Pharma for Students

8/3/2019 Pharma for Students

1/23

PHARMACOLOGY -study of drugs and its interaction to the body. DRUG -any substance used to diagnose, cure, or prevent a condition or disease.

DRUG NAME:1. Chemical Name refers to the chemical structure of the drug.2. Generic Name common or official name not restricted by trademark;usually written in small caps.

3. Band Name TRADEMARK; name given by the manufacturer

PHARMACOKINETICS is the process of drug movement to achieve drug action. 1.ABSORPTION- process from the time of administration until it enters the bloodstream.

2.DISTRIBUTION - is the transportation of a drug to body fluids and tissues PLASMA-PROTEIN BINDING

a. Medications attach to plasma proteins (albumin: anticonvulsants or globulin:lidocaine)b. Protein-bound drugs inactive bcoz it is not available to receptorsc. Free or Active drugs can cause a pharmacologic response by binding to cell receptorsd. Clients with reduced plasma proteins (kidney/liver d/s malnutrition) could receive a

heightened drug effect and eventually drug toxicity.

BARRIERS - prevent some medications from entering certain body organs.

a. Blood-brain barrier - to pass this barrier, drug must be lipid soluble and loosely attachedto plasma protein.

b. Placental barrier many substances ( nicotine, alcohol) can cross

3.METABOLISM (biotransformation)- irreversible transformation of drugs - major organ responsible: LIVER

a. First-pass effect the process wherein drugs pass through the liver first before enteringthe systemic circulation and some portion of the drug is inactivated.

b. Bioavailability percentage of the administered drug dose that reaches the systemiccirculation.

c. Infants and elderly have reduced ability to metabolize some drugs.

4.EXCRETION - process by which drugs are eliminated from the body- major organ responsible: KIDNEYS- other organs: intestines, lungs, and mammary, sweat, and salivary glands

a. Half-life (t1/2) the time it takes for one half of the drug to be eliminated.

!!!Note: Most accurate test to determine Renal function: Creatinine Clearance (CLCR) (N: 85-135ml/min)

DRUG INTERACTION1. Synergistic Effect/Potentiation two drugs with different mechanism of action produce greater effect2. Antagonistic Effect effects of two drugs cancel each other

-- basis for specific antidotes

DRUG ORDERo Types of Medication Orders

a. Stat Order given at once or immediatelyb. Standing Order ongoing order or may be given

for a specific number of doses or days.c. PRN Order given as neededd. Verbal Order telephone order and must be

signed by the doctor w/in 24 Hours.

If possible a medicine intern should takethe telephone order.

e. Single Order given once and usually at a specific time

1

Antidotes:1. acetaminophen

2. benzodiazepine

3. digoxin

4. heparin

5. warfarin

6. iron

7. magnesium sulfate

8. mestinon

9. neostigmine

10.narcotics


2/23

10 RIGHTSb. RIGHT CLIENT

a. The nurse must verify the clients identity.b. Check the identification bracelet.c. Have the client state his name. (dont call out his name)d. Check the bed tag. (least reliable)

c. RIGHT DRUG

a. The client must receive the prescribed drug.b. Check the drug label three times.

b.1. At the time of contact with the drug containerb.2. Before preparing the drugb.3. After preparing the drug

d. RIGHT DOSEa. Refers to the dose prescribed to a client.b. Calculate the drug dose correctly.c. When in doubt, it should be checked by another nurse.d. Check the drug handbook for recommended range of specific drug doses.e. Dosage Calculations:

e.1. D VH

e.2. Flow Rate gtts/min = Amount of fluid x Drop Factor(gtts/ml)

H x mins/H (60)

ml/H = Amount of Solution# of Hours

ml/min = Milliliters per Hour60 mins

No. of H = Amount of Solutionml/H

e.3. Freids RuleAge in Months x Adult Dose

150e.4. Clarks Rule

Weight in Pounds x Adult Dose150

e.5. Youngs Rule Age in YearsAge in years + 12

e. RIGHT TIMEf. RIGHT ROUTE

a. Oral liquid, elixir, suspension, pill, tablet, capsuleb. Sublingual under tongue for venous absorption; high rate of absorptionc. Buccal between gum and cheek

d. Via feeding tube - NGTe. Topical applied to the skinf. Inhalation aerosol spraysg. Instillation EENh. Suppository rectal or vaginali. 4 Parenteral Routes: IV, IM, SC, IDj. Stay with the client until oral drugs have been swallowed.

2

Common Conversion60 drops = 1 tsp1 tbsp = 15 ml3 tsps = 1 tbsp1 gr = 60 mg8 oz = 1 glass15 gr = 1 gram

1000 mcg = 1 mg15 gtts = 1 ml

Drop Factor:

Macrodrip:

a. Abbott 15b. Cutter 20c. Travenol 10

Microdrip:

a. Minidrip sets60


3/23

g. RIGHT ASSESSMENTa. Requires that the appropriate data be collected before drug administration.

Ex. Assess Apical heart rate before giving digitalis.Asses blood sugar before giving insulin. Assess ability of the elderly tocoordinate eye medication instillation at home.

h. RIGHT DOCUMENTATIONi. RIGHT TO EDUCATION based on informed consent

j. RIGHT EVALUATIONk. RIGHT TO REFUSE

General Drug Administration Guidelines:

Practice asepsis. Nurses who administer medications are responsible for their own actions. Do not administer medication

prepared by another nurse.

Check medication order with physicians order, Kardex, medicine sheet, medicine card. Use only medications that are in clearly labeled containers. Return liquid that are cloudy or have changed in color to the pharmacy. Before administering a medication identify the client correctly.

Do not leave the medication. If the pt vomits after taking the oral medication, report this to the nurse in charge and/ or physician. When a medication error is made, report it immediately to the nurse in charge and /or physician.

ROUTES OF ADMINISTRATIONa. Enteral Route

ORAL MEDICATIONS

- Position:Adult: Sit the client uprightInfant: 45 degrees angle

1. TABLETS AND CAPSULES- Ensure the patients ability to swallow.- Place medication well back on the tongue.- Give pt liquid to swallow the medication (60-100ml except cough syrups).- Remain with the pt while the medication is taken and until its gone.- Do not crush enteric-coated tablets or sustained-release tablets.- Scored tablets can be broken

2. LIQUIDS- Shake liquid medication.- Pour away from bottle label.

- Read the liquid amount at the lower meniscus at eye level.- Administer the drug immediately. (prevent contamination)- Iron or HCl: have the client use straw to prevent staining the teeth.

3. SUBLINGUAL AND BUCCAL*SUBLINGUAL under the tongue for venous absorption (high rate of absorption)*BUCCAL between gum and cheek

Nursing Alert!!!!- Instruct the pt NOT to swallow the medication.- Do not give fluids 30 minutes following administration.

4. NASOGASTRIC TUBE

- Indication: inability to swallow- Position: Semi-Fowlers to High Fowlers position or on the Right side if comatose- Measurement: NEX- Liquid form of the drug should be used.- If tablet: Crush medications and dissolve in 5-10 ml of water- Check location of the NGT before administering the medication.

3

Solid: tab, cap, pill, powderLiquid:

-Syrup: sugar-based

-Susp: water-based; shake well b4 use

-Emulsion: oil-based-Elixir: alcohol-based; wait 3o mins b4

giving water

*Crushing enteric-coated tabs: irritate gastric

mucosa.

*Crushing sustained-release tabs: release all ofthe medications at once decreasing its duration.


