Pharmacology Study Guide
A comprehensive study guide that will supplement your pharmacology
lectures and readings
By: Barbara O.
Instagram: @yournursingeducator
E-mail: yournursingeducator@gmail.com
*Disclaimer: This PDF was created by cross referencing several resources. It is not meant to replace your pharmacology lecture/study notes or drug guide book but is
instead a supplementary resource to aid in studying. While all attempts were made to ensure accuracy, there is no guarantee of validity or accuracy. The purchaser of
this guide assumes all responsibility for the use of this material.
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Table of Contents
General Pharmacology Information …………………………………………………………………………………… 3
Autonomic Nervous System Drugs ……………………………………………..……………………………………… 5
Neurological + Neuromuscular Drugs ………………………………………………………………………………. 10
Analgesics ………………………………………..………………………………………………………………………………. 16
Cardiovascular Drugs ……………………………….…………………………………………………………………….… 19
Respiratory Drugs ………………………………………………………………………………..…………………………… 27
Gastrointestinal Drugs ……………………………………………………………………………………………………… 30
Genitourinary Drug ………………………………………………………..………………………………………………… 35
Hematology Drug …………………………………………………………..………………………………………………… 38
Endocrine Drugs ………………………………………………………..…………………………………………………..… 41
Mental Health Drugs ……………………………………….………..…………………………………………………..… 44
Substances of Addiction …………………………………………………………………………………………………… 49
Immune, Antibiotic/Antiviral, & Anti-Inflammatory Drugs ……………………………………………..… 52
Fluids and Electrolytes …………………………………………..…..…………………………………………………..… 57
Quick Overview of Drugs………………………………………………………..…….………………………………..… 59
Common Medication Prefixes and Suffixes………………………………………………………………………. 64
Medication Calculation ………………………………………………………..………………………………………..… 65
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GENERAL PHARMACOLOGY INFORMATION
Classifications
Therapeutic class: broad purpose of drug (e.g. antihypertensive is used for HTN)
Pharmacologic class: specific pharmacological approach within the therapeutic class (e.g. beta blocker, calcium channel
blocker, etc. are within the antihypertensive therapeutic class)
Generic name: actual name of the drug (e.g. amlodipine)
Trade name: the name that the drug is marketed under; several different ways to name the generic drug (e.g. Norvasc)
FDA Pregnancy Categories
A: good studies show no risk of fetal abnormalities; good human research – no risk
B: safe in animals but not adequate enough studies in humans OR adverse effect in animal studies but human studies do
not show increased risk; safe in animals but no studies in humans or no harm in humans
C: adverse effect in animals but no good studies in humans OR no animal studies and no human studies; no evidence of
good or bad in humans
D: risk to fetus but benefits may outweigh risk; evidence of harm in humans
X: causes fetal abnormalities; should not be used during pregnancy
Routes of Administration
Enteral – through GI tract
1. Tablets/Capsules – some can be enteric coated (prevents digestion by stomach acids)
2. Sublingual/Buccal – drug goes directly into blood due to amount of blood vessels in this area
3. Nasogastric/Gastric (G-tube)
Topical – applied to intended site of action
1. Transdermal
2. Ophthalmic
3. Otic
4. Nasal
5. Respiratory – administered via inhalation
6. Vaginal or rectal – suppositories, ointments, creams, gels; for irritation or infection
Parenteral – involves needles penetrating skin
1. Intradermal – rapid absorption due to vasculature; local anaesthetics or allergy testing
2. Subcutaneous – insulin, heparin, vaccines; no more than 1 mL to be injected
3. Intramuscular – faster than ID or SC; proper landmarking needed; no more than 3 mL to be injected
4. Intravenous – very rapid onset; continuous infusion, intermittent infusion, IV push
Pharmacokinetics
Absorption → distribution → metabolism → excretion
1. Oral → Stomach/small intestine → Absorbed/Carried by Portal Vein/blood supply → Liver (Primary Site of
metabolism in body) → Two possibilities:
1. Systemic Circulation → Tissue (Heart/Brain/Muscle/Kidney)
2. Excretion (Biliary) (Gall bladder/Bile ducts) → small-large intestines → Excretion (feces)
2. Parenteral/ Other routes → Directly absorbed into Systemic Circulation → Two possibilities:
1. Systemic Circulation → Tissue (Heart/Brain/Muscle/Kidney)
2. Excretion (Biliary) (Gall bladder/Bile ducts) → small-large intestines → Excretion (feces)
Adverse Effects
Unintended & undesired responses from drugs
1.
Side effects
• Secondary to main therapeutic effect of drug & are expected
• Often occur at normal doses & are often unavoidable
• Often due to poor specificity/selectivity of drug.
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2.
3.
4.
5.
6.
7.
E.g. antihistamines block H1 histamine receptors preventing allergy symptoms (runny nose, watery eyes).
Side effects include drowsiness, dry mouth & urinary retention
Drug toxicity: any severe adverse drug event
• Often mediated by overdose
• Reactions are often extensions of therapeutic effect
o E.g. patient taking too much insulin = hypoglycemia
Allergic Reactions: mediated by immune system
• Requires prior sensitization where patient is exposed to allergen (ie. drug)
• Upon subsequent exposure, an allergic reaction occurs → mast cells release chemical mediators such as
histamine
• Reactions can vary from itching rash to life threatening anaphylaxis (bronchospasm, edema, & severe
hypotension)
• Intensity is independent of dosage size (ie. small dose can produce severe allergy)
Idiosyncratic Reaction: reactions that occur rarely & unpredictably
• Genetic polymorphisms account for majority of idiosyncratic reactions
• Examples of genetic polymorphisms that cause idiosyncratic reactions:
▪ CYP2C9: polymorphism decreasing metabolism (15% Caucasians)
▪ CYP2D6: poor metabolizers (10% African American/Caucasian). Patients do not experience pain relief when
taking codeine (drug metabolized by CYP2D6 → morphine)
▪ Glucose 6-Phosphate dehydrogenase deficiency (G6PDH): enzyme important in red blood cell metabolism.
Deficiency common in African/Middle-Eastern. Patients w/ deficiency may have red blood cell hemolysis w/
certain analgesics (ie. Aspirin) or anti-malarial drugs.
Carcinogenic Effects: ability of a drug to cause cancer
• Few drugs are carcinogenic
• Diethylstilbestrol (DES) used to be given to prevent spontaneous abortion is high risk pregnancies. Years later →
female offspring = vaginal/uterine cancer
Mutagenic Effects: changes DNA & often carcinogenic or teratogenic
• Drugs that aren’t carcinogenic or teratogenic may receive approval for use from regulatory agencies if there is
sufficient evidence of safety from preclinical studies
Teratogenic Effects: produce birth defects or impair fertility
• Defects include behavioural & metabolic defects
• Sensitivity to teratogens changes during development.
• Gross malformation typically occurs in the 1st trimester
• Exposure during 2nd + 3rd trimesters usually disrupts function as opposed to gross anatomy
• Drug transfer across placenta is greatest in 3rd trimester (surface area for transfer between maternal & fetal
circulation increases as placenta develops)
Main Neurotransmitters to Know
Acetylcholine (Ach) – found throughout nervous system; sends + received information between the motor neurons and
voluntary muscles (muscles you have conscious control over). Every movement you make depends on the release of Ach
from your motor neurons to your muscles
Dopamine (DA) – used by neurons to make voluntary movements + movements in response to emotion. Also plays role in
pleasure/reward system in brain. Also crucial in focus + memory
Norepinephrine (NE) – regulates mood + arousal (known as the stress hormone); Used in fight or flight - NE increases O2
to brain, increases HR and BP when needed, shuts down metabolic processes in stressful events to preserve energy, etc.
Serotonin – plays large role in mood, sleep, wakefulness, and eating behaviours
GABA + Glutamate – These 2 are the most plentiful neurotransmitters in the brain. GABA produces an inhibitory
postsynaptic potential; it decreases the likelihood that a neuron will fire an action potential. Inhibitory = allows for us to
stay calm/not overwhelm ourselves Glutamate produces an excitatory postsynaptic potential; it increases the likelihood
that a neuron will fire an action potential. Excitatory = contributes to learning + memory
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AUTONOMIC NERVOUS SYSTEM DRUGS
Autonomic nervous system (ANS) regulates involuntary functions including heart rate, respiratory rate, and
digestion by balancing sympathetic nervous system (SNS) and parasympathetic nervous system (PNS)
Cholinergic drugs
Promotes action of neurotransmitter acetylcholine (Ach) = increase in Ach
Stimulates PNS – rest & relaxation
1. Cholinergic agonist
• Mechanism of Action (MOA): stimulates cholinergic receptors (mimics action of Ach) → allows
body to ‘rest & relax’
• Produces these effects: salivation, bradycardia, dilated blood vessels, constriction of bronchioles,
increased GI activity, increased contraction of bladder muscles, and constriction of pupils
• Used for: weak bladder, abdominal distention, constriction of pupils/high eye pressure, and
hypofunction of salivary gland
• Side effects: nausea (N)/vomiting (V)/diarrhea (D), blurred vision, bradycardia, hypotension, SOB,
urinary frequency, increased salivation, diaphoresis, corneal clouding, abdo pain/cramps, and
flushing
• Rarely administered by IV/IM route due to immediate breakdown by cholinesterase and due to
potential of cholinergic crisis (extreme muscle weakness + possible paralysis of respiratory
muscles)
Cholinergic drugs
Drug
Acetylcholine
→ Miochol E
Bethanechol
→ Urecholine
Carbachol
→ Miostat
Indication
Constriction of pupil during ocular
surgery
Urinary retention
Pilocarpine
→ Isopto
Carpine, Pilocar
Xerostomia (dry mouth)
Glaucoma, inhibition of
perioperative intraocular pressure
Nursing
Instill into anterior chamber of eye
Potential for influx infection if the sphincter
doesn’t relax
Instill to anterior chamber of eye.
Contraindicated in inflammation of anterior
chamber
Inform pt that blurred vision can impair driving,
particularly @ night
2. Anticholinesterase drugs
• MOA: normally, Ach is broken down by the enzyme acetylcholinesterase. By destroying this
enzyme, more Ach accumulates → allows body to ‘rest & relax’
• Used to: decrease eye pressure, increase bladder tone, improve peristalsis, promote contraction
in myasthenia gravis, diagnose myasthenia gravis, and temporarily improve dementia
• Side effects: arrhythmias, N/V/D, seizures, headache, anorexia, pruritius, urinary frequency,
induction of preterm labor, SOB
• Build-up of Ach can precipitate cholinergic crisis (S/S: abdo cramps, N/V/D, pupillary miosis,
hypotension, increased secretions/salivation/perspiration, bronchospasm, bradycardia)
• When quick effect is needed = use IV/IM route
Drug
Donepezil
→ Aricept
Anticholinesterase drugs
Indication
Nursing
Alzheimer’s Disease
Important to take daily at same time (usually
before bed)
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Edrophonium
→ Enlon
Galantamine
→ Razadyne
Neostigmine
→Prostigmin
Pyridostigmine
→ Mestinon
Rivastigmine
→ Exelon
Tacrine
→ Cognex
Diagnosing Myasthenia Gravis (MG),
reversing a nondepolarizing
neuromuscular blocker
Alzheimer’s disease
Myasthenia Gravis, post-op distention or
urinary retention
Myasthenia Gravis, reversal of muscle
relaxants
Alzheimer’s disease
Alzheimer’s disease
If muscle weakness occurs during MG
diagnosis test, discontinue drug and give
atropine IV
Administer twice daily (morning and evening)
with food
Contraindicated in peritonitis or mechanical
GI obstruction
Contraindicated in mechanical GI or urinary
obstruction
Take at regular intervals. Remind pt that drug
can cause dizziness; avoid driving
Can cause hepatic impairment – monitor LFTs
Anticholinergic drugs
Also known as cholinergic blockers
Interrupt PNS impulses; prevent Ach from stimulating cholinergic receptors = decrease in Ach
These drugs will do the OPPOSITE of above cholinergic drugs
• MOA: Competitively inhibits the action of Ach
• Used to: treat nausea, treat Parkinson’s, relax the GI and GU system, manage headaches, dilate the
lungs, dilate the eye, and increase heart rate
• Side effects: dry mouth, dry eyes, dry nasal passage, blurred vision, urinary hesitancy or retention,
constipation, tachycardia
• Contraindicated in: narrow angle glaucoma, hemorrhage, tachycardia, and myasthenia gravis
Anticholinergics
Drug
Atropine
Indications
Symptomatic sinus bradycardia
Ipratropium
→ Atrovent
COPD, acute asthma exacerbation
Scopolamine
→ Scopace
Glycopyrrolate
→ Robinul
Nausea, vomiting, motion sickness
prophylaxis, chemotherapy induced N & V
Pre- and post- op reduction of saliva, drooling
Benztropine
→ Cogentin
Parkinsonism, drug-induced extrapyramidal
disorders (S/S: restlessness, rigidity, tremors,
pill rolling, masklike face, shuffling gait, muscle
spasms, twisting motions, difficulty speaking,
loss of balance)
Irritable bowel syndrome (IBS)
Dicyclomine
→ Bentyl
Oxybutynin
→ Ditropan
XL
Overactive bladder (incontinence, frequency,
urgency)
Nursing
Monitor ECG and heart rate (can cause
increased HR and ventricular ectopy). Also
monitor intake + output due to possible
retention
Administered via nebulizer or inhaler.
If administered with other inhalers, administer
adrenergic bronchodilators first, followed by
ipratropium, then corticosteroids. Wait 5 min
between each
Administered via transdermal patch, IV, IM, or
SC. Contraindicated in closed angle glaucoma
May increase GI lesions in patients taking oral
potassium chloride tablets. Monitor intake +
output – can cause retention
PO dose to be taken with food. Therapeutic
effects seen in 2-3 days. Frequent rinsing of
mouth will decrease dryness.
Administer 30 mins before meals and at
bedtime. Monitor intake + output due to
possible retention. Monitor for drowsiness
Administered PO, transdermal patch, or
transdermal gel. Contraindicated in glaucoma,
intestinal obstruction, and urinary retention
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Tolterodine
→ Detrol
Overactive bladder (urge incontinence)
Assess for rash during therapy; can cause
Stevens-Johnson syndrome. Stop medication if
accompanied with fever, general malaise,
fatigue, muscle or joint aches, blisters, oral
lesions, conjunctivitis, or hepatitis.
High doses can cause prolonged QT complex
Adrenergic drugs
Also called sympathomimetic drugs
Produce effects similar to SNS – fight or flight = increase in norepinephrine (NE)
• MOA: direct acting adrenergic = the drug directly stimulates adrenergic receptors. Indirect acting
adrenergic = drug stimulates the release of norepinephrine from nerve endings
• Receptor sites:
o Alpha1 adrenergic receptors = cause vasoconstriction, papillary dilation, closure of sphincter and
bladder
o Alpha2 adrenergic receptors = cause decreased SNS activity, reduced NE release, insulin release
o Beta1 adrenergic receptors = located in heart; cause increased HR and increased force of
contraction
o Beta2 adrenergic receptors = cause vasodilation, bronchodilation, increased release of glucagon
o Dopamine receptors
1. Catecholamines
• Primarily direct-acting adrenergics
• Produce these effects: constrict blood vessels, increase heart rate, increase blood pressure, and
dilate bronchi
• Catecholamines are positive inotropes (make heart contract more forcefully) and positive
chronotropes (make heart beat faster)
• These drugs aren’t taken PO due to quick destruction by digestive enzymes
• Side effects: dry mouth, N/V, CNS stimulation, appetite suppression, increased HR,
bronchodilation, decreased blood flow to GI, pupil dilation, increased glucose levels
• Contraindicated: uncorrected tachyarrhythmias
Drug
Dobutamine
→ Dobutrex
Dopamine
Epinephrine
→ Adrenalin,
Epi-Pen
Catecholamines
Indication
Nursing
Cardiac decompensation, low cardiac
Stimulates beta1 receptors. Administer drug
output
into large vein; monitor site for inflammation
+ pain. Perform independent double check
Hypotension, low cardiac output, poor
Stimulates dopaminergic and beta1
perfusion of vital organs
receptors. Administer drug into large vein;
Low dose: increases urine output + renal
monitor site for inflammation + pain.
blood flow
Perform independent double check.
Medium dose: increases renal blood flow,
cardiac output, heart rate, and heart
contractility
High dose: increases BP, potential risk of
tachyarrhythmias
Cardiac arrest, hypotension due to septic
Stimulates beta1 and beta2 receptor. Can
shock, anaphylaxis, symptomatic
cause paradoxical bronchospasm (wheezing)
bradycardia, management of asthma and
with overuse of inhaler. Teach pt using
COPD
autoinjector about proper placement (into
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Norepinephrine
→ Levophed
Acute hypotension, cardiac arrest, septic
shock
Isoproterenol
hydrochloride
Shock, bronchospasm during anesthesia
thigh @ right angle to leg, hold for 10 sec).
Perform independent double check.
Stimulates alpha receptors mostly; minor
beta activity. Overdose can result in severe
peripheral vasoconstriction with resultant
ischemia and necrosis of peripheral tissue
Stimulates beta1 and beta2 receptors.
2. Noncatecholamines
• Can be direct-acting, indirect-acing, or dual-acting
• Produce these effects: local or systemic vessel constriction, nasal/eye decongestion, dilation of
bronchi, and smooth muscle relaxation
• Can be taken orally, and have longer half life
• Contraindicated: Monoamine oxidase inhibitors (can cause severe hypertension), tricyclic
antidepressants (can cause hypertension + arrhythmias)
• Side effects: headache, irritability, trembling, seizures, hypertension, palpitations, tachycardia,
arrhythmias, flushing, angina
Noncatecholamines
Drug
Phenylephrine
Indication
Severe hypotension/shock
Albuterol
→ Ventolin
Bronchospasm
Salmeterol
→ Serevent
Diskus
Asthma prevention and maintenance,
COPD maintenance, prevention of exercise
induced asthma
Terbutaline
Bronchospasm, pre-term labor (this drug
will stop contractions)
Nursing
Stimulates alpha receptors. Can cause severe
bradycardia + decreased cardiac output due
to increase in afterload
Stimulates beta2 receptor. Can cause
paradoxical bronchospasm with excessive
inhaler use
Stimulates beta2 receptor. Do not use to treat
acute symptoms. Should only be used for
patients not adequately controlled on other
asthma controller medications; long term use
can increase risk of asthma-related death
Stimulates beta2 receptor. Should not be
used in pregnancy for the prevention of
prolonged treatment (48-72 hr) of preterm
labor
Adrenergic blocking drugs
Also called sympatholytic drugs
Block the effects of SNS = decrease in NE
1. Alpha adrenergic blockers (alpha blockers)
• Interrupts action of epinephrine (E) and NE at alpha receptors
• MOA: blocks the synthesis/storage/release/reuptake of NE, or the drug will antagonize E, NE, or
adrenergic drug at alpha receptor site
• Produces: relaxed/dilated blood vessels, decreased BP
• Side effects: orthostatic hypotension, reflex tachycardia, nasal congestion
Alpha Blockers
Drug
Doxazosin
→ Cardura
Indication
Hypertension, BPH
Nursing
Inform pt that urine flow will increase. Monitor
BP and HR. Inform pt that medication is to be
taken even if feeling better
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Prazosin
→ Minipress
Tamsulosin
→ Flomax
Hypertension, BPH, Raynaud
phenomenon
BPH
Silodosin
→ Rapaflo
BPH, renal impairment
Monitor BP and HR
Pregnant women and women of childbearing
potential should not handle drug (drug is
cytotoxic)
Monitor BP and HR
2. Beta adrenergic blocks (beta blockers)
• Selective beta blockers affect just beta1 adrenergic sites
• Nonselective beta blockers affect both beta1 and beta2 adrenergic sites
• MOA: drug will occupy beta receptor site = prevents NE or E from occupying the site = decrease
in SNS
• Used for: HTN, arrhythmias, angina, narrow angle glaucoma
• Side effects: hypotension, bradycardia, bronchospasm
Beta Blockers
Drug
Atenolol
→ Tenormin
Indication
HTN, angina, post-MI, SVT
Carvedilol
→ Coreg
CHF, HTN, angina, LV dysfunction after
MI
Metoprolol
→ Lopressor
Nadolol
→ Corgard
HTN, acute MI, CHF, angina, acute
tachyarrhythmia
HTN, angina, SVT, migraine
Nursing
Ischemic heart disease and angina can be
exacerbated after abrupt withdrawal of drug.
