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Cholinesterase Inhibitors
* Neostigmine (Prostigmin)
ACTION: Prevent the enzyme cholinesterase (CHE) from inactivating
acetycholine (ACh), thereby increasing the amount of ACh available at
receptor sites. Transmission of nerve impulses is increased at all sites
responding to ACh as a transmitter
Therapeutic Use (TU)
increases muscle strength by increasing ACh effects at motor neurons in
Myasthenia Gravis
Causes reversal of nondepolarizing neuromuscular blocking agents (tubocurarine)
following surgery
Side Effects/Adverse Effects
Increased GI motility and secretion, bradycardia & urinary Urgency due to
excessive muscarinic stimulation
0
* 1) If effects become intolerable notify primary care provider, Side effects
can be treated with ATROPINE
Cholinergic Crisis- excessive muscarinic stimulation and respiratory depression
from neuromuscular blockade
0
* Treat with Muscarinic effects with ATROPINE
0
TU : Tx for Urinary Retention in post opt and post pardum pt. NOT urinary
retention caused by physiological obstruction..b/c it cam cause injury due
to increased pressure
S/E : Hypotension and bradycardia. Excessive salivation ,increased sec. of
gastric acid, abdominal cramps and diarrhea
CI : Patients with low blood pressure, gastric ulcers, intestinal obstruction
(can rupture the bladder) patients with asthma (it causes
bronchoconstriciton), hyperthyroid patients (Can cause dysrhythmias)
S/E : Xerostomia (Dry Mouth), Blurred Vision (paralyze ciliary muscle focus
on far objects causes blurred vision) photophobia (paralysis of iris sphincter
prevents constriction of the pupil) (NI: where glasses 4photophobia-when
unable to adapt to bright light)
Urinary Retention and Constipation (blockade of muscarinic receptors
increase the pressure w/in bladder and increases the tone of the urinary
sphincter and trigone)
Anhidrosis (absence of sweat), Tachycardia, Asthma(cause thickening and
drying of bronchial secretions
Drug Interactions : Anti-histamines, phenothiazines, antipsychotics, tricyclic
- Carbidopa does not possess any therapeutic effects, but is used to augment levodopa.
Carbidopa inhibits conversion of levodopa to DA in the intestine and periphery, and thereby allows for
increase amounts of levodopa to reach the CNS
Dopamine agonists:
Medications: Pramipexole (Mirapex), Ropinirole (Requip), bromocrptine (Parlodel)
Actions:
-Act directly on DA receptors
Centrally Acting Anticholinergics:
Medications: Benztropine (Cogentin), Trihexyphenidyl (Artane)
Actions: These medications block acetylcholine at muscarnic receptors, which assists in maintaining
the balance between dopamine and acetylcholine in the brain.
Dopamine releaser (Antiviral):
Medications: Amantadine (Symmetrel)
Actions: Antiviral stimulate DA release, prevent dopamine reuptake, and may block cholinergic and
glutamate receptors
Therapeutic Uses:
- These medications do not halt the progression of Parkinsons disease (PD): however, they do
offer symptomatic relief from dyskinesias (e.g., bradykinesis, resting tremors, and muscle
rigidity).
- Levodopa may be used as a first-line medication for PD treatment
- Pramipexole (Mirapex) is used as monotherapy in early-stage PD, and used in conjunction with
levodopa in late- stage PD. It is used often in younger clients who are more able to tolerate
daytime drowsiness and postural hypotension
Side/Adverse Effects: Nursing Interventions and Client Education
Dopaminergics: levodopa- usually dose dependant
- N&V, drowsiness
o Administer in small doses at the start of treatment and with food
- Dyskinesias (e.g.), head bobbing, tics, grimacing, tremors)
o Decrease dosage of medication, but the decrease may result in resumption of PD
symptoms
- Orthostatic hypotension
o Monitor the clients b/p
o Instruct the client about signs of postural hypotension
- Cardiovascular effects from beta1 stimulation (e.g., tachycardia, palpitations, irregular
heartbeat)
o Monitor the clients vital signs
o Use cautiously in clients with cardiovascular disorders
o Monitor ECG
- Psychosis (e.g., visual hallucinations, nightmares)
o Administer antipsychotic medications such as clozapine (Clozaril) if symptoms occur.
