes, or darkening of your urine. Nsg Resp:obtain baseline uric acid levels, Take each dose with a full glass (8 ounces) of water. Take all of the pyrazinamide that has been prescribed for you even if you begin to feel better. Your symptoms may begin to improve before the infection is completely treated.

Rifampicin (Nydrazid) ANTITUBERCULOSIS AGENT MOA- Inhibits DNA-dependent RNA polymerase in susceptible strains of bacteria Indication: treat and to prevent tuberculosis CI: Hypersensitivity to any rifamycin, SE:urine may turn orange, Headache; drowsiness; fatigue; dizziness AE:Hypotension; shock, pruritis, Visual disturbances; exudative conjunctivitis. Nsg Resp:Inform patient that body fluids may turn red-orange in color and that soft contact lenses may become permanently stained. Advise patient to wear glasses during course of therapy, Advise patient who uses oral contraceptives to use nonhormonal form of contraception during therapy.

isoniazid (Nydrazid) ANTIBIOTIC-ANTI TUBERCULOUS BACTERIA MOA- inhibits mycobacterium cell wall synthesis Indication: treat and to prevent tuberculosis (TB). CI: severe hypersensitivity reactions, including drug -induced hepatitis; previous isoniazid-associated hepatic injury SE: peripheral neuritis, hepatitis, unusual weakness or fatigue; nausea, vomiting, or loss of appetite; abdominal pain; yellow skin or eyes; AE: numbness or tingling in your hands or feet; seizures; blurred vision; or confusion or abnormal behavior. Nsg Resp:take meds on empty stomach, no alcohol, If isoniazid and pyrazinamide are used alone, isoniazid should be continued

Ethambutol (Myambutol) ANTITUBERCULOSIS AGENT MOA-It prevents growth of the tuberculous bacteria in the body; given in resistant cases, inhibit cellular metabolism Indication: treat and to prevent tuberculosis CI: ever had an allergic reaction to ethambutol; cataracts, diabetic retinopathy, or optic neuritis; or kidney disease. SE:changes in visual acuity, perception. Headache; drowsiness; fatigue; dizziness AE:difficult or painful urination; painful or swollen joints; worsening gout; or a rash, yellowing of your skin or eyes, or darkening of your urine. Nsg Resp:check for visual acuity, color perception, Take all of the ethambutol that has been prescribed for you even if you begin to feel better. Your symptoms may begin to improve before the infection is completely treated.

ANTITUSSIVES Streptomycin ANTITUBERCULOSIS AGENT MOA-aminoglycoside. It works by killing sensitive bacteria by stopping the production of essential proteins needed by the bacteria to survive. Indication: treat and to prevent tuberculosis, severe TB, resistant CI: you are allergic to any ingredient in Streptomycin or other similar medicines you are taking a nondepolarizing muscle relaxant (eg, pancuronium) SE:ototoxicity Headache; drowsiness; fatigue; dizziness, damage to CN VIII, AE:ringing or roaring in the ears; skin rash or itching; vaginal irritation or discharge; vomiting. Nsg Resp:Drinking extra fluids while you are taking Streptomycin is recommended. The place of injection should be alternated. the preferred place of injection is the upper right portion of the buttock or the middle portion of the thigh. In children, the preferred place of injection is the middle portion of the thigh.

codeine ANTITUSSIVES-NARCOTIC MOA-act directly on the medullary cough center of the brain to depress the cough reflex Indication: treat and to prevent tuberculosis, severe TB, resistant CI: Alcoholism SE:Headache; drowsiness; fatigue; dizziness, damage to CN VIII, AE:feelings of extreme happiness or sadness; seizure (convulsions); or problems with urination. Nsg Resp:Do not drink alcohol; Take codeine with food or milk if it upsets your stomach. Do not stop using codeine suddenly, or you could have unpleasant withdrawal symptoms.

benzonatate (Tessalon) ANTITUSSIVES MOA-It works by numbing the throat and lungs, making the cough reflex less active. Indication:reduce chest congestion caused by the common cold, infections, or allergies. CI: allergic to benzonatate or topical numbing medicines such as tetracaine or procaine (found in some insect bite and sunburn creams); younger than 10 years old SE:dizziness or headache, a rash, or nausea, vomiting, or stomach upset., AE:choking feeling, chest pain or numbness, feeling like you might pass out, confusion, or hallucinations Nsg Resp:ever suck or chew on a benzonatate capsule. Swallow the pill whole. Sucking or chewing the capsule may cause your mouth and throat to feel numb or cause other serious side effects.

