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.