Pharmacology CMS study guide By: Beth Ryan :) Standard Lab Values: - - Sodium (NA): 135-145 [“odd numbers are 1-3-5”] Potassium (K+): 3.5-5 [“3-5 bananas in a bunch”] - WBC’s: 5,000-10,000 [“Wanna Buy a Car for 5,000 to 10,000”] - BUN: 10-20 [“10-20$ for a hamburger BUN”] Creatinine: 0.5-1.5 [“0.5-1.5 is the rating for an ugly creature”] Glucose: 70-105 [“Glucose is energy & energy is low at 70-105 years old”] (HbA1C: 4-6%) Liver function tests (LFT): Ø AST: 5-40 units/L Ø ALT 8-20 units/L Ø ALP 30-120 units/L Insulin RAPID-ACTING: ONSET PEAK DURATION 15 mins 1 to 2 hours 3 to 4 hours 30 to 60 mins 2 to 4 hours 5 to 7 hours 2 to 4 hours 4 to 10 hours 10 to 16 hours 3 to 4 hours NONE 24 hours Lispro Aspart Glulisine SHORT-ACTING: Regular (can give IV) INTERMEDIATE: NPH (cloudy solution) LONG-ACTING: Glargine Detemir Pharmacology CMS study guide By: Beth Ryan :) ANALGESICS Drug Class Opioid Agonist Drugs - Codeine Sulfate: for mild-moderate pain/cough suppressant - Morphine: - Fentanyl: balance anesthesia - Hydromorphone: 7x stronger than morphine - Methadone: for addiction - Meperidine: not given to elderly - Opioid Antagonist Non-Opioid Analgesics - Naloxone Naltrexone Acetaminophen (Tylenol) *Adult dose/day= 3000 mg/day *Older adult dose/day = 2000 mg/day Action Adverse Effects Bind to opioid pain receptor; analgesic response (reduction of pain sensation) Ø Resp. depression Ø Nausea and vomiting Ø Urinary retention Ø Diaphoresis and flushing Ø Pupil constriction (miosis) Ø Constipation Ø Itching Reverse the effects of opioids (given for overdose) Ø Anxiety/Irritable Ø Chills/hot flashes Ø Joint pain Ø Lacrimation Ø Rhinorrhea Ø Diaphoresis Ø Nausea/vomit Ø Cramps/diarrhea Ø Confusion Blocks pain impulses peripherally by inhibiting prostaglandin synthesis Ø Hepatotoxicity **Antidote= Acetylcysteine** Interactions Contradictions Ø Alcohol Ø Antihistamines Ø Barbiturates Ø Benzodiazepines Ø Monoamine oxidase inhibitors Ø Severe Asthma Ø Known drug allergy Ø Drug allergy Ø Liver dysfunctions Ø Possible liver failure Ø G6PD deficiency Ø Severe liver disease Ø Severe hepatic impairment Pharmacology CMS study guide By: Beth Ryan :) HYPOTHYROIDISM PATHOPHYSIOLOGY Suboptimal low levels of thyroid hormone resulting in decreased metabolism MANIFESTATIONS -Fatigue and weakness -Increased sensitivity to cold -Constipation -Dry skin, brittle hair, and nails -Weight gain -Deepened, hoarse voice -Hyperlipidemia and anemia (low RBC/Hgb) -Depression -Menstrual irregularities DIAGNOSTIC FINDINGS/LABS -Low serum T3 and T4 -High TSH COMPLICATIONS -Myxedema coma is rare, life-threatening condition seen in untreated or uncontrolled hypothyroidism, leading to severely decreased metabolism, respiratory depression, and cardiovascular collapse NURSING INTERVENTIONS -Provide a warm environment -Provide a low-calorie, low-cholesterol, and low-fat diet -Avoid sedatives (respiratory depression risk) -Plan rest periods for the client -Weigh the client daily MEDICATION Levothyroxine CLIENT EDUCATION -Educate client regarding lifelong medication therapy on Levothyroxine -Take Levothyroxine medication on an empty stomach each morning (before breakfast) -Know manifestations of medication toxicity (palpitations, insomnia, increased appetite, tremors) -Eat a diet high in fiber -Monitor need for sleep -Continue follow-up with healthcare provider Pharmacology CMS study guide By: Beth Ryan :) HYPERTHYROIDISM PATHOPHYSIOLOGY -Excessive secretion of thyroid hormone resulting in increased metabolism -Graves’ disease is the most common type MANIFESTATIONS -Anxiety and irritability -Insomnia and fatigue due to decreased sleep -Tachycardia -Tremors -Diaphoresis (excessive sweating) -Intolerance to heat -Weight loss (despite adequate food intake) -Exophthalmos (bulging eyes) -Diarrhea -Light or absent menstrual cycle DIAGNOSTIC FINDINGS/LABS -Elevated serum T3 and T4 -Decreased TSH *note that TSH is low in hyperthyroidism because there is no need for stimulating hormone if secretion of thyroid hormone is already high COMPLICATIONS -Thyroid storm is a life-threatening condition seen in untreated or uncontrolled hyperthyroidism, leading to increased temperature/high fevers, tachycardia, hypertension, & other exaggerated manifestations of hyperthyroidism NURSING INTERVENTIONS -Assess vital signs. Report temperature increase of 1 degree or greater to the provider -Encourage client to get rest in a cool, quiet environment -Provide a high-caloric diet without extra stimulants (avoid caffeine) -Weigh the client daily -Provide the client with emotional support MEDICATIONS -Propylthiouracil (PTU) Blocks thyroid hormone production -Methimazole Short-term use to block production of thyroxine; usually used no more than 8 weeks; monitor CBC frequently for occurrence of agranulocytosis Pharmacology CMS study guide By: Beth Ryan :) PITUITARY DRUGS: CH 30 Drug Class Anterior pituitary drugs Drug Cosyntropin (Cortrosyn) Anterior pituitary drugs Somatropin Anterior pituitary drugs Action/uses Stimulates release of cortisol from adrenal cortex Stimulate skeletal growth Treatment of hypopituitary, dwarfism octreotide (Sandostatin) Adverse Effect Hypertension, hypernatremia, edema HA, Hyperglycemia, flulike symptoms, hypercalciuria - Cannot be given to a child after the - -Suppress growth hormone production & reduce diarrhea associated with VIP Posterior pituitary Vasopressin -Increase water drugs resorption, reducing • Potent vasoconstrictor water excretion -treatment of diabetes insipidus & Hypotensive emergencies -used to stop bleeding of esophageal varices. impair gallbladder function, hyperglycemia Posterior pituitary Desmopressin drugs Same as vasopressin -Increase water resorption, reducing water excretion. -treatment of diabetes insipidus -Management of nocturnal enuresis Nursing implications HTN, fever, vertigo, HA, N/V heartburn, tremors, sweating epiphyseal plate has closed Precaution with diabetes Hypersensitivity Pharmacology CMS study guide By: Beth Ryan :) ADRENAL DRUGS: CH 33 Drug Class Glucocorticoids Treatment of; -Addison’s