TOPICAL NASAL DECONGESTANT Ephedrine (Kondons nasal) TOPICAL NASAL DECONGESTANT MOA- decongestant and bronchodilator. It works by reducing swelling and constricting blood vessels in the nasal passages and widening the lung airways, allowing you to breathe more easily. Indication:temporary relief of shortness of breath, chest tightness, and wheezing due to bronchial asthma. CI: asthma; you have high blood pressure, heart disease, an irregular heartbeat, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland or other severe heart problems SE:Dizziness; headache; nausea; nervousness; tremor; loss of appetite; restlessness; sleeplessness; stomach irritation. AE:Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); difficulty urinating. Nsg Resp:ephedrine may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation Diabetes patients - ephedrine may affect your blood sugar. Check blood sugar levels closely and ask your doctor before adjusting the dose of your diabetes medicine phenylephrine (Coricidin) TOPICAL NASAL DECONGESTANT MOA-decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose). Indication:treat nasal congestion and sinus pressure caused by allergies, the common cold, or the flu. Phenylephrine may be used to treat congestion of the tubes that drain fluid from your inner ears, called the eustachian tubes. CI: < 4 y.o., you have used linezolid (Zyvox) or procarbazine (Matulane), SE:headache, dizziness; feeling excited or restless (children); upset stomach; AE:severe dizziness, restless feeling, nervousness, or insomnia; unusual thoughts or behavior; feeling like you might pass out; Nsg Resp:You should not use this medication if you are allergic to phenylephrine. Do not use phenylephrine if you have used linezolid (Zyvox) or procarbazine (Matulane), or if you have taken a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone),

TOPICAL NASAL STEROID DECONGESTANTS

budesonide (Entocort EC) TOPICAL NASAL DECONGESTANT MOA-It prevents the release of substances in the body that cause inflammation Indication:treat mild to moderate Crohn's disease. CI: lactating mothers SE:thinning of the skin, easy bruising; headache; runny or stuffy nose, cough, sore throat; muscle pain; AE:changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist); increased blood pressure (severe headache, fast or uneven heart rate, blurred vision); or general ill feeling with headache, tiredness, nausea, and vomiting. Nsg Resp:Grapefruit and grapefruit juice may interact with budesonide and cause increased levels of the medication in your blood.Avoid being near people who are sick or have infections. ORAL DECONGESTANT phenylpropanolamine (Neozep) ORAL DECONGESTANT MOA-works by constricting (shrinking) blood vessels (veins and arteries) in your body. Constriction of blood vessels in your sinuses, nose, and chest allows drainage of those areas, which decreases congestion. Indication:congestion associated with allergies, hay fever, sinus irritation, and the common cold. Phenylpropanolamine also causes a decrease in appetite and is used in some over-the-counter diet aids. CI: conditions exacerbated by sympathetic activity SE:thinning of the skin, easy bruising; headache; runny or stuffy nose, cough, sore throat; muscle pain; AE:changes in the shape or location of body fat (especially in your arms, legs, face, neck,

breasts, and waist); increased blood pressure (severe headache, fast or uneven heart rate, blurred vision); or general ill feeling with headache, tiredness, nausea, and vomiting. Nsg Resp:Grapefruit and grapefruit juice may interact with budesonide and cause increased levels of the medication in your blood.Avoid being near people who are sick or have infections.

ANTIHISTAMINES cetirizine (Virlix, Reactine) ANTIHISTAMINE-1st gen MOA-antihistamine that reduces the natural chemical histamine in the body. Indication:cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. CI: Alcoholism, children younger than 4 years old, allergic to cetirizine SE:dizziness, drowsiness; tired feeling; AE:fast, pounding, or uneven heartbeat; weakness, tremors (uncontrolled shaking), or sleep problems (insomnia); severe restless feeling, hyperactivity; confusion; Nsg Resp: Avoid drinking alcohol. FDA pregnancy category B. You may take cetirizine with or without food. The chewable tablet must be chewed before you swallow it. may impair your thinking or reactions

thinking or reactions. Be careful if you drive or do anything that requires you to be alert. loratadine (Allegra) ANTIHISTAMINE-2nd gen MOA-antihistamine that reduces the natural chemical histamine in the body. Indication:cold or allergy symptoms such as sneezing, itching, watery eyes, or runny nose. CI: kidney disease; or liver disease. younger than 6 years old SE:headache; nervousness; feeling tired or drowsy; AE:fast or uneven heart rate; feeling like you might pass out; jaundice (yellowing of your skin or eyes); or seizures (convulsions). Nsg Resp: Avoid drinking alcohol. FDA pregnancy category B. You may take cetirizine with or without food. The chewable tablet must be chewed before you swallow it. may impair your thinking or reactions