4/23

X-RAY ASPIRATION OF GASTRICCONTENTS

INTRODUCTION OF AIR

-Confirms properplacement

-normal gastric color: grassy green,yellow to brown, clear-litmus paper color:RED

-pH:1-5; respi and intestinal: >7

-auscultation of gurgling sounds

Procedure:1. Clamp the tubing and attach bulb syringe.2. Unclamp the tubing and allow the medication to run.3. Flush tubing with 50 ml of water or prescribed amount.4. Clamp the tubing at the end of the medication administration.5. Maintain pt in semi-fowlers for at least 30 minutes after administration.6. Provide oral care if necessary.

b. PARENTERAL ROUTE

1. INTRADERMAL ROUTEa. Action:

-Local Effect-Used for observation on an inflammatory (allergic) reaction to foreign proteins.

b. Sites:lightly pigmented, hairless, thinly keratinized-ventral forearm-scapular area-upper chest (clavicular area)

c. Equipment:

-Needle: 26-27g; 1 inch in length (max vol: 0.1 ml)

-Syringe: 1 ml or tuberculin syringed. Angle:

-10-15 degrees, bevel up

e. Technique:-Put on gloves.-Cleanse the area.-Stretch the skin taut.-Inject the medication slowly to form a wheal.-Dont massage.-Mark with a pen, and ask the client not to wash it off.

-Assessed after 48-72 hours.

2. SUBCUTANEOUS ROUTE

a. Action:

-Systemic and Sustained Effect-Used for small doses of non-irritating, water-soluble drugs.

b. Sites:adequate fat pads-Lateral aspect of the upper arm-Upper back, scapular area-Anterior thigh

-Abdomen (1 in away from umbilicus)-Upper Hips

c. Equipment:

-Needle: 25-27g; - 5/8 inches in length, 1 inch-Syringe: 1 to 3 ml-Maximum volume of 1.5 ml

d. Angle -45 degrees (90 degrees in abdomen)

4

e. Technique:-Put on gloves.-Cleanse the area.-Pinch the skin to form SC fold.-Aspirate, except for insulin orheparin.-Gently massage the area unless CI.


5/23

3. INTRAMUSCULAR ROUTEa. Action:

-Systemic Effect-Used for irritating drugs, aqueous suspensions, and oil-based drugs.

b. Sites:adequate muscle size, minimal nerves and blood vessels-Ventrogluteal

-Vastus lateralis-Dorsogluteal-Deltoid

c. Equipment:

-Needle: 18-23g; 1-3 inches in length-Syringe: 1 to 3 ml-Maximum volume of 5 ml

d. Angle:-90 degrees

e. Technique:

-Put on gloves.-Cleanse the area.-Flatten the injection site.-Aspirate.-Massage the area.

VASTUS LATERALIS (anterior thigh) DELTOID-Recommended site for infants and children (bcozits well developed in both adults and children)

-No major blood vessels nor nerves-Site: middle third of the anterior lateral aspect of

the thigh-Position: supine or sitting-Volume: Pediatrics


6/23

Procedure:

1. Change the needles after withdrawing the drug from the vial.2. The skin is stretched or pulled into one side.3. Inject the needle into the muscle.4. Aspirate to check for blood.5. Wait for 10 seconds after injecting the medication before withdrawing the needle.

6. Release the displaced skin.7. Do not massage or rub the site.

4. INTRAVENOUS ROUTE

a. Action: -Systemic Effect: -Most rapid routeb. Sites: -Cephalic vein, Median Cubital vein, Dorsal and metacarpal veins, Radial vein, Basilic vein

c. Equipment:-Needle:

*Adults: 20-21g; 1-1.5 inches*Children: 22g; 1 inch*Infants: 24g; 1 inch*Blood Transfusion: Adults: 18-19g; Children: 23g

d. Angle: -25 degreese. Technique:

-Apply a tourniquet.-Cleanse the area using aseptic technique.-Insert needle until blood returns. Remove the tourniquet.-Stabilize the needle and dress site.-Monitor the flow rate, distal pulses, skin color, temperature, and insertion site.

f. General Considerations:1. Prime tubing.2. Avoid use of the veins of the lower extremities.3. Avoid use of vessels over a bony prominence.4. Initiate the IV in the nondominant hand.5. Select site from distal to proximal.6. Do not use an extremity with an impaired blood flow.7. Commonly used veins: dorsal vein network, cephalic, basilic.

6


7/23

ComplicationsTHROMBOPHLEBITIS inflammation of thevein + clot formation

INFILTRATION - dislodgement of the IV catheter +accumulation of fluids in the SC tissues

S/Sa. Pain along the vein.b. Hard & cord-likevein.c. Edema & redness @insertion site.d. Warmth on theinsertion site.

Nursing Mgt:a. Change IV site q72H.b. Use large veins forirritating fluids.c. Stabilize venipuncturesite.d. Apply cold compressto relieve pain &

inflammation.e. Apply warm compressto stimulate circulationand absorption.

S/Sa. Painb. Edemac. Cold skin @ needlesite.d. Pallor of the site.e. Flow of IV decreasesor stops.

f. Absence of backflowof blood.

Nursing Mgt:a. Change the insertionsite.b. Apply warm compressto reabsorb fluids.

AIR EMBOLISM presence of air in tubing thatmanaged to get into the circulatory system (>5 ml)

CIRCULATORY OVERLOAD caused by RAPIDrate of infusion

HYPERTONIC-higher concentration of

solutes than the cells

-Cells SHRINK-Use: Clients with Edema

ISOTONIC (N:275-295mOsm/kg)-same solute concentration ascells and blood-Cells maintain normal shape andsixe-Use: Burn clients

HYPOTONIC-lower concentration of solutes

than the body fluids-Cells SWELLUse: DHN, Hemorrhage

1. 3% NSS

2. 5 % NSS3. D10W4. D5 in 0.9 %NSS5. D5 in 0.45% NSS6.D5LR

1. 0.9% Saline

2. D5W3. D5 in 0.25% NSS4. LR5. NSS

1. 0.45% Saline

2. 0.225% Saline3. 0.33 % Saline

Nursing Interventions:a. Monitor for circulatoryoverload.b. CI for clients with Renal &cardiac d/o.c. CI for clients with DHN.

a. Avoid D5W if client is at riskfor IICP bcos it moves from theintravascular to theintracellular compartment.b. D5W, when infusedcontinuously or rapidly, becomesa hypotonic solution.

a. CI for clients with IICP.b. Monitor client carefully (LOC:cos fluid shifts into brain cells)

7
http://www.biology-online.org/dictionary/Concentrationhttp://www.biology-online.org/dictionary/Soluteshttp://www.biology-online.org/dictionary/Cellshttp://www.biology-online.org/dictionary/Concentrationhttp://www.biology-online.org/dictionary/Soluteshttp://www.biology-online.org/dictionary/Cells


8/23

S/Sa. Chest, Shoulder,Back painb. Hypotensionc. Dyspnead. Cyanosise. Tachycardiaf. Increased venous

pressureg. Loss ofconsciousness

Nursing Mgt:a. Do not allow IV bottleto run dry.b. Prime tubing beforestarting infusion.c. Turn the pt to his leftside in the

Trendelenburg position.

To allow air to rise in theright side of the heartand would prevent airembolism.

S/Sa. H/Ab. Flushed skinc. Tachycardiad. HTNe. Weight gainf. Syncope or faintnessg. Pulmonary edema

h. Cracklesi. SOBj. Tachypneak. Coughing

Nursing Mgt:a. Slow the infusion toKVO (5-10 gtts/min)b. Place the pt in highfowlers position to easebreathing.c. Administer diureticsor a bronchodilator as

ordered.