disease -Diseases associated with inflammatory response Drug Prednisone Aldosterone replacement Fludrocortisone Adrenal steroid inhibitor Aminoglutethimide Methylprednisolone Action/uses Glucocorticoids inhibit or help control inflammatory and immune responses Adverse Effect Nursing implications hypokalemia, hypernatremia convulsions, headache, vertigo, mood swings, nervousness, insomnia hypertension Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, peptic ulcers, fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism muscle weakness, loss of muscle mass, osteoporosis, glaucoma, weight gain Hypokalemia Hypernatremia Hypertension !!KNOW LAB VALUES!! Dizziness, drowsiness, muscle pain, weakness, nausea Pharmacology CMS study guide By: Beth Ryan :) DERMATOLGIC DRUGS: CH 56 Drug class Topical Antiinfective Drugs *Silver sulfadiazine (Silvadene) Action Used to prevent or treat infection at the site of second- and third-degree burns Topical Antibacterial Drugs *Bacitracin *Neomycin *Polymyxin *Neomycin and polymyxin B (Neosporin) Bacitracin- To treat/prevent local skin infections (minor skin tears/scraps) Topical Antibacterial Drugs Antiacne Drugs *Mupirocin (Bactroban) *Used topically for Staphylococcus and Streptococcus impetigo *Intranasal form for MRSA Affects bacterial growth and replication Antiacne Drugs *Isotretinoin Treatment of severe acne Stimulates the turnover of epithelial cells, resulting in skin peeling Topical Antifungal *Clotrimazole *Miconazole (Monistat) Treatment of yeast infections and thrush (oral candidiasis) Topical Antiviral Drugs *Acyclovir *Penciclovir Reduce healing process and pain of Herpes simplex 1 or 2, HPV infections Topical Anesthetic Drugs *Antihistamines (antiantagonist) *Corticosteroids Reduce pain or pruritus with insect bites, sunburn, poison ivy *Benzoyl peroxide *Erythromycin *Tetracycline *Clindamycin Adverse effects - Pain - Burning - Itching Nursing implications - Do not use in pts ALLERGIC TO SULONAMIDE drugs Skin rashes (dermatitis) Itching Burning Inflammation - local inflammatory reactions, edematous blisters, crusted skin, and temporary alterations in skin pigmentation - Cover up with going outside and use sunscreen daily - Strict guidelines for pregnancy tests Monitor liver function before & during - Know when to call HPC and when to stop medications - - Contact dermatitis Burning - For small scrapes/wounds, if big wound; seek medical attention The more you use Neosporin, can increase likelihood of future allergic reaction Pharmacology CMS study guide By: Beth Ryan :) Used to numb skin before painful injections Anti-Psoriatic Drugs Topical Ectoparasitic Drugs Hair growth drugs *Tazarotene *Tar-containing products *Anthralin *Calcipotriene *Etanercept *Alefacept *Ustekinuamab *Ixekizumab *Permethrin *Malathion *Crotamiton *Benzyl alcohol 5% *Spinosad *Ivermectin Topical: *Minoxidil (Rogaine) Used in the treatment of psoriasis (autoimmune disease) Treatment for pediculosis (Phthirus pubis, Pediculus humanus corporis, Pediculus humanus capitis) head/body lice and scabies (Carcopetes scabiei) - - - - - Finasteride: pregnancy category X drug Ø Women not to handle drug w/o gloves Ø Do not crush, making it airborne - Drug interactions: Digoxin, Antidysrhythmics, Diuretics Systemic: *Finasteride Herbal Products Aloe/ Aloe Vera Used for wound healing Reduce stress Regimen is trial & error Don’t use corticosteroids b/c of rebound effect - Diarrhea Abdominal pain Dermatitis Pharmacology CMS study guide By: Beth Ryan :) OPHTHALMIC DRUGS: CH 57 Drug Class Antiglaucoma drugs Drug Cause pupillary constriction (miosis), which leads to reduced IOP caused by increased outflow of aqueous humor *Timolol (Timoptic) Reducing aqueous humor formation Increasing aqueous humor outflow *Latanoprost (Xalatan) Reduce IOP by increasing the outflow of aqueous fluid Eye color will change permanently to brown. (Light to brown) *Brimonidine (Alphagan P) Stimulate the dilator muscle to contract ¬ Result is increased pupil size (mydriasis). Enhance aqueous humor outflow through the canal of Schlemm ¬ IOP is reduced. Treatment of symptoms of herpes simplex virus Burning, Eye pain, Lacrimation Anti-adrenergic: beta blockers Antiglaucoma drugs Adverse Effects *Acetylcholine *Pilocarpine Direct-acting cholinergic Antiglaucoma drugs Action Hypotension, bradycardia, or tachycardia Headache, nausea, vomiting, diarrhea, abdominal cramps, asthma attacks with systemic absorption Primarily ocular effects Transient burning and discomfort Blurred vision, Pain Photophobia Prostaglandin agonists Antiglaucoma drugs Adrenergic: sympathomimetics Antiviral drops Diagnostic drops *Viroptic *Atropine sulfate Results in: Ø Mydriasis Ø Cycloplegia Used for: Ø Ophthalmic examinations Ø Uveitis (which benefits from pupillary dilation) Rare systemic effects: Hypertension, Tachycardia, Extrasystoles, Headache, Faintness Secondary glaucoma, corneal punctate defects, uveitis, and stromal edema (edema in the tough, fibrous, transparent portion of the cornea known as the stroma). Pharmacology CMS study guide By: Beth Ryan :) OTIC DRUGS: CH 58 Drug class Drugs Action Antibiotics Antifungals Antiinflammatories Local analgesics Local anesthetics Corticosteroids Earwax emulsifiers Adverse effects Local dizziness if administered cold. Carbamide peroxide (Debrox) Combined with other drugs, such as glycerin, to loosen and help remove cerumen Dizziness Nursing implications Assess baseline hearing or auditory status. Evaluate the patient’s symptoms. Assess drug and food allergies. Assess for contraindications. Assess knowledge of eardrop administration. Keep in mind that perforated eardrum(s) may be a contraindication to these drugs. - Ciprofloxacin and ofloxacin can be used with perforated eardrums. Ø If necessary or if ordered, remove cerumen by irrigation before instilling eardrops. - Cleanse the outer ear thoroughly. Ø Ø Ø Ø Ø Ø Pharmacology CMS study guide By: Beth Ryan :) Antihypertensive Drugs- CH. 22 Drug class Alpha2 receptor agonists (central) Drugs Clonidine and methyldopa Action and use Decrease norepinephrine production, decrease blood pressure Adverse effects orthostatic hypotension, fatigue, and dizziness Nursing implications Watch for HYPOTENSION Alpha1 receptor blockers (peripheral) Doxazosin, prazosin, and terazosin Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Tachycardia, dizziness, N/V/D, constipation, dry mouth, HA, chest pain, depression Also used for BPH Beta receptor blockers (peripheral) Propranolol, metoprolol, and atenolol Cause reduced secretion of renin, Combination alpha1 and beta receptor blockers AngiotensinConverting Enzyme (ACE) Inhibitors Labetalol and carvedilol Uses: hypertension and HF Bradycardia Drowsiness, Impotence Constipation, dry mouth, Edema hypoglycemia hypotension See above captopril (Capoten) enalapril (Vasotec) fosinopril (Monopril) lisinopril (Prinivil) Inhibit ACE, decrease angiotensin II, and decrease BP Fatigue, Dizziness Headache Mood changes Impaired taste hyperkalemia Dry, nonproductive cough, which reverses when therapy is stopped Angioedema: rare Pregnancy D Angiotensin II Receptor Blockers(ARBs) losartan (Cozaar) eprosartan (Teveten) valsartan (Diovan) irbesartan (Avapro) ARBs block vasoconstriction and the secretion of aldosterone Pregnancy D Calcium Channel Blockers amlodipine (Norvasc) Diuretics Hydrochlorothiazide Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction First-line antihypertensives Decrease plasma and extracellular fluid volumes Chest pain Fatigue Diarrhea Hypoglycemia Urinary tract infection Anemia Weakness hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea, Fluid and electrolyte imbalance Monitor K, Na, hydration status - Acute toxicity Ø Monitor ECG for dysthymias Pharmacology CMS study guide Vasodilators hydralazine - Oral - Injectable: hypertensive emergencies - BiDil Directly relax arteriolar or venous smooth muscle (or both), Decrease BP dizziness, headache, anxiety, tachycardia, edema, dyspnea, N/V hypotension, diarrhea, hepatitis Vasodilators minoxidil See above T-wave electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash, and thrombocytopenia Vasodilators nitroprusside (Nitropress) See above bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and (rarely) cyanide toxicity By: Beth Ryan :) - May cause tachycardia, sodium retention, arrhythmias, angina - Use caution with MOIAs - Monitor BP/ instruct how to take BP - NEVER double dose - NEVER abruptly stop taking, rebound hypertensive crisis and lead to stroke - Take oral with meal - If giving IV, use IV pump for accuracy - AVOID HOT TUBS/ SHOWERS/ WEATHER/ prolonged sitting/standing/ alcohol = will aggervate BP Use in HTN crisis Pharmacology CMS study guide By: Beth Ryan :) Antianginal Drugs- CH. 23 Drug class Nitrates and Nitrites Drug Action and use - Nitroglycerin (both rapid & long acting) Cause vasodilation because of relaxation of smooth muscles - Isosorbide dinitrate (both rapid & long acting) Potent dilating effect on coronary arteries Available forms: - Isosorbide mononitrate (only long acting) - Beta Blockers atenolol metoprolol propranolol nadolol Sublingual, translingual sprays, IV, transdermal patches (bypass liver & first-pass effect) Chewable tablets Oral capsules/tablets Ointments Mainstay in the treatment of several cardiovascular diseases Angina Adverse effect - Headaches (Usually diminish in intensity and frequency with continued use) - Reflex tachycardia Postural hypotension Tolerance may develop. Nursing implications Contraindications: - Known drug allergy Severe anemia Closed-angle glaucoma Hypotension Severe head injury Use of erectile dysfunction drugs Monitor vitals - Hypotension Headache Tolerance Monitor vitals - Hypotension Headache Tolerance Monitor vitals MI Hypertension Dysrhythmias Reduce the workload of the heart Calcium Channel Blockers amlodipine diltiazem nicardipine nifedipine verapamil *Reduce the workload of the heart and decreased myocardial oxygen demand *Treatment of HTN, Angina, dysrhythmias, migraines Pharmacology CMS study guide By: Beth Ryan :) Heart Failure Drugs- CH. 24 Drug class ACE inhibitors Drug lisinopril, enalapril, captopril ARBs valsartan, candesartan, losartan beta blockers Metoprolol, carvedilol Loop diuretics furosemide Aldosterone inhibitors spironolactone Vasodilators hydralazine/isosorbide dinitrate (BiDil) Digoxin Increases myocardial nd (2 choice b/c contractility dangerous) - Increase stroke volume - Decrease venous BP - Blood supply increased Cardiac Glycoside Action & Use Uses: hypertension, HF, and acute MI Decrease workload on heart Uses: hypertension, HF, Decrease workload on heart prevent catecholaminemediated actions on the heart by blocking sympathetic nervous system stimulation Decrease workload on heart Inhibits reabsorption of fluids causing fluid excretion Decrease workload on heart Inhibits aldosterone causing sodium and fluid excretion Decrease workload on heart Adverse effects Hypotension, dry cough, hyperkalemia, others Nursing implication Hypotension, others Bradycardia, hypotension, bronci constriction (NO ASTHMA/COPD PTS), Blood sugar masking - Assess BP/pulse Hyponatremia, hypokalemia, hypotension, others - Monitor potassium levels Hyperkalemia, others - Monitor potassium levels - Look for hypokalemia, hepatic dysfunction, hypercalcemia, hypothyroidism, renal or respiratory disease, use of cardiac pacemaker Assess: apical pulse 1 full minute, weight, I&O, ECG, Labs: electrolytes & liver function tests Apical pulse: less than 60 or greater than 100: hold med and call doc AVOID HIGH FIBER FOODS Hypotension, others Narrow therapeutic window: 0.5- 2 ng/mg Cardiac: dysthymias, bradycardia, tachycardia CNS: headaches, fatigue, malaise, confusion, convulsions Eyes: colored vision (seeing green, yellow, purple), halo vision, flicking lights GI: anorexia, nausea, vomiting, diarrhea - Pharmacology CMS study guide By: Beth Ryan :) Anticoagulation Drugs- CH. 26 Drug class Drugs Action and use Adverse effects Nursing implications Anticoagulants Heparin (LMWH: Enoxaparin) Routes: Subcute: DVT prophylaxis Inhibit clotting factors II, IX, X, XI, XII