DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM: SYMPATHETIC NERVOUS SYSTEM

- Flight or Fight response - Major Neurotransmitter: EPINEPHRINE - Stimulates ALL o!" s"stems E#$EP% &I%'&(% - All )aso*onstri*ts E#$EP% P(PILS+ ,R-N$H(S+ (%ER(S

PARASYMPATHETIC NERVOUS SYSTEM

- Rest an! .igest - Major Neurottransmitter: A$E%5L$H-LINE - Inhi its ALL o!" s"stems E#$EP% &I%'&(% - All )aso!ilates E#$EP% P(PILS+ ,R-N$H(S+ (%ER(S

-.R(& $lassi/i*ations: 01 A!renergi* 21 S"mpathomimeti*s 31 $holinesterase 41 Anti*holinergi* A*tion: S%IM(LA%ES

-.R(& $lassi/i*ations: 01 A!renergi* ,lo*6ing Agents 21 Paras"mpathomimeti*s 31 Anti*holinesterase 41 $holinergi* A*tion: ,L-$7S

Alpha1 vasoconstriction BP Beta1 HR CO BP Beta2 relax smooth muscles (bronchodilation, uterine relaxation

vasodilation !BP !HR !CO !BP contraction o" smooth muscles (bronchoconstriction, uterine contraction

SIDE EFFECTS: SNS 1. Tachycardia 2. HTN 3. Dry mouth 4. Constipation 5. Urinary retention 6. Pupi and !ronchodi ation ". Uterine re a#ation $. %asoconstriction e#cept in smooth musc es

SIDE EFFECTS: PNS 1. &radycardia 2. Hypotension 3. 'ncreased sa i(ation 4. Diarrhea 5. 'ncreased urination 6. Pupi and !ronchoconstriction ". )timu ates uterine contraction $. %asodi ation e#cept in smooth musc es

SNS DRUGS
Adrenergic Drugs:
01 epinephrine 8A!renaline $hlori!e9 21 norepinephrine 8Le)ophe!+ Le)arterenol9 31 !opamine 8Intropin9 41 !o utamine 8.o utre:9

Indications a1 SH-$7: $ar!ia* stimulant 1 $AR.IA$ FAIL(RE

Nursing Management:
01 Best taken: EARLY MORNING 21 Assess HR ; ,P 8ta*h"*ar!ia'!"srh"thmias9 31 Monitor I'- 8(rgen*"'urinar" in*ontinen*e9 41 Monitor lung soun!s1 8Epi < pulmo e!ema+ ron*ho!ilator < a sen*e o/ =hee>ing9 ?1 A!minister through a large )ein 8E'NE91 @1 I/ e:tra)asation o**urs+ in/iltrate the site =ith normal saline an! phentolamine 8regitine91#

a1 al uterol 8Aentolin+ Pro)entil9 1 salmeterol 8Sere)ent9 *1 ter utaline sul/ate 8,rethine+ ,ri*an"l9 !1 isoproterenol 8Isuprel9 e1 ipratropium romi!e 8Atro)ent9 /1 ipratropium B al uterol 8$om i)ent9

?1 ,ron*ho!ilators:

a1 AS%HMA 1 ,R-N$H-SPASM *1 $AL

Anticholinergic: 01 atropine sul/ate 8Isopto9 21 s*opolamine 8H"!rolomi!e9 31 gl"*op"rrolate 8Ro inul9

Indications a1 Preanestheti* me! 8!secretions $ brad%cardia 1 M"!riati*s

a. Anti-EPS b. Anti-Parkinsonian

Nursing Management:

01 A)oi! !ri)ing 8 lurre! )ision9 21 En*ourage use o/ sunglasses 8photopho ia9 31 Relie)e !r" mouth 8har! *an!"+ i*e
*hips+ sugarless gum9 ?1

41 en>tropine 8$ogentin9 ?1 trihe:ipheni!"l 8Artane9 @1 iperi!en 8A6ineton9 C1 pro*"*li!ine 87ema!rin9

41 $I in glau*oma1 8e"e e:ams9

"luids $ hi&h "iber inta'e (Constipation # (# )onitor "or heatstro'e#

PNS DRUGS
Adrenergic Blocking Agents:
01 pra>osin 8Minipress9 21 phentolamine 8Regitine9 8Anti!ote /or:9 31 tera>osin 8H"trin9 41 reserpine 8Serpasil+ Serpalan9 ?1 nitroprussi!e 8Nipri!e9 @1 h"!rala>ine 8Apresoline9 C1 atenolol 8%enormin9 D1 propranolol 8In!eral9 E1 metoprolol 8Lopressor9 0F1 na!olol 8$orgar!9

Indications a1 H%N

Nursing Management:
01 Assess ,P

21 .o not !is*ontinue a ruptl" 8re/le: ta*h"*ar!ia9 31 Priorit" : SAFE%5 8Light-hea!e!+ !i>>"+ orthostati* h"potension9 41 .e*rease salt inta6e 8*an *ause e!ema'h2o retention9 ?1 In/orm regar!ing se:ual !i//i*ulties 8)aso*onstri*tion o/ smooth mus*les9

N-%E: Reserpine *an *ause !epression+ &I irritation+ impoten*e+ in*rease ris6 /or reast $A1

aka anticholinesterase 01 a*et"l*holine *hlori!e 8Mio*hol9 21 neostigmine 8Prostigmin9 31 p"ri!ostigmine 8Mestinon+ Regonol9 41 e!rophonium *hlori!e 8%ensilon9 ?1 ethane*ol 8(re*holine9 8use! to t: post op urine retention9

Cholinergic:

Indications a1 Miosis 1 M"asthenia &ra)is *1 (rinar" retention

Nursing Management:

01 Prepare anti!ote: atro!ine sul"ate !ralido#ime chloride $%AL& 21 E//e*ti)eness: -impro)e! mus*le strength 31 Monitor /or *holinergi* *risis 41 %a6e =ith !rug or /oo! 8G&I irr9

$ommon ,oar! E:am Huestions: .rug /or the !iagnosis o/ M"asthenia &ra)is: e!rophonium *hlori!e 8%ensilon9 .rug /or the pre)ention o/ Pre %erm La or: ter utaline sul/ate 8,rethine+ ,ri*an"l9 $ontrain!i*ate! /or &lau*oma: Anti*holinergi*s $ommon emergen*" !rug /or allergi* rea*tion an! ron*hospasm: Epinephrine 8A!renaline9 .rug o/ *hoi*e /or h"pertensi)e $risis: phentolamine mes"late 8Regitine9I nitroprussi!e 8Nipri!e9 .rug /or (rinar" Retention: ethane*ol 8(re*holine9 .rug /or ,PH: tera>osin 8H"trin9 8rela:es la!!er sphin*ter9 8.-$: /inasteri!e JPros*arK<an!rogen inhi itor9