MUCOLYTIC

EXPECTORANT

Guaifenesin (Robitussin) EXPECTORANT MOA-loosen congestion in your chest and throat, making it easier to cough out through your mouth. Indication:reduce chest congestion caused by the common cold, infections, or allergies. CI: Alcoholism, children younger than 4 years old SE:dizziness or headache, a rash, or nausea, vomiting, or stomach upset., AE:hives; difficult breathing; swelling of your face, lips, tongue, or throat.. Nsg Resp:Do not give guaifenesin to a child younger than 4 years old.Drink extra fluids to help loosen the congestion and lubricate your throat while you are taking this medication. This medication may impair your

acetylcysteine (Mucomyst) MUCOLYTIC MOA-breaks down mucus, the substance that lubricates many parts of the body such as the mouth, throat, and lungs. Indication:thin the mucus in people with certain lung conditions such as cystic fibrosis, emphysema, bronchitis, tuberculosis. Acetylcysteine is also used during surgery or anesthesia, and to prepare the throat or lungs for a medical test. CI: kidney disease; or liver disease. younger than 6 years old SE:sticky feeling around the nebulizer mask, white patches or sores inside your mouth or on your lips, nausea, fever, runny nose, sore throat, drowsiness, skin rash, or clammy skin. AE:hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Nsg Resp: Acetylcysteine solution can be inhaled directly from the nebulizer, or with a face mask, mouth piece, tent, or intermittent positive pressure breathing (IPPB) machine. liquid may change color once you have opened the bottle. This is caused by a chemical reaction and will not affect the medicine.

Nsg Resp: Avoid eating excessive amounts of grilled or char-broiled foods. Doing so may also change the dosage of aminophylline that you need. Dornase alfa (Pulmozyme) MUCOLYTIC MOA-synthetic protein that breaks down excess DNA in the pulmonary secretions of people with cystic fibrosis. Indication:improve lung function in people with cystic fibrosis by thinning pulmonary secretions and reducing the risk of respiratory tract infections. CI: Chinese Hamster Ovary cell products. SE:voice alteration; sore throat; rash; AE:increased difficulty breathing; chest pain; or fever; laryngitis; eye redness, irritation, or inflammation; or nasal stuffiness or discharge. Nsg Resp: Dornase alfa must be stored in the refrigerator between 36 and 46 degrees Fahrenheit (2 and 8 degrees Celsius) and protected from strong light. Keep unused ampules in the protective foil pouch. Dornase alfa should be kept refrigerated during transport; inhalation using a recommended nebulizer;Do not use any dornase alfa solution that is cloudy or discolored.

SYMPATHOMIMETICS

XANTHINES aminophylline (Phyllocontin) XANTHINES MOA-.it relaxes muscles in your lungs and chest to allow more air in, decreases the sensitivity of your lungs to allergens and other substances that cause inflammation, and increases the contractions of your diaphragm to draw more air into the lungs. Indication:treat the symptoms of asthma, bronchitis, and emphysema CI: a stomach ulcer; seizures or epilepsy; high blood pressure, a heart condition, or any type of heart disease; SE:slight nausea, decreased appetite, or weight loss; restlessness, tremor, or insomnia; or headache, lightheadedness, or dizziness. AE:seizures;increased or irregular heartbeats; severe nausea or vomiting.

epinephrine (Adrenaline) SYMPATHOMIMETICS MOA-.chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction. Indication:severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis. CI: high blood pressure, a heart rhythm disorder, coronary artery disease, Parkinson's disease, diabetes, or a thyroid disorder. SE:sweating; nausea and vomiting; pale skin; feeling short of breath; AE:increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure). Nsg Resp: Seek emergency medical attention even after you use epinephrine to treat a severe allergic reaction. The effects of epinephrine may wear off after 10 or 20 minutes.

