NURS 221013 pages basic drugs

ANTIHYPERINTENSIVES • Alpha 2 agonists – stimulate the inhibitory receptors, inhibit SNS, central • Clonidine (Catapres) • Alpha 1 blockers – block peripheral receptors • “zosin” • Beta blockers – peripheral acting, B1 – heart only, nonselective B1 & B2 • affects lungs • “olol” • Alpha & Beta blockers – block peripheral receptors • “ilol” ANTICOAGULATION Heparin PG 4 Warfarin (Coumadin) • Related to Vitamin K which is a precursor to clotting factor, inhibits Vit K action • Vitamin K is antidote o IV – risk for anaphylaxis, over 30 min., dilute, use lowest dose possible) o PO – preferred • Chapter 54 – Anemic Drugs Epoeitin alfa (Epogen) • Stimulates erythropoiesis • Synthetic erythropoietin – released by kidneys to increase RBC Production • Iron • Needed for RBC production and O2-carrying capacity • “ferrous” medications • Antibiotics Chapter 23- Angina Medications • PO – be aware of sustained release preparations, take on empty stomach unless GI upset occurs, then can be taken with food • Nitrates • These medication are considered first-line, gold-standard for angina. • They cause venous and arterial dilation, which decreases preload & afterload. • “Nitrate” or “nitro” in generic names. Beta Blockers Calcium Channel Blockers -“olol” medications - “dipine” meds, diltiazem (Cardizem) • Chapter 24 – Heart Failure Medications o These are repeat drugs – Other drugs to know – nesiritide, digoxin • ACE Inhibitors • ARBs • Beta Blockers • Diuretics Nitrates BNP-Nesiritide (Natrecor) • Causes arterial and venous vasodilation • Used in ICU as last resort but you may see used on cardiac units • Adults only, not administered to pediatric patients • Adverse effects: hypotension, dysrhythmias, headache • Interactions: anti-hypertensives • IV infusion Cardiac Glycosides-Digoxin (Lanoxin)This medication is a positive inotrope (increased contractility), This drug is no longer first line and is used only after others fail and in combination with other drugs. Contraindications: • 2nd / 3rd degree heart block (may block last resort electrical impulses) • Diastolic failure (problem is filling, not pumping) • Aortic stenosis (pushing against high pressure, less flexible area) • Chapter 25 – Antidysrhythmics Therapies used in addition to medications: • Pacemaker (heart block, severe bradycardia, asystole) • Defibrillation • Cardioversion Chapter 27 – Antilipemic Medications o Specific drugs to know – statins HMG-COA Reductase Inhibitors “statins” First-line medications Decrease LDL and small increase in HDL Decrease cholesterol production Maximum therapeutic level 6-8 weeks Prodrugs – lovastatin, simvastatin • Chapter 12 – CNS Depressants/Muscle Relaxants o Specific drugs to know – benzodiazepines, barbiturates • Barbiturates These medications decrease nerve impulse transmission and depress the CNS. They are Schedule II – IV drugs, depending on the medication. Phenobarbital is a Schedule IV drug. These drugs end in “barbital.” • Overdose – CNS, Resp depression, phenobarbital coma, activated charcoal is the antidote, may do forced diuresis Benzodiazepines These are CNS depressants that inhibit brain stimulation. These drugs end in “zepam” and “zolam” and are Schedule IV Controlled Substances • Overdose – severe CNS depression, hypotension, resp. distress (especially when given with other CNS depressive medications); flumazenil is antidote Interactions:Grapefruit juice Considerations:Take on an empty stomach unless GI upset Chapter 13 – CNS Stimulants • Caution with use in pediatrics Xanthines Caffeine • Can give to premature infants for respiratory distress o Specific drugs to know – amphetamine aspartate (Adderall), methylphenidate (Ritalin), sumatriptan (Imitrex), atomoxetine (Strattera) Amphetamines Increase alertness, euphoria, sympathetic nervous system resp. effects These drugs have long duration and action Indications: ADHD, narcolepsy, obesity • “phetamine” drugs, such as dextroamphetamine (Dexedrine), amphetamine aspartate (Adderall) Methylphenidate (Ritalin)(synthetic Serotonin Receptor Agonists Stimulate