- Discoloration of sweat and urine
o Advise the client that this is a harmless side effect
- Activation of malignant melanoma
o Avoid use of medication in clients with skin lesions that have not been diagnosed
Dopaminergics: levodopa
Proteins interfere with levodopa absorption and transport across the blood-brain barrier. High
protein meal decrease therapeutic effects.
o Proteins trigger an off episode
o Advise the client to eat protein in several portions during the day
Conventional-antipsychotic agents (e.g., chlorpromazine [Compazine], haloperidol [Haldol]
decrease therapeutic effects.
o Avoid use with levodopa
o To treat levodopa-induced psychosis, use the atypical antipsychotic clozapine (Clozaril)
Cholinesterase Inhibitors
Prototype Medication: Neostigime (Prostigmin)
Action: Prevent the enzyme cholinesterase (ChE) from inactivating acetylcholine (Ach), thereby
increasing the amount of Ach available at receptor sites. Transmission of nerve impulses is increased
at all sites responding to Ach as a transmitter.
Therapeutic Uses:
- Neostigmine (Prostigmin) increase muscle strength by increasing Ach effects at motor neurons
in myasthenia gravis
- Neostigmine causes reversal of nondepolarizing neuromuscular blocking agents (tubocurarine)
following surgery
Side/Adverse Effects:
- Excessive muscarine stimulation as evidenced by increased GI motility, increased GI
secretions, bradycardia, and urinary urgency
o Side effects may be treated with atropine
- Cholinergic crisis excessive muscarnic stimulation and respiratory depression from
neuromuscular blockade
o Muscarinic effects can be treated with atropine
o Provide respiratory support through mechanical ventilation and oxygen
Contraindications/Precautions
- Pregnancy Risk Category C
- Contraindicated in clients with obstruction of GI and GU system
- Use cautiously in clients with seizure disorders, hyperthyroidism, peptic ulcer disease, asthma,
bradycardia, and hypotension.
Medication/Food Interactions
Atropine-counteracts the effects of neostigmine
- Used to treat neostigmine toxicity
- Monitor the client closely and provide mechanical ventilation until the client has regained full
muscle function
Turocurarine:
- Neostigmine reverses neuromuscular blockade after surgical procedures and overdose.
Monitor the client for return of respiratory function. Support respiratory function as necessary.
If used to treat overdose, provide mechanical ventilation until the client has regained full
muscle function
Succinylcholine: increase blockade
- Avoid concurrent use
Drugs for Epilepsy (Antiepileptics) AEDs
Select Prototype Medications:
Barbiturates: Phenobarbital (Luminal)
Hydantoins: phenytoin (Dilantin)
Benzodiazepines: diazepam (Valium)
Lorazepam (Ativan)
Carbamazepine (Tegretol)
Ethosuximide (Zarontin)
Valproic acid (Depakote)
Gabapentin (Neurontin)
Action: AEDs control seizure disorders by various mechanism, which include
- Slowing the entrance of sodium and calcium back into the neuron and, thus extending the time
it takes for the nerve to return to its active state
- Suppressing neuronal firing, which decreases seizure activity and prevents propagation of
seizure activity into other areas of the brain
- Potentiating the inhibitory effects of gamma butyric acid (GABA) and thereby suppressing
seizure activity.
Therapeutic Uses
- Treatment of generalized seizures
o Tonic clonic ( Grand mal)
o Absence seizures (Petit mal)
o Atonic seizures
o Myoclonic seizures
o Status epilepticus
o Febrile seizures
- Treatment of partial seizures
o Simple partial
o Complex partial
- Complete eradication of seizure activity
Medications/ Therapeutic Uses
Phenobarbital (Luminal)
- Used for partial seizures and generalized tonic-clonic seizures
- Not effective against absence seizures
Phenytoin (Dilantin)
- Is effective against all major forms of epilepsy except absence seizures
- Use IV route for status epilepticus
- Antidysrhythmic
Carbamazepine (Tegretol)
- Used for the treatment of partial (simple and complex) seizures, tonic-clonic seizures, bipolar
disorder and trigeminal and glossopharyngeal neuralgias
Ethosuximide (Zarontin)
- Only indicated for absence seizures
Ethosuximide (Zarontin)
- Gastrointestinal effects N&V
- CNS effects
Valproic acid (Depakote)
- Gastrointestinal effects
- Hepatoxicity (e.g., anorexia, abdominal pain, jaundice)
o Medication should be prescribed in lowest effective dose
- Pancreatits as evidenced by nausea, vomiting, and abdominal pain
o Monitor amylase level
o Medication should be discontinued if pancreatitis develops
- Thrombocytopenia
o Monitor platelet count
o Advise client to observe for signs of bruising
Gabapentin (Neurotin)
- CNS effects
- Respiratory depression
o Monitor clients vital signs
o Have resuscitation equipment ready
o Administer oxygen\
- Anterograde amnesia
o Monitor clients memory loss
- Teratogenic (e.g., cleft palate, heart defects)
Contraindication/Precautions
Barbiturates- contraindicated in clients with intermittent porphyria
Phenytoin contraindicated in clients with sinus bradycardia, sinoatrial blocks, second- and third degree
AV block, or stokes-Adam syndrome
Carbamazepine- contraindicated in clients with bone marrow suppression or with bleeding disorders
Valproic Acid- contraindicated in clients with liver disorders.
