CLASS: MUSCARINIC ANTAGONISTS
Atropine (Sal-Tropine)
Treats: bradycardia, muscarinic poisoning, PUD, biliary colic.
Does: Competitive blocking of Ach at muscarinic receptor sites. Increase HR,
lowers secretions, relaxes bronchi.
CLASS: NON-SELECTIVE BETA BLOCKERS
Propranolol (Inderal)
Make sure and check BP before you give it to them. AE: bradycardia, reduced cardiac output
Lowers heart rate and force of contraction and the speed of impulses thru the AV node. Use for angina, HTN, dysrhythmias
If you are super allergic to bees and have to carry an EpiPen, don’t use these. The Beta Blockers interfere with the action of Epinephrine
CLASS: CENTRALLY ACTING ALPHA 2 AGONIST
Clondine (Catapres)
Decreases release of norEpi, limiting vasoconstriction. It acts centrally (on the brain). You get Xerostomia (dry mouth) very badly on this shiz
CLASS: SYMPATHOMIMETICS
Neo-synephrine (phenylephrine)
MOA/Use: Reduce Nasal Congestion
CLASS: ANDRENERGIC AGONIST
Epinephrine
MOA/Use: direct binding to mimic the
CNS (stimulation)
AE: Rebound congestion, CNS stimulation. It’s
basically cocaine.
TE: Vasoconstriction (increase BP) and
bronchodilates.
CLASS: ANTISEIZURES
Dilantin (Phenytoin)
Small therapeutic range. Treat partial and tonic-clonic seizures and selected
cardiac dysrythmias
If you use more than 5 days in a row your nose
could become dependent on it and not work
properly, lots of congestion.
AE: HTN, necrosis, tachycardia,
tremor, angina
TOC for anaphylactic reactions
(EpiPen)
The range can vary widely. Read the
label carefully!
AE: Gingival hyperplasia, devil babies (teratogen), ataxia, sedation, rash
CLASS: OPIOD AGONIST/ANTAGONIST
Morphine (Strong) & Codine (less strong)
MOA/Use: Mimics action of
AE: Respiratory depressant! Most
endogenous opioid receptors to
common cause of OD death! Also
produce analgesia. CNS depressant!
constipation, Orthostatic
hypotension, etc.
ADME: Time frame varies depending
on the route used (po, IV, etc.)
Codine is a very strong cough
suppressant. Raised cough threshold
in brain…
Precautions: people who can’t
breathe well while not on it! Liver
disease, pregnancy (cause it crosses
placenta)
Narcan (naloxone)
Competes for opiate site and block effects of opioid agonist. Use for overdose of morphine!!
Demerol (meperidine)
Interacts w/ several drugs (esp MAOI’s). Old people can’t handle it well. Avoid use past 48 hrs and don’t exceed 600mg/24hr
CLASS: ANTIDEPRESSANTS
 Goal is to make people feel better/functional
 Suicidal thoughts may increase with Rx
 5 groups
o Tricyclic Antidepressants (TCA’s)
 Blocks reuptake of NE (norepinephrine) and serotonin
o SSRI Antidepressants
 Blocks reuptake of serotonin
o MAOI Antidepressants
 Use when others don’t work cause it causes lots of stimulation
o Atypical Antidepressants
 They don’t really know how they work, but they do…
CLASS: BARBITURATES
 No ceiling limits of CNS depression b/c it mimics GABA! Can readily cause death!
CLASS: BENZODIAZEPINES
 Depress neuronal function by using the GABA you already have. It’s limited because GABA is finite (only so much of it) which makes it safer
 Can cause amnesia (which is good b/c they don’t remember the traumatic procedure they just went thru)
CLASS: DIURETICS
Furosemide (Lasix)
Monitor K levels for hypokalcemia (s/s are N/V). Ototoxic. This is a super strong drug so only use when you need something super strong.
CLASS: ACE INHIBITORS
Ramipril (Altace)
Reduces angiotensin II and increases bradykinin to dilate vessels. Used for diabetic nephropathy esp. Also, if you use these after an MI you have a better chance
of not dying…
An AE is a dry hacking cough (which is the main reason people stop taking them). Also 1st dose hypotension
CLASS: ARB’S
Valsartan (Diovan)
Blocks action of angiotensin II. Useful in prophylactic migraine prevention
CLASS: CALCIUM CHANNEL BLOCKERS
Verapamil
Ca helps with contraction of heart. Stop the calcium, stop the contraction.
