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MODULE 2: NEUROLOGICAL SYSTEM (PART 1)

CENTRAL NERVOUS SYSTEM DEPRESSANTS

DRUG THERAPY FOR SLEEP DISORDERS


■■ Benzodiazepine – temazepam (Restoril)

■■ Non-benzodiazepine – zolpidem (Ambien)

DRUG THERAPY FOR MUSCLE SPASMS


■■ Centrally acting muscle relaxants – baclofen (Lioresal)

■■ Peripherally acting muscle relaxants – dantrolene (Dantrium)

Photosentivity

DRUG THERAPY FOR SEIZURE DISORDERS


■■ Hydantoins – phenytoin (Dilantin)-> skin rash (Steven Johnson syndrome). If oral Hydroxyzine

spension-> u should sake well


■■ Iminostilbenes – carbamazepine (Tegretol)

■■ Valproic acid – valproic acid (Depakote, Depacon, Depakene)

DRUG THERAPY THAT SUPPORTS ANESTHESIA


■■ Local anesthesia – lidocaine (Xylocaine)

■■ General anesthesia/barbiturates – sodium thiopental (Pentothal)

■■ General anesthesia/benzodiazepine – midazolam (Versed)

■■ General anesthesia/opioid – fentanyl (Sublimaze)

Nabulphine: miosis, constipation, urinary urgency

DRUG THERAPY FOR ADHD AND NARCOLEPSY


■■ Amphetamines – amphetamine and dextroamphetamine sulfate (Adderall)

■■ Methylphenidate – methylphenidate (Ritalin, Concerta)

■■ Non-amphetamine – modafinil (Provigil)

DRUG THERAPY FOR PARKINSON’S DISEASE


■■ Dopamine-replacement drugs – levodopa/carbidopa (Sinemet)

■■ Direct-acting dopamine receptor agonists – pramipexole (Mirapex)

■■ Indirect-acting dopamine receptor agonists/MAOs – selegiline (Eldepryl, Zelapar ODT)

DRUG THERAPY FOR ALZHEIMER’S DISEASE


Cholinesterase inhibitors – donepezil (Aricept, Aricept ODT)
NMDA receptor antagonist – memantine (Namenda)
DRUG THAT TREAT MULTIPLE SCLEROSIS
■■ Immunomodulators – Interferon beta-1a (Avonex, Rebif), Interferon beta 1b (Betaseron)

DRUG THAT TREAT MIGRAINE HEADACHES


■■ Serotonin agonists – sumatriptan (Imitrex)

Transdermal: take as needed,, activate 15 min


PSYCHOTHERAPEUTIC DRUGS

DRUG THERAPY FOR ANXIETY DISORDERS


■■ Benzodiazepines – diazepam (Valium), alprazolam (Xanax)-> monitor paradoxical effect:

insomnia and excitation, hypotension, inability to reacall events (amnesia)


■■ Non-benzodiazepines – buspirone

DRUG THERAPY FOR DEPRESSION


■■ Tricyclic antidepressants – amitriptyline- block reutake of nore and serotonin-> risk for

orthostatic hypotension, avoid alcohol, should take at bedtime due to drowsiness and sedation
■■ SSRIs – fluoxetine (Prozac)

■■ SNRIs – venlafaxine

■■ MAOIs – phenelzine (Nardil)

■■ Atypical antidepressants – bupropion HCL (Wellbutrin)

DRUG THERAPY FOR BIPOLAR DISORDER


■■ Lithium (0.8-1.4) – lithium carbonate (Lithobid)-> engage in strenuous exercise, take 7-10 day

to achieve, therapeutic dose 300


SA: muscle weakness
Toxic: hypokalemia: dehydration, diarrhea, sweating, excessive exercise in hot
weather, diuretic use, low sodium diet)
■■ Antiepileptic drugs (AED) – valproic acid (Depakote)

Paroxetine (antidepressant)- SSRI


Valproate, Carbamazepine (anticonvulsants), smooth stabilizer

DRUG THERAPY FOR SCHIZOPHRENIA


■■ Conventional antipsychotics – chlorpromazine, fluphenazine sleepiness should subside within

a week
Anticholinergic effects
Haloperidol EPS
Tardive dyspnea: tongue thrusting and lip smacking, facial grimacing and eye
blinking
Dystonia: repetitive muscular contraction cause twisting of the body
Clozapine
Agranulocytosis
■■ Atypical antipsychotics – risperidone (Risperdal)