Contraindicated in AV block, bradycardia, and
shock. Monitor ECG, BP, and HR frequently.
Contraindicated in bronchial asthma,
bronchospasm, COPD, AV block, shock, and
hepatic impairment. Abrupt withdrawal can
lead to arrhythmia, HTN, and myocardial
ischemia
Same as above.
Same as above. Contraindicated in
breastfeeding pt, AV block, COPD, bradycardia
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NEUROLOGIC & NEUROMUSCULAR DRUGS
Nervous system = includes Central Nervous System (CNS) and Peripheral Nervous System (PNS)
• CNS = brain and spinal cord
• PNS = somatic and automatic nervous systems
Neuromuscular system = muscles of body (plus the nerves that supply these muscles)
Drugs include: skeletal muscle relaxants, neuromuscular blocking drugs, antiparkinsonian drugs, anticonvulsant
drugs, and antimigraine drugs
Skeletal muscle relaxants
Relieve MSK pain, spasms, spasticity (stiff movement), multiple sclerosis (MS), cerebral palsy, stroke
1. Centrally acting agents
• Treat acute muscle spasms due to anxiety, inflammation, pain, and trauma
• Also treat spasticity due to MS and cerebral palsy
• MOA: specifics are unknown, but the drugs are CNS depressants; skeletal relaxation is an effect from
the sedative effects of decreasing CNS stimulation
• Side effects: physical dependence, cessation can lead to withdrawal symptoms, dizziness,
drowsiness, bradycardia, N/V
Drug
Carisoprodol
→ Soma
Chlorzoxazone
→ Lorzone
Cyclobenzaprine
→ Amrix
Metaxalone
→ Skelaxin
Methocarbamol
→ Robaxin
Orphenadrine
→ Norflex
Tizanidine
→ Zanaflex
Centrally Acting Drugs
Indication
Nursing
Muscle spasm associated with acute
Should only be used for acute pain (not to
painful MSK conditions
exceed treatment of 2-3 weeks).
MSK pain
Contraindicated in impaired liver function
Muscle spams
Monitor for serotonin syndrome (mental
changes, autonomic instability [tachycardia,
change in BP, hyperthermia], neuromuscular
changes [hyperreflexia, incoordination], and
GI changes
Drug can cause dizziness/drowsiness – teach
pt to avoid driving
Avoid in kidney injury pts. Can cause
seizures as side effect
Contraindicated in narrow angle glaucoma,
BPH, paralytic ileus, and toxic megacolon
Caution in kidney/liver failure pts
Muscle spasm from acute MSK pain
Muscle spasm, tetanus
Muscle spasm & pain
Muscle spasticity
2. Direct acting agents
• Dantrolene sodium is the only drug in this category
• Used for: spasticity in cerebral palsy, MS, spinal cord injury, and stroke
• MOA: acts directly on muscle; interferes with calcium release = weakens force of contractions
• Side effects: drowsiness, dizziness, muscle weakness
Direct Acting Drugs
Drug
Dantrolene
→ Dantrium
Indication
Spasticity, malignant hyperthermia,
neuroleptic malignant syndrome
Nursing
Must monitor liver function – possible side effect
is hepatotoxicity
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3. Others
• Baclofen
• Used for: spasticity in MS and spinal cord injury
• MOA: specifics are unknown; reduces nerve impulses in spinal cord to skeletal muscles = decreases
severity of muscle spasms
• Side effects: drowsiness, N, fatigue, muscle weakness
Drug
Baclofen
→ Lioresal
Diazepam
→ Valium
Other Skeletal Muscle Relaxants
Indication
Nursing
Spasticity from MS
Abrupt discontinuation can lead to fever, change
in mental status, and rebound spasticity + muscle
rigidity
Muscle spasms, seizure disorder
Promotes GABA (an inhibitory neurotransmitter)
= lessens muscle contraction. Also used to treat
anxiety, alcohol withdrawal, and seizures
Neuromuscular blocking drugs
Disrupt transmission of nerve impulse at motor end plate = relaxation of skeletal muscles
Used to relax skeletal muscles during surgery, reduce muscle spasms in seizures, and manage patients fighting
ventilator in ICU
1. Nondepolarizing blocking drugs
• MOA: drug competes with Ach at cholinergic receptor site = blocks Ach action = prevents muscle
from contracting
• *Effect can be counteracted by anticholinesterase
• Used for: muscle relaxation to ease ET tube, muscle relaxation to help realignment of dislocated
bones, muscle relaxation for pt fighting mechanical ventilation, and prevent muscle relaxation
• Side effects: apnea, hypotension, bronchospasm, excessive salivation
• Neuromuscular blocking drugs do not affect consciousness or pain; anesthesia + analgesia should
always be used when neuromuscular blocking agents are used
Drug
Atracurium
→ Tracrium
Cisatracurium
→ Nimbex
Pancuronium
→ Pavulon
Rocuronium
→ Zemuron
Nondepolarizing Blocking Drugs
Indication
Nursing
Endotracheal intubation, mechanical
Adequate ventilatory support is mandatory
ventilation, skeletal muscle relaxation during
surgery
Intubation
Do not administer before unconsciousness.
Bradycardia may occur
General anesthesia adjunct, endotracheal
Adequate ventilatory support is mandatory
intubation
Intubation
Adequate ventilatory support is mandatory.
Use cautiously in pt with liver disease
2. Depolarizing blocking drugs
• Succinylcholine is only drug in this category
• MOA: acts like acetylcholine but does NOT get inactivated by cholinesterase. Once administered, it
attaches to receptor sites on skeletal muscles = prevents repolarization of motor end plate = muscle
paralysis
• Drug of choice for short term relaxation during intubation
• Side effects: primary side effect is hypotension + prolonged apnea
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Depolarizing Blocking Drugs
Drug
Indication
Nursing
Succinylcholine Rapid onset and brief duration of muscle
Adequate ventilatory support is mandatory.
→ Anectine
relaxation needed during surgery or
Administer sedative beforehand.
intubation
Anticonvulsant Drugs
Seizure = disturbed electrical activity in brain
1. Partial/focal = part of brain is affected
• Simple: experience some elements of aura, some twitching (usually in 1 limb)
• Complex: experience some elements of aura. Often consists of repeated movements, some
altered consciousness, autonomic, sensory & motor signs, confusion after seizure
2. Generalized = involves all of brain
• Absence (petit mal): starring + transient loss of responsiveness and then retrograde amnesia (not
remembering what happened)
• Atonic: short episodes where patient suddenly falls
• Tonic-clonic (grand mal): may experience some elements of aura, then tonic phase (muscle
contraction) then clonic phase (repeated contraction & relaxation), usually followed by deep
sleep (postictal state). Also has retrograde amnesia
3. Special cases
• Febrile seizures: tonic-clonic seizure related to rapid rise in body temperature
• Myoclonic seizures: large jerky body movements due to uncontrollable skeletal muscle
contraction
• Status epilepticus: seizure is repeated or prolonged (life-threatening due to risk of hypoxia)
Medications for seizures will decrease neuron excitability
Observe and record intensity, duration, and location of seizure activity
1. Barbiturates
• For generalized tonic clonic seizures
• MOA: stimulates gamma-aminobutyric acid (GABA) neurotransmitter (an inhibitory
neurotransmitter), which then inhibits brain activity; this is what causes the drowsy/calming effects
• Side effects: drowsiness, tolerance, dependence, respiratory depression, GI effects
• Contraindication: liver or kidney disease
• Medications are not to be stopped abruptly as this can cause seizure activity
Drug
Phenobarbital
→ Luminal
Primidone
→ Mysoline
Barbiturates
Indication
Status epilepticus, seizures, sedation,
hypnotic, insomnia
Nursing
Risk of toxicity increases when taken with CNS
depressants, valproic acid, chloramphenicol,
felbamate, cimetidine, or phenytoin
Therapeutic serum range: 15-40 mcg/mL
Seizures
2. Benzodiazepines
• For absence & myoclonic seizures
• MOA, side effects, and contraindications are same as above
• For IV injection, administer slowly to avoid bradycardia
• If there is an overdose on benzodiazepines = give flumazenil (Romazicon)
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Drug
Lorazepam
→ Ativan
Diazepam
→ Valium
Benzodiazepines
Indication
Nursing
Anxiety, status epilepticus, seizures
Use with opioids can result in profound sedation,
respiratory depression, coma, and death
Therapeutic serum range: 50-240 ng/mL
Anxiety, alcohol withdrawal, pre-op sedation, Use with opioids can result in profound sedation,
seizure, muscle spasm, status epilepticus
respiratory depression, coma, and death. Do not
use in pts with depressed respiration or patients
who recently received respiratory depressants.
3. Hydantoins (Phenytoin)
• For partial and tonic clonic seizures
• MOA: block Na+ influx = neurons are kept in absolute refractory for a longer time = less frequent
action potentials
• Side effects: dependence, respiratory depression, gingivitis, ataxia, dizziness, lethargy, alter vitamin K
metabolism, dysrhythmias, nystagmus
• Frequent bloodwork is needed to monitor drug levels
Drug
Phenytoin
→ Dilantin
Indication
Seizures
Hydantoins
Nursing
Risk of hypotension and arrhythmia – monitor BP
and HR. Monitor for change in mood – there is a
risk of suicidal ideation
Therapeutic serum range: 10-20 mcg/mL
4. Phenytoin-like drugs
• For absence, tonic-clonic seizures, bipolar, and migraines
• MOA same as above
• Side effects: increased bleeding times, photosensitivity, hepatotoxic, pancreatitis
Drug
Valproic acid
→ Depakene
Carbamazepine
→ Tegretol
Zonisamide
→ Zonegran
Phenytoin-like
Indication
Nursing
Seizures, bipolar mania, migraine
Monitor for suicidal tendencies (especially early
prophylaxis
on). Monitor for signs of pancreatitis (abdo
pain, N/V, anorexia). Monitor liver function
Epilepsy, trigeminal neuralgia, bipolar
Using an MAOI drug with carbamazepine may
mania
result in hyperpyrexia, hypertension, seizures,
and death
Therapeutic serum range: 3-14 mcg/mL
Seizures
5. Succinimides
• For absence seizures
• MOA: prevents Ca+2 entry through specialized T-type channels in thalamus = decreases neuron
excitability
• Side effects: anorexia, N/V, blood dyscrasia
Succinimides
Drug
Indication
Ethosuximide Absence seizures
→ Zarontin
Nursing
Do not discontinue rapidly; abrupt withdrawal
can cause absence seizure
Therapeutic serum range: 40-100 mcg/mL
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Antiparkinsonian Drugs
Parkinson’s disease = neurologic disorder characterized by:
1. Muscle rigidity
2. Akinesia (loss of voluntary movement)
3. Tremors at rest
4. Change in posture/balance
The above can also be known as extrapyramidal symptoms (restlessness, rigidity, tremors, pill rolling, masklike
face, shuffling gait, muscle spasms, twisting motions, difficulty speaking/ swallowing, loss of balance control)
Chemical imbalance with Parkinson’s: too little dopamine, too much Ach
Too much Ach = increased cholinergic activity = creates the involuntary movements/tremors
Goal of anti-Parkinson’s medication = symptom relief and improve mobility by either inhibiting Ach or enhancing
dopamine
1. Anticholinergic Drugs
• Also known as parasympatholytic drugs = inhibit action of Ach in parasympathetic nervous system
(PNS)
• MOA: inhibition of Ach at receptor sites = reduction of tremors; this category of drug reduces the
tremors + drooling but has minimal effect on the bradykinesia, rigidity, and balance abnormalities
• Side effects: anticholinergic effects = confusion, drowsiness, urine retention, blurred vision, N/V/C,
dry mouth/secretions, increased HR
• Contraindicated in: narrow angle glaucoma, BPH, GI obstructions, myasthenia gravis, dysrhythmias
• If discontinued abruptly, S/S of Parkinsonism can be intensified
Drug
Benztropine
→ Cogentin
Parkinsonism
Anticholinergic Drugs for Parkinson’s
Indication
Nursing
Reduces rigidity + tremors. Avoid driving due to
side effect of drowsiness/dizziness
2. Dopaminergic Drugs
• These drugs increase effects of dopamine
• MOA: increase in neurotransmission of dopamine
• Side effects: too much dopamine = uncontrolled + involuntary movements, muscle twitching,
spasmodic winking, orthostatic hypotension
• Interact with: TCAs, MAOIs, antihypertensives, antipsychotics, anticonvulsants, antacids
• Contraindicated in: cardiac, kidney & liver disease, narrow angle glaucoma, history of seizures
Drug
Carbidopa/Levodopa
→ Sinemet
Amantadine
→ Osmolex
Selegiline
→ Eldepryl
Dopaminergic Drugs
Indication
Nursing
Parkinson Disease
Avoid in narrow angle glaucoma. Avoid in pt
taking MAOI (can cause hypertensive
reaction). Monitor for GI complications.
Divide total daily prescribed protein among
all meals (high protein diet interferes with
medication availability to CNS)
Parkinson Disease, dyskinesia associated
Avoid in narrow angle glaucoma and in
with Parkinson Disease, drug-induced
breastfeeding pts. Monitor for orthostatic
extrapyramidal symptoms
hypotension and constipation
Parkinson Disease
Monitor for changes in behavior and
suicidal tendencies. Contraindicated in
concurrent use with SSRI or TCA
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Ropinirole
→ Requip
Parkinson Disease, restless leg syndrome
Monitor for changes in behaviour. Monitor
BP – risk of orthostatic hypotension
Anti-Migraine Drugs
Migraine = unilateral headache pain (pounding/pulsating/throbbing), sometimes preceded by aura
Other S/S = light/sound sensitivity, N/V/C/D
Migraine is due to vasodilation or due to release of vasoactive + inflammatory substances from nerves in
trigeminal system
Treatment = abort migraine after it has started OR prevent one from starting
o Abortive medications = analgesics, NSAIDs, ergotamine, serotonin agonists
o Preventative medications = beta blockers, TCAs, valproic acid, and NSAIDs
1. Serotonin Agonists
• Treatment for moderate to severe migraines
• MOA: serotonin agonist = cause constriction + reduction of inflammation in trigeminal nerve =
provides relief
• Side effects: tingling, flushing, dizziness, weakness, somnolence, chest pain, dry mouth, N
• Contraindicated: ischemic heart disease, stroke, CAD
Drug
Almotriptan, Eletriptan,
Frovatriptan, Naratriptan,
Rizatriptan, Suma triptan,
Zolmitriptan
Serotonin Agonists
Indication
Nursing
Acute treatment of migraine
Contraindicated in ischemic heart disease,
attack with or without aura
hypertension, or cerebrovascular syndrome.
Overuse of medication can lead to exacerbation
of headache. Do not use within 24 hrs of
another serotonin agonist
2. Ergotamine
• For abortion of migraine
• MOA: blocks inflammation + partially acts as serotonin agonist
• Side effects: N/V, numbness, tingling, muscle pain, weakness
Ergotamine
Drug
Ergotamine
→ Ergomar
Indication
Migraine, menopausal hot flashes
Nursing
Do not give with CYP3A4 inhibitor (e.g.
erythromycin) – can lead to serious peripheral
ischemia due to high risk of vasospasm
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ANALGESICS
Non-Opioid analgesics, Antipyretics, NSAIDs
• Control pain, control fever, and produce anti-inflammatory effects
• No physical dependence
1. Salicylates
• Used for pain control and reduction of fever + inflammation
• Most common salicylate = aspirin
• MOA: inhibits synthesis of prostaglandin (a chemical mediator that sensitizes nerves to pain) = relief
of pain. Stimulation of hypothalamus = blood vessel dilation = reduction of fever + increased
sweating (promotes cooling)
• Aspirin MOA also includes interference of thromboxane A2 production (necessary for platelet
aggregation) = inhibition of platelet aggregation = used to enhance blood flow during myocardial
infarction
• Side effects: N/V/D, bleeding tendency, dizziness, confusion, hearing loss if drug is taken for
prolonged time, and risk of Reye’s syndrome if given to children with chickenpox/flulike symptoms
Drug
Acetylsalicylic acid
→ Aspirin
Salicylates
Indication
Pain, fever, acute coronary syndrome,
ischemic stroke
Nursing
Not to be given to pts with GI bleed, hemolytic
anemia, hemorrhoids, or thrombocytopenia.
Avoid use in children.
2. Acetaminophen
• MOA: reduces pain + fever but does not affect inflammation or platelet function. Inhibits
prostaglandin synthesis to reduce pain and acts on hypothalamus to reduce heat
• Side effects: liver toxicity
Acetaminophen
Drug
Acetaminophen
→ Tylenol
Indication
Pain, fever
Nursing
Not to be given to pt with active liver disease.
To minimize GI irritation, avoid alcohol when
taking medication
3. Nonselective NSAIDs
• Normally, inflammatory disorder produces/releases prostaglandins = causes pain
• MOA: inhibits prostaglandin synthesis by blocking COX-1 and COX-2 = decreased inflammation +
analgesic effect
o COX1 – prostaglandins in stomach lining; therefore produces GI side effects
o COX2 – prostaglandins that mediate inflammatory process
• Side effects: abdo pain + bleeding, diarrhea, N, ulcers, liver toxicity, drowsiness/confusion, tinnitus,
bladder infection, HTN
• Contraindicated for perioperative pain for CABG
• Take the drug with meals or milk to reduce GI side effects
Drug
Indomethacin
→ Indocin
Nonselective NSAIDs
Indication
Nursing
Inflammatory/rheumatoid disorders,
Risk of MI and stroke. Elderly pts are at greater
tendonitis, gouty arthritis, pain
risk of GI side effects.
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Ibuprofen
→ Advil,
Motrin
Pain, fever, dysmenorrhea, inflammatory
disease, osteoarthritis (OA), rheumatoid
arthritis (RA)
Diclofenac
→ Voltaren
RA, OA, ankylosing spondylitis,
dysmenorrhea, mild-moderate acute pain,
acute migraine
Moderate-severe acute pain
Ketorolac
→ Toradol
Naproxen
→ Aleve
Pain, RA, OA, ankylosing spondylitis,
dysmenorrhea, acute gout, migraine
Oxaprozin
→ Daypro
OA, RA
Risk of MI and stroke. Elderly pts are at greater
risk of GI side effects. Patients who have
asthma, aspirin-induced allergy, and nasal
polyps are at higher risk for developing
hypersensitivity reactions
Same as above
Same as above + contraindicated in L&D as it
can affect fetal circulation/inhibit uterine
contractions
Risk of MI and stroke. Elderly pts are at greater
risk of GI side effects. Patients who have
asthma, aspirin-induced allergy, and nasal
polyps are at higher risk for developing
hypersensitivity reactions
Same as above
4. Selective NSAIDs
• MOA: selectively blocks COX2 = decreases prostaglandin synthesis = decreases pain + inflammation
• Side effects: HTN, fluid retention, edema, dizziness, headache, GI ulcers (less than nonselective
NSAIDs)
Selective NSAIDs
Drug
Indication
Celecoxib
Acute pain, dysmenorrhea, ankylosing
→ Celebrex spondylitis, OA, RA
Nursing
Risk of MI and stroke. Elderly pts are at greater
risk of GI side effects.