serotonin receptors and the CNS, also cause vasoconstriction Indications: migraines (treatment, not prevention)(first-line) Contraindications: caution with severe cardiac problems, allergy Examples: • Sumatriptan (Imitrex) • “triptan” drugs • Atomoxetine (Strattera) • This is a nonstimulant that acts like a stimulant and increases norepinephrine uptake to increase SNS. • Has a lower abuse potential and does not cause insomnia as much as stimulants. Still has increased risk of suicide in adolescents. • Indications: ADHD, narcolepsy, only for adults and children >6 years old Chapter 16 – Psychotherapeutics Specific drugs to know – tricyclic antidepressants, SSRIs, lithium, haloperidol, buspirone, buproprion Tricyclic Antidepressants These drugs are used for depression, neuropathic pain, insomnia, but are not considered first-line drugs. The drug imipramine can also be used for nocturesis, or bedwetting. The drug clomipramine is used for OCD (obsessive-compulsive disease). These drugs increase serotonin and norepinephrine. Examples: • “ipramines” • Amitriptyline (Elavil) SSRIs These drugs inhibit the reuptake of serotonin (makes more available). Used for depression, bipolar disorder, obesity, eating disorders, OCD, panic disorder, PTSD, alcoholism, and other uses (wide range of mental health problems). Contraindications: allergy, severe heart or seizure disorders Interactions: MAOI, warfarin (Coumadin), fiber supplements, phenytoin (Dilantin) Adverse effects: • Insomnia • Wt gain • Sexual dysfunction Examples: • “line” or “tine” • drugs , such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) • “opram” drugs, such as citalopram (Celexa), escitalopram (Lexapro) Lithium Lithium is a mood stabilizer that increases serotonin. It is an anti-manic drug used to treat bipolar disorder. This drug may be used in combination with other psychotherapeutic meds. It has a narrow therapeutic range and requires blood-level monitoring. The normal lithium level is 1-1.5 (acute treatment) and 0.6-1.2 (chronic or maintenance dosing). Blood levels are taken 8-12 hours after last dose. Antipsychotics (HALOPERIDOL) These drugs block dopamine. They are indicated for psychoses, drug abuse, schizophrenia, autism, mania, bipolar disorder, and severe depression. Interactions: antihypertensives, CNS depressants, grapefruit juice Examples: • Phenothiazines “azine” medications • Phenylbutylpiperidines, such as haloperidol (Haldol) Buspirone (Buspar)Increases serotonin and dopamine stimulation with less sedation and dependence risk as other medications.Used for anxiety Buproprion (Wellbutrin)(Do not confuse with Buspirone Dopaminergic medication indicated for depression, smoking cessation • Chapter 36 – Upper Respiratory Medications Which drugs cause sedation? Diphenhydramine (Bendadryl) • Sedation and issue, caution with elderly, CNS depressants, and alcohol Specific drugs to know – antihistamines, pseudophedrine, phenylephrine , dextromethorphan,benzonatate, guafinesin Antihistamines Histamine is released as part of any inflammatory or allergic (hypersensitivity) process. These drugs block histamine receptors so the histamine cannot become active on the basophils or mast cells. They do not kick histamine off of the receptor. Rather, they can only bind to an unoccupied receptor. Effects include dried secretions, drowsiness, decreased nerve and smooth muscle stimulation, decreased urine output or difficulty with urination, elevated HR or palpitations but….Sometimes you want dried secretions. Sometimes you want to sleep Take as directed (even if OTC) Decongestants (pseudophedrine, phenylephrine Three routes: oral (systemic effects), inhaled or topical (local effects). There is quicker but shorter acting effects when inhaled or topical routes are used, but oral medications take a bit longer to act. Rebound congestion is common when using topical adrenergic decongestants • adrenergics (mimic the sympathetic nervous system) o shrink nasal mucous membrane arterioles (opens passage and decreases circulation to area) o pseudophedrine o phenylephrine o here