AUTONOMIC NERVOUS SYSTEM DRUGS


Drug therapy for glaucoma
■■ Beta adrenergic blocker – betaxolol (Betoptic), timolol (Timoptic)

■■ Cholinergic agonists – pilocarpine (Isopto Carpine)

regular schedule for rest of life


■■ Cholinesterase inhibitors – echothiophate (Phospholine Iodide)

Prostaglandin, latanoprost
DRUG FOR RETINAL DETACHMENT:
Phenylephrine (mydriatic meds) dilate pupil after surgeries

MODULE 3: MUSCULOSKELETAL SYSTEM


DRUG THERAPY FOR RHEUMATOID ARTHRITIS
DMARD I – methotrexate
DMARD II – etanercept (Enbrel)

DRUG THERAPY FOR OSTEOPOROSIS


■■ SERMs – raloxifene (Evista)

■■ Bisphosphonates – alendronate (Fosamax)

■■ Calcitonin – calcitonin-salmon (Miacalcin)

■■ Calcium supplements – calcium citrate (Citracal), calcium carbonate (Tums)

DRUG THERAPY FOR MYASTHENIA GRAVIS


Cholinesterase inhibitors – neostigmine (Prostigmin), pyridostigmine (Mestinon)

DRUGS WITH NEUROMUSCULAR BLOCKING EFFECTS


Neuromuscular blocking agents – succinylcholine (Anectine)

GLUSOSEMINE: suppress joint inflammation and cartilage degradation

MODULE 4: RESPIRATORY SYSTEM


DRUG THERAPY FOR AIRFLOW DISORDERS
Beta2-adrenergic agonists – albuterol (Proventil, Ventolin)
Inhaled anticholinergics – ipratropium (Atrovent, Atrovent HFA): SA: nervousness, tachy,
diziness
Concern if pt develop change in vision
Methylxanthines – theophylline (Theo-24, Theolair, Theochron)
SA: tachy, diarrhea, urinary frequency, insomia
Glucocorticoids
■■ Oral – prednisone

■■ Inhalation – beclomethasone dipropionate (QVAR)

■■ Nasal – beclomethasone (Beconase AQ)

Mast cell stabilizers – cromolyn (Crolom)


Leukotriene modifiers – montelukast (Singulair)

Drug therapy for upper respiratory disorders – allergic rhinitis


H1-receptor antagonists
■■ Sedating antihistamines – diphenhydramine-> cause drowsiness-> give bedtime

For pt with Parkinson’s: decrease tremors


■■ Nonsedating antihistamines – cetirizine (Zyrtec)

Sympathomimetics
■■ Decongestants – phenylephrine (Neo-Synephrine)

DRUG THERAPY FOR UPPER RESPIRATORY DISORDERS – COUGH


Antitussives
■■ Opioid – codeine
Nonopioid – dextromethorphan
■■

suppress urge to cough


Expectorants – guaifenesin (Mucinex)

Stimulant secretions to improve cough products

Mucolytics – acetylcysteine- unsual odor

MODULE 5: THE CARDIOVASCULAR SYSTEM


DRUG THERAPY FOR HYPERTENSION
RAAS Suppressants
■■ ACE inhibitors – captopril (Capoten)

■■ ARBs – losartan (Cozaar)

■■ Aldosterone antagonists – eplerenone (Inspra)

■■ Direct renin inhibitors – aliskiren (Tekturna)

Calcium channel blockers – nifedipine (Adalat, Procardia)


Sympatholytics
■■ Alpha1 adrenergic blockers – doxazosin (Cardura)

■■ Beta adrenergic blockers – atenolol (Tenormin), metoprolol (Lopressor)

■■ Adrenergic neuron blockers – reserpine

■■ Centrally acting alpha2 agonists – clonidine (Catapres)

■■ Alpha/beta blockers – carvedilol (Coreg)

