PHARMACOLOGY

DRUG NAME:

-study of drugs and its interaction to the body. DRUG -any substance used to diagnose, cure, or prevent a condition or disease.

1. Chemical Name refers to the chemical structure of the drug. 2. Generic Name common or official name not restricted by trademark;usually written in small caps. 3. Band Name TRADEMARK; name given by the manufacturer PHARMACOKINETICS is the process of drug movement to achieve drug action. 1.ABSORPTION - process from the time of administration until it enters the bloodstream. 2.DISTRIBUTION - is the transportation of a drug to body fluids and tissues
PLASMA-PROTEIN BINDING a. Medications attach to plasma proteins (albumin: anticonvulsants or globulin:lidocaine) b. Protein-bound drugs inactive bcoz it is not available to receptors c. Free or Active drugs can cause a pharmacologic response by binding to cell receptors d. Clients with reduced plasma proteins (kidney/liver d/s malnutrition) could receive a heightened drug effect and eventually drug toxicity.

BARRIERS - prevent some medications from entering certain body organs. a. Blood-brain barrier - to pass this barrier, drug must be lipid soluble and loosely attached b.
to plasma protein. Placental barrier many substances ( nicotine, alcohol) can cross

3.METABOLISM (biotransformation) - irreversible transformation of drugs

- major organ responsible: LIVER

a. First-pass effect the process wherein drugs pass through the liver first before entering b.
c. the systemic circulation and some portion of the drug is inactivated. Bioavailability percentage of the administered drug dose that reaches the systemic circulation. Infants and elderly have reduced ability to metabolize some drugs.

4.EXCRETION - process by which drugs are eliminated from the body

- major organ responsible: KIDNEYS - other organs: intestines, lungs, and mammary, sweat, and salivary glands

a.

Half-life (t1/2) the time it takes for one half of the drug to be eliminated.

!!!Note: Most accurate test to determine Renal function: Creatinine Clearance (CLCR) (N: 85-135ml/min)
DRUG INTERACTION 1. Synergistic Effect/Potentiation two drugs with different mechanism of action produce greater effect Antidotes: 2. Antagonistic Effect effects of two drugs cancel each other
1. acetaminophen 2. benzodiazepine 3. digoxin DRUG ORDER 4. heparin o Types of Medication Orders 5. warfarin a. Stat Order given at once or immediately b. Standing Order ongoing order or may be given iron 6. for a specific number of doses or days. magnesium sulfate 7. c. PRN Order given as needed 8. mestinon d. Verbal Order telephone order and must be 9. neostigmine -- basis for specific antidotes

signed by the doctor w/in 24 Hours. 10.narcotics If possible a medicine intern should take the telephone order. e. Single Order given once and usually at a specific time

 10 RIGHTS b. RIGHT CLIENT a. The nurse must verify the clients identity. b. Check the identification bracelet. c. Have the client state his name. (dont call out his name) d. Check the bed tag. (least reliable) c. RIGHT DRUG a. The client must receive the prescribed drug. b. Check the drug label three times. b.1. At the time of contact with the drug container b.2. Before preparing the drug b.3. After preparing the drug a. b. c. d. e. d. RIGHT DOSE Refers to the dose prescribed to a client. Calculate the drug dose correctly. When in doubt, it should be checked by another nurse. Check the drug handbook for recommended range of specific drug doses. Dosage Calculations: e.1. D V
H

Drop Factor: e.2. Flow Rate Macrodrip: gtts/min = Amount of fluid x Drop Factor(gtts/ml) a. Abbott 15 H x mins/H (60) b. Cutter 20 c. Travenol 10 ml/H = Amount of Solution Microdrip: # of Hours a. Minidrip sets 60 ml/min = Milliliters per Hour 60 mins No. of H = Amount of Solution ml/H

Common Conversion
60 drops 1 tbsp 3 tsps 1 gr 8 oz 15 gr 1000 mcg 15 gtts

e.3. Freids Rule Age in Months x Adult Dose 150 e.4. Clarks Rule Weight in Pounds x Adult Dose 150 e.5. Youngs Rule Age in Years Age in years + 12

= 1 tsp = 15 ml = 1 tbsp = 60 mg = 1 glass = 1 gram = 1 mg = 1 ml

a. b. c. d. e. f. g. h. i. j.

e. RIGHT TIME f. RIGHT ROUTE Oral liquid, elixir, suspension, pill, tablet, capsule Sublingual under tongue for venous absorption; high rate of absorption Buccal between gum and cheek Via feeding tube - NGT Topical applied to the skin Inhalation aerosol sprays Instillation EEN Suppository rectal or vaginal 4 Parenteral Routes: IV, IM, SC, ID Stay with the client until oral drugs have been swallowed.

g. RIGHT ASSESSMENT a. Requires that the appropriate data be collected before drug administration. Ex. Assess Apical heart rate before giving digitalis. Asses blood sugar before giving insulin. Assess ability of the elderly to coordinate eye medication instillation at home. h. RIGHT DOCUMENTATION i. RIGHT TO EDUCATION based on informed consent j. RIGHT EVALUATION k. RIGHT TO REFUSE
General Drug Administration Guidelines: Practice asepsis. Nurses who administer medications are responsible for their own actions. Do not administer medication prepared by another nurse. Check medication order with physicians order, Kardex, medicine sheet, medicine card. Use only medications that are in clearly labeled containers. Return liquid that are cloudy or have changed in color to the pharmacy. Before administering a medication identify the client correctly. Do not leave the medication. If the pt vomits after taking the oral medication, report this to the nurse in charge and/ or physician. When a medication error is made, report it immediately to the nurse in charge and /or physician.

ROUTES OF ADMINISTRATION a. Enteral Route

ORAL MEDICATIONS - Position: Adult: Sit the client upright Infant: 45 degrees angle 1. TABLETS AND CAPSULES - Ensure the patients ability to swallow. - Place medication well back on the tongue. - Give pt liquid to swallow the medication (60-100ml except cough syrups). - Remain with the pt while the medication is taken and until its gone. - Do not crush enteric-coated tablets or sustained-release tablets. - Scored tablets can be broken *Crushing enteric-coated tabs: irritate gastric 2. LIQUIDS mucosa. - Shake liquid medication. *Crushing sustained-release tabs: release all of the medications at once decreasing its duration. - Pour away from bottle label. - Read the liquid amount at the lower meniscus at eye level. - Administer the drug immediately. (prevent contamination) - Iron or HCl: have the client use straw to prevent staining the teeth. 3. SUBLINGUAL AND BUCCAL
*SUBLINGUAL under the tongue for venous absorption (high rate of absorption) *BUCCAL between gum and cheek Nursing Alert!!!! - Instruct the pt NOT to swallow the medication. - Do not give fluids 30 minutes following administration. -

Solid: tab, cap, pill, powder Liquid: -Syrup: sugar-based -Susp: water-based; shake well b4 use -Emulsion: oil-based -Elixir: alcohol-based; wait 3o mins b4 giving water

4. NASOGASTRIC TUBE

Indication: inability to swallow Position: Semi-Fowlers to High Fowlers position or on the Right side if comatose Measurement: NEX Liquid form of the drug should be used. If tablet: Crush medications and dissolve in 5-10 ml of water Check location of the NGT before administering the medication.