Prevent clot formation Therapeutic value Bleeding Heparin-induced thrombocytopenia (HIT) Nausea, vomiting, abdominal cramps. ANTIDOTE: Protamine sulfate - Double check doses - Assess for bleeding (CBC & clotting studies) - NEVER give heparin & enoxapin together - Assess allergy to benzyl alcohol Anticoagulants Warfarin Inhibits production of vitamin K– Prevent clot formation Bleeding Skin necrosis Purple toe syndrome ANTIDOTE: Vit. K - Same time all the time - Routine labs: Pt/INR: goal 2-3/ 2.5-3.5 for mechanical heart valve - St. John’s wart: decreased warfarin effect - Avoid alcohol & cranberry juice - Soft Toothbrush/Electric Razor Antiplatelets Aspirin (also antipyretic) Clopidogrel Prevent platelet adhesion or start of a blood clot - Reduce risk of stroke & MI; after stents Aspirin: GI bleed, nausea/gastritis; low platelets, anemia Clopidogrel: Bleeding, abdominal pain/nausea, flullike symptoms aspirin w/ 6-8oz of water & sit up 30 min after taking - Take w/ food - Aspirin: not for kids/teens b/c risk of Reye’s syndrome - NOT IN PREGNANCY - Held 5-7 days before surgery - Monitor CBC (H&H, platelets) & pt/INR baseline Antiplatelet Pentophylline Decrease blood viscosity bleeding Thrombolytic Alteplase Routes: IV break down, or lyse, preformed clots Indications: Acute MI, DVT, occulted shunts or catheters, pulmonary embolism, acute ischemic strokes Bleeding Nausea, vomiting, hypotension Cardiac dysrhythmias Promote clot formation: > Prevent lysis of fibrin For people with: Hemophilia, vonWilebrand’s disease & post-surgery to prevent bleeding Stroke, Heart attack, Clot formation Antifibrinolytics Desmopressin Aminocaproic acid - Monitor IV sites for bleeding, redness, pain Aseptic technique in IV management Monitor for bleeding in gums, nose, stool, urine, emesis, injection sites, bruising Pharmacology CMS study guide By: Beth Ryan :) Drugs for Anemia- CH. 54 Iron Ferric gluconate Ferrous sulfate Iron dextran (may cause anaphylactic shock, give test dose) Iron sucrose Treatment of iron deficiency anemia nausea, vomiting, diarrhea, constipation, stomach cramps black, tarry stools Liquid oral preparations may stain teeth- use straw Injectable forms cause pain upon injection- use Z-Track Water-soluble Bcomplex vitamin Folate Folic acid Treatment of folic acid deficiency anemia - Administer w/ food Drug for megaloblastic anemia Cyanocobalamin (Vitamin B12) Treat pernicious anemia - Untreated pernicious anemia ErythropoiesisStimulating Agents Epoetin alfa - Biosynthetic form of the natural hormone erythropoietin Stimulates the bone marrow to produce red blood cell - Used for: end-stage renal disease, chemoinduced anemia - Assess CBC, iron levels, B12, Folic acid Obtain nutritional assessment: signs for bleeding and malnutrition Oral forms taken between meals with orange juice hypertension, fever, headache, pruritus, rash, nausea/vomiting, arthralgia, Food that promote absorption_________ Food that impair absoption____________ Tx for overdose: Deferoxamine Interactions: - - Pharmacology CMS study guide By: Beth Ryan :) Antidysrhythmic Drugs- CH. 25 Drug class Class Ia Class Ib Drug procainamide, quinidine Uses: atrial fibrillation, premature atrial contractions, phenytoin, lidocaine Class Ic flecainide, propafenone Class II beta blockers Atenolol (Tenormin) Class III Amiodarone Calcium channel blockers Unclassified Anti Diltiazem Adenosine Action/ use Fast sodium channel blockers, Delay repolarization Increase APD Block sodium channels Lidocaine used for ventricular dysrhythmias Both are used for dysrhythmias caused by digoxin toxicity Block sodium channels Used for severe ventricular dysrhythmias First-line for atrial fibrillation block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart’s conduction system Increase APD Used for dysrhythmias that are difficult to treat - Drug of choice for ventricular dysthymias Adverse effects ventricular dysrhythmias, blood disorders, SLE–like syndrome, N,V,D, fever, leukopenia, twitching, convulsions, confusion, respiratory depression or arrest, hypotension, bradycardia, and dysrhythmias Nursing implications dizziness, visual disturbances, and dyspnea - - corneal microdeposits visual halos photophobia dry eyes photosensitivity pulmonary toxicity Radial pulse for a full minute: under 60= hold meds Drug interactions: - Digoxin, warfarin, grapefruit juice Contraindications: - Hypersensitity Temporary control of rapid vent response Dysrh Contraindications: - KDA Pharmacology CMS study guide By: Beth Ryan :) Diuretics Drug class Loop diuretics Drug bumetanide ethacrynic acid furosemide (Lasix) Action/ use Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption - Treatment of edema in HF, nephrotic syndrome, ascites, - To control hypertension Adverse effects Dizziness, headache, tinnitus, blurred vision GI: Nausea, vomiting, diarrhea Agranulocytosis, neutropenia, thrombocytopenia Blood: Hypokalemia, hyperglycemia, hyperuricemia Dizziness, headache Cramps, nausea, vomiting, diarrhea Urinary frequency, weakness, hyperkalemia Gynecomastia Amenorrhea Irregular menses Postmenopausal bleeding CNS: Dizziness, headache, blurred vision GI: Anorexia, nausea, vomiting, diarrhea, Genitourinary Impotence Hematologic: Jaundice, leukopenia Urticaria, photosensitivity, Hypokalemia, hyperglycemia, hyperuricemia, hyperchloremic alkalosis Potassium-sparing diuretics spironolactone (Aldactone) Work in collecting ducts and distal convoluted tubules Promote the excretion of sodium and water Thiazide and thiazide-like diuretics Hydrochlorothiazide 1st line for HTN Action primarily in the distal convoluted tubule Result: water, sodium, and chloride are excreted - 1st line for HTN, Nursing implications Interactions: - Neurotoxic - Nephrotoxic - Thiazide - NSAIDs Cover up when going outside Monitor intake & output Teach about high potassium diet (bananas, dates, - Monitor electrolytes (potassium)!! Assess vitals Pharmacology CMS study guide By: Beth Ryan :) Antilipemic Drugs- CH. 27 Drug class HMG–CoA reductase inhibitors First-line for hypercholesterolemia Drugs atorvastatin (Lipitor) simvastatin (Zocor) lovostatin (Mevacor) pravastatin (Pravachol) rosuvastatin (Crestor) Action and use Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol Reduces LDL, and triglycerides Increases HDL Adverse effects (GI) disturbances Rash, Headache Myopathy (muscle pain), rhabdomyolysis Elevations in liver enzymes or liver disease Monitor for: Anorexia, vomiting, nausea, jaundice Bile acid sequestrants B vitamin niacin cholestyramine (Questran) colestipol (Colestid) Niacin Prevent resorption of bile acids from small intestine Prevent absorption of cholesterol Increases activity of lipase, which breaks down lipids Fibric acid derivatives (fibrates). gemfibrozil (Lopid) fenofibrate (Tricor) activating lipase, which breaks down cholesterol Constipation Heartburn, nausea, belching, bloating Flushing (caused by histamine release) Pruritus GI distress Abdominal discomfort, diarrhea, nausea Blurred vision, headache Risk of gallstones Longer prothrombin time Nursing implications Interactions: - Oral anticoagulants Contraindicated in active liver disease Monitor serum cholesterol levels before and 4 weeks after Monitor LFT’s Report muscle weakness Pregnancy cat. X Take @ NIGHT Also used in Treatment of loose bowel movements Contraindications: - KDA - Severe liver or kidney disease - Cirrhosis - Gallbladder disease Interactions: Oral anticoagulants & Statins cholesterol absorption inhibitor Herbal Product ezetimibe (Zetia): Herbal Product Flax Garlic Inhibits absorption of cholesterol and related sterols from the small intestine Used as an antispasmodic, antihypertensive, antiplatelet, lipid reducer Uses: atherosclerosis, hypercholesterolemia, GI distress, menopausal symptoms dermatitis, vomiting, diarrhea, flatulence, antiplatelet activity diarrhea and allergic reactions Pharmacology CMS study guide By: Beth Ryan :) Respiratory drugs Drug class Antihistamines (Sedating) Decongestants Adrenergics - Drugs diphenhydramine(sedating) loratadine (non- sedating) cetirizine fexofenadine Action and use For: Allergies, Insomnia Blocks histamine I receptor sites to stop vasodilation and capillary permeability Adverse effects Dry mouth, Difficulty urinating, Constipation, Changes in vision, Drowsiness pseudoephedrine (Sudafed)- oral ephedrine- topical phenylephrine- topical Constrict small blood vessels, shrinking nasal tissue, and nasal secretions in the swollen mucous membranes are better able to drain. Nervousness Insomnia Palpitations Tremors Decongestants Anticholinergics - ipratropium (Atrovent)nasal spray Dry nasal secretion Dry mucous membrane, hypertension, tachycardia, urinary retention, constipation (with systemic absorption) Decongestants Corticosteroids - fluticasone (Flonase) beclometha Local mucosal dryness and irritation Antitussives Opioids - Codeine Hydrocodone Decreased inflammation results in decreased congestion Suppress the cough reflex Antitussives Non opioids - Dextromethorphan Benzonatate (cause HA) For: Cough Suppress the cough reflex Dizziness, drowsiness, nausea Expectorants - guaifenesin (Musinex) For: Resp. congestion, cough Reduce the viscosity of secretions loosening/thinning Nausea, vomiting, GI irritation Sedation, N, V lightheadedness, constipation Nursing implications Contraindications: - liver disease - breastfeeding Interactions: Pregnancy B Contraindications: - Narrow angle glaucoma - uncontrolled cardio disease, HTN - Diabetes / hyperthyroidism - BPH Interactions: - Methyldopa - Urinary acidifiers & alkalinizes & sympathomimetics Contraindications: Opioid dependency, Resp. depression, Renal impairment Interactions: CNS depressants, ETOH, Tricyclic Antidepressants Pregnancy C Pharmacology CMS study guide By: Beth Ryan :) Respiratory drugs Drug class Bronchodilators: Short acting BetaAdrenergic Agonists Drugs - albuterol levalbuterol terbutaline salmeterol Anticholinergics - ipratropium tiotropium aclidinium Xanthine Derivatives - theophylline Synthetic xanthines: aminophylline (IV) Leukotriene receptor antagonists - Montelukast Corticosteroids - beclomethasone dipropionate budesonide fluticasone triamcinolone acetonide methylprednisolone Mast cell stabilizers cromolyn and nedocromil, Action and use For: Acute asthma attacks Activates beta2 receptors relaxes smooth muscle in the airway and results in bronchial dilation and increased airflow. For: Decrease in bronchospasms Binds with ACH receptor to prevent bronchoconstriction For: long term COPD or asthma Increase levels of energyproducing cAMP Cause bronchodilation Blocks leukotriene and decrease inflammation Adverse effects Hypotension or hypertension Vascular headache Tremor Nursing implications - Avoid caffeine - Monitor for tachycardia/tremors - Pregnancy C Dry mouth, cough, Nasal congestion, Palpitations, GI distress, DO NOT give if narrow-angle glaucoma or BPH (Will worsen) - Pregnancy B Hyperglycemia tachycardia, Nausea, vomiting, anorexia Therapeutic range: 5-15 mcg/ml - Avoid caffeine - Pregnancy C Headache, nausea, diarrhea Suicide risk - Pregnancy B For: Antiinflammatory/decrease airway mucus Turns off immune system and decrease inflammation Pharyngeal irritation Coughing, Dry mouth Oral fungal infections Systemic effects rare with low doses for inhalation therapy. Stabilize membranes of cells that release harmful bronchoconstricting substances N,V,D headache - Pregnancy C Pharmacology CMS study guide By: Beth Ryan :) Acid Controlling Drugs- CH. 50 Drug class Drug Action/uses Adverse effect Nursing implication Antacids Aluminum salts Neutralize acid secretions -Recommended for pts w/ renal disease (more easily excreted) -Pts w/ kidney disease Constipation Often used w/ magnesium to counteract constipation (EXCEPT w/ renal pts) Antacids Magnesium salts: magnesium hydroxide Neutralize acid secretions Diarrhea Contraindications: - Pts w/ RENAL FAILURE (failing kidney cannot excrete extra magnesium) Carbonate salt: Gaviscon Antacids Calcium salts - Dietary calcium: Tums (calcium carbonate) Neutralize acid secretions kidney stones, produces gas and belching, constipation, acid rebound Not