Opioid Agonists + Antagonists
Opioid = drug that imitates natural narcotic
Opioid agonists = relieve or decrease pain
Opioid antagonists = NOT pain medication, but instead can reverse the side effects (CNS or respiratory
depression) produced by opioid agonist
1. Opioid agonist
• MOA: drug binds to opioid receptor in PNS and CNS = produces effects of analgesia + cough
suppression
• Side effects: decreased RR, flushing, hypotension, pupil constriction
• Risk of opioid addiction, abuse, and misuse MUST be assessed (can lead to overdose and death)
Opioid Agonists
Drug
Codeine
Indication
Pain, cough
Fentanyl
General anesthesia, analgesia
Nursing
Use cautiously in pts on MAO inhibitor.
Monitor RR. Regularly administered dose may
be more effective than PRN dose
Risk of opioid addiction/abuse/misuse, which
can lead to overdose and death. Monitor for
respiratory depression. Prolonged use during
pregnancy can cause neonatal opioid
withdrawal syndrome. Avoid use in pt
receiving MAO inhibitor. Transdermal fentanyl
is for moderate-severe chronic pain, not for
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the control of postoperative, mild,
intermittent, or short term pain
Extended release tablet. Use cautiously in pts
on MAO inhibitor.
Hydrocodone
Chronic pain
→ Zohydro,
Hysingla
Hydromorphone Moderate to severe pain, moderate to
→ Dilaudid
severe chronic pain, cough
Meperidine
→ Demerol
Moderate to severe pain, analgesic during
labour, pre-op sedation, rigors
Methadone
Long term pain treatment, detoxification
Morphine
Acute pain, chronic severe pain
Oxycodone
→ Oxycontin,
Oxyneo
Tramadol
Moderate to severe pain
Use cautiously in pts on MAO inhibitor.
Monitor RR. Rapid IV administration =
respiratory depression, hypotension,
circulatory collapse
Can cause seizures as side effect. Monitor RR.
Use cautiously in pts on MAO inhibitor. Risk of
toxicity increases with dose over 600 mg per
day, chronic administration (>2 days), and
kidney injury. IV Push – administer slowly over
5 minutes
Not to be used with MAO inhibitors. Avoid use
of CNS depressants, benzodiazepines, or
alcohol as it can cause severe sedation, resp
depression, coma, or death
Use cautiously in patients receiving MAO
inhibitors (can have severe reactions). Monitor
for respiratory depression
Monitor for respiratory depression. If pt has
liver failure, initial dose should be decreased.
Monitor BP, HR, and RR
Monitor for seizures (higher dose has higher
risk). Monitor for serotonin syndrome. Avoid
use in pts on MAO inhibitor.
Moderate to severe pain
2. Opioid Antagonist
• MOA: Attach to opioid receptors but do NOT stimulate them = prevention of opioid effects
• Used to reverse effects of opioids
• MOA: drug blocks the receptor site = opioid receptor cannot attach = no opioid effects
• Side effects: HTN, palpitation, shortness of breath, anxiety, diarrhea, N/V, thirst, urinary frequency
Opioid Antagonist
Drug
Naloxone
→ Narcan
Indication
Opioid overdose, reversal of respiratory
depression
Nursing
Dilute 0.4mg ampule of naloxone in 10 mL of
NS and administer 0.5 mL (0.02 mg) by IV push
every 2 min. Monitor RR, rhythm, and depth;
HR, ECG, BP; and LOC frequently
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CARDIOVASCULAR DRUGS
Cardiovascular system includes = heart, arteries, capillaries, veins, and lymphatics
Goal: promotes oxygen + nutrient delivery to cells and removal of metabolic waste
Types of drugs used to improve the cardiovascular system: inotropic, antiarrhythmic, antianginal,
antihypertensive, diuretics, and antilipemic
Inotropic Drugs
Inotrope = increases force of heart contraction (positive inotrope)
These drugs can prevent remodeling of L or R ventricle (common in heart failure)
1. Cardiac glycosides
• Positive inotrope, negative chronotrope (decreases HR)
• MOA: inhibits Na/K activated ATP = increase in intracellular levels of Na and Ca = increase in Ca will
strengthen myocardial contraction. These drugs also act on CNS to increase vagal tone = slowing of
HR by slowing the SA and AV nodes
• Used for: atrial fibrillation (controls the HR from being too fast), atrial flutter, heart failure, and
supraventricular tachycardia (SVT)
• Side effects: N/V/D, abdo pain, confusion, vision changes, bradycardia, complete heart block
• Herbals like St. John’s wort and ginseng can increase digoxin levels = increased risk of digoxin toxicity
Cardiac Glycoside
Drug
Digoxin
→ Lanoxin
Indication
Atrial fibrillation, heart failure
Nursing
Check HR before administration (ensure HR is
above 60 bpm). Monitor for bradycardia.
Monitor digoxin levels (digoxin has a narrow
therapeutic range)
2. Phosphodiesterase inhibitors
• Used for short term management of heart failure
• MOA: PDEI move Ca into cardiac cells = improve cardiac output by strengthening contractions. Also,
the drug relaxes smooth muscle = less vascular resistance and less amount of blood returning to
heart = decreased afterload + preload
• Side effects: arrhythmias, N/V, headache, chest pain, hypokalemia, increase in HR, hypotension
PDE Inhibitors
Drug
Milrinone
Indication
Heart failure (HF)
Nursing
Monitor ECG during infusion. Ensure that HR is
controlled in atrial fib before administration
because this drug can increase HR
Antiarrhythmic Drugs
Benefits vs risks need to be weighed because these drugs can worsen arrhythmias
4 classes: I, II, III, IV
1. Class I
• Used for: atrial and ventricular arrhythmias
• MOA: block Na channels = interfere with conduction of cardiac impulses = slows action potential
• Side effects: N/V/D, anorexia, arrhythmias (conduction delays; AV blocks), hypotension, bradycardia,
palpitations
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Class I Antiarrhythmics
Drug
Procainamide
→ Pronestyl
Indication
Arrhythmia
Quinidine
→ Quinaglute
Arrhythmia
Mexiletine
Life threatening ventricular
arrhythmias
Ventricular arrhythmias, pulseless
ventricular tachycardia
Lidocaine
Flecainide
→ Tambocor
Prevention of arrhythmias (SVT,
paroxysmal afib, VT)
Nursing
Long term use can lead to positive ANA. Monitor
CBC. Contraindicated in AV heart block, SLE, and
torsades de pointes
May cause increased mortality in treatment of
afib/aflutter. Contraindicated in absence of atrial
activity, AV block, torsades, prolonged QTc, and
pregnancy
Contraindicated in shock, AV block
If IV route not available, use IO/ET. Monitor ECG
and BP continuously. Contraindicated in SA/AV
block, CHF, and shock
Not used for chronic afib. Increased risk of PVCs,
ventricular tachycardia. Contraindicated in AV
block.
2. Class II
• MOA: block beta adrenergic receptor sites in conduction system of heart = SA node is slowed down =
reduction of electrical impulses
• Strength of contractions are reduced = heart beats less forcefully (negative inotrope) = heart does
not need as much oxygen to work
• Side effects: arrhythmias, bradycardia, heart failure, hypotension, N/V/D, bronchospasm, fatigue
Drug
Propranolol
→ Inderal
Esmolol
→ Brevibloc
Class II Antiarrhythmics
Indication
Nursing
HTN, migraine, angina, pheochromocytoma,
Can exacerbate ischemic heart disease and
supraventricular arrhythmias, portal hypertension angina with abrupt withdrawal.
Contraindicated in asthma, COPD, severe
bradycardia, shock, and heart failure. If
giving via IV = constant ECG monitoring is
necessary. Monitor HR and BP
Intraoperative tachycardia/HTN, SVT,
Contraindicated in bradycardia, AV block,
hypertensive emergency
heart failure
3. Class III
• Used for: ventricular arrhythmias
• MOA is not known; thought to delay repolarization & lengthen refractory period of action potential
• Side effects: hypotension, bradycardia, N, vision disturbance
Drug
Amiodarone
→ Pacerone
Dofetilide
→ Tikosyn
Class III Antiarrhythmics
Indication
Stable monomorphic or polymorphic ventricular
tachycardia, pulseless ventricular
tachycardia/ventricular fibrillation
Converting afib/flutter to sinus rhythm
Nursing
Constant ECG monitoring needed.
Contraindicated in AV block and
bradycardia. Avoid during breastfeeding
Continuous ECG monitoring needed.
Contraindicated in prolonged QT complex
and bradycardia. Grapefruit juice may
increase levels.
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4. Class IV
• Calcium channel blockers
• Used for supraventricular arrhythmias (SVT) with rapid HR, to relieve angina, and to relieve
hypertension
• MOA: inhibits Ca influx into cardiac muscle = decreased heart contractility and O2 demand. Also
dilates coronary arteries
• Side effects: bradycardia, AV block, heart failure, ventricular fibrillation, dizziness, headache,
hypotension
Drug
Verapamil
→ Isoptin
Diltiazem
→ Cardizem
Class IV Antiarrhythmics
Indication
Nursing
Angina, HTN, SVT, afib/flutter, tardive dyskinesia
Contraindicated in shock, HF, hypotension,
AV block. Monitor ECG. Monitor daily
weight.
Angina, HTN, SVT, afib/flutter
Contraindicated in hypotension, sick sinus
syndrome, AV block, MI. Assess for signs of
HF (weight gain, SOB, crackles)
5. Adenosine
• Used for acute treatment of SVT
• MOA: adenosine suppresses SA node = reduces HR. AV node is unable to conduct impulse from atria
to ventricles = temporary pause in rhythm
• Side effects: facial flushing, shortness of breath, dizziness, dyspnea, chest discomfort
Adenosine
Drug
Adenosine
Indication
Nursing
Contraindicated in AV block, sick sinus
syndrome, bradycardia. Used for
cardioversion. Monitor ECG continuously
SVT
Antianginal Drugs
Sign of angina = chest pain
These drugs work by increasing the O2 supply to the heart
1. Nitrates
• For acute angina
• Can be given sublingually, buccally, as tablets, aerosols, inhalation, transdermally, or via IV
• MOA: cause smooth muscle of veins and arteries to dilate = coronary arteries dilate = improvement
of O2 supply to myocardium. ALSO, the dilated blood vessels means there is less blood return to
heart = reduces preload = reduction of ventricular wall tension = reduces O2 requirements of heart
• Side effects: headache, hypotension, dizziness, and increased HR
• Have pt sit/lay when providing first dose
Nitrates
Drug
Isosorbide dinitrate
→ Isordil
Nitroglycerin
Indication
Angina pectoris
Angina pectoris,
Nursing
Contraindicated in pts taking PDE-5 inhibitors
(e.g. sildenafil), shock, and hypotension
Contraindicated in pts taking PDE-5 inhibitors
(e.g. sildenafil), shock, and hypotension
2. Beta blockers
• For long term prevention of angina
• MOA: block beta receptor sites in heart = decreased HR, force of contraction, BP = lower O2 demand
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•
•
Side effects: bradycardia, heart failure, arrhythmias (AV block), fainting, fluid retention, edema,
shock, N/V/D
Assess apical pulse before administration; hold if <50 bpm
Beta Blockers
Drug
Atenolol
→ Tenormin
Indication
HTN, angina, post-MI, SVT
Carvedilol
→ Coreg
CHF, HTN, angina, LV dysfunction after MI
Metoprolol
→ Lopressor
Nadolol
→ Corgard
HTN, acute MI, CHF, angina, acute
tachyarrhythmia
HTN, angina, SVT, migraine
Nursing
Ischemic heart disease and angina can be
exacerbated after abrupt withdrawal of drug.
Contraindicated in AV block, bradycardia, and
shock. Monitor ECG, BP, and HR frequently.
Contraindicated in bronchial asthma,
bronchospasm, COPD, AV block, shock, and
hepatic impairment. Abrupt withdrawal can lead
to arrhythmia, HTN, and myocardial ischemia
Same as above.
Same as above. Contraindicated in breastfeeding
pt, AV block, COPD, bradycardia
3. Calcium Channel Blockers
• Used when other drugs fail to prevent angina (also used as antiarrhythmic + for treatment of HTN)
• MOA: prevent Ca from coming into myocardial cell membrane = causes dilation of coronary +
peripheral arteries = decreased force of contractions + decreased afterload = decreased workload of
heart = decreased O2 demand
o No calcium = dilation
• Side effects: orthostatic hypotension, heart failure, bradycardia, AV block, dizziness, headache,
flushing, weakness
• Risk of angioedema
• Monitor I+O, daily weight
Calcium Channel Blockers
Drug
Amlodipine
→ Norvasc
Indication
HTN, angina, CAD
Diltiazem
→ Cardizem
Nifedipine
→ Procardia
Angina, HTN, SVT, afib/flutter
Verapamil
→ Isoptin
Angina, HTN, SVT, afib/flutter, tardive
dyskinesia
Angina, HTN, pulmonary HTN, Raynaud,
anal fissures
Nursing
Assess BP and HR before administration. Educate
pt on changing positions slowly to avoid
orthostatic hypotension
Contraindicated in AV block, acute MI,
pulmonary congestion.
Contraindicated in pts taking CYP3A4 inducers
(reduces nifedipine efficacy). Contraindicated in
cardiogenic shock
Contraindicated in shock, HF, symptomatic
hypotension, AV block. Educate pt on informing
MD of irregular HR, swelling, dizziness.
Antihypertensive Drugs
HTN = elevation of systolic BP (SBP), diastolic BP (DBP), or both
1. Angiotensin-converting enzyme inhibitors (ACE inhibitors)
• Used for sodium + water retention and HTN
• MOA: inhibits ACE = prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor)
= decreases peripheral arterial resistance and promotes excretion of aldosterone (normally
promotes Na and water retention) = decrease in BP + reduction of Na and water
• Side effects: headache, fatigue, dry cough, N/V, increased K+, elevation of BUN + Cre
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ACE inhibitors
Drug
Benazepril
→ Lotensin
Captopril
→ Capoten
Enalapril
Lisinopril
→ Prinivil
Ramipril
→ Altace
Indication
HTN
Acute HTN, HTN, CHF, LV dysfunction after MI,
diabetic nephropathy
HTN, LV dysfunction, CHF
Acute MI, HTN, CHF, diabetic nephropathy
HTN, CHF, MI/stroke prevention, diabetic
nephropathy
Nursing
Not to be used during pregnancy (causes
oligohydramnios)
Same as above. May cause positive ANA – monitor
CBC
Not to be used during pregnancy (causes
oligohydramnios)
Same as above
Same as above
2. Angiotensin II receptor blocking agents (ARBs)
• MOA: Interferes with the renin angiotensin aldosterone system (RAAS) by blocking binding of
angiotensin II to the angiotensin II receptor = prevents vasoconstriction = also prevents aldosterone
secretion = decrease in BP
• Side effects: headache, fatigue, cough, N/V, elevation of BUN + Cre
• ARBs are not to be used during pregnancy
ARBs
Drug
Candesartan HTN, CHF
→ Atacand
Indication
Irbesartan
→ Avapro
Losartan
→ Cozaar
HTN, nephropathy in T2DM
Telmisartan
→ Micardis
Valsartan
→ Diovan
HTN
HTN, diabetic nephropathy, HTN with LV
hypertrophy
HTN, CHF, post-MI
Nursing
Not to be used during pregnancy (causes
oligohydramnios). Contraindicated with severe
hepatic impairment. Use cautiously in pts with
hx of angioedema
Same as above
Not to be used during pregnancy (causes
oligohydramnios). Use cautiously in volume- or
Na-depleted pts (can cause symptomatic
hypotension)
Same as above. Also contraindicated in bilateral
renal artery stenosis.
Not to be used during pregnancy (causes
oligohydramnios). Use cautiously in pt with hx of
angioedema, volume depletion, hepatic/renal
failure
3. Beta blockers
• Used to treat HTN (and ocular HTN) and angina
• MOA: blocks beta receptor sites in heart = decreased HR, force of contraction, BP = lower O2
demand
• Side effects: bradycardia, heart failure, arrhythmias (AV block), fainting, fluid retention, edema,
shock, N/V/D
• Assess apical pulse before administration; hold if <50 bpm
• Betaxolol, carteolol, and timolol are used for ocular HTN
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Beta Blockers
Drug
Atenolol, Carvedilol,
Metoprolol, Nadolol,
Bisoprolol
Indication
HTN, angina, post-MI, SVT
Nursing
Ischemic heart disease and angina can be
exacerbated after abrupt withdrawal of drug.
Contraindicated in AV block, bradycardia, and
shock. Monitor ECG, BP, and HR frequently.
4. Calcium channel blockers
• Used for: HTN, arrhythmias, and angina
• MOA: prevent Ca from coming into myocardial cell membrane = causes dilation of coronary +
peripheral arteries = decreased force of contractions + decreased afterload = decreased workload of
heart = decreased O2 demand
• No calcium = dilation
• Side effects: orthostatic hypotension, heart failure, bradycardia, AV block, dizziness, headache,
flushing, weakness
• Monitor I+O, daily weight
Drug
Amlodipine
→ Norvasc
Diltiazem
→ Cardizem
Nifedipine
→ Procardia
Verapamil
→ Isoptin
Calcium Channel Blockers
Indication
Nursing
HTN, angina, CAD
Assess BP and HR before administration. Educate
pt on changing positions slowly to avoid
orthostatic hypotension
Angina, HTN, SVT, afib/flutter
Contraindicated in AV block, acute MI,
pulmonary congestion.
Angina, HTN, pulmonary HTN, Raynaud,
Contraindicated in pts taking CYP3A4 inducers
anal fissures
(reduces nifedipine efficacy). Contraindicated in
cardiogenic shock
Angina, HTN, SVT, afib/flutter, tardive
Contraindicated in shock, HF, symptomatic
dyskinesia
hypotension, AV block. Educate pt on informing
HCP of irregular HR, swelling, dizziness.
5. Thiazides (hydrochlorothiazide)
• Used for: edema, HTN, diabetes insipidus
• MOA: reduce Na reabsorption by inhibiting Na+/Cl-cotransporter in the ascending loop of Henle =
prevent reabsorption of Na in kidneys = increased excretion of Na (and thus water). There is also an
increase in excretion of Cl, K, and bicarb
• Side effects: hypokalemia, hyperglycemia, hyperlipidemia, hyponatremia, hypercalcemia, low BP,
orthostatic hypotension
• Decreases responsiveness to oral hypoglycemics
Drug
Hydrochlorothiazide HTN, edema
→ HCTZ, microzide
Indapamide
Metolazone
→ Zaroxolyn
HTN, edema
HTN, edema
Thiazide Diuretics
Indication
Nursing
Contraindicated in anuria. Use cautiously in
pts with DM, fluid/electrolyte imbalance,
gout, hypotension, SLE, kidney/liver disease.
Same as above
Same as above. Avoid concurrent use with
lithium.
