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DRUGS AFFECTING THE NERVOUS SYSTEM ANTICONVULSANTS/ANTISEIZURE MEDICATIONS Prototype : a. Hydantoins - phenytoin (Dilantin) b. Barbiturates - phenobarbital ( Luminal) Adverse effects : - sedation & drowsiness, gingival hyperplasia - diplopia, nystagmus, vertigo, dizziness - thrombocytopenia, aplastic anemia Nursing considerations : 1. Advise female clients to use contraceptives. 2. Inform clients taking phenytoin that harmless urine discoloration is common. 3. Warn clients with diabetes that hydantoins may increase blood sugar level. 4. Reassure that barbiturates are not addictive at a low dosage. 5. Avoid taking alcohol with barbiturates. 6. Administer IV phenytoin slowly to avoid cardiotoxicity. 7. Avoid mixing other drugs in same syringe with phenytoin. ANTIPARKINSONIAN AGENTS Prototype : a. Anticholinergic agents - trihexyphenidyl (Artane), benztropine (Congentin) b. Dopaminergic agents - Levodopa, carbidopa-levodopa (Sinemet), amantidine (Symmetrel) Adverse effects of dopaminergic agents: a. levodopa–nausea, vomiting, anorexia, orthostatic hypotension, dark-colored urine and sweat b. amantidine – ankle edema, constipation Nursing considerations: 1. Give dopaminergic agents after meals to reduce GI symptoms. 2. Reassure client that levodopa may cause harmless darkening of urine and sweat. 3. Avoid taking Vit B6 (pyridoxine) because it reverses effects of levodopa. 4. Change positions slowly to avoid orthostatic hypotension. 5. Elevate leg to reduce ankle edema. DRUGS AFFECTING MENTAL FUNCTIONING SEDATIVES, HYPNOTICS, AND ANXIOLYTICS – induce sleep, sedate & calm clients Prototype: a. Benzodiazepines (end with –epam) - diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), flurazepam (Dalmane) b. Barbiturates - phenobarbital, Adverse effects: - hangover-effect, dizziness, CNS depression - respiratory depression, drug-dependence
insomnia . Other Agents – olanzapine (Zyprexa) .Neuroleptic malignant syndrome (NMS) a. 6. Adverse effects: . desipramine b. urine retention. soy sauce and yeast 6. tachypnea. 6. involuntary movements of arms and leg . Take antidepressant with food to enhance absorption 3. and not hoarded. . Warn female clients that diazepam is associated with cleft lip. beer.Extra pyramidal syndrome (or EPS) such as dystonia. and other regions of the brain. ANTIPSYCHOTIC DRUGS (Neuroleptics) Prototype: a. and an irreversible tardive dyskinesia as manifested by: a. Explain to client that full response may take several weeks (2 weeks) 4. constipation (anticholinergic effects) . Avoid alcohol while taking these drugs. 2. cardiovascular collapse b. ANTIDEPRESSANTS AND MOOD DISORDER DRUGS Prototype: a. 3. Warn clients of injuries and falls. blurred vision. Teach family members the signs of EPS and NMS. Be sure that oral doses are swallowed. 2. Brief period of confusion and excitement upon waking up is common with benzodiazepines. chocolate. pseudoparkinsonism.Nursing considerations: 1.hypertensive crisis (MAO) Nursing considerations: 1.orthostatic hypotension. tranylcypromine (Pernate) c.thioridazine (Mellaril) b.dry mouth. hypothalamus. Phenothiazines . 5. lip smacking b. and report to physician immediately 2. Caution client to rise slowly to reduce the effects of orthostatic hypotension. wine. yogurt. Rotate and don’t shake the ampoules of barbiturates. Watch out for orthostatic hypotension and photosensitivity with phenothiazine. Inform physician and withhold fluoxetine if client develop rashes. haloperidol (Haldol) Mechanism of action: . . sour cream.block dopamine receptors in the limbic system. Assess client for constipation resulting from tricyclic antidepressant use. fever. Don’t mix with other drugs. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid hypertensive crisis. muscle rigidity. Second-generation antidepressants . seizures.Orthostatic hypotension Nursing considerations: 1. Tricyclic antidepressants . diaphoresis.amitriptyline (Elavil). 7. -aged cheese.chlorpromazine (Thorazine). . fine wormlike tongue movement c. 4. Normalization of symptoms may not occur for several weeks after beginning of therapy 3. imipramine (Tofranil).fluoxetine (Prozac) Adverse effects: . Warn clients not to discontinue medications abruptly without consulting a physician. tachycardia. MAOI (monoamine oxidase inhibitors) -phenelzine (Nardil).
WARFARIN sodium (coumadin) . Non. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM ANTICOAGULANTS Prototype: . Narcotic analgesics . and do not discontinue narcotics abruptly in narcotic-dependent clients.relieve pain and fever by inhibiting the prostaglandin pathway.suppress coagulation by acting as an antagonist of vitamin K after 4-5 days.codeine. Indications: . Warn clients about possibility of dependency. Monitor hearing loss in clients taking aspirin. Narcotic analgesics . Indications: .alter pain perception by binding to opioid receptors in CNS.prevents thrombin from converting fibrinogen to fibrin. myocardial infarction Adverse effect: .test : PTT .inhibit the aggregation of platelet thereby prolonging bleeding time. meperidine (Demerol). 5. Warfarin . Nursing considerations: 1. Advice clients to take NSAIDs with food and monitor for bleeding complications.test : INR . Naloxone is the antidote for narcotic overdose. Heparin .thrombosis. Monitor respiratory depression & hypotension in clients taking narcotic analgesics. pulmonary embolism. 7.bleeding Nursing considerations: 1.antidote : (protamine sulfate) 2. 2. b. morphine b. Injury and accident precautions in clients taking narcotic analgesic.DRUGS USED IN PAIN MANAGEMENT ANALGESICS Prototype: a. Non – narcotic analgesics NSAIDs – aspirin (acetylsalicylic acid). Aspirin is contraindicated in clients below 18 years old with flu-like symptoms. ibuprofen (Motrin) paracetamol and acetaminophen (Tylenol) Mechanism of actions: a. Clopidogrel (Plavix) Mechanism of action: . 3. . 4.Heparin (SQ and IV) Warfarin (Orally) Mechanism of actions: a. 6. HEPARIN sodium .reduce intake of green leafy vegetables.antidote : Vitamin K ( Aquamephyton) ANTIPLATELET MEDICATIONS Prototype: aspirin (ASA).narcotic analgesics . Dipyridamole (Persantin). b.
isosorbide dinitrate (Isordil) . peripheral arterial occlusive disease. halo vision. atrial tachycardia and fibrillation Nursing considerations: .sustained release medications should be swallowed and not crushed . coronary revascularization & thrombotic CVA Nursing considerations: .Take the medication with food. enalapril (Vasotec).Monitor for toxicity as evidenced by: o nausea.Monitor bleeding time ( NV = 1-9 mins) . allowing 10-12 hours “patch free” each day to prevent tolerance 2.nitroglycerine (Deponit. vomiting.angina pectoris.. Adverse effects: . which causes the heart muscle fibers to contract more efficiently. Nursing Considerations: 1. producing positive inotropic & negative chronotropic action.note the BP before giving the medication. Indications: . seek medical help. orthostatic hypotension . MI.one tablet for pain and repeat every 5 mins.I.Should be caution in patient with hypothyroidism and hypokalemia.for a total of three doses. CARDIAC GLYCOSIDES Prototype: digoxin (Lanoxin) Mechanism of actions: • increase intracