DRUG SUFFIXES CHEAT SHEET –SORTED ALPHABETICALLY– A suffix is the ending of a word, placed after the word’s stem, which often communicates meaning. Drug suffixes are commonly used to group drugs based on the drug’s action. Name -actone -ase azine -caine -cycline -dipine Drug Classification Potassium-Sparing Diuretics Thrombolytics Antiemetics Examples Action spironolactone aldactone Increase the fluid excreted by the kidneys, while retaining potassium in the body. reduces cardiovascular congestion and edema that results from CHF. They also lower blood pressure. streptokinase alteplase (tPA) “Clot busters” that break down clots that lead to heart attacks or strokes, to restore blood flow to the obstructed area. promethazine Local Anesthetics lidocaine xylocaine Tetracyclines tetracycline doxycycline Calcium Channel Blockers Treat and prevent nausea and vomiting. Prevent the transmission of nerve impulses or pain without causing unconsciousness. Broad spectrum antibiotics that treat bacterial infections. Relax blood vessels, therefore increasing blood amlodipine nifedipine supply and oxygen to the heart and reducing the heart’s workload while lowering blood pressure. Name -floxacin -ide Drug Classification Examples Fluoroquinolones ciprofloxacin levofloxacin Broad spectrum antibiotics that treat bacterial infections. repaglinide nateglinide glyburide glipizide Lower blood glucose levels by triggering the production of insulin; used to treat type 2 diabetes. Meglitinides Sulfonylureas Antihistamines diphenhydramine loratadine brompheniramine -ine Selective Serotonin Reuptake Inhibitors (SSRIs) -lam -lol -lone Benzodiazepines Beta Blockers Corticosteroids fluoxetine sertraline alprazolam atenolol metoprolol propranolol methylprednisolone Action Treat allergy symptoms, such as sneezing, runny nose, itching, and hives, caused by histamine activation. Block or delay the reabsorption of serotonin; used to treat major depressive disorders and anxiety disorders Treat anxiety; prolonged use may lead to physical dependence. Increase the fluid excreted by the kidneys, while retaining potassium in the body. reduces cardiovascular congestion and edema that results from CHF. They also lower blood pressure. Anti-inflammatory drugs used to control many different inflammation-related symptoms. Name -micin mycin -pam -phylline Drug Classification Examples Aminoglycosides gentamicin tobramycin Benzodiazepines Bronchodilators alprazolam diazepam lorazepam theophylline -pram Selective Serotonin Reuptake Inhibitors (SSRIs) citalopram -prazole Proton Pump Inhibitors lansoprazole omeprazole -pril ACE Inhibitors -sartan Angiotensin-II Receptor Blockers -sone Corticosteroids captopril lisinopril losartan valsartan dexamethasone prednisone Action Broad spectrum antibiotics that treat bacterial infections. Treat anxiety; prolonged use may lead to physical dependence. Dilate the bronchi and bronchioles, decreasing resistance in the airway and increasing airflow to the lungs. Often used for asthma and COPD. Block or delay the reabsorption of serotonin; used to treat major depressive disorders and anxiety disorders Anti-ulcer drugs that reduce gastric acid production. Reduce blood pressure by dilating blood vessels, thus reducing the heart’s workload. Inhibit blood vessel constriction, helping blood vessels relax, which lowers blood pressure. Anti-inflammatory drugs used to control many different inflammation-related symptoms. Name -statin -terol -thiazide -tidine -triptyline Drug Classification Antilipidemics Bronchodilators Thiazide Diuretics H2-receptor Antagonists (H2 Blockers) Tricyclic Antidepressants Examples Action atorvastatin simvastatin Reduce LDL cholesterol and lower risks from cardiovascular disease. albuterol levabutero hydrochlorothiazide cimetidine famotidine amitriptyline nortriptyline Dilate the bronchi and bronchioles, decreasing resistance in the airway and increasing airflow to the lungs. Often used for asthma and COPD. Increase fluid and potassium excreted by the kidneys. Reduces cardiovascular congestion and edema that results from CHF. They also lower blood pressure. Block the action of histamine in the stomach, decreasing the production of stomach acid. Treat depression, bipolar disorder, anxiety, OCD, and other mood disorders. Antibiotics Antibiotics are powerful medications that treat certain infections and can save lives when used properly. They either stop bacteria from reproducing or destroy them. They include a range of powerful drugs used to treat diseases caused by bacteria. Antibiotics cannot treat viral infections, such as cold, flu, and most coughs. The main types of antibiotics include: Penicillins - for example, phenoxymethylpenicillin, flucloxacillin and amoxicillin. Cephalosporins for example, cefaclor, cefadroxil and cefalexin. Tetracyclines - for example, tetracycline, doxycycline and lymecycline Fast facts on antibiotics Side effects of Antibiotics Alexander Fleming discovered penicillin, the first natural antibiotic, in 1928. Antibiotics cannot fight viral infections. Fleming predicted the rise of antibiotic resistance. Diarrhea Nausea Vomiting Rash Upset stomach Sensitivity to sunlight, when taking tetracyclines Types of antibiotics Class Pencillins Examples Amoxicillin (Amoxil) Macrolides Azithromycin (Zithromax) Cephalosporins Cephalexin (Keflex) Fluoroquinolones Ciprofloxacin (Cipro) Lincosamides Clindamycin (Cleocin) Allergy A raised rash, or hives Swelling of the tongue and face Coughing Wheezing Difficulty breathing Antibiotics to prevent infection Antibiotics are sometimes given as a precaution to prevent, rather than treat, an infection. This is called antibiotic prophylaxis. Situations where antibiotics are given as a preventive treatment include: if you're having an operation after a bite or wound that could get infected if you have a health problem that means you're at higher risk of infection such as if you've had your spleen removed or you're having chemotherapy treatment When antibiotics are needed? Antibiotics may be used to treat bacterial infections that: are unlikely to clear up without antibiotics could infect others could take too long to clear without treatment carry a risk of more serious complications People at a high risk of infection may also be given antibiotics as a precaution, known as antibiotic prophylaxis. Missing a dose of antibiotics If you forget to take a dose of your antibiotics, take that dose as soon as you remember and then continue to take your course of antibiotics as normal.But if it's almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Pain Medications Pain medicines, whether they’re over-the-counter or prescription strength, can help you manage chronic pain and other kinds of pain. They’re powerful drugs, so it's important to use them with care. It’s best to start with the safest drugs at the lowest effective dose for the shortest amount of time and work up from there as needed. Over-the-Counter Pain Relievers Over-the-counter (OTC) pain relievers include: Acetaminophen (Tylenol) Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and diclofenac gel Types of over-the-counter pain relievers Common OTC pain medications include: Acetaminophen: This drug (Tylenol®) dulls pain receptors in the brain. As a result, you feel less pain. Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs lower the production of prostaglandins. These hormone-like chemicals irritate nerve endings, causing inflammation and pain. NSAIDs include aspirin compounds (Excedrin®), ibuprofen (Advil® and Motrin®) and naproxen sodium (Aleve®). Combination: Some pain relievers contain both acetaminophen and aspirin (an NSAID). Certain OTC headache medicines also have caffeine. Topical: You apply this pain medication directly to your skin. It comes as a cream, gel, spray or patch. Topical medicines block pain receptors in the brain. They may contain aspirin, lidocaine, capsaicin pepper or other medication. Some topical treatments make the skin feel warmer or cooler. What do over-the-counter pain relievers treat? OTC pain medications lower fevers and ease pain from a variety of problems, including: Arthritis, bursitis and tendonitis. Back strains and sprains. Broken bones. Burns, including sunburns. Colds, flu and ear infections. Headaches and migraines. Menstrual cramps (dysmenorrhea). Muscle pain, including neck pain. Surgeries and minor procedures. Toothaches. Prescription Pain Relievers Prescription medicines to treat pain include: Corticosteroids Opioids Antidepressants Anticonvulsants (anti-seizure medications) NSAIDs What do prescription pain relievers treat? Prescription pain relievers can alleviate pain brought on by: Cancer. Fibromyalgia. Migraines. Nerve (neuropathic) pain, including diabetes-related neuropathy. Postoperative pain. Severe arthritis pain. Severe muscle pain, including back pain. Traumatic injuries, including broken bones and burns. Types of prescription pain relievers Prescription pain medications provide stronger pain relief than OTC drugs. Types of prescription pain relievers include: Antidepressants: Antidepressants work on chemicals called neurotransmitters in the brain. These drugs work best for chronic pain, including migraines. The largest pain relief comes from tricyclics (Elavil®) and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor® and Cymbalta®. Studies show that selective serotonin reuptake inhibitors (SSRIs) like Prozac® don’t work as well for pain. SSRIs may make other pain medicines less effective. Anti-seizure medications: Medications for epilepsy interrupt pain messages to the brain. Types include gabapentin (Gabarone®) and pregabalin (Lyrica®). These medicines can ease nerve pain and fibromyalgia. Muscle relaxers: These medications reduce pain by relaxing tight muscles. They also relieve muscle spasms. Opioids: Opioids are lab-made narcotic pain medicines. They change how your brain perceives pain messages. Because they can be addictive, healthcare providers rarely prescribe opioids for chronic pain. You may take opioids for a short time after a surgery or traumatic injury. Codeine, fentanyl, hydrocodone and morphine are all opioids. Steroids: Corticosteroids are strong anti-inflammatory drugs. Like NSAIDs, they stop your body from making chemicals that cause irritation and inflammation. Steroids such as Prednisone® treat migraines and severe arthritis and back pain. Topical: Your provider can choose among prescription-strength skin creams, gels, sprays and patches. They can ease muscle pain, arthritis and fibromyalgia. Psychiatric Medication A to Z A B C D E F Abilify Benperidol Clozaril Denzapine Ebesque Faverin Alaquet Biquelle Cipramil Depakote Edronax Fluanxol Alzain Brancico Clopizol Depefex Efexor Fluoxetine Anquil Brintellix Clopixol Depixol Epilim Flupentixol Axalid Buspirone Cipralex Dolmatil Escitalopram Foraven Alventa H Chloractil I L M Amphero Haldol Circadin Imipramine Lamictal Majoven Arpoya Halkid Cariprazine Invega Largactil Manerix Ativan Haloperidol N Isocarboxazid Latuda Mintreleg Allegron Heminevrin Nardil Lecaent Modecate P Q Psytoxil O Nozinan Olena Li-liquid Mogadon Quetiapine Nortriptyline Orap Librium Molipaxin Prozep R Nitrazepam Oxactin Lomont Prozac Reaglia Prothiaden S T Oxazepam V Seroquel Risperdal Tegretol Olanzapine Valdoxan Seroxat Priadel Reboxetine Tenprolide Venaxx Sinepin Politid Risperidone Tensium Venlablue Slenyto Venlalic Solian W Welldorm X Trevicta Z Parnate Xanax Tropium Zalasta Venlasoz Sominex Pimozide Xeplion Temazepam Zaluron Vensir Stelazine Trazodone Zaponex Venzip Stemetil Trimipramine Zimovane ViePax Stesolid -- Zispin Venlafaxine Stilnoct ----- Zolpidem Vortioxetine Sulpor Zopiclone Valproate Sunveniz ZypAdhera --- Surmontil Phenergan Paroxetine Phenelzine ------ -------- Zyprexa Sycrest Cardiac Medications Sacubitril/valsartan This is the first in a class of heart failure medication called angiotensin receptor neprilysin inhibitors. It combines an angiotensin receptor blocker (valsartan) with a neprilysin enzyme inhibitor (sacubitril). Neprilysin breaks down natriuretic peptides, which are responsible for sodium and water loss when ventricles are overloaded. Delaying their breakdown lengthens their effects and removes more sodium and water from the body, decreasing intravascular volume and blood pressure, resulting in decreased preload and afterload. Nursing points: Sacubitril/valsartan should not be given with an ACE inhibitor. Adverse effects: Adverse effects include dizziness, fatigue, cough, hypotension, and hyperkalemia. Indications: Sacubitril/valsartan is indicated to reduce the risk of hospitalization and death in patients with chronic heart failure and reduced ejection fraction. Angiotensin receptor blockers Similar to ACE inhibitors, ARBs block the action of angiotensin II. However, they work at a different level of interaction with angio ten – sin II, reducing the risk of hyperkalemia or cough that’s seen with ACE inhibitors. ARBs block angiotensin II receptors in the blood vessels and the adrenal glands. In the blood vessels, ARBs cause venous and arterial dilation to reduce both preload and afterload. Blocking angiotensin II receptors in the adrenal glands decreases the release of aldosterone, which in turn increases the excretion of sodium and water. Nursing points: ARBs and ACE inhibitors shouldn’t be used interchangeably. ACE inhibitors are preferred over ARBs because they’re associated with a decrease in morbidity and mortality. Adverse effects: ARBs are well tolerated and have minimal side effects. Beta-blockers Beta-blockers block the effects of adrenaline, which comes on in response to stressful situations. Beta-blockers are prescribed in the treatment of these four conditions: Angina. Heart attack. Congestive heart failure. Abnormal heart rhythms. Dosage of these medications must be adjusted for the desired response. Your doctor will monitor you for dizziness (due to low heart rate) kidney and liver problems. Nursing points: Fluid retention may worsen heart failure but can usually be managed with diuretics. If bradycardia or hypotension are problematic, the provider may reduce the beta blocker dose. Because of decreased heart rate and blood pressure associated with beta blockers, they shouldn’t be administered at the same time as ACE inhibitors. Adverse effects: Adverse effects of beta blockers include fluid retention, fatigue, bradycardia, and hypotension. Examples: Bisoprolol, carvedilol, sustained-release metoprolol. ACE inhibitors Angiotensin-converting enzyme (ACE) inhibitors cause vasodilation in both the venous and arterial systems, so they decrease both preload and afterload, increasing blood flow to vital organ systems and improving ejection fraction. These medications also block the enzyme needed to convert angiotensin I to angiotensin II. Angiotensin II is a strong vasoconstrictor that raises blood pressure, releases aldosterone, and leads to sodium and water retention. ACE inhibitors prevent this cascade of effects. Adverse effects: Nursing points: Include hyperkalemia, renal failure, and a dry, persistent cough associated with increased bradykinin. If the cough is intolerable, the provider may discontinue the ACE inhibitors in favor of an angiotensin receptor blocker (ARB). Although the cough can be annoying, explain to the patient that it’s a side effect of the medication and encourage him or her to continue its use. Ivabradine Adverse effects: Ivabradine, the first sinoatrial (SA)include bradycardia and hypotension. node modulator approved to treat heart failure, decreases normal SA node activity and lowers heart rate. It Nursing points: Administer ivabradine as ordered if a does not affect myocardial patient’s heart rate is 70 bpm. contractility. ≥ Diuretics Diuretics help the body get rid of excess fluid and sodium. This helps reduce the work the heart must do. It also decreases fluid buildup in the lungs and elsewhere in the body. It is prescribed to lower blood pressure and to reduce swelling. Some of the common drug names are amiloride, chlorothiazide, Lasix, Lozol and Aldactone. Adverse effects: Electrolyte loss. Nursing points: Instruct patients to decrease their dietary intake of sodium, weigh themselves daily, and take the diuretic early in the day to prevent nocturia. Hypokalemia is a side effect of loop diuretics, so monitor patients’ serum potassium levels Examples: Furosemide, bumetanide, and torsemide. Hydralazine/isosorbide dinitrate The drugs isosorbide dinitrate and hydralazine have been combined into a single pill to reduce both cardiac preload and afterload through venous and arterial vasodilation. Adverse effects: include headache, dizziness, and orthostatic hypotension. Nursing points: Advise patients to change position slowly to prevent falls due to postural changes in blood pressure. Indications: This medication decreases deaths and hospitalization in African Americans, who are less responsive to angiotensin-converting enzyme inhibitors because of suspected differences in endothelial function. Endocrine Medications Endocrine medications can be broken down into the following categories: Diabetic agents Hormone agonists Hormone antagonists Diabetic Agents Sulfonylureas (1st Generation) Name Chlorpropamide Tolazamide Tolbutamide Mechanism of Action Inhibits ATP-sensitive K+ channels resulting in βcell depolarization and insulin release Key Indication(s) Key Toxicity Second-line Hypoglycemia treatment for type II Renal failure diabetes Disulfiram effects Sulfonylureas (2nd Generation) Name Glipizide Glyburide Mechanism of Action Inhibits ATP-sensitive K+ channels resulting in βcell depolarization and insulin release Key Indication(s) Key Toxicity Second-line Hypoglycemia (longtreatment for type II lasting) diabetes Renal failure Disulfiram effects Biguinides Name Metformin Mechanism of Action Exact mechanism unknown ↓ gluconeogenesis ↑ insulin sensitivity ↑ glycolysis ↓ serum glucose levels ↓ postprandial glucose levels Key Indication(s) First-line treatment for type II diabetes and metabolic syndrome Key Toxicity Lactic acidosis in patients with poor renal function Alpha-Glucosidase Inhibitor Name Acarbose Miglitol Mechanism of Action Prevents breakdown of carbohydrates into single glucose molecules decreasing rate of absorption Key Indication(s) Refractory type II diabetes mellitus Key Toxicity Osmotic diarrhea Flatulence Thioglitazones Name Pioglitazone Troglitazone Rosiglitazone Mechanism of Action Key Indication(s) Stimulates PPAR-γ which Type II diabetes controls insulin-sensitive combination genes resulting in increased therapy insulin sensitivity in peripheral tissues Key Toxicity Heart failure Hepatotoxicity Weight gain Hormone Agonists Progestins Name Megestrol acetate Mechanism of Action Key Indication(s) Synthetic progestin suppresses leuteinizing hormone by inhibition of pituitary function Anorexic mechanism Appetite stimulant Anti-neoplastic agent Key Toxicity Weight gain Nausea Vomiting Estrogen Name Polyestradiol Mechanism of Action Inhibits actions of dihydrotestosterone Blocks LH secretion by pituitary Decreases testosterone synthesis Blocks testosterone uptake into prostate cells Key Indication(s) Key Toxicity Palliative prostate cancer therapy Feminization Nausea Headache Water retention Believed to decrease Clear cell carcinoma Blocks testosterone synthesis incidence of stillbirth Vaginal adenosis Induces chemical castration T-shaped uterus Diethylstilbestrol Inhibits HPG axis Gonadotropin Releasing Hormones Name Leuprorelin Mechanism of Action Key Indication(s) Acts as a gonadotropin releasing hormone agonist which inhibits gonadotropin secretion Hormone responsive cancer (non-pulsatile) Fertility (pulsatile) Key Toxicity Flushing Sweating Fatigue Edema Hormone Antagonists Anti-Estrogens Name Tamoxifen Mechanism of Action Competitively binds to estrogen receptors inhibiting effects of estrogen Key Indication(s) ER/PR positive breast cancer Key Toxicity Endometrial cancer Growth plate fusion Increased bone density Anti-Androgens Name Flutamide Mechanism of Action Blocks action of testosterone by binding to adrogen receptors Key Indication(s) Key Toxicity Gynecomastia Prostate cancer (used prior to GnRH GI disturbance analogues) Enzyme Inhibitors Name Anastrozole Mechanism of Action Inhibits aromatase Key Indication(s) ER/PR positive breast cancer Fertility Key Toxicity Osteoporosis Bone fracture Medications For Infection Penicillin Penicillin is a medication used to manage and treat a wide range of infections. It is in the beta-lactam antibiotic class of drugs. This activity describes penicillin's indications, action, and contraindications as a valuable agent in treating infection. Carbapenems Carbapenems exhibit unique pharmacological properties and are typically used to treat complicated bacterial infections. A carbapenem is often combined with an antibiotic that targets Gram-positive bacteria when used for the empirical treatment of patients with serious nosocomial infections of unidentified origin. Lincosamides Lincomycin is the prototype of this class and clindamycin the only member of this group in clinical use. Clindamycin is a bacteriostatic antibiotic. It is mainly used in the treatment of infections caused by Gram-positive bacteria. Cephalosporin Cephalosporins are beta-lactam antimicrobials used to manage a wide range of infections from gram-positive and gram-negative bacteria. The five generations of cephalosporins are useful against skin infection, resistant bacteria, meningitis, and other infections Tetracycline Tetracyclines (tetracycline, doxycycline, minocycline, tigecycline) are a class of medication used to manage and treat various bacterial infections. Tetracyclines classify as protein synthesis inhibitor antibiotics and are considered to be broadspectrum. Macrolides Macrolides are a class of drugs used to manage and treat various bacterial infections. Azithromycin, clarithromycin, and erythromycin are commonly used to treat infections like pneumonia, sinusitis, pharyngitis, and tonsillitis. Aminoglycoside Aminoglycosides are used in the treatment of severe infections of the abdomen and urinary tract, as well as bacteremia and endocarditis. They are also used for prophylaxis, especially against endocarditis. Resistance is rare but increasing in frequency Antifungal Antifungal medicines are used to treat fungal infections, which most commonly affect your skin, hair and nails. Topical Antibacterials Topical antibacterials are commonly used for superficial pyodermas such as impetigo and treatment or prevention of infections following minor cuts, abrasions, burns, and surgical wounds. Several antibiotics and antiseptics are available for use in different indications. One of the major uses of topical antibacterials is acne in which benzoyl peroxide is the drug of the first choice either singly or in combination with antibiotics or retinoids. Sulfonamide Sulfonamides (SN) or sulfanilamides belong to an important class of synthetic antimicrobial drugs that are pharmacologically used as broad spectrum for the treatment of human and animal bacterial infections Antiprotozoal Antiprotozoal agents are a class of drugs used to treat infections caused by protozoa, which are single-cell organisms, belonging to a group of parasites. Protozoans typically are microscopic and similar to plants and animals as they are eukaryotes, thus having a clearly defined cell nucleus Antivirals Antivirals are medications that help your body fight off certain viruses that can cause disease. Antiviral drugs are also preventive. They can protect you from getting viral infections or spreading a virus to others. Antitubercular A broad-spectrum antibiotic used in the treatment of tuberculosis and certain urinary tract infections (UTI). An aminoglycoside antibiotic used as an adjunct drug in tuberculosis. Drug Drug Class Generic Name Dosage Indications Adverse Effects Mechanisms of Action Contraindications Nursing Considerations Brand Name Interactions Patient Education Therapeutic drug levels Therapeutic drug levels are lab tests to look for the amount of a drug in the blood. Tourniquet is applied and area is disinfected Needle is introduced into vein, blood is drawn into vial and analyzed How the Test is Performed? A blood sample is needed. Most of the time, blood is drawn from a vein located on the inside of the elbow or the back of the hand. How to Prepare for the Test? You will need to prepare for some drug level tests. Your health care provider will tell you if you need to change the times you take any of your medicines. DO NOT stop or change your medicines without talking to your provider first. Why the Test is Performed? With most medicines, you need a certain level of the drug in your blood to get the proper effect. Some medicines are harmful if the level rises too high and do not work if the levels are too low. Monitoring the amount of the drug found in your blood allows your provider to make sure the drug levels are in the proper range. Drug level testing is important in people taking drugs such as: Flecainide, procainamide or digoxin, which are used to treat abnormal beating of the heart Lithium, used to treat bipolar disorder Phenytoin or valproic acid, which are used to treat seizures or other conditions Gentamicin or amikacin, which are antibiotics used to treat infections Tacrolimus, sirolimus or cyclosporine, which are used to suppress immune system activity against transplanted organs Normal Test Results Acetaminophen: varies with use Amikacin: 15 to 25 mcg/mL (25.62 to 42.70 micromol/L) Carbamazepine: 5 to 12 mcg/mL (21.16 to 50.80 micromol/L) Cyclosporine: 100 to 400 ng/mL (83.20 to 332.80 nmol/L) (12 hours after dose) Desipramine: 150 to 300 ng/mL (563.10 to 1126.20 nmol/L) Digoxin: 0.8 to 2.0 ng/mL (1.02 to 2.56 nanomol/L) Ethosuximide: 40 to 100 mcg/mL (283.36 to 708.40 micromol/L) Flecainide: 0.2 to 1.0 mcg/mL (0.5 to 2.4 micromol/L) Gentamicin: 5 to 10 mcg/mL (10.45 to 20.90 micromol/L) Imipramine: 150 to 300 ng/mL (534.90 to 1069.80 nmol/L) Kanamycin: 20 to 25 mcg/mL (41.60 to 52.00 micromol/L) Lidocaine: 1.5 to 5.0 mcg/mL (6.40 to 21.34 micromol/L) Lithium: 0.8 to 1.2 mEq/L (0.8 to 1.2 mmol/L) Methotrexate: varies with use Nortriptyline: 50 to 150 ng/mL (189.85 to 569.55 nmol/L) Phenobarbital: 10 to 30 mcg/mL (43.10 to 129.30 micromol/L) Phenytoin: 10 to 20 mcg/mL (39.68 to 79.36 micromol/L) Quinidine: 2 to 5 mcg/mL (6.16 to 15.41 micromol/L) Salicylate: varies with use Sirolimus: 4 to 20 ng/mL (4 to 22 nmol/L) Tacrolimus: 5 to 15 ng/mL (4 to 25 nmol/L) (12 hours after dose) Theophylline: 10 to 20 mcg/mL (55.50 to 111.00 micromol/L) Valproic acid: 50 to 100 mcg/mL (346.70 to 693.40 micromol/L) AbNormal Test Results Acetaminophen: greater than 250 mcg/mL (1653.50 micromol/L) Amikacin: greater than 25 mcg/mL (42.70 micromol/L) Carbamazepine: greater than 12 mcg/mL (50.80 micromol/L) Cyclosporine: greater than 400 ng/mL (332.80 micromol/L) Desipramine: greater than 500 ng/mL (1877.00 nmol/L) Digoxin: greater than 2.4 ng/mL (3.07 nmol/L) Ethosuximide: greater than 100 mcg/mL (708.40 micromol/L) Flecainide: greater than 1.0 mcg/mL (2.4 micromol/L) Gentamicin: greater than 12 mcg/mL (25.08 micromol/L) Imipramine: greater than 500 ng/mL (1783.00 nmol/L) Kanamycin: greater than 35 mcg/mL (72.80 micromol/L) Lidocaine: greater than 5 mcg/mL (21.34 micromol/L) Lithium: greater than 2.0 mEq/L (2.00 millimol/L) Methotrexate: greater than 10 mcmol/L (10,000 nmol/L) Nortriptyline: greater than 500 ng/mL (1898.50 nmol/L) Phenobarbital: greater than 40 mcg/mL (172.40 micromol/L) Phenytoin: greater than 30 mcg/mL (119.04 micromol/L) Quinidine: greater than 10 mcg/mL (30.82 micromol/L) Salicylate: greater than 300 mcg/mL (2172.00 micromol/L) Theophylline: greater than 20 mcg/mL (111.00 micromol/L) Tobramycin: greater than 12 mcg/mL (25.67 micromol/L) Valproic acid: greater than 100 mcg/mL (693.40 micromol/L) Respiratory Medications Beta2-agonists Beta2-agonists (bronchodilators) are a group of drugs prescribed to treat asthma. Short-acting betaagonists (SABAs) provide quick relief of asthma symptoms. They can also be prescribed to be taken before exercising in order to prevent exercise-induced bronchoconstriction. Decongestants Decongestants are a type of medicine that can provide shortterm relief for a blocked or stuffy nose (nasal congestion). They can help ease the symptoms of conditions such as colds and flu, hay fever and other allergic reactions, catarrh and sinusitis. They work by reducing the swelling of the blood vessels in your nose, which helps to open the airways. Examples include pseudoephedrine Types of decongestants nasal sprays Drops Tablets or capsules Liquids or syrups Flavoured powders to dissolve in hot water Methylxanthines Methylxanthines are relatively weak bronchodilators that are administered systemically. They have been used for treatment of acute exacerbations as well as for long-term control of asthma symptoms. The most common methylxanthine used for asthma treatment is theophylline. Antihistamines An antihistamine is a prescription or over-the-counter medication that blocks some of what histamine does. “Anti” means against, so antihistamines are medicines that work against or block histamine. Glucocorticoids Inhaled and intranasal glucocorticoids (GCs) are the most common and effective drugs for controlling symptoms and airway inflammation in respiratory diseases such as allergic rhinitis, chronic rhinosinusitis with/without nasal polyps, and asthma, and the respiratory epithelium is a primary target of GC anti-inflammatory actions. Nursing Process Related to Respiratory Medications Implementation of Interventions Respiratory medications are available in many different formulations, such as nasal spray, inhalations, oral tablets or liquids, injections, or intravenous route, so it is always important to verify the correct route and anticipate the associated side effects. For example, inhalations deliver the required medicine or medicines directly to the lungs, which means the medicine(s) can act directly on the lung tissues, minimizing systemic side effects. On the other hand, intravenous medications are administered to act quickly, but can cause systemic side effects. Additionally, some products contain more than one medicine with different dosages (for example, inhalers that combine a long-acting bronchodilator with a glucocorticoid). Respiratory medications are available in many different formulations, such as nasal spray, inhalations, oral tablets or liquids, injections, or intravenous route, so it is always important to verify the correct route and anticipate the associated side effects. For example, inhalations deliver the required medicine or medicines directly to the lungs, which means the medicine(s) can act directly on the lung tissues, minimizing systemic side effects. On the other hand, intravenous medications are administered to act quickly, but can cause systemic side effects. Additionally, some products contain more than one medicine with different dosages (for example, inhalers that combine a long-acting bronchodilator with a glucocorticoid). Additionally, the nurse should also ensure the proper use of the inhalers by the patient. Observe the patient self-administering the medication, and further instruct the patient in proper use Nursing Process Related to Respiratory Medications Nursing Process: Evaluation Finally, it is important to always evaluate the patient’s response to a medication. With respiratory medications, the nurse should assess decrease in allergy symptoms (cough, runny nose, tearing eyes) and any decrease in shortness of breath. The nurse should complete a respiratory assessment (respirations, pulse oximetry, and lung auscultation) before and after the medications have been administered and compare the results. If the symptoms are not improving or the clinical assessment is worsening, prompt intervention is required (such as notification of the health care provider for further orders) to prevent further clinical deterioration. Musculoskeletal Meds Musculoskeletal Pain Musculoskeletal pain is pain that affects: Bones. Joints. Ligaments. Muscles. Tendons. Musculoskeletal pain can be acute, meaning it is sudden and severe. Or the pain can be chronic (long-lasting). You may have localized pain (in one area of your body), or it may affect your entire body. Types of musculoskeletal pain The most common types of musculoskeletal pain include: Bone pain: Injuries such as bone fractures or other musculoskeletal injuries cause bone pain. Less commonly, a tumor may cause bone pain. Joint pain: Stiffness and inflammation often accompany joint pain. For many people, joint pain gets better with rest and worsens with activity. Muscle pain: Muscle spasms, cramps and injuries can all cause muscle pain. Some infections or tumors may also lead to muscle pain. Tendon and ligament pain: Ligaments and tendons are strong bands of tissue that connect your joints and bones. Sprains, strains and overuse injuries can lead to tendon or ligament pain. Types of musculoskeletal pain Common causes of musculoskeletal pain include: Bone fractures. Joint dislocation Direct blows to muscles, bones or joints. Overuse injuries. Poor posture. Symptoms of musculoskeletal pain Symptoms may vary depending on the cause of your musculoskeletal pain. Common symptoms include: Aching and stiffness. Burning sensations in the muscles. Fatigue. Muscle twitches. Pain that worsens with movement. Sleep disturbances. How is musculoskeletal pain diagnosed? Your healthcare provider starts a diagnosis by taking a thorough medical history. Your healthcare provider may ask you questions to determine: If you have other symptoms, such as a rash or fever. Whether your pain is acute or chronic. Which factors make pain worse or relieve it. Then, your healthcare provider does a hands-on exam to look for the pain’s source. Your provider may touch or move the affected area. How is musculoskeletal pain treated? Your treatment plan will depend on the underlying cause of your musculoskeletal pain. Common treatments include: Acupuncture. Chiropractic adjustment. Occupational therapy. Pain relievers. Physical therapy. Splints. Steroid injections. Therapeutic massage. Can musculoskeletal pain treated at home? Your healthcare provider may guide you to manage musculoskeletal pain at home. Recommendations may include: Hot and cold therapy. Over-the-counter pain relievers. Strengthening and conditioning exercises. Stretching exercises. Stress reduction techniques. Medications used for musculoskeletal pain Acetaminophen (Tylenol®). Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription medications, such as opioids. How to prevent musculoskeletal pain? Maintaining strong bones and joints is crucial for preventing musculoskeletal pain. You can work to avoid musculoskeletal pain if you: Limit repetitive movements. Use good posture. Practice correct lifting techniques. Stretch regularly. How to cope with musculoskeletal pain? To cope with musculoskeletal pain: Avoid smoking, which increases inflammation. Eat a healthy, non-inflammatory diet. Rest the injured muscle, joint or bone. Stretch daily or as often as your healthcare provider advises. Take pain medications as prescribed. Use ice and heat to decrease swelling and inflammation. Vitamins Vitamins are organic substances present in minute amounts in natural foodstuffs. Having too little of any particular vitamin may increase the risk of developing certain health issues. A vitamin is an organic compound, which means that it contains carbon. It is also an essential nutrient that the body may need to get from food. Fat-soluble vitamins Vitamins A, D, E, and K are fat-soluble. The body storesTrusted Source fat-soluble vitamins in fatty tissue and the liver, and reserves of these vitamins can stay in the body for days and sometimes months. Dietary fats help the body absorb fat-soluble vitamins through the intestinal tract. Water-soluble vitamins Water-soluble vitamins do not stay Trusted Source in the body for long and cannot be stored. They leave the body via the urine. Because of this, people need a more regular supply of water-soluble vitamins than fatsoluble ones. Vitamin C and all the B vitamins are water-soluble. Vitamin A It is fat-soluble. Function: It is essential for eye health. Deficiency: This may cause night blindness and keratomalacia, which causes the clear front layer of the eye to grow dry and cloudy. Good sources: These include liver, cod liver oil, carrots, broccoli, sweet potatoes, butter, kale, , some cheeses, eggs, apricots, cantaloupe and milk. Vitamin B1 It is water-soluble. Function: It is essential for producing various enzymes that help break down blood sugar. Deficiency: This may cause beriberi and Wernicke-Korsakoff syndrome. Good sources: These include yeast, pork, cereal grains, sunflower seeds, brown rice, whole grain rye, asparagus, kale, cauliflower, potatoes, oranges, liver, and eggs. Vitamin B2 It is water-soluble. Function: It is essential for the growth and development of body cells and helps metabolize food. Deficiency: Symptoms include inflammation of the lips and fissures in the mouth. Good sources: These include asparagus, bananas, persimmons, okra, chard, cottage cheese, milk, yogurt, meat, eggs, fish, and green beans. Vitamin B3 It is water-soluble. Function: The body needs niacin for the cells to grow and work correctly. Deficiency: Low levels result in a health issue called pellagra, which causes diarrhea, skin changes, and intestinal upset. Good sources: Examples include chicken, beef, tuna, salmon, milk, eggs, tomatoes, leafy vegetables, broccoli, carrots, nuts and seeds, tofu, and lentils. Vitamin B6 It is water-soluble. Function: It is vital for the formation of red blood cells. Deficiency: Low levels may lead to anemia and peripheral neuropathy. Good sources: These include chickpeas, beef liver, bananas, squash, and nuts. Vitamin B5 It is water-soluble. Function: It is necessary for producing energy and hormones. Deficiency: Symptoms include paresthesia, or “pins and needles.” Vitamin C It is water-soluble. Function: It contributes to collagen production, wound healing, and bone formation. It also strengthens blood vessels, supports the immune system, helps the body absorb iron, and acts as an antioxidant. Deficiency: This may result in scurvy, which causes bleeding gums, a loss of teeth, and poor tissue growth and wound healing. Vitamin E It is fat-soluble. Function: Its antioxidant activity helps prevent oxidative stress, an issue that increases the risk of widespread inflammation and various diseases. Deficiency: This is rare, but it may cause hemolytic anemia in newborns. This condition destroys blood cells. Good sources: These include wheat germ, kiwis, almonds, eggs, nuts, leafy greens, and vegetable oils. Vitamin D It is fat-soluble. Function: It is necessary for the healthy mineralization of bone. Deficiency: This may cause rickets and osteomalacia, or softening of the bones. Good sources: Exposure to UVB rays from the sun or other sources causes the body to produce vitamin D. Fatty fish, eggs, beef liver, and mushrooms also contain the vitamin. Vitamin K It is fat-soluble. Function: It is necessary for blood clotting. Deficiency: Low levels may cause an unusual susceptibility to bleeding, or bleeding diathesis. Good sources: These include natto, leafy greens, pumpkins, figs, and parsley. Cancer Medications The most common Trusted Source types of cancer medications include: Alkylating agents Nitrosoureas Antimetabolites Anti-tumor antibiotics Plant alkaloids Corticosteroids Miscellaneous drugs that do not fall into any of these categories Alkylating agents The National Cancer Institute Trusted Source states that alkylating agents were one of the earliest anticancer drugs and that they remain among the most common treatments today. They work by damaging the DNA of cancer cells to prevent them from dividing. Some examples of alkylating agents include: Altretamine Bendamustine Busulfan Carboplatin Chlorambucil Cisplatin Cyclophosphamide Dacarbazine Ifosfamide Mechlorethamine Melphalan Oxaliplatin Temozolomide Thiotepa Trabectedin Alkylating agents Treat Doctors primarily use alkylating agents to treat slow-growing cancers, as they are less effective against cells that divide quickly. For example, doctors might use these medications to treat: Breast cancer Hodgkin disease Lung cancer Leukemia Lymphoma Multiple myeloma Ovarian cancer Sarcoma Side Effects of Alkylating agents Some side effects Trusted Source of alkylating agents may include: Low blood pressure Fewer periods Blood disorders Seizures Hair loss Reduced sperm production Alkylating agents damage DNA in cancer cells, but they may also affect bone marrow cells, which can cause leukemia. The risk of developing leukemia is small, but it increases with larger doses of alkylating agents. The risk of developing leukemia is highest around 5–10 years Trusted Source after treatment. Nitrosoureas Nitrosoureas are a subcategory of alkylating agents that can cross Trusted Source the blood-brain barrier. This barrier protects the brain from many substances in the body. However, getting through the bloodbrain barrier is important for treating some cancers, including brain cancer. Nitrosoureas work by attaching themselves to DNA strands in cancer cells. This prevents them from dividing. Some examples of nitrosoureas include: Carmustine Lomustine Streptozocin Antimetabolites Antimetabolites work by convincing cancer cells to consume them Trusted Source and then preventing their division into new cells. Some examples of antimetabolites include: Azacitidin Cladribine Gemcitabine 5-fluorouracil Clofarabine Hydroxyurea 6-mercaptopurine Floxuridine Methotrexate Capecitabine Fludarabine Antimetabolites Treat Antimetabolites are usually effective for treating: Breast cancer Leukemia Ovarian cancer Head and neck cancers Anal cancer Stomach cancer Colon cancer Some skin cancers Side Effects of Antimetabolites Some side effects Trusted Source of antimetabolites include: Fatigue Nausea Fever Pancreatitis Hair loss Loss of appetite Kidney damage Ulcers Liver failure Vomiting Low white blood cell count Anti-tumor antibiotics Anti-tumor antibiotics are chemicals that interfere with enzymes that support growth in cancer cells. Anthracyclines are a type of anti-tumor antibiotic. They bind with the DNA of fast-growing Trusted Source cancer cells to prevent them from reproducing. Some examples of anthracyclines Trusted Source include: Daunorubicin Doxorubicin Doxorubicin liposomal Epirubicin Idarubicin Valrubicin There are also several anti-tumor antibiotics that are not anthracyclines, including bleomycin, dactinomycin, and mitoxantrone. Anti-tumor antibiotics Treat Doctors might use anti-tumor antibiotics to treat: Colorectal cancer Lung cancer Ovarian cancer Prostate cancer Side Effect of Anti-tumor antibiotics One major side effect Trusted Source of anti-tumor antibiotics is : An increased risk of heart damage. This side effect is rare, but it can occur with high doses of the drug. For this reason, doctors typically limit how much of an anti-tumor antibiotic that someone can take. Plant Alkaloids These are drugs that come from plants and have anti-tumor properties Trusted Source. They have different names depending on the enzyme that they act on. Mitotic inhibitors, for example, are a class of plant alkaloids that prevent cancer cells from replicating or stop enzymes from creating proteins to support reproduction in cancer cells. Some examples of these drugs include taxanes and vinca alkaloids. Topoisomerase inhibitors are a class of plant alkaloids that also have different names depending on which enzyme they work on. Topoisomerase I inhibitors, for instance, interrupt DNA replication Trusted Source in cancer cells. One example is irinotecan. There are also topoisomerase II inhibitors, one example of which is etoposide. Plant Alkaloids Treat Plant alkaloids are useful for treating several cancers, including: Leukemia Lung cancer Ovarian cancer Gastrointestinal cancer Colorectal cancer Pancreatic cancer Side Effects of Plant Alkaloids Some possible side effects include: Nausea Vomiting Abdominal pain Diarrhea Fatigue Allergic reactions Hair loss Corticosteroids These are synthetic versions of naturally occurring hormones that can reduce inflammation and treat cancer. Some corticosteroids that are useful in cancer treatment include prednisone, methylprednisolone, and dexamethasone. Their antiinflammatory properties can reduce nausea, vomiting, and appetite problems from chemotherapy. Side Effects of Corticosteroids Some possible side effects of corticosteroids include: An increased risk of infections Mood changes Difficulty sleeping Heartburn Blood sugar fluctuations Weight gain Headaches High blood pressure Other Cancer Medications Some examples of these medications Trusted Source include: all-trans-retinoic acid mitotane arsenic trioxide omacetaxine asparaginase pegaspargase eribulin procarbazine hydroxyurea romidepsin ixabepilone vorinostat Alternative options for cancer treatment Targeted therapies Immunotherapy Cancer cells grow, divide, and spread through the body based on instructions they receive from proteins. Targeted therapies attack those proteins and prevent them from working effectively. They can help treat cancer in many ways, depending on the type of cancer The body’s immune system typically seeks and kills unusual cells around the body. Doctors use immunotherapy Trusted Source to help the body identify cancerous cells and attack them. This can cause side effects such as flu-like symptoms or skin reactions at the needle site. Radiation therapy This uses high doses of radiation to destroy cancer cells and shrink tumors. Doctors either use a machine to emit radiation from outside the body or place a radiation device inside the body. This option can also cause some side effects, including tiredness and skin irritation Surgery Doctors sometimes recommend surgery to remove a cancerous tumor. This is usually when the cancer is localized and has not spread to other areas of the body. Mood Stabilizing Medications The oldest and most studied of mood stabilizers is lithium. However, many drugs that were first developed as anticonvulsants to treat epilepsy also act as mood stabilizers. These include carbamazepine, divalproex and lamotrigine. Gabapentin and topiramate are also anticonvulsants that may act as mood stabilizers, but they are usually given in addition to other medications. Lithium (lithium carbonate or lithium citrate) Lithium (Carbolith, Duralith, Lithane) is found in nature in some mineral waters and is also present in small amounts in the human body. Lithium is used to treat mania and to prevent further episodes of mania and depression. Common side-effects of lithium Common side-effects of lithium include increased thirst and urination, nausea, weight gain and a fine trembling of the hands. Less common sideeffects can include tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes (e.g., dry skin, acne) and slight muscle weakness. These effects are generally mild and fade as treatment continues. If, however, any of these effects are severe, they should be reported to your doctor immediately. Thyroid and kidney function can be affected by lithium in some people and must be monitored regularly by your doctor. Moods are a natural part of your emotional rhythm. Understanding your moods helps you manage them and feel better faster. Signs of Lithium Overdose Lithium blood levels can increase to dangerous levels when a person becomes severely dehydrated. Remember to drink eight to 12 cups of fluid per day, especially when it’s hot or when you’re exercising. Severe vomiting, diarrhea or a fever can also cause dehydration. If you have these symptoms, stop taking lithium and see your doctor as soon as possible. Changing the amount of salt you use can also affect lithium levels: avoid switching to low- or no-salt diets. Signs that the amount of lithium in the body is higher than it should be include severe nausea, vomiting and diarrhea, shaking and twitching, loss of balance, slurred speech, double vision and weakness. Divalproex, valproic acid or valproate The differing names for this anticonvulsant medication reflect the various ways it is formulated. Divalproex (and its various forms) is used for acute manic episodes. Brand names include Depakene and Epival. Common side-effects of Divalproex Common side-effects of divalproex include drowsiness, dizziness, nausea and blurred vision. Less common side-effects are vomiting or mild cramps, muscle tremor, mild hair loss, weight gain, bruising or bleeding, liver problems and, for women, changes in the menstrual cycle. Carbamazepine Carbamazepine (Tegretol) is another anticonvulsant. It is used for mania and mixed states that do not respond to lithium or when the person is irritable or aggressive Common side-effects of carbamazepine include dizziness, drowsiness, blurred vision, confusion, muscle tremor, nausea, vomiting or mild cramps, increased sensitivity to sun, skin sensitivity and rashes, and poor co-ordination. A rare but dangerous side-effect of carbamazepine A rare but dangerous side-effect of carbamazepine is reduced blood cell counts. People who take this drug should have their blood monitored regularly for this effect. Soreness of the mouth, gums or throat, mouth ulcers or sores, and fever or flu-like symptoms can be a sign of this effect and should be reported immediately to your doctor. If carbamazepine is the cause of these symptoms, they will go away when the medication is stopped. Lamotrigine Lamotrigine (Lamictal) may be the most effective mood stabilizer for depression in bipolar disorder, but is not as helpful for mania. The starting dose of lamotrigine should be very low and increased very slowly over four weeks or more. This approach decreases the risk of a severe rash—a potentially dangerous side-effect of this drug. Common side-effects of lamotrigine Include fever, dizziness, drowsiness, blurred vision, nausea, vomiting or mild cramps, headache and skin rash. Although it is rare, a severe skin rash can occur with lamotrigine. Any rashes that begin in the first few weeks of treatment should be reported to your doctor. What does Mood Stabilizing Medication do? How mood stabilizers work is not fully understood. It is thought that the drugs work in different ways to bring stability and calm to areas of the brain that have become overstimulated and overactive, or to prevent this state from developing. Side effects of Mood Stabilizing Medication The side-effects of mood stabilizers vary depending on the type of medication. With some medications, side-effects are kept to a minimum through regular monitoring of the level of the drug in the blood. Some people experience no side-effects. Others may find the side-effects distressing. Side-effects usually lessen as treatment continues. Check the information given to you by your doctor or pharmacist on the specific effects of any drug you have been prescribed. If sideeffects are not mild and tolerable, let your doctor know as soon as possible. Your doctor may: adjust your dose suggest you take the medication at a different time of day suggest you take your medication with food prescribe other medications to help control side-effects change your medication. Immunosuppressant Medications Immunosuppressants are drugs or medicines that lower the body's ability to reject a transplanted organ.Your immune system recognizes and attacks anything different from the substances normally present in your body, even those only slightly different, like your newly transplanted kidney. The immune system does not discriminate between harmful substances, like bacteria, fungi and viruses, and transplanted organs — so your immune system responds to your new kidney as a foreign substance that needs to be eliminated. To protect your new kidney, we prescribe a variety of medications to suppress your body's natural immune response. These medications are called "immunosuppressants," and they trick the immune system into believing that your new organ is not foreign, and thus it is not attacked. After transplantation, you will be taking immunosuppressant medications for the rest of your life. The following are a list of common post-transplant medications. Cyclosporines (Neoral®, Gengraf®, Sandimmune®) Purpose Neoral® is an immunosuppressive medicine that helps prevent organ rejection. Dosage The dose we prescribe for you is based on your lab values. The capsules come in 25mg, 50 mg and 100mg sizes; the liquid in 100mg/cc strength. When In the morning, take with breakfast after your lab work is completed. Repeat the dose in the pm, 12 hours after your am dose. If you are on Cyclosporin twice a day, your blood level must be measured 12 hours after your last dose. Most children and some adults may be on a three times a day schedule, if so, each dose must be 8 hours apart and blood level must be drawn 8 hours after the last dose. Precautions Cyclosporine blood levels may be altered by some medicines. Before you take any new drugs please contact the transplant team. New mothers taking cyclosporine are advised NOT to breast feed. Common Side Effects Headache, tremors, fluid retention, decreased kidney function, elevated potassium levels, high blood pressure, hot flushes, diarrhea, nausea/vomiting, hair growth, gum swelling, increased risk of infection, joint discomfort, leg cramping, low magnesium levels. Tacrolimus (Prograf®, FK506) Tacrolimus (Prograf®, FK506) Purpose Prograf® is an immunosuppressive medicine that helps prevent organ rejection. Dosage The dose we prescribe for you is based on your lab values. The capsules come in .5mg, 1mg, 5mg, and in a solution of 5mg/ml. When In the morning, take with breakfast after your lab work is completed. Repeat the dose in the pm, 12 hours after your am dose. Precautions Prograf® blood levels can be altered by some medicines. Before you take any new drugs please contact the transplant team. New mothers taking Prograf are advised NOT to breast feed. Common Side Effects Headache, tremors, seizures, change in mental staus, insomnia/nightmares, high blood sugar, high-blood pressure, anemia, loss of appetite, diarrhea, decreased kidney function, leg cramping, elevated potassium levels, lowered magnesium levels, hair loss. Mycophenolate mofetil (CellCept®) Purpose CellCept® is an immunosuppressive medicine that helps prevent organ rejection. Dosage The dose we prescribe for you is based on your lab values. The capsules come in 250mg and 500mg sizes. Liquid formulation can be made by your pharmacist in a concentration of 200mg/cc. When In the morning, take on an empty stomach. Repeat the dose in the pm, 12 hours after your am dose. Precautions Antacids such as Maalox and Mylanta decrease your body's absorption of CellCept. You should never take antacids at the same time as CellCept. You will be prescribed other medicines to protect your stomach, such as Prilosec or Prevacid, while on CellCept. Common Side Effects Nausea, vomiting, low white blood cell count, loss of appetite, abdominal pain, diarrhea, anemia. Prednisone Purpose Prednisone is an immunosuppressive medicine that helps prevent organ rejection. Dosage BE SURE TO READ LABEL INSTRUCTIONS. Adults: Use only 5mg tablets unless instructed otherwise by the transplant team. Children: Prednisone in liquid formulation of 1mg/cc concentration is recommended. When In the morning, take on an empty stomach. Repeat the dose in the pm, 12 hours after your am dose. Common Side Effects Mood swings, depression, euphoria, irritability, thrush, increased risk of infection, joint discomfort, muscle deterioration, osteoporosis, high blood sugar, "moonface," cataracts, height-ened sun