Lowers the force with which the heart can contract and slows conduction thru
the nodes.
CLASS: ANTICOAGULANTS
Warfarin (Coumadin)
Antagonist of Vit K. Blocks shit needed for clotting to happen.
Used for cardiac dysrhythmias. Your hearts in A-fib and not giving itself time to
fill up before it pumps again. This slows it down so it can fill up!
Can cause gingival hyperplasia (your gums go crazy and overgrow your teeth)
Constipation can be severe in the elderly
Risk for bleeding. And don’t eat with any green, leafy vegetables either… Use
Vit K for overdose
VITAMINS OR WHATEVER…
B12 (Cyanocobalmin)
Lack of this causes megaloblastic anemia. Provides B12 for synthesis of DNA to help anemia and problems from deficiency. Don’t give IV or you will have
anaphylaxis
Iron (Ferrous Sulfate, Feosol)
Restores Iron for production of hemoglobin to prevent/relieve symptoms of iron deficiency anemia. AE: constipation is extreme in old people
No antacids 2 hours before or 4 hours after taking. Don’t take with milk, cereal, fiber, tea, etc...
CLASS: INSULINS
Humalog (lispro)- can mix with NPH, right before and after a meal. Short duration rapid acting (sdra)
NovoLog (aspart)- can mix with NPH, 5-10 mins before meal (sdra)
Novolin R (regular insulin)- 30-60 mins before a meal. Short duration slower acting
Lantus (glargine)- long (24 hour) duration. CANT MIX
NPH (Neutral protamin Hagedorn)- intermediate duration
Glucagon- exact opposite of insulin. Give to people in hypoglycemic shock. Produced in alpha cells (not beta cells like insulin) in the pancreas
CLASS: ANTIHISTAMINES
Diphenhydramine (Benadryl)
MOA/Use: blocks histaminic receptors to reduce
TE: Constricts vessels, shrinks capillaries (edema
AE: Excess sedation. Don’t take in 3rd trimester.
histamine response to stuff (allergic reactions)
goes down), CNS (sedation).
Anticholinergic effects (see last page)
CLASS: COX INHIBITORS
Aspirin
MOA/Use: binds to platelet (for life of platelet) and makes it not sticky, can’t group together and form a clot. Cox 1 & 2 inhibitor. Analgesic, anti-inflammatory.
Helps prevent heart attack, stroke. Makes blood flow more smoothly.
AE: Occult (hidden) blood in poo. Salicylims (overdose of aspirin) causes ringing in ears. Also cardioprotective!
Celecoxib (Celebrex)
Benefit= lower GI bleeding risk than others! Not cardioprotective.
Acetaminophen (Tylenol)
Pain relief, not anti-inflammatory!
It’s a really good pain reliever but doesn’t give you the mental cloudiness that
narcotics do. Don’t use with blood thinners because celebrex can cause
bleeding…
Hepatotoxic. Use mucomyst as the antidote for Tylenol, has to be within 24
hours. But you won’t see overdose s/s until it’s usually too late to use
mucomyst.
CLASS: GLUCOCORTICOIDS
 Metabolic effects
o They want glucose and steal it if they have to. You get a chipmunk face from redistribution of fat
 Cardiovascular effects
o Can make your WBC count to go up
 They make you feel absolutely wonderful while they are doing all these bad things to you. Sweet Poison.
 Fucks up the body’s ability to have an immune response.
o Don’t give people on these a vaccine (cause the body can’t fight even a crappy dead virus, it won’t do anything. It’s a wasted vaccine)
 Used for inflammatory problems (RA, lupus, whatever)
 Adverse effects
o They raise your blood sugar. If it’s that way long enough, you can become diabetic. Growth retardation in children
CLASS: BIPHOSPHONATES
Alendronate (Fosamax)
Goes into bone and inhibits reabsportion by decreasing osteoclast activity. Half life may be weeks -180 years. They don’t fucking know…
NEVER TAKE WITH FOOD! ONLY WATER! Sit upright for a while after you take it…
CLASS: EXPECTORANTS
Guaifenesin (Muscinex)
MOA/Use: increases flow of respiratory tract secretions
CLASS: PPI’S
Omeprazole (Prilosec)
MOA/Use: suppress secretion of gastric acid.
Irreversible days to weeks after stopping drug
AE: HA, diarrhea, N/V
ADME: Very important when you take it! Give 30
mins before meal, once a day.
