ENDOCRINE MEDICATIONS

I. PITUITARY MEDICATIONS A. Description 1. Anterior pituitary gland: Secretes growth hormone (GH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), and gonadotropins (follicle-stimulating hormone, or FSH, and luteinizing hormone, or LH) 2. Posterior pituitary gland: Secretes antidiuretic hormones (ADH, vasopressin) and oxytocin B. Growth hormones and related medications 1. Uses the side effects 2. Implementation a. Assess childs physical growth and compare growth with standards b. Recommend annual bone age determinations for children receiving growth hormones c. Monitor blood and urine glucose levels d. Teach the client and family about the importance of follow-up regarding blood and urine glucose testing
Growth Hormones and Related Medications Use Side effects Somatrem (Protropin) Growth failure Development of antibodies to GH

Somatropin (Humatrope)

Growth failure

Headache, muscle pain, weakness, mild hyperglycemia, allergic reaction (rash, swelling), pain at injection site

Sermorelin (Geref)

Growth failure Diagnose pituitary function

Pain, swelling, redness at injection site; facial flushing, nausea, vomiting, headache, altered taste, chest tightness Nausea, headache, dizziness

Bromocriptine (Parlodel)

Acromegaly

Octreotide (Sandostatin)

Acromegaly

Diarrhea, nausea, increased glucose

abdominal

discomfort,

Medication(s)

II. ANTIDIURETIC HORMONES A. Description 1. Enhance reabsorption of water in the kidneys by the distal renal tubules, promoting an antidiuretic effect and regulating fluid balance and causes vasoconstriction and increased muscle tone of the bladder, GI tract, uterus, and blood vessels 2. Used in diabetes insipidus 3. Available in parenteral (IM, SC) or nasal preparation B. Antidiuretic hormones  Desmopressin acetate (DDAVP, Stimate)  Lypressin (Diapid)  Vasopressin (Pitressin) C. Side effects 1. Flushing 2. Headache 3. Nausea and abdominal cramps 4. Water intoxication 5. Hypertension with water intoxication 6. Nasal congestion with nasal administration D. Implementation 1. Monitor weight 2. Monitor intake and output (I & O) and urine osmolality 3. Monitor electrolytes 4. Restrict fluid intake as prescribed to prevent water intoxication 5. Monitor for signs of water intoxication, such as drowsiness, listlessness, and headache 6. Instruct the client in how to use the intranasal medication
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Instruct the client to report signs of water intoxication or symptoms of headache or shortness of breath

III. THYROID HORMONES (Thyroid enhancers) A. Description 1. Control the metabolic rate of tissues and accelerate heat production and oxygen consumption 2. To replace hormonal deficit in the treatment of hypothyroidism, myxedema, or cretinism 3. Enhance the action of oral anticoagulants, sympathomimetics, and antidepressants, and decrease the action of insulin, oral hypoglycemics, and digitalis preparations 4. Available in oral and parenteral (IV) preparations 5. Phenytoin (Dilantin) and aspirin can enhance the action of thyroid hormone B. Thyroid hormones  Levothyroxine (Synthroid, Levothyroid, Levoxyl)  Liothyronine (Cytomel)  Liotrix (Thyrolar)  Thyroglobulin (Proloid)  Thyroid (Thyrar) C. Side effects 1. Nausea and vomiting 2. Cramps and diarrhea 3. Weight loss 4. Nervousness and tremors 5. Headache 6. Hypertension 7. Tachycardia and dysrhythmias 8. Sweating and heat intolerance
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9. Insomnia 10. Toxicity: Hyperthyroidism Implementation 1. Assess client for history of medications currently being taken 2. Monitor vital signs 3. Monitor weight 4. Monitor triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels 5. Instruct the client to take the medication at the same time each day, preferably in the morning without food 6. Instruct the client in how to monitor pulse rate 7. Advise the client to report symptoms of hyperthyroidism, such as tachycardia, chest pain, palpitations, and excessive sweating 8. Instruct the client to avoid foods that can inhibit thyroid secretion, such as strawberries, peaches, pears, cabbage, turnips, spinach, kale, Brussels sprouts, cauliflowers, radishes, and peas 9. Advise the client to avoid over-the-counter medications 10. Instruct the client to wear a Medic-Alert bracelet ANTITHYROID MEDICATIONS (Thyroid inhibitors) Description 1. Inhibit the synthesis of thyroid hormone 2. Used for hyperthyroidism, or Graves disease 3. Available in oral and parenteral (IV) preparations Antithyroid medications  Iodine solution (Lugol solution, potassium iodide solution)  Methimazole (Tapazole)  Propylthiouracil (PTU) Side effects 1. Nausea and vomiting 2. Diarrhea 3. Hypersensitivity 4. Agranulocytosis 5. Iodine: bitter taste, stains teeth (local oral effect on mucosa and teeth) 6. Toxicity: Hypothyroidism 7. Iodism: Characterize by vomiting, abdominal pain, metallic taste in the mouth, rash, and sore salivary glands Implementation 1. Monitor vital signs 2. Monitor T3, T4, and TSH levels 3. Monitor weight 4. Instruct the client to take medication with meals to avoid gastrointestinal (GI) upset 5. Instruct the client in how to monitor the pulse rate 6. Inform the client of side effects and when to notify the physician 7. Advise the client to contact the physician if a fever or sore throat develops 8. Instruct the client in the signs of hypothyroidism 9. Instruct the client regarding the importance of medication compliance and that abruptly stopping the medication could cause thyroid crisis (thyroid storm) 10. Instruct the client to monitor for signs and symptoms of thyroid crisis (fever, flushed skin, confusion and behavioral changes, tachycardia, dysrhythmias, and signs of heart failure)