X-RAY -Confirms proper placement

ASPIRATION OF GASTRIC CONTENTS

-normal gastric color: grassy green, yellow to brown, clear -litmus paper color:RED -pH:1-5; respi and intestinal: >7

INTRODUCTION OF AIR -auscultation of gurgling sounds

Procedure: 1. Clamp the tubing and attach bulb syringe. 2. Unclamp the tubing and allow the medication to run. 3. Flush tubing with 50 ml of water or prescribed amount. 4. Clamp the tubing at the end of the medication administration. 5. Maintain pt in semi-fowlers for at least 30 minutes after administration. 6. Provide oral care if necessary.

b. PARENTERAL ROUTE 1. INTRADERMAL ROUTE

a. Action: -Local Effect -Used for observation on an inflammatory (allergic) reaction to foreign proteins. b. Sites: lightly pigmented, hairless, thinly keratinized -ventral forearm -scapular area -upper chest (clavicular area) c. Equipment: -Needle: 26-27g; 1 inch in length (max vol: 0.1 ml) -Syringe: 1 ml or tuberculin syringe d. Angle: -10-15 degrees, bevel up e. Technique: -Put on gloves. -Cleanse the area. -Stretch the skin taut. -Inject the medication slowly to form a wheal. -Dont massage. -Mark with a pen, and ask the client not to wash it off. -Assessed after 48-72 hours.

2. SUBCUTANEOUS ROUTE
a. Action: -Systemic and Sustained Effect -Used for small doses of non-irritating, water-soluble drugs. b. Sites: adequate fat pads -Lateral aspect of the upper arm e. Technique: -Upper back, scapular area -Put on gloves. -Anterior thigh -Cleanse the area. -Abdomen (1 in away from umbilicus) -Pinch the skin to form SC fold. -Upper Hips -Aspirate, except for insulin or c. Equipment: heparin. -Needle: 25-27g; - 5/8 inches in length, 1 inch -Gently massage the area unless CI. -Syringe: 1 to 3 ml -Maximum volume of 1.5 ml d. Angle -45 degrees (90 degrees in abdomen)

3. INTRAMUSCULAR ROUTE
a. Action: -Systemic Effect -Used for irritating drugs, aqueous suspensions, and oil-based drugs. b. Sites: adequate muscle size, minimal nerves and blood vessels -Ventrogluteal -Vastus lateralis -Dorsogluteal -Deltoid c. Equipment: -Needle: 18-23g; 1-3 inches in length -Syringe: 1 to 3 ml -Maximum volume of 5 ml d. Angle: -90 degrees e. Technique: -Put on gloves. -Cleanse the area. -Flatten the injection site. -Aspirate. -Massage the area.

VASTUS LATERALIS (anterior thigh)

-Recommended site for infants and children (bcoz its well developed in both adults and children) -No major blood vessels nor nerves -Site: middle third of the anterior lateral aspect of the thigh -Position: supine or sitting -Volume: Pediatrics <0.5 to 1 ml Adults 1 to 2 ml

DELTOID
-NOT safe (small muscle and close to the radial nerve and artery) -most convenient (readily accessible for children over 18 mos and adults) -site: 2-3 fingerbreadths below the acromnion process -Volume: <2ml

DORSOGLUTEAL (gluteus medius)

-Not used for children under age 3 years unless the child has been walking for at least 1 year (this muscle is developed by walking, so if the child havent been walking, this muscle aint developed yet) -Site: 1. Draw an imaginary line from greater trochanter to Posterior Iliac Spine 2. Injection site: ABOVE THE IMAGINARY LINE -Position: PRONE or LATERAL -Volume: 1-3 ml -Nursing alert!!!: Avoid HITTING THE

(gluteus minimus) VENTROGLUTEAL (von Hochsteters site)

-Safest (No major nerves or blood vessels) -Site: 1. Place the heel of hand on greater trochanter 2. Point index finger towards the anterior iliac spine 3. Abduct middle finger forming V

-Position: PRONE or LATERAL

-Volume: 1-3 ml

SCIATIC

NERVE Z-TRACK METHOD

Purpose: To seal the drug deep into the muscle, prevent drug leakage into the SC tissue, and prevent permanent staining of the skin.

Best Site: Ventrogluteal muscle and Dorsogluteal muscle

 Procedure: 1. Change the needles after withdrawing the drug from the vial. 2. The skin is stretched or pulled into one side. 3. Inject the needle into the muscle. 4. Aspirate to check for blood. 5. Wait for 10 seconds after injecting the medication before withdrawing the needle. 6. Release the displaced skin. 7. Do not massage or rub the site.

4. INTRAVENOUS ROUTE a. Action: -Systemic Effect: -Most rapid route b. Sites: -Cephalic vein, Median Cubital vein, Dorsal and metacarpal veins, Radial vein, Basilic vein c. Equipment:
-Needle: *Adults: 20-21g; 1-1.5 inches *Children: 22g; 1 inch *Infants: 24g; 1 inch *Blood Transfusion: Adults: 18-19g; Children: 23g

d. Angle: -25 degrees e. Technique:

-Apply a tourniquet. -Cleanse the area using aseptic technique. -Insert needle until blood returns. Remove the tourniquet. -Stabilize the needle and dress site. -Monitor the flow rate, distal pulses, skin color, temperature, and insertion site. f. General Considerations:
1. Prime tubing. 2. Avoid use of the veins of the lower extremities. 3. Avoid use of vessels over a bony prominence. 4. Initiate the IV in the nondominant hand. 5. Select site from distal to proximal. 6. Do not use an extremity with an impaired blood flow. 7. Commonly used veins: dorsal vein network, cephalic, basilic.

HYPERTONIC

-higher concentration of solutes than the cells

ISOTONIC (N:275-295 mOsm/kg)

HYPOTONIC

-Cells SHRINK

-Use: Clients with Edema

-same solute concentration as cells and blood -Cells maintain normal shape and sixe -Use: Burn clients
1. 0.9% Saline 2. D5W 3. D5 in 0.25% NSS 4. LR 5. NSS

-lower concentration of solutes than the body fluids -Cells SWELL Use: DHN, Hemorrhage

1. 3% NSS 2. 5 % NSS 3. D10W 4. D5 in 0.9 %NSS 5. D5 in 0.45% NSS 6.D5LR

1. 0.45% Saline 2. 0.225% Saline 3. 0.33 % Saline

Nursing Interventions: a. Monitor for circulatory overload. b. CI for clients with Renal & cardiac d/o. c. CI for clients with DHN.

a. Avoid D5W if client is at risk for IICP bcos it moves from the intravascular to the intracellular compartment. b. D5W, when infused continuously or rapidly, becomes a hypotonic solution.

a. CI for clients with IICP. b. Monitor client carefully (LOC: cos fluid shifts into brain cells)

Complications THROMBOPHLEBITIS inflammation of the

vein + clot formation

INFILTRATION - dislodgement of the IV catheter +

accumulation of fluids in the SC tissues

S/S
a. Pain along the vein. b. Hard & cord-like vein. c. Edema & redness @ insertion site. d. Warmth on the insertion site.

Nursing Mgt:
a. Change IV site q72H. b. Use large veins for irritating fluids. c. Stabilize venipuncture site. d. Apply cold compress to relieve pain & inflammation. e. Apply warm compress to stimulate circulation and absorption.

S/S
a. Pain b. Edema c. Cold skin @ needle site. d. Pallor of the site. e. Flow of IV decreases or stops. f. Absence of backflow of blood.

Nursing Mgt:
a. Change the insertion site. b. Apply warm compress to reabsorb fluids.

AIR EMBOLISM presence of air in tubing that

managed to get into the circulatory system (>5 ml)

CIRCULATORY OVERLOAD caused by RAPID

rate of infusion

S/S
a. Chest, Shoulder, Back pain b. Hypotension c. Dyspnea d. Cyanosis e. Tachycardia f. Increased venous pressure g. Loss of consciousness

Nursing Mgt:
a. Do not allow IV bottle to run dry. b. Prime tubing before starting infusion. c. Turn the pt to his left side in the Trendelenburg position. To allow air to rise in the right side of the heart and would prevent air embolism.