PSYCHOTROPIC AGENTS

AN'IAN(IE'Y ) AN(IOLY'IC* Re"erred to as: a1 Antian:iet"

+, Ben-odia-e!ine . am/0 . !am/ .ia>epam 8Aalium9 Alpra>olam 8#ana:9 -:a>epam 8Sera:9 Lora>epam 8Ati)an9 $lona>epam 87lonopin9 $hlora>epate 8%ran:ene9 $hlor!ia>epo:i!e 8Li rium9 Esta>olam 8ProSom9 Mi!a>olam 8Aerse!9

1 Minor %ranLuili>ers

*1 .o=ners
c, Inter1entions: 01 Rinse mouth =ith =ater o/ten an! sugarless gum1 21 Assist in am ulation1 31 $aution against !ri)ing1 41 Not use! =ith !ail" minor stresses1 ?1 $aution in patients =ith glau*oma1 @1 No al*ohol an! $NS !epressants1 C1 %herapeuti* ene/it is a*hie)e! in 2 =ee6s1 D1 $autious IA use as !rug *an pre*ipitate1 E1 Smo6ing !e*reases !rug e//e*t1 0F1 A)oi! a rupt !is*ontinuation1 001 Anti!ote /or -.: /luma>enil 8Roma>i*on9 eat

Side Effects:

01 $NS !epression S'E -!i>>iness+ *on/usion+ !isorientation+ ata:ia+ /atigue 21 Anti*holinergi* S'E -e)er"thing is !r"I !r" e"es+ !r" mouth+ *onstipation+ urinar" retention 31 -rthostati*'Postural h"potension

2. Nonbenzodiazepine *epro!amate +,-uani . *i to/n0 &uspirone +&u)par0 Hydro#y1ine +%istari . 2tara#0 . Seda!i"e H#pno!i$ %enzodiazepine& 3 ura1epam +Da mane0 Tria1o am +Ha cion0 Tema1epam +4estori 0

.-$ /or al*ohol =ith!ra=al: $hlor!ia>epo:i!e 8Li rium9 .-$ /or Status Epilepti*us: .ia>epam 8Aalium9 An:iol"ti* *onsi!ere! as: .-$ as pre-op me!i*ation: Lora>epam 8Ati)an9 .-$ /or el!erl": -:a>epam 8Sera:9I Lora>epam 8Ati)an9

ANTIPSYCHOTICS:
Re"erred to as: a1 Neurolepti*s P'eno!'iazine&: +, Chlor!roma-ine $'hora-ine& 21 %ri/luopera>ine 8Stela>ine9 2, 3lu!hena-ine $%roli#in& 41 Perphena>ine 8%rila/on9 ?1 %ri/luproma>ine 8Aesprin9 @1 %hiori!a>ine 8Mellaril9 C1 Molin!one 8Mo an9 Nonp'eno!'iazine&: + But6ro!henones +, 4alo!eridol $4aldol& 21 .roperi!ol 8Inapsine9 + 'hio#anthenes 01 $hlorprothi:ene 8%ara*tan9 21%hiothi:ene 8Na)ane9 At6!ical +, Clo-a!ine $Clo-aril& 21 Risperi!one 8Risper!al9 31 -lan>apine 8O"pre:a9 41 Huetiapine 8SeroLuel9 ,# Oiprasi!one 8&eo!on0 Ne( Gene)a!ion 01 Aripipra>ole 8A ili/"9 1 Major %ranLuili>ers Side Effects: Nursing Management: 01 $NS .epressant E//e*ts: For CNS Depression: -!i>>iness+ *on/usion+ !isorientation+ ata:ia+ /atigue 01 Sa/et" pre*autions 21 A)oi! a*ti)ities that reLuires Alertness 8.RIAIN&9 21 Anti*holinergi* E//e*ts: -e)er"thing is !r"I !r" e"es+ !r" mouth+ *onstipation+ urinar" retention 31 -rthostati* H"potension *# Prola*tin le)els ?1 %4O'O*EN*I'I5I'Y @1 .iminishe! li i!o+ Ere*tile an! orgasmi* !"s/un*tion C1 Meight gain D1 Pruritis E1 Neurole!tic Malignant *6ndrome $NM*& For Anticholinergic Effects: 01 Relie)e !r" mouth1 21 $I in P:Ns =ith galu*oma For orthostatic hypotension: 01 Monitor ,P 21 &ra!ual *hange o/ position 31 Assist in am ulation

FOR P O!OSENS"!"#"!$: 1. 2pp y sun! oc5. +)P3:156370 2. Protecti(e c othin8.

Extra Pyramidal Symptoms (EPS)

Dystonia Risk: + 7 da6s + Frightening spasms o/ major mus*le groups + %orti*ollis + -pisthotonus + -*ulog"ri* *risis Pseudopar%insonism Risk: + 8 9eeks + A6inesia + Rigi!it" + ,ilateral /ine han! tremors+ pill-rolling + Mas6-li6e /a*e+ !rooling + Shu//ling+ /estinating gait A%athisia Risk: + : 9eeks + (n*ontrolle! motor restlessness an! the ina ilit" to sit still + Pa*ing + Foot tapping !ardi&e Dys%inesia Risk: Long term use In)oluntar": + tongue mo)ement + su*6ing + lip sma*6ing + *he=ing + grima*ing + lin6ing + li*6ing

R./.R01B2.

R./.R01B2.

R./.R01B2.

IRREVERSIB E

Anti P EPS !rugs: 8Anti*holinergi* !rugs9 ,en>tropine $-&EN%IN ,iperi!in A7INE%-N .iphenh"!ramine ,ENA.R5L %rihe:"pheni!"l AR%ANE Pro*"*li!ine 7EMA.RINE Amanta!ine S5MME%REL .ia>epam 8Aalium9

A* %* C* D* S*

A)!ane+ A,ine!on %enad)#Co.en!in diazepa/ S#//e!)e- 0Dopa a.oni&!1

3hen is the best time to re"ill Clo4apine5 67d (meds are usuall% dispensed &ood "or 7 da%s onl% 8%pical Antips%chotics relieve 9hat 0x5 Positive A%pical Antips%chotics relieve 9hat 0x5 Both Positive and :e&ative 0x )ost potent 8;P1CA2 Antips%chotic< Haloperidol (Haldol )a=or reason 9h% At%pical Antips%chotics are pre"erred< 2esser .P0 2a& period< ->( 9ee's ?OC "or ?%stonia< ?iphenh%dramine (Benadr%l Beta>bloc'er used "or ?ru&>induced A'athisia< Propranolol (1nderal
AN'IDE%RE**AN'* 4e9erred to as: a. *ood e e(ator !. Psychic ener8i1er
+, 'CAs MOA: Blocks the reu!take o" NE and 7 4' *ide E""ects:

Nursing Management:
'in general Inter1entions: 01 Initiate sa/et" pre*autions1 21 A!minister =ith meals1 31 Monitor the sui*i!al *lient espe*iall" !uring impro)e! moo!1 41 Instru*t the *lient to *hange positions slo=l"1 ?1 Instru*t the *lient to a)oi! !ri)ing an! other a*ti)ities reLuiring alertness1

Imi!ramine $'o"ranil& Amitri!t6line $Ela1il& 'rimi!ramine $*urmontil& Clomi!ramine $Ana"ranil& Ma!rotiline $Ludiomil& %rotri!t6line $5i1actil& Nortri!t6line $%amelor& Do#e!in $*ine;uan& Desi!ramine $Nor!ramine& Amo#a!ine $Asendin&

Photosensiti)it" $ar!io)as*ular !istur an*es: arrh"thmias %a*h"*ar!ia -rthostati* h"potension Meight gain .e*rease! li i!o+ Eja*ulator" !istur an*es

=,**RIs MOA: Blocks serotonin reu!take

3luo#etine $%ro-ac& *ertraline $>olo"t& %aro#etine $%a#il& 3lu1o#amine $Lu1o#& Citalo!ram $Cele#a& Escitalo!ram $Le#a!ro&

*ide E""ects: N'A .iarrhea Photosensiti)it" Insomnia Ner)ousness H'A+ !i>>iness Male se:ual !"s/un*tion 8E.9

2, MAOIs MOA: Inhi?its Monoamine O#idase 'ran6lc6!romine $%arnate& %henel-ine $Nardil& Isocar?o#acid $Mar!lan& Rasagiline $A-ilect& *elegiline $Elde!r6l0 Emsam&

*ide E""ects: -rthostati* h"potension Insomnia Mea6ness &I upset Meight gain Peripheral e!ema .ela" in eja*ulation 4Y%ER'EN*I5E CRI*I*

%rinci!les o" MAOI < 'CA Administration 01 %$ANs gi)en /irst 21 .onNt use together =ith al*ohol 31 E:pe*t a lag %$A: 2-4 =ee6s SSRI: 0-3 =ee6s MA-I: 2-@ =ee6s 41 &ap et=een me!s: 04 !a"s ?1 Surger": 0F !a"s /or MA-Is: 01 Assess /or h"pertensi)e *risis 21 A)oi! t"ramine-*ontaining /oo!s: Mine 8e:*ept )o!6a9+ *heese 8e:*ept *ottage an! *ream9+ "ogurt+ )inegar

%herapeuti* e//e*t o/ anti!epressant: li/ting o/ !epression Foo!s to a)oi! =hen ta6ing MA-I: %"ramine-ri*h /oo!s Most re*ommen!e! anti!epressant: SSRINs Esa/e an! /e=er *ar!io)as*ular SENs9 .-$ /or -$.: Flu)o:amine 8Lu)o:9+ $lomipramine 8Ana/ranil9

AN'IMANIC Action: the release o/ norepinephrine

A1aila?ilt6: -'a?let -Ca!sule -*6ru! + 'rade Name: Eskalith0 Lithota?s0 Litho?ids0 Ci?alith0 Lithonate Lag !eriod: +@ =+ da6s %oints to !onder regarding Li$-3: 01 Li$-3 is maintaine! =ith 3FFmg %1I1.1 21 ,loo! le)el is *he*6e! D-02 hours a/ter last !ose1 %hen: a1 e)er" =ee6 /or the 0st month 1 e)er" 2-3 months 2, 'hera!eutic le1el A @,7 B +,7 mE;)L adults A &,: B +,C mE;)L children

a1

Pol"uria+ Pol"!ipsia+ .r" mouth 1 Anore:ia+ Nausea *1 Meight gain !1 A !ominal loating e1 So/t stools or !iarrhea /1 Fine han! tremors g1 Ina ilit" to *on*entrate h1 Mus*le =ea6ness+ /atigue+ i1 H'A+ !ro=siness+ !i>>iness j1 Hair loss

Side Effects:

Nursing Management: 01 A!minister the me!i*ation on time an! =ith /oo!1 21 .o not s6imp on !ietar" Na inta6e1 31 .rin6 0F-03 glasses o/ =ater per !a"1 41 A)oi! e:*essi)e use o/ e)erages *ontaining *a//eine an! al*ohol1 ?1 Noti/" ph"si*ian i/ /e)er+ PERSIS%EN% )omiting or !iarrhea o**urs1 @1 $arr" alert *ar! al=a"s1 C1 Lithium shoul! e tapere! o// an! not !is*ontinue! a ruptl"1

!" it#i$m %oxicity Prodrome V@ &@ N@ D@ &@ @ %@

'" it#i$m I(toxicatio( () '"* mE+, ) :%sta&mus 1mpaired consciousness Oli&uria or Anuria 0ei4ure Coma ?eatth

AN'ICON5DL*AN'* Action: Pre)ents !issemination o/ ele*tri*al !is*harges in motor *orte: area o/ the rain " enhan*ing &A,A1

46dantoins: . toin/

01 !hen6toin $Dilantin& %herapeuti* le)el: 0F-2F m*g'ml %o:i* Le)el: Q3F m*g'ml 21 ethotoin 8Peganone9 31 mephen"toin 8Mesantoin0 4. 9osphenytoin +Cere!y#0

*ide E""ects: 01 &ingi)al h"perplasia a1 -ral $are 1 (se so/t- ristle! tooth rush *1 ,rush 2-3 times a !a" !1 Massage gums 21 Slurre! spee*h 31 *on/usion 41 .epression ?1 N'A @1 $onstipation C1 H'A D1 H"pergl"*emia E1 ,loo! !"s*ra*ias 8leu6openia'throm o*"topenia9 0F1 Alope*ia 001 Hirsutism

Nursing Management: 01 Monitor serum le)el1 21 Monitor signs o/ to:i*it"1 31 IA phen"toin shoul! e !ilute! in NSS 8!e:trose -Q pre*ipitate91 41 &oo! oral h"giene1 ?1 In*rease /oli* a*i!1 8inter/eres =ith /oli* a*i! a sorption9 @1 .o not stop !rug a ruptl" 8gra!ual as it *an lea! to status epilepti*us9 C1 $an turn urine pin6+ re!+ or re!- ro=n1 D1 %a let *an e *rushe!1 8mi: =ith /oo!9 E1 Suspension must e sha6en =ell1 8ma6e sure a**urate !osage is gi)en9 0F1 Lag perio!: C-0F !a"s

Bar?iturates . ?ital/
+,!heno?ar?ital $ Luminal&
21 amo ar ital 8Am"tal9 31 pento ar ital 8Nem utal9 41 se*o ar ital 8Se*onal9 ?1 mepho ar ital 8Me aral9 @1 thiopental Na 8Pentothal Na9 C1 uta ar ital 8,utisol9 D1 primi!one 8M"soline9 :a8 time: 364 /ee5s

*ide E""ects:

Nursing Management:

01 $NS !epression a1 !i>>iness+ !ro=siness 1 ata:ia *1 han! tremors 21 H"potension 31 Respirator" !epression

01 *ar ama>epine 8%egretol9 21 )alproi* a*i! 8.epa6ene9 31 !i)alproe: Na 8.epa6ote9 41 lamotrigine 8Lami*tal9 ?1 ga apentin 8Neurontin9 @1 /al amate 8Fel atol9 C1 topiramate 8 %opama:9 Most *ommon si!e e//e*t o/ phen"toin 8.ilantin9: &ingi)al H"perplasia

Other Anticon1ulsants:

*;2: hinders mo(ement o9 impu ses 9rom the tha amus to the !rain corte#.