11. Instruct the client to monitor for signs of Iodism 12. Advise the client to consult physician before eating iodized salt and iodine-rich foods 13. Instruct the client to avoid acetylsalicylic acid (aspirin) and medications containing iodine V. PARATHYROID MEDICATIONS A. Description 1. Parathyroid hormone regulates serum calcium levels 2. Low serum levels of calcium stimulate parathyroid hormone release 3. Hyperparathyroidism results in a high serum calcium level and bone demineralization, and medication is used to lower the serum calcium level 4. Hypoparathyroidism results in a low serum calcium level, which increases neuromuscular excitability, and the treatment includes calcium and vitamin D supplements 5. Parathyroid and antihypercalcemic agents may cause hypermagnesemia 6. Calcium salts and administered with digoxin (Lanoxin) increases the risk of digoxin toxicity 7. Oral calcium salts reduce the absorption of tetracycline hydrochloride B. Medications to Treat Calcium Disorders 1. Calcium supplements a. Calcium carbonate (BioCal, Caltrate 600, Rolaids, Tums) b. Calcium carbonate, oyster-shell delivered (OsCal 500, Oysco, Oyst-Cal) c. Calcium citrate (Citracal) d. Calcium glubionate (Calcionate, Neo-Calglucon) e. Calcium gluconate f. Dibasic calcium phosphate g. Tribasic calcium phosphate (Posture) 2. Vitamin D supplements a. Calcifediol (Calderol) b. Calcitriol (Calcijex, Rocaltrol) c. Dihydrotachysterol (Calciferol, Drisdol) 3. Calcium regulators a. Alendronate (Fosamax) b. Calcitonin human (Cibacalcin) c. Calcitonin salmon (Calcimar, Miacalcin) d. Etidronate (Didronel) e. Pamidronate (Aredia) f. Risedronate (Actonel) g. Tiludronate (Skelid) 4. Antihypercalcemics a. Edetate disodium (Disotate, Endrate) b. Gallium nitrate (Ganite) C. Implementation 1. Monitor electrolyte and calcium levels 2. Assess for signs and symptoms of hypocalcemia and hypercalcemia 3. Assess for symptoms of tetany in the client with hypocalcemia 4. Instruct the client in the signs and symptoms of hypercalcemia and hypocalcemia 5. Instruct the client to check over-the-counter medication labels for the possibility of calcium content
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Instruct the client receiving oral calcium to maintain an adequate intake of vitamin D enhances absorption of calcium

VI. ADRENOCORTICOTROPIC HORMONES A. Description 1. Stimulate the adrenal cortex to secrete cortisol 2. Produce an anti-inflammatory effect 3. Used to diagnose adrenocortical disorders (See below: Medications Used in Diagnosing Adrenal Gland) 4. Used to treat acute multiple sclerosis 5. Available in oral, parenteral (IM, IV), inhalation, intraarticular, and topical, including ophthalmic preparations B. Medications for Adrenal Replacement Therapy  Betamethasone (Celestone)  Cortisone (Cortone)  Fludrocortisone (Florinef)  Hydrocortisone (Cortef)  Triamcinolone (Aristocort, Kenacort)  Dexamethasone (Decadron)  Methylprednisone (Depo-Medrol, Solu-Medrol)  Prednisolone (Delta-Cortef, Prelone)  Prednisone (Orasone, Deltasone, Meticorten) C. Medications Used in Diagnosing Adrenal Gland  Corticotropin (Acthar)  Corticotropin repository (Acthar gel)  Cosyntropin (Cortrosyn) D. Side effects 1. Nausea and vomiting 2. Increased appetite 3. Mood swings 4. Petechiae 5. Water and sodium retention 6. Hypokalemia 7. Hypocalcemia E. Implementation 1. Monitor vital signs 2. Monitor I & O, weight, and for edema 3. Monitor for signs of infection 4. Monitor electrolyte and calcium level 5. Avoid administering to the client with adrenocortical hyperfunction 6. Instruct the client to decrease salt intake 7. Instruct the client to report side effects such as muscle weakness, edema, petechiae, ecchymoses, decrease in growth, decreased wound healing, and menstrual irregularities 8. Monitor for adverse effects when the medication is discontinued; dose should be tapered and not stopped abruptly, because adrenal hypofunction may result 9. Advise the client to wear Medic-Alert bracelet
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VII. CORTICOSTEROIDS A. Description 1. Produce metabolic effects 2. Alter the normal immune response and suppress inflammation 3. Promote sodium and water retention and potassium excretion 4. Produce anti-inflammatory, antiallergic, and anti-stress effects 5. May be used as a replacement for adrenocortical insufficiency B. Medications for Adrenal Replacement Therapy  Betamethasone (Celestone)  Cortisone (Cortone)  Fludrocortisone (Florinef)  Hydrocortisone (Cortef)  Triamcinolone (Aristocort, Kenacort)  Dexamethasone (Decadron)  Methylprednisone (Depo-Medrol, Solu-Medrol)  Prednisolone (Delta-Cortef, Prelone)  Prednisone (Orasone, Deltasone, Meticorten) C. Side effects 1. Hyperglycemia 2. Hypokalemia 3. Sodium and water retention 4. Edema 5. Cause muscle wasting, osteoporosis, growth retardation in children, peptic ulcer, increased serum glucose levels, hypertension, convulsions, mood swings, cataracts, glaucoma, fragile skin, hirsustism, altered fat distribution 6. Mask the signs and symptoms of infection D. Contraindications and cautions 1. Contraindicated in hypersensitivity, psychosis, and fungal infections 2. Use with caution in diabetes mellitus 3. Dexamethasone (Decadron) decreases the effects of oral anticoagulants and oral antidiabetic agents 4. Increase the potency of medications taken concurrently, such as aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs), thus increasing the risk of GI bleeding and ulceration 5. Use of potassium-wasting diuretics increases potassium loss, resulting in hypokalemia 6. Barbiturates, phenytoin (Dilantin), and rifampin (Rifadin) decrease the effect of prednisone 7. The action of dexamethasone (Decadron) is decreased by the use of phenytoin (Dilantin), theophylline, rifampin (Rifadin), barbiturates, and antacids 8. NSAIDs, aspirin, and estrogen increase the effect of dexamethasone (Decadron) 9. Should be used with extreme caution in clients with infections because they mask the signs and symptoms of infection 10. Advise the client to wear Medic-Alert bracelet E. Implementation 1. Monitor vital signs 2. Monitor serum electrolytes and blood glucose level 3. Monitor for hypokalemia and hyperglycemia 4. Monitor I & O, weight, and for edema 5. Monitor for hypertension
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Assess medical history for glaucoma, cataracts, peptic ulcer, mental health disorders, or diabetes mellitus 7. Monitor the older client for signs and symptoms of increased osteoporosis 8. Assess for change in muscle strength 9. Prepare a schedule for the client on short-term, tapered doses 10. Instruct the client to take at mealtime or with food 11. Advise the client to eat foods high in potassium 12. Instruct the client to avoid individuals with respiratory infections 13. Advise the client to inform all health care providers of taking the medication 14. Instruct the client to report signs and symptoms of a medication overdose or Cushings syndrome, including a moon-face, puffy eyelids, edema in the feet, increase bruising, dizziness, bleeding, and menstrual irregularities 15. Note that the client may need additional doses during periods of stress, such as surgery 16. Instruct the client not to stop medication abruptly, as abrupt withdrawal can result in severe adrenal insufficiency 17. Advise the client to consult with the physician before receiving vaccinations 18. Advise the client to wear Medic-Alert bracelet F. Mineralocorticoids 1. Description a. Steroid hormones that enhance the reabsorption of sodium and chloride and promote the excretion of potassium and hydrogen from the renal tubules, thereby helping to maintain fluid and electrolyte balance b. Used for replacement therapy un primary and secondary adrenal insufficiency in Addisons disease 2. Medication: Fludrocortisone (Florinef) 3. Side effects a. Sodium and water retention b. Hypokalemia c. Hypocalcemia d. Increased susceptibility to infection e. Delayed wound healing f. GI distress g. Diarrhea or constipation h. Increased appetite i. Weight gain j. Insomnia k. Mood swings l. Abdominal distention 4. Implementation a. Monitor vital signs b. Monitor weight c. Monitor electrolytes and calcium levels d. Instruct the client to take medication with food or milk e. Instruct the client to consume a high-potassium diet f. Instruct the client not to stop the medication abruptly g. Instruct the client to notify the physician of signs of infection, muscle aches, sudden weight gain, or headaches occur
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Instruct the client to avoid exposure to disease or trauma Instruct the client not to take aspirin or any other medication without consulting the physician Instruct the client to wear a Medic-Alert bracelet