Famotidine (Pepsid)
For heartburn, acid indigestion, sour stomach. It doesn’t do a lot of the things that Tagamet does (antiandrogenic effects)
Tagamet (cimetadine)
DOC for tummy ulcers. Promotes healing thru acid reduction
AE: gynecomastia (boobies in men), reduced libido, impotence
CLASS: BULK-FORMING LAXATIVES
 You can’t absorb them. They swell in your insides to form a gel like solution that softens your poo, making it easier to poo out!
CLASS: STIMULANT LAXATIVES
 Stimulate gut motility, increase secretion of water and ions into the intestine and reduce water and electrolyte absorption. Keeps the water in your poo
and makes your gut move quickly to get it out of there.
 Bowel rupture can occur!
CLASS: CEPHALOSPORINS
 Similar to penicillins
 Bacteriocidal: disrupt bacteria cell wall synthesis
 Broad Spectrum and most widely used of all antibiotics
o 4 generations, each progressively more and more specific
CLASS: MONOBACTAMS
Vancomycin
MOA/Use: disrupts cell wall. Used in severe
ADME: Poor oral absorption
AE: Ototoxic!
infection like MRSA and C. Diff. The whole if you
Red Man Syndrome: you turn red with rapid
use it you lose it philosophy
infusion
CLASS: TETRACYCLINES
Tetracycline (Sumycin)
MOA/Use: inhibits protein synthesis. Broad
spectrum used in rickets, Chlamydia, acne
ADME: lowered absorption with Ca, Fe, and Mg
laxatives, antacids, and milk
AE: Hepatotoxic, renal toxicity (take with lots of
water). Photosensitivity
Chloramphenicol
MOA/Use: Broad spectrum Antibiotic, inhibits
protein synthesis
AE: Reversible bone marrow depression resulting in
aplastic anemia
Only for life-threatening infections for which safer
drugs are ineffective or contraindicated!
ADME: typically IV cause it’s not absorbed p.o.
Needs peak/trough
AE: Ototoxic! It’s nephrotoxic if the total cumulative
dose is too high. Causes acute tubular necrosis
CLASS: AMINOGLYCOCIDES
Gentamicin (Garamycin)
MOA/Use: narrow spectrum for gram negative stuff
CLASS: ANTIFUNGALS
Amphotericin-B (Fungizone)
MOA/Use: Broad spectrum. Binds to ergosterol on fungal wall and increases
permeability. Fungocidal. DOC for the super bad guys that are going to kill you
if you don’t get this med…
ADME: Highly toxic. It breaks down the fungal ergosterol. You have sterols in
you. Hence it breaks down the bugs sterols and your sterols too! Bad news for
you…
Griseofulvin (Grifulvin V)
MOA/Use: for superficial mycoses only. Inhibits fungal mitosis. You take it and
it goes to your keratin. Fungus likes keratin. It eats the keratin with the med in
it and dies…
CLASS: ANTIVIRALS
Acyclovir
MOA/Use: Suppresses synthesis of viral DNA, but
does not cure it. (No cure for virus)
AE: headache, rash.
The med is liver intensive, so don’t use in people with fucked up livers
AE: when IV can cause reversible nephrotoxicity so
you infuse slowly and keep them hydrated
Randoms: If you are on it long enough, you develop
a resistance to it. Just b/c your partner is on it
doesn’t mean you won’t get the herp.
Only topically or slow IV
Interferon A (Peg-Intron)
MOA/Use: Blocks entry of virus. Tx of chronic Hep B and C (but the first choice
is to vaccinate!)
AE: flu like symptoms and depression. Makes you feel real, real bad…
Ribavarin (Rebetol)
MOA/Use: not really clear, goes along with Interferon. Therapy is long, 24-48
wks
Teratogenic (Category X) You have to be on 2 forms of BC! Devil babies!
OTHER
NURSING RESPONSIBILITIES
 6 Rights (drug, time, dose, patient, route, documentation)
 As a nurse, it’s your job to make sure everything is ok both before you give the med (checking BP) and after giving (reevaluating pain level after 30 mins)
 Not only do you make sure you didn’t just kill the patient with the med, but you get a firsthand look at the therapeutic effectiveness of the drug. If his
GERD medicine doesn’t do shit to help his GERD, it’s your job to inform the Doctor.