01 %a6en =ith /oo!1 8re!u*e gastri* !istress9 21 .o not !is*ontinue a ruptl"1 31 A)oi! al*ohol1 41 A)oi! a*ti)ities that reLuires alertness1 ?1 .ro=siness in /irst /e= =ee6s ; =ill !e*rease1 @1 report s"mptoms o/ loo! !"s*rasias ". <i(e reconstituted so utions /ithin 37 minutes o9 mi#in8. $. Terato8enic

AN'I%AREIN*ON* DRDG* Anticholinergics: *ide E""ects: Nursing Management:

M-A: Re!u*e tremors an! rigi!it" " inhi iting A*h1 01 en>tropine mes"late 8$ogentin9 21 trihe:ipheni!"l 8 Artane9 31 iperi!ine H$l 8A6ineton9 41 pro*"*l"!ine H$l 8 7ema!rin9

Do!aminergics:
01 amanta!ine 8S"mmetrel9 21 romo*riptine 8Parlo!el9 31 *ar i!opa-le)o!opa 8Sinemet9 41 le)o!opa 8Laro!opa+ .opar9

01 $NS .epression a1 ."s6inesia 8impaire! )oluntar" mo)ement9 1 .i>>iness *1 Ata:ia !1 $on/usion 21 Anti*holinergi* E//e*ts a1 (rinar" retention 1 $onstipation *1 .r" mouth !1 lurre! )ision 31 -rthostati* h"potension 41 Nausea an! )omiting

01 A)oi! /oo!s high in Aitamin ,@ 8in*reases le)o!opa meta olism to !opamine in the PNS9 an! high protein /oo!s1 21 .onNt a ruptl" stop the !rug1 31 $hange position slo=l"1 41 A)oi! al*ohol ?1 .is*oloration o/ s=eat an! urine is harmless1

Mhat )itamin shoul! e a)oi!e! =hen ta6ing le)o!opaR P"ri!o:ine

2 DRUGS AFFECTING THE CARDIOVASCU3AR SYSTEM

AN'I4Y%ER'EN*I5E* .ABCD/ ACE Inhi?itors:/ !ril/ Action: Pre)ents )aso*onstri*tion " inhi iting *on)ersion o/ Angiotensin I to Angiotensin II1
01 ena>epril 8 Lotensin9 21 *aptopril 8 $apoten9 31 enalapril 8 Aasote*9 41 /osinopril 8 Monopril9 ?1 lisinopril 8 Prini)il+ Oestril9 @1 ramipril 8Alta*e9 C1 losarten 8$o>aar9

*ide E""ects:

N$rsi(- .a(a-eme(t:

01 N'A+ !iarrhea 21 Persistent *ough 31 H"potension 41 %a*h"*ar!ia ?1 Ageusia 80st month onl"9 @1 .i>>iness C1 H'A D1 H"pogl"*emia

01 Monitor A'S: espe*iall" the ,P1 21 .o not !is*ontinue a ruptl"1 31 A)oi! al*ohol1 41 For orthostati* h"potension - a)oi! hot aths - gra!ual *hange o/ position

Beta Blockers: . olol/ Action:,lo*6s eta re*eptors1

01 a*e utolol 8 Se*tral9 21 atenolol 8%enormin9 31 eta:olol 8,etopti*9 41 esmolol 8,ri)i lo*9 ?1 metoprolol 8Lopressor9 @1 na!olol 8$orgar!9 C1 propranolol 8In!eral9

*ide E""ects:
01 ,ra!"*ar!ia 21 ,ron*hospasm 31 H"potension

A$E INHI,I%-RS E#!ect dr6 cough ,E%A ,L-$7ERS C)I: A*'4MA < CO%D

*# :A/ ,# 1ntensi"ied h%po&l%cemia

$. pindo o +%is5en0 Calcium Channel Blockers . di!ine/ Action:Inhi?its mo1ement o" Ca across the cell
mem?rane into cardiac and smooth muscles

*ide E""ects:
01 ,ra!"*ar!ia 21 H"potension 31 Hea!a*he 41 .i>>iness ?1 $onstipation

01 )erapamil 8 $alan+ Isoptin9 21 ni/e!ipine 8Pro*ar!ia9 31 !iltia>em 8$ar!i>em9 41 amlo!ipine 8Nor)as*9 ?1 /elo!ipine 8 Plen!il9 @1 ni*ar!ipine 8$ar!ene9 C1 nimo!ipine 8Nimotop9

Diuretics
4. 3OOP DIURETICS

*ide E""ects: 01 -rthostati* H"potension 21 H"peruri*emia 31 .ro=siness 41 H'A ?1 Anore:ia @1 H"po6alemia e:*ept 7sparing C1 Rash D1 H"ponatremia E1 .eh"!ration For %hia>i!e: 01 H"per*al*emia For 7-sparing: 01 H"per6alemia

N$rsi(- /o(sideratio(s:

Action:

inhi?it NA < Cl rea?sor!tion at the loo! o" 4enle

01 &i)e earl" in the morning1 8pre)ent no*turia9 21 Monitor I'- an! =eight1 31 Ma6e positional *hanges slo=l"1 41 A!minister =ith /oo!1 ?1 Monitor /or /lui! an! ele*trol"te Im alan*e1 H5P-7ALEMIA H5PER7ALEMIA H5PER$AL$EMIA @1 Assess ,P e/ore a!ministration1 C1 $onsume /oo!s ri*h in 71

01 /urosemi!e 8Lasi:9 21 etha*r"ni* a*i! 8E!e*rin9 31 umetami!e 8,ume:9 41 torsemi!e 8.ema!e:9

2. THIA5IDE DIURETICS Action: ?locks Na rea?sor!tion

in the DC'