VIII.ANDROGENS A. Description 1. Used either to replace deficient hormones or to treat hormone-sensitive disorders 2. Can cause bleeding if the client is taking oral anticoagulants (increase the effect of anticoagulants) 3. Cause decreased serum glucose concentration, thereby reducing insulin requirements in the client with diabetes mellitus 4. Hepatotoxic medications are avoided with the use of androgens because of the risk of additive damage to the liver 5. Usually avoided in men with known prostatic or breast carcinoma because androgens often stimulate growth of these tumors B. Androgens  Fluoxymesterone (Android-F, Halotestin)  Methyltestosterone (Android, Testred, Virilon)  Testosterone (Andro, Histerone, Testaqua)  Testosterone (Androderm, Testoderm)  Testosterone (Testopel pellets)  Testosterone cypionate (Andronate, Depotest, Virilon-IM)  Testosterone enanthate (Delatest, Delatestryl, Everone)  Testosterone propionate (Testex) C. Side effects 1. Masculine secondary sexual characteristics (body hair growth, lowered voice, muscle growth) 2. Bladder irritation and urinary tract infections 3. Breast tenderness 4. Gynecomastia 5. Priapism 6. Menstrual irregularities 7. Virilism 8. Edema 9. Nausea, vomiting, or diarrhea 10. Acne 11. Changes in libido 12. Hepatotoxicity D. Implementation 1. Monitor vital signs 2. Monitor for edema, weight gain, and skin changes 3. Assess mental status and neurological function 4. Assess for signs of liver dysfunction, including right upper quadrant abdominal pain, malaise, fever, jaundice, pruritus 5. Assess for the development of secondary sexual characteristics 6. Instruct the client to take with meals or a snack
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Instruct the client to notify the physician if Priapism develops Instruct the client to notify the physician if fluid retention occurs Instruct women to use a nonhormonal contraceptive while on therapy

IX. ESTROGEN AND PROGESTINS A. Description 1. Estrogens are steroids that stimulate female reproductive tissue 2. Progestins are steroids that specifically stimulate the uterine lining 3. Estrogen and progestin preparations may be used to stimulate the endogenous hormones to restore hormonal balance or to treat hormone-sensitive tumors (suppress tumor growth) B. Estrogens  Chlorotrianisene (Tace)  Dienestrol (Dienestrol)  Diethylstilbestrol (DES)  Estradiol (Estrace, Climara, Estraderm, FemPatch, Vivelle)  Estradiol cypionate (Depo-Estradiol)  Estradiol valerate (Delestrogen)  Estrogens, conjugated (Premarin)  Estrogens, esterified (Estratab)  Estrone (Aquest, Estragyn 5)  Estropipate (Ogen Ortho-Est)  Ethinyl Estradiol (Estinyl) C. Progestins  Hydroxyprogesterone (Hylutin)  Levonorgestrel (Norplant)  Medroxyprogesterone (Cycrin, Provera)  Medroxyprogesterone (Depo-Provera)  Medroxyprogesterone and conjugated estrogens (Premphase, Prempro)  Megestrol (Megace)  Norethindrone acetate (Aygestin)  Progesterone (Prometrium)  Progesterone (Gesterol, Crinone, Progestasert) D. Contraindications and cautions 1. Estrogens a. Contraindicated in clients with breast cancer, endometrial hyperplasia, or endometrial cancer b. Increase the risk of toxicity when used with Hepatotoxic medications 2. Progestins: Contraindicated in clients with thromboembolitic disorders, and avoided in clients with breast tumors or hepatic disease E. Side effects 1. Monitor vital signs 2. Monitor for hypertension 3. Assess for edema and weight gain 4. Advise the client not to smoke 5. Advise the client to undergo routine breast and pelvic examinations X. ORAL CONTRACEPTIVES A. Description
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These medications contain combination of estrogen and progestin or a progestin alone Estrogen-progestin combinations suppress ovulation and change the cervical mucus, making it difficult for sperm to enter 3. Medications that contain only progestins are less effective than the combined medications 4. Usually taken for 21 consecutive days and stopped for 7 days, then the administration cycle is repeated 5. Provide reversible prevention of pregnancy 6. Useful in controlling irregular or excessive menstrual cycles 7. Risk factors associated with the development of complications related to the use of oral contraceptives include smoking, obesity, and hypertension 8. Contraindicated in women with hypertension or thrombolytic disease 9. Avoided with the use of Hepatotoxic medications 10. Interfere with the activity of bromocriptine (Parlodel) and anticoagulants and increase the toxicity of tricyclic antidepressants 11. May alter blood glucose levels B. Side effects 1. Breakthrough bleeding 2. Excessive cervical mucus formation 3. Breast tenderness C. Implementation 1. Monitor vital signs and weight 2. Instruct the client in the administration of the medication (it may take up to 1 week for full contraceptive effect to occur when the medication is begun) 3. Instruct the client with diabetes mellitus to monitor blood glucose levels carefully 4. Instruct the client to report signs of thromboembolitic complications 5. Instruct the client to notify the physician if vaginal bleeding or menstrual irregularities occur or if pregnancy is suspected 6. Inform the client that many medications interfere with the effectiveness of birth control pills 7. Instruct the client to perform breast self-examination monthly and about the importance of yearly physical examinations 8. If the client decides to discontinue the oral contraceptive to become pregnant, recommend that the client use an alternative form of birth control for 2 months after discontinuation to ensure more complete excretion of hormonal agents before conception XI. FERTILITY MEDICATIONS A. Description 1. Act to stimulate follicle development and ovulation in functioning ovaries and are combined with human chorionic gonadotropin (HCG) to maintain the follicles once ovulation has occurred 2. Contraindicated in the presence of primary ovarian function, thyroid or adrenal dysfunction, ovarian cysts, pregnancy, or idiopathic uterine bleeding 3. Used with caution in clients with thromboembolitic or respiratory diseases B. Fertility medications  Bromocriptine (Parlodel)  Chorionic gonadotropin (A.P.L., Profasi)  Clomiphene (Clomid)  Follitropin beta (Follistin)  Menotropins (Humegon, Pergonal)
ST. MICHAELS COLLEGE, INC. ILIGAN CITY