6. Loop diuretics
• Used for: hypercalcemia, hyperkalemia, pulmonary edema, CHF, HTN
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•
•
MOA: inhibits Na and Cl reabsorption in ascending loop of Henle = increases excretion of Na, Cl, and
water
*very rapid effect
Side effects: hyperglycemia, electrolyte imbalance, hypokalemia, hypovolemia, hypotension, ototoxic
Loop Diuretics
Drug
Furosemide
→ Lasix
Indication
HTN, edema, acute pulmonary edema,
increased ICP, hyperkalemia in ALCS
Bumetanide
→ Bimex
HTN, edema
Nursing
If given in excess can cause severe diuresis +
water/electrolyte depletion. Contraindicated in
anuria. Use cautiously in pts with kidney/liver
disease. Risk of ototoxicity. Monitor BUN and
Cre
Same as above
7. Potassium sparing diuretics
• MOA: inhibition of aldosterone by canrenone = increases Na+ excretion, decreases K+ secretion &
excretion = Na+ excretion promotes water excretion
• Side effects: hyperkalemia
• Contraindication: hyperkalemia, renal insufficiency
K+ Sparing Diuretics
Drug
Indication
Nursing
Spironolactone Hyperaldosteronism, edema, HTN, CHF,
Contraindicated in Addison disease,
→ Aldactone
hypokalemia, hirsutism, acne
hyperkalemia, and co-administration with
eplerenone. Monitor serum K+
Amiloride
CHF, HTN, thiazide-induced hypokalemia
Take with food. Monitor serum K+ (may cause
→ Midamor
hyperkalemia). Monitor BUN and Cre
8. Adrenergic agents
• To reduce BP, drugs in this category will inhibit/block the following receptors (thus producing an
opposite effect)
• Alpha 1 – causes peripheral vasoconstriction
• Alpha 2 – causes reduced sympathetic response (*drug to help with BP will agonize this receptor)
• Beta 1 – causes increased HR, conduction & contractility
• Beta 2 – causes increased HR, bronchodilation
Adrenergic Agents
Drug
Doxazosin
→ Cardura
Indication
HTN, BPH
Clonidine
→ Catapres
HTN, cancer pain, alcohol withdrawal,
restless legs syndrome, Tourette’s
syndrome, menopausal flushing
Atenolol,
metoprolol
HTN, angina, post MI, SVT
Nursing
Alpha 1 antagonist = causes vasodilation. Side
effects: orthostatic hypotension, syncope, N/V,
hypothermia, dry mouth, tachycardia
Alpha 2 agonist. Last choice for pts who don’t
respond to other drugs. Reduces sympathetic
output but also increases Na & water retention
(usually given with diuretic). Side effects:
hypotension, dry mouth, edema
Beta 1 antagonist. Slows HR + reduces
contractility = reduced cardiac output. Side
effects: bronchospasm, bradycardia,
hypotension. Contraindicated in bradycardia,
heart block, cardiogenic shock, COPD, asthma
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Antilipemic Drugs
Used to lower lipid levels (cholesterol, triglycerides, phospholipids)
High density lipoprotein (HDL) = good
• HDL transports fats from tissues to liver = cholesterol is used to form bile salts that are excreted
Low density lipoprotein (LDL) = bad
• LDL transports fats from liver to tissues for use or storage but some gets stored in lining of blood
vessels = atherosclerosis
1. Statins (HMG-CoA reductase inhibitors)
• Drops LDL and raises HDL levels (drug is taken for life)
• Used to: prevent atherosclerosis, reduce likelihood of CAD
• MOA: drug inhibits the enzyme that is responsible for converting HMG-CoA to mevalonate =
biosynthesis of cholesterol is limited
• Side effects: myopathy, muscle weakness, N/V
• Contraindication: grapefruit juice (reduces metabolism by liver), pregnancy, liver/kidney disease
Drug
Atorvastatin, Lovastatin,
Simvastatin, Rosuvastatin
→ Lipitor, Altroprev,
Zocor, Crestor
HMG-CoA reductase Inhibitors
Indication
Nursing
Hyperlipidemia, cardiovascular
Contraindicated in acute liver disease and
disease prevention
pregnancy. Risk of myopathy with lovastatin is
increased with concurrent use of strong CYP3A4
inhibitor
2. Bile Acid Resins
• Used to: prevent atherosclerosis
• MOA: resins bind to bile acids (which contain cholesterol) in the GI system = this combo creates an
insoluble compound = leads to excretion. Decrease in bile acid triggers the liver to synthesize more bile
acid from its precursor, cholesterol = lower cholesterol levels
• Side effects: no systemic effects because drug stays in GI tract, N/V/D
• Take with liquid to avoid GI upset
• Contraindicated in pts with: ulcers, IBD, hemorrhoids, constipation
Bile Acid Resins
Drug
Cholestyramine
→ Questran
Indication
Hyperlipidemia
Nursing
Always mix with fluids or food. Take before or
with meals. Contraindicated in complete biliary
obstruction.
3. Fibric Acid Derivatives
• Used to: prevent atherosclerosis
• MOA: unknown mechanism lowers LDL + raises HDL
• Side effects: GI effects, gallstones
• Contraindicated in: gallbladder disease, biliary disease
Drug
Gemfibrozil
→ Lopid
Fenofibrate
→ Tricor
Fibric Acid Derivatives
Indication
Nursing
Hypertriglyceridemia, hypercholesterolemia Contraindicated in severe kidney/liver disease,
biliary cirrhosis, and gallbladder disease. If no
response after 3 mos, d/c drug
Hypercholesterolemia, hypertriglyceridemia Contraindicated in kidney/liver disease,
gallbladder disease, and nursing mothers. Should
be used in conjunction with diet restrictions,
exercise, and cessation of smoking
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RESPIRATORY DRUGS
Routes of medication administration:
Metered dose inhaler (MDI) = puffer
Dry powder inhaler (DPI) = inhalation activates release of fine powder into lungs
Nebulizer = liquid drug is vaporized for inhalation through a facemask
Goals of drugs for respiratory system = dilate bronchioles (stop bronchospasms) & reduce/prevent
inflammation
Beta2 Adrenergic Agonists
Used to treat: asthma and COPD
These drugs can either be short-acting or long acting
1. Short acting (immediate onset, lasts 5-6 hrs) = metaproterenol, terbutaline, pirbuterol, salbutamol
2. Long acting (delayed onset, lasts 8-12 hrs) = albuterol, levalbuterol, bitolterol, salmeterol
Short acting is drug of choice for fast relief of symptoms in asthmatic pts
MOA: stimulates beta2 receptors = relaxes smooth muscle in airway = allows increased airflow to the lungs
Side effects: paradoxical bronchospasm, tachycardia, palpitation, tremors, dry mouth, HTN
Contraindicated in: dysrhythmias, benign prostatic hyperplasia, palpitations
Drug
Albuterol
→ Ventolin
Levalbuterol
→ Xopenex
Metaproterenol
Terbutaline
→ Brethaire
Drug
Albuterol
→ Ventolin
Salmeterol
→ Serevent
Diskus
Short acting Beta2 Adrenergic Agonists
Indication
Nursing
Bronchospasm (acute, severe, or exerciseAvoid use in uncontrolled arrhythmias. Observe
induced)
for paradoxical bronchospasm (wheezing) –
most likely with first dose from new puffer
Bronchospasm, asthma exacerbation
Same as above.
Bronchospasm, asthma exacerbation
Bronchospasm, preterm labor
Contraindicated in tachycardia secondary to
heart condition. Risk of hypokalemia
Risks outweigh benefits in pregnant women
receiving prolonged treatment (>48hrs). Serious
side effects include tachycardia, hyperglycemia,
hypokalemia, arrhythmias, and MI
Long acting Beta2 Adrenergic Agonists
Indication
Nursing
Bronchospasm (acute, severe, or exerciseAvoid use in uncontrolled arrhythmias. Observe
induced)
for paradoxical bronchospasm (wheezing) –
most likely with first dose from new puffer
Asthma prevention and maintenance, COPD
Can increase risk of asthma-related death (this
maintenance, prevention of exercise-induced
drug should be used in pt’s who aren’t
asthma
adequately controlled on other asthma
medication).
Anticholinergics
Competitively antagonize actions of Ach
Usually not used to treat asthma and COPD due to thickening of secretions, but, ipratropium is one drug in this
category that is used for COPD
Used in: pts with COPD to prevent wheezing, SOB, chest tightness, and cough
MOA: blocks PNS = inhibits muscarinic receptors = causes bronchodilation
Side effects: tachycardia, nervousness, N/V, dizziness, headache, paradoxical bronchospasm
Contraindicated in: benign prostatic hypertrophy, narrow angle glaucoma
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Drug
Ipratropium
→ Atrovent
Anticholinergics for bronchodilation
Indication
Nursing
COPD, adjunct for bronchospasm caused by If given with other inhalers - administer
asthma
adrenergic bronchodilators 1st, followed by
ipratropium, then corticosteroids. Wait 5 min
between medications.
Corticosteroids
Used for: long term prevention of asthma attacks
MOA: inhibit production of cytokines, leukotrienes, and prostaglandins + promote recruitment of eosinophils
and inflammatory mediators = reduce inflammation
These drugs will not help in an acute asthma attack
Side effects: mouth irritation, oral candidiasis, upper respiratory tract infection, cough. Oral corticosteroids =
hyperglycemia, N/V, headache, growth suppression in children
Contraindicated in: active infection, hypertension, CHF
Pt’s with diabetes will need closer monitoring of blood glucose due to side effect of hyperglycemia
Drug
Beclomethasone
→ QVAR
Fluticasone
→ Flovent
Prednisone
Anticholinergics for bronchodilation
Indication
Nursing
Chronic asthma
Contraindicated in primary treatment of status asthmaticus or
acute bronchospasm. Assess patients changing from systemic
corticosteroids to inhalation corticosteroids for signs of
adrenal insufficiency (anorexia, nausea, weakness, fatigue,
hypotension, hypoglycemia) during initial therapy + periods of
stress
Maintenance of asthma (not for
Same as above
acute relief)
Acute asthma, RA, advanced
Contraindicated in untreated serious infections, varicella, and
pulmonary TB, autoimmune
in administration of live or attenuated live vaccine. Monitor for
hepatitis
Cushing syndrome and hyperglycemia. Prolonged use can
increase risk of infection
Leukotriene Modifiers
Used for: prevention of acute asthmatic episodes and long term control of mild asthma
Leukotrienes are pro-inflammatory and cause smooth muscle contraction
MOA: leukotriene receptors are blocked = smooth muscle relaxes + bronchodilation
Side effects: headache, dizziness, N/V, myalgia, cough
Contraindicated in: liver disease, active infections
Drug
Montelukast
→ Singulair
Zafirlukast
→ Accolate
Leukotriene Modifiers
Indication
Nursing
Prophylaxis and maintenance of asthma, Not to be given during an acute asthma attack.
exercise-induced bronchospasm, allergic Monitor for behaviour that could indicate depression
rhinitis
or suicidal thought.
Chronic asthma treatment and
Not to be given during an acute asthma attack.
prophylaxis
Behavioural changes are reported. Use with warfarin
can result in increased INR
Mast Cell Stabilizers
Used for: prevention & long term control of asthma
MOA: inhibits calcium (necessary for degranulation) = prevents histamine release by mast cells = reduction in
inflammation
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Not effective in asthma attack
Side effects: tracheal irritation, cough, wheeze, bronchospasm, headache
Mast Cell Stabilizers
Indication
Nursing
Asthma, bronchospasm prophylaxis
Not to be given during an acute asthma attack.
Symptoms may reoccur when withdrawing the drug
Drug
Cromolyn
Expectorants
Used in cold and flu medications
MOA: Increases bronchial secretions = thins mucous = easier to cough up mucous = easier to clear the airway
Side effects: N/V/D, drowsiness, abdo pain, headache
Expectorants
Drug
Guaifenesin
→ Robitussin,
Mucinex
Indication
Cough
Nursing
Notify MD if no improvement in >7 days.
Antitussives
Used to relieve a dry + nonproductive cough
MOA: suppress cough reflex by direct action on cough center in medulla
Side effects: N/V/C, sedation, dizziness
Contraindicated in: COPD (it is important to cough in COPD)
Expectorants
Drug
Hydrocodone bitartrate
→ Tussigon
Dextromethorphan
→ Benylin, Buckley’s
Benzonatate
→ Tessalon
Indication
Cough
Cough
Cough
Nursing
Contraindicated in paralytic ileus, acute abdo conditions, and
respiratory depression.
Contraindicated in use with MAOI (can cause serotonin
syndrome). Avoid OTC cough/cold medication while breast
feeding or to children <4 years.
Risk of severe hypersensitivity reaction (bronchospasm,
cardiovascular collapse). Keep away from children. Risk of
mental confusion/hallucinations.
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GASTROINTESTINAL SYSTEM DRUGS
GI tract: mouth - pharynx - esophagus - cardiac sphincter - stomach - pyloric sphincter - duodenum - jejunum ileum - ascending - transverse - descending - sigmoid - rectum
Peptic ulcer disease (PUD): Acid irritates lining of the stomach or small intestine (SI)
Stomach produces mucous, SI produces bicarb = this protects the lining from acid
85% of cases of PUD are due to H. pylori = irritates epithelial cells and is toxic = lining becomes less able to
protect itself. If irritation is severe enough = bleeding occurs = manifested as blood and vomit, or as coffee
ground appearance.
Antiulcer Drugs
Used to eradicate H. pylori or restore balance between acid and pepsin secretions in GI mucosa
Patient teaching = elevate HOB, don’t lie down 1-2 hours after eating, decrease intake of fat; chocolate; citrus;
coffee; and alcohol, avoid smoking, take medications with water to avoid stomach irritation, exercise regularly
1. Systemic Antibiotics
• H. pylori is a gram -ve bacteria
• Eradicate bacteria = promote ulcer healing and decrease recurrence
• Usually combined with proton pump inhibitor or H2 antagonist
• Side effects: mild GI disturbance, abnormal taste, diarrhea
Systemic Antibiotics
Drug
Amoxicillin
→ Amoxil
Clarithromycin
→ Biaxin
Metronidazole
→ Flagyl
Tetracyclines
(e.g.
doxycycline)
→ Vibramycin
Indication
ENT infections, GU tract infections, skin
infections, lower respiratory tract
infections, H. pylori, infective endocarditis
Acute exacerbation of chronic bronchitis,
acute maxillary sinusitis, mycobacterial
infection, PUD, pharyngitis, CAP, skin
infection, pertussis, endocarditis
Anaerobic bacterial infections, STI,
colorectal surgical infection,
trichomoniasis, Gardnerella infection, H.
pylori infection, pelvic inflammatory
disease, Crohn disease
Gram negative bacteria, specific bacterial
infections, respiratory tract infections,
STIs, periodontal disease, rosacea,
anthrax, malaria, infective endocarditis,
cellulitis from MRSA
Nursing
Monitor bowel function. Report diarrhea, abdo
cramping, fever, and bloody stools (can be sign of
c.diff)
Concurrent use with pimozide can prolong the QT
interval and increase risk of arrhythmias.
Contraindicated in co-administration with
colchicine in patients with liver/kidney disease.
Increased risk of rhabdomyolysis with lovastatin
and simvastatin.
Possible carcinogenic effect. Contraindicated in 1st
trimester patients with trichomoniasis.
Superinfection may occur with prolonged use.
Avoid alcohol while taking medication and for at
least three days after discontinuation.
Monitor bowel function. Report diarrhea, abdo
cramping, fever, and bloody stools (can be sign of
c.diff). This is not the drug of choice for any staph
infection. If given during last half of pregnancy or
in pediatric patients, it may cause yellow/brown
discoloration and softening of teeth and bones.
2. Antacids
• Used for: PUD and GERD
• Alkalines (calcium, magnesium, aluminum, sodium carbonates & hydroxides) that neutralize pH of
stomach
• MOA: neutralize acid in GI tract = allows peptic ulcers time to heal
• Pepsin (digestive enzyme) acts more effectively when acidity in stomach is higher. By reducing
acidity, pepsin is reduced.
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•
Side effects: constipation (Ca), diarrhea (Mg, Al), bloating, electrolyte imbalance, aluminum
accumulation
Antacids
Drug
Indication
Aluminum
Heartburn
hydroxide/magnesium
carbonate
→ Gaviscon
Calcium carbonate
GI distress, calcium supplementation
→ Tums
Magnesium hydroxide Constipation, acid indigestion
→ Milk of magnesia
Nursing
Use cautiously in kidney failure
Contraindicated in hypercalciuria, renal calculi,
hypophosphatemia, hypercalcemia.
Contraindicated in kidney failure, electrolyte
imbalance, appendicitis, fecal impaction, and
intestinal obstruction. Use cautiously in kidney
disease
3. H2-receptor antagonist
• Used for: PUD and GERD
• In stomach, histamine binds to H2 receptors (on parietal cells) = stimulates acid secretion
• MOA: blocks H2 receptors = prevents stimulation for acid secretion
• Side effects: D, headaches, decreased liver function, loss of vitamin B12 absorption
H2 Receptor Antagonist
Indication
Nursing
Benign gastric ulcer, duodenal ulcer,
This drug is an antiandrogen and may cause
erosive GERD, heartburn
feminization & sexual dysfunction in males
GERD, benign gastric ulcer, erosive
If GERD is not improved after 6 weeks, switch to
esophagitis
a PPI. Can lead to Vit B12 deficiency. Use
cautiously in renal/liver disease.
Duodenal ulcer, benign gastric ulcer,
Side effects include confusion, delirium,
GERD, heartburn
hallucinations, disorientation, agitation
Drug
Cimetidine
→ Tagamet
Ranitidine
→ Zantac
Famotidine
→ Pepcid
4. Proton Pump Inhibitors (PPI)
• Used for: short-term relief of PUD & GERD
• MOA: blocks last step in gastric acid secretion by combining with H+, K+, and ATP in parietal cells of
stomach
• Enteric coated = bypasses stomach and will dissolve in small intestine
• Side effects: abdo pain, N/V/D
• Take before eating. Pantoprazole can be taken with or without food
• Swallow the tablets or capsules whole; don’t crush or chew them
Drug
Pantoprazole,
→ Protonix,
Pantoloc, Tecta
Omeprazole
→ Prilosec
Lansoprazole
→ Prevacid
Proton Pump Inhibitors
Indication
Nursing
Erosive esophagitis associated with
Monitor bowel function. Report diarrhea, abdo
GERD, short term treatment of GERD,
cramping, fever, and bloody stools (can be sign
Zollinger-Ellison syndrome, PUD,
of c.diff). Use cautiously in liver failure.
Duodenal ulcer, H. pylori, gastric ulcer, Same as above
GERD, Zollinger-Ellison syndrome
Duodenal ulcer, gastric ulcer, GERD,
Same as above
erosive esophagitis, Zollinger-Ellison
syndrome, H. pylori infection,
heartburn
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Adsorbent Drugs
These drugs are antidotes for ingestion of toxins that can lead to OD or poisoning
Most commonly prescribed = charcoal
MOA: drug attracts/binds to toxins = inhibits toxins from being absorbed from GI tract = toxin is excreted with
the activated charcoal (body does not metabolize this)
*These drugs don’t prevent the toxic effect brought on before the adsorbent drug was administered; it is
important to administer charcoal as soon after the toxic ingestion as possible
Adsorbent Drugs
Drug
Activated charcoal
Indication
Overdose, poisoning
Nursing
Shake vigorously before use. Contraindicated in
intestinal obstruction and unprotected airway
(risk of aspiration). Vomiting may occur.
Anti-diarrheal and Laxative Drugs
Goal of anti-diarrheals = treat primary condition, then reduce frequency of bowel movement by inhibiting
peristaltic movements
In constipation, there is a decrease in frequency + fluidity of bowel movements = stools can become hard & dry
= difficult to pass. After giving meds for constipation, use bowel sounds as an indicator that peristalsis is
occurring
All laxatives are contraindicated in obstructions or fecal impactions
1. Opioid-related anti-diarrheals
• Used for: diarrhea
• MOA: decrease peristalsis by depressing the muscles in the large and small intestines = prolongs
transmit of GI contents
• Side effects: N/V, abdo distention, fatigue, CNS depression, tachycardia, paralytic ileus
Opioid-related anti-diarrheals
Indication
Nursing
Diarrhea
Contraindicated in obstructive jaundice. Use
cautiously in pts with respiratory depression or
coma as the drug can cause CNS depression
Acute diarrhea, chronic diarrhea
Contraindicated in pt’s younger than 2 yo.
Overdose of this drug can lead to torsades de
pointes and cardiac arrest.