Direct acting vasodilators – hydralazine


DRUG THERAPY FOR HEART FAILURE
Diuretics
■■ Thiazide diuretics – hydrochlorothiazide (HydroDIURIL)

■■ Loop diuretics – furosemide (Lasix)

High ceiling loop diuretic Bumetanide


■■ Potassium-sparing diuretics – spironolactone (Aldactone)

Cardiac glycosides – digoxin (Lanoxin)


Sympathomimetics – dobutamine
Phosphodiesterase inhibitors – milrinone (Primacor)

DRUG THERAPY FOR CORONARY HEART DISEASE


Antilipemic
■■ HMG-CoA reductase inhibitors (statins) – atorvastatin (Lipitor)

■■ Fibrates – gemfibrozil (Lopid)

Antianginals
■■ Nitrates – nitroglycerin (Nitrostat, Nitro-Dur), isosorbide (Isordil)

Headade is SA-> use analsgesic

DRUG THERAPY FOR CARDIAC DYSRHYTHMIAS


Class I/sodium channel blockers
■■ Class IA – quinidine, procainamide
■■ Class IB – lidocaine (Xylocaine)
■■ Class IC – flecainide (Tambocor)
Class II/beta adrenergic blockers – propranolol (Inderal)
Class III/potassium channel blockers – amiodarone (Cordarone)
Class IV/calcium channel blockers – verapamil (Calan)

MODULE 6: THE HEMATOLOGIC SYSTEM


DRUG THERAPY FOR ANEMIA
Iron deficiency anemia – iron freparations – ferrous sulfate (Feosol) taking between meal to increase
absorption, iron dextran (INFeD)
Pernicious anemia – vitamin B12, cyanocobalamin (Nascobal, Cyanoject)
Megaloblastic (macrocytic) anemia – folic acid

DRUG THERAPY FOR BLEEDING DISORDERS


Hemophilia
■■ Factor VIII – plasma-derived (Hemofil-M) or recombinant factor VIII (Advate)

■■ Factor IX – plasma-derived (AlphaNine SD) or recombinant factor IX (BeneFix)

■■ Desmopressin – desmopressin (DDAVP, Stimate)

DRUG THERAPY TO PREVENT AND DISSOLVE THROMBI


Anticoagulants
■■ Factor Xa and thrombin inhibitor – heparin- not dissolve clots, stop new clots from forming,

work immediately
■■ Factor Xa inhibitor – enoxaparin (Lovenox)

■■ Vitamin K inhibitor – warfarin (Coumadin), interact with ginkgo biloba (suppress coagulant

Antiplatelets
■■ Salicylics – aspirin (Ecotrin)

■■ ADP Inhibitors – clopidogrel (Plavix)

Thrombolytics – alteplase (Activase)

DRUG THERAPY THE SUPPORTS HEMATOPOIESIS


Erythropoietic growth factor – epoetin alpha (Epogen, Procrit)
Leukopoietic growth factor – filgrastim (Neupogen)
Thrombopoietic growth factors – oprelvekin (Neumega)

MODULE 7: THE GASTROINTESTINAL SYSTEM


DRUG THERAPY FOR PEPTIC ULCERS
Histamine2-receptor antagonists – ranitidine hydrochloride (Zantac)
Take a night to prevent nocturnal acid.
Proton pump inhibitors – omeprazole (Prilosec)
Mucosal protectant – sucralfate (Carafate), require no water
Antacids – aluminum hydroxide (Amphojel)
Prostaglandin E analog – misoprostol (Cytotec)
Antibiotics – amoxicillin (Amoxil), metronidazole (Flagyl), tetracycline
DRUG THERAPY FOR NAUSEA
Serotonin antagonists – ondansetron (Zofran)
Antihistamines – dimenhydrinate, Hydroxyzine (anxiety, pain relief, control emesis)-> drying secretion
Prokinetic – metoclopramide (Reglan)

DRUG THERAPY FOR CONSTIPATION


Fiber supplements – psyllium (Metamucil)
Stool softeners – docusate sodium (Colace), docusate sodium and senna (Peri-Colace)
Stimulant laxatives – bisacodyl (Dulcolax)

DRUG THERAPY FOR DIARRHEA


Opioids – diphenoxylate and atropine (Lomotil), loperamide (Imodium)
APTROPINE: restore rhythm if it is bradycardia