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 Urofollitropin (Metrodin, Fertinex) C. Side effects 1. Risk of multiple births and birth defects 2. Ovarian overstimulation (abdominal pain, distention, ascites, pleural effusion) 3. Headache 4. Fluid retention and bloating 5. Nausea 6. Uterine bleeding 7. Ovarian enlargement 8. Gynecomastia 9. Febrile reactions D. Implementation 1. Instruct the client regarding administration of the medication 2. Provide a calendar of treatment days and instructions on when intercourse should occur, to increase therapeutic effectiveness of the medication 3. Provide information about the risks and hazards of multiple births 4. Instruct the client to notify the physician if signs of ovarian stimulation occur 5. Inform the client about the need for regular follow-up for evaluation XII. MEDICATIONS FOR PENILE ERECTION DYSFUNCTION A. Description 1. Alprostadil (Caverject, MUSE) is a prostaglandin that relaxes smooth muscle and promotes blood flow into the corpus cavernosum 2. Sildenafil (Viagara) may be classified as a cardiovascular agent and selectively inhibits receptors and increases nitrous oxide levels, allowing blood into the corpus cavernosum 3. Contraindicated in the presence of any anatomical obstruction or condition that might predispose to Priapism and in clients with penile implants 4. Caution should be used in clients with penile implants 5. Sildenafil (Viagara) is used cautiously in clients with coronary artery disease, active peptic ulcer, or retinitis pigmentosa 6. Sildenafil (Viagara) cannot be administered to clients taking any organic nitrates B. Side effects 1. Alprostadil (Caverject, MUSE): Pain at the injection site, infection, Priapism, fibrosis, rash 2. Sildenafil (Viagara): Headache, flushing, dyspepsia, urinary tract infection, diarrhea, dizziness, rash C. Implementation 1. Perform a thorough assessment of health and medication history 2. Instruct the client regarding administration of the medication; Alprostadil (Caverject, MUSE) is injected, and Sildenafil (Viagara) is taken orally 3. Inform the client of the side effects necessitating the need to notify the physician XIII.MEDICATIONS FOR DIABETES MELLITUS A. Insulin and oral hypoglycemic medications 1. Description a. Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels
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Oral hypoglycemic agents stimulate the pancreas to produce more insulin and increase the sensitivity of peripheral receptors to insulin, thereby decreasing serum glucose levels 2. Contraindications and concerns a. Insulin is contraindicated in clients with hypersensitivity b. Oral hypoglycemic agents are contraindicated in type 1 diabetes mellitus and in individuals allergic to sulfonylureas c. Sulfonylureas can affect cardiac function and oxygen consumption and lead to cardiac dysrhythmias d. Use of hypoglycemic medications with beta-adrenergic blocking agents masks signs and symptoms of hypoglycemia e. Anticoagulants, chloramphenicol (Chloromycetin), clofibrate (Atromid-S), salicylates, propranolol (Inderal), monoamine oxidase inhibitor (MAOIs), pentamidine (pentam-300), and sulfonamides may cause hypoglycemia f. Corticosteroids, sympathomimetics, thiazide diuretics, phenytoin (Dilantin), thyroid preparations, oral contraceptives, and estrogen compounds may cause hyperglycemia g. Side effects of the sulfonylureas include gastrointestinal symptoms and dermatological reactions; hypoglycemia can occur when an excessive dose is administered or when meals are omitted or delayed, food intake is decreased, or activity is increased h. Chlorpropamide (Diabenese) can cause a disulfiram (Antabuse) type of reaction when alcohol is ingested B. Oral hypoglycemic medications 1. Prescribed for clients with type 2 diabetes mellitus 2. Sulfonylureas a. Classified as firs- or second-generation sulfonylureas b. Stimulate the beta cells to produce more insulin c. First-Generation Sulfonylureas: are rarely used  Short-acting y Tolbutamide (Orinase)  Intermediate-acting y Acetohexamide (Dymelor) y Tolazamide (Tolinase)  Long-acting y Chlorpropamide d. Second-generation Sulfonylureas  Glipizide (Glucotrol, Glucotrol XL)  Glyburide (DiaBeta, Micronase, Glynase)  Glimepiride (Amaryl) 3. Nonsulfonylureas a. Affect the hepatic and gastrointestinal production of glucose b. May be used in combination with a sulfonylureas  Biguanide(s): reduce the rate of endogenous glucose production by liver; increase the use of glucose by muscle and fat cells; metformin (Glucophage) y Metformin (Glucophage)  Alpha Glucosidase Inhibitor: block digestion of complex carbohydrates and slow absorption of glucose y Acarbose (Precose)
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y Miglitol (Glyset) Thiozolidinediones: improve insulin sensitivity, thus improving peripheral glucose uptake y Troglitazone (Rezulin) y Pioglitazone (Actos) y Rosiglitazone (Avandia) Meglitinide: stimulate quick release of insulin by beta cells y Rapaglinide (Prandin)

Implementation a. Assess the clients knowledge of diabetes mellitus and the use of oral antidiabetic agents b. Obtain a medication history regarding the medications that the client is currently taking c. Assess vital signs and blood glucose levels d. Instruct the client to recognize symptoms of hypoglycemia and hyperglycemia e. Instruct the client to avoid over-the-counter medications unless prescribed by the physician f. Instruct the client not to ingest alcohol with sulfonylureas g. Inform the client that insulin may be needed during stress, surgery, or infection h. Instruct the client in the necessity of compliance with prescribed medication i. Advise the client to obtain a Medic-Alert bracelet C. Insulin 1. Primarily acts in the liver, muscle, and adipose tissue by attaching to receptors on cellular membranes and facilitating the passage of glucose, potassium, and magnesium 2. Available in three forms: human, beef, and pork; human and purified pork insulins are less antigenic; administered parenterally; brands or forms should not be substituted without medical supervision 3. Available in rapid-acting, intermediate-acting, and long-acting forms; rapid-acting and intermediate-acting forms are available in mixed preparations (e.g., Humulin 70/30, which contains 70% NPH and 30% regular insulin) 4. Prescribed for clients with type 1 diabetes mellitus 5. Storing insulin a. Exposure to extremes in temperature is avoided; insulin should not be frozen or kept in direct sunlight or a hot car b. Before injection, insulin should be at room temperature c. If a vial of insulin will be used up in a month, it may be kept at room temperature; otherwise, the vial should be refrigerated 6. Insulin injection sites a. The main areas for injections  Abdomen  Arms (posterior surface)  Thighs (anterior surface)  Hips