C. PERCUTANEOUS ADMINISTRATION1. EYE DROPS AND OINTMENT

-Purpose:a. Instill required eye medication.b. Irrigate foreign bodies from the eye.

-Position: supine or sit with head turned to affected side to aid in gravitational flowProcedure: EYEDROPS

1. Wash Hands.2. Check the medication.3. Have the pt look upward.4. Apply gentle traction to the lower eyelid to exposethe lower conjunctiva.5. Administer medication to the lower conjunctivanot on the cornea.6. Close the eye gently.

7. Press lacrimal duct for 1-2 mins.8. Wait 3-5 mins before instilling another drop.

Procedure: EYE OINTMENT1. Squeeze strip of ointment (1/4 in) ontoconjunctival sac.2. Apply meds from inner to outer canthus.3. Have the pt blink 2-3 times.4. Close the eye gently for 2-3 mins.5. Instruct the pt to expect blurred vision for ashort time.

NURSING ALERT!!!!

Avoid touching the tip of the medication to theeye!!!!

2. EAR DROPS-Purpose:

a. Soften & Remove cerumenb. Treat inflammation and infectionc. Relieve pain

d. Remove a foreign body.-Position: Side-lying with the ear being treated uppermost

Procedure:-Children under 3yrs old: Pull the PINNA down and back-children over 3 yrs old & adults: Pull the pinna UP and back-Warm eardrops at room or body temperature.-DO NOT insert dropper into the ear canal.-Administer medication on the lateral walls of the auditory canal.-Maintain position for 5-10 mins.

3. NOSE DROPS

-Purpose:a. Shrink swollen mucous membraneb. Loosen secretions & Facilitate drainagec. Treat infections

-Position: Supine or Sitting and lean head backwards-Procedure:

-Gently blow the nose.

8


9/23

-Instill medication.-Have the pt remain in the position for 5 mins.-Inform client the drops may produce an unpleasant taste.

4. RECTAL SUPPOSITORIES-Absorption: Local or Systemic-Position: Left Sims Lateral-Procedure:

-Provide privacy.

-Use a glove for insertion.-Ask pt to take a deep breath & exhale thru mouth. (relaxes anal sphincter)-Gently insert the suppositories at approximately 2 inches. (use KY jelly)-Ensure that the suppository is in contact with the rectal wall. (Accurate absorpt!)-Remain lying on the side for 10-20 mins. (if enema: 20-30 mins)

5. VAGINAL MEDICATIONS-Position: Dorsal Recumbent or Lithotomy-Procedure:

-Have the client void.-Cleanse the perineum.-Lubricate the applicator tip.-spread the labia to expose the vagina-gently insert the applicator or suppository (2 inches)-remain in supine position with the hips elevated for 15-20 mins.

D. INHALATION ROUTE-Use of a Nebulizer or Metered-Dose Inhalers (MDI)-Position: Semi to High Fowlers, StandingProcedure:

-Insert the medication firmly into the inhaler.

-Remove the cap from the mouthpiece.-Shake the inhaler. (To mix the medication & ensure uniform dosage delivery)-Hold mouthpiece 1-2 inches from the mouth.-Have the pt inhale fully while pressing on the inhaler.-Remove inhaler and hold breath for 10 s.-Exhale slowly thru the pursed lips-Wait 2 minutes between puffs.-Give bronchodilator inhalant before a glucocorticoid for an interval of 5 mins.-Instruct client to rinse mouth after steroid inahalation. (prevent oral fungal infxn)

NOTE: To better facilitate delivery of inhalant medications, use a SPACER.

DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM:

9


10/23

SYMPATHETIC NERVOUS SYSTEM

- Flight or Fight response

- Major Neurotransmitter: EPINEPHRINE

- Stimulates ALL body systems EXCEPT GIT/GUT

- All vasoconstricts EXCEPT PUPILS, BRONCHUS,

UTERUS

-DRUG Classifications:

1. Adrenergic

2. Sympathomimetics

3. Cholinesterase

4. Anticholinergic

Action: STIMULATES

Alpha1 vasoconstrictionBP

Beta1HR CO BP

Beta2relax smooth muscles (bronchodilation,uterine relaxation)

PARASYMPATHETIC NERVOUS SYSTEM

- Rest and Digest

- Major Neurottransmitter: ACETYLCHOLINE

- Inhibits ALL body systems EXCEPT GIT/GUT

- All vasodilates EXCEPT PUPILS, BRONCHUS,

UTERUS

-DRUG Classifications:

1. Adrenergic Blocking Agents

2. Parasympathomimetics

3. Anticholinesterase

4. Cholinergic

Action: BLOCKS

vasodilationBP

HR CO BP

contraction of smooth muscles(bronchoconstriction, uterine contraction)

SIDE EFFECTS: SNS

1. Tachycardia

2. HTN

3. Dry mouth

4. Constipation

5. Urinary retention

6. Pupil and bronchodilation

7. Uterine relaxation

8. Vasoconstriction except in smooth muscles

SIDE EFFECTS: PNS

1. Bradycardia

2. Hypotension

3. Increased salivation

4. Diarrhea

5. Increased urination

6. Pupil and bronchoconstriction

7. Stimulates uterine contraction

8. Vasodilation except in smooth muscles

SNS DRUGS

Adrenergic Drugs: 1. epinephrine (Adrenaline Chloride)2. norepinephrine (Levophed,

Levarterenol)3. dopamine (Intropin)4. dobutamine (Dobutrex)

Indications

a. SHOCK: Cardiac stimulantb. CARDIAC FAILURE

Nursing Management:

1. Best taken:EARLY MORNING

2. Assess HR & BP(tachycardia/dysrhythmias)

3. Monitor I/O (Urgency/urinaryincontinence)4. Monitor lung sounds. (Epi = pulmoedema, bronchodilator = absence ofwheezing)

5. Administer through a large vein (E/NE).6. If extravasation occurs, infiltrate thesite with normal saline and phentolamine

(regitine)..

5. Bronchodilators:a. albuterol (Ventolin, Proventil)b. salmeterol (Serevent)c. terbutaline sulfate (Brethine,

Bricanyl)

d. isoproterenol (Isuprel)e. ipratropium bromide (Atrovent)f. ipratropium + albuterol

(Combivent)

a. ASTHMAb. BRONCHOSPASM

c. CAL

10


11/23

Anticholinergic:

1. atropine sulfate (Isopto)2. scopolamine (Hydrolomide)3. glycopyrrolate (Robinul)

Indications

a. Preanesthetic med(secretions & bradycardia)b. Mydriatics

Nursing Management:1. Avoid driving (blurred vision)2. Encourage use of sunglasses(photophobia)3. Relieve dry mouth(hard candy, icechips, sugarless gum)

4. CI in glaucoma. (eye exams)

5. fluids & high fiber intake

(Constipation).6. Monitor for heatstroke.

4. benztropine (Cogentin)5. trihexiphenidyl (Artane)

6. biperiden (Akineton)7. procyclidine (Kemadrin)

a. Anti-EPS

b. Anti-Parkinsonian

PNS DRUGSAdrenergic Blocking Agents:1. prazosin (Minipress)2. phentolamine (Regitine) (Antidote for:)3. terazosin (Hytrin)

4. reserpine (Serpasil, Serpalan)5. nitroprusside (Nipride)6. hydralazine (Apresoline)7. atenolol (Tenormin)8. propranolol (Inderal)9. metoprolol (Lopressor)10. nadolol (Corgard)

Indications

a. HTNNursing Management:1. Assess BP

2. Do not discontinue abruptly (reflex

tachycardia)

3. Priority : SAFETY (Light-headed,dizzy, orthostatic hypotension)

4. Decrease salt intake (can causeedema/h2o retention)5. Inform regarding sexualdifficulties (vasoconstriction ofsmooth muscles)NOTE: Reserpine can cause depression,

GI irritation, impotence, increase risk forbreast CA.