sensitivity, acne, high blood pressure, increased appetite, vision changes weight gain, fluid retention. Azathioprine (Imuran®) Purpose Imuran® is an immunosuppressive medicine that helps prevent organ rejection. Dosage The dose we prescribe for you is based on your weight and white blood cell count. Adults: Tablets are available in 50mg size which can easily be broken in half. Children: Imuran can be taken in the same 50mg tablet form, or in a liquid formulation of 10mg/cc. When At bedtime with your other nighttime medications. Precautions Certain medications, such as allopurinol, can increase the effects of Imuran and further deplete your white blood cell count. Remember to always contact the transplant team before taking any new medication. Common Side Effects Decreased white blood cell count, decreased platelet count, hair loss. Rapamune® (Sirolimus) Purpose Rapamune is an immunosuppressive medicine that helps prevent organ rejection. Dosage Available in liquid formulation at a 5mg/ml concentration and 1mg tablets. When In the morning, take consistently either before or after breakfast. Precautions Rapamune levels can be altered by certain medications. Remember to always contact the transplant team before taking any new medication. New mothers taking Rapamune are advised NOT to breast feed. Common Side Effects Low white blood cell count, low platelet count, high cholesterol levels, leg swelling, joint pain, headache, diarrhea, anemia. Zenapax® (Daclizumab) and Simulect® (Basiliximab) Purpose Both are immunosuppressive medicines that help prevent organ rejection. Dosage One of these medications, which are administered only by IV, may be given at the time of your operation, and in the first few days to weeks postoperatively. When The transplant team orders the medication and it will be administered by the nurse during your hospitalization, or as an out patient in the Comprehensive Transplant Center. Common Side Effects Constipation, nausea, diarrhea, edema, abdominal distention. OKT3® (Monoclonal Antibody) Purpose OKT3 is an immunosuppressive medicine that helps prevent organ rejection. Dosage Administered intravenously only. Adults: Usually receive 5 to 10mg per day over 7 to 14 days. Children: Usually receive 2.5 to 5mg per day over 7 to 14 days. When The transplant team orders the medication and it will be administered by the physician during your hospitalization, or in the Comprehensive Transplant Center after your discharge. Common Side Effects Fever, chills, flu-like symptoms, shortness of breath, headache, lowered blood pressure, joint pain, diarrhea. Guidelines for Taking Medications 1. Always take your medications at the same time every day. 2. Never skip a dose. If you accidentally miss a dose, call the transplant team. 3. Do not stop taking or change the dose of any medication without prior knowledge and approval of the transplant team. 4. Call your transplant team if you are experiencing side effects from your medications, or are having vomiting or diarrhea. 5. Never take medications other than those prescribed by your transplant team, including over-the-counter medications or those prescribed by other physicians without first calling the transplant team. 6. Store your medications out of reach of small children. 7. Store medications in a cool, dry place. NOTE: REMEMBER THAT NOT TAKING MEDICATIONS AS PRESCRIBED IS ONE OF THE MOST COMMON REASONS FOR TRANSPLANT FAILURE. Therefore, be very careful when taking medications. Call your transplant team with any questions or concerns no matter how small they may seem. Some of your immunosuppressive medicines are dosed by the levels of the drug in your blood. That is why it is important to have your blood tested at the correct time. Drug Dosage Calculations Abbreviations Commonly Used in Dosage Abbreviation po Term by mouth (or orally) susp suspension pm as needed tab cap tablet q capsule every bid twice a day tid qid three times a day four times a day Formula: Term Dosage ordered or desired dose Dosage strength or supply on hand D/H * Q=X Symbol Tips for Correct Calculations: Make sure that all measurements are in the same units. If necessary, convert between units. • In most cases, it is best to convert a larger unit to smaller units (e.g. convert grams to milligrams). This conversion uses multiplication and most often keeps the calculation in whole numbers. • Always check for reasonableness of your answer. Does the drug dosage make sense? (Amounts less than half a tablet or greater than 3 tablets are not common, but still possible.) Desired/Have * Quantity=X Meaning Example D The amount of medication that the physician prescribed "Give 500 milligrams" " Give grains/v" " Give 1.2 milliliters" H The amount of drug in a specific unit of measure (what is available; in stock) 250 milligrams Grains/v The unit of measure for the specific dosage strength or supply on hand per 2 milliliters per capsule per tablet The dosage you are trying to calculate Not applicable Unit of measure or quantity of unit Q Unknown Dosage S Dosage Calculations Conversions 1 kg = 2.2 lb 1 gallon = 4 quart 1 tsp = 5 mL 1 inch = 2.54 cm 1 L = 1,000 mL 1 kg = 1,000 g 1 oz = 30 mL = 2 tbsp 1 g = 1,000 mg 1 lb = 16 oz 1 tbsp = 3 tsp 60 minute = 1 hour 1 cc = 1 mL 2 pints = 1 qt 8 oz = 240 mL = 1 glass 1 tsp = 60 gtt 1 pt = 500 mL = 16 oz 1 mg = 1,000 mcg 1 cm = 10 mm 1 tbsp = 15 mL 1 cup = 8 fl oz 1 pint = 2 cups 12 inches = 1 foot 1 L = 1.057 qt 1 oz = 30 mL Unit Conversions Mass: Converting lb to kg and kg to lb mcg mg g kg ( ÷ by 1,000 ) mcg mg g kg ( x by 1,000 ) lb kg ( ÷ by 2.2 ) lb kg ( x by 2.2 ) lb = kg × 2.2 kg = lb ÷ 2.2 → ← → → → ← ← ← Volume: → mL → L → kL ← mL ← L ← kL Time: min → hr ( ÷ by 60 ) min ← hr ( x by 60 ) mcL mcL ( ÷ by 1,000 ) ( x by 1,000 ) Converting mL to L and L to mL mL = L × 1,000 L = mL ÷ 1,000 Converting mg to g, g to mg, mg to mcg, and mcg to mg mg = g × 1,000 g = mg ÷ 1,000 mcg = mg × 1,000 mg = mcg ÷ 1,000 Figuring IV flow rate, infusion time, and total volume flow rate (mL/hr) = total volume (mL) ÷ infusion time (hr) infusion time (hr) = total volume (mL) ÷ flow rate (mL/hr) total volume (mL) = flow rate (mL/hr) × infusion time (hr) Example: if you must administer 1 L (1,000 mL) of fluid over 4 hours, use the first formula to calculate the flow rate, like so: flow rate (mL/hr) = total volume (mL) ÷ infusion time (hr) flow rate (mL/hr) = 1,000 ÷ 4 flow rate (mL/hr) = 250 The flow rate is 250 mL/hr. Drug Dosage Calculations Formula Mass for Mass Dosage By Weight Formula: Weight in Kg * Dosage Per Kg = Y (Required Dosage) Formula: Ordered \ Have = Y (Tablets Required) Mass/Liquid For Liquid IV Fluid Formula: Ordered \ Have x Volume Per Have = Y (Liquid Required) Formula: Volume (mL) \ Time (min) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Volume/Time - IV mL Volume/Time - IV Drop Formula: Volume (mL) \ Time (hr) = Y (Flow Rate in mL/hr) Formula: Concentration % \ 100 x Volume (mL) = Y (Dosage Amount in g) Volume/Time - IV mL Formula: Volume (mL) \ Time (hr) = Y (Flow Rate in mL/hr) Volume/Time - IV Drop Formula: Volume (mL) \ Time (min) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Fluid Maintenance Weight Range Required Daily Fluid 0-10 kg 100 mL per kg 10-20 kg 1,000 mL + 50 mL per each kg above 10 kg 20-70 kg 1,500 mL + 20 mL per each kg above 20 kg Over 70 kg 2,500 mL (adult requirement) TYPES OF DOSAGE FORMS Classification Physical state Route of Administration Based on Site of Application Uses Based on Physical state SOLID SEMI-SOLID LIQUID GAS 1. Monophasic liquid: Syrup solution 1. Unit solid: tablets capsules 2.Biphasic liquid: emulsion suspension 2. Bulk dosage form: powder dusting powder Inhaler aerosols Cream paste gel suppositories TYPES OF DOSAGE FORMS Based on Physical state Oral Parenteral Rectal Trans dermal Powders Solutions Suppositories Ointments Tablets Suspensions Enemas Powders Capsules Emulsions Ointments Creams Solutions Pastes Solutions Vaginal Lotions Suspensions Suppositories Emulsions Tablets Solutions Syrups Ointments Sprays Elixirs Creams Inhalations Magmas Douches Intra respiratory Ointments Gels Sublingual Cachets Tablets Pills Lozenges Intranasal Plasters Intra ocular Solutions Suspensions Aerosols Conjuntival -- Ointments -- Site of Application Uses 1. Skin- Ointments, creams, lotions, liniments 2. Eye- Solutions, ointments, creams 3. Tooth- Tooth powder, tooth paste 4. Hand- Hand creams, lotions, hand washings 5. Foot- Creams, ointments, dusting powders 6. Hair- Hair cream, hair lotions, shampoos, hair fixing 7. Nasal- Solutions, sprays, inhalations 1. Internal – all preparations except external 2. External – Ointments, lotions, creams, powders, solutions, liniments, paste, hair dyes, hair colorants Metric System 9 KEY FACTS VOLUME Weight Kilogram (kg) Killo-graham-cracker In the metric system ,the gram (g/gm) is used to describe weight. 1 kilogram (kg)= 1,000 grams (g). Gram (g/gm) Graham-cracker In the metric system, the gram (g/gm) is used to describe weight. 1 gram (g) = 1,000 milligrams (mg). Milligram (mg) Millionaire-graham-cracker In the metric system, the gram (g/gm) is used to describe weight. 1 milligram (mg) = 1,000 mcg. Microgram (mcg) Microphone-graham-cracker In the metric system, the gram (g/gm) is used to describe weight. 1,000 microgram (mcg) = 1 milligram (mg). Liter (L) Liter-of-cola In the metric system, the liter (L) is used to describe volume.1 liter = 1,000 milliliters (mL). Milliliter (mL) Millionaire-liter-of-cola In the metric system, the liter (L) is used to describe volume. 