Insulin injected into the abdomen may absorb more evenly and rapidly than at other sites Systemic rotation within one anatomical area is recommended to prevent lipodystrophy; client should be instructed not to use the same site more than once in a 2- to 3-week period d. Injections should be 1.5 inches apart within the anatomical area e. Heat, massage, and exercise of the injected area can increase absorption rates and may result in hypoglycemia f. Injection into scar tissue may delay absorption of insulin 7. Administering insulin a. To prevent dosage errors, be certain that there is a match of the insulin concentration noted on the vial with the calibration of units on the insulin syringe; the usual concentration of insulin is U 100 (100 units per mL) b. Most insulin syringes have a 27- to 29-gauge needle that is approximately 0.5 inch long c. Before use, roll, not shake (to avoid bubbles) the insulin bottle to ensure that the insulin and ingredients are mixed well; otherwise an inaccurate dose will be drawn d. Premixed insulins (NPH to regular insulin) are available as 70/30 (most commonly used), 80/20, 60/40, 50/50 e. A 3-week supply of insulin may be prepared and kept in the refrigerator; prefilled syringes should be kept flat or with the needle in an upright position to avoid clogging of the needle f. Inject air into the insulin bottle (a vacuum makes it difficult to draw up the insulin) g. It is recommended to draw up the Regular (shorter-acting) insulin first h. Regular insulin may be mixed with any other type insulin i. Insulin zinc suspensions may be mixed only with each other and Regular insulin, not with other types of insulin j. Administer a mixed dose of insulin within 5 to 15 minutes of preparation; after this time the Regular insulin binds with the NPH insulin and its action is reduced k. Aspiration is generally not recommended with self-injection l. Administer insulin at a 45- to 90-degree angle and at a 45- to 60-degree angle in thin persons m. REMEMBER: Regular insulin is the only type of insulin that can be administered by IV D. Glucagon 1. A hormone secreted by the alpha cells of the islets of Langerhans in the pancreas 2. Increases blood glucose by stimulating glycogenolysis in the liver
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Can be administered by SC, IM, or IV routes Used to treat insulin-induced hypoglycemia when the client is semiconscious and is unable to ingest liquids 5. The blood glucose level begins to increase within 5 to 20 minutes after administration 6. Instruct the family in the procedure for administration 7. Read about additional information regarding implementation for severe hypoglycemia E. Diazoxide (Proglycem) 1. Increases blood glucose by inhibiting insulin release from the beta cells and stimulating the release of epinephrine from the adrenal medulla 2. Used to treat chronic hypoglycemia caused by hyperinsulinism resulting from islet cell cancer or hyperplasia 3. It is not used for hypoglycemic reactions from insulin
Common Types of Insulin Onset Peak 10 to 15 minutes 0.5 to hour 1 1 hour

3. 4.

7.Confirm clients identity 8.Provide client teachings 9.Stay with client until meds is gone; dont leave at bedside 10. After giving meds, leave client in position of comfort 11. Give meds w/n 30 minutes of prescribed time. 12. To ensure safety do not give a medication that someone else prepared SEVEN RIGHTS RIGHT CLIENT RIGHT DRUG RIGHT DOSE RIGHT ROUTE RIGHT TIME RIGHT DOCMENTATION RIGHT DRUG PREPARATION & ADMINISTRATION GENERAL CONSIDERATIONS FOR ORAL MEDS 1.Assess oral cavity & ability to swallow meds 2.Enteric-coated meds must not be crushed. Only scored tablets can be broken 3.Do not administer alcohol-based products like elixirs to alcohol dependent persons 4.Have patients swallow meds except for sublingual & buccal route. Do not allow fluids 30 minutes after giving meds. Give iron preparation using straw to prevent teeth staining. 5.When giving meds via NGT, do not mix with food. Give before or after meals & flush tubing with 30 ml of H2O Check for tube patency before giving medications. GENERAL CONSIDERATIONS FOR PARENTERAL MEDS 1.Select appropriate needle size & syringe for ID, SQ, IM ROUTES 2.Use tuberculin syringe for meds less than 1 ml 3.Draw up air equal to amount of meds needed 4.Inject air to vial to prevent negative pressure & aid in aspirating meds 5.Ampule: place needle into ampule to draw meds & use filter needle to avoid glass shards 6.Select & rotate sites avoiding bruised or tender areas 7.Insert needle quickly with bevel side up. Aspirate to check for blood except heparin. If blood is present, remove needle & start again. For giving IV meds, blood return is desired 8.Apply gentle pressure after giving injections except for heparin & Z-track. SQ ADMINISTRATION 1.Use 25g to 27g, to 1 inch needle 2.Maximum volume of 1.5 ml 3.Pinch skin to form SC fold & insert at 45 degrees in thigh or arm & 90 degrees in abdomen 4.Possible sites: lateral aspect of upper arm, anterior thigh, abdomen1 inch from umbilicus & scapular area ID ADMINISTRATION INTRADERMAL ADMINISTRATION 1.Use 26g to 27g, 1" needle on a 1 ml or tuberculin syringe (vol approximately 0.1 ml) 2.Insert needle at 10-15 angle with 1-2 mm depth with needle bevel upward 3.When wheal appears, do not massage..mark 4.Possible sites: ventral forearm, scapula, upper chest
ST. MICHAELS COLLEGE, INC. ILIGAN CITY

Type Rapid-acting insulin Lispro (Humalog) Short-acting insulin Humulin Regular Intermediate-acting insulin Humulin NPH Humulin Lente Long-acting insulin Humulin Ultralente Premixed insulin 70% NPH and 30% Regular