Cholinergic:- aka anticholinesterase

1. acetylcholine chloride (Miochol)2. neostigmine (Prostigmin)3. pyridostigmine (Mestinon,

Regonol)4. edrophonium chloride (Tensilon)

5. bethanecol (Urecholine)(used to tx post op urine retention)

Indications

a. Miosisb. Myasthenia Gravis

c. Urinary retention

Nursing Management:1. Prepare antidote:

-atropine sulfate

-pralidoxime chloride (PAL)

2. Effectiveness:-improved muscle strength

3. Monitor for cholinergic crisis4. Take with drug or food (


12/23

ANTIANXIETY / ANXIOLYTICS

Referred to as: a. Antianxiety b. Minor Tranquilizers c. Downers1. Benzodiazepine -am, -pam

Diazepam (Valium) Alprazolam (Xanax) Oxazepam (Serax) Lorazepam (Ativan) Clonazepam (Klonopin) Chlorazepate

(Tranxene) Chlordiazepoxide

(Librium) Estazolam (ProSom) Midazolam (Versed)

2. Nonbenzodiazepine

Meprobamate (Equanil,Miltown)

Buspirone (BuSpar)

Hydroxyzine (Vistaril,Atarax)

3. Sedative HypnoticBenzodiazepines

Flurazepam (Dalmane)

Triazolam (Halcion)

Temazepam (Restoril)

Side Effects:1. CNS depression S/E-dizziness, confusion,disorientation, ataxia, fatigue

2. Anticholinergic S/E-everything is dry; dry eyes, drymouth, constipation, urinaryretention

3. Orthostatic/Posturalhypotension

c. Interventions:

1. Rinse mouth with water often and eatsugarless gum.

2. Assist in ambulation.

3. Caution against driving.

4. Not used with daily minor stresses.

5. Caution in patients with glaucoma.

6. No alcohol and CNS depressants.

7. Therapeutic benefit is achieved in 2weeks.8. Cautious IV use as drug canprecipitate.9. Smoking decreases drug effect.10. Avoid abrupt discontinuation.11. Antidote for OD:flumazenil (Romazicon)

DOC for alcohol withdrawal: Chlordiazepoxide (Librium) DOC for Status Epilepticus: Diazepam (Valium)Anxiolytic considered as: DOC as pre-op medication: Lorazepam (Ativan)

DOC for elderly: Oxazepam (Serax); Lorazepam (Ativan)

ANTIPSYCHOTICS: Referred to as:

a. Neuroleptics b. Major TranquilizersPhenothiazines:

1. Chlorpromazine (Thorazine)

2. Trifluoperazine (Stelazine)3. Fluphenazine (Prolixin)4. Perphenazine (Trilafon)5. Triflupromazine (Vesprin)6. Thioridazine (Mellaril)

7. Molindone (Moban)

Side Effects:

1. CNS Depressant Effects:-dizziness, confusion,disorientation, ataxia, fatigue

2. Anticholinergic Effects:-everything is dry; dry eyes,dry mouth, constipation,urinary retention

3. Orthostatic Hypotension4. Prolactin levels5. PHOTOSENSITIVITY6. Diminished libido, Erectileand orgasmic dysfunction7. Weight gain

8. Pruritis9. Neuroleptic MalignantSyndrome (NMS)

Nursing Management:

For CNS Depression:

1. Safety precautions2. Avoid activities that requires

Alertness (DRIVING)

For Anticholinergic Effects:

1. Relieve dry mouth.2. CI in Pxs with galucoma

For orthostatic hypotension:

1. Monitor BP2. Gradual change of position3. Assist in ambulation

FOR PHOTOSENSITIVITY:1. Apply sunblock. (SPF:15-30)

2. Protective clothing.

Nonphenothiazines:

Butyrophenones

1. Haloperidol (Haldol)

2. Droperidol (Inapsine) Thioxanthenes

1. Chlorprothixene (Taractan)2.Thiothixene (Navane)

Atypical

1. Clozapine (Clozaril)

2. Risperidone (Risperdal)3. Olanzapine (Zyprexa)4. Quetiapine (Seroquel)

5. Ziprasidone (Geodon) New Generation

1. Aripiprazole (Abilify)

Extra Pyramidal Symptoms (EPS)

12


13/23

Dystonia Pseudoparkinsonism Akathisia Tardive Dyskinesia

REVERSIBLERisk: 1-5 days

Frightening spasmsof major muscle groups Torticollis Opisthotonus Oculogyric crisis

REVERSIBLERisk: 1-4 weeks

Akinesia

Rigidity

Bilateral fine handtremors, pill-rolling

Mask-like face,drooling

Shuffling, festinatinggait

REVERSIBLERisk: 1-6 weeks

Uncontrolledmotor restlessnessand the inability tosit still Pacing

Foot tapping

IRREVERSIBLE

Risk: Long term useInvoluntary:

tongue movement sucking lip smacking chewing

grimacing blinking licking

Anti EPS drugs: (Anticholinergic drugs)Benztropine COGENTIN

Biperidin AKINETONDiphenhydramine BENADRYLTrihexyphenidyl ARTANEProcyclidine KEMADRINEAmantadine SYMMETREL

Diazepam (Valium)

A Artane; Akineton

B BenadrylC CogentinD diazepamS Symmetrel (Dopa agonist)

When is the best time to refill Clozapine? Q7d (meds are usually dispensed good for 7 days only)

Typical Antipsychotics relieve what Sx? Positive

Aypical Antipsychotics relieve what Sx? Both Positive and Negative SxMost potent TYPICAL Antipsychotic: Haloperidol (Haldol)

Major reason why Atypical Antipsychotics are preferred: Lesser EPS

Lag period: 3-6 weeks

DOC for Dystonia: Diphenhydramine (Benadryl)Beta-blocker used for Drug-induced Akathisia: Propranolol (Inderal)

ANTIDEPRESSANTSReferred to as:

a. Mood elevatorb. Psychic energizer

1. TCAs

MOA:Blocks the reuptake of NEand 5-HT

Imipramine(Tofranil)

Amitriptyline(Elavil)

Trimipramine(Surmontil)

Clomipramine(Anafranil)

Maprotiline (Ludiomil)

Protriptyline(Vivactil)

Nortriptyline(Pamelor)

Doxepin(Sinequan) Desipramine(Norpramine)

Amoxapine(Asendin)

Side Effects:

Photosensitivity Cardiovascular disturbances:

arrhythmias

Tachycardia Orthostatic hypotension Weight gain Decreased libido, Ejaculatory

disturbances

Nursing Management:

-in general Interventions:

1. Initiate safety precautions.2. Administer with meals.3. Monitor the suicidal clientespecially during improved mood.4. Instruct the client to changepositions slowly.5. Instruct the client to avoiddriving and other activitiesrequiring alertness.