recommended for pts w/ renal disease- may accumulate to toxic levels Antacids Sodium Bicarbonate Neutralize acid secretions Quick onset, short duration Sodium content may cause problems in patients with heart failure (HF), hypertension, or renal insufficiency. May cause metabolic alkalosis For all Antacids: Assess for - Fluid imbalances - Renal disease - GI obstruction/ Antiflatulents Simethicone Helps excrete gas H2 receptor blockers - cimetidine - famotidine - ranitidine Competitively block the H2 receptor of acid-producing parietal cells Decrease acid production cimetidine: Gynecomastia, induce impotence Interactions: Smoking!! - Caution in confused, disoriented, elderly pts - 1 hr before or after antacid Headaches, lethargy, confusion, diarrhea, Pharmacology CMS study guide By: Beth Ryan :) Proton Pump Inhibitors - omeprazole - lansoprazole (granules can be given NG tubes) - rabeprazole - pantoprazole (IV form available) - esomeprazole Prevents the movement of hydrogen ions from the parietal cell into the stomach. Total inhibition of gastric acid secretion Used for: - GERD, Erosive esophagitis, Work best 30-60 min before meals PPIs are generally well tolerated for SHORT TERM USE GI tract infections Osteoporosis Assess for allergies/ hx of liver disease Pantoprazole given IV - May increase diazepam & phenytoin levels - Increased chance for bleeding w/ warfarin Miscellaneous Sucralfate forming a protective barrier in stomach lining and prevent erosion For: stress ulcers, peptic ulcer disease, ulcer prophylaxis constipation, nausea, and dry mouth May impair absorption of other drugs Administer 2 hours prior to other drugs May be used in chronic renal failure Miscellaneous Misoprostol Protect gastric mucosa from injury Used for: Prevention of NSAIDinduced gastric ulcers cramps and diarrhea DO NOT USE IN PREGNANCY (spontaneous abortion) Category X Pharmacology CMS study guide By: Beth Ryan :) Bowel Disorder Drugs- CH. 51 Drug class Drug Action/use Adverse effect Adsorbents bismuth subsalicylate (PeptoBismol) colestipol and cholestyramine Coat walls of gastrointestinal (GI) tract Bind to causative bacteria/toxin, which is eliminated through stool Increased bleeding time Constipation, dark stools Confusion Tinnitus Metallic taste Blue tongue Antimotility drugs Anticholinergics belladonna alkaloids Decrease intestinal muscle tone and peristalsis of GI tract Result: slows the movement of fecal matter through the GI tract Urinary retention, impotence Headache, dizziness, confusion, anxiety, drowsiness, confusion Dry skin, flushing Blurred vision Hypertension, tachycardia Antimotility drugs Opiates opium tincture, codeine loperamide, diphenoxylate Decrease bowel motility and reduce pain by relief of rectal spasms Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed Drowsiness, dizziness, lethargy Nausea, vomiting, constipation Respiratory depression Hypotension Urinary retention Flushing Probiotics Lactobacillus acidophilus (Bacid) Also known as intestinal flora modifiers and bacterial replacement drugs Bulk forming laxative psyllium (Metamucil) methylcellulose (Citrucel) Absorb water to increase bulk Impaction Fluid overload Electrolyte imbalances Esophageal blockage Hyperosmotic Laxative Polyethylene glycol (PEG) Sorbitol, glycerin Lactulose (also used to reduce elevated serum ammonia levels) Increase fecal water content Results in bowel distention, increased peristalsis, and evacuation Abdominal bloating Electrolyte imbalances Rectal irritation Nursing Implications Monitor for constipation All laxatives can cause electrolyte imbalances! Adequate fluid Pharmacology CMS study guide Saline Laxative Magnesium hydroxide (Milk of Magnesia) Magnesium citrate (Citroma) Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines Magnesium toxicity (with renal insufficiency) Cramping Electrolyte imbalances Diarrhea Increased thirst Stimulant Laxative senna (Senokot) bisacodyl (Dulcolax) Increases peristalsis via intestinal nerve stimulation Nutrient malabsorption Skin rashes Gastric irritation Electrolyte imbalances Discolored urine Rectal irritation By: Beth Ryan :) Antiemetic and Antinausea Drugs: CH 52 Drug Class Drug Action/Uses Adverse effect Antidopaminergic drugs prochlorperazine (Compazine) promethazine (Phenergan) Block dopamine receptors in the CTZ Drowsiness, dizziness, dry mouth, blurred vision Prokinetic drugs Metoclopramide (Reglan) Block dopamine receptors in the CTZ Also stimulate peristalsis in GI tract, enhancing emptying of stomach contents Drowsiness, dizziness, headache, diarrhea Block serotonin receptors in the GI tract, CTZ, and VC Dizziness, drowsiness, HA, constipation, Nursing implications Commonly used Serotonin blockers dolasetron (Anzemet) granisetron (Kytril) ondansetron (Zofran) palonosetron (Aloxi) Assess motor function like Tardive dyskinesia (uncontrolled movement) -CAT B Pharmacology CMS study guide By: Beth Ryan :) Anti-infectives: CH. 38 Drug class Sulfonamides Broad spectrum Drugs - Sulfamethoxazole and trimethoprim(SMX-TMP) Action and use Inhibit bacterial growth (Bacteriostatic) Uses: UTI, Staph infections (MRSA), Broad Sprectrum Adverse effects Nursing implications Allergic reaction (fever/rash) Stevens-Johnson Syndrome Photosensitivity GI Blood(anemia, thrombocytopenia) Contraindications: - Allergy to Sulfa/Sulfur - Pregnant women @ term - Infants <2 mo old Interactions: Oral contraceptives, Warfarin, Sulfonylureas (hypoglycemia), Cyclosporine (nephrotoxicity) Penicillins (PCN) Amoxicillin, nafcillin, piperacillin Bactericidal: Destroy bacteria cell wall = lysis and death Uses: Streptococcus, Enterococcus, Staphylococcus Angioedema, Allergic reaction, CNS depression, GI Interactions: - Oral contraceptives - Warfarin Cephalosporins Broad spectrum Cefazolin, Cephalexin (1st gen), Ceftiaxone Closely related to PCN Bactericidal: Destroy bacteria cell wall Same as PCN Contrindications: - Cross-sensitivity to PCN Interactions: ETOH, Antiacids Macrolides Erythromycin, Azithromycin, Clarithromycin Bacteriostatic: Dosent kill, but inhibits anymore growth