Terbutaline sulfate (Brethine) SYMPATHOMIMETICS MOA-.works by relaxing muscles in the airways to improve breathing. Indication:bronchospasm (wheezing, shortness of breath) associated with lung diseases such as asthma, bronchitis, and emphysema. CI: heart disease or high blood pressure; epilepsy or another seizure disorder; diabetes; SE:headache; dizziness or lightheadedness; insomnia; tremor or nervousness; sweating; nausea, vomiting, or diarrhea; or dry mouth. AE:chest pain or irregular heartbeats. Nsg Resp: Take each dose with a full glass of water;Do not take terbutaline more often or in larger doses than is prescribed by your doctor.

ANTICHOLINERGIC BRONCHODILATOR Ipratropium bromide (Atrovent) ANTICHOLINERGIC BRONCHODILATOR MOA-.blocks the action of neurotransmitter acetylcholine at vagal mediated receptor site Indication:prevent bronchospasm, or narrowing airways in the lungs, in people with bronchitis, emphysema, or COPD CI: narrow-angle glaucoma, or an enlarged prostate or bladder obstruction. Extreme heat can cause the ipratropium inhalation canister to burst. SE:headache; dizziness or lightheadedness; insomnia; tremor or nervousness; sweating; nausea, vomiting, or diarrhea; or dry mouth. AE:upset stomach; or blurred vision. Nsg Resp: Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.Attach the mouthpiece or face mask to the drug chamber. If you use more than one inhalation at a time, wait at least 15 seconds before using the second inhalation.

Salbutamol (Ventolin) SYMPATHOMIMETICS MOA-.sympathomimetic (beta agonist) bronchodilator that relaxes the smooth muscle in the airways which allows air to flow in and out of the lungs more easily. Indication:bronchospasm in people with reversible obstructive airway disease. It is also used to prevent exercise-induced bronchospasm. CI: allergic to albuterol; heart disease, high blood pressure, congestive heart failure; a heart rhythm disorder; a seizure disorder such as epilepsy; diabetes; SE:headache, dizziness, nervousness; sleep problems (insomnia); cough, hoarseness, sore throat, runny or stuffy nose AE:chest pain or irregular heartbeats, tremors, dangerously high blood pressure Nsg Resp: Ventolin may increase the risk of asthma-related death. If you use more than one inhalation at a time, wait at least 1 minute before using the second inhalation and shake the inhaler again.Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

LEUKOTRIENE RECEPTOR ANTAGONIST

Zafirlukast (Accolate) LEUKOTRIENE RECEPTOR ANTAGONIST MOA-.chemicals your body releases when you breathe in an allergen (such as pollen). These chemicals cause swelling in your lungs and tightening of the muscles around your airways, which can result in asthma symptoms. Indication:chronic treatment of asthma, and to prevent asthma attacks in adults and children as young as 5 years old. CI: allergic to zafirlukast, or if you have liver disease (including cirrhosis). SE:headache; diarrhea, stomach pain; weakness;. AE:worsening asthma symptoms; new or worsening cough, fever, trouble breathing; mood or behavior changes, anxiety, depression, sleep problems (insomnia); Nsg Resp: Take zafirlukast on an empty stomach, at least 1 hour before or 2 hours after a meal. Zafirlukast will not work fast enough to treat an asthma attack that has already begun. Use only a fast-acting inhalation medicine to treat an asthma attack.

Montelukast (Singulair) LEUKOTRIENE RECEPTOR ANTAGONIST MOA-.chemicals your body releases when you breathe in an allergen (such as pollen). These chemicals cause swelling in your lungs and tightening of the muscles around your airways, which can result in asthma symptoms. Indication:to prevent asthma attacks in adults and children as young as 12 months old. It is also used to relieve runny nose and sneezing caused by allergies in adults and children as young as 6 months old.prevent exercise-induced bronchoconstriction (narrowing of the air passages in the lungs) in adults and teenagers who are at least 15 years old CI: Do not use this medication if you are allergic to montelukast. The chewable tablet form of this medication may contain phenylalanine. SE:headache; diarrhea, stomach pain; weakness;. AE:worsening asthma symptoms; new or worsening cough, fever, trouble breathing; mood or behavior changes, anxiety, depression, sleep problems (insomnia); Nsg Resp: use only a fast-acting inhalation medicine to treat an asthma attack;