DRUG THERAPY FOR IRRITABLE BOWEL SYNDROME (IBS)


5-HT3 serotonin receptor blocker – alosetron (Lotronex)
Selective chloride channel activator – lubiprostone (Amitiza)
DRUG THERAPY FOR INFLAMMATORY BOWEL DISEASE
5-aminosalicylates – sulfasalazine (Azulfidine)
Immunosuppressants – azathioprine (Imuran)

MODULE 8: REPRODUCTIVE AND GENITOURINARY SYSTEMS

FEMALE REPRODUCTIVE DRUGS


Estrogen and progesterone hormones
Drug therapy for contraception and premenstrual syndrome (PMS)
Oral contraceptives – ethinyl estradiol and drospirenone (Yasmin)
Drug therapy for menopause
Estrogen HRT
Oral – conjugated equine estrogen (Premarin)
Transdermal – estradiol (Estraderm)
Intravaginal – estradiol (Vagifem, Estrace Vaginal Cream)
Estrogen and progesterone HRT
Oral – conjugated estrogen and medroxyprogesterone acetate (Prempro)
Transdermal – estradiol and norethindrone acetate transdermal system (CombiPatch)
Drug therapy for endometrial hyperplasia and endometriosis
GnRH agonist – leuprolide (Lupron, Lupron Depot)
Progesterone – medroxyprogesterone acetate (Provera)
Drug therapy for infertility
LH and FSH stimulant – clomiphene (Clomid)
Ovulation stimulant – hCG (Pregnyl)
Hyperprolactinemia inhibitor – cabergoline
Drug therapy that induces uterine contractions
Oxytocin – oxytocin (Pitocin)
Ergot alkaloids – methylergonovine (Methergine)
Fundus firm to palpation. SA: increase BP
Synthetic prostaglandin – dinoprostone (Cervidil)
Ripen cervix
Drug therapy to accelerate fetal lung maturity
Betamethasone (Celestone)
Drug therapy to prevent and treat seizures
Magnesium sulfate-> the nurse should now that the women is 1st (respiratory) and then FHR

Drug therapy that stops uterine contractions


Beta2-adrenergic agonists – terbutaline (Brethine): weakened urine, increase FHR,
hyperglycemia, tremor, nervousness, headade. LIFE THREATENING: dyspnea
Male reproductive drugs
Testosterone hormone
Drug therapy for replacement of androgens
Testosterone – testosterone (Androderm, Delatestryl)
Drug therapy for benign prostatic hypertrophy and outflow disorders
5-alpha reductase inhibitor – finasteride (Propecia, Proscar)
Alpha-adrenergic receptor antagonists – tamsulosin (Flomax)
Drug therapy for erectile dysfunction
PDE5 inhibitor – sildenafil (Viagra)
Urinary tract drugs
Drug therapy for urinary incontinence/over-active bladder
Anticholinergics – oxybutynin chloride (Ditropan)
Drug therapy for urinary retention
Cholinergics – bethanechol (Urecholine)

MODULE 9: THE ENDOCRINE SYSTEM

DRUG THERAPY FOR DIABETES MELLITUS


Oral hypoglycemics
■■ Sulfonylureas – glipizine (Glucotrol)

■■ Meglitinides – repaglinide (Prandin)

■■ Biguanides – metformin (Glucophage)

■■ Thiazolidinediones – pioglitazone (Actos)

■■ Alpha-glucosidase inhibitors – acarbose (Precose)

■■ Gliptins – sitagliptin (Januvia)

Injectable hypoglycemics
■■ Insulin – lispro (Humalog), Regular (Humulin R), insulin glargine (Lantus)

NPH (Humulin N) peaks 6-14hr-> eat snake after 8hr to prevent hypoglycemia then
recheck in 15 mins
■■ Amylin mimetics – pramlintide (Symlin)

■■ Incretin mimetics – exenatide (Byetta)

Hyperglycemics – glucagon (GlucaGen)


DRUG THERAPY FOR THYROID DISORDERS
Thyroid replacements – levothyroxine (Synthroid)
Expected: decrease in TSH-> Increase in T4, improve mood
Antithyroid drugs
■■ Propylthiouracil – propylthiouracil (PTU)-> agranulocytosis