N/V/D, hepatotoxicity, hearing loss, tinnitus, jaundice, anorexia Interactions: Carbamazepine, Cyclosporine, Theophylline, Warfarin Bacteriostatic: Inhibit protein synthesis Allergic reaction GI Photosensitivity Hematologic changes Tooth discolorations Older than 8 to be used CAT D PREGNANCY Alternative for beta-lactam ABX (allergy to PCN) Tetracyclines Wide spectrum Doxycycline, demeclocycline Used alot for intra abdominal infections Aminoglycosides Mostly gram -ve gentamicin neomycin (Neo-fradin) tobramycin (TOBI) Bactericidal; prevent protein synthesis Nephrotoxicity Ototoxicity Paresthesia Fever, Vertigo CAT C-D Quinolones Broad spectrum ciprofloxacin (Cipro) norfloxacin (Noroxin) levofloxacin (Levaquin) Bactericidal: Alter DNA of bacteria, causing death N,V,D peripheral neuropathy, Black box warning for tendinitis & tendon rupture Pharmacology CMS study guide By: Beth Ryan :) Antibiotics Pt 2: CH 39 Drug class Drugs Action and use Adverse effects Nursing implications Miscellaneous Antibiotics linezolid (Zyvox) Treat MRSA, and VRE Inhibits protein synthesis hypotension, serotonin syndrome if taken with (SSRIs), Miscellaneous Antibiotics metronidazole (Flagyl) Intraabdominal and gynecologic infections Interferes with DNA Used for: TRICK Dizziness, Headache, GI discomfort, nasal congestion, metallic taste in mouth, neutropenia, thrombocytopenia Miscellaneous Antibiotics nitrofurantoin (Macrodantin) Primarily used for UTIs Disrupt bacteria cell wall formation Hepatotoxicity, blood dyscrasias, dizziness, headache, skin rash Miscellaneous Antibiotics vancomycin (Vancocin) Inhibit cell wall synthesis Ototoxicity, nephrotoxicity, Red man syndrome(infused too rapidly) Antitubercular isoniazid Inhibit cell wall peripheral neuropathy, hepatotoxicity TX of neuropathy_______ Antitubercular rifampin Inhibit protein synthesis hepatitis; discoloration of urine, stools, and other body fluids Pt teaching__________ Antitubercular ethambutol Inhibit growth retrobulbar neuritis, blindness Contraindications: Hypersensitivity, 1st trimester of pregnancy Peak and trough levels: 10-20 Slow infusion to prevent red man symdrome Pharmacology CMS study guide By: Beth Ryan :) Antiviral Drugs: CH 40 Antiviral Acyclovir (Zovirax) Suppress replication of HSV-1, HSV-2, VZV Ginggival hyperplasia, GI, Burning topically, Photosensitivity Antiviral Ganciclovir (Cytovene) Used to treat infection with CMV Bone marrow toxicity N,V headache seizures Antiviral Oseltamivir (Tamiflu) zanamivir (Relenza) Active against influenza types A and B N/V Antiviral Ribavirin (Virazole) infants with RSV infections Rash, anemia, conjunctivitis, bronchospasm Antiviral Simeprevir (Olysio) hepatitis C Photosensitivity, rash, pruritus, nausea Antiviral Lamivudine Hepatitis B NVD Antiretroviral Zidovudine Inhibit enzyme needed for replication, enters host cell FOR HIV Lipid abnormalities, Bone demineralization, Osteoporosis Antiretroviral indinavir Inhibit enzyme needed for replication Lipid abnormalities, Bone demineralization, Osteoporosis Antiretroviral tenofovir/ enfuvirtide Inhibit fusion of virus Lipid abnormalities, Bone demineralization, Osteoporosis Wear gloves when applying Start within 2 days of when symptoms occur Assess CBC Pharmacology CMS study guide By: Beth Ryan :) Anti-Fungal drugs: CH 42 Drug Class Drug Mode of Action/ Use Adverse Effects Nursing considerations Antifungal Griseofulvin Disrupts cell division Numbness, tingling, stomach ache, N,V,D, heart burn Antifungal Amphotericin B Bind to sterols in cell membrane lining, causing cell death Neurotoxicity, Renal toxicity, Pulmonary infiltrates, Fever, chills, headache, nausea, hypotension, gastrointestinal (GI) upset, anemia Used for severe systemic fungal infections Premedicate: Antipyretic, Antihistamines, Corticosteroids, NsAIDs Longer infusion time Order BUN, creatinine, AST, ALT, Given IV Antifungal Nystatin Similar to Amphotericin B Nausea, vomiting, anorexia, diarrhea, rash Antifungal Fluconazole Destroy cell wall For: systemic and topical infections Nausea, vomiting, diarrhea, stomach pain, Increased liver enzymes Drugs for TB: CH 41 Drug Class Drug First line for TB Isoniazid (INH) antibiotics Rifampin Mode of Action/ Use Inhibits bacterial DNA-dependent RNA polymerase: stops DNA transcription Adverse Effects Nursing considerations Peripheral Neuropathy (VIT. B6 NEEDED), ototocixity, N/V, nephrotoxocity Contraindications: Renal pts Monitor for liver dysfunction Turns any body fluid red/orange/brown, hepatitis, hematologic disorders Monitor for liver labs, CBC Pharmacology CMS study guide By: Beth Ryan :) Women’s Health/ Cancer Drugs Drug class Drug Action and use Selective estrogen receptor modifiers (SERMs) tamoxifen (Nolvadex) Stimulate estrogen receptors on bone and increase bone density **Used to treat breast cancer** Cancer Drug methotrexate Bone marrow suppression Adverse effect Nursing implication Hot flashes, leg cramps, pulmonary embolism, Hypercalcemia, GI upset, Abnormal vaginal discharge/bleeding Epistaxis & bleeding gums- CALL HCP!! CBC drawn to check for platelet levels Use soft toothbrush Muscle Relaxants Drug Class Drug Action and use Adverse effects Muscle relaxant Baclofen (Lioresal): MS Cyclobenzaprine (Flexeril): Musculoskeletal injury Dantrolene (Dantrium): MH Metaxalone (Skelaxin) Tizanidine (Zanaflex) Act to relieve pain associated with skeletal muscle spasms Euphoria Lightheadedness Dizziness Drowsiness Fatigue Muscle weakness Nursing implications Pharmacology CMS study guide By: Beth Ryan :) Antineoplastic Drugs: CH 45-46 Drug class Antimetabolites Mitotic Inhibitors Drugs methotrexate (MTX) fluorouracil (5-FU) Mercaptopurine (6-MP) Vincristine paclitaxel Action and use Antagonize the actions of key cellular metabolites. retard cell division Adverse effects Hair loss, N/V, myelosuppression, Tumor lysis syndrome, SJS, Neurologic, cardiovascular, pulmonary, hepatobiliary toxicity Hair loss, nausea and vomiting, myelosuppression Liver, kidney, lung toxicities, Convulsions, Extravasation Alkylating Drugs Cyclophosphamide (Cytoxan) Work by