S/S
a. H/A b. Flushed skin c. Tachycardia d. HTN e. Weight gain f. Syncope or faintness g. Pulmonary edema h. Crackles i. SOB j. Tachypnea k. Coughing

Nursing Mgt:
a. Slow the infusion to KVO (5-10 gtts/min) b. Place the pt in high fowlers position to ease breathing. c. Administer diuretics or a bronchodilator as ordered.

C. PERCUTANEOUS ADMINISTRATION
1. EYE DROPS AND OINTMENT
-Purpose: a. Instill required eye medication. b. Irrigate foreign bodies from the eye. -Position: supine or sit with head turned to affected side to aid in gravitational flow Procedure: EYE OINTMENT 1. Squeeze strip of ointment (1/4 in) onto conjunctival sac. 2. Apply meds from inner to outer canthus. 3. Have the pt blink 2-3 times. 4. Close the eye gently for 2-3 mins. 5. Instruct the pt to expect blurred vision for a short time. NURSING ALERT!!!! Avoid touching the tip of the medication to the eye!!!!

Procedure: EYEDROPS 1. Wash Hands. 2. Check the medication. 3. Have the pt look upward. 4. Apply gentle traction to the lower eyelid to expose the lower conjunctiva. 5. Administer medication to the lower conjunctiva not on the cornea. 6. Close the eye gently. 7. Press lacrimal duct for 1-2 mins. 8. Wait 3-5 mins before instilling another drop.

2. EAR DROPS

-Purpose: a. Soften & Remove cerumen b. Treat inflammation and infection c. Relieve pain d. Remove a foreign body.

-Position: Side-lying with the ear being treated uppermost

Procedure: -Children under 3yrs old: Pull the PINNA down and back -children over 3 yrs old & adults: Pull the pinna UP and back -Warm eardrops at room or body temperature. -DO NOT insert dropper into the ear canal. -Administer medication on the lateral walls of the auditory canal. -Maintain position for 5-10 mins.

3. NOSE DROPS -Purpose:

a. Shrink swollen mucous membrane b. Loosen secretions & Facilitate drainage c. Treat infections -Position: Supine or Sitting and lean head backwards -Procedure: -Gently blow the nose.

-Instill medication. -Have the pt remain in the position for 5 mins. -Inform client the drops may produce an unpleasant taste.

4. RECTAL SUPPOSITORIES

-Absorption: Local or Systemic -Position: Left Sims Lateral -Procedure: -Provide privacy. -Use a glove for insertion. -Ask pt to take a deep breath & exhale thru mouth. (relaxes anal sphincter) -Gently insert the suppositories at approximately 2 inches. (use KY jelly) -Ensure that the suppository is in contact with the rectal wall. (Accurate absorpt!) -Remain lying on the side for 10-20 mins. (if enema: 20-30 mins)

5. VAGINAL MEDICATIONS

-Position: Dorsal Recumbent or Lithotomy -Procedure: -Have the client void. -Cleanse the perineum. -Lubricate the applicator tip. -spread the labia to expose the vagina -gently insert the applicator or suppository (2 inches) -remain in supine position with the hips elevated for 15-20 mins.

D. INHALATION ROUTE

-Use of a Nebulizer or Metered-Dose Inhalers (MDI) -Position: Semi to High Fowlers, Standing Procedure: -Insert the medication firmly into the inhaler. -Remove the cap from the mouthpiece. -Shake the inhaler. (To mix the medication & ensure uniform dosage delivery) -Hold mouthpiece 1-2 inches from the mouth. -Have the pt inhale fully while pressing on the inhaler. -Remove inhaler and hold breath for 10 s. -Exhale slowly thru the pursed lips -Wait 2 minutes between puffs. -Give bronchodilator inhalant before a glucocorticoid for an interval of 5 mins. -Instruct client to rinse mouth after steroid inahalation. (prevent oral fungal infxn) NOTE: To better facilitate delivery of inhalant medications, use a SPACER.

DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM:

SYMPATHETIC NERVOUS SYSTEM

- Flight or Fight response - Major Neurotransmitter: EPINEPHRINE - Stimulates ALL body systems EXCEPT GIT/GUT - All vasoconstricts EXCEPT PUPILS, BRONCHUS, UTERUS

PARASYMPATHETIC NERVOUS SYSTEM

- Rest and Digest - Major Neurottransmitter: ACETYLCHOLINE - Inhibits ALL body systems EXCEPT GIT/GUT - All vasodilates EXCEPT PUPILS, BRONCHUS, UTERUS

-DRUG Classifications: 1. Adrenergic 2. Sympathomimetics 3. Cholinesterase 4. Anticholinergic Action: STIMULATES

-DRUG Classifications: 1. Adrenergic Blocking Agents 2. Parasympathomimetics 3. Anticholinesterase 4. Cholinergic Action: BLOCKS

Alpha1 vasoconstriction BP Beta1 HR CO BP Beta2 relax smooth muscles (bronchodilation, uterine relaxation)

vasodilation BP HR CO BP contraction of smooth muscles (bronchoconstriction, uterine contraction)

SIDE EFFECTS: SNS 1. 2. 3. 4. 5. 6. 7. 8. Tachycardia HTN Dry mouth Constipation Urinary retention Pupil and bronchodilation Uterine relaxation Vasoconstriction except in smooth muscles

SIDE EFFECTS: PNS 1. 2. 3. 4. 5. 6. 7. 8. Bradycardia Hypotension Increased salivation Diarrhea Increased urination Pupil and bronchoconstriction Stimulates uterine contraction Vasodilation except in smooth muscles

SNS DRUGS
Adrenergic Drugs:
1. epinephrine (Adrenaline Chloride) 2. norepinephrine (Levophed, Levarterenol) 3. dopamine (Intropin) 4. dobutamine (Dobutrex)

Indications a. SHOCK: Cardiac stimulant b. CARDIAC FAILURE

Nursing Management:
1. Best taken: EARLY MORNING 2. Assess HR & BP (tachycardia/dysrhythmias) 3. Monitor I/O (Urgency/urinary incontinence) 4. Monitor lung sounds. (Epi = pulmo edema, bronchodilator = absence of wheezing) 5. Administer through a large vein (E/NE). 6. If extravasation occurs, infiltrate the site with normal saline and phentolamine (regitine)..

5. Bronchodilators:
a. albuterol (Ventolin, Proventil) b. salmeterol (Serevent) c. terbutaline sulfate (Brethine, Bricanyl) d. isoproterenol (Isuprel) e. ipratropium bromide (Atrovent) f. ipratropium + albuterol (Combivent)

a. ASTHMA b. BRONCHOSPASM c. CAL

10

Anticholinergic: 1. atropine sulfate (Isopto) 2. scopolamine (Hydrolomide) 3. glycopyrrolate (Robinul)

Indications a. Preanesthetic med (secretions & bradycardia) b. Mydriatics

a. Anti-EPS b. Anti-Parkinsonian

Nursing Management:

1. Avoid driving (blurred vision) 2. Encourage use of sunglasses (photophobia) 3. Relieve dry mouth (hard candy, ice
chips, sugarless gum) 5.

4. benztropine (Cogentin) 5. trihexiphenidyl (Artane) 6. biperiden (Akineton) 7. procyclidine (Kemadrin)

4. CI in glaucoma. (eye exams)

fluids & high fiber intake (Constipation). 6. Monitor for heatstroke.

PNS DRUGS
Adrenergic Blocking Agents:
1. prazosin (Minipress) 2. phentolamine (Regitine) (Antidote for:) 3. terazosin (Hytrin) 4. reserpine (Serpasil, Serpalan) 5. nitroprusside (Nipride) 6. hydralazine (Apresoline) 7. atenolol (Tenormin) 8. propranolol (Inderal) 9. metoprolol (Lopressor) 10. nadolol (Corgard)

Indications a. HTN

Nursing Management:
1. Assess BP

2. Do not discontinue abruptly (reflex tachycardia) 3. Priority : SAFETY (Light-headed, dizzy, orthostatic hypotension) 4. Decrease salt intake (can cause edema/h2o retention) 5. Inform regarding sexual difficulties (vasoconstriction of smooth muscles)
NOTE: Reserpine can cause depression, GI irritation, impotence, increase risk for breast CA.