Drug
Diphenoxylate
with atropine
→ Lomotil
Loperamide
→ Imodium
2. Non-opioid related anti-diarrheals
• Used for: diarrhea
• MOA: acts as adsorbents (bind to bacteria/irritants) = excreted in feces
• Side effects: constipation
• Monitor for fluid and electrolyte imbalance
• Contraindicated in: dehydration, electrolyte imbalance, kidney/liver disease, glaucoma
Drug
Bismuth
Subsalicylate
→ Pepto Bismol
Non-opioid-related anti-diarrheals
Indication
Nursing
Diarrhea, gas, upset stomach,
Contraindicated in infectious diarrhea, von
indigestion, heartburn, nausea, H.
Willebrand disease, hemorrhage, GI bleed, and
pylori
hemophilia. Can cause black stool.
3. Bulk forming laxatives
• Used for: constipation
• MOA: fiber not absorbed by bowel = creates bulk that passes quickly through bowel
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•
Should be taken with water
Side effects: flatulence, sensation of abdo fullness, intestinal obstruction, fecal impaction, severe
diarrhea
Bulk Forming Laxatives
Indication
Nursing
Constipation, fiber supplementation
Contraindicated in GI obstruction, fecal
impaction. Mix the powder with water or juice.
Drug
Psyllium
→ Metamucil
4. Stool softeners
• Used for: constipation
• MOA: surfactant lowers stool surface tension = water moves more easily into stool = stool is easier
to pass
• Side effects: diarrhea, throat irritation, abdo cramps
Stool Softeners
Drug
Docusate Sodium
→ Colace
Indication
Nursing
Can be given PO or PR. This med does not
stimulate peristalsis. May take 3-5 days for a
result
Stool softener
5. Stimulant Laxatives
• Used for: constipation
• MOA: irritates bowel = promotes peristalsis + secretion of water into bowel = movement of feces
increases and softens
• Rapid effect (used as prep prior to surgery)
• Side effects: weakness, N, abdo cramps, mild inflammation of rectum
Stimulant Laxatives
Drug
Bisacodyl
→ Dulcolax
Indication
Constipation
Senna
→ Senokot
Constipation, bowel preparation
Nursing
Can be given PO or PR (enema or suppository).
Should only be used for short term therapy (no
longer than 1 week).
Contraindicated in GI obstruction, ulcerative
colitis, fecal impaction, and GI bleed
6. Osmotic Laxatives
• Used for constipation
• MOA: osmotically draws water into bowel
• Risk of dehydration
• Side effects: weakness, fatigue, abdo distention, N/V/D, electrolyte imbalance, weakness,
dehydration
Osmotic Laxatives
Drug
Lactulose
→ Enulose
Indication
Constipation, portal systemic
encephalopathy
Glycerin
→ Fleet glycerin
suppository
Polyethylene glycol
→ PEG
Constipation
Constipation, colonoscopy bowel
prep
Nursing
Contraindicated in impaction. Monitor for
electrolyte imbalance with long-term use. Avoid
using other laxatives concomitantly.
Same as above.
Same as above.
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Anti-emetic and Anti-nausea Drugs
Nausea (N) leads to vomiting (V)
Excessive N/V can lead to metabolic alkalosis, dehydration, and electrolyte imbalances
1. Antiemetics
• Ondansetron (Zofran) is the medication of choice
• MOA varies on the drug;
o Antihistamines – block H1 receptor = prevents Ach from binding to receptor
o Phenothiazines – block dopaminergic receptors in chemoreceptor trigger zone (normally
stimulates vomiting)
o Serotonin receptor antagonist – blocks serotonin stimulation in chemoreceptor trigger zone
and in vagal nerve terminals (both of these normally stimulate vomiting)
• Side effects:
o Antihistamines: drowsiness
o Phenothiazines + serotonin receptor antagonists: confusion, anxiety, agitation, depression,
headache, restlessness, weakness
o Anticholinergic effects of antiemetics: constipation, dry mouth, urine retention
Antiemetics
Drug
Dimenhydrinate
→ Dramamine,
Gravol
Chlorpromazine
→ Thorazine
Ondansetron
→ Zofran
Indication
Antihistamine; prevention of motion
sickness
Phenothiazine; N/V, schizophrenia,
intraoperative sedation, migraine
headache
Serotonin receptor antagonist;
chemotherapy or radiation-induced N/V,
post-op N/V, hyperemesis gravidarum
Nursing
Contraindicated in lower respiratory disease
(asthma) and nursing women. Can cause driving
impairment.
Not approved for pt’s with dementia-related
psychosis. Contraindicated in lactation.
Use according to schedule, not PRN. Use with
apomorphine increases the risk of severe
hypotension and loss of consciousness. Monitor
for signs of serotonin syndrome.
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GENITOURINARY DRUGS
GU system: reproductive system + urinary system (kidneys, ureters, bladder, urethra)
Kidneys: dispose of wastes in the form of urine, filter blood, maintain fluid/electrolyte balance, produce
hormones + enzymes, convert vitamin D to a more active form, and help regulate BP + volume by secreting
renin
Diuretics
1. Thiazides (hydrochlorothiazide)
• Used for: edema, HTN, diabetes insipidus
• MOA: reduce Na reabsorption by inhibiting Na+/Cl- cotransporter in the ascending loop of Henle =
prevent reabsorption of Na in kidneys = increased excretion of Na (and thus water). There is also an
increase in excretion of Cl, K, and bicarb
• Side effects: hypokalemia, hyperglycemia, hyperlipidemia, hyponatremia, hypercalcemia, low BP,
orthostatic hypotension
• Decreases responsiveness to oral hypoglycemics
Drug
Hydrochlorothiazide
→ HCTZ, microzide
Indapamide
Metolazone
→ Zaroxolyn
Thiazide Diuretics
Indication
HTN, edema
HTN, edema
HTN, edema
Nursing
Contraindicated in anuria. Use cautiously in
pts with DM, fluid/electrolyte imbalance,
gout, hypotension, SLE, kidney/liver disease.
Same as above
Same as above. Avoid concurrent use with
lithium.
2. Loop diuretics
• Used for: hypercalcemia, hyperkalemia, pulmonary edema, CHF, HTN
• MOA: inhibits Na and Cl reabsorption in ascending loop of Henle = increases excretion of Na, Cl, and
water
• *very rapid effect
• Side effects: hyperglycemia, electrolyte imbalance, hypokalemia, hypovolemia, hypotension, ototoxic
Loop Diuretics
Drug
Furosemide
→ Lasix
Indication
HTN, edema, acute pulmonary edema,
increased ICP, hyperkalemia in ACLS
Bumetanide
→ Bimex
HTN, edema
Nursing
If given in excess can cause severe diuresis +
water/electrolyte depletion. Contraindicated in
anuria. Use cautiously in pts with kidney/liver
disease. Risk of ototoxicity. Monitor BUN and
Cre
Same as above
3. Potassium sparing diuretics
• MOA: inhibition of aldosterone by canrenone = increases Na+ excretion, decreases K+ secretion &
excretion = Na+ excretion promotes water excretion
• Side effects: hyperkalemia
• Contraindication: hyperkalemia, renal insufficiency
K+ Sparing Diuretics
Drug
Indication
Nursing
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Spironolactone
→ Aldactone
Hyperaldosteronism, edema, HTN, CHF,
hypokalemia, hirsutism, acne
Amiloride
→ Midamor
CHF, HTN, thiazide-induced hypokalemia
Contraindicated in Addison disease,
hyperkalemia, and co-administration with
eplerenone. Monitor serum K+
Take with food. Monitor serum K+ (may cause
hyperkalemia). Monitor BUN and Cre
Urinary Tract Antispasmodics
These drugs help decrease urinary tract muscle spasms
Used for: overactive bladder, urge incontinence, neurogenic bladder
MOA: drug inhibits PNS = relieves smooth muscle spasm by relaxing detrusor and urinary muscles
Side effects: blurred vision, headache, urinary retention, dry mouth, N/V/C, weight gain, glaucoma
Monitor voids and assess for S/S of overactive bladder (urgency, incontinence, and frequency)
If co-administered with strong CYP3A4 inhibitors, drug should be given at reduced dosage
Drug
Darifenacin
→ Enablex
Flavoxate
Oxybutynin
→ Ditropan
Solifenacin
→ Vesicare
Tolterodine
→ Detrol
Urinary Tract Antispasmodics
Indication
Nursing
Overactive bladder
Contraindicated in urinary retention, narrow
angle glaucoma, liver failure, GI/GU obstruction.
If angioedema occurs, d/c medication. Avoid use
in patients with myasthenia gravis because of
decreased cholinergic activity
Overactive bladder, dysuria
Same as above
Overactive bladder with neurogenic bladder Same as above
Overactive bladder
Same as above
Overactive bladder, urge incontinence
Same as above
Erectile Dysfunction Drugs (Phosphodiesterase 5 Enzyme Inhibitors)
Erectile dysfunction = due to lack of blood flowing through corpus cavernosum
MOA: drug selectively inhibits phosphodiesterase type 5 receptors = causes increase in nitric oxide = activation
of cGMP enzyme = relaxation of smooth muscle = increased blood flow to corpus cavernosum = erection
Side effects: (sildenafil = hypotension, MI, cerebrovascular hemorrhage), headache, dizziness, flushing,
dyspepsia, vision change
Drug is to be taken 30 minutes-4 hours before sexual activity
If the erection lasts >4 hours, medical intervention is needed
Do not take erectile dysfunction drugs if also on nitrates or beta blockers for HTN or angina
These drugs have no effect without the presence of sexual stimulation
Drug
Sildenafil
→ Viagra
Tadalafil
→ Adcirca
Vardenafil
→ Levitra
Erectile Dysfunction Drugs
Indication
Nursing
Erectile dysfunction, pulmonary arterial HTN Co-administration with soluble guanylate
cyclase stimulators (e.g. riociguat) or nitrates
can cause severe hypotension. Sudden
decrease/loss of hearing can occur.
Erectile dysfunction, BPH
Same as above
Erectile dysfunction
Same as above. Co-administration with Class I
antiarrhythmics (e.g. quinidine or procainamide)
or Class III antiarrhythmics (e.g. amiodarone )
increases the risk of serious arrhythmias
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Hormonal Contraceptive Drugs
These drugs inhibit ovulation
MOA: suppresses gonadotropins = inhibits ovulation
• Estrogen (E) = suppresses follicle stimulating hormone = blocks follicular development + ovulation
• Progestin (P) = suppresses secretion of luteinizing hormone = prevents ovulation even if follicle develops
• Progestin = thickens cervical mucous = interferes with sperm migration + implantation of fertilized egg
Side effects: arterial thrombosis, thrombophlebitis, PE, MI, HTN, gallbladder disease, acne, bleeding between
periods, bloating, breast tenderness, change in libido, weight fluctuation
1. Oral Contraceptive
• Usually a combo of P + E
• Taken for 21 of 28 days with 7 days of placebos
• If pt misses one day, double up on the next day
• Monophasic = constant amounts of P & E
• Biphasic = E is constant but P changes to better thicken endometrium
• Triphasic = P & E both vary during cycle
2. Non-Oral Contraceptive
• IM injections of medroxyprogesterone (depo-provera) = 3 months of contraception
• Norplant system; silastic capsules containing levonorgestrel that are implanted into skin = up to 5
years of contraception
• Transdermal patch (E&P); Orthoevra = change patch once a week for 3 weeks, then no patch
• Nuva ring; vaginal ring containing P&E that’s changed once per cycle
Pregnancy Drugs
1. Oxytocic’s
• Used to: promote uterine contraction
• MOA: activates G-protein-coupled receptors that trigger increases in intracellular calcium levels in
uterine myofibrils = stimulates uterine smooth muscle = promotes uterine contractions
• Also has vasopressor and antidiuretic effects
• Oxytocin is contraindicated for contractions closer than two minutes apart
• Monitor pt’s for HTN
Drug
Oxytocin
→ Pitocin
Oxytocic Drug
Indication
Nursing
Postpartum hemorrhage, labour induction,
Monitor intrauterine pressure, FHR, maternal
incomplete abortion
BP + HR. Contraindicated in unfavorable fetal
positions, fetal distress, hypertonic uterus, and
in elective labor induction.
2. Tocolytic’s
• Used to: block uterine contractions
Drug
Terbutaline
→ Brethaire
Magnesium sulfate
Tocolytic Drug
Indication
Nursing
Bronchospasm, pre-term labor
Beta blocker. Monitor maternal HR and BP,
frequency and duration of contractions, and
FHR. Maternal side effects include tachycardia,
palpitations, tremor, anxiety, and headache
Hypomagnesemia, torsades de
Monitor HR, BP, RR, and ECG frequently.
pointes, preterm labour
Monitor newborn for hypotension,
hyporeflexia, and respiratory depression.
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HEMATOLOGY DRUGS
Hematology system = plasma (liquid component of blood) and blood cells (RBC, WBC, platelets)
Hematinic Drugs
Aid in RBC production (which then also increases hgb = increases oxygen transportation)
Used for: microcytic and macrocytic anemia
1. Iron
• Treats the most common form of anemia = iron deficiency anemia
• Most important role of iron = production of hgb by increased erythropoiesis (production of RBC)
• Pregnant pt’s should take iron due to fetus using up the iron
• Iron absorption is reduced by: spinach, whole-grains, coffee, tea, eggs, and milk products
• Side effects: gastric irritation, constipation, dark stool
Iron Drugs
Drug
Indication
Ferrous fumarate, ferrous Prevention/treatment of irongluconate, ferrous sulfate deficiency anemia
→ Feostat, Fergon,
Feosol
Iron sucrose, iron dextran
→ Venofer, DexFerrum
Prevention/treatment of irondeficiency anemia
Nursing
Oral iron can decrease the absorption of
tetracyclines, fluoroquinolones, or
penicillamine.
Oral preparations are most effectively absorbed
if administered 1 hr before or 2 hr after meals
Given via injection. Monitor BP and HR
frequently.
2. Vitamin B12
• Used to: treat pernicious anemia
• B12 is necessary for cell growth + replication and for maintenance of myelin in nervous system
o HCl acid and intrinsic factor from the parietal cells of gastric mucosa are necessary for
absorption of Vitamin B12
• Pernicious anemia = decreased gastric production of HCl acid + deficiency of intrinsic factor
• Side of effects of parenteral B12: itching, rash, hives, hypokalemia, polycythemia vera, heart failure,
pulmonary edema, anaphylaxis
• Assess pt for S/S of vitamin B12 deficiency (pallor; neuropathy; psychosis; red + inflamed tongue)
Drug
Cyanocobalamin,
hydroxocobalamin
→ Nascobal,
cyanokit
Vitamin B12 Drugs
Indication
Nursing
B12 deficiency, pernicious anemia
Water soluble vitamin. Pt’s with small-bowel
disease, malabsorption syndrome, or
gastric/ileal resections require parenteral, not
PO, administration. With PO route, administer
med with meals to increase absorption.
3. Folic Acid
• Used to: treat megaloblastic anemia caused by folic acid deficiency
• Usually occurs in pediatric, pregnant, elderly, or alcoholic patients
• Folic acid is necessary in RBC production + growth
• Large doses of folic acid can counteract effects of anticonvulsants
• Side effects: erythema, itching, rash, anorexia, N, difficulty concentrating, irritability
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Folic Acid Drugs
Drug
Folic Acid
→ Folvite
Indication
Folic acid deficiency, neural tube defects
prophylaxis
Nursing
Phenytoin (& other anticonvulsants) may
decrease folic acid absorption.
4. Epoetin Alfa
• Erythropoietin forms in kidneys when there is hypoxia + anemia; it stimulates erythropoiesis in bone
marrow (RBC production)
• These drugs are given to pts with decreased erythropoietin production
• Side effects: HTN is most common, headache, N/V/D, edema, fatigue, dizziness, chest pain, skin
reaction
Epoetin Alfa Drugs
Drug
Epoetin Alfa
→ Epogen
Indication
Chronic kidney disease-associated
anemia, chemotherapy-related
anemia
Darbepoetin Alfa
→ Aranesp
Same as above
Nursing
Contraindicated in cancer pt’s whose anemia is
due to factors other than chemo and in pt’s with
uncontrolled HTN. Additional heparin may be
needed to prevent blood clotting if the patient is
on dialysis.
Same as above
Anticoagulant Drugs
These drugs reduce the ability of the blood to clot
Assess for S/S of bleeding or hemorrhage: bleeding gums, nosebleed, bruising, black tarry stools, hematuria
1. Heparin & Heparin Derivatives
• Used to: prevent clot formation
• Does not dissolve already formed clots
• MOA: drug activates antithrombin 3 = prevents formation of thrombin + fibrin
• Thrombin time and PTT are prolonged in pt taking heparin
• Low molecular weight heparin = used for DVT prevention
• Side effects: few side effects. Bleeding, bruising, hematoma
• PTT is maintained at 1.5-2x the normal
• Antidote for heparin is protamine sulfate
Drug
Heparin
Dalteparin,
Enoxaparin
→ Fragmin, Lovenox
Heparin & Heparin Induced Derivatives
Indication
Nursing
DVT, PE, ACS, anticoagulation,
High alert drug – can cause fatal hemorrhage.
catheter patency
Contraindicated in uncontrolled active bleed
(except DIC). Heparin-induced thrombocytopenia
can occur. Monitor PTT
Prevention of DVT and/or PE
Low molecular weight heparin. Contraindicated
in active bleed, history of heparin-induced
thrombocytopenia, and in pt’s who had epidural
neuraxial anesthesia. Do not give via IM route.
2. Oral anticoagulants
• Main drug in this category = warfarin
• Rapid absorption, but effects are not seen for 36-48 hrs
• MOA: inhibits Vitamin K dependent activation of clotting factors
• Side effects: minor bleeding, bruising, hematoma
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•
The effects of warfarin can be reversed with Vitamin K
Monitor INR
Drug
Warfarin
→ Coumadin
Oral anticoagulants
Indication
Nursing
Prophylaxis and treatment of venous
Instruct pt not to drink alcohol or take
thrombosis, PE, afib with embolization,
OTC/herbal medication, especially those
and cardiac valve replacement
containing ASA or NSAIDs.
3. Antiplatelets
• Used to: prevent arterial thromboembolism (used in pt’s at risk for MI, stroke, and arteriosclerosis)
• Absorbed quickly + reaches peak in 1-2 hours
• MOA: drug blocks synthesis of prostaglandin = prevents formation of platelet-aggregating substance,
thromboxane A2
• Side effects: bleeding is most common side effect. Others include stomach pain, heartburn, N/D/C
• Contraindicated in active bleeding
Drug
Aspirin
→ ASA
Clopidogrel
→ Plavix
Antiplatelets
Indication
Nursing
ACS, pain + fever, ischemic stroke, RA,
Teach pt to avoid alcohol when taking aspirin – it
OA, MI prophylaxis
increases risk of GI bleed.
ACS, MI, stroke, CAD
Monitor patient for signs of thrombotic
thrombocytic purpura. Prolonged bleeding time
is expected – monitor CBC and platelet count.
Thrombolytic Drugs
These drugs dissolve existing clots
MOA: drug converts plasminogen to plasmin = dissolves thrombi + fibrinogen
These drugs are most effective when given within 6 hrs of onset of symptoms
Side effects: bleeding
Contraindicated in active bleed
Maintain bleeding precautions during administration
Drug
Alteplase
→ TPA, alteplase
Thrombolytic Drugs
Indication
Nursing
Acute MI, PE, acute ischemic stroke,
Must be administered within 3-4.5 hr of onset of
peripheral artery occlusion, restoration
ischemic stroke. Avoid IM injections on pt’s
of patency in clotted IV access
taking alteplase.