Principles of MAOI &

13


14/23

TCA Administration

1. TCAs given first2. Dont use together with alcohol3. Expect a lag

TCA: 2-4 weeksSSRI: 1-3 weeksMAOI: 2-6 weeks

4. Gap between meds: 14 days

5. Surgery: 10 days

for MAOIs:1. Assess for hypertensive crisis2. Avoid tyramine-containingfoods: Wine (except vodka),cheese (except cottage andcream), yogurt, vinegar

2.SSRIs

MOA: Blocks serotonin reuptake

Fluoxetine(Prozac)

Sertraline(Zoloft)

Paroxetine(Paxil)

Fluvoxamine(Luvox)

Citalopram(Celexa)

Escitalopram(Lexapro)

Side Effects:

N/V Diarrhea

Photosensitivity Insomnia Nervousness H/A, dizziness

Male sexual dysfunction (ED)

3. MAOIs

MOA:Inhibits Monoamine Oxidase

Tranylcypromine (Parnate)

Phenelzine (Nardil)

Isocarboxacid (Marplan) Rasagiline (Azilect) Selegiline (Eldepryl,

Emsam)

Side Effects:

Orthostatic hypotension Insomnia

Weakness GI upset Weight gain Peripheral edema

Delay in ejaculation

HYPERTENSIVE CRISIS

Therapeutic effect of antidepressant: lifting of depressionFoods to avoid when taking MAOI: Tyramine-rich foodsMost recommended antidepressant: SSRIs 9safe and fewer cardiovascular SEs)DOC for OCD: Fluvoxamine (Luvox), Clomipramine (Anafranil)

ANTIMANIC

Action: the release of norepinephrine

Availabilty:

-Tablet -Capsule -Syrup Trade Name:

Eskalith, Lithotabs, Lithobids,

Cibalith, Lithonate

Lag period:10-21 days Points to ponder regardingLiCO3:

1. LiCO3 is maintained with 300mgT.I.D.2. Blood level is checked 8-12 hoursafter last dose. Then:

a. every week for the 1st monthb. every 2-3 months

3. Therapeutic level

* 0.5 1.5 mEq/L adults* ).6 1.8 mEq/L children

Side Effects:

a. Polyuria, Polydipsia,Dry mouthb. Anorexia, Nauseac. Weight gaind. Abdominal bloatinge. Soft stools ordiarrheaf. Fine hand tremorsg. Inability toconcentrateh. Muscle weakness,

fatigue,i. H/A, drowsiness,dizzinessj. Hair loss

Nursing Management:

1. Administer the medication on timeand with food.2. Do not skimp on dietary Na intake.3. Drink 10-13 glasses of water per

day.4. Avoid excessive use of beverages

containing caffeine and alcohol.5. Notify physician if fever,

PERSISTENT vomiting or diarrheaoccurs.6. Carry alert card always.

7. Lithium should be tapered off andnot discontinued abruptly.

1. Lithium Toxicity Prodrome

V

A

N

D

A

L

T

2. Lithium Intoxication

(> 2.5 mEq/L)

Nystagmus Impaired consciousnessOliguria or Anuria Seizure

Coma Deatth

14


15/23

ANTICONVULSANTS

Action: Prevents dissemination of electrical discharges in motor cortex area of the brain by enhancing GABA.

Hydantoins: -toin1. phenytoin (Dilantin)Therapeutic level: 10-20 mcg/ml

Toxic Level: >30 mcg/ml2. ethotoin (Peganone)3. mephenytoin (Mesantoin)4. fosphenytoin (Cerebyx)

Side Effects:1. Gingival hyperplasia

a. Oral Careb. Use soft-bristled toothbrushc. Brush 2-3 times a dayd. Massage gums

2. Slurred speech3. confusion4. Depression5. N/V6. Constipation7. H/A8. Hyperglycemia9. Blood dyscracias(leukopenia/thrombocytopenia)10. Alopecia11. Hirsutism

Nursing Management:

1. Monitor serum level.2. Monitor signs of toxicity.3. IV phenytoin should be diluted in NSS(dextrose -> precipitate).4. Good oral hygiene.5. Increase folic acid. (interferes withfolic acid absorption)6. Do not stop drug abruptly (gradual asit can lead to status epilepticus)7. Can turn urine pink, red, or red-brown.8. Tablet can be crushed. (mix with food)9. Suspension must be shaken well. (makesure accurate dosage is given)10. Lag period: 7-10 days

Barbiturates -bital1.phenobarbital ( Luminal)2. amobarbital (Amytal)3. pentobarbital (Nembutal)4. secobarbital (Seconal)5. mephobarbital (Mebaral)6. thiopental Na (Pentothal Na)7. butabarbital (Butisol)

8. primidone (Mysoline)Lag time: 3-4 weeks

Side Effects:1. CNS depression

a. dizziness, drowsinessb. ataxiac. hand tremors

2. Hypotension3. Respiratory depression

MOA: hinders movement ofimpulses from the thalamus to thebrain cortex.

Nursing Management:1. Taken with food. (reduce gastricdistress)2. Do not discontinue abruptly.3. Avoid alcohol.4. Avoid activities that requiresalertness.5. Drowsiness in first few weeks & will

decrease.6. report symptoms of blood dyscrasias7. Give reconstituted solutions within 30minutes of mixing.8. Teratogenic

Other Anticonvulsants:1. carbamazepine (Tegretol)2. valproic acid (Depakene)3. divalproex Na (Depakote)4. lamotrigine (Lamictal)5. gabapentin (Neurontin)6. falbamate (Felbatol)7. topiramate ( Topamax)

Most common side effect of phenytoin (Dilantin): Gingival Hyperplasia

ANTIPARKINSONS DRUGS

Anticholinergics:MOA: Reduce tremors and rigidity byinhibiting Ach.1. benztropine mesylate (Cogentin)2. trihexiphenidyl ( Artane)3. biperidine HCl (Akineton)4. procyclydine HCl ( Kemadrin)

Side Effects:1. CNS Depression

a. Dyskinesia (impairedvoluntary movement)

b. Dizzinessc. Ataxiad. Confusion

2. Anticholinergic Effects

a. Urinary retentionb. Constipationc. Dry mouthd. blurred vision

3. Orthostatic hypotension4. Nausea and vomiting

Nursing Management:1. Avoid foods high in Vitamin B6(increases levodopa metabolism todopamine in the PNS) and high

protein foods.2. Dont abruptly stop the drug.3. Change position slowly.

4. Avoid alcohol

5. Discoloration of sweat and urine isharmless.

Dopaminergics:

1. amantadine (Symmetrel)2. bromocriptine (Parlodel)3. carbidopa-levodopa (Sinemet)4. levodopa (Larodopa, Dopar)

15


16/23

What vitamin should be avoided when taking levodopa? Pyridoxine

DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM

ANTIHYPERTENSIVES ABCD

ACE Inhibitors:-pril

Action: Prevents vasoconstriction by

inhibiting conversion of Angiotensin Ito Angiotensin II.

1. benazepril ( Lotensin)2. captopril ( Capoten)3. enalapril ( Vasotec)4. fosinopril ( Monopril)5. lisinopril ( Prinivil, Zestril)6. ramipril (Altace)7. losarten (Cozaar)

Side Effects:1. N/V, diarrhea2. Persistent cough3. Hypotension4. Tachycardia5. Ageusia (1st month only)6. Dizziness7. H/A8. Hypoglycemia

Nursing Management:1. Monitor V/S: especially the BP.

2. Do not discontinue abruptly.

3. Avoid alcohol.

4. For orthostatic hypotension- avoid hot baths- gradual change of position

ACE INHIBITORS-Expect dry cough

BETA BLOCKERS -C/I: ASTHMA & COPD

Beta Blockers: -olol

Action:Blocks beta receptors.