Duration 3 hours

2 to 3 hours

4 to 6 hours

3 to 4 hours 3 to 4 hours 6 to 8 hours 0.5 to hour 1

4 to 12 hours 4 to 12 hours 12 to 16 hours 2 to 12 hours

16 to 20 hours 16 to 20 hours 20 to 30 hours 18 to 24 hours

PHARMACOLOGY
FACTORS AFFECTING DRUG ABSORPTION 1. ABSORPTION 2. DISTRIBUTION = plasma-protein binding, volume of distribution, barriers (blood- brain & placental), obesity & receptor combination 3. METABOLISM = oral meds, age, nutrition & hormones 4. EXCRETION = renal excretion, drugs affecting elimination of other drugs, blood concentration levels GENERAL PRINCIPLES OF DRUG ADMINISTRATION 1.Confirm client diagnosis & appropriateness of meds 2.Identify all concurrent meds & any potential C/I & allergies 3.Research drug compatibilities, action, purpose, route, C/I, S/E 4.Calculate dosage accurately especially for pediatric clients 5.Check for expiration date of meds 6.Compare drug label 3x (when removing meds from cabinet, before & after medications)
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IM ADMINISTRATION 1.Use 18 g to 23 g, 1-2 inch needle, maximum volume is 5 ml 2.Stretch skin taut 3.Insert at 90 degrees angle. 45 degrees for infants & children 4.Possible sites: gluteus medius (ventrogluteal & dorsogluteal, vastus lateralis (anterior thigh), rectus femoris(medial thigh) & deltoid 5.For Z-track: 20-22 g, 2-3 inches long with a different needle to draw meds; draw skin laterally with nondominant hand to ensure meds enter muscle; wait 10 sections before removing injection; do not massage to lock irritating substances in place IV ADMINISTRATION 1.Check site for complications (redness, swelling, tenderness) 2.Check blood return 3.Prepare meds according to manufacturers specifications 4.Prepare tubing according to requirement: micro or macro tubing 5.Change tubing & dress site every 24-72 days depending on hospital policy & label appropriately 6.Never hang solutions more than 24 hours 7.Use syringe infusers & infusion pumps IV PRECAUTIONS 1.Monitor the risk for fluid overload especially in patients with respiratory, cardiac, renal & liver diseases. Elderly clients & very young clients cannot tolerate excessive fluid volume 2.Clients with CHF cannot tolerate solutions containing sodium 3.Clients with diabetes mellitus does not typically receive dextrose (glucose) solutions 4.Lactated Ringers Solution contain potassium & should not be given to clients with renal failure COMPLICATIONS OF IV THERAPY 1.INFECTION LOCAL: redness, swelling & drainage at site SYSTEMIC: fever, chills, HA, tachycardia, malaise *the longer the site, the higher the risk *at risk are HIV/AIDS patients & those receiving chemo *assess for the S/Sx of infection, maintain strict asepsis in IV site care, monitor WBC, check the integrity of solutions, change tubings & dressings q 24-72 hrs, prepare to obtain blood culture from venipuncture device 2.PHLEBITIS/THROMBOPHLEBITIS PHLEBITIS: redness, heat & tenderness at site, sluggish IV THROMBOPHLEBITIS: hard & cordlike vein *use IV cannula smaller than vein *avoid lower extremities as the site & areas of flexion 3. INFILTRATION edema, pain & coolness at site d/t seepage of IV fluid outside vein & into the interstitial space; may or may not have blood return *caused when devise dislodged or perforates vein or when vein backs up pressure d/t venospasm *infiltrated if no backflow of blood upon lowering fluid container or after occluding the vein proximal to site and IV continues to flow *remove infiltrated IV, elevate extremity & apply cold or warm compress based on MDs order 4. CIRCULATORY OVERLOAD increased BP, distended jugular veins, rapid breathing dyspnea, moist cough & crackles *use infusion pump esp. for clients at risk of overload and time tape
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*if it occurs, KVO rate, elevate head of bed, assess for edema & inform MD *if these occurs, remove & restart in opposite extremity apply warm & moist compress; inform doctor 5. AIR EMBOLISM tachycardia, dyspnea, hypotension, cyanosis & decreased LOC *occurs when air bolus enters vein through inadequately primed IV line, from loose connection, change & IV removal *if S/Sx occur, clamp the tubing, turn the patient on the left side with the head lowered (Trendelenburg position) to trap area in the right atrium, call MD right away

tubing

CONSIDERATIONS IN GIVING OPTHALMIC MEDS 1.Have patient lie on back or sit w/ head turned to the affected side to facilitate gravitational flow 2.Cleanse eyelids & eyelashes with sterile gauze pads soaked with physiologic saline 3.Keep eye open by pulling down on cheekbone with thumb & pointer finger to expose lower conjunctiva 4.Place the necessary drops near the outer canthus & away from cornea 5.If using ointment, squeeze into lower conjunctiva & move from inner to outer canthus. Do not touch tip to the eye & twist tube to break medication stream 6.Let patient blink 2-3 times 7.Press on nasolacrimal glands 8.Wipe excess meds starting from inner canthus 9.Droppers & ointments are for individual clients & never shared CONSIDERATIONS IN GIVING OTIC MEDS 1.Clean outer ear using wet gauze pad. 2.Straighten ear canal: pull pinna up & back for adults; pull pinna down & back for children under 3 3.Instill necessary number of drops along side of canal without touching ear with dropper. Maintain ear position until meds has totally entered canal 4.Have client remain on side for 5-10 minutes to allow meds to reach to reach inner ear. CONSIDERATIONS IN GIVING TOPICAL MEDS 1.Cleanse area to remove old meds using gauze with soap & warm water 2.Spread medication evenly & thinly wearing gloves if the skin is broken 3.When applying nitroglycerin ointment, take the clients BP 5 minutes before & after application 4.Wash hands after applying to prevent self-absorption 5.For transderm patches, wear gloves to prevent self absorption & place in an area with little hair. Press down edges to secure patch CONSIDERATION OF GIVING VAGINAL MEDS 1.Let client void 2.Drape to provide privacy & wear gloves 3.Place client on bedpan in a dorsal recumbent position with hips & knees flexed 4.Cleanse perineum with warm, soapy water working from inner to outer 5.Moisten suppository with water-soluble lubricant 6.Separate labia & insert 2 inchesangled downward & backward 7.Provide pillow under buttocks & let patient remain in that position for 15-20 minutes (no sphincter to hold suppository in place) 8.Provide with pads CONSIDERATION OF RECTAL MEDS
ST. MICHAELS COLLEGE, INC. ILIGAN CITY

1.Check patients bowel function/ability to retain the enema or suppository 2.Store suppositories in the refrigerator 3.Provide privacy & position client left laterally 4.Don gloves & moisten suppository with water-soluble lubricant 5.Insert suppository tapered end 1st & insert 2 inches to pass the internal sphincter 6.Hold buttocks together. 7.Encourage patient to retain: suppositories for 10-20 minutes; enema for 20-30 minutes