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ENDOCRINE DRUGS
Insulin: pancreatic hormone that increases activity + production of glucose transporter, helps move glucose into
cells and out of blood, promotes storage of carbs, lipids & proteins
• Insulin decreases blood glucose levels
Glucagon: promotes conversion of stored carbs, lipids and proteins into glucose; releases glucose into blood
• Glucagon increases blood glucose levels
Type 1 Diabetes Mellitus:
• Due to genetic, immunologic factors
• Adequate amounts of insulin are not produced = pt requires insulin injections on a daily basis
• S/S: polyuria, polydipsia, polyphagia, hyperglycemia, glycosuria
Type 2 Diabetes Mellitus:
• Onset is usually during middle age
• Insulin is produced but not enough to compensate for hyperglycemia
• Treatment = diet, exercise, oral hypoglycemics, insulin
Antidiabetic Drugs + Glucagon
1. Insulin
• Used for: type 1 diabetics, adjunct treatment for type 2 diabetics, and for diabetic ketoacidosis (DKA)
• 4 types of insulin – rapid acting (e.g. lispro), short acting (e.g. regular insulin), intermediate acting
(e.g. NPH), long acting (glargine)
Type
Rapid acting
(Lispro, Aspart, Glulisine)
Short acting
(Regular)
Intermediate acting
(NPH)
Long acting
(Glargine, Detemir)
•
•
•
•
•
Insulin
Onset
Peak
<15 minutes
1-2 hrs
Duration
3-6 hrs
30-60 minutes
2-4 hrs
6-10 hrs
2-4 hrs
4-8 hrs
10-18 hrs
1-2 hrs
NO PEAK
Up to 24 hrs
S/S of hypoglycemia: Cold, clammy, irritable, pale, weak, diaphoretic
S/S of hyperglycemia: Polyphagia, polyuria, polydipsia, blurred vision, fruity breath, hot + dry
Side effects: hypoglycemia, somogyi effect (hypoglycemia followed by rebound hyperglycemia),
lipodystrophy (disturbance in fat deposition), and insulin resistance
When mixing regular insulin with NPH, always draw up regular insulin (clear) into the syringe first
Treat hypoglycemia with oral glucose tablets, glucagon, or IV glucose
2. Oral antidiabetic drugs
• Used for: type 2 diabetics
• MOA: stimulates insulin release from beta cells in pancreas & reduces glucose output by liver
• Side effects: hypoglycemia is the main side effect
• Pt may need insulin during times of bodily stress (e.g. infection, fever, surgery, trauma)
• Metformin, acarbose, miglitol ,and thiazolidinediones don’t cause hypoglycemia when
taken alone but may increase the hypoglycemic effect of other hypoglycemic agents
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Drug
Glimepiride, glipizide, glyburide
→ Amaryl, Glucotrol, DiaBeta
Pioglitazone, Rosiglitazone
→ Actos, Avandia
Metformin
→ Glucophage
Acarbose, miglitol
→ Precose, Glyset
Repaglinide
→ Prandin
Sitagliptin
→ Januvia
Oral Antidiabetic Drugs
Indication
Nursing
T2DM
2nd generation sulfonylureas. Contraindicated in T1Dm and
DKA
T2DM
Thiazolidinedione drug. This drug can cause or exacerbate
CHF - assess for S/S of CHF after initiation and dose increases.
Contraindicated in DKA and CHF
T2DM
Biguanide drug. This drug can cause lactic acidosis, especially
in pt’s with kidney disease (elevated lactate, decreased blood
pH, EL disturbance). S/S of lactic acidosis: chills, D, dizziness,
hypotension, muscle pain, abdo pain, sleepiness, bradycardia,
dyspnea, or weakness
T2DM
Alpha-glucosidase inhibitor drug. Contraindicated in DKA,
cirrhosis, inflammatory bowel disease, GI impairment.
T2DM
Meglitinide drug. Contraindicated in DKA, T1DM, and in coadministration with gemfibrozil (can lead to severe
hypoglycemia)
T2DM
Incretin modifier drug. Use cautiously in CHF. Not effective in
DKA or T1DM
3. Glucagon
• A hormone normally produced by alpha cells in the pancreas
• This drug raises blood glucose levels
• Used for: emergency treatment of severe hypoglycemia
• MOA: promotes glycogenolysis (conversion of glycogen into glucose), gluconeogenesis (formation of
glucose from fatty acids + protein), and lipolysis (release of fatty acids to be converted into glucose)
• Side effects: rarely any
Thyroid Drugs
1. Thyroid drugs
• Used to: treat hypothyroidism
• These drugs contain triiodothyronine (T3), thyroxine (T4), or both
• MOA: stimulates metabolism of all body tissue by accelerating rate of cellular oxidation
o Thyroid stimulates protein synthesis, gluconeogenesis, and increases glycogen storage
• Levothyroxine is the drug of choice
• Side effects: D, abdo cramps, weight loss, palpitations, HTN, headache, tremor, heat intolerance
Thyroid Drugs
Drug
Levothyroxine
→ Synthroid
Indication
Hypothyroidism, myxedema coma
Thyroid USP
Hypothyroidism
Nursing
Contains T4. Not used for treatment of obesity.
The dose needs to be properly titrated and
monitored. Monitor for tachyarrhythmias.
Contains T3 and T4. Use cautiously in angina,
cardiovascular disease, and HTN.
2. Thyroid Antagonist
• Used to: treat hyperthyroidism
• MOA: blocks iodine’s ability to combine with tyrosine = prevents thyroid synthesis
• Side effects: granulocytopenia
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Drug
Propylthiouracil,
methimazole
→ PropylThyracil,
Tapazole
Thyroid Antagonist Drugs
Indication
Nursing
Hyperthyroidism, Graves Disease Thioamide drugs. Agranulocytosis can develop
quickly and usually occurs during first 2 mos. Closely
monitor for liver injury in first 6 mos. Propylthiouracil
is used over methimazole in pregnant pt’s because
the drug does not cross the placenta (methimazole
can cause congenital abnormalities)
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MENTAL HEALTH DRUGS
Antidepressant Drugs
S/S of depression: sleep disturbances, extreme fatigue, abnormal eating patterns, vague physical symptoms,
inability to focus attention, death-obsessed, avoiding personal interactions, lack of interest in sex/personal
appearance, delusions/hallucinations
1. SSRIs
• Used to: treat major depression, panic disorders, eating disorders, personality disorders, and anxiety
• Drug of choice for depression
• MOA: drug inhibits neuronal reuptake of serotonin = increase in serotonin levels
• Abrupt discontinuation can lead to SSRI discontinuation syndrome (S/S: lowered mood, lethargy,
irritability, paresthesia)
• Side effects: anxiety, insomnia, somnolence, palpitations, sexual dysfunction, orthostatic
hypotension, increased suicidal ideation
• Drug needs to be taken for 2-4 weeks for relief of symptoms to be seen
SSRI Drugs
Drug
Citalopram
→ Celexa
Escitalopram
→ Lexapro
Fluoxetine
→ Prozac
Paroxetine
→ Paxil
Sertraline
→ Zoloft
Indication
Depression
Major depressive disorder, generalized
anxiety disorder, OCD, insomnia
secondary to panic disorder, PTSD
Major depressive disorder, OCD, bulimia
nervosa, panic disorder, premenstrual
dysphoric disorder
Depression, OCD, panic disorder, social
phobia, generalized anxiety disorder,
PTSD, premenstrual dysphoric disorder,
menopausal vasomotor symptoms
Major depressive disorder, OCD, panic
disorder, PTSD, social anxiety disorder,
premenstrual dysphoric disorder
Nursing
Do not administer to pt taking MAOI (increases
risk of serotonin syndrome). S/S of serotonin
syndrome: mental changes (agitation,
hallucinations, coma), autonomic instability
(tachycardia, labile BP, hyperthermia),
hyperreflexia, incoordination, and/or GI
symptoms (N/V/D). Monitor for suicidal ideation.
Use cautiously in pregnancy (risk of pulmonary
HTN of newborn)
Same as above.
Same as above. Monitor for neuroleptic
malignant syndrome (S/S: fever, resp distress,
tachycardia, seizures, diaphoresis, arrhythmias,
HTN or hypotension, pallor, tiredness, muscle
stiffness, loss of bladder control)
Same as above. Monitor for serotonin syndrome
+ neuroleptic malignant syndrome
Do not administer to pt taking MAOI (increases
risk of serotonin syndrome). S/S of serotonin
syndrome: mental changes (agitation,
hallucinations, coma), autonomic instability
(tachycardia, labile BP, hyperthermia),
hyperreflexia, incoordination, and/or GI
symptoms (N/V/D). Monitor for suicidal ideation.
Use cautiously in pregnancy (risk of pulmonary
HTN of newborn)
2. Monoamine oxidase Inhibitors (MAOIs)
• Used to: treat depression, panic disorder, eating disorder, PTSD
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•
•
•
•
•
Used when a pt does not respond to SSRI or TCA
MOA: inhibits monoamine oxidase (normally metabolizes neurotransmitters like serotonin and
norepinephrine) = increases the amount of neurotransmitters (serotonin, dopamine,
norepinephrine)
MAOI taken with amphetamines, methylphenidate, levodopa, or sympathomimetics may increase
catecholamine release = causes hypertensive crisis
Stop an MAOI 2 weeks before starting another antidepressant
Avoid foods high in tyramine (aged cheese, red wine, beer, avocado, chocolate) and caffeine = can
lead to hypertensive crisis
Side effects: hypertensive crisis, orthostatic hypotension, restlessness, drowsiness, dizziness,
headache, N/V/C, dry mouth, blurred vision, urine retention
MAOI Drugs
Drug
Phenelzine
→ Nardil
Indication
Nursing
Monitor BP. Monitor for suicidal ideation.
Contraindicated in pheochromocytoma, CHF,
HTN, liver/kidney disease
Abrupt discontinuation can lead to withdrawal
effects (including delirium). Monitor for suicidal
ideation. Contraindicated in pheochromocytoma,
CHF, HTN, liver/kidney disease, schizophrenia
Depression
Tranylcypromine
→ Parnate
Major depressive disorder
3. Tricyclic antidepressants (TCAs)
• Used to: treat major depression
• 2nd choice of drug after SSRI
• MOA: inhibits reuptake of NE & serotonin, but not dopamine (also blocks acetylcholine and
histamine receptors)
• Side effects: orthostatic hypotension, cardiac dysrhythmias, anticholinergic effects (dry mouth,
blurred vision, tachycardia, C, restlessness), sedation, weight gain, respiratory depression
TCA Drugs
Drug
Amitriptyline
→ Elvail
Indication
Depression, migraine prophylaxis, eating
disorder
Amoxapine
→ Asendin
Depression
Clomipramine
→ Anafranil
Desipramine
→ Norpramin
Doxepin
→ Silenor
Nortriptyline
→ Pamelor
Trimipramine
OCD
Nursing
Monitor for suicidal ideation (SI). Not to be used
in pediatric pts. Pt’s with cardiovascular hx or
those taking a high dose should have ECG
monitored. Contraindicated in pt’s taking MAOI
Monitor for SI. Not to be used in pediatric pts.
Contraindicated in narrow angle glaucoma,
severe cardiovascular disease, and with MAOI
use.
Same as above
Depression
Same as above
Depression, anxiety, insomnia
Same as above
Depression, ADHD, chronic neurogenic
pain
Depression
Same as above. Monitor ECG - may prolong PR +
QT intervals, and may flatten T waves.
Monitor for SI. Not to be used in pediatric pts.
Contraindicated in severe cardiovascular disease,
narrow angle glaucoma, and MAOI use
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4. Atypical Antidepressants
• Trazodone: serotonin antagonist and reuptake inhibitor (SARI); increases serotonin release
• Buproprion: NE & dopamine reuptake inhibitors (NDRI)
• Venlafaxine & Duloxetine: serotonin & NE reuptake inhibitors (SNRIs); used in pt’s that aren’t
responsive to SSRIs and for patients that suffer from chronic pain as a symptom of depression (in
combo with TCAs)
• Mirtazapine: similar to SNRIs but also antagonizes H1 histamine receptors (produces sedation,
increased appetite and weight gain as side effects)
Bipolar Drugs
Bipolar = cyclic episodes of mania & depression
Mania: due to excess excitatory neurotransmitters or deficit of inhibitory neurotransmitters (such as GABA)
In bipolar, pt has episodes of excessive catecholamine stimulation and diminished catecholamine stimulation
MOA: exact mechanism is unknown. Alters levels of NE, serotonin, and dopamine.
S/S of mania: insomnia, activity without fatigue, agitated, aggressive, overconfidence, seeking others, unusual
interest in sex, substance abuse, denial of problem
A pt on a severe salt-restricted diet is susceptible to lithium toxicity. Increased intake of Na+ may reduce the
therapeutic effects of lithium
Bipolar Drugs
Drug
Lithium
→ Eskalith, Lithobid
Indication
Bipolar disorder
Nursing
Take with plenty of water and after meals to
minimize GI upset. Monitor lithium levels
(narrow therapeutic index); S/S of toxicity:
diarrhea, vomiting, tremor, drowsiness, muscle
weakness, and ataxia
Antipsychotic Drugs
These drugs control psychotic symptoms – delusions, hallucinations, thought disorder
Used for: schizophrenia, mania, and psychosis
S/S of schizophrenia: hallucinations, delusions, paranoia, indifference/detachment from surroundings,
deteriorating performance of basic skills, withdrawal from social interaction, strange communication
behaviours, irregular moods
• Positive symptoms = add on to normal behavior; hallucinations, delusions, disorganized
thought/communication
• Negative symptoms = subtract from normal behavior; lack of interest in daily activities, lack of
motivation, lack of responsiveness
1. Typical Antipsychotics
• Include phenothiazines and nonphenothiazines
• Block positive symptoms by antagonizing dopamine & serotonin
• Side effects: anticholinergic, sexual dysfunction, sedation, orthostatic hypotension, weight gain,
extrapyramidal effects (acute dystonia, akathisia, Parkinsonism, tardive dyskinesia), neuroleptic
malignant syndrome (fever, muscle rigidity, unstable BP, sweating, dyspnea)
• Contraindicated in: Parkinson’s, CNS depression, bone marrow depression, alcohol withdrawal
syndrome, Reye’s syndrome, COPD
Drug
Haloperidol
→ Haldol
Typical Antipsychotic Drugs
Indication
Nursing
Schizophrenia, psychosis, Tourette
Monitor ECG and QT interval (risk of QT
disorder
prolongation). Monitor for neuroleptic malignant
syndrome. Not to be used for dementia-related
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Loxapine
→ Loxitane
Schizophrenia
Chlorpromazine
→ Thorazine
Schizophrenia, psychotic disorder,
intraoperative sedation, migraine
headache
Psychotic disorders
Fluphenazine
→ Modecate
Thioridazine
→ Mellaril
Schizophrenia, depressive disorder
psychosis. Haloperidol decanoate should not be
administered via IV route. Contraindicated in
severe CNS depression, Parkinson’s, and
dementia with Lewy bodies
Not to be used in dementia-related psychosis.
This drug can cause bronchospasm + respiratory
distress. Contraindicated in CNS depression,
neuroleptic malignant syndrome, and seizure
disorder
Primarily causes sedation + anticholinergic
effects. Not to be used in dementia-related
psychosis. Do not use in lactating pts.
Primarily cause extrapyramidal reactions. Not to
be used in dementia-related psychosis. Do not
use in lactating pts.
Primarily cause sedation, anticholinergic, and
cardiac effects. Not to be used in dementiarelated psychosis. Do not use in lactating pts.
2. Atypical Antipsychotics
• Blocks positive & negative symptoms by blocking dopamine, serotonin, ACh and alpha adrenergic
receptors (these drugs don’t block the receptors as much as the typical antipsychotics = less side
effects)
• Drug group of choice
• Side effects: weight gain, decreased libido, risk of type II diabetes due to altered glucose metabolism,
bone marrow depression, few motor (EPS) side effects
• Contraindicated in: epilepsy, leucopenia, CNS depression, hypotension
Drug
Clozapine
→ Clozaril
Olanzapine
→ Zyprexa
Risperidone
→ Risperdal
Quetiapine
→ Seroquel
Aripiprazole
→ Abilify
Atypical Antipsychotic Drugs
Indication
Nursing
Schizophrenia, suicidal behaviour in
Monitor for signs of myocarditis (fatigue,
schizophrenia
dyspnea, tachypnea, fever, chest pain,
palpitations, heart failure, ECG changes,
arrhythmias). This drug lowers the seizure
threshold (institute seizure precautions for pts
with hx of seizures). Monitor for neuroleptic
malignant syndrome. Monitor WBC and ANC
before and during treatment (stop the drug if
there is clozapine-induced neutropenia – can
lead to serious infection and death)
Schizophrenia, bipolar mania, agitation
Not to be used in dementia-related psychosis.
with schizophrenia and bipolar, bipolar
Risk of severe sedation. Monitor for change in
depression
mental status, and for neuroleptic malignant
syndrome
Schizophrenia, bipolar disorder
Not to be used in dementia-related psychosis.
Monitor for suicidal ideation and neuroleptic
malignant syndrome.
Schizophrenia, bipolar disorder, major
Same as above. Not to be used in pts under 10
depressive disorder
years.
Schizophrenia, bipolar mania, major
Not to be used in dementia-related psychosis.
depressive disorder
Monitor for suicidal ideation.
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Stimulants
These drugs treat ADHD (inattention, impulsiveness, hyperactivity)
MOA: drug increases levels of dopamine and NE by blocking reuptake of dopamine + NE
Stimulants shouldn’t be used with MAOI
Side effects: risk of drug abuse, restlessness, tremor, insomnia, tachycardia, palpitations, arrhythmias, dizziness
These drugs should be given at least 6 hours before bedtime to avoid sleep interference
Pts should avoid caffeine as it increases the effects of amphetamines
Stimulant Drugs
Indication
ADHD, narcolepsy
Drug
Dextroamphetamine
→ Dexedrine
Amphetamine/Dextroamphetamine
→ Adderall
Methylphenidate
→ Ritalin
ADHD, narcolepsy
ADHD, narcolepsy
Nursing
High potential for abuse and dependence.
Contraindicated in glaucoma, HTN, hx of
drug abuse, MAOIs
Same as above
Focuses attention by promoting alertness.
Used in children (less effective in adults).
Monitor for growth inhibition. Chronic
abuse can lead to high tolerance and
dependence. Used as cognitive enhancer in
university.
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SUBSTANCES OF ADDICTION
Dependence: unable to stop taking drug due to satisfaction/pleasure from taking drug → linked to dopamine
receptor stimulation in limbic system providing a sense of euphoria
Tolerance: higher dose needed to produce same response due to repeated exposure to drug
Withdrawal symptoms = opposite to the effects of the drug
CNS Depressants
Produce feeling of sedation/relaxation
1. Sedatives
• Used for: sleep disorders, epilepsy, anxiety
• Barbiturates and benzodiazepines
• MOA: stimulates GABA receptors, which then inhibits brain activity; this is what causes the
drowsy/calming effects
• Overdose = suppresses respiratory system
• Contraindications: airway obstruction, narrow angle glaucoma
• Benzodiazepines produce more mild effects while barbiturates have more intense effects
including dependence and potential for lethality
• Benzodiazepine antagonist = flumazenil
• Barbiturates antagonist = megimide
Barbiturates
Drug
Phenobarbital
→ Luminal
Indication
Status epilepticus, seizures, sedation,
hypnotic, insomnia
Primidone
→ Mysoline
Seizures
Nursing
Risk of toxicity increases when taken with CNS
depressants, valproic acid, chloramphenicol,
felbamate, cimetidine, or phenytoin
Benzodiazepines
Drug
Lorazepam
→ Ativan
Indication
Anxiety, status epilepticus, seizures
Diazepam
→ Valium
Anxiety, alcohol withdrawal, pre-op
sedation, seizure, muscle spasm, status
epilepticus
Nursing
Use with opioids can result in profound
sedation, respiratory depression, coma, and
death
Use with opioids can result in profound
sedation, respiratory depression, coma, and
death. Do not use in pts with depressed
respirations or patients who recently received
respiratory depressants
2. Opioids
• Used for: pain, cough, diarrhea, and anesthesia support
• Sedation can occur after the initial “rush”: constricted pupils, respiratory depression, increased
pain tolerance, analgesia, tranquility, euphoria
• MOA: opioids bind to mu opioid receptors on neurons in nervous system + immune system;
produces these effects → pain relief, mood alteration (euphoria and decreased anxiety),
respiratory depression, decreased GI motility, cough suppression, pinpoint pupils (miosis), N/V,
pruritis
• During withdrawal you give = methadone (reduces withdrawal symptoms)
• When injected or inhaled, levels in the brain rise rapidly = causing a rush
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Opioids
Drug
Indication
Heroin
Narcotic
Morphine
Acute pain, chronic severe pain
Fentanyl
→ Sublimaze
General anesthesia, analgesia
Codeine
Pain, cough
Oxycodone
→ Oxycontin,
Oxyneo
Hydromorphone
→ Dilaudid
Moderate to severe pain
Meperidine
→ Demerol
Moderate to severe pain, analgesic
during labour, pre-op sedation,
rigors
Moderate to severe pain, moderate
to severe chronic pain, cough
Nursing
Derived from morphine. When used via IV
route, it is 3-5x more potent
Use cautiously in patients receiving MAO
inhibitors (can have severe reactions). Monitor
for respiratory depression
Risk of opioid addiction/abuse/misuse, which
can lead to overdose and death. Monitor for
respiratory depression. Prolonged use during
pregnancy can cause neonatal opioid
withdrawal syndrome. Avoid use in pt receiving
MAO inhibitor. Transdermal fentanyl is for
moderate-severe chronic pain, not for the
control of postoperative, mild, intermittent, or
short-term pain
Use cautiously in pts on MAO inhibitor. Monitor
RR. Regularly administered dose may be more
effective than PRN dose
Monitor for respiratory depression. If pt has
liver failure, initial dose should be decreased.