1. acebutolol ( Sectral)2. atenolol (Tenormin)3. betaxolol (Betoptic)4. esmolol (Brivibloc)5. metoprolol (Lopressor)6. nadolol (Corgard)7. propranolol (Inderal)8. pindolol (Visken)

Side Effects:

1. Bradycardia2. Bronchospasm3. Hypotension

4. N/V

5. Intensifiedhypoglycemia

Calcium Channel Blockers -dipine

Action:Inhibits movement of Ca across the cellmembrane into cardiac and smooth muscles

1. verapamil ( Calan, Isoptin)2. nifedipine (Procardia)3. diltiazem (Cardizem)4. amlodipine (Norvasc)5. felodipine ( Plendil)6. nicardipine (Cardene)7. nimodipine (Nimotop)

Side Effects:

1. Bradycardia2. Hypotension3. Headache4. Dizziness5. Constipation

Diuretics

1. LOOP DIURETICSAction: inhibit NA & Cl reabsorption at theloop of Henle

1. furosemide (Lasix)2. ethacrynic acid (Edecrin)3. bumetamide (Bumex)4. torsemide (Demadex)

2. THIAZIDE DIURETICS

Action: blocks Na reabsorption in the DCT 1. chlorothizide (Diuril)

2. hydrochlorothiazide ( HydroDIURIL,Esidrex)

3. benzthiazide (Exna)

3. OSMOTIC DIURETIC

Action: inhibit reabsorption of F/E1. mannitol (Osmitrol)

Side Effects:

1. Orthostatic Hypotension2. Hyperuricemia3. Drowsiness4. H/A5. Anorexia6. Hypokalemia except K-sparing7. Rash8. Hyponatremia9. Dehydration

For Thiazide:1. Hypercalcemia

For K-sparing:1. Hyperkalemia

Nursing Considerations:

1. Give early in the morning. (preventnocturia)

2. Monitor I/O and weight.

3. Make positional changes slowly.4. Administer with food.5. Monitor for fluid and electrolyte

Imbalance.HYPOKALEMIA

HYPERKALEMIA

HYPERCALCEMIA6. Assess BP before administration.7. Consume foods rich in K.

16


17/23

2. urea (Ureaphil)

4. POTASSIUM SPARING DIURETIC

Action: blocks aldosterone, inhibitsreabsorption of water & Na

1. spironolactone (Aldactone)2. amiloride ( Midamor)3. triamterene ( Dyrenium)

5. CARBONIC ANHYDRASEINHIBITORS

Action: Promotes excretion of Na, K, HCO3,and water.

1. acetazolamide (Diamox)2. dichlorphenamide (Daranide)3. Methazolamide (Neptazane)

NOTE: OSMOTIC

DIURETICS DECREASE

ICP; DEC. IOP IN

NARROW-ANGLE

GLAUCOMA

NOTE: CAI DECREASE

IOP IN OPEN-ANGLEGLAUCOMA; USED TO

TREAT METABOLIC

ALKALOSIS

8. For potassium sparing:

Monitor for kidneyfunction. Avoid K-rich foods.

9. Antidote for Hyperkalemia:*Na polystyrene sulfate (Kayexalate)-exchanges Na for K in the colon;rectal or oral*IV NaHCO3 = promotes intracellularshift of K*Insulin and glucose = promotesintracellular shift of K

DIRECT ACTING VASODILATORS

Action:Promotes direct relaxation of

arteriolar smooth muscle causing vasoldilation.

1. hydralazine (Apresoline)2. nitroprusside ( Nipride, Nitropress)3. diazoxide ( Hyperstat)4. nitroglycerine (Nitrobid)5. minoxidil (Loniten)

Side Effects:

a. Hypotensionb. Palpitations

c. H/A

d. Confusion and dizziness

Nursing Considerations:

1. Monitor V/S.

2. Na Nitroprussidea. Monitor cyanide and

thiocyanate levels.

b. Protect from light. (cos drug

decomposes) IV tubing andcontainer must be covered in

aluminum foil.

c. Discard if medication isred/blue.

DOC for Angina Pectoris: NTGDiuretic drug for cerebral edema: Mannitol (Osmitrol)Calcium Sparing Diuretic: ThiazideDiuretic for Metabolic Alkalosis: CAIDrug used for Hypertensive Crisis: Nitroprusside (Nipride)

Beta blocker used to tx akathisia: Propranolol (Inderal)

NITRATES

Action: Decrease preload and afterload thus reduce myocardial oxygen consumption.

1. nitroglycerine (Nitrostat,Nitrobid)2. isosorbide dinitrate (Isordil)3. isosorbide mononitrate (Imdur)Onset:SL: 1-3 minsSR Cap: 20-45 minsUng: 20-60 minsPatch: 30-60 minsIV: 1-3 mins

Side Effects:Headache

Orthostatic HypotensionDizzinessFaintnessFlushing or pallor

Patch/Ung Sites:Chest, back, abdomen, upperarm, anterior thigh

Nursing Management:

1. Rise slowly.2. Best taken when seated

3. Expect for headacheSL:1. One tablet every 5 minutes (for atotal of 3 doses).2. Store drug in a dark container3. Shell life: 3 - 6 months4. Expect for SUBLINGUALTINGLING (potent)Patch:1. Apply on hairless area2. Remove patch after 12-14H (remain

patch free for 10-12H to avoidtolerance)Ung:1. Remove previous Ung from skin2. Spread over a 6x6 inch area & coverw/ a plastic wrap

17


18/23

CARDIAC GLYCOSIDES/DIGITALIS

ACTION: positive inotropy (thus increasing cardiac output; used for CHF); negative chronotropy

1. digoxin ( Lanoxin)2. digitoxin ( Crystodigin)

SE:

-dizziness, drowsiness-fatigue-insomnia-H/A

Monitor for toxicity:

BradycardiaAnorexia

N/VDiarrheaAbdominal crampsVisual disturbancesblurred vision, green or

yellow halos

Nursing Management:1. Assess APICAL PULSE (withhold if60 bpmElectrolyte to monitor when taking digoxin: PotassiumEarliest Sx of Digoxin toxicity: BradycardiaAntidote for Digoxin: Digoxin Immune Fab (Digibind)Effect of Hypokalemia in clients taking Digoxin: Increased risk for toxicity

ANTICOAGULANTS

Action: Inhibits clot formation.Subcutaneous:

1. heparin (Liquaemin)2. enoxaparin (Lovenox)3. ardeparin (Normiflo)4. danaparoid (Orgaran)(therapy: 7-14days)

Side effects:

a. Hemorrhageb. Hematuriac. Epistaxisd. Ecchymosise. Bleeding gumsf. Thrombocytopeniag. Hypotension

Nursing Management:

1. Do not aspirate (to preventhematoma)2. Antidote at bedside:

Heparin: Protamine sulfateWarfarin: Vitamin K

3. Monitor Coagulation tests:Heparin: aPTT

(N:20-36s x INR: 1.5-2/ maintain at60-80s)

Warfarin: PT(N:9.6-11.8s x 2-3 =19 -36)

4. For warfarin:a. desired effect: 2-3 days

b. avoid green leafy vegetables

ORAL: (blocks prothrombinsynthesis)

1. warfarin (Coumadin) (usu given for 2-3mos after MI)2. bihydrooxycoumarin (Dicumarol)3. anisindione (Miradon) (Orderedseldomly)

Nursing Management: very important1. Assess for bleeding 2. Bleeding Precautions: 3. Avoid taking with ASPIRIN

THROMBOLYTICS -ase

Action: Dissolve clots.