ANXIOLYTICS BARBITURATES phenobarbital; mephobarbital; methabarbital; amobarbital BENZODIAZEPINES diazepam (Valium) lorazepam (Ativan) chlorazepate (Tranxene), NONBENZODIAZEPINE diphenhydramine (Benadryl) doxylamine (Unisom) buspirone(Buspar) NONBARBITURATES Hydroxyzine (vistaril), Atarax, Meprobamate (Equanil) ANTICONVULSANTS

NERVOUS SYSTEM

CNS

PNS

BRAIN

SPINAL CORD

SOMATIC

AUTONOMIC ADRENERGIC 1.ALPHA 2.BETA CHOLINERGIC

BARBITURATES Mephobarbital (mebaral); Metharbital (gemonil); Phenobarbital (luminal) BENZODIAZEPINES Clonazepam (klonopin); Clorazepate (tranxene); Diazepam(valium) HYDANTOINS Ethotoin (peganone); Mephenetoin (mesantoin); Phenytoin (dilantin) MISCELLANEOUS carbamazepine (Tegretol)lorazipam (Ativan),MgSO4, Valproic acid (Depakene) SUCCINIMIDES Ethosuximide (zarantoin); Methoximide (celontin); Phensuximide (milontin) NEUROLEPTICS (Antipyschotic Agents/ Antischizophrenic/Major Tranquilizers)

NEUROLOGIC MEDS ANALGESICS 1.NARCOTIC ANTAGONISTS a.) morphine-like derivatives codeine (codeine SO4); morphine (roxanol); levorphanol (levodromoran) b.) meperidine-like derivatives fentanyl (sublimaze); meperidine (Demerol) c.) methadone-like derivatives methadone, dolophine 2. NARCOTIC PARTIAL AGONISTS NARCOTIC ANTAGONISTS * Butorphanol Tartrate (Stadol), Nalbuphine, Pentazocine *naloxone, naltrexone (trexan) 3. NON-STEROIDAL ANTI-INFLAMMATORY *salycilates ( aspirin= reyes syndrome, avoid < 18, GIT irritant) *ibuprofen, mefenamic acid, naproxyn ( naprosyn), ketoprufen (orudis) 4. MISCELLANEOUS ANALGESIC AGENTS *acetaminophen (Tylenol)

ANTIDEPRESSANT MAOI *isocarboxazid (marplan) * tranylcypromine sulfate (parnate), phenylzine sulfate (nardil) Tricylics * Amitriptyline hcl (Elavil) *Imipramine (Tofranil) * Desipramine hcl (pertofrane, norpramin) SSRI (Selective serotonin reuptake inhibitors * Fluoxetine (proxac), Paroxetine (Paxil), Sertraline hcl (Zoloft) PHENOTHIAZINES Chlorpromazine(Thorazine) severe hypotensive effect Mesoridazine(Serentil) Thioridazine(Mellaril) Fluphenazine(Prolixin,Permitil) long-acting form Prochlorperazine(Compazine) Perphenazine(Trilafon) Trifluoperazine(Stelazine) Thioredazine (Mellaril)- retinitis pigmentosa above 800 mg Benzisoxasole: Risperidone(Risperdal) COMPARISON OF CHARACTERISTICS OF ANTICOAGULANT DRUGS HEPARIN COUMADIN

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ST. MICHAELS COLLEGE, INC. ILIGAN CITY

ONSET OF ACTION ROUTE OF ADMIN DURATION OF ACTION LABTES T ANTIDOTE COST

immediate parenteral short (<4hrs) APTT Protamine SO4 expensive

slow (24-48hrs) oral long (approximately 2-5 days) PT Vitamin K, whole blood or plasma inexpensive

ADRENERGIC INHIBITING AGENT. *.clonidine, methyldopa, reserpine, prazoline ; *usually diuretic added to prevent fluid retention STEP 3 VASODILATOR AGENT * hydralazine ; added w/ adrenergic blocking agent & diuretic decrease workload STEP 4 GUANETHEDINE, MINOXIDIL, OR ANGIOTENSIN INHIBITORS CAPTOPRIL OR ANALAPRIL ANTIDYSRHYTMIC GROUP 1 generally inhibit the fast sodium channel in cardiac muscle resulting in an increased refractory period a.Disopyramide phosphate (NORPACE); Procainimide hcl (PROCAN); Quinidine (QUINIDEX) b.Lidocaine (XYLOCAINE) c.Flecainide

THROMBOLYTIC MEDs Salteplase (Activase, t-PA tissue plasminogen activator); Urokinase (Abbokinase) Streptokinase (Streptase, Kabikinase) ANTIHEMOPHILIC FACTOR VIII; factorate, hemofil-T, humafac, koate, profilate ANTIINHIBITOR COAGULANT COMPLEX Autoplex, feiba VH immuna FACTOR IX COMPLEX contains factor II, VII, IX & X (vit K coagulant factor) ; hemophilia SYSTEMIC HEMOSTATICS aminocaproic acid (AMIKAR, EPSIKARON); competetive antagonist of plasminogen C/I in intravascular active clotting TOPICAL HEMOSTATICS absorbable gelatin sponge (Gelfoam); absorbable gelatin film (Gelfilm); absorbable gelatin powder oxidized cellulose CARDIOVASCULAR ANTILIPIDEMICS BILE ACID SEQUESTRANTS cholestyramine (Questran) *Mix powder thoroughly with juice & H2O *A/R: constipation & PUD HMGCoA REDUCTASE INHIBITORS atorvastatin (Lipitor) ;simvastatin (Zocor) *Check serum liver enzymes & eye exam annually for cataract OTHERS clofibrate (Lopid) *Dont take with anticoagulants ANTIHYPERTENSIVES STEP 1 DIURETIC (1st step for younger clients w/ tachycardia & marked lability of BP) STEP 2 BETA-BLOCKING AGENT Beta 1adrenergic (cardioselective) blocking agents : Acetabulol (sectral); atenolol (tenormin); metoprolol (betaloc) Beta 1 & 2 (nonselective) blocking agents: Nadolol (corgard), pindolol (visken), propranolol (inderal, novopranol), timolol
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GROUP 2 BETA BLOCKERS THAT DECREASE STIMULATION OF THE HEART Beta 1 selective antagonists *cardiogenic blockers; block Beta1 cardiac receptors *atelonol (ternonim), acebutolol sectral, metoprolol (betaloc) Beta 2 Selective *mucolytics & bronchodilators Nonseletive Beta Adrenergic blocking agents ; (beta 1 & beta 2 blockers) * nadolol (corgard), oxyprenelol (trasicor), pindolol (visken)propranolol (inderal) , timolol GROUP 3 * generally do not affect depolarization but work by prolonging cardiac repolarization Anti adrenergic; positive inotropic action Bretylium, amiodarone hcl (cordarone) GROUP 4 Calcium antagonist action= depression of heart & smooth muscle contraction, decreased atomaticity, & decreased condction velocity verapamil BRONCHODILATOR/XANTHINES Aminophyline Isoproterenol, isuprel Terbutaline SO4, Brethrine Atrovent Albuterol, proventil Epinephrine, adrenalin Acetylcysteine, mucomyst Intal