01 *hlorothi>i!e 8.iuril9 21 h"!ro*hlorothia>i!e 8 H"!ro.I(RIL+ Esi!re:9 31 en>thia>i!e 8E:na9

. OSMOTIC DIURETIC Action: inhi?it rea?sor!tion

01 mannitol 8-smitrol9 21 urea 8(reaphil9

o" 3)E

6. POTASSIUM SPARING DIURETIC Action: ?locks aldosterone0 inhi?its

rea?sor!tion o" 9ater < Na

01 spironola*tone 8Al!a*tone9 21 amilori!e 8 Mi!amor9 31 triamterene 8 ."renium9

NO'E: O*MO'IC DIDRE'IC* DECREA*E IC%F DEC, IO% IN NARROG ANGLE GLADCOMA NO'E: CAI DECREA*E IO% IN O%EN ANGLE GLADCOMAF D*ED 'O 'REA' ME'ABOLIC ALEALO*I*

D1 For potassium sparing:

Monitor /or 6i!ne" /un*tion1

A)oi! 7-ri*h /oo!s1

7. CAR%ONIC ANHYDRASE INHI%ITORS Action: %romotes e#cretion o" Na0

and 9ater,

E0 4CO20

01 a*eta>olami!e 8.iamo:9 21 !i*hlorphenami!e 8.arani!e9 31 Metha>olami!e 8Nepta>ane9 *ide E""ects:

E1 Anti!ote /or H"per6alemia: SNa pol"st"rene sul/ate 87a"e:alate9 -e:*hanges Na /or 7 in the *olonI re*tal or oral SIA NaH$-3 < promotes intra*ellular shi/t o/ 7 SInsulin an! glu*ose < promotes intra*ellular shi/t o/ 7

DIRE/% &/%ING V&S0DI &%0RS Action: %romotes direct rela#ation o"

arteriolar smooth muscle causing 1asoldilation,

01 h"!rala>ine 8Apresoline9 21 nitroprussi!e 8 Nipri!e+ Nitropress9 31 !ia>o:i!e 8 H"perstat9 41 nitrogl"*erine 8Nitro i!9 ?1 mino:i!il 8Loniten9

a# H%potension b# Palpitations c# HAA d# Con"usion and di44iness

N$rsi(- /o(sideratio(s: 1# )onitor /A0# 2# :a :itroprusside a# )onitor c%anide and thioc%anate levels# b# Protect "rom li&ht# (cos dru& decomposes 1/ tubin& and container must be covered in aluminum "oil# c# ?iscard i" medication is redAblue#

D;C 9or 2n8ina Pectoris: NT< Diuretic dru8 9or cere!ra edema: *annito +;smitro 0 Ca cium )parin8 Diuretic: Thia1ide Diuretic 9or *eta!o ic 2 5a osis: C2'

?ru& used "or H%pertensive Crisis< :itroprusside (:ipride Beta bloc'er used to tx a'athisia< Propranolol (1nderal
NI'RA'E* Action: Decrease !reload and a"terload thus reduce m6ocardial o#6gen consum!tion,
01 nitrogl"*erine 8Nitrostat+ Nitro i!9 21 isosor i!e !initrate 8Isor!il9 31 isosor i!e mononitrate 8Im!ur9 ;nset: ):: 163 mins )4 Cap: 27645 mins Un8: 27667 mins Patch: 37667 mins '%: 163 mins

*ide E""ects:

Hea!a*he -rthostati* H"potension

.i>>iness Faintness Flushing or pallor Pat*h'(ng Sites: $hest+ a*6+ a !omen+ upper arm+ anterior thigh

Nursing Management: 01 Rise slo=l"1 21 ,est ta6en =hen seated 31 E:pe*t /or hea!a*he *L: 01 -ne ta let e)er" ? minutes 8/or a total o/ 3 !oses91 21 Store !rug in a !ar6 *ontainer 31 Shell li/e: 3 - @ months 41 E:pe*t /or S(,LIN&(AL %IN&LIN& 8potent9 Pat*h: 01 Appl" on hairless area 21 Remo)e pat*h a/ter 02-04H 8remain pat*h /ree /or 0F-02H to a)oi! toleran*e9 (ng: 01 Remo)e pre)ious (ng /rom s6in 21 Sprea! o)er a @:@ in*h area ; *o)er =' a plasti* =rap

CARDIAC GLYCO*IDE*)DIGI'ALI* AC'ION: !ositi1e inotro!6 $thus increasing cardiac out!utF used "or C43&F negati1e chronotro!6

N$rsi(- .a(a-eme(t:
01 !igo:in 8 Lano:in9 21 !igito:in 8 $r"sto!igin9 ),: 6di11iness. dro/siness 69ati8ue 6insomnia 6H=2

Monitor /or to:i*it"<

,ra!"*ar!ia Anore:ia N'A .iarrhea A !ominal *ramps Aisual !istur an*es lurre! )ision+ green or "ello= halos

01 Assess API$AL P(LSE 8=ithhol! i/ G@F pm ; noti/" Ap9 21 Monitor serum potassiuman! En*ourage /oo!s high in 71 8N: 31?-?I h"po7 in* !igo:in to:i*it"9 31 Monitor therapeuti* le)el1 8F1?-2ng'mlI 0F-3?ng'ml!igito:in9

41 Anti!ote: .igo:in immune Fa

8.igi in!9

?1 Monitor /or sign o/ e//e*ti)eness:

Mhen is the est time to re/ill nitrogl"*erinR H@mos An in!i*ation o/ nitrogl"*erin e//e*ti)ess: Relie/ /rom *hest pain An In!i*ation o/ SL N%& poten*": %ingling or urning sensation un!er the tongue Most *ommon si!e e//e*t o/ nitrogl"*erine: H'A Important assessment e/ore gi)ing !igo:in: Api*al pulse Q@F pm Ele*trol"te to monitor =hen ta6ing !igo:in: Potassium Earliest S: o/ .igo:in to:i*it": ,ra!"*ar!ia Anti!ote /or .igo:in: .igo:in Immune Fa 8.igi in!9 E//e*t o/ H"po6alemia in *lients ta6ing .igo:in: In*rease! ris6 /or to:i*it"

AN'ICOAGDLAN'* Action: Inhi?its clot "ormation, S8b$8!aneo8&:

01 heparin 8LiLuaemin9 21 eno:aparin 8Lo)eno:9 31 ar!eparin 8Normi/lo9 41 !anaparoi! 8-rgaran9

+therapy: "614days0 ORA3: 0b-o$,& p)o!')o/bin &#n!'e&i&1

01 =ar/arin 8$ouma!in9 8usu gi)en /or 2-3 mos a/ter MI9 21 ih"!roo:"*oumarin 8.i*umarol9 31 anisin!ione 8Mira!on9 8-r!ere! sel!oml"9 Nursing Management: )er" important 01 Assess /or lee!ing