- aka anticholinesterase 1. acetylcholine chloride (Miochol) 2. neostigmine (Prostigmin) 3. pyridostigmine (Mestinon, Regonol) 4. edrophonium chloride (Tensilon) 5. bethanecol (Urecholine) (used to tx post op urine retention)

Cholinergic:

Indications a. Miosis b. Myasthenia Gravis c. Urinary retention

Nursing Management:

1. Prepare antidote: -atropine sulfate -pralidoxime chloride (PAL) 2. Effectiveness: -improved muscle strength 3. Monitor for cholinergic crisis 4. Take with drug or food (<GI irr)

Common Board Exam Questions: Drug for the diagnosis of Myasthenia Gravis: edrophonium chloride (Tensilon) Drug for the prevention of Pre Term Labor: terbutaline sulfate (Brethine, Bricanyl) Contraindicated for Glaucoma: Anticholinergics Common emergency drug for allergic reaction and bronchospasm: Epinephrine (Adrenaline) Drug of choice for hypertensive Crisis: phentolamine mesylate (Regitine); nitroprusside (Nipride) Drug for Urinary Retention: bethanecol (Urecholine) Drug for BPH: terazosin (Hytrin) (relaxes bladder sphincter) (DOC: finasteride [Proscar]=androgen inhibitor)

PSYCHOTROPIC AGENTS

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ANTIANXIETY / ANXIOLYTICS Referred to as: a. Antianxiety

1. Benzodiazepine -am, -pam Diazepam (Valium) Alprazolam (Xanax) Oxazepam (Serax) Lorazepam (Ativan) Clonazepam (Klonopin) Chlorazepate (Tranxene) Chlordiazepoxide (Librium) Estazolam (ProSom) Midazolam (Versed)

b. Minor Tranquilizers

c. Downers
c. Interventions: 1. Rinse mouth with water often and sugarless gum. 2. Assist in ambulation. 3. Caution against driving. 4. Not used with daily minor stresses. 5. Caution in patients with glaucoma. 6. No alcohol and CNS depressants. 7. Therapeutic benefit is achieved in 2 weeks. 8. Cautious IV use as drug can precipitate. 9. Smoking decreases drug effect. 10. Avoid abrupt discontinuation. 11. Antidote for OD: flumazenil (Romazicon) eat

Side Effects:

1. CNS depression S/E -dizziness, confusion, disorientation, ataxia, fatigue 2. Anticholinergic S/E -everything is dry; dry eyes, dry mouth, constipation, urinary retention 3. Orthostatic/Postural hypotension

2. Nonbenzodiazepine Meprobamate (Equanil, Miltown) Buspirone (BuSpar) Hydroxyzine (Vistaril, Atarax) 3. Sedative Hypnotic Benzodiazepines Flurazepam (Dalmane) Triazolam (Halcion) Temazepam (Restoril)

DOC for alcohol withdrawal: Chlordiazepoxide (Librium) DOC for Status Epilepticus: Diazepam (Valium) Anxiolytic considered as: DOC as pre-op medication: Lorazepam (Ativan) DOC for elderly: Oxazepam (Serax); Lorazepam (Ativan)

ANTIPSYCHOTICS:

Referred to as: a. Neuroleptics Phenothiazines: 1. Chlorpromazine (Thorazine) 2. Trifluoperazine (Stelazine) 3. Fluphenazine (Prolixin) 4. Perphenazine (Trilafon) 5. Triflupromazine (Vesprin) 6. Thioridazine (Mellaril) 7. Molindone (Moban) Nonphenothiazines: Butyrophenones 1. Haloperidol (Haldol) 2. Droperidol (Inapsine) Thioxanthenes 1. Chlorprothixene (Taractan) 2.Thiothixene (Navane)

b. Major Tranquilizers Side Effects: Nursing Management: 1. CNS Depressant Effects: For CNS Depression: -dizziness, confusion, disorientation, ataxia, fatigue 1. Safety precautions 2. Avoid activities that requires Alertness (DRIVING) 2. Anticholinergic Effects: -everything is dry; dry eyes, dry mouth, constipation, urinary retention 3. Orthostatic Hypotension 4. Prolactin levels 5. PHOTOSENSITIVITY 6. Diminished libido, Erectile and orgasmic dysfunction 7. Weight gain 8. Pruritis 9. Neuroleptic Malignant Syndrome (NMS) For Anticholinergic Effects: 1. Relieve dry mouth. 2. CI in Pxs with galucoma For orthostatic hypotension: 1. Monitor BP 2. Gradual change of position 3. Assist in ambulation

Atypical 1. Clozapine (Clozaril)

2. 3. 4. 1.

5.

Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) New Generation Aripiprazole (Abilify)

FOR PHOTOSENSITIVITY: 1. Apply sunblock. (SPF:15-30) 2. Protective clothing.

Extra Pyramidal Symptoms (EPS) 12

Dystonia Risk: 1-5 days Frightening spasms of major muscle groups Torticollis Opisthotonus Oculogyric crisis

Pseudoparkinsonism Risk: 1-4 weeks Akinesia Rigidity Bilateral fine hand tremors, pill-rolling Mask-like face, drooling Shuffling, festinating gait

Akathisia Risk: 1-6 weeks Uncontrolled motor restlessness and the inability to sit still Pacing Foot tapping

Tardive Dyskinesia Risk: Long term use Involuntary: tongue movement sucking lip smacking chewing grimacing blinking licking

REVERSIBLE

REVERSIBLE

REVERSIBLE

IRREVERSIBLE

Anti EPS drugs: (Anticholinergic drugs) Benztropine COGENTIN Biperidin AKINETON Diphenhydramine BENADRYL Trihexyphenidyl ARTANE Procyclidine KEMADRINE Amantadine SYMMETREL Diazepam (Valium)

A B C D S

Artane; Akineton Benadryl Cogentin diazepam Symmetrel (Dopa agonist)

When is the best time to refill Clozapine? Q7d (meds are usually dispensed good for 7 days only) Typical Antipsychotics relieve what Sx? Positive Aypical Antipsychotics relieve what Sx? Both Positive and Negative Sx Most potent TYPICAL Antipsychotic: Haloperidol (Haldol) Major reason why Atypical Antipsychotics are preferred: Lesser EPS Lag period: 3-6 weeks DOC for Dystonia: Diphenhydramine (Benadryl) Beta-blocker used for Drug-induced Akathisia: Propranolol (Inderal)
ANTIDEPRESSANTS Referred to as: a. Mood elevator b. Psychic energizer
1. TCAs MOA: Blocks the reuptake of NE and 5-HT Side Effects:

Nursing Management:
-in general Interventions: 1. Initiate safety precautions. 2. Administer with meals. 3. Monitor the suicidal client especially during improved mood. 4. Instruct the client to change positions slowly. 5. Instruct the client to avoid driving and other activities requiring alertness.