Medication/Food interactions
Phenytoin (Dilantin)
- Oral contraceptives, warfarin (Coumadin), and glucocorticoids- phenytoin causes a
decrease effects of these medications due to the stimulation of hepatic drug-metabolizing
enzymes
o Advise the client to increase dose of oral contraceptives
- Alcohol, diazepam (valium), cimetidine (tagamet), and valproic acid increase phenytoin
levels.
- Carbamazepine (Tegretol), Phenobarbital, and chronic alcohol use decrease phenytoin
levels.
- CNS depressants (e.g., barbiturates, alcohol)
o Additive CNS depressant effects can occur with concurrent use
Carbamazepine (Tergretol)
- Oral contraceptives and warfarin (Coumadin) carbamazepine causes decrease in the
effects of these medications due to stimulation of hepatic drug-metabolizing enzymes
- Grapefruit juice inhibits metabolism, and thus increase carbamazepine levels
- Phenytoin and phenobarbital- decrease the effects of carbamazepine
Valproic acid (Depakote)
Phenytoin and Phenobarbital concurrent use with valproic acid increase the levels of these
medications
Side effects:
GI effects such as bleeding, hemorrhagic stoke
Interactions:
Nsaids, heparin, warfarin
Local Anesthetics
Ester-type Local anesthetics: procaine (Novocain)
Amide-type Local anesthetics: lidocaine (Xylocaine)
Action:
Decrease pain by blocking conduction of pain impulses in a circumscribed area. Loss of consciousness
does not occur
Use:
Dental procedures
Minor surgical procedures
Labor and delivery
Diagnostic procedures
Side effects:
CNS excitation (seizures, followed by resp. depression, leading to unconsciousness), Hypotensiins,
cardio suppression aeb bradycardia, heart block, and cardiac arrest, allergic rxns, spinal headache and
urinary retention
General Anesthetics
Inhalation Anesthetics: halothane (Fluothane)
Action:
Produces loss of consciousness, loss of all sensations, relaxation of muscles, and memory loss
Uses:
Anesthesia for surgery
Diagnostic procedures
Cardiological procedures
Relief of pain
Muscle relaxation
Side effects:
Hypotension, respiratory and cardiac depression, malignant hyperthermia, hepatotoxicity
Interactions: CNS depressants (barbiturates, benzodiazepines, alcohol), CNS stimulants
(amphetamines, cocaine), Opioid analgesics (morphine), succinylcholine
Intravenous Anesthetics: thiopental (Pentothal)
Action:
Produce loss of consciousness and elimination of response to painful stimuli
Uses:
Adjunct to inhalation anesthetics
Induction and maintenance of anesthesia
Amnesia
Side effects:
Respiratory and cardiovascular depression (hypotension)
Interactions:
CNS depressants (barbiturates, benzodiazepines, alcohol), CNS stimulants (amphetamines, cocaine),
Opioid analgesics (morphine),
Opioid (narcotic) Analgesics and Antagonists
Pure Opioid Agonists: Morphine sulfate
Action:
Act on mu receptors and to lesser degree on kappa receptors. Activation of mu receptors produces
analgesia, respiratory depression, euphoria, and sedation.
Uses:
Relief of moderate to sever pain
Sedation
Reduction of bowel motility
Side effects:
Respiratory depression, constipation, orthostatic hypotension, urinary retention, coughs suppression,
sedation
Interactions:
CNS depressants (barbiturates, benzodiazepines, Phenobarbital, alcohol), anticholinergic agents
(antihistamines and tricyclic depressants, MAIOs, antihypertensive
Agonist-Antagonist Opioid: pentazocine (Talwin)
Action:
Compared to pure opioid agonists, these have a low potential for abuse causing little euphoria and less
respiratory depression
Uses:
Relieve mild to moderate pain, not severe pain
Side effects:
Abstinence syndrome (cramping, hypertension, vomiting)
Pure Opiod Antagonists: naloxone (Narcan)
Action:
Interfere with the action of opioids by competing for opioid receptors. Opioid antagonists have no
effect in the absence of opioids.