but also available as an inhaler) Nonopioid(dextromethorphan): Benzonatate Dextromethorphan (Robitussin, Zelsyn)( Suppresses the cough and dries up secretions) Benzonatate (Tessalon Perles) (numbs cough receptors) • Less effective than opioids • Contraindications (dextromethorphan): o Hyperthyroidism o Hypertension o Glaucoma o MAOI Expectorants Guaifenesin INCREASE FLUIDS These meds help cough up secretions and rid the body of them. This is helpful when there is excess mucus. They reduce the viscosity of secretions and are assisted by increased water intake. Chapter 37 – Lower Respiratory Medications Specific drugs to know – albuterol&salmeterol. theophylline, montelukast, fluticasone maintenance, and more long-acting meds are great for maintenance only. Short-acting beta-adrenergic agonists • Albuterol (Ventolin) Long-acting beta-adrenergic agonists • Salmeterol (Servent) Nonbronchodilators These drugs help with respiratory problems but not by dilating the bronchioles. They each work in different ways. Class #1 – Leukotriene receptor antagonists Montelukast (Singulair) Leukotrienes are produced during an immune response to some type of trigger or allergen. These substances cause inflammation (swelling, mucus, and constriction). These drugs, in one way or another, decrease the action of leukotrienes. Drugs to know: PG 28 • Montelukast (Singulair) Interactions: • TB drugs • Warfarin • Erythromycin • Aspirin Class #2 – Corticosteroids • Fluticasone (FLovent) Class #3 Xanthine Derivatives theophylline) These are plant alkaloids (caffeine & theophylline) and synthetic xanthines (aminophylline). Caffeine is actually a metabolite of the drug theophylline, and aminophylline is metabolized to theophylline.The energy substance we all love, called cAMP, relaxes smooth muscle and dilates the bronchioles. What else does this do? Revs up that SNS! This is helpful for chronic lung patients who experience a decreased respiratory drive and CO2 retention. On the side, the cAMP substance inhibit some parts of the allergic response.These drugs are kind of heavy on the adverse effects & interactions, though, so they are not used as much, especially in minor cases. They are also considered slow onset. Aminophylline is administered IV and only in severe cases, so we will cover that more in pharm III; however, all of the information here applies. Chapter 41 Antituberculosis Rifampin (Rifadin) Isoniazid (INH)** - may be used by itself (can cause pyridoxine (vit B6) deficiency) If GI upset occurs – take with food (otherwise empty stomach) IV site care and prevention of extravasation with IV doses Sun protection for photosensitivity Emphasis on nutrition to fight infection (this may be issue for most patients with TB) Alternate method of birth control because of interference with oral contraceptives Chapter 14 Antiepileptic Phenytoin (Dilantin) Classification - hydantoin Call if skin rash appears in pediatric patient IV site care very important – highly irritating to veins, danger of extravasation (in rare cases can lead to necrosis and amputation) fosphenytoin (Cerebyx) Related to phenytoin but designed to have less of the risk Injection only (IM or IV) Give slow to avoid hypotension or respiratory depression Chapter 15 Antiparkinson’s Amantadine (Symmetrel) Dopamine Modulators 32 This drug works in a few ways but ultimately makes more dopamine available where it is needed. You can read about this in your text if you are interested in the specifics. This drug also has slight anticholinergic properties. The problem is that the drug only works short-term (short-term compared to the duration of the disease at 6 months to a year). An interesting fact is that this drug is also used as an anti-viral for influenza. Carbidopa-levodopa (Sinemet) Dopamine Replacement Drugs This is what we have been waiting to discuss…the meds that actually replace the dopamine (levodopa). In order for levodopa to be activated, it must be combined with carbidopa (carbidopa-levodopa). Why don’t we just give oral dopamine? Contraindications Glaucoma (as with other adrenergic