Indicated: Pulmonary emboli, DVT, MI (w/in 4-6H of the onset of the infarct to restore bloodflow)

1. streptokinase (Streptase)2. urokinase (Abbokinase)3. alteplase (Tissue Plasminogen Activator [t-PA])

Side Effects:

a. Bleeding

b. Dysrhythmiasc. Feverd. Allergic Reactions

Nursing Management:1. Bleeding precautions.

2. Asses pulses. (tachycardia)3. Pressure over puncture site for20-30 mins.4. Use electric razor for shavingand soft toothbrush.5. Antidote: Aminocaproic acid(Amicar)

18


19/23

Rapid acting anticoagulant: Heparin (Liquaemin) Used to monitor effectiveness of warfarin: PTFoods to avoid if on Dicumarol: Vit K rich foods Antidote for Heparin: ProtaminesulfateAntidote for Thrombolytics: Aminocaproic acid (Amicar) Antidote for Warfarin: Vit. K

DRUGS AFFECTING THE DIGESTIVE SYSTEMANTI-ULCERS

ANTACIDS:

Action: Neutralize gastric acids (by inactivating pepsin)ALUMINUM-BASED:

1. aluminum hydroxide(Amphojel)

2. aluminum carbonate(Basaljel)

Side Effect:-Constipation

MAGNESIUM-BASED:1.magnesium hydroxide

(Milk of Magnesia)

Side Effect:-Diarrhea

CALCIUM-BASED:1.calcium carbonate

(Tums, Dicarbosil)

Side Effect:-Constipation, belching,flatulence, HyperCa,H/A

Al-Mg COMBINATION1. Mg-Al hydroxide

( Maalox, Mylanta)2. Mg-Al trisilicate

(Gaviscon)3. magaldrate (Riopan)

Nursing Management: Antacids

1. Taken 1-2 hours after meal.2. Never give along with other drugs.(1H gap)

H2 BLOCKERS -tidine TPAZ

Action: Supress secretion of gastric acid.1. cimetidine (Tagamet)2. famotidine (Pepcid)3. nizatidine (Axid)4. ranitidine ( Zantac)

Side Effects:

a. Confusionb. Dizziness, drowsinessc. H/Ad. Depression

Nursing Management:1. Taken with meals.2. Never give along with antacids.(decrease absorption)3. Stop smoking. (dec effect)4. Caution with CNS S/Es.

PROTON PUMP INHIBITORS: -prazoleAction: Supress secretion of gastric acidup to 90% greater than H2 blockers.

1. esomeprazole (Nexium)2. lansoprazole ( Prevacid)3. omeprazole ( Prilosec)4. pantoprazole (Protonix)5. rabeprazole (Aciphex)

Side Effects:a. Diarrheab. Abdominal painc. Nausead. H/A

Nursing Management1. Taken before meal2. Monitor lab tests

- liver function test- renal function test

MUCOSAL PROTECTIVE DRUGS

ACTION: Covers and protect the

ulcer from acid and pepsin.

1. sucralfate (Carafate)2. misoprostol (Cytotec)

Side Effects:For Sucralfate:

a. Sleepiness

b. Constipationc. Dry mouthd. back pain

For Misoprostol:a. Diarrheab. Abdominal painc. Flatulence

Nursing Management:1. Taken before meals and HS.2. Increase fluids, dietary bulk, , and

exercise.3. Separate administration from otherdrugs. (by 2H;dec absorption of

warfarin, phenytoin, theophylline,digoxin, tetracycline)4.Avoid gastric irritants. (caffeine,alcohol, spices)For Misoprostol:1. Taken with meals.2. CI in pregnant women.

DOC for GERD: Proton Pump Inhibitors especially esomeprazole (Nexium)

Common side effect of Magnesium-based:Common side effect of Aluminum-based:Antacid of choice for hyperphosphatemia:H2 blocker that has CNS side effects: Cimetidine (Tagamet)An abortive drug: Misoprostol (Cytotec)

19

for aluminum based: for calcium based: for magnesium based:

-Hypophosphatemia -dont take w/ Vit D -CI for RF


20/23

PAIN MEDICATIONS:

NON-NARCOTICS:1.acetylsalicylic acid (Aspirin [Ecotrin,Bayer, Aspilet] [buffered: Alka-Seltzer, Bufferin])

4 AsAntipyretic

AnalgesicAnti-inflammatoryAntiplatelet

Side Effects:a. GI Bleeding (melena,hematochezia)b. Epistaxisc. Bruisingd. Diarrhea

Aspirin/ SalicylateToxicity:a. Tinnitus (earliest)b. Confusionc. Dizzinessd. Metabolic acidosise. Respi alkalosis

Nursing Management:1. Take with food, antacid, or milk.2. Avoid giving to children with Viral

Infection. (may cause Reyes Syn)3. Never give along with anticoagulants.(potentiates anticoag)

4. Report signs of bleeding.5. Assess for hearing problems.6. Avoid use in pregnant women.7. Should not be taken with NSAIDs.(dec effect of nsaids)8. D/C 3-7 days before surgery.

2. acetaminophen ( Tylenol)

-Antipyretic-Analgesic

Side Effects:a. Anorexiab. N/Vc. Hypoglycemiaadverse effect:

HEPATOXICITY

Nursing Management:1. Assess history of liver dysfunction.2. Monitor hepatic damage. (N/V,diarrhea, abdominal pain)3. Monitor liver enzyme tests.4. Antidote: Acetylcysteine (Mucomyst)

NSAIDS:

Action:Inhibit synthesis of Prostaglandin(prostaglandin inhibitors)

Indications: Pain, Arthritis1. diclofenac Na (Voltaren)2. ibuprofen (Motrin, Advil)3. naproxen (Flanax, Naprosyn,

Anaprox)4. ketorolac (Toradol) (1st injectableNSAID [IM])5. piroxicam (Feldene)6. indomethacin (Indocin)7. mefenamic acid (Ponstan)8. sulindac (Clinoril)9. diflunisal (Dolobid)

Side effects:a. Gastric irritationb. Dizzinessc. Tinnitusd. Hypotensione. Na and H2O retention

Nursing Management:1. Take with food.

2. Do not take with Aspirin.

3. Monitor liver enzymes.

NARCOTICS/OPIATES

Action: Blocks pain receptors. (induces

sedation, analgesia, euphoria)Indications: Moderate to severe pain1. morphine (Morphine SO4)2. codeine (Codeine SO4)3. meperidine HCl (Demerol)4. oxycodone (Oxycontin)5. propoxyhene (Darvon)6. methadone (Dolophine)7. hydromorphone (Dilaudid)8. fentanyl (Duragesic)9. pentazocine (Talwin)

10. nalbuphine (Nubain)11. Butorphanol (Stadol)

Side Effects:a. Dizziness

b. Decrease RRc. Hypotensiond. Constipation

*Oxycodone + Aspirin:

Percodan

*Oxycodone +

Acetaminophen:

Percocet

*Darvon contains aspirin

*Darvon-N:acetaminophen

Nursing Management:1. Assess RR/VS. (w/hold:RR=12cpm)

2. Antidote at bedside*Narcan = IM, IV, SC: qive q2-3 mins

*Revia = PO once per day givenafter Narcan* 3. Avoid alcohol. (CNS depression)4. Safety precautions. (CNS depression)-side rails, night light, supervisedambulation

Narcotic of choice for pancreatitis (pain): Meperidine HCl (Demerol)NSAID used for the closure of Patent Ductus Arteriosus: Indomethacin (Indocin)Drug of choice for opioid withdrawal: Methadone (Dolophine) (replacement med for opiate dependence/withdrawal)