Uses:
Treatment of opioid overdose
Side effects:
Tachycardia and tachypnea, abstinence syndrome (cramping, hypertension, vomiting)
Antipsychotic drugs
Traditional antipsychotic: chlorpromazine (Thorazine), haloperidol (Haldol)
Actions:
Dopamine, acetylcholine, histamines, and norepinephrine receptors in the brain and periphery are
blocked.
Uses:
Schizophrenia
Bipolar disorders
Tourettes syndrome
Delusional disorders
Schizoaffective disorder
Dementia and other organic mental syndromes
Huntingtons chorea
Side effects:
Early extrapyramidal symptoms: acute dystonia (severe spasms of the tongue, neck, face, and back),
parkinsonism tremors, akathisia (inability to stand still or sit). Late extrapyramidal symptoms: (tardive
dyskinesia). Neuroleptic malignant syndrome ( sudden high grade fever, blood pressure fluctuations,
dysrhythmias), anticholinergic effects.
Interactions:
Anticholinergic agents, CNS depressants (barbiturates, benzodiazepines, Phenobarbital, alcohol),
Levodopa
Atypical Antipsychotics: clozapine (Clozaril)
Action:
Block serotonin and dopamine receptors
Uses:
Severe schizophrenia
Psychosis induced by levodopa therapy
Side effects:
Agranulocytosis, seizures, new onset diabetes, weight gain, inflammation of the heart muscles
Interactions:
Immunosuppressive medications
Antidepressants:
Tyicyclic Antidepressants: imipramine (Tofranil)
Action:
Block reuptake of norepinephrine and serotonin
Uses:
Depression
Bipolar disorders
Side effects:
Orthostatic hypotension, anticholinergic effects, cardiac toxicity, sedation
Interactions:
MAOIs, antihistamines, epinephrine, ephedrine, alcohol, benzodiazepines, opioids
Selective Serotonin Reuptake Inhibitors: fluoxetine (Prozac)
Action:
Block reuptake of serotonin
Uses:
Major depression
OCD
Bulimia nervosa
PMDD
Panic disorders
PTSD
Side effects:
Sexual dysfunction, weight gain, serotonin syndrome (mental confusion, agitation, anxiety),
withdrawal syndrome, hyponatremia, rash
Interactions:
MAIOs, Coumadin, tricyclic antidepressnats and lithium, NSAIDs and anticoagulants
Monoamine Oxidase Inhibitors: phenelzine (Nardil)
Action:
Block MAO-A in the brain thereby increasing the amount of norepinephrine and serotonin available
for transmission
Uses:
Atypical depression
Bulimia nervosa
OCD
Side effects:
CNS stimulation, orthostatic hypotension, hypertensive crisis
Interactions:
Ephedrine, amphetamine, tricylic antidepressants, SSRIs antihypertensices, Demerol, Tyramine rich
foods
Atypical Antidepressants: bupropion HCL (Wellbutrin)
Action:
Inhibit dopamine uptake
Uses:
Treatment of depression
Aid to quit smoking
Side effects:
Headache, dry mouth, constipation, increase heart rate, nausea, restlessness, weight loss, seizures
Interactions:
MAOIs
Drugs for Bipolar Disorder
Lithium carbonate, carbamazepine (Tegrertol), valproic acid (Depakote)
Action:
Produces neurochemical changes in the brain including serotonin receptor blockade
Uses:
Treatment of bipolar (they control episodes of acute mania, and help to prevent the return of
mania or depression)
Alcoholism
Bulimia
Schizophrenia
Side effects:
GI effects, tremors, polyuria, renal toxicity, goiter and hypothyroidism, teratogenesis
Interactions:
Diuretics, NSAIDs, anticholinergics
CLASS: Adrenergic Agonists
PRO: epinephrine and dopamine (catecholamine)
ACTION: vasoconstriction (up BP), bronchodialation, increase heart rate
SE: hypertensive crisis, dysrythmias
CONTRA: tachydysrhythmia and ventricular fibrillation
IINTERACT: MAOIS and general anesthetics
INTERVENTIONS: IV only and ECG monitoring
CLASS: Alpha Adrenergic Blockers
PRO: prazosin (minipress)
ACTION: dilate arteries and veins
USES: hypertension
SE: orthostatic hypertension (first dose at night, change position slow)