drugs) Adverse effects Amino acids/dietary protein (portion control) (take ½ hr before protein meal) Chapter 18 Adrenergic Medications Neurotransmitters for the SNS are called catecholamines and include epinephrine, norepinephrine, and dopamine. Dobutamine is a synthetic catecholamine. Phenylephrine & albuterol are also adrenergics but were discussed in respiratory. Chapter 19 Adrenergic-blocking medications Class #1 Alpha Blockers Medications to remember “zosins” 34 Doxazosin (Cardura)00 Prazosin (Minipress) Terazosin (Hytrin) Tamulosin (Flomax)(for BPH) Phentolamine (antidote for sympathetic drug extravasation) Contraindications Toxicity Activated charcoal Support ABCs and vital signs+ Anticonvulsants for seizures Class #2 Beta Blockers Block B1 only (cardio-selective) or B1 and B2 (nonselective)(really wouldn’t want to block B2 only) Medications to remember “olols” Metoprolol (Lopressor)(selective) atenolol (Tenormin)(selective) esmolol (Brevibloc)(more in pharm III) propranolol (Inderal)(nonselective)(not with asthma 3 pageToxicity Atropine (anticholinergic) for bradycardia Vasopressors (vasoconstrictors) for severe hypotension Support ABCs and vital signs Anticonvulsants for seizures Pacemaker if needed Class #3 Alpha and Beta Blockers Have alpha1 and beta1 blocking Drugs to remember “ilol” or “alol” medications Carvedilol (Coreg) Labetalol (normodyne)(more in pharm III) Effects, interactions, and contraindications same as alpha and beta specific medications. Chapter 20 – Cholinergic medications These drugs are pro-parasympathetic nervous system drugs (parasympathomimetics). This is the “rest & digest” version of the ANS. Acetylcholine is the neurotransmitter of interest here, and the receptors are nicotinic and muscarinic instead of alpha and beta like the SNS. Chapter 21 – Cholinergic-blocking medications These medications block the PSNS nervous system. They are also called PSNS antagonists, parasympatholytics, anticholinergics, cholinergic blockers, or antimuscarinic medications Atropine - Atropine - Atropine General effects: Increased heart rate (dose and med dependent), vasodilation or vasoconstriction (vs, symptom support, safety) Bronchodilation (resp. assessment) Nursing considerations: Activated charcoal or physostigmine (a cholinergic with high adverse effect potential) as overdose treatment along with ABCs and safety, supportive treatment, including fluid balance Check labels in combination drugs Check carefully for drug/solution compatibility Follow directions carefully for timing, regard to meals, and route dependent instructions Chapter 30 Pituitary Drugs *lecture posted* Adrenal Cortex Medications/Hormones ACTH, corticotropin; cosyntropin Usually secreted by anterior pituitary to stimulate the adrenal cortex “tropin” usually indicates pituitary level Stimulates cortical release of the following hormones (discussed more in adrenal chapter) Growth hormone, somatotropin Usually secreted by anterior pituitary to simulate growth and anabolic processes throughout the body Results of anabolic stimulation Special instructions – Do not shake the solution Vasopressin Used for emergencies Adverse effects result of action – water retention, HTN, headache, low Na (dilutional), GI distress (electrolyte imbalance) Caution in renal disease (increases kidney workload), seizure disorder (low Na levels and fluid shifts can increase risk of seizures), CV and/or resp. disease (may increase fluid load on heart and lungs) Desmopressin Normal ADH effects plus blood clotting uses Can be used for nocturnal enuresis because of effects on output Can be given nasally Chapter 31 Thyroid drugs Levothyroxine (Synthroid) Adverse effects relate to increased thyroid action Contraindications MI (recent or acute) (increase workload) Hyperthyroidism (duh) Adrenal insufficiency (adrenal gland function is essential to the stress response, if it is insufficient, increased metabolism may cause a stress the body can’t handle) Interactions Hypoglycemic (may need to adjust doses based on effect on blood sugar) Calcium (decreases absorption, should