Imipramine (Tofranil) Amitriptyline (Elavil) Trimipramine (Surmontil) Clomipramine (Anafranil) Maprotiline (Ludiomil) Protriptyline (Vivactil) Nortriptyline (Pamelor) Doxepin (Sinequan) Desipramine (Norpramine) Amoxapine (Asendin)

Photosensitivity Cardiovascular disturbances: arrhythmias Tachycardia Orthostatic hypotension Weight gain Decreased libido, Ejaculatory disturbances

Principles of MAOI &

13

2.SSRIs MOA: Blocks serotonin reuptake

Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro)

Side Effects: N/V Diarrhea Photosensitivity Insomnia Nervousness H/A, dizziness Male sexual dysfunction (ED)

TCA Administration 1. TCAs given first 2. Dont use together with alcohol 3. Expect a lag TCA: 2-4 weeks SSRI: 1-3 weeks MAOI: 2-6 weeks 4. Gap between meds: 14 days 5. Surgery: 10 days for MAOIs: 1. Assess for hypertensive crisis 2. Avoid tyramine-containing foods: Wine (except vodka), cheese (except cottage and cream), yogurt, vinegar

3. MAOIs MOA: Inhibits Monoamine Oxidase Tranylcypromine (Parnate) Phenelzine (Nardil) Isocarboxacid (Marplan) Rasagiline (Azilect) Selegiline (Eldepryl, Emsam)

Side Effects: Orthostatic hypotension Insomnia Weakness GI upset Weight gain Peripheral edema Delay in ejaculation HYPERTENSIVE CRISIS

Therapeutic effect of antidepressant: lifting of depression Foods to avoid when taking MAOI: Tyramine-rich foods Most recommended antidepressant: SSRIs 9safe and fewer cardiovascular SEs) DOC for OCD: Fluvoxamine (Luvox), Clomipramine (Anafranil)

ANTIMANIC Action: the release of norepinephrine

Availabilty: -Tablet -Capsule -Syrup Trade Name: Eskalith, Lithotabs, Lithobids, Cibalith, Lithonate Lag period: 10-21 days Points to ponder regarding LiCO3: 1. LiCO3 is maintained with 300mg T.I.D. 2. Blood level is checked 8-12 hours after last dose. Then: a. every week for the 1st month b. every 2-3 months 3. Therapeutic level * 0.5 1.5 mEq/L adults * ).6 1.8 mEq/L children

Side Effects:

a. Polyuria, Polydipsia, Dry mouth b. Anorexia, Nausea c. Weight gain d. Abdominal bloating e. Soft stools or diarrhea f. Fine hand tremors g. Inability to concentrate h. Muscle weakness, fatigue, i. H/A, drowsiness, dizziness j. Hair loss

Nursing Management: 1. Administer the medication on time and with food. 2. Do not skimp on dietary Na intake. 3. Drink 10-13 glasses of water per day. 4. Avoid excessive use of beverages containing caffeine and alcohol. 5. Notify physician if fever, PERSISTENT vomiting or diarrhea occurs. 6. Carry alert card always. 7. Lithium should be tapered off and not discontinued abruptly.

1. Lithium Toxicity Prodrome V A N D A L T

2. Lithium Intoxication (> 2.5 mEq/L) Nystagmus Impaired consciousness Oliguria or Anuria Seizure Coma Deatth

14

ANTICONVULSANTS Action: Prevents dissemination of electrical discharges in motor cortex area of the brain by enhancing GABA.

Hydantoins: -toin

1. phenytoin (Dilantin) Therapeutic level: 10-20 mcg/ml Toxic Level: >30 mcg/ml 2. ethotoin (Peganone) 3. mephenytoin (Mesantoin) 4. fosphenytoin (Cerebyx)

Side Effects: 1. Gingival hyperplasia a. Oral Care b. Use soft-bristled toothbrush c. Brush 2-3 times a day d. Massage gums 2. Slurred speech 3. confusion 4. Depression 5. N/V 6. Constipation 7. H/A 8. Hyperglycemia 9. Blood dyscracias (leukopenia/thrombocytopenia) 10. Alopecia 11. Hirsutism

Nursing Management: 1. Monitor serum level. 2. Monitor signs of toxicity. 3. IV phenytoin should be diluted in NSS (dextrose -> precipitate). 4. Good oral hygiene. 5. Increase folic acid. (interferes with folic acid absorption) 6. Do not stop drug abruptly (gradual as it can lead to status epilepticus) 7. Can turn urine pink, red, or red-brown. 8. Tablet can be crushed. (mix with food) 9. Suspension must be shaken well. (make sure accurate dosage is given) 10. Lag period: 7-10 days

Barbiturates -bital
1.phenobarbital ( Luminal)
2. amobarbital (Amytal) 3. pentobarbital (Nembutal) 4. secobarbital (Seconal) 5. mephobarbital (Mebaral) 6. thiopental Na (Pentothal Na) 7. butabarbital (Butisol) 8. primidone (Mysoline) Lag time: 3-4 weeks

Side Effects:

Nursing Management:

1. CNS depression a. dizziness, drowsiness b. ataxia c. hand tremors 2. Hypotension 3. Respiratory depression

MOA: hinders movement of impulses from the thalamus to the 1. carbamazepine (Tegretol) brain cortex. 2. valproic acid (Depakene) 3. divalproex Na (Depakote) 4. lamotrigine (Lamictal) 5. gabapentin (Neurontin) 6. falbamate (Felbatol) 7. topiramate ( Topamax) Most common side effect of phenytoin (Dilantin): Gingival Hyperplasia

Other Anticonvulsants:

1. Taken with food. (reduce gastric distress) 2. Do not discontinue abruptly. 3. Avoid alcohol. 4. Avoid activities that requires alertness. 5. Drowsiness in first few weeks & will decrease. 6. report symptoms of blood dyscrasias 7. Give reconstituted solutions within 30 minutes of mixing. 8. Teratogenic

ANTIPARKINSONS DRUGS Anticholinergics: Side Effects: Nursing Management:

MOA: Reduce tremors and rigidity by inhibiting Ach. 1. benztropine mesylate (Cogentin) 2. trihexiphenidyl ( Artane) 3. biperidine HCl (Akineton) 4. procyclydine HCl ( Kemadrin)

Dopaminergics:
1. amantadine (Symmetrel) 2. bromocriptine (Parlodel) 3. carbidopa-levodopa (Sinemet) 4. levodopa (Larodopa, Dopar)

1. CNS Depression a. Dyskinesia (impaired voluntary movement) b. Dizziness c. Ataxia d. Confusion 2. Anticholinergic Effects a. Urinary retention b. Constipation c. Dry mouth d. blurred vision 3. Orthostatic hypotension 4. Nausea and vomiting

1. Avoid foods high in Vitamin B6 (increases levodopa metabolism to dopamine in the PNS) and high protein foods. 2. Dont abruptly stop the drug. 3. Change position slowly. 4. Avoid alcohol 5. Discoloration of sweat and urine is harmless.

15

What vitamin should be avoided when taking levodopa? Pyridoxine

DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM

ANTIHYPERTENSIVES ABCD ACE Inhibitors:-pril Action: Prevents vasoconstriction by inhibiting conversion of Angiotensin I to Angiotensin II.
1. benazepril ( Lotensin) 2. captopril ( Capoten) 3. enalapril ( Vasotec) 4. fosinopril ( Monopril) 5. lisinopril ( Prinivil, Zestril) 6. ramipril (Altace) 7. losarten (Cozaar)

Side Effects:

Nursing Management:

1. N/V, diarrhea 2. Persistent cough 3. Hypotension 4. Tachycardia 5. Ageusia (1st month only) 6. Dizziness 7. H/A 8. Hypoglycemia

1. Monitor V/S: especially the BP. 2. Do not discontinue abruptly. 3. Avoid alcohol. 4. For orthostatic hypotension - avoid hot baths - gradual change of position

Beta Blockers: -olol Action:Blocks beta receptors.