Side e99e$!&: a. Hemorrha8e !. Hematuria c. ,pista#is d. ,cchymosis e. & eedin8 8ums 9. Throm!ocytopenia 8. Hypotension

N8)&in. Mana.e/en!:

01 .o not aspirate 8to pre)ent hematoma9 21 Anti!ote at e!si!e: Heparin: Protamine sul/ate Mar/arin: Aitamin 7 31 Monitor $oagulation tests: Heparin: aP%% 8N:2F-3@s : INR: 01?-2' maintain at @F-DFs9 or 3F-4? : INR in other sour*es Mar/arin: P% 8N:E1@-001Ds : 2-3 <0E -3@9 41 For =ar/arin: a1 !esire! e//e*t: 2-3 !a"s

!1 a1oid green lea"6 1egeta?les

21 ,lee!ing Pre*autions: 31 A)oi! ta6ing =ith ASPIRIN

'4ROMBOLY'IC* . ase/ Action: Dissol1e clots,

In!i*ate!: Pulmonar" em oli+ .A%+ MI 8='in 4@H o/ the onset o/ the in/ar*t to restore loo! /lo=9 01 strepto6inase 8Streptase9 21 uro6inase 8A o6inase9 31 alteplase 8%issue Plasminogen A*ti)ator JtPAK9

*ide E""ects: a1 ,lee!ing 1 ."srh"thmias *1 Fe)er !1 Allergi* Rea*tions

Nursing Management:

01 ,lee!ing pre*autions1 21 Asses pulses1 8ta*h"*ar!ia9 31 Pressure o)er pun*ture site /or 2F-3F mins1 41 (se ele*tri* ra>or /or sha)ing an! so/t tooth rush1 ?1 Anti!ote: Amino*aproi* a*i! 8Ami*ar9

Rapi! a*ting anti*oagulant: Heparin 8LiLuaemin9

(se! to monitor e//e*ti)eness o/ =ar/arin: P%

3oods to a(oid i9 on Dicumaro : %it > rich 9oods 2ntidote 9or Throm!o ytics: 2minocaproic acid +2micar0

2ntidote 9or Heparin: Protamine su 9ate 2ntidote 9or ?ar9arin: %it. >

@ DRUGS AFFECTING THE DIGESTIVE SYSTEM A:81>D2C.R0

AN'ACID*: Action: Neutrali-e gastric acids $?6 inacti1ating !e!sin&
AL(MIN(M-,ASE.: 01 aluminum h"!ro:i!e 8Amphojel9 21 aluminum *ar onate 8,asaljel9
Si!e E//e*t: -$onstipation

MA&NESI(M-,ASE.: 01magnesium h"!ro:i!e 8Mil6 o/ Magnesia9

$AL$I(M-,ASE.: 01*al*ium *ar onate 8%ums+ .i*ar osil9 Si!e E//e*t: -$onstipation+ el*hing+ /latulen*e+ H"per$a+ H'A

Si!e E//e*t:

Al-Mg $-M,INA%I-N 01 Mg-Al h"!ro:i!e 8 Maalo:+ M"lanta9 21 Mg-Al trisili*ate 8&a)is*on9 31 magal!rate 8Riopan9

>?iarrhea Nursing Management: Antacids

01 %a6en 0-2 hours a/ter meal1 21 Ne)er gi)e along =ith other !rugs1 80H gap9

9or a uminum !ased:

9or ca cium !ased:

9or ma8nesium !ased : :CI 9o) RF

:H#pop'o&p'a!e/ia :don;! !a,e (< Vi! D

4= BLOCEER* . tidine/ .'%A>/ Action: *u!ress secretion o" gastric acid,

01 *imeti!ine 8%agamet9 21 /amoti!ine 8Pep*i!9 31 ni>ati!ine 8A:i!9 41 raniti!ine 8 Oanta*9

*ide E""ects: a1 $on/usion 1 .i>>iness+ !ro=siness *1 H'A !1 .epression *ide E""ects:

Nursing Management:

01 %a6en =ith meals1 21 Ne)er gi)e along =ith anta*i!s1 8!e*rease a sorption9 31 Stop smo6ing1 8!e* e//e*t9 41 $aution =ith $NS S'Es1

%RO'ON %DM% IN4IBI'OR*: . !ra-ole/

Action: *u!ress secretion o" gastric acid

u! to H@I greater than 4= ?lockers,

01 esomepra>ole 8Ne:ium9 21 lansopra>ole 8 Pre)a*i!9 31 omepra>ole 8 Prilose*9 41 pantopra>ole 8Protoni:9 ?1 ra epra>ole 8A*iphe:9

a1 .iarrhea 1 A !ominal pain *1 Nausea !1 H'A

Nursing Management
01 %a6en e/ore meal 21 Monitor la tests - li)er /un*tion test - renal /un*tion test

MDCO*AL %RO'EC'I5E DRDG* AC'ION: Co1ers and !rotect the ulcer "rom acid and !e!sin,
01 su*ral/ate 8$ara/ate9 21 misoprostol 8$"tote*9

Si!e E//e*ts: For Su*ral/ate: a1 Sleepiness 1 $onstipation *1 .r" mouth !1 a*6 pain For Misoprostol: a1 .iarrhea 1 A !ominal pain *1 Flatulen*e

Nursing Management: 01 %a6en e/ore meals an! HS1 21 In*rease /lui!s+ !ietar" ul6+ + an! e:er*ise1 31 Separate a!ministration /rom other !rugs1 8 " 2HI!e* a sorption o/ =ar/arin+ phen"toin+ theoph"lline+ !igo:in+ tetra*"*line9 41A)oi! gastri* irritants1 8*a//eine+ al*ohol+ spi*es9 For Misoprostol: 01 %a6en =ith meals1 21 $I in pregnant =omen1

.-$ /or &ER.: Proton Pump Inhi itors espe*iall" esomepra>ole 8Ne:ium9 $ommon si!e e//e*t o/ Magnesium- ase!: $ommon si!e e//e*t o/ Aluminum- ase!: 1E

Anta*i! o/ *hoi*e /or h"perphosphatemia: H2 lo*6er that has $NS si!e e//e*ts: $imeti!ine 8%agamet9 An a orti)e !rug: Misoprostol 8$"tote*9
PAIN MEDICATIONS: NON NARCO'IC*:

01a*et"lsali*"li* a*i! 8Aspirin JE*otrin+ ,a"er+ AspiletK J u//ere!: Al6aSelt>er+ ,u//erinK9 4 ANs Antip"reti* Analgesi* Anti-in/lammator" Antiplatelet

*ide E""ects:

Nursing Management:

a1 &I ,lee!ing 8melena+ hemato*he>ia9 1 Epista:is *1 ,ruising !1 .iarrhea Aspirin' Sali*"late %o:i*it": a1 %innitus 8earliest9 1 $on/usion *1 .i>>iness !1 Meta oli* a*i!osis e1 Respi al6alosis

01 %a6e =ith /oo!+ anta*i!+ or mil61 21 A)oi! gi)ing to *hil!ren =ith Airal In/e*tion1 8ma" *ause Re"eNs S"n9 31 Ne)er gi)e along =ith anti*oagulants1 8potentiates anti*oag9 41 Report signs o/ lee!ing1 ?1 Assess /or hearing pro lems1 @1 A)oi! use in pregnant =omen1 C1 Shoul! not e ta6en =ith NSAI.Ns1 8!e* e//e*t o/ nsai!Ns9 D1 .'$ 3-C !a"s e/ore surger"1

21 a*etaminophen 8 %"lenol9 -Antip"reti* -Analgesi*

*ide E""ects:

a1 Anore:ia 1 N'A *1 H"pogl"*emia ad1erse e""ect: 4E%A'O(ICI'Y

Nursing Management:

01 Assess histor" o/ li)er !"s/un*tion1 21 Monitor hepati* !amage1 8N'A+ !iarrhea+ a !ominal pain9 31 Monitor li)er en>"me tests1 41 Anti!ote: A*et"l*"steine 8Mu*om"st9

N*AID*: Action:Inhi?it s6nthesis o" %rostaglandin

$!rostaglandin inhi?itors&

*ide e""ects:

Indications: %ain0 Arthritis

01 !i*lo/ena* Na 8Aoltaren9 21 i upro/en 8Motrin+ A!)il9 31 napro:en 8Flana:+ Napros"n+ Anapro:9 41 6etorola* 8%ora!ol9 80st inje*ta le NSAI. JIMK9 ?1 piro:i*am 8Fel!ene9 @1 in!ometha*in 8In!o*in9 C1 me/enami* a*i! 8Ponstan9 D1 sulin!a* 8$linoril9 E1 !i/lunisal 8.olo i!9

a1 &astri* irritation 1 .i>>iness *1 %innitus !1 H"potension e1 Na an! H2- retention

Nursing Management:
01 %a6e =ith /oo!1

21 .o not ta6e =ith Aspirin1 31 Monitor li)er en>"mes1

NARCO'IC*)O%IA'E* Action: Blocks !ain rece!tors, $induces

sedation0 analgesia0 eu!horia&

*ide E""ects:
a1 .i>>iness 1 .e*rease RR *1 H"potension !1 $onstipation

Nursing Management:

01 Assess RR'AS1 8='hol!:RR<02*pm9 21 Anti!ote at e!si!e

Indications: Moderate to se1ere !ain

01 morphine 8Morphine S-49 21 *o!eine 8$o!eine S-49 31 meperi!ine H$l 8.emerol9 41 o:"*o!one 8-:"*ontin9 ?1 propo:"hene 8.ar)on9 @1 metha!one 8.olophine9 C1 h"!romorphone 8.ilau!i!9 D1 /entan"l 8.uragesi*9 E1 penta>o*ine 8%al=in9 0F1 nal uphine 8Nu ain9 001 ,utorphanol 8Sta!ol9

ANarcan B '*. '%. )C: -i(e -263 mins A4e(ia B P; once per day 8i(en a9ter Narcan
A 31 A)oi! al*ohol1 8$NS !epression9 41 Sa/et" pre*autions1 8$NS !epression9 6side rai s. ni8ht i8ht. super(ised am!u ation

10xycodo(e 2 &spiri(: Percoda( 10xycodo(e 2 &cetami(op#e(: Percocet F?arvon contains aspirin F?arvon>:< acetaminophen

Nar*oti* o/ *hoi*e /or pan*reatitis 8pain9: Meperi!ine H$l 8.emerol9

11

NSAI. use! /or the *losure o/ Patent .u*tus Arteriosus: In!ometha*in 8In!o*in9 .rug o/ *hoi*e /or opioi! =ith!ra=al: Metha!one 8.olophine9 8repla*ement me! /or opiate !epen!en*e'=ith!ra=al9

ENDOCRINE DRDG* IN*DLIN action: 3acilitates trans!ort o" glucose across the cell,
SH-R%-A$%IN& Insulin %"pe Regular -Regular Iletin -Humulin R -No)olin R -Semilente 3F mins P 0H 2 P 4H @ P 02H IN%ERME.IA%E NPH 8Isophane9 - NPH Iletin -Humulin N - A*trapi! N - Lente 2P4H @ -02 H 0D P 24 H L-N&-A$%IN& (ltralente - Humulin (

-nset Pea6 .uration

@ P 02 H 0D P 24 H 3@ P C2 H

N8)&in. Mana.e/en!:

01 Rotate inje*tion sites1 8lipo!"stroph": lipoh"petroph"<!e)Nt o/ /i rous /att" masses *ause! " repeate! use o/ an inje*tion siteI a !omen+ arms JposteriorK+ thigh JanteriorK+ hips9 21 .o not massage1 8in*rease a sorption rates thus h"pogl"*emia9 31 Mhen mi:ing 2 insulins : SInje*t air: N P R SMith!ra=ing o/ insulin: R- N 41 Sta le at room temperature+ i/ pre/ille! or mi:e! 6eep re/rigerate! 8not /ro>en91 ?1 .onNt inje*t *ol! insulin1 8lipo!"stroph": lipoatroph" loss o/ S$ /at an! appears as slight !impling9 @1 &entl" roll insulin ottle e/ore use1 .onNt sha6e1 8to ensure insulin is mi:e! =ellI u les =ill *ause ina**urate !osage9 C1 Monitor loo! glu*ose le)el1 Inter)ention /or H"pogl"*emia: D1 A)oi! smo6ing1 8!e* insulin a sorption9 i/ *ons*ious: gi)e /ast a*ting simple $HE1 Assess /or h"pogl"*emia i/ un*ons*ious: % -tire! hospital: 2? P ?F ml o/ .?FM I -irrita ilit" home: &lu*agon 8S$' IM+ 2n! !ose at 0F R -restless mins i/ *lient remains un*ons*ious99 E Pe:*essi)e hunger . -!iaphoresis

ORAL 4Y%OGLYCEMIC AGEN'* - Sul/on"lureas: A*tion: Stimulates eta *ells o/ the pan*reas to pro!u*e more insulin1 *hlorpropami!e 8.ia inese9 tola>ami!e 8%olinase9 tol utami!e 8-rinase9 -Non-Sul/on"lureas: A*tion: ! hepati* glu*ose pro!u*tion met"ormin $Gluco!hage&