■■ Radioactive iodine – iodine-131 (131I, Iodotope)

DRUG THERAPY FOR HYPOTHALAMIC DISORDERS


Growth hormone – somatropin (Genotropin, Nutropin, Humatrope, Serostim)
Antidiuretic hormone – desmopressin (DDAVP, Stimate, Minirin )

DRUG THERAPY FOR ADRENAL DISORDERS


Glucocorticoids – hydrocortisone (Solu-Cortef)
Mineralocorticoids – fludrocortisone (Florinef)

MODULE 10: THE IMMUNE SYSTEM

DRUG THERAPY TO PREVENT DISEASE


Childhood vaccines
Adult and older adult vaccines

DRUG THERAPY FOR CANCER


Cytotoxic drugs
Antimetabolites
☐☐ Folic acid analog – methotrexate

☐☐ Pyrimidine analog – cytarabine (Cytosar-U, DepoCyt)

☐☐ Purine analogs – mercaptopurine (Purinethol)

Alkylating agents
☐☐ Nitrogen mustards – cyclophosphamide

☐☐ Nitrosoureas – carmustine (BiCNU)

Platinum compounds – cisplatin


Antitumor antibiotics
☐☐ Anthracyclines – doxorubicin (Adriamycin, Doxil)

Antimitotics
☐☐ Vinca alkaloid – vincristine

☐☐ Taxanes – paclitaxel (Taxol, Abraxane)

Topoisomerase inhibitors – topotecan (Hycamtin)


Hormonal agents
■■ Gonadotropin-releasing hormone agonists – leuprolide (Lupron, Lupron Depot)

■■ Androgen receptor blockers – flutamide

■■ Estrogen receptor blockers – tamoxifen (Soltamox)

■■ Aromatase inhibitors – anastrozole (Arimidex)

■■ Monoclonal antibody – trastuzumab (Herceptin)

Biologic response modifiers


■■ Interferon – interferon alfa-2a (Roferon-A), interferon alfa-2b (Intron A)

Targeted antineoplastic drugs


■■ BCR-ABL tyrosine kinase inhibitor – imatinib (Gleevec)
DRUG THERAPY FOR HIV
Antiretrovirals
Viral entry blockers
☐☐ Entry and infusion inhibitors – enfuvirtide (Fuzeon)

☐☐ CCR5 antagonist – maraviroc (Selzentry)

Enzyme inhibitors
☐☐ Nucleoside reverse transcriptase inhibitors (NRTIs) – zidovudine (Retrovir)

bone marrow suppression, agranulocytosis, aplastic anemia.


☐☐ Non-nucleoside reverse transcriptase inhibitors (NNRTIs) – delavirdine (Rescriptor)

☐☐ Integrase inhibitor – raltegravir (Isentress)

☐☐ Protease inhibitors (PIs) – ritonavir (Norvir)

MODULE 11: PAIN AND INFLAMMATION


DRUG THERAPY FOR PAIN
“I will call for pain meds before previous dose ears off”-> prevent pain become severe
Nonopioid analgesics
■■ NSAIDs (COX-1 and COX-2 inhibitors) – aspirin, ibuprofen (Advil, Motrin), sustained realease

medications
■■ NSAIDs (COX-2 inhibitor) – celecoxib (Celebrex)

■■ Acetaminophen – acetaminophen (Tylenol) poision: n/v, abdominal distress and sweating

■■ Centrally acting nonopiods – tramadol (Ultram)

Opioid analgesics
■■ Opioid agonists – morphine

■■ Opioid agonist-antagonists – butorphanol, pentazocine (Talwin)

Opioid antagonists – naloxone

DRUG THERAPY FOR INFLAMMATION


Uricosurics (fout) – allopurinol (Zyloprim)
Glucocorticoids – prednisone

MODULE 12: INFECTION


DRUG THERAPY FOR BACTERIAL INFECTIONS
Drugs that interfere with cell wall synthesis
■■ Penicillins – amoxicillin (Amoxil), amoxicillin and clavulanic acid (Augmentin)