1 liter = 1,000 milliliters (mL). LENGTH Meter (m) Meter-Pan In the metric system, the meter is used to describe length. CONVERTING Larger to Smaller: Multiply Large Metro Car Turned into a Small Metro Car by Multiplying The metric system applies the idea that units within the system get larger or smaller by a power of 10. Conversions between the units in the metric system can be done by multiplying or dividing by 1,000. To convert larger to smaller, multiply by 1,000, or move the decimal point 3 places to the right. Smaller to Larger: Divide Small Metro Car Turned into a Large Metro Car by Dividing The metric system applies the idea that units within the system get larger or smaller by a power of 10. Conversions between the units in the metric system can be done by multiplying or dividing by 1,000. To convert smaller to larger, divide by 1,000 or move the decimal point 3 spaces to the left. Medication Routes of Administration Introduction A medication administration route is often classified by the location at which the drug is administered, such as oral or intravenous. The choice of routes in which the medication is given depends not only on convenience and compliance but also on the drug’s pharmacokinetics and pharmacodynamic profile. Therefore it is crucial to understand the characteristics of the various routes and techniques associated with them. Many interprofessional healthcare team members are involved in the administration of medications to patients. Anatomy and Physiology Enteral Route of Medication Oral administration of medication is a convenient, cost-effective, and most commonly used medication administration route. The primary site of drug absorption is usually the small intestine, and the bioavailability of the medication is influenced by the amount of drug absorbed across the intestinal epithelium. The first-pass effect is an important consideration for orally administered medications. It refers to the drug metabolism whereby the drug concentration is significantly diminished before it reaches the systemic circulation, often due to the metabolism in the liver. A sublingual or buccal route is another form of the enteral route of medication administration that offers the benefit of bypassing the first-pass effect. By applying the drug directly under the tongue (sublingual) or on the cheek (buccal), the medication undergoes a passive diffusion through the venous blood in the oral cavity, which bypasses the hepatic portal vein and flows into the superior vena cava. Compared to sublingual tissue, which has highly permeable mucosa with rapid access to the underlying capillaries, buccal tissue is less permeable and has slower drug absorption A rectal route is another enteral route of medication administration, and it allows for rapid and effective absorption of medications via the highly vascularized rectal mucosa. Similar to sublingual and buccal routes, rectally administered medications undergo passive diffusion and partially bypass the first-pass metabolism. Only about half of the drug absorbed in the rectum directly goes to the liver. Parenteral Route of Medication Intravenous injection is the most common parental route of medication administration and has the benefit of bypassing the firstpass metabolism by the liver. Given their superficial location on the skin, peripheral veins provide easy access to the circulatory system and are often utilized in the parenteral administration of medications. The upper extremity is usually the preferred site for intravenous medication as it has a lower incidence of thrombophlebitis and thrombosis than the lower limbs. The median basilic or cephalic veins of the arm or the metacarpal veins on the hand's dorsum are commonly used. In the lower extremity, the dorsal venous plexus of the foot can be used. An intramuscular medication route can be administered in different body muscles, including deltoid, dorsogluteal, ventrogluteal, rectus femoris, or vastus lateralis muscles. Although the dorsogluteal site, or the buttock's upper outer quadrant, is a common site chosen traditionally for intramuscular injections by healthcare professionals, it poses a potential risk of injury to the superior gluteal artery and sciatic nerve.[3] On the other hand, the ventrogluteal site, or the anterior gluteal site, targets the gluteus medius muscle and avoids these potential complications; thus, it is recommended. The intraarterial route is not commonly used for drug administration. Injection of contrast material after an arterial puncture is done for angiography. The other uses of this route are for the administration of regional chemotherapeutic agents and for the treatment of malignant tumors of the brain. Subcutaneous injections are another form of the parental route of medication and are administered to the layer of skin referred to as cutis, just below the dermis and epidermis layers. Subcutaneous tissue has few blood vessels; therefore, the medications injected undergo absorption at a slow, sustained rate. Subcutaneous medication can be administered to various sites, including the upper arm's outer area, abdomen avoiding a 2-inch circle around the navel, the front of the thigh, the upper back, or the upper area of the buttock behind the hip bone. Other Routes of Medication A transnasal drug route facilitates drug absorption by passive diffusion across the single-layered, well-vascularized respiratory epithelium directly into the systemic circulation. An inhaled medication is delivered rapidly across the large surface area of the respiratory tract epithelium. Drugs absorbed into the pulmonary circulation enter directly into the systemic circulation via the pulmonary vein, bypassing the first-pass metabolism. The particle size of the inhaled medication is usually 1 to 10 µm for effective delivery. The efficacy of drug delivery to the lungs depends not only on the drug particle size and morphology but also on the patient’s respiratory physiology, such as tidal volume and tracheal inspiration velocity. A vaginal route is an underexplored drug delivery route that is not commonly used but has the advantage of bypassing the first-pass effect and can serve as an effective method for local and systemic therapy. The venous plexuses from the vagina communicate with the vesical, uterine, and rectal venous plexuses and drain into the internal iliac veins. The veins from the middle and upper vagina drain directly into the inferior vena cava and bypass the hepatoportal system. The transdermal route can deliver drugs through the skin. The common methods of administration through this route are local application formulations like transdermal ointments and gels, drug carriers like nanoparticles and liposomes, and transdermal patches. The intraosseous route is useful especially in neonates for the administration of fluids and drugs when both peripheral and central venous accesses have failed.[6] Clinical trials are now being conducted on its usefulness in the administration of drugs in out-of-hospital cardiac arrest.It is also used for the administration of prophylactic antibiotics for regional surgeries. Indications Enteral Route of Medication 1. Oral This is convenient and is indicated for patients who can ingest and tolerate an oral form of medication. Some medications with short half-lives are administered orally as timed-release or sustained-release forms that get absorbed over several hours. Advantages: Ease of administration Widespread acceptance by the patients. Disadvantages: Variable absorption rates Degradation of some drugs before reaching the site of absorption into the bloodstream The inability of many compounds to effectively traverse the intestinal epithelial membrane cells to reach the bloodstream. The insolubility of many drugs at low pH levels prevalent in the digestive tract. The inactivation of the drug in the liver on its way to the systemic circulation Irritation of the mucous lining of the gastrointestinal tract. This can be prevented to some extent by coating 2. Sublingual and Buccal Routes These are indicated for medications with high first-pass metabolism that need to avoid clearance by the liver. For instance, nitroglycerin is cleared more than 90% during a single pass through the liver; therefore, it is given in a sublingual form. Advantages: Rapid absorption due to the abundant mucosal network of systemic veins and lymphatics, thereby leading to a rapid onset of action. If there is any untoward event, the tablet can be removed. Avoids first-pass hepatic metabolism. A tablet can be kept for a long duration of time in the buccal cavity which helps the development of formulations having a sustainedrelease effect. This route is useful in patients having swallowing difficulties. Low risk of infection Convenience Disadvantages: The tablet has to be kept in place in the buccal cavity and neither chewed nor swallowed. Excessive salivation may cause quick dissolution and absorption of the tablet. Patients may find it difficult to accept an unpalatable tablet. Hence some drugs are applied as a patch or a spray. 3. Rectal Route This route is useful for patients with gastrointestinal motility problems such as dysphagia or ileus that can interfere with delivering the drug to the intestinal tract. The rectal route is also often utilized in patients near the end of life undergoing hospice care. Advantages: A relatively big amount of the drug can be administered. Those drugs that are destroyed by the acidic medium in the stomach and those metabolized by pancreatic enzymes can be administered effectively. Safe and convenient for infants and the elderly. Can be used in emergency situations such as in infants having seizures when the intravenous route is unavailable. The rate of absorption is uninfluenced by the ingestion of food or the rate of gastric emptying. Bypasses hepatic metabolism Less degradation of drugs compared to that in the upper gastrointestinal tract. Disadvantages: Some hydrophilic drugs like antibiotics and peptide drugs are not suitable for rectal administration as they are not readily absorbed. Some drugs can cause rectal irritation and proctitis leading to ulceration and bleeding. Parenteral Routes of Medication 1. Intravenous Route This can be utilized in administering nasal decongestants for cold or allergy treatment. Other uses include desmopressin for the treatment of diabetes insipidus or intranasal calcitonin for the treatment of osteoporosis. Factors that affect the rate of absorption of drugs via the nasal route are: 1. The rate of nasal secretion - The rate of secretion is inversely proportional to the bioavailability of the drug. 2. Ciliary movement - The speed of ciliary movement is inversely proportional to the bioavailability of the drug. 3. Vascularity of the nose - The volume of blood flow is directly proportional to the rate of drug absorption. 4. Metabolism of drugs in the nasal cavity - The enzymes present in the nasal tissues alter the absorption of some compounds especially peptides that are disintegrated by aminopeptidases. 5. Diseases affecting nasal mucous membrane. Common colds can affect nasal drug absorption. Enhancement of nasal drug delivery: Rapid mucociliary clearance can lead to poor bioavailability of the drug. This can be overcome by in situ gelling drug delivery. Chitosan is a natural bioadhesive polysaccharide obtained from crustacean shells that can be used as an absorption enhancer. Chitosan binds to the nasal mucosal membrane and facilitates drug absorption through paracellular transport and other mechanisms. Advantages: Increased permeability of the nasal mucosa compared to the gastrointestinal mucosa. Highly vascularized subepithelial tissue. Quick absorption, usually within thirty minutes Avoids the first-pass effect. Avoids the effects of gastric stasis and vomiting. Ease of administration. Higher bioavailability of the drugs than in the case of the enteral route or inhalational route. Disadvantages: Nasal cavity diseases and conditions may result in impaired absorption. The dose is limited due to the small area available for absorption. The time available for absorption is limited. This route is not applicable to all drugs. 2. Inhalational Route The alveolar epithelium is approximately 100 square meters in adults and the alveolar volume is 4000–6000 mL when compared to the airway volume of 400 ml. This provides a greater surface area for absorption of the inhaled substances. An inhaled medication route can be utilized to administer albuterol or corticosteroids such as fluticasone and to deliver inhaled anesthetics to patients. Barriers to the absorption of substances in the alveoli are surfactants, surface lining fluid including the mucus, the epithelial membrane, extravascular space, and vascular endothelium. The absorption of macromolecules by the lungs is considered to be by transcytosis (not significant for macromolecules >40 kDa), paracellular absorption, and drug transporter proteins. Advantages: Large surface area Proximity to blood flow Avoids first-pass hepatic metabolism Only smaller doses are enough to achieve equivalent therapeutic effects as the oral route Disadvantages: The aerodynamic filter of the lungs has to be overcome. Clearance of particles by the mucus lining the airways. Only 10–40% of the drug from a conventional inhalation device is actually deposited in the lungs. 