INTERACT: antihypertensive meds (hypotension), NSAIDS counteract the effects
INTERVENTIONS: take with food and first dose at night
CLASS: centrally acting alpha2 agonist
PRO: clonidine (catapres)
ACTION: lower sympathetic outflow, lower nowepinephrine, lower BP
USE: hypertension
SE: drowsiness (will diminish), dry mouth (resolves in 2-4 wks)
INTERACT: antihypertensive meds (hypotension), prazosin (counteract effects), alcohol
INTERVENTIONS: take large dose at night to lower drowsiness, transdermal patches
changed every 7d
CLASS: beta adrenergic blockers (beta blockers)
PRO: metoprolol (lopressor), propranolol (inderal)
ACTION: lower HR, lower myocardial contractility, lower conduction through AV node
USE: angina pectoris, hypertension, dysrythmias, MI, heart failure
SE: bradycardia, lower cardiac output (1-3 months for beneficial effects),
bronchoconstriction (avoid
asthma pt)
INTERACT: pt with AV block and sinus bradycardia, calcium channel blockers (intensifies),
insulin
INTERVENTIONS: avoid sudden position changes
INTERVENTIONS: angina attack 1) take rapid-acting 2) wait 5 min 3) can take 2 more
doses at 5 min intervals if unrelieved
CLASS: cardiac glycosides
PRO: digoxin
ACTION: increase force of contraction, decrease HR
USE: heart failure, dysrhythmias (A Fib)
SE: dysrhythmias if toxic
INTERACT: thiazide diuretics, ACE and ARB, dopamine
INTERVENTIONS: take same time daily, avoid OTC drugs, do not take potassium-sparing
diuretics, treat dysryhthmias with lidocaine, trear bradycardia with atropine
CLASS: antidysrythmic meds
PRO: Sodium Channel Blockers 1A (procainamide)
ACTION: decrease electrical conduction, decrease rate of repolorization
USE: Afib, Aflutter
SE: lupus, cardiotoxicity
INTERACT: antichollinergics
PRO: Sodium Channel Blockers 1B (lidocaine)
ACTION: decrease electrical conduction, increase rate of repolorization
USE: short term dysrhythmias
SE: CNS effects, resp. arrest
INTERACT: cimetidine, beta blockers phenytoin
INTERVENTIONS: do not crush
INTERVENTIONS: never administer with epinephrine, administrations is usually loading
dose followed by maintenance dose of 1-4 mg
CLASS: statins
PRO: Lipitor, lovastatin
ACTION: increase LDL receptors to remove greater amt of LDL, increase HDL
USES: hypercholesterolemia
SE: hepatotoxicity (up in serum tranaminase), myopathy
CONTRA: pregnancy
INTERACT: fibrates (up myopathy), grapefruit juice
INTERVENTION: lovastatin take with evening meal, increase med dose if taking
erythromycin
CLASS: bile-acid sequestrants
PRO: cholestyramine (questran)
ACTION: increase LDL receptors to remove more LDL
USES: use adjunct with HMG CoA reductase inhibitors (atorvastatin)
SE: so systemic effects, constipation
INTERACT: digoxin, warfarin, thiazide (all interfere with absorption)
INTERVENTION: take other med 1hr before or 4hr after
CLASS: loop diuretics
PRO: furosemide (lasix)
ACTION: block reabsorption of Na, Cl, and H2O in loop of henle
USE: pulmonary edema, conditions not responsive to other diuretics, renal impairment
LAXATIVES
Surfactants Docusate Sodium [Colace]
Action: lower surface tension of the stool to allow penetration of H20
Therapeutic Use: short term use r/t pregnancy or opoid use. To relieve
painful elimination (hemorrhoids)., prevent straining, decrease risk of fetal
impaction of immobile, promote peristalsis due to aging
*other info below
Stimulant Laxatives Bisacodyl [dulcolax]
Action: stimulate intestinal peristalsis-act on the colon by reducing water
and electrolyte absorption and increasing the secretion of water and ions
into the intestine.
Therapeutic Use: prior to surgery, short term treatment caused by high
opoid use.
Sides/Adverse Effects: discourage clients from using suppositories on a
regular basis as it may cause burning and can lead to proctitis.