not take with calcium supplements) Anticonvulsants (decrease the effects, look at risk vs benefit and adjust dose) Chapter 33 Adrenal drugs Glucocorticoids – prednisolone (Prednisone), methylprednisolone (Solu-medrol or Solu-cortef)(corticosteroids) Simulate action of cortisol with some minor mineralcorticoid effects Used as replacement, decrease inflammation, or decreased immune response) Effects again: Decrease inflammation (big reason they are used in many systems) Interactions K-depleting diuretics (K levels) NSAIDs (GI effects and risk of perforation) Immunosuppressants Antidiabetic meds Thyroid meds Oral contraceptives (not because they inactivate contraceptives but because the contraceptives increase the half-life of the glucocorticoid) Mineralcorticoids – fludrocortisone (Florinef) This is a medication that is used to exert stronger mineralcorticoid effects, but it also has a slight glucocorticoid effect. Effects Na and water retention (fluid and electrolyte balance, hypertension) K excretion (hypokalemia and all the problems that come with it) Increased intracranial pressure, seizures 40 Some glucocorticoid effects Contraindications Fungal infection Sepsis Interactions Steroids Anticonvulsants Estrogen K-depleting diuretics Digoxin (related to K dropping) Vaccines Salicylates (GI) Adrenal Cortex Medications Nursing considerations Do not discontinue abruptly (therapy suppresses adrenal action through feedback loop, if meds are discontinued abruptly, there is no adrenal function and leads to adrenal crisis (review in text)) Give PO with food or milk May need calcium and vitamin D supplement Report weight gain based on standard protocol Avoid caffeine, alcohol, aspirin, NSAIDs Rinse mouth after inhaled Chapter 57 – Ophthalmic Drugs Mydriatics – dilate Miotics – constrict Cycloplegics – paralyze, may also have dilatory properties Nursing considerations If administer too much – remove the excess and place pressure on inner canthus for a minute (this also helps decrease risk of systemic effects) Ointments are administered to conjunctiva rather than cornea Classifications/Action/Indication Cholinergic – Action: PSNS, miotic, Vasodilate eye vessels, Quick vs long-acting; Indications: Glaucoma, Iridectomy, Miosis, Mydriatic or cycloplegic reversal Sympathomimetic – Action: SNS, adrenergic, mydriatic, Aqueous humor drainage & decreased production (dose-dependent); Indications: Glaucoma, Ocular hypertension Beta Blockers – Action: Block SNS, Decrease aqueous humor production, Minimal effect on drainage; Indications: Glaucoma, Ocular hypertension Carbonic Anhydrase Inhibitors – Action: Sulfonamide, Inhibit carbonic anhydrase (enzyme involved in aqueous humor production); Indications: Glaucoma, Ocular hypertension Osmotic Diuretics – Action: Can be given locally or systemically, Increases osmolarity to draw out fluid for excretion; Indications: Ocular hypertension, Acute glaucoma complications, Post-surgical Prostaglandin Agonists – Action: Decreases intraocular pressure, Increases aqueous humor outflow, Long-acting; Indications: Glaucoma Antimicrobials/Antiinfectives – Action: Treat eye infections which should be taken very seriously; Local effects unless severe cases, then may administer systemic meds Antiinflammatory (NSAIDs and corticosteroids) – Action: Decrease inflammation and pain; Indications: Inflammation, Surgical Topical Anesthetics – Action: Decrease eye pain, anesthetic; Indications: Procedures & exams Anti-allergy Eye medications – Action: Decrease allergic symptoms via different mechanisms Cycloplegics – Action: Dilate, prevent accommodation; Indications: Exam or specific inflammation (atropine) Dye - Used to identify corneal defects and foreign objects Lubricants and Moisturizers Chapter 58 Otic medications Adult – pull pinna up and back; Child – pull pinna down and back To make sure med gets to right place, have the patient lie on side with affected side up. Have him wait a minute after administering the medication, and massage the tragus. Antiinfectives Antiinflammatory & corticosteroids Analgesics & anesthetics Cerumen softeners (wax emulsifiers) Chapter 28 – Diuretics w/ Chapter 29 – Fluid & Electrolytes medications that decrease K levels can also put the patient at risk for Dig toxicity, interact with corticosteroids, and may require K supplements K levels will need to be monitored for all of these drugs (whether high or low) Many of the classifications are sulfonamides and have the potential for cross-sensitivity. Which ones? Foods high in potassium – bananas, citrus, broccoli, potatoes, meats, fish, legumes The effectiveness of diuretics may be affected by long-term NSAID use. Because these drugs all have risk of fluid volume deficit, they can also increase risk of Lithium toxicity. Carbonic Anydrase Inhibitors These were discussed in the eye chapter because they are also used for glaucoma. 43 Drug to know: Acetazolamide (Diamox) Action Sulfonamide Inhibits enzyme Exchanges H+ and decreases HCO3 levels (makes it good for high bicarb) Decreases Na and water retention, increases excretion Contraindications Low Na or K Severe renal/hepatic problems Addison’s (adrenal insufficiency and fluid volume deficit) Cirrhosis Interactions Digoxin Corticosteroids Antiepileptics (ion gradients) Lithium Adverse effects Hyperglycemia, glycosuria (especially diabetics) Acidosis (decreased HCO3) (acid/base balance & ABGs) Hypokalemia Blood in urine/stool Loop Diuretics These are used most frequently and can work very quickly. They are also great because they can work even when renal function is significantly reduced. Drug to know: Furosemide (Lasix) Action: Sulfonamide Decrease NaCl absorption, increase excretion Some vasodilation Contraindication: Hepatic coma Severe electrolyte disorders Interaction: Nephrotoxic and neurotoxic meds such as certain antibiotics (vancomycin as example) Corticosteroids Digoxin Lithium Adverse effects: Hypokalemia, hyponatremia, hypocalcemia Ototoxicity/tinnitus 44 Blood disorders (torsemide) Increased uric acid, hyperglycemia Skin reactions Osmotic Diuretics These are generally administered IV and are not used frequently. They are potent diuretics. This was discussed in the eye chapter also. Drug to know: Mannitol (Osmitrol) Action: Increase osmolarity and osmotic pressure – draws fluid into blood supply for excretion Less effect on electrolyte levels Some vasodilation Able to decrease fluid levels fast Contraindications: Severe renal failure/anuria Pulmonary edema (pulls fluid to blood vessels and can congest lungs) Brain bleed (increases bleeding) Severe dehydration (gets rid of fluid fast) Adverse effects: Seizures and headache (fluid shifts) Pulmonary congestion Vascular dehydration (if successfully excreting large amounts of fluid) Thiazide Diuretics These drugs are often used in combination with other drugs and are not as potent. They also have a ceiling effect. Drug to know: Hydrochlorothiazide (HCTZ)(Hydrodiuril) Action: Sulfonamide Decrease NaCl and water absorption, increase excretion Contraindications: Severe renal failure/anuria Interactions: Corticosteroids Digoxin Lithium Adverse effects: Hypokalemia Hypercalcemia (this is different from loop diuretics), hyperglycemia, increased uric acid Decreased libido, impotence Potassium-sparing Diuretics These are the only diuretics that we discussed that will actually increase K levels. Drug to know: Spironolactone (Aldactone) Action: Inhibits aldosterone (Remember that aldosterone involves Na/water retention and K excretion) Decreases Na and water retention, increases excretion Decreases excretion of potassium (K-sparing) Contraindications: Hyperkalemia (remember there are MAJOR dangers associated with hyperkalemia) Severe renal/anuria (besides the extra workload on the kidneys, this can also increase the risk of hyperkalemia) Interactions: Lithium ACE Inhibitors (can also increase K levels) Week 1 •20 questions/day •10 mnemonics/day •20 terminology/day Week 2 •60 questions/ day •10 mnemonics/ day •20 terminology/ day Week 3 •100 questions/day •5 mnemonics/ day •10 terminology/ day Week 4 •120 questions/day •5 mnemonics/ day •10 terminology/ day