1. acebutolol ( Sectral) 2. atenolol (Tenormin) 3. betaxolol (Betoptic) 4. esmolol (Brivibloc) 5. metoprolol (Lopressor) 6. nadolol (Corgard) 7. propranolol (Inderal)

Side Effects:
1. Bradycardia 2. Bronchospasm 3. Hypotension

ACE INHIBITORS -Expect dry cough BETA BLOCKERS -C/I: ASTHMA & COPD

4. N/V 5. Intensified hypoglycemia

8. pindolol (Visken) Calcium Channel Blockers -dipine Action:Inhibits movement of Ca across the cell
membrane into cardiac and smooth muscles

Side Effects:
1. Bradycardia 2. Hypotension 3. Headache 4. Dizziness 5. Constipation

1. verapamil ( Calan, Isoptin) 2. nifedipine (Procardia) 3. diltiazem (Cardizem) 4. amlodipine (Norvasc) 5. felodipine ( Plendil) 6. nicardipine (Cardene) 7. nimodipine (Nimotop)

Diuretics 1. LOOP DIURETICS Action: inhibit NA & Cl reabsorption

loop of Henle

Side Effects:
at the

Nursing Considerations:

1. furosemide (Lasix) 2. ethacrynic acid (Edecrin) 3. bumetamide (Bumex) 4. torsemide (Demadex)

2. THIAZIDE DIURETICS Action: blocks Na reabsorption

in the DCT

1. chlorothizide (Diuril) 2. hydrochlorothiazide ( HydroDIURIL, Esidrex) 3. benzthiazide (Exna)

1. Orthostatic Hypotension 2. Hyperuricemia 3. Drowsiness 4. H/A 5. Anorexia 6. Hypokalemia except Ksparing 7. Rash 8. Hyponatremia 9. Dehydration For Thiazide: 1. Hypercalcemia For K-sparing: 1. Hyperkalemia

1. Give early in the morning. (prevent nocturia) 2. Monitor I/O and weight. 3. Make positional changes slowly. 4. Administer with food. 5. Monitor for fluid and electrolyte Imbalance. HYPOKALEMIA HYPERKALEMIA HYPERCALCEMIA 6. Assess BP before administration. 7. Consume foods rich in K.

3. OSMOTIC DIURETIC Action: inhibit reabsorption

1. mannitol (Osmitrol)

of F/E

16

2. urea (Ureaphil)

4. POTASSIUM SPARING DIURETIC Action: blocks aldosterone, inhibits

reabsorption of water & Na

1. spironolactone (Aldactone) 2. amiloride ( Midamor) 3. triamterene ( Dyrenium)

NOTE: OSMOTIC DIURETICS DECREASE ICP; DEC. IOP IN NARROW-ANGLE GLAUCOMA NOTE: CAI DECREASE IOP IN OPEN-ANGLE GLAUCOMA; USED TO TREAT METABOLIC ALKALOSIS

8. For potassium sparing:

Monitor for kidney

function.
Avoid K-rich foods.

5. CARBONIC ANHYDRASE INHIBITORS Action: Promotes excretion of Na,

and water.

K, HCO3,

1. acetazolamide (Diamox) 2. dichlorphenamide (Daranide) 3. Methazolamide (Neptazane) Side Effects:

9. Antidote for Hyperkalemia: *Na polystyrene sulfate (Kayexalate) -exchanges Na for K in the colon; rectal or oral *IV NaHCO3 = promotes intracellular shift of K *Insulin and glucose = promotes intracellular shift of K

DIRECT ACTING VASODILATORS Action: Promotes direct relaxation of

arteriolar smooth muscle causing vasoldilation.

1. hydralazine (Apresoline) 2. nitroprusside ( Nipride, Nitropress) 3. diazoxide ( Hyperstat) 4. nitroglycerine (Nitrobid) 5. minoxidil (Loniten)

a. Hypotension b. Palpitations c. H/A d. Confusion and dizziness

Nursing Considerations: 1. Monitor V/S. 2. Na Nitroprusside a. Monitor cyanide and thiocyanate levels. b. Protect from light. (cos drug decomposes) IV tubing and container must be covered in aluminum foil. c. Discard if medication is red/blue.

DOC for Angina Pectoris: NTG Diuretic drug for cerebral edema: Mannitol (Osmitrol) Calcium Sparing Diuretic: Thiazide Diuretic for Metabolic Alkalosis: CAI

Drug used for Hypertensive Crisis: Nitroprusside (Nipride) Beta blocker used to tx akathisia: Propranolol (Inderal)
NITRATES Action: Decrease preload and afterload thus reduce myocardial oxygen consumption.
1. nitroglycerine (Nitrostat, Nitrobid) 2. isosorbide dinitrate (Isordil) 3. isosorbide mononitrate (Imdur) Onset: SL: 1-3 mins SR Cap: 20-45 mins Ung: 20-60 mins Patch: 30-60 mins IV: 1-3 mins

Side Effects:

Headache Orthostatic Hypotension

Dizziness Faintness Flushing or pallor Patch/Ung Sites: Chest, back, abdomen, upper arm, anterior thigh

Nursing Management: 1. Rise slowly. 2. Best taken when seated 3. Expect for headache SL: 1. One tablet every 5 minutes (for a total of 3 doses). 2. Store drug in a dark container 3. Shell life: 3 - 6 months 4. Expect for SUBLINGUAL TINGLING (potent) Patch: 1. Apply on hairless area 2. Remove patch after 12-14H (remain patch free for 10-12H to avoid tolerance) Ung: 1. Remove previous Ung from skin 2. Spread over a 6x6 inch area & cover w/ a plastic wrap

17

CARDIAC GLYCOSIDES/DIGITALIS ACTION: positive inotropy (thus increasing cardiac output; used for CHF); negative chronotropy

Nursing Management:
1. digoxin ( Lanoxin) 2. digitoxin ( Crystodigin) SE: -dizziness, drowsiness -fatigue -insomnia -H/A

Monitor for toxicity:

Bradycardia Anorexia N/V Diarrhea Abdominal cramps Visual disturbances blurred vision, green or yellow halos

1. Assess APICAL PULSE (withhold if <60bpm & notify Ap) 2. Monitor serum potassiumand Encourage foods high in K. (N: 3.5-5; hypoK inc digoxin toxicity) 3. Monitor therapeutic level. (0.5-2ng/ml; 10-35ng/mldigitoxin)

4. Antidote: Digoxin immune Fab

(Digibind)

5. Monitor for sign of effectiveness:

When is the best time to refill nitroglycerin? Q6mos An indication of nitroglycerin effectivess: Relief from chest pain An Indication of SL NTG potency: Tingling or burning sensation under the tongue Most common side effect of nitroglycerine: H/A Important assessment before giving digoxin: Apical pulse >60 bpm Electrolyte to monitor when taking digoxin: Potassium Earliest Sx of Digoxin toxicity: Bradycardia Antidote for Digoxin: Digoxin Immune Fab (Digibind) Effect of Hypokalemia in clients taking Digoxin: Increased risk for toxicity

ANTICOAGULANTS Action: Inhibits clot formation. Subcutaneous:

1. heparin (Liquaemin) 2. enoxaparin (Lovenox) 3. ardeparin (Normiflo) 4. danaparoid (Orgaran)

(therapy: 7-14days) ORAL: (blocks prothrombin synthesis)

1. warfarin (Coumadin) (usu given for 2-3 mos after MI) 2. bihydrooxycoumarin (Dicumarol) 3. anisindione (Miradon) (Ordered seldomly) Nursing Management: very important 1. Assess for bleeding

Side effects: a. Hemorrhage b. Hematuria c. Epistaxis d. Ecchymosis e. Bleeding gums f. Thrombocytopenia g. Hypotension

Nursing Management:

1. Do not aspirate (to prevent hematoma) 2. Antidote at bedside: Heparin: Protamine sulfate Warfarin: Vitamin K 3. Monitor Coagulation tests: Heparin: aPTT (N:20-36s x INR: 1.5-2/ maintain at 60-80s) Warfarin: PT (N:9.6-11.8s x 2-3 =19 -36) 4. For warfarin: a. desired effect: 2-3 days

b. avoid green leafy vegetables

2. Bleeding Precautions: 3. Avoid taking with ASPIRIN

THROMBOLYTICS -ase Action: Dissolve clots.