Monitor BP, HR, and RR
Use cautiously in pts on MAO inhibitor. Monitor
RR. Rapid IV administration = respiratory
depression, hypotension, circulatory collapse
Can cause seizures as side effect. Monitor RR.
Use cautiously in pts on MAO inhibitor. Risk of
toxicity increases with dose over 600 mg per
day, chronic administration (>2 days), and
kidney injury. IV Push – administer slowly over
5 minutes
3. Ethanol (Alcohol)
• Absorbed orally, detoxified in stomach by alcohol dehydrogenase
• MOA: increases activity of GABA system
o GABA is the major inhibitory neurotransmitter in the brain (decreases activity in nervous
system)
• Effect depends on dose. Side effects: loss of motor coordination, slurred speech, sleep
• Liver detoxifies alcohol at rate of 10 – 15 mL/hour; long term abuse = cirrhosis
Cannabinoids
• MOA: release of central biogenic amines including NE
• Side effects: dizziness, fatigue, slows motor activity, less coordination, paranoia, euphoria, food cravings,
red eyes due to dilated blood vessels
• Therapeutic effect: decreased pain and spasticity
• Active ingredient: delta 9 THC
Cannabinoids
Drug
Cannabidiol
→ Sativex
Indication
Spasticity in multiple sclerosis, neuropathic
pain in MS or advanced cancer patients
Nursing
Avoid alcohol use
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Hallucinogens
• No medical use
• MOA: acts on serotonin receptors in brain (serotonin agonist); causes change in mood (usually
euphoria), change in pain, perception, personality, sexual activity, feelings of intimacy/empathy
Drug
LSD
Psilocybin
→ Mushrooms
Mescaline
→ Peyote
PCP
→ Phencyclidine
Ketamine
→ Special K
MDMA
→ Ecstasy
Hallucinogens
Produces these effects:
Altered perception (can lead to dangerous behaviour), increased BP/HR/T, dizziness, sleepiness,
loss of appetite, sweating, numbness/weakness
Relaxation, paranoia, panic reaction, spiritual experience
Increased HR and T, ataxia (uncoordinated movement), sweating, flushing
Poor coordination, rapid eye movements, slurred speech, confusion, stupor, rigid muscles,
irregular HR, low BP, decreased RR
Powerful anesthetic, increased HR/BP, confusion, agitation, delirium, feelings of paralysis,
urinary frequency, abdominal cramps
Increased energy, involuntary teeth clenching, high T, depression, lack of appetite, detachment
from oneself, disorganized thoughts, restless legs, sweating
CNS Stimulants
• Increase in neurotransmitter NE; known as cognitive enhancers
• MOA: stimulates NE = increased CNS stimulation
• Side effects: increase in BP, increase in RR, reduced appetite, feelings of exhilaration, mental alertness,
dilates pupils, abdo pain, irritability, headache
Drug
Amphetamines
→ Evekeo,
Adderall
Cocaine
Methylphenidate
→ Ritalin
Caffeine
CNS Stimulants
Indication
Nursing
Narcolepsy (excessive sleepiness), obesity,
For narcolepsy, lowest dose should be
ADHD
administered. Dextroamphetamine is used for
appetite suppression (obesity). Avoid
administration to pts taking MAOI (can result in
hypertensive crisis)
Medical use: topical anesthesia
When used recreationally: “high” is reached
quickly and more intensely. Can cause delirium,
hyperactivity, psychosis, arrhythmias,
hypertension, stroke, vasoconstriction
ADHD, narcolepsy
Focuses attention by promoting alertness. Used in
children (less effective in adults). Monitor for
growth inhibition. Chronic abuse can lead to high
tolerance and dependence. Used as cognitive
enhancer in university.
Fatigue, drowsiness, respiratory failure,
Withdrawal symptoms include headaches, fatigue,
diuretic
depression, impaired performance of skills. Used
as cognitive enhancer in university. Not to be given
to pts with anxiety, agitation, or tremors.
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IMMUNE, ANTIBIOTIC/ANTIVIRAL, AND ANTIINFLAMMATORY DRUGS
Bacterial Infection Drugs (Antibiotics)
Classified by ability to live in O2 (aerobic, anaerobic), shape (spiral, cocci, bacilli), and gram +/- (gram - is more
difficult to treat)
It is ideal to do a culture + sensitivity to determine the bacteria you’re dealing with before initiating therapy
Antibiotics can be bacteriostatic (ABX prevents further growth/reproduction of bacteria) or bactericidal (ABX
kills the bacteria)
1. Penicillin
• Used for: gram positive bacteria
• MOA: bactericidal; drug binds to penicillin-binding proteins (PBPs), which are involved in cell wall
synthesis + cell division = prevents the proper development of the bacterial cell well (no cell wall =
membrane is exposed = lysis of bacterial membrane)
• Side effects: skin rash, anaphylactic reactions
• Contraindications: allergy to penicillin
• These drugs can produce c.diff diarrhea
• Take the drug exactly as prescribed; complete the entire prescribed regimen
• Drugs in this category: penicillin G benzathine, penicillin G sodium, dicloxacillin, cloxacillin sodium,
amoxicillin, ampicillin, amoxicillin-clavulanate potassium
2. Cephalosporins
• Used for: primarily gram negative bacteria
• First gen = Gram positive
• Second gen = intermediate coverage, more potent, more resistant to lactamase
• Third gen = broad spectrum, resistant to beta-lactamase, can cross BBB
• Fourth gen = broad spectrum, can handle bacteria resistant to 1st & 2nd generation cephalosporins
and can cross BBB
• MOA: bactericidal; inhibits cell wall synthesis
• Side effects: confusion, seizures, N/V/D
• Drugs in this category: cefadroxil, cefazolin sodium, cephradine, cefaclor, cefuroxime sodium,
cefdinir, cefixime, ceftazidime, cefepime hydrochloride
3. Tetracyclines
• Used for: a broad spectrum of bacteria (+, -, spirochetes)
• MOA: bacteriostatic; bind to 30S subunit = prevent protein synthesis (required for maintenance of
bacterial cell)
• Side effects: superinfection, N/V/D, abdo distention, tooth discoloration of pediatric patients,
impaired fetal skeletal development if taken during pregnancy
• Contraindications: pregnancy, nursing, children under age of 8, kidney disease
• Drugs in this category: demeclocycline hydrochloride, tetracycline hydrochloride, doxycycline,
minocycline
4. Macrolides
• Used for: upper resp tract infx, lower resp tract infx., skin infx., legionella, Chlamydia, listeria,
campylobacter, opportunistic infections
• MOA: bacteriostatic; inhibit RNA-dependent protein synthesis
• Side effects: N/V/D, rash, fever
• Drugs in this category: erythromycin, azithromycin, clarithromycin
5. Aminoglycosides
• Used for: primarily gram - bacteria and resistant bacteria
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•
MOA: bacteriostatic; bind to 30S ribosomal subunit = prevents protein synthesis; also damages cell
wall = tends to be synergistic with beta-lactams
• Not used during pregnancy or during nursing
• Should not be given with other nephrotoxic drugs
• Trough concentration must be at or below certain value to decrease risk of ototoxicity and
nephrotoxicity
• Side effects: neuromuscular reactions, ototoxicity, nephrotoxicity, N/V/D
• Drugs in this category: amikacin, gentamicin, kanamycin, neomycin, streptomycin, tobramycin
6. Fluoroquinolones
• Used for: broad spectrum (primarily gram - but also gram +)
• MOA: bacteriostatic; inhibit DNA gyrase & topoisomerase (necessary for DNA synthesis) = DNA is
unable to reproduce
• Side effects: dizziness, N/V/D, abdo pain, fever, chills, blurred vision, tinnitus
• Drugs in this category: ciprofloxacin, levofloxacin, moxifloxacin hydrochloride, norfloxacin, ofloxacin
7. Sulfonamides
• Used for: UTIs
• MOA: bacteriostatic; alters folic acid metabolism (necessary for modification of bacterial proteins)
• Side effects: allergy, skin rash, crystalluria, oliguria, acute kidney failure
• Drugs in this category: trimethoprim, sulfadiazine, sulfasalazine
8. Vancomycin
• Used for: MRSA, MRSE, gram + infections, c. diff, enterococci
• Given PO for enterococci and c.diff, otherwise given parenterally
• MOA: binds to and weakens cell wall = makes cell membrane more susceptible to lysis
• Side effects: hypersensitivity, eosinophilia, neutropenia, hearing loss, red man syndrome
• Drugs in this category: vancomycin hydrochloride
Anti-Viral Drugs
1. Synthetic Nucleosides
• Used for: various viral syndromes including HSV and cytomegalovirus
• MOA: Interferes with DNA synthesis + inhibits viral multiplication
• Side effects: kidney injury, headache, N/V/D, hypersensitivity
• Monitor kidney and liver function
• Drugs in this category: acyclovir, famciclovir, ganciclovir, valacyclovir
2. Influenza A and syncytial virus drugs
• MOA: inhibits viral replication
• Side effects: confusion, depression, fatigue, insomnia, irritability, N, nervousness
• Drugs in this category: amantadine hydrochloride, ribavirin, rimantadine hydrochloride, oseltamivir
phosphate, zanamivir
3. Nucleoside reverse transcriptase inhibitors (NRTI)
• Used for: advanced HIV infections
• MOA: mimics thymidine = reverse transcriptase (RT) incorporates it into DNA strand = ends up being
non-functional = not incorporated into host DNA
• Side effects: headache, fever, dizziness, muscle pain, N/V/D
• Drugs in this category: zidovudine, didanosine, zalcitabine, abacavir sulfate, lamivudine, stavudine,
emtricitabine, tenofovir
4. Non-nucleoside reverse transcriptase inhibitors (NNRTI)
• Used in combination with other anti-vrials to treat HIV infection
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• MOA: direct inhibitor of RT = prevents HIV replication
• Side effects: hepatotoxic (monitor liver enzymes), skin rash, N/V/D, headache
• Drugs in this category: delavirdine mesylate, efavirenz, etravirine, nevirapine
5. Protease inhibitor
• Used for: HIV
• MOA: inhibit activity of HIV protease = prevents cleavage of viral polyproteins
• Side effects: N/V/D, kidney and liver toxicity, kidney stones, paresthesia
• Drugs in this category: saquinavir mesylate, nelfinavir mesylate, ritonavir, indinavir sulfate, lopinavir
Lines of defense when there is injury to our body:
1st line of defense: innate immunity (barriers, antibodies, acid in stomach; things that prevent bacteria from
penetrating our skin)
2nd line of defense: Inflammation (vascular component: histamine, bradykinin, prostaglandins, and cellular
component [neutrophils, monocytes/macrophages (antigen-presenting cells), lymphocytes; these are attracted
to sites of injury by chemokines])
3rd line of defense: cell mediated/specific. Largely coordinated by T4 helper cells. These will connect with CD8
and B cells. They will use chemical signals such as interleukin-2. This will help to stimulate the proper B cells and
CD8 cells. B cells produce plasma cells and memory cells. Plasma cells produce antibodies (IgG in particular) and
memory cells prepare for the next situation of infection (the next time we see those antigens we see a quick
and large secondary response).
Antihistamines: block the effects of histamine on target tissues
Corticosteroids: suppress immune responses and reduce inflammation
Immunosuppressants (non-corticosteroids): prevent rejection of transplanted organs + can be used to treat
autoimmune diseases
Uricosurics: control gouty arthritis attacks.
Vaccines
Expose our immune system to small amounts of antigens so that it can create a primary response.
1. Microbes that have been killed (organisms are intact but not alive/functional)
2. Attenuated microbes (weakened thus cannot produce disease) alive but cannot cause disease
3. Toxoids (modified bacterial toxins that do not have hazardous properties) pieces of protein or viruses
have been isolated and can be used to create a secondary response
Contraindications: allergies to egg products, fever, concurrent infections
Antihistamines
Primarily block the effects of an allergic reaction/type 1 hypersensitivity reaction
1. Histamine-1 receptor antagonists
• Used for: S/S of type 1 hypersensitivity (allergic rhinitis, allergic conjunctivitis, urticaria, angioedema)
• MOA: drug competes with histamine for the H1 effector cell sites (these cells cause S/S of allergic
reaction) = blocks histamine from its effects. The drug does not displace the histamine that’s already
bound to receptors
• The following are the effects of blocking H1 receptor sites:
o Blocking action of histamine on small blood vessels
o Decreasing arteriole dilation and tissue engorgement
o Reducing leakage of plasma proteins + fluids out of the capillaries = less edema
o Inhibiting smooth-muscle responses to histamine (blocking the constriction of bronchial, GI,
and vascular smooth muscle)
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•
o Acting on the terminal nerve endings in the skin that flare/itch = relief of symptoms
Side effects: dizziness, fatigue, muscle weakness, N/V/D/C, arrhythmias
Antihistamine Drugs
Indication
Nursing
Motion sickness
Contraindicated in lower respiratory disease (e.g.
asthma), neonates, and nursing women. May
impair ability to drive.
Allergic reaction, insomnia, cough,
Same as above
motion sickness, Parkinsonism
Allergies, seasonal allergies
Same as above
Drug
Dimenhydrinate
→ Dramamine, Gravol
Diphenhydramine
→ Benadryl
Brompheniramine
→ Dimetane
Promethazine
→ Phenergan
Allergies, N/V, motion sickness, pre-op
sedation
Loratadine
→ Claritin
Meclizine
→ Bonine
Allergic rhinitis, urticaria
IV administration can cause severe tissue injury;
IM route is preferred. Contraindicated in
newborns, SC or intra-arterial route, and in
treatment of lower respiratory disease (e.g.
asthma). May impair ability to drive. Monitor for
neuroleptic malignant syndrome
May cause drowsiness
Motion sickness, vertigo
May cause drowsiness
Corticosteroids
These drugs suppress the immune response + reduce inflammation
1. Glucocorticoids
• Used for: adrenocortical insufficiency, anti-inflammatory, immunosuppressive, or antineoplastic
activity
• MOA: not entirely known, but these drugs suppress hypersensitivity + immune responses
• Side effects: these drugs affect almost every system; insomnia, increased water retention, increased
K+ excretion, suppressed immune response, peptic ulcers, impaired wound healing, HTN, increased
susceptibility to infx, DM, hyperlipidemia
• Do not administer live vaccines to pts on large corticosteroid dose
Drug
Beclomethasone
→ QVAR RediHaler (puffer),
Beconase (intranasal)
Dexamethasone
→ Decadron
Hydrocortisone
→ A-Hydrocort
Methylprednisolone
→ Medrol
Prednisone
→ Deltasone
Glucocorticoid Drugs
Indication
Nursing
Chronic asthma (puffer version),
Do not use as a primary treatment for status
allergic rhinitis (intranasal version) asthmaticus or acute asthma attack.
Monitor for vision change
Inflammation, acute exacerbation Contraindicated in systemic fungal infx (can
of MS, cerebral edema, shock,
exacerbate the infx)
asthma, dermatitis, allergic
rhinitis, altitude sickness,
Inflammation, status asthmaticus, Contraindicated in serious infx.
acute adrenal crisis, chronic renal
insufficiency
Allergy, acute exacerbation of MS Same as above. Avoid grapefruit juice.
Acute asthma, giant cell arteritis,
idiopathic thrombocytopenic
purpura, RA, advanced TB,
autoimmune hepatitis
Take with meal. High dose can cause
insomnia. Contraindicated in serious
infection and varicella. Monitor for
hyperglycemia.
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2. Mineralocorticoids
• These affect electrolyte + water balance
• Used for: replacement therapy for pts with adrenocortical insufficiency
• MOA: act on distal tubule to increase Na+ reabsorption and K+ secretion
• Side effects are similar to those of glucocorticoids
Drug
Fludrocortisone
→ Florinef
Mineralocorticoid Drugs
Indication
Nursing
Addison disease, salt-losing forms of
Contraindicated in systemic fungal infx. Abrupt
congenital adrenogenital syndrome
discontinuation can lead to Addisonian crisis.
Immunosuppressants
These drugs are used to prevent rejection of a transplant
MOA: Inhibit cell-mediated immune responses by different mechanisms
Do not administer this drug to a patient with an infection
Monitor for S/S of infection – WBC, fever, sputum, urine
Lifelong drug administration is needed to prevent transplant rejection
Side effects: bone marrow suppression, N/V, liver and kidney disease, infection, HTN, tachycardia, edema,
reduced WBC, weakness
Drug
Azathioprine
→ Azasan
Cyclosporine
→ Neoral
Mycophenolate
→ CellCept, Myfortic
Tacrolimus
→ Prograf
Immunosuppressant Drugs
Indication
Nursing
Kidney transplant, RA, lupus nephritis,
Not to be taken by pregnant/lactating pt. Long
Crohn disease, ulcerative colitis
term use increases the risk of neoplasia
Solid organ transplant, RA, psoriasis, ALS,
Not to be taken by pregnant/lactating pt.
lung transplant
Monitor for gingival hyperplasia, infx, and HTN.