preventing cancer cells from reproducing Similar to mitotic agent Cytotoxic Antibiotics Bleomycin: causes pulmonary toxicity Daunorubicin: heart failure Doxorubicin: left ventricular failure blockade of DNA synthesis Similar to Mitotic agent except bleomycin. Suppression of tumor growth. Blocks the body sex’s hormone receptor. Used most as adjuvant and palliative therapy. Stroke; thromboembolism; edema; confusion; N/V; headache; weakness Hormonal drugs Tamoxifen Nursing implications Pharmacology CMS study guide By: Beth Ryan :) Biologic Response-Modifying Drugs CH. 47 Drug class Drugs Action and use Adverse effects Hematopoietic drugs Filgrastim Pegfilgrastim sargramostim Decrease duration of chemotherapy-induced anemia; neutropenia; thrombocytopenia. Enhance the production of bone marrow cells Fever; muscle ache; bone pain; flushing; alopecia; rash; anorexia Disease-modifying antirheumatic drugs Nursing implication Modify the disease of RA. exhibit anti-inflammatory, antiarthritic, and immunomodulating effects Immunosuppressant Drug CH. 48 Drug class Drugs Action and use Adverse effects Nursing implications Immunosuppressant Drug Cyclosporine (Sandimmune) Inhibits activation of T cells by blocking the production and release of the cytokine mediator IL-2. Prevention of organ rejection. Moderate hypotension; nephrotoxicity; hepatotoxicity; neurotoxicity. Document findings presence of jaundice, edema, or ascites; urinary functioning and patterns; dysrhythmia, chest pain, and heart failure Immunosuppressant drug azathioprine Blocks metabolism of purines; inhibiting the synthesis of T-cells DNA, RNA, and Protein. Prevention of organ rejection in kidney transplantation; treatment of RA. Leukopenia; thrombocytopenia; hepatoxicity Document findings presence of jaundice, edema, or ascites; urinary functioning and patterns; dysrhythmia, chest pain, and heart failure Pharmacology CMS study guide By: Beth Ryan :) Antiepileptics: CH 14 Drug class Action and use Adverse effects Nursing implications Alters movement of Na, K, Ca, and Mg ions. This results in a more stabilized and less excited cell membrane CNS effects (Dowsiness, dizziness) gingival hyperplasia, acne, hirsutism, Dilantin facies, and osteoporosis Therapeutic drug levels: 1020mcg/ml Status epilepticus: seizure lasting more than 5 minutes. Tx: Diazepam, lorazepam (IV, IM) If not effective give barbiturates Follow with routine drug phenytoin IV *Carbamazepine (Tegretol) 2 line Action similar to phenytoin CNS and GI symptoms Autoinduction of hepatic enzymes Monitor liver enzyme Antiepileptic Drugs Ethosuximide (Zarontin) Action similar to phenytoin CNS and GI symptoms Antiepileptic Drugs *Gabapentin (Neurontin) Potentiate GABA CNS and GI symptoms Antiepileptic Drugs Levetiracetam (Keppra) unknown generally, well tolerated, CNS effects Antiepileptic Drugs *Pregabalin (Lyrica) Action similar to phenytoin Use: neuropathic pain, postherpetic neuralgia, and fibromyalgia CNS effects, blurred vision, peripheral edema Antiepileptic Drugs Antiepileptic Drugs Drugs Phenytoin (1st line0 nd Most commonly used for neuropathy Pharmacology CMS study guide By: Beth Ryan :) Antiparkinsons Meds: CH 15 Drug class Drugs Action and use Adverse effects Antiparkinson Drugs Carbidopa levodopa Work presynaptically to increase brain levels of dopamine confusion, involuntary movements, GI distress, hypotension, and cardiac dysrhythmias, palpitations, urinary retention, dyskinesia Nursing implications Check vitals: BP, Ht & Wt Therapeutic response: Ability to perform ADLs, increased appetite, Decrease in parkinson's symptoms Psychotherapeutic Drugs: CH 16 Drug class Drugs Action and use Adverse effects Nursing implications Benzodiazepines Benzodiazepines alprazolam (Xanax) diazepam (Valium) lorazepam (Ativan) Reduce anxiety by reducing overactivity in central nervous system (CNS) Decreased CNS activity, sedation, Hypotension if taken with other CNS depressant, Drowsiness, loss of coordination, dizziness, headaches Nausea, vomiting, dry mouth, constipation Antidote: Flumazenil (Romazicon) may be used to reverse benzodiazepines’ effects. cardiac dysrhythmia drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension Therapeutic index: 0.6 and 1.2 mEq/L Hyponatremia potentiates lithium toxicity. Give 30-60 min before bedtime Use cautiously w/ elderly Mood-Stabilizing Drugs Lithium carbonate Antidepressants Tricyclic antidepressants amitriptyline (Elavil) It is thought to potentiate serotonergic neurotransmission Block reuptake of neurotransmitters, causing accumulation at the nerve endings Sedation Impotence Orthostatic hypotension Dizziness, postural hypotension, constipation, delayed Pharmacology CMS study guide By: Beth Ryan :) Anesthesia Drugs: CH 11 Drug class Drugs Action and use Adverse effects Nursing implications General Anesthetics Dexmedetomidine Ketamine Nitrous Oxide Propofol (Diprivan) Sevoflurane (Ultane) Pain relief Depression of consciousness Skeletal muscle relaxation Reflex reduction Myocardial depression Respiratory suppression Malignant hyperthermia Acute porphyria Tx of MH Dantrolene Pregnancy (potential harm to fetus) Psychotherapeutic Drugs: CH 16 Drug class Drugs Action and use Adverse effects Nursing implications Antidepressants Monoamine oxidase inhibitors (MAOIs) also given to treat Parkinson disease Phenelzine Selegiline Inhibits reuptake of serotonin Wt gain, dizziness, hypotension, blood dyscrasias, syncope potential to cause hypertensive crisis when taken with tyramine wine, cheese, chocolate Antidepressants Second generation SSRI Citalopram (Celexa) Fluoxetine (Prozac) Selective serotonin reuptake inhibitor anxiety, dizziness, drowsiness, insomnia, Second generation Antidepressants SNRI Duloxetine(Cymbalta)* Serotonin-norepinephrine reuptake inhibitor (SSNRI) dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity Antipsychotics Atypical clozapine (Clozaril) Aripiprazole (Abilify) ziprasidone (Geodon) risperidone (Risperdal) Quetiapine (Seroquel) Identify a common SE of antidepressant and describe nursing management and teaching.