20


21/23

ENDOCRINE DRUGS

INSULIN -action: Facilitates transport of glucose across the cell.SHORT-ACTING INTERMEDIATE LONG-ACTING

Insulin Type Regular-Regular Iletin

-Humulin R-Novolin R-Semilente

NPH (Isophane)- NPH Iletin

-Humulin N- Actrapid N- Lente

Ultralente- Humulin U

Onset 30 mins 1H 2 4 H 6 12 H

Peak 2 4H 6 -12 H 18 24 H

Duration 6 12H 18 24 H 36 72 H

Nursing Management:

1. Rotate injection sites. (lipodystrophy: lipohypetrophy=devt of fibrous fatty masses caused by repeateduse of an injection site; abdomen, arms [posterior], thigh [anterior], hips)2. Do not massage. (increase absorption rates thus hypoglycemia)3. When mixing 2 insulins : *Inject air: N R *Withdrawing of insulin: R- N4. Stable at room temperature, if prefilled or mixed keep refrigerated (not frozen).5. Dont inject cold insulin. (lipodystrophy: lipoatrophy loss of SC fat and appears as slight dimpling)6. Gently roll insulin bottle before use. Dont shake. (to ensure insulin is mixed well; bubbles will cause

inaccurate dosage)7. Monitor blood glucose level.8. Avoid smoking. (dec insulin absorption)9. Assess for hypoglycemia

T -tiredI -irritabilityR -restlessE excessive hungerD -diaphoresis

ORAL HYPOGLYCEMIC AGENTS

- Sulfonylureas:Action: Stimulates beta cells of the pancreas

to produce more insulin.chlorpropamide (Diabinese)

tolazamide (Tolinase)tolbutamide (Orinase)

- second generation sulfonylureas:glimiperide (Amaryl)glipizide (Glucotrol)

glyburide (Diabeta)

-Non-Sulfonylureas:Action: hepatic glucose production

metformin (Glucophage) acarbose (Precose) miglitol (Glyset) rosiglitazone (Avandia)

NURSING ALERT!!!* Assess allergy to sulfur!!! [For sulfonylureas]* Take with meals.* Avoid alcohol. [trigger hypoglycemic rxn]

*Inform the client that insulin is needed during stress, infection, or surgery.

Only IV type Insulin: Regular insulinSite with even and rapid insulin absorption: AbdomenDistance between insulin site injections: 1 inches (2.54 cm)Most common premixed insulin: NPH Regular

21

Intervention for Hypoglycemia:if conscious: give fast acting simple CHOif unconscious:

hospital: 25 50 ml of D50 Whome: Glucagon (SC/ IM, 2nd dose at 10mins if client remains unconscious))


22/23

ANTIINFECTIVE MEDICATIONS

1. ANTIBIOTICS

Aminoglycosides: -micin or -mycinIndications: gram negative infections

-Escherichia Coli-Klebsiella-Enterobacter

1. gentamicin sulfate (Garamycin)2. neomycin sulfate (Mycifradin)3. kanamycin sulfate (Kantrex)4. streptomycin sulfate (Streptomycin)

Fluoroquinolones: -floxacinbroad spectrum

Indications: wide range of gram + and gram -UTI -bronchitis

-STDs -bone and joint infection1. ciprofloxacin (Cipro)2. levofloxacin (Levaquin)3. norfloxacin (Noroxin)4. ofloxacin (Floxin)

Cephalosporins ceph/-cefFirst Generation Second Generation Third Generation

1. cefadroxil (Duricef)2. cefazolin (Ancef, Kefzol)3. cephalexin (Keflex)4. cephapirin (Cefadyl)

1. cefaclor (Ceclor)2. cefmetazole (Zefazone)3. cefonicid (Monocid)4. cefotetan (Cefotan)5. cefoxitin (Mefoxin)6. cefpodoxime (Vantin)7. cefprozil (Cefzil)8. cefuroxime (Zinacef)

1. cefdinir (Omnicef)2. cefixime (Suprax)3. cefoperazone (Cefobid)4. cefotaxime (Claforan)5. ceftazidime (Fortaz)6. ceftibuten (Cedax)7. ceftizoxime (Cefizox)8. ceftriaxone (Rocephin)

Macrolides: -mycin

1. erythromycin (Erythrocin)2. azithromycin (Zithromax)

3. clarithromycin (Biaxin)

Pennicillins: -cillin

1. amoxicillin (Amoxil)2. ampicillin (Omnipen)

3. cloxacillin (Apo-Cloxi)4. methicillin (Staphcilin)5. penicillin G (Pentids)6. penicillin V (V-Cillin)7. amoxicillin cluvanate (Augmentin)

Sulfonamides: -sulf

1. sulfixazole (Gantrisin)2. sulfamethoxazole-trimthoprim(Bactrim)3. sulfasalazine (Azuldifine)

Tetracyclines: -cycline

1. tetracycline (Achromycin)2. doxycycline (Vibramycin)3. democlocycline (Declomycin)4. minocycline (Minocin)

Nursing Management:1. Obtain culture 4. Monitor I&O and renal function2. Monitor for allergic reaction 5. Adequate hydration3. Taken best on empty stomach 6. Monitor hearing and balance

2. ANTIVIRALS1. acyclovir (Zovirax)2. cidofovir (Vistide)3. indinavir (Crixivan0

4. ritonavir (Norvir)5. ganciclovir (Cytovene)

Antiretrovirals:6. zidovudine (AZT,Retrovir)7. lamivudine (Epivir)8. stavudine (Zerit)9. nevirapine (Viramune)

Adverse Effects:-Bone Marrow Suppression-Nephrotoxicity

Side Effects:1. headache2. nausea and vomiting

Nursing Management:1. Monitor CBC2. Increase Vitamins ACE3. Increase Fiber

22


23/23

3. ANTIFUNGALS

1. amphotecerin B(Fungizone)2. ketoconazole (Nizoral)3. miconazole (Monistat)4. nystatin (Mycostatin)5. clotrimoxazole (Mycelex)6. fluconazole (Dilfulcan)

Indications:1. candidiasis2. histoplasmosis3. ringworm infections of

the skin

Nursing Management:1. Monitor BUN, Creatinine,2. Take with food3. Take full course of meds4. Hygeine measures5. Infusion pump

4. ANTIPROTOZOAL

1. metronidazole (Flagyl)2. eflornithine (Ornidyl)3. hydroxychloroquine (Plaquenil)4. pentamidine (Pentam 300)

Indications:1. Trichomoniasis2. Amoebiasis3. Giardiasis4. PCP5. Malaria

Nursing Management:1. best taken with food

2. avoid alcohol

3. Monitor S/Es:

4. Reminder: this drug is teratogenic

Remember:

1. Metronidazole (Flagyl) should not be taken with alcohol because it can cause disulfiram-like reactions

(Antabuse-like reactions).

2. Remember the brand names and the different preparations of Lithium carbonate.3. Diazepam (Valium) is commonly asked in the exam.

4. Propofol (Diprivan) is a sedative given to clients in mechanical ventilation and to those undergoing surgical

procedures. It is milk-like or cream-like in color. This is given intravenously. It was rumored that M.J. diedfrom propofol overdose.

5. R.A. 9165 Comprehensive Dangerous Drugs Act of 2002

6. R.A. 9502 Cheaper Medicines Act of 2008 authored by Sen. Mar Roxas7. R.A. 6675 Generics Act

Date post:	07-Apr-2018
Category:	Documents
Upload:	dominic-llamera-reambonanza
View:	218 times
Download:	0 times

Pharma for Students

Documents