*other below
Osmotic Laxatives-magnesium hydroxide [Milk of Mag]
Action: Osmotic lax draw H2O into the mass of stool stretching
musculature and stimulating peristalsis
Therapeutic Use: used in clients to prevent painful elimination, prep for
surgery of diagnostic test, evacuate bowel after ingestion of poison or
antihelminthic to rid body of dead parasites.
Sides/Adverse Effects: Can lead to accumulation of toxic level of Mg
(avoid in folks with renal dysfunction). Osmotics can also cause
dehydration.
Anitemetics
Serotonin Antagonists Ondansetron [Zofran]
Action: blocks serotonin receptors in the chemoreceptor trigger zone (CTZ)
and antagonizing the serotonin receptors on the afferent vagal neurons that
travel from the upper GI tract to CTZ
Therapeutic Use: Sides/Adverse Effects: prevents emesis related to
chemo, radiation therapy and postoperative recovery
Sides/Adverse: Headache, diarrhea, dizziness
*see below
Dopamine Antagonists Prochlorperazine [Compazine]
Action: Anitemetic effects result from blockade of dopamine receptors in
the CTZ.
Therapeutic Use: prevents emesis r/t chemo, opoid and postoperative
recovery
Sides/Adverse Effects: EPS Extrapyramidal symptoms i.e. restlessness,
anxiety, spasms of the neck and facetreat with an anticholinergic like
benadryl
*See below
Cannabinoids; dronabinol [Marinol]
Action: unknown
Therapeutic Use: Control vomiting and nausea(CINV) in chemo
Sides/Adverse Effects: Potential for dissociation, dysphoria
Contraindications/Precautions: avoid using in clients with mental health
disorders
* See Below
Prototype mineralocorticoid
Key function treats addisons disease, primary hypoaldosteronism, and
congenital adrenal hyperplasia. (In most cases used with glucocorticoid)
Adverse Effects When dosage is too high, salt and water are retained in excess,
while excessive amounts of potassium are lost. Expansion of blood volume,
hypertension, edema, cardiac enlargement, hypokalemia.
Intervention monitor weight gain, elevation of b/p, and hypokalemia.
Womens Health
Estrogen (ATI pg 488-490)
Prototype Conjugated equine estrogens (Premarin)
Estradiol (Estrace)
Action: estrogens are hormones needed for growth and maturation of the female
reproductive tract and secondary sex characteristics. Estrogens block bone resorption
and reduce low density lipoprotein levels. At high levels, estrogens suppress the release
of follicle stimulating hormone needed for conception.
Uses: contraception, relief of potmenopausal symptoms (hot flashes, mood
changes), prevention of postmenopausal osteoporosis, treatment of dysfunctional
uterine bleeding and endometriosis, treatment of prostate cancer.
Side Effects: Endometrail and ovarian cancers occur when prolonged estrogen is
the only potmenopausal therapy, potential risk for estrogen-dependent breast cancer,
embolic events, impotence, and decrease libido in males
Nursing interventions: Give the client progestins alson with estrogen, instruct
the client to report persistent vaginal bleeding, encourage regular self-breast exams and
mammograms, discourage smoking, monitor pain, swelling, warmth of legs for emboli
(make sure pt takes the med at the same time each day)
Interaction: estrogens can decrease the effectiveness of warfarin. (monitor INR)
Use of phenytoin with estrogen can increase the risk of toxicity (monitor signs of
toxicity)
Contraceptive Agents (ATI pg 493-494)
Combination Oral Contraceptives
Ethinyl Estradiol/norethindrone
Progestin-Only Oral Contraceptives
Norethindrone
Long-Acting Contraceptives
Subdermal progestin implant (Norplant)
Depot medroxyprogesterone acetate
Drugs for Emergency Contraception
Leveonorgestrel alone
Ethinyl estradiol/levonorgestrel (the Yuzpe Regimen)
PROTOTYPE: OVCON 35 (Necon 1/35, ortho-novum)
Action: Oral contraceptives decrease fertility by inhibiting ovulation, thickening
cervical mucus, and making the lining of the endometrium less favorable for
implantation.
Uses: Oral contraceptives are used to prevent pregnancy.
Side Effects: Thromboembolic events, hypertension, breakthrough or abnormal
uterine bleeding, cervical cancer
Androgens
Prototype Testosterone enanthate (Delatestryl)
Action: Androgens are a hormone needed for growth and maturation of male sex
organs and secondary sex characteristics. This hormone promotes skeletal muscle
growth in sexually mature males.
Uses: Androgens are used for treatment of hypogonadism in androgen deficient
men, treat delayed puberty, treat androgen-responsive breast cancer.