3. Vaginal Route This is not commonly used but can deliver low, continuous dosing of medications which can help achieve stable drug levels. A variety of formulations can be given vaginally, including tablets, creams, gels, ointments, and pessaries. Common medications given via the vaginal route include vaginal estrogen therapy for urogenital atrophy, contraceptive rings, antibiotics, or antifungals. 4. Vaginal Route Iontophoresis and microneedles are playing an increasing role in transdermal drug delivery. A technique has been described using hydrogelforming microneedle arrays in combination with electro-phoresis for controlled transdermal delivery of biomacromolecules in a simple, one-step approach Drug Delivery to the Cardiovascular System Methods for local administration of drugs to the cardiovascular system are: Delivery to the myocardium - direct intramyocardial injection, drugeluting implanted devices. Delivery via the coronary venous system. Delivery via cardiac catheter into coronary arteries Intrapericardial delivery Delivery into the arterial lumen from drug-eluting stents Drug Delivery to the Central Nervous System (CNS) The blood-brain barrier is a major obstruction to the delivery of drugs into the central nervous system. Some methods to reduce the obstruction by this barrier include: Systemic administration of drugs for CNS action Direct administration of drugs to the CNS - Intrathecal[14], into the cerebral arteries, into the brain parenchyma, and direct positive pressure infusion Drug delivery by manipulation of the blood-brain barrier Drug delivery using novel formulations like conjugates, and nanocarriers-based delivery systems (including polymeric nanocarriers, micelles, nanotubes, dendrimers, magnetic nanoparticles, and quantum dots (QDs))[15] Drug delivery systems like pumps and catheters Use of microorganisms like bacteriophages and bacterial vectors Cell therapy - CNS implants of live cells or genetically engineered cells Gene transfer - Direct injection into the CNS, intranasal instillation, retrograde axonal transport, or through vectors. Antidepressants Depression is a mental health issue that starts most often in early adulthood. It’s also more common in women. However, anyone at any age may deal with depression. Depression affects your brain, so drugs that work in your brain may prove beneficial. Common antidepressants may help ease your symptoms, but there are many other options as well. Each drug used to treat depression works by balancing certain chemicals in your brain called neurotransmitters. These drugs work in slightly different ways to ease your depression symptoms. Many common drugs for depression fall into the following drug classes Trusted Source: Selective serotonin reuptake inhibitors (SSRIs) Serotonin-norepinephrine reuptake inhibitors (SNRIs) Tricyclic antidepressants (TCAs) Tetracyclic antidepressants Dopamine reuptake blockers 5-HT2 receptor antagonists 5-HT3 receptor antagonists Monoamine oxidase inhibitors (MAOIs) Mirtazapine Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs are the most commonly prescribed class of antidepressants. An imbalance of serotonin may play a role in depression. These drugs fight depression symptoms by decreasing serotonin reuptake in your brain. This effect leaves more serotonin available to work in your brain. (SSRIs) Include: Sertraline (Zoloft) Fluoxetine (Prozac, Sarafem) Citalopram (Celexa) Escitalopram (Lexapro) Paroxetine (Paxil, Pexeva, Brisdelle) Fluvoxamine (Luvox) Common side effects of SSRIs Nausea Trouble sleeping Nervousness Tremors Sexual problems Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) SNRIs help improve serotonin and norepinephrine levels in your brain. This may reduce depression symptoms. These drugs include: Desvenlafaxine (Pristiq, Khedezla) Duloxetine (Cymbalta) Levomilnacipran (Fetzima) Venlafaxine (Effexor) In addition to treating depression, duloxetine may also relieve pain. This is important because chronic pain can lead to depression or make it worse. In some cases, people with depression become more aware of aches and pains. A drug that treats both depression and pain, such as duloxetine, can be helpful to these people. Common side effects of SNRIs Common side effects of SNRIs includeTrusted Source: Nausea Drowsiness Fatigue Constipation Dry mouth Tricyclic Antidepressants (TCAs) TCAs are often prescribed when SSRIs or other antidepressants don’t work. It isn’t fully understood how these drugs work to treat depression. Common side effects of TCAs Constipation Dry mouth Fatigue Blurred vision TCAs Include Amitriptyline (Elavil) Amoxapine (Asendin) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Silenor) Imipramine (Tofranil) Nortriptyline (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil) Tetracyclic antidepressants Tetracyclic antidepressants, like Maprotiline (Ludiomil), are used to treat depression and anxiety. They also work by balancing neurotransmitters to ease symptoms of depression. Common side effects Drowsiness Weakness Lightheadedness Headache Blurry vision Dry mouth Dopamine Reuptake Blockers Dopamine reuptake blockers, like Bupropion (Wellbutrin, Forfivo, Aplenzin), are a mild dopamine and norepinephrine reuptake blockers. They are used for depression and seasonal affective disorder. They are also used for quitting smoking. Common side effects Nausea Vomiting Constipation Dizziness Dlurry vision 5-HT2 Receptor Antagonists Two 5-HT2 receptor antagonists, nefazodone (Serzone) and trazodone (Oleptro), are used to treat depression. These are older drugs. They alter chemicals in your brain to help depression. Common side effects Drowsiness Dizziness Dry mouth 5-HT3 Receptor Antagonist The 5-HT3 receptor antagonist vortioxetine (Brintellix) treats depression by affecting the activity of brain chemicals. Common side effects Sexual problems Nausea Monoamine Oxidase Inhibitors (MAOIs) MAOIs are older drugs that treat depression. They work by stopping the breakdown of norepinephrine, dopamine, and serotonin. They’re more difficult for people to take than most other antidepressants because they interactTrusted Source with prescription drugs, nonprescription drugs, and some foods. They also can’t be combined with stimulants or other antidepressants. MAOIs include: Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (Emsam), which comes as a transdermal patch Tranylcypromine (Parnate) Common side effects Dizziness Drowsiness Trouble sleeping Restlessness Mirtazapine Mirtazapine (Remeron) is used primarily for depression. It alters certain chemicals in your brain to ease depression symptoms Common side effects Drowsiness Dizziness Weight gain Uses of Antidepressants Antidepressants are commonly prescribed for a number of medical diagnoses, including Trusted Source: Major depressive disorder Persistent depressive disorder (dysthymia) Premenstrual dysphoric disorder Obsessive-compulsive disorder (OCD) Social anxiety disorder Panic disorder Generalized anxiety disorder (GAD) Post-traumatic stress disorder (PTSD) Side effects Medications to treat depression generally come with side effects. The specific changes you may experience depend in part on the class of drug you’re taking. Common side effects: Gastrointestinal symptoms: indigestion, diarrhea, constipation, loss of appetite Feelings of sickness: headache, dizziness, dry mouth, sweating Nervousness: agitation, shakiness, nervous feeling Heart rhythm changes: palpitations, fast heartbeat Vision changes: blurry vision Weight changes: unexpected weight loss or weight gain Sexual dysfunction: low sex drive Sleep changes: insomnia Principles of Ethics for Nurses Autonomy Autonomy is recognizing each individual patient’s right to selfdetermination and decision-making. As patient advocates, it is imperative that nurses ensure that patients receive all medical information, education, and options in order to choose the option that is best for them. This includes all potential risks, benefits, and complications to make well-informed decisions. Once the patient has all relevant information, the medical and nursing team can make a plan of care in compliance with the medical wishes of the patient. It is important that nurses support the patient in their medical wishes and ensure that the medical team is remembering those wishes. Sometimes, nurses will need to continue to advocate for a patient despite the wishes being verbalized. Beneficence Beneficence is acting for the good and welfare of others and including such attributes as kindness and charity. The American Nurses Association defines this as “actions guided by compassion.” Justice Justice is that there should be an element of fairness in all medical and nursing decisions and care. Nurses must care for all patients with the same level of fairness despite the individual's financial abilities, race, religion, gender, and/or sexual orientation. An example of this is when working at a free flu clinic or diabetes screening clinic. These are open to all individuals in the community regardless of the previously mentioned factors. Nonmaleficence Nonmaleficence is to do no harm. This is the most well known of the main principles of nursing ethics. More specifically, it is selecting interventions and care that will cause the least amount of harm to achieve a beneficial outcome The principle of nonmaleficence ensures the safety of the patient and community in all care delivery. Nurses are also responsible to report treatment options that are causing significant harm to a patient which may include suicidal or homicidal ideations. Principles of Ethics for Nurses Fidelity Veracity People want to know they can count on nurses, no matter what. Fidelity as an ethical principle can best be described by keeping your word. Nurses should be honest and loyal to each patient, as this helps the nurse gain trust and fulfill their professional commitment. Without fidelity, more trusting relationships cannot be formed, which leads to less positive patient outcomes and less trust in professional relationships. Working in healthcare is challenging for many reasons, and in some cases, nurses must communicate unpleasant information to a patient. Veracity is the ethical principle of being completely open and honest with patients, even if the truth causes distress. While being completely truthful can be daunting, especially in certain patient care circumstances, it is important for establishing trust and strengthening the nurse-patient relationship. Veracity also helps patients become more autonomous, making decisions for their care based on all relevant, factual information.