- se*on! generation sul/on"lureas: glimiperi!e 8Amar"l9 glipi>i!e 8&lu*otrol9 gl" uri!e 8.ia eta9

acar?ose $%recose&

miglitol $Gl6set&

rosiglita-one $A1andia&

N(RSIN& ALER%TTT S Assess allerg" to sul/urTTT JFor sul/on"lureasK S %a6e =ith meals1 S A)oi! al*ohol1 Jtrigger h"pogl"*emi* r:nK SIn/orm the *lient that insulin is nee!e! !uring stress+ in/e*tion+ or surger"1

;n y '% type 'nsu in: 4e8u ar insu in )ite /ith e(en and rapid insu in a!sorption: 2!domen

12

Distance !et/een insu in site inCections: 1 inches +2.54 cm0 *ost common premi#ed insu in: NPH D 4e8u ar

AN'IIN3EC'I5E MEDICA'ION* +, AN'IBIO'IC* Aminogl6cosides:

In!i*ations: gram negati)e in/e*tions -Es*heri*hia $oli -7le siella -Entero a*ter

micin or

m6cin

3luoro;uinolones:

"lo#acin

01 gentami*in sul/ate 8&aram"*in9 21 neom"*in sul/ate 8M"*i/ra!in9 31 6anam"*in sul/ate 87antre:9 41 streptom"*in sul/ate 8Streptom"*in9

!road spectrum In!i*ations: =i!e range o/ gram B an! gram P -(%I - ron*hitis -S%.s - one an! joint in/e*tion 01 *ipro/lo:a*in 8$ipro9 21 le)o/lo:a*in 8Le)aLuin9 31 nor/lo:a*in 8Noro:in9 41 o/lo:a*in 8Flo:in9

Ce!halos!orins Bce!h) ce"

First &eneration 01 *e/a!ro:il 8.uri*e/9 21 *e/a>olin 8An*e/+ 7e/>ol9 31 *ephale:in 87e/le:9 41 *ephapirin 8$e/a!"l9

Se*on! &eneration 01 *e/a*lor 8$e*lor9 21 *e/meta>ole 8Oe/a>one9 31 *e/oni*i! 8Mono*i!9 41 *e/otetan 8$e/otan9 ?1 *e/o:itin 8Me/o:in9 @1 *e/po!o:ime 8Aantin9 C1 *e/pro>il 8$e/>il9 D1 *e/uro:ime 8Oina*e/9

%hir! &eneration 01 *e/!inir 8-mni*e/9 21 *e/i:ime 8Supra:9 31 *e/opera>one 8$e/o i!9 41 *e/ota:ime 8$la/oran9 ?1 *e/ta>i!ime 8Forta>9 @1 *e/ti uten 8$e!a:9 C1 *e/ti>o:ime 8$e/i>o:9 D1 *e/tria:one 8Ro*ephin9

Macrolides:

m6cin

%ennicillins:

cillin

01 er"throm"*in 8Er"thro*in9 21 a>ithrom"*in 8Oithroma:9 31 *larithrom"*in 8,ia:in9

01 amo:i*illin 8Amo:il9 21 ampi*illin 8-mnipen9 31 *lo:a*illin 8Apo-$lo:i9 41 methi*illin 8Staph*ilin9 ?1 peni*illin & 8Penti!s9 @1 peni*illin A 8A-$illin9 C1 amo:i*illin *lu)anate 8Augmentin9

*ul"onamides:

sul"

'etrac6clines:

c6cline

01 sul/i:a>ole 8&antrisin9 21 sul/ametho:a>ole-trimthoprim8,a*trim9 31 sul/asala>ine 8A>ul!i/ine9

01 tetra*"*line 8A*hrom"*in9 21 !o:"*"*line 8Ai ram"*in9 31 !emo*lo*"*line 8.e*lom"*in9 41 mino*"*line 8Mino*in9

Nursing Management:

01 - tain *ulture 21 Monitor /or allergi* rea*tion 31 %a6en est on empt" stoma*h

41 Monitor I;- an! renal /un*tion ?1 A!eLuate h"!ration @1 Monitor hearing an! alan*e

1-

=, AN'I5IRAL*

01 a*"*lo)ir 8Oo)ira:9 21 *i!o/o)ir 8Aisti!e9 31 in!ina)ir 8$ri:i)anF 41 ritona)ir 8Nor)ir9 ?1 gan*i*lo)ir 8$"to)ene9

Ad1erse E""ects:

-,one Marro= Suppression -Nephroto:i*it" Si!e E//e*ts: 01 hea!a*he 21 nausea an! )omiting

Nursing Management:

01 Monitor $,$ 21 In*rease Aitamins A$E 31 In*rease Fi er

Antiretro1irals:

@1 >i!o)u!ine 8AO%+Retro)ir9 C1 lami)u!ine 8Epi)ir9 D1 sta)u!ine 8Oerit9 E1 ne)irapine 8Airamune9

2, AN'I3DNGAL*
11 amphote*erin ,8Fungi>one9 21 6eto*ona>ole 8Ni>oral9 31 mi*ona>ole 8Monistat9 41 n"statin 8M"*ostatin9 ?1 *lotrimo:a>ole 8M"*ele:9 @1 /lu*ona>ole 8.il/ul*an9

Indications:

01 *an!i!iasis 21 histoplasmosis 31 ring=orm in/e*tions o/ the s6in

Nursing Management:

01 Monitor ,(N+ $reatinine+ 21 %a6e =ith /oo! 31 %a6e /ull *ourse o/ me!s 41 H"geine measures ?1 In/usion pump

8, AN'I%RO'O>OAL
01 metroni!a>ole 8Flag"l9 21 e/lornithine 8-rni!"l9 31 h"!ro:"*hloroLuine 8PlaLuenil9 41 pentami!ine 8Pentam 3FF9

Indications:

01 %ri*homoniasis 21 Amoe iasis 31 &iar!iasis 41 P$P ?1 Malaria

Nursing Management:
01 est ta6en =ith /oo! 21 a)oi! al*ohol 31 Monitor S'Es: 41 Remin!er: this !rug is teratogeni*

Remember< 1# )etronida4ole (Gla&%l should not be ta'en 9ith alcohol because it can cause disul"iram>li'e reactions (Antabuse>li'e reactions # 2# Remember the brand names and the di""erent preparations o" 2ithium carbonate# -# ?ia4epam (/alium is commonl% as'ed in the exam# *# Propo"ol (?iprivan is a sedative &iven to clients in mechanical ventilation and to those under&oin& sur&ical procedures# 1t is mil'>li'e or cream>li'e in color# 8his is &iven intravenousl%# 1t 9as rumored that )#H# died "rom propo"ol overdose# ,# R#A# C1(, @ Comprehensive ?an&erous ?ru&s Act o" 2EE2 (# R#A# C,E2 @ Cheaper )edicines Act o" 2EEB 7# R#A# ((7, @ Ienerics Act

1*