Indicated: Pulmonary emboli, DVT, MI (w/in 46H of the onset of the infarct to restore blood flow) 1. streptokinase (Streptase) 2. urokinase (Abbokinase) 3. alteplase (Tissue Plasminogen Activator [tPA])

Side Effects: a. Bleeding b. Dysrhythmias c. Fever d. Allergic Reactions

Nursing Management:

1. Bleeding precautions. 2. Asses pulses. (tachycardia) 3. Pressure over puncture site for 20-30 mins. 4. Use electric razor for shaving and soft toothbrush. 5. Antidote: Aminocaproic acid (Amicar)

18

Rapid acting anticoagulant: Heparin (Liquaemin)

Used to monitor effectiveness of warfarin: PT

Foods to avoid if on Dicumarol: Vit K rich foods sulfate Antidote for Thrombolytics: Aminocaproic acid (Amicar)

Antidote for Heparin: Protamine Antidote for Warfarin: Vit. K

DRUGS AFFECTING THE DIGESTIVE SYSTEM ANTI-ULCERS

ANTACIDS: Action: Neutralize gastric acids (by inactivating pepsin)
ALUMINUM-BASED: 1. aluminum hydroxide (Amphojel) 2. aluminum carbonate (Basaljel)
Side Effect: -Constipation

MAGNESIUM-BASED: 1.magnesium hydroxide (Milk of Magnesia)

CALCIUM-BASED: 1.calcium carbonate (Tums, Dicarbosil) Side Effect: -Constipation, belching, flatulence, HyperCa, H/A

Side Effect:

Al-Mg COMBINATION 1. Mg-Al hydroxide ( Maalox, Mylanta) 2. Mg-Al trisilicate (Gaviscon) 3. magaldrate (Riopan)

-Diarrhea Nursing Management: Antacids

1. Taken 1-2 hours after meal. 2. Never give along with other drugs. (1H gap)

for aluminum based:

for calcium based:

for magnesium based: -CI for RF

-Hypophosphatemia -dont take w/ Vit D

H2 BLOCKERS -tidine TPAZ Action: Supress secretion of gastric acid.

1. cimetidine (Tagamet) 2. famotidine (Pepcid) 3. nizatidine (Axid) 4. ranitidine ( Zantac)

Side Effects: a. Confusion b. Dizziness, drowsiness c. H/A d. Depression Side Effects:

Nursing Management:

1. Taken with meals. 2. Never give along with antacids. (decrease absorption) 3. Stop smoking. (dec effect) 4. Caution with CNS S/Es.

PROTON PUMP INHIBITORS: -prazole

Action: Supress secretion of gastric acid

up to 90% greater than H2 blockers.

1. esomeprazole (Nexium) 2. lansoprazole ( Prevacid) 3. omeprazole ( Prilosec) 4. pantoprazole (Protonix) 5. rabeprazole (Aciphex)

a. Diarrhea b. Abdominal pain c. Nausea d. H/A

Nursing Management
1. Taken before meal 2. Monitor lab tests - liver function test - renal function test

MUCOSAL PROTECTIVE DRUGS ACTION: Covers and protect the ulcer from acid and pepsin.
1. sucralfate (Carafate) 2. misoprostol (Cytotec)

Side Effects: For Sucralfate: a. Sleepiness b. Constipation c. Dry mouth d. back pain For Misoprostol: a. Diarrhea b. Abdominal pain c. Flatulence

Nursing Management: 1. Taken before meals and HS. 2. Increase fluids, dietary bulk, , and exercise. 3. Separate administration from other drugs. (by 2H;dec absorption of warfarin, phenytoin, theophylline, digoxin, tetracycline) 4.Avoid gastric irritants. (caffeine, alcohol, spices) For Misoprostol: 1. Taken with meals. 2. CI in pregnant women.

DOC for GERD: Proton Pump Inhibitors especially esomeprazole (Nexium) Common side effect of Magnesium-based: Common side effect of Aluminum-based: Antacid of choice for hyperphosphatemia: H2 blocker that has CNS side effects: Cimetidine (Tagamet) An abortive drug: Misoprostol (Cytotec)

19

 PAIN MEDICATIONS: NON-NARCOTICS:

1.acetylsalicylic acid (Aspirin [Ecotrin, Bayer, Aspilet] [buffered: AlkaSeltzer, Bufferin]) 4 As Antipyretic Analgesic Anti-inflammatory Antiplatelet

Side Effects:

Nursing Management:

a. GI Bleeding (melena, hematochezia) b. Epistaxis c. Bruising d. Diarrhea Aspirin/ Salicylate Toxicity: a. Tinnitus (earliest) b. Confusion c. Dizziness d. Metabolic acidosis e. Respi alkalosis

1. Take with food, antacid, or milk. 2. Avoid giving to children with Viral Infection. (may cause Reyes Syn) 3. Never give along with anticoagulants. (potentiates anticoag) 4. Report signs of bleeding. 5. Assess for hearing problems. 6. Avoid use in pregnant women. 7. Should not be taken with NSAIDs. (dec effect of nsaids) 8. D/C 3-7 days before surgery.

2. acetaminophen ( Tylenol) -Antipyretic -Analgesic

Side Effects:

a. Anorexia b. N/V c. Hypoglycemia adverse effect: HEPATOXICITY

Nursing Management:

1. Assess history of liver dysfunction. 2. Monitor hepatic damage. (N/V, diarrhea, abdominal pain) 3. Monitor liver enzyme tests. 4. Antidote: Acetylcysteine (Mucomyst)

NSAIDS: Action:Inhibit synthesis of Prostaglandin

(prostaglandin inhibitors)

Side effects:

Indications: Pain, Arthritis

1. diclofenac Na (Voltaren) 2. ibuprofen (Motrin, Advil) 3. naproxen (Flanax, Naprosyn, Anaprox) 4. ketorolac (Toradol) (1st injectable NSAID [IM]) 5. piroxicam (Feldene) 6. indomethacin (Indocin) 7. mefenamic acid (Ponstan) 8. sulindac (Clinoril) 9. diflunisal (Dolobid)

a. Gastric irritation b. Dizziness c. Tinnitus d. Hypotension e. Na and H2O retention

Nursing Management:
1. Take with food.

2. Do not take with Aspirin. 3. Monitor liver enzymes.

NARCOTICS/OPIATES Action: Blocks pain receptors. (induces

sedation, analgesia, euphoria)

Side Effects:
a. Dizziness b. Decrease RR c. Hypotension d. Constipation

Nursing Management:

1. Assess RR/VS. (w/hold:RR=12cpm) 2. Antidote at bedside

Indications: Moderate to severe pain

1. morphine (Morphine SO4) 2. codeine (Codeine SO4) 3. meperidine HCl (Demerol) 4. oxycodone (Oxycontin) 5. propoxyhene (Darvon) 6. methadone (Dolophine) 7. hydromorphone (Dilaudid) 8. fentanyl (Duragesic) 9. pentazocine (Talwin) 10. nalbuphine (Nubain) 11. Butorphanol (Stadol)

*Narcan = IM, IV, SC: qive q2-3 mins *Revia = PO once per day given after Narcan

*Oxycodone + Aspirin: Percodan *Oxycodone + Acetaminophen: Percocet *Darvon contains aspirin *Darvon-N: acetaminophen

* 3. Avoid alcohol. (CNS depression) 4. Safety precautions. (CNS depression) -side rails, night light, supervised ambulation