Avoid grapefruit juice
Kidney transplant, heart transplant, liver
Not to be taken by pregnant/lactating pt. Assess
transplant
for S/S of progressive multifocal
leukoencephalopathy (hemiparesis, apathy,
confusion, cognitive deficiency, ataxia)
Kidney transplant, heart transplant, liver
Risk of serious infx/malignancies including
transplant
lymphoma and skin malignancies
Uricosurics
Increased uric acid in blood = gout
Normally, uric acid is excreted by the kidneys
MOA: reduce reabsorption of uric acid @ proximal convoluted tubule of kidney = increased excretion of uric
acid in urine = reduced uric acid levels
Side effects: headache, anorexia, N/V, GI pain, indigestion
Uricosuric Drugs
Drug
Probenecid
→ Benemid
Indication
Gout, pelvic inflammatory disease,
gonorrhea
Allopurinol
→ Zyloprim, Aloprim
Gout, antineoplastic-induced
hyperuricemia
Colchicine
→ Colcrys
Acute gout
Nursing
Should not be given during an acute gouty attack (this
drug will actually prolong the inflammation) – give
colchicine instead. Monitor kidney function. Give drug
with milk, food, or antacid to minimize GI distress
Helps prevent acute gout attacks. Continue taking
allopurinol along with an NSAID or colchicine during
an acute attack of gout
Co-administration with CY3A4 inhibitor can increase
levels of toxicity (need to decrease the colchicine
dose). Do not give to liver/kidney disease pt
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FLUIDS AND ELECTROLYTES
Electrolyte Replacement
Electrolyte (EL) = element that carries an electric charge when dissolved in water; helps maintain homeostasis
1. Potassium (K+)
• Primary intracellular EL
• Body can’t store K+, so it needs to be ingested daily (if not, then K+ replacement is necessary)
• K+ is necessary for proper nerve function, muscle function, tissue growth + repair, and maintenance
of acid-base balance
• Hypokalemia is common in: V/D, NG suction, excessive urination, kidney disease, burns, excessive
antidiuretic hormone, laxative abuse, starvation
• Monitor K+ levels; S/S of hyperkalemia: abdo cramp, N/D, tall T waves, hypotension, muscle
weakness
• When giving IV K+, always dilute; never give as in IV bolus or IM injection
• Give PO K+ with or after meals to minimize GI effects
2. Calcium (Ca2+)
• 99% of Ca is stored in bone
• Function of Ca: nerve and muscle excitability; function of heart, kidney, lungs; blood coagulation;
neurotransmitter; bone + tooth formation
• Ca is helpful in treating magnesium intoxication and helps strengthen myocardial tissue after
defibrillation or poor response to epinephrine
• Hypocalcemia is common in: tetany, cardiac arrest, vitamin D deficiency, parathyroid surgery,
alkalosis
• Monitor Ca levels; S/S of hypercalcemia: drowsiness, lethargy, muscle weakness, headache, C, ECG
changes (short QT), heart block
• When giving PO calcium, don’t take with foods that interfere with absorption (e.g. spinach, rhubarb,
whole grain cereal, fresh fruit + vegetables)
3. Magnesium (Mg+)
• Function of Mg: transmits nerve impulses to muscle, activates enzymes for carb + protein
metabolism, stimulates parathyroid secretion, aids in cell metabolism
• Used to prevent deficiency, control seizures, treat/prevent preeclampsia, and treat ventricular
arrhythmias
• Hypomagnesemia is common in: malabsorption, chronic D, prolonged diuretic use, NG suction,
hyperaldosteronism, hypoparathyroidism, excessive release of adrenocortical hormones
• Mg taken with digoxin = can lead to heart block
• Monitor Mg levels; S/S of hypermagnesemia: hypotension, circulatory collapse, flushing, depressed
reflexes, respiratory paralysis
• Administering IV Mg too quickly can lead to cardiac arrest
4. Sodium (Na+)
• Major cation in extracellular fluid
• Function of Na: maintains osmotic pressure, acid-base balance, water balance; aids in nerve
conduction and neuromuscular function; aids in glandular secretion
• Hyponatremia is seen in: anorexia, excessive GI loss, excessive perspiration, overuse of diuretics,
trauma, SIADH
• To replace Na, sodium chloride IV is usually given
• Side effects: pulmonary edema, hypernatremia, and K+ loss
• S/S of pulmonary edema = SOB, cough, anxiety, wheezing, pallor
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Electrolyte Relationships:
Sodium/Potassium – inverse; high Na = low K
Calcium/Phosphorus – inverse; high Ca = low Phos
Calcium/Vitamin D – similar; high Ca = high Vit D
Magnesium/Calcium – similar; low Mg = low Ca
Magnesium/Potassium – similar; low Mg = low K
Magnesium/Phosphorus – inverse; low Mg = high Phos
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QUICK OVERVIEW
Anti-Alzheimer’s
o Increase Ach in CNS by inhibiting cholinesterase
o Cholinergic effects = excessive salivation, cramps, D, blurred vision, bradycardia
o Desired outcome: temporary improvement in cognitive function
Anti-anemics
o Iron is needed for production of hgb, which is necessary for O2 transport to cells
o Desired outcome: resolution of anemia
Anti-anginals
o Nitrates are used in acute treatment of angina pectoris; calcium channel blockers + beta blockers are
used in long term management
o Nitrates dilate coronary arteries and cause systemic vasodilation
o Monitor for hypotension
o Desired outcome: decrease in frequency + severity of anginal attacks, increase in activity tolerance
Anti-anxiety medications
o Causes generalized CNS depression
o Avoid use in pregnant patients
o Monitor for suicidal ideation
o Desired outcome: decrease in anxiety level
Antiarrhythmics
o Class 1A (quinidine, procainamide, disopyramide), class 1B (lidocaine, phenytoin, mexiletine), class 1C
(flecainide, propafenone) class 2 (esmolol, propranolol, metoprolol), class 3 (amiodarone, ibutilide,
sotalol) class 4 (diltiazem, verapamil), adenosine, atropine, and digoxin
o Assess apical pulse before administration
o Desired outcome: resolution of arrhythmia
Antiasthmatics
o Includes adrenergic bronchodilators, corticosteroids, anticholinergics, leukotriene receptor antagonists,
and mast cell stabilizers
o Do not use corticosteroids, long acting adrenergics, or mast cell stabilizers during an acute asthma attack
o Desired outcome: prevention of and reduction in symptoms of asthma
Anticholinergics
o Atropine for bradyarrhythmia’s, ipratropium for bronchospasm, scopolamine for N/V r/t motion
sickness, glycopyrrolate for gastric secretions, benztropine for Parkinson’s disease, oxybutynin +
tolterodine for urinary spasms
o Contraindicated in narrow angle glaucoma, severe hemorrhage, tachycardia, and myasthenia gravis
o Anticholinergic effects = dry mouth, dry eyes, blurred vision, constipation
o Desired outcome: increased HR, decreased N/V, dry mouth, dilated pupils, decreased GI motility, and
resolution of S/S of Parkinson’s
Anticoagulants
o Prevent and treat clot formation (DVT, PE, and atrial fibrillation); they do NOT dissolve clots
o Pregnant patient should not take warfarin
o Monitor for signs of bleeding (bleeding gums, nosebleed, unusual bruise, black stool, hematuria)
o Monitor PTT (heparin) and INR (warfarin)
o Heparin OD = protamine sulfate; warfarin OD = vitamin K
o Desired outcome: prevention of clotting without signs of hemorrhage; prevention of stroke, MI, and
death in patient’s at risk
Anticonvulsants
o Act by depressing abnormal neuronal discharges in the CNS
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o Fetal hydantoin syndrome can occur in offspring of patient receiving phenytoin during pregnancy
o Monitor serum drug levels routinely
o Do not discontinue abruptly – can precipitate status epilepticus
o Desired outcome: decrease or cessation of seizures without excessive sedation
Antidepressants
o Prevents the reuptake of dopamine, norepinephrine, and serotonin
o Should not be used in narrow angle glaucoma or in pregnant/lactating patient
o Tricyclic antidepressants have anticholinergic side effects (dry eyes, dry mouth, blurred vision, C)
o Taking an MAOI with tyramine containing food can lead to hypertensive crisis
o Avoid alcohol and other CNS depressants
o Desired outcome: resolution of depression, decrease in anxiety, management of chronic neurogenic
pain
Antidiabetics
o Insulin is used in T1DM whereas oral agents are used primarily in T2DM
o Insulin lowers blood glucose by increased transport of glucose into cells + promotes conversion of
glucose to glycogen
o Patient’s exposed to stress, fever, trauma, infx, or surgery may need a change in insulin dose
o Desired outcome: control of blood glucose without hypo/hyperglycemia
Antidiarrheals
o Slows intestinal motility and propulsion
o Desired outcome: decrease in diarrhea
Antiemetics
o Inhibit N/V and diminish motion sickness
o Phenothiazines are to be used cautiously in children with viral illness
o Desired outcome: prevention or decrease in N/V
Antifungals
o Affect the permeability of the fungal cell membrane or protein synthesis within the fungal cell
o Use cautiously in patient with depressed bone marrow
o Full course needs to be taken
o Desired outcome: resolution of S/S of infx
Antihistamines
o Block the effects of histamine at the H1 receptor
o Also have anticholinergic properties (dry eyes, dry mouth, blurred vision, C)
o If used with opioid analgesic, monitor for increased sedation
o Desired outcomes: decrease in allergic symptoms, decreased N/V, decreased anxiety, relief of pruritis
Antihypertensives
o Includes alpha agonists, beta blockers, vasodilators, ACE inhibitor, ARBs, CCB, and diuretics
o ACE inhibitors and ARBs should be avoided in pregnant patients
o Abrupt discontinuation can lead to rebound HTN
o Encourage weight reduction, low sodium diet, regular exercise, cessation of smoking + alcohol use
o Desired outcome: decrease in BP
Anti-infectives
o Kill or inhibit growth of bacteria
o Culture and sensitivity should be done before to optimize treatment
o Prolonged use can lead to superinfection or resistant bacteria
o Full course needs to be taken
o Desired outcome: resolution of S/S of infx
Antiparkinsonian drugs
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o Aims to balance Ach and dopamine (there is a lack of dopamine and excess of Ach in Parkinson’s)
o May cause drowsiness/dizziness
o Desired outcome: resolution of parkinsonian and extrapyramidal S/S
Antiplatelets
o Treat and prevent thromboembolic events (stroke, MI) by inhibiting platelet aggregation and prolonging
bleeding time
o Desired outcome: prevention of stroke and MI
Antipsychotics
o Block dopamine receptors in brain
o Atypical antipsychotics have fewer side effects compared to typical antipsychotics
o Not to be used in patients with narrow angle glaucoma or CNS depression
o Can cause neuroleptic malignant syndrome (fever, resp distress, tachycardia, convulsions, diaphoresis,
BP change, pallor, muscle stiffness, loss of bladder control)
o Desired outcome: decrease in excitable/paranoid/withdrawn behaviour
Antipyretics
o Inhibit prostaglandins. Most antipyretics also affect platelet function
o May cause Reye’s syndrome if ASA is given to children with varicella or viral illness
o Desired outcome: reduction in fever
Antiretrovirals
o Goal for HIV is to improve CD4 cell count and decreased viral load; these drugs do not cure HIV nor does
it decrease the risk of transmission
o Desired outcome: decrease in viral load + increase in CD4 count
Antirheumatics
o Manage symptoms of RA (pain + swelling)
o Corticosteroids are reserved for advanced symptoms due to the side effects
o Do not use corticosteroid in patient with active untreated infx
o Desired outcome: improvement in S/S of RA
Antiulcer drugs
o H2 receptor antagonists + proton pump inhibitors
o Contraindicated in pregnancy
o Administer antacids 1 hr before or after other oral medications
o Desired outcome: decrease in GI pain/irritation, prevention of GI bleeding, healing of ulcers, decreased
GERD S/S
Antivirals
o Used for management of herpes virus infxs, chickenpox management, prevention of influenza infx,
treatment of cytomegalovirus, treatment of ophthalmic viral infx
o Inhibits viral replication
o Need to take full course of therapy
o Desired outcome: prevention/resolution of S/S of viral infx
Beta Blockers
o Used for HTN, angina, tachyarrhythmias, migraines, MI, glaucoma, and heart failure
o Beta1 receptor sites = located in heart; stimulation results in increased HR and contractility
o Beta2 receptor sites = located in bronchial and vascular smooth muscle + uterus; stimulation produces
vasodilation, bronchodilation, and uterine relaxation
o Monitor BP, HR, intake + output, and daily weight
o Abrupt withdrawal can lead to rebound HTN + tachycardia
o Desired outcome: decreased BP, decrease in frequency/severity of angina, arrhythmia control,
prevention of MI, prevention of migraines
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Bronchodilators
o Beta2 agonists
o Therapeutic effects can be antagonized by beta blockers
o Desired outcome: decreased bronchospasm, increased ease of breathing
Calcium Channel Blockers
o For HTN, angina, and coronary artery spasm; blocks calcium entry into cells of vascular smooth muscle
and myocardium = dilates coronary arteries
o Safety in pregnancy is not established
o Do not crush/open sustained-release capsules
o Monitor for orthostatic hypotension
o Desired outcomes: decreased BP, decrease in frequency/severity of angina, increase in activity tolerance
Central Nervous System Stimulants
o Used for narcolepsy and management of ADHD; increases levels of neurotransmitters in CNS (respiratory
stimulation, dilated pupils, increased alertness, diminished sense of fatigue)
o If used with MAOI, can cause hypertensive crisis
o Avoid in patients with psychotic personalities
o Abrupt cessation can lead to extreme fatigue and mental depression
o Desired outcome: decreased narcoleptic episodes, improved attention span
Corticosteroids
o Treat adrenocortical insufficiency. Also used for the anti-inflammatory, immunosuppressive, and
antineoplastic activity
o Contraindicated in serious infections
o Desired outcome: suppressed inflammatory and immune response, replacement therapy in adrenal
insufficiency, and resolution of skin inflammation
Diuretics
o Used for HTN, edema, and heart failure
o Safety in pregnancy is not established
o Hypokalemia can increase the risk of digoxin toxicity
o Monitor daily weight, intake + output, edema, lung sounds, skin turgor
o Monitor for orthostatic hypotension
o Desired outcome: decreased BP, decreased urine output, decreased edema, reduced ICP
Immunosuppressants
o Used to prevent transplant rejection
o Use cautiously in patient with infx. Safety in pregnancy is not established
o Monitor for infx (vitals, WBC, urine, sputum)
o Lifelong therapy is needed to prevent transplant rejection
o Desired outcome: prevention or reversal of rejection of transplanted organ
Laxatives
o Treat constipation (and prep the bowel for procedures); includes stimulants, stool softeners, bulk
forming drugs, and osmotic cathartics
o Should only be used on a short-term basis
o Desired outcome: soft + formed BM, evacuation of the colon
Lipid lowering drugs
o Decreases cholesterol levels
o HMG-CoA reductase inhibitors are not to be used in pregnant patients
o Patient should also be making changes to diet, exercise, and smoking/alcohol when taking this drug
o Desired outcome: decreased LDL, increased HDL
Nonopioid Analgesics
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o Controls mild-moderate pain and/or fever
o Avoid alcohol use (increases risk of GI bleed with salicylates and NSAIDs)
o Desired outcome: relief or mild-moderate pain, reduction of fever
Nonsteroidal Anti-Inflammatory drugs
o Control mild-moderate pain, fever, and inflammation (RA, OA); analgesic + anti-inflammatory processes
is due to inhibition of prostaglandins. Antipyretic process is due to vasodilation + inhibition of
prostaglandin syntheses in CNS
o Use cautiously in patients with bleeding disorder
o Avoid alcohol use
o Desired outcome: relief of mild-moderate pain, reduction of fever
Opioid Analgesics
o Controls moderate-severe pain
o Smaller dose should be used for older patients and those with respiratory diseases
o Monitor respiratory rate
o Opioid overdose = naloxone is the antidote
o Desired outcome: decreased severity of pain without significant change in LOC or RR
Sedatives
o Cause generalized CNS depression; there is no analgesic effect with these drugs
o Avoid use in pregnant patients and in those with CNS depression
o Can cause daytime drowsiness
o Desired outcome: improved sleep, controlled seizures, decreased muscle spasm
Thrombolytics
o Used for management of STEMI, PE, and acute ischemic stroke; converts plasminogen to plasmin =
degrades fibrin in the clots = results in lysis of clots
o To be given within 3-4.5 hours of onset of acute ischemic stroke symptoms
o If local bleeding occurs = apply pressure, discontinue infusion, infuse packed RBCs
o Teach patient to avoid shaving and vigorous tooth brushing. Minimal handling will also decrease risk of
bleeding
o Desired outcome: lysis of clot + restoration of blood flow, prevention of neurological damage in acute
ischemic stroke, catheter patency
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COMMON MEDICATION PREFIXES AND SUFFIXES
Prefix, root, suffix
-afil (e.g. sildenafil)
Drug category
Phosphodiesterase
inhibitor
-bital (e.g. phenobarbital) Barbiturate
Cef- (e.g. cefaclor)
Cephalosporin ABX
Cort (e.g. hydrocortisone) Corticosteroid
-dipine (e.g. amlodipine) Calcium channel blocker
-eprazole (e.g.
omeprazole)
-floxacin (.e.g.
ciprofloxacin)
-mysin (e.g.
azithromycin)
-olone (e.g.
prednisolone)
-oprazole (e.g.
pantoprazole)
-phylline (e.g.
theophylline)
Pred- (e.g. prednisone)
-profen (e.g. ibuprofen)
Proton pump inhibitor
Prefix, root, suffix
-asone (e.g.
betamethasone)
-caine (e.g. lidocaine)
-cillin (e.g. amoxicillin)
-cycline (e.g. doxycycline)
-dronate (e.g.
alendronate)
-fenac (e.g. diclofenac)
Quinolone ABX
-gliptin (e.g. sitagliptin)
Antidiabetic
ABX
-olol (e.g. metoprolol)
Beta blocker
Corticosteroid
-onide (e.g. budesonide)
Corticosteroid
Proton pump inhibitor
-parin (e.g. Dalteparin)
Anticoagulant
Bronchodilator
-setron (e.g. ondasetron)
-tadine (e.g. loratadine)
Serotonin receptor
antagonist
Antihistamine
-vir (e.g. acyclovir)
-zolam (e.g. midazolam)
Antiviral
Benzodiazepine
-pramine (e.g.
Tricyclic antidepressant
clomipramine)
-pril (e.g. ramipril)
ACE inhibitor
-sartan (e.g. candesartan) Angiotensin 2 receptor
antagonist
-statin (e.g. atorvastatin) HMG-CoA reductase
inhibitor (statin)
-terol (e.g. albuterol)
Beta agonist;
bronchodilator
-zepam (e.g. lorazepam)
Benzodiazepine
-zosin (e.g. prazosin)
Alpha blocker
Corticosteroid
NSAID
Drug category
Corticosteroid
Local anesthetic
Penicillin antibiotic
Tetracycline ABX
Bone resorption inhibitor
NSAID
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MEDICATION CALCULATION
Conversions
1 teaspoon (t) = 5 ml
1 oz = 30 ml
1 tablespoon (T) = 3 t = 15 ml
1 cup = 8oz
1 gram (g) = 1,000 mg
1 kilogram (kg) = 2.2 lbs
1 mcg = 0.000001 g
1 mg = 1000 mcg or 0.001 g
*Always convert everything to the same units before solving the calculation.
1 quart = 2 pints
1 pint = 2cups
1 lb = 16oz
Generic dose calculation
Dose required X Quantity = x
Dose on Hand
E.g. Metoprolol (Lopressor), 25 mg PO, is ordered. Metoprolol is available as 50 mg tablets. How many tablets would the
nurse administer?
25 mg/50 mg x 1 tablet = 0.5 tablets
Infusion Time
Total Volume
mL/hr
E.g. Infuse 1 L of NS at 125 mL/hr. How many hours total will the infusion run for?
1000 mL/125 mL per hour = 8 hours
mL/hr
Total Volume (mL)
Total Time (hr)
E.g. Infuse 250 mL over the next 120 minutes by infusion pump
250 mL/2 hrs = 125 mL/hr
Drops per minute
total volume X drop factor
total time (min)
mL/hr X drop factor
time (60 min)
E.g. Calculate the IV flow rate for 1200 mL of NS to be infused in 6 hours. The infusion set is calibrated for a drop factor
of 15 gtts/mL
1200 mL x 15gtt per mL /360 min = 50 drops per minute
Drug Dosage and Flow Rate
D (desired amount in dose [mcg, mg, units] / time [min or hr] X Q (quantity in IV bag)
H (what you have available in the IV bag)
= x (mL/min, mL/hr)
E.g. Give patient 500 mg of dopamine in 250 mL of D5W to infuse at 20 mg/hr. Calculate the flow rate in mL/hr.
20 mg per hr/500mg x 250 mL = 10 mL/hr
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