Side Effects: Hepatotoxicity, Cardiovascular risk high LDL, lower HDL, edema,
virilism effects, males- acne, facial hair, gynecomastia, impotence, priapism, femalesdeeper voice, unusual hair growth, clitoral enlargement, menstrual irreg, acne.
Hyercalcemia
Nursing interventions: Liver function test, check cholesterol levels, edema, low
sodium diet, hypercalcemia
Interactions: Warfarin, oral hypoglycemic, and glucocorticoids-androgen effects
on metabolism can increase med levels of these meds. Heaptotoxic drugs can increase
the risk of liver damage. (monitor INR, signs of bleeding, infection, liver function)
***Instruct pt to report weight fain of more than 2 pounds in a week.
Drugs for Erectile Dysfunction
Prototype sildenafil (Viagra)
Action: augments the effects of nitric oxide released during sexual stimulation
resulting in enhanced blood flow to corpus cavernosum and penile erection.
Uses: treat erectile dysfunction
Side effects: MI, sudden death, priapism
Nursing Interventions: Monitor pt risk factors and history with regard to
cardiovascular health, notify dr if erection lasts more than 4 hr.
**Do not take with Nitroglycerine
Interaction: Organic nitrates (nitroglycerin)-can lead to fatal hypotension,
Ketoconazole, erythromycin, grapefruit juice-inhibit metabolism of sildenafil thereby
increases plasma level of med
**Instruct pt to take 1 hr before sexual activity and limit use to once a day
Drugs for Benign Prostatic Hyperplasia (NOT IN ATI)
Interacts with Phenytoin and levels may need to be adjusted, Avoid alcohol. Take on an empty
stomach.
Drugs for Funal Infections
Pro Drug- Polyene Macrolides (Amphotericin B)
Drug- Azoles (Itraconazole)
Drug- Echinocandins (Caspofungin)
Uses: Used for systemic fungal infections, Azoles are used for superficial fungal infections.
Side Effects: Infusion reactions (pretreat with diphenhydramine), Nephrotoxicty (monitor I&O, BUN),
Hypokalemia
Give 1 Liter of saline on day of amphotericin infusion. Contraindicated in renal failure patients. Avoid
use with antimicrobials such as aminoglycosides.
Viral Infections
Drugs for Cytomegalovirus Infection
Action: prevents the reproduction of viral DNA
Uses:
- medication of choice for herpes simplex virus, varicella zoster virus, and
cytomegalovirus
- Ganciclovir is treatment choice for CMV retinitis in immunocompromised pts with
HIV, and transplant pts at risk for CMV infection
Pro drug: acyclovir (Zovirax)
SE:
- phlebitis and inflammation at site of injection
- Nephrotoxicity
- mild discomfort
Contraindications:
- should be used cautiously in pts with renal impairment, dehydration, and pts taking
nephrotoxic meds
Interventions:
- administer slowly over 1 hr
- ensure adequate hydration during infusion and 2 hr after to minimize nephrotoxicity
Other: Ganciclovir (Cytovene), ribavirin (Rebetol)
SE:
- granulocytopenia and thrombocytopenia
- reproductive toxicity
Contraindications:
- pregnancy
- pts with neutrophils count <500/mm3
Interventions:
- obtain baseline CBC and platelet count and monitor
- if neutrophils count is <500/mm3, stop treatment, cell counts improve within 3-5
days
- advise women to avoid pregnancy during coarse of therapy and for 90 days after end
of therapy
- inform men of risk for sterility
Education:
- use rubber gloves for topical administration to avoid transfer of virus to other parts of
body
- acyclovir diminishes symptoms but does not cure virus
- refrain from sexual activity when lesions are present
- pts with healed lesions should continue to use protection during sexual activity to
prevent transmission of virus
Childhood Immunizations
Hepatitis B: doses given at birth, 1-2 mo, and 6-18 mo
~ SE: local reaction (anorexia, soreness, fatigue), anaphylaxis
~ Contraindicated in pts with a prior history of anaphylactic reaction and/or and allergy to
Bakers yeast
Diptheria and tetanus toxoids and pertussis vaccine (DTaP): doses at 2, 4, 6, 15-18mo, and at 4-6
years
~ SE: encephalopathy (fever, irritability, persistent crying that cant be consoled),
seizures, and/or local reaction at site of injection
~ Contraindicated in children with: severe febrile illness, history of prior anaphylactic