Narcotic of choice for pancreatitis (pain): Meperidine HCl (Demerol) NSAID used for the closure of Patent Ductus Arteriosus: Indomethacin (Indocin) Drug of choice for opioid withdrawal: Methadone (Dolophine) (replacement med for opiate dependence/withdrawal)

20

 ENDOCRINE DRUGS INSULIN -action: Facilitates transport of glucose across the cell.
SHORT-ACTING Insulin Type Regular -Regular Iletin -Humulin R -Novolin R -Semilente 30 mins 1H 2 4H 6 12H INTERMEDIATE NPH (Isophane) - NPH Iletin -Humulin N - Actrapid N - Lente 24H 6 -12 H 18 24 H LONG-ACTING Ultralente - Humulin U

Onset Peak Duration

6 12 H 18 24 H 36 72 H

Nursing Management:

1. Rotate injection sites. (lipodystrophy: lipohypetrophy=devt of fibrous fatty masses caused by repeated use of an injection site; abdomen, arms [posterior], thigh [anterior], hips) 2. Do not massage. (increase absorption rates thus hypoglycemia) 3. When mixing 2 insulins : *Inject air: N R *Withdrawing of insulin: R- N 4. Stable at room temperature, if prefilled or mixed keep refrigerated (not frozen). 5. Dont inject cold insulin. (lipodystrophy: lipoatrophy loss of SC fat and appears as slight dimpling) 6. Gently roll insulin bottle before use. Dont shake. (to ensure insulin is mixed well; bubbles will cause inaccurate dosage) Intervention for Hypoglycemia: 7. Monitor blood glucose level. if conscious: give fast acting simple CHO 8. Avoid smoking. (dec insulin absorption) if unconscious: 9. Assess for hypoglycemia hospital: 25 50 ml of D50 W T -tired I -irritability R -restless E excessive hunger D -diaphoresis home: Glucagon (SC/ IM, 2nd dose at 10 mins if client remains unconscious))

ORAL HYPOGLYCEMIC AGENTS - Sulfonylureas: Action: Stimulates beta cells of the pancreas to produce more insulin. chlorpropamide (Diabinese) tolazamide (Tolinase) tolbutamide (Orinase) -Non-Sulfonylureas: Action: hepatic glucose production metformin (Glucophage)

- second generation sulfonylureas: glimiperide (Amaryl) glipizide (Glucotrol) glyburide (Diabeta)

acarbose (Precose)

miglitol (Glyset)

rosiglitazone (Avandia)

NURSING ALERT!!! * Assess allergy to sulfur!!! [For sulfonylureas] * Take with meals. * Avoid alcohol. [trigger hypoglycemic rxn] *Inform the client that insulin is needed during stress, infection, or surgery.

Only IV type Insulin: Regular insulin Site with even and rapid insulin absorption: Abdomen Distance between insulin site injections: 1 inches (2.54 cm) Most common premixed insulin: NPH Regular

21

ANTIINFECTIVE MEDICATIONS 1. ANTIBIOTICS Aminoglycosides:

Indications: gram negative infections -Escherichia Coli -Klebsiella -Enterobacter

-micin or -mycin

Fluoroquinolones: -floxacin
broad spectrum Indications: wide range of gram + and gram -UTI -bronchitis -STDs -bone and joint infection 1. ciprofloxacin (Cipro) 2. levofloxacin (Levaquin) 3. norfloxacin (Noroxin) 4. ofloxacin (Floxin)

1. gentamicin sulfate (Garamycin) 2. neomycin sulfate (Mycifradin) 3. kanamycin sulfate (Kantrex) 4. streptomycin sulfate (Streptomycin)

Cephalosporins ceph/-cef
First Generation 1. cefadroxil (Duricef) 2. cefazolin (Ancef, Kefzol) 3. cephalexin (Keflex) 4. cephapirin (Cefadyl)

Second Generation 1. cefaclor (Ceclor) 2. cefmetazole (Zefazone) 3. cefonicid (Monocid) 4. cefotetan (Cefotan) 5. cefoxitin (Mefoxin) 6. cefpodoxime (Vantin) 7. cefprozil (Cefzil) 8. cefuroxime (Zinacef)

Third Generation 1. cefdinir (Omnicef) 2. cefixime (Suprax) 3. cefoperazone (Cefobid) 4. cefotaxime (Claforan) 5. ceftazidime (Fortaz) 6. ceftibuten (Cedax) 7. ceftizoxime (Cefizox) 8. ceftriaxone (Rocephin)

Macrolides: -mycin
1. erythromycin (Erythrocin) 2. azithromycin (Zithromax) 3. clarithromycin (Biaxin)

Pennicillins: -cillin
1. amoxicillin (Amoxil) 2. ampicillin (Omnipen) 3. cloxacillin (Apo-Cloxi) 4. methicillin (Staphcilin) 5. penicillin G (Pentids) 6. penicillin V (V-Cillin) 7. amoxicillin cluvanate (Augmentin)

Sulfonamides: -sulf
1. sulfixazole (Gantrisin) 2. sulfamethoxazole-trimthoprim(Bactrim) 3. sulfasalazine (Azuldifine)

Tetracyclines: -cycline
1. tetracycline (Achromycin) 2. doxycycline (Vibramycin) 3. democlocycline (Declomycin) 4. minocycline (Minocin)

Nursing Management:

1. Obtain culture 2. Monitor for allergic reaction 3. Taken best on empty stomach

4. Monitor I&O and renal function 5. Adequate hydration 6. Monitor hearing and balance

2. ANTIVIRALS

1. acyclovir (Zovirax) 2. cidofovir (Vistide) 3. indinavir (Crixivan0 4. ritonavir (Norvir) 5. ganciclovir (Cytovene)

Adverse Effects:

-Bone Marrow Suppression -Nephrotoxicity Side Effects: 1. headache 2. nausea and vomiting

Nursing Management:

1. Monitor CBC 2. Increase Vitamins ACE 3. Increase Fiber

Antiretrovirals:
6. 7. 8. 9.

zidovudine (AZT,Retrovir) lamivudine (Epivir) stavudine (Zerit) nevirapine (Viramune)

22

3. ANTIFUNGALS
1. amphotecerin B(Fungizone) 2. ketoconazole (Nizoral) 3. miconazole (Monistat) 4. nystatin (Mycostatin) 5. clotrimoxazole (Mycelex) 6. fluconazole (Dilfulcan)

Indications:

1. candidiasis 2. histoplasmosis 3. ringworm infections of the skin

Nursing Management:

1. Monitor BUN, Creatinine, 2. Take with food 3. Take full course of meds 4. Hygeine measures 5. Infusion pump

4. ANTIPROTOZOAL
1. metronidazole (Flagyl) 2. eflornithine (Ornidyl) 3. hydroxychloroquine (Plaquenil) 4. pentamidine (Pentam 300)

Indications:

1. Trichomoniasis 2. Amoebiasis 3. Giardiasis 4. PCP 5. Malaria

Nursing Management:
1. best taken with food 2. avoid alcohol 3. Monitor S/Es: 4. Reminder: this drug is teratogenic

Remember: 1. Metronidazole (Flagyl) should not be taken with alcohol because it can cause disulfiram-like reactions (Antabuse-like reactions). 2. Remember the brand names and the different preparations of Lithium carbonate. 3. Diazepam (Valium) is commonly asked in the exam. 4. Propofol (Diprivan) is a sedative given to clients in mechanical ventilation and to those undergoing surgical procedures. It is milk-like or cream-like in color. This is given intravenously. It was rumored that M.J. died from propofol overdose. 5. R.A. 9165 Comprehensive Dangerous Drugs Act of 2002 6. R.A. 9502 Cheaper Medicines Act of 2008 authored by Sen. Mar Roxas 7. R.A. 6675 Generics Act

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