ST. MICHAELS COLLEGE, INC. ILIGAN CITY

GIT MEDS ANTACIDS & MUCOSAL PROTECTIVES sucralfate (carafate); magnesium hydroxide ( milk of magnesia); aluminum hydroxide ( amphojel, alu-cap) calcium carbonate, tums H2 BLOCKERS cimetidine (tagamet); ranitidine, (zantac) PANCREATIC ENZYME REPLACEMENT pancreatin (creon); pancrelipase (cotazym, vickase, pancrease) MEDS Rx HEPATIC ENCEHALOPATHY lactulose (cephulac) ; neomycin (mycifradin) LAXATIVES Bulk Forming Laxatives: Psylium Hydrophillic Mucilloid (Metamucil) Stool Softeners: Docusate Calcium (Surfak); Docusate Sodium ( Colace) Lubricants: Mineral oil Stimulant Cathartics: Bisodyl (Dulcolax); Cascara (Castor oil) RENAL DRUGS DIURETICS Proximal Tubule Diuretics: Carbonic Andydrase Inhibitors= actazolamide (diamox) Diluting Segment Diuretics Thiazide Diuretics=chlorothiazide (diuril) Loop Diruretics Furosemide (Lasix) Distal Tubule Diuretic Amiloride (Midamor); Spironolactone (Aldactone); Trieamtrine

ANTIVIRAL AGENTS Acyclovir (Zovirax); Zydovudine(AZT, Retrovir) Related Drugs: didanosine (Videx), Lamivudine (Epivir) & Zalcitabine (ddC) Protease inhibitor= inavir (Invirase); *A/R: photosensitivity = ritonavir (Norvir); *A/R: increase triglyceride levels =stavudine (d4T, Zerit) ANTIMICROBIALS SULFONAMIDES-Sulfisoxazole (Gantrisin) PENICILLINS-penicillin G potassium; probenecid (benemid) CEPHALOSPORINS- 1st Generation = cefazolin sodium (Ancef) 2nd Generation= cefoxidin sodium (Mefoxin) 3rd Generation= cefotaxim (claforan) QUINOLONES -ciprofloxacin (ciprobay); -chloramphenicol (chloromycetin); -tetracycline hydrochloride (achromycin V) AMINOGLYCOSIDES- gentamicin (garamycin); - vancomycin hcl (vancocin) LINCOMYCIN -clindamicin hcl (cleocin, dalacin C); -lincomycin hcl (lincocin) MACROLIDE -erythromycin ANTIFUNGAL Amphoterizin B (fun gizone); disrupts cell membrane; Rx systemic fungal infections & meningitis Butoconazole nitrate (femstat) Ketonazole (nizoral) Miconazole (monistat) Nystatin (mycostatin) ) ANTITURBECULAR DRUGS ISONIAZID (INH) *Initial TTT against PTB; prophylaxis for high-risk groups *A/R: peripheral neuritis)give vitamin B6 (pyridoxine); hepatitischeck liver enzymes frequently; hyperexcitability *Taken on empty stomach, avoid alcohol & interferes with Phenytoin (Dilantin) requiring lowering of INH dose ETHAMBUTOL (MYAMBUTOL) *A/R: optic neuritis & loss of red-green color discrimination but its reversible RIFAMPICIN *A/R: hepatitis, flu-like syndrome, may turn body fluids (urine, tears, saliva etc. ) orange *Interacts with anticoagulants, oral contraceptives, oral hypoglycemics, methadone & corticosteroids STREPTOMYCIN *A/R: cranial nerve 8 damage (roaring, ringing & feeling of fullness in the ear); vestibular damage (dizziness & vertigo) PYRAZINAMIDE *A/R: increased uric acid causing gout or hepatitis
ST. MICHAELS COLLEGE, INC. ILIGAN CITY

Osmotic Diuretic Manitol (Osmitrol); Isosrbide; Urea (ureaphil) URINARY TRACT ANTISEPTICS Nitofurantoin (Furadantin, Furalan, Macrobid) URINARY ANALGESICS Phenazopyridine Hcl (Pyridium) CHOLINERGIC Bethanecol Chloride (Duvoid, urecholine) ANTISPASMODIC Oxybutynin chl (Ditropan); Probanthine Bromide (Probranthine) HEMATOPOIETIC GROWTH FACTOR Epoetin alfa (Epogen, procrit) PREVENTING ORGAN REJECTION Immunosuppressants: cyclosporine sandimmune; Cytotoxic Meds: azathioprine (imuran)
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INTEGUMENTARY DRUGS ACNE PRODUCTS Isotretinoin (Accutane) BURNS PRODUCT Mafenide (Sulfamylon); nitrofurazone (Furacin); silver sulfadiazine (Silvadene, Flint SSD); silver nitrate ANTINEOPLASTIC MEDS ALKYLATING MEDICATIONS chlorambucil (Leukeran) & mechlorethamine HCl (Mustargen) ALKALYTING AGENTS cisplatin (Platinol); cyclophosphamide (Cytoxan) ANTITUMOR ANTIBIOTIC MEDS plicamycin (Mithracin); daunorubicin (Cerubidine); bleomycin SO4 (Blenoxane); doxorubicin (Adriamycin) & idarubicin (Idamycin) ANTIMETABOLITE MEDS Cytarabine HCl (ara-C, Cytosar-U); 5-Fluorouracil (5-FU; Adrucil); 6-mercatopurine (Purinethol) Methotrexate (Folex)given with leukovorin (folinic acid) VINCA (PLANT) ALKALOIDS vincristine SO4 (Oncovin) HORMONAL MEDS & ENZYMES aspariginase (Elspar) mitotane (Lysodren) tamoxifen citrate (Nolvadex) Diethylstilbestrol (DES, Stilphostrol)

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ST. MICHAELS COLLEGE, INC. ILIGAN CITY