reaction to DTaP, occurrence of encephalopathy 7 days after administration of
DTaP immunization
Tetanus and diphtheria toxoids and pertussis vaccine (Tdap): 11-12 years
Tetanus and diphtheria (Td) booster: every 10 years following DTaP
Haemphilus influenza Type B (Hib): doses at 2, 4, 6, and 12-15 mo
Inactivated poliovirus vaccine (IPV): doses at 2, 4, 6-18mo, and 4-6 years
~ SE: vaccine associated paralytic poliomyelitis and/or local reaction
Measles, Mumps, Rubella vaccine (MMR): doses at 12-15 mo and at 4-6 years
~SE: local reactions (fever, rash, swollen glands), anaphylaxis
~ Contraindicated in:
- pregnant women and children who are allergic to eggs, gelatin, and neomycin
- history of thrombocytopenia
- immunocompromised children
- pts with advanced HIV
- pts who just received blood products or immunoglobulins
Varicella vaccine: single dose at 12-18 mo or 2 doses administered 4 wks apart after age 13
~ SE: varicella like rash
~ Contraindicated for:
- women who are pregnant
- clients with cancer
- pts with history of allergy to neomycin and/or gelatin
- immunocompromised pts
- children with congenital immunodeficiency
- pts taking immunosuppressive meds
Pneumococcal conjugate vaccine (PCV): doses at 2, 4, 6, and 12-15 mo
~SE: mild local reaction, fever
Hepatitis A: 2 doses 6 mo apart after 12 mo
Adult Immunizations
Influenza Vaccine: given one dose annually after age 50 (earlier if specific risk factors such as
chronic disease)
Pneumococcal polysaccharide vaccine (PPV): one dose at age 65, and revaccinated every 6-8 years
after initial vaccination
Meningococcal vaccine: students entering college and living in college dormitories if not
previously immunized
Tetanus diphtheria (Td) booster: every 10 years
Action: Prevent infectious diseases through the production of antibodies that provide
active immunity
Uses: prevention of infectious diseases and their complications
Side effects: local reaction (redness, swelling, pain) at injection site, low grade fever,
risk of systemic allergic reaction (urticaria, anaphylaxis), small risk of GuillainBarre syndrome
Contraindications/precautions:
~ acute febrile illness- dont give until symptoms resolve
~ hypersensitivity to eggs
Nursing Interventions:
~ administer IM deep in the deltoid muscle
~ have emergency meds and equipment on standby in case of the occurrence of an
allergic reaction
Anticancer Drugs
Alkylating Agents
- Nitrogen mustards: cyclophosphamide (Cytoxan, Neosar)
Platinum compounds:
- cisplatin (Platinol AQ)
Antimetabolites
- Folic acid analog: methotrexate (Rheumatrex, Trexall)
- Pyrimidine analog: cytarabine (Cytosar-U)
- Purine analogs: mercaptopurine (Purinethol)
Antitumor Antibiotics:
- doxorubicin (Adriamycin, Rubex)
Mitotic Inhibitors:
- vincristine (Oncovin)
- paclitaxel (Taxol, Onxol)
Topoisoomerase Inhibitors:
- topotecan (Hycamtin)
- irinotecan (Camptosar)
Cytotoxic Medications:
- asparaginase (Elspar)
- hydroxyurea (Hydrea)
- procarbazine (Matulane)
Breast Cancer: antiestrogen:
- tamoxifen (Nolvadex)
Prostate Cancer:
- leuprolide (Lupron)
Progestins:
- megestrol acetate (Megace)
Action: Destroy cancer cells, as well as healthy cells, by preventing the replication of DNA
Uses: Used in the treatment of a variety of cancers
Side Effects:
- Bone marrow suppression
~ monitor CBC
~ assess for bruising and bleeding gums
~ instruct pt to avoid crowds and contact with infectious individuals
- GI discomfort
- Alopecia
~ advise that hair loss will occur 7-10 days after beginning of treatment and will
last for a maximum of 2 mo after last administration of chemo agent
- Muscositis (GI tract)
~ assess for mouth sores
- Reproductive toxicity such as congenital abnormalities, amenorrhea, menopausal
symptoms and atrophy of vaginal epithelium, and sterility in males
~ advise females against becoming pregnant while taking meds
~ advise male clients to consider sperm banking prior to treatment
- Hyperuricemia
~ monitor kidney function, BUN, and creatinine
~ increase fluid intake and monitor I&O
~ administer allopurinol if uric acid level is elevated
Nursing interventions:
- dosage of agents should be individualized