 Also, you have to know the interactions, adverse effects, etc. If you aren’t sure you should give the med, then don’t friggin give it. If it’s wrong, call the
pharmacy to double check the order. If they say it’s all good and you still don’t think it looks right, call the dr. If you don’t and the guy dies, it’s your ass.
 You get to make PRN decisions. Whoo hoo.
 You are also basically responsible for teaching the client about his meds. You get to tell him why he gets it, how to take it, etc.
DRUG REGULATIONS
 1906 Federal Pure Food & Drug Act
 1938 Food, Drug & Cosmetic Act (FDCA) – FDA established
o Looks at results of drug before it can go on the market. You have to have testing and all that.
 1962 Harris-Kefauver Amendments to FDCA
o Drug makers had to prove their shit worked before it was approved for use.
 1970 Controlled Substance Act
o Scheduled Classes 1-5 (1 being super addictive, 5 being the least)
 1997 Food & Drug Administration Modernization Act
o Changed FDA regulations
o Put HIV and cancer drugs on the market quicker, said you had to be notified 6 mo prior to your favorite drug being taken off the market, etc.
PHARMACOKINETICS
 “drug motion”
 ADME fits in here… It’s what happens to the pill once you swallow it (where it’s broken down, where parts of it go after that, etc.)
PHARMACODYNAMICS
 What drugs do to the body and how they do it
 Like, how when you take morphine it makes you feel good because it’s working on receptors and what not…
DRUG INTERACTIONS
 Consequences of D/D Interactions
o Intended vs. unintended
o Good vs. bad
o Intensification (Potentiative, increasing)
o Reduction / Diminished effects (Inhibitory)
o Can create entirely new or unique effects.
INDIVIDUAL DRUG RESPONSES
 Tylenol doesn’t exactly affect you and Jimbo the same way. It’s because of
o Body weight and composition
o Age
o Gender (women can’t drink as much alcohol as men can)
o Race/Genetics
o Diet
DRUG REACTIONS IN ELDERLY
 Watch out for them polypharmacy bitches…
 Their organs don’t work right, they might have co-morbidities, they may be forgetful and not take stuff, they may be on a fixed income and not have
enough $$, etc.
MEDICATION ERRORS
 Any preventable even that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare
professional, patient, or consumer
 Most common cause is human error (i.e. poor communication, name confusion, improper math and dose calculation, etc.)
 If something in the process goes wrong, (either with the dr writing the order, the pharmacy filling the order, whatever) and you give the med and he
dies, it’s your ass. It’s your responsibility to make sure everything is right before you give the med!
 If you make a mistake, your first priority is to stay with the patient and make sure they’re ok. Don’t go find a dr, don’t fill out an incident report, nothing.
Don’t leave their side until you know they are going to be ok!
OTHER THINGS I FELT LIKE ADDING
*You want drugs to be effective, selective, and safe. Effectiveness is the most important property a drug can have, there is no such thing as a “safe” drug, and a
completely selective drug is one that only does what you want it to (i.e. no side/adverse effects).
Drug- any chemical that can affect living processes
Pharmacology- the study of drugs and their interactions with living systems
ADME- Absorption, distribution, metabolism, and excretion (all part of pharmacokinetics)
Maximal efficacy- the max effect a drug can produce.
Potency- amount of drug required to produce the desired effect
Adverse Drug Reactions – any noxious, unintended, and undesired effect that occurs at normal doses
Contraindication- something you already have that you know will cause problems if you take it. Only use for extreme circumstances!
Precaution- something you already have that increases your risk of having a shitty reaction to a drug, but it’s not really life threatening
Drug abuse- using a drug in a fashion inconsistent with medical or social norms
Addiction- you have to have it! You will not eat and steal from your baby daddy to get your shiz…
Cross-tolerance- if you take a lot of hydrocodone the morphine might not do you much good. If you’re used to a drug, you might be used to its drug cousin
Psychological dependence- mentally addicted to chocolate or whatever
Physical dependence- your body freakin needs it!
Cross-dependence- if you are dependent on a drug, you are very likely to become addicted to its drug cousin
Anticholinergic Effects
 Salivary glands- decreased secretion
 Sweat glands- decreased secretion
 Bronchial glands- decreased secretion
 Heart- Increased rate
 Eye- mydriasis, blurred vision
 Urinary tract- interference with voiding
Intestine- decreased tone and motility
Lung- dilation of bronchi
High doses= stomach and decreased acid secretion