■■ Cephalosporins – cephalexin (Keflex)

■■ Monobactams – aztreonam (Azactam)

■■ Carbapenem – imipenem and cilastatin (Primaxin)

■■ Vancomycin – vancomycin (Vancocin)

Antibiotics that inhibit protein synthesis


■■ Tetracyclines – tetracycline

■■ Macrolides – erythromycin-> GI disturbance: small yellow emesis (expected), headache, mild

rash, vaginal yeast infection


■■ Aminoglycosides – gentamicin

Drugs that inhibit DNA replication or cell division


■■ Fluoroquinolones – ciprofloxacin (Cipro)
DRUG THERAPY FOR URINARY TRACT AND OTHER BACTERIAL INFECTIONS
Drugs that inhibit folic acid synthesis
■■ Sulfonamides – trimethoprim and sulfamethoxazole (Bactrim, Septra)

■■ Urinary tract antiseptics – nitrofurantoin (Macrodantin)

DRUG THERAPY FOR TUBERCULOSIS


Antimicobacterials – isoniazid (INH, Nydrazid-IM form), rifampin (Rifadin)

DRUG THERAPY FOR PARASITIC INFECTIONS


Antiparasitics – metronidazole (Flagyl), chloroquine (Aralen)

DRUG THERAPY FOR FUNGAL INFECTIONS


Antifungals
■■ Polyene antibiotics – amphotericin B (Fungizone)

■■ Azoles – ketoconazole

DRUG THERAPY FOR VIRAL INFECTIONS


Antivirals – acyclovir (Zovirax)

DRUG THERAPY FOR GOUT


Colchicine. SA: diarrhea (toxicity), anorexia, muscle pain
Phencyclidine (angel dust) intoxication: hypertension, tachy, seizures, coma-> ad vasodialtors
(nitroprusside), hyperthermia

Cyclobenzaprine to relieve muscle spasm that cause pain of fractures

Pain scale: FLACC (2-7months)


Oucher (3-13 years)
FACES (3 years)
Visual Analog Scale

Metered dose inhaler:


Sake 3-5 s, wait 20-30s between inhalations

Colesevepam for low density lipoprotein level-> take this meds 4hr after other meds

Inhlation Anthrax: Cipro, doxycycline, amoxicillin

Fat overload: elevated temp-> multiple organ damage

Behavior indicate pain: restlessness, grimacing, moaning, clenching

Take out subclavian venous cath-> use Valsalva maneuver by holding breath and bearing down->
prevent air from entering lumen, hear, and pulmonary circulation, flat position or Trendelenburg

IM injection: inject to deltoid if 0.5-1ml, 2in below acrmonion process, 23-25 gauze
IV: dorsal metacarpal vein
Other: cephalic, basilica
Cause pain-> meet the nerve ends-> remove and reinsert
IV fluid volume excess: crackles upon auscultation-> dyspnea
Infiltration: edema at injection site, damp dressing
Phlebitis: erythema, throbbing pain, warmth, streak formation
Venipuncture: antecubital fossa (forearm)

Cath policy: clean perineal twice daily, ONLY IRRIGATE IF OBSTRUCTION, CHANGE IF BLOCKAGE->
check for kinks or twisting to prevent infection
Spina bifida: catherize every 4hr
Change in length = dislodgment, catheter occlusion = diff administer fluids

NG: 15-30ml water after each medication, prior administration, after givng multiple medications

HERBS:
Echianeca boots immunue system, treat fever-> reduce meds treat TB
Ginger treat vertigo and motion sickness
Ginkgo biloba increase ability to walk futher sistance
Saw palmetto blocks testosterone receptors, relieve urinary frequency
Black cohos relieve menopausal symptoms: hot flashes
Feverfew prevent migraine, increase risk for bleeding due to suppress platelet
Valerian promotes sleep
Milk thistle reduces effectiveness of oral contraceptives
Ephedra elevate BP
Comfrey wound healing
Licorice treat GI problems
Chamomile calming agents
Garlic lower cholesterol
Isofamide, antineoplastic stop cancer-> renal failure
Vincristine, antineoplastic-> paresthesia and paralysis
Daunorubin antitumor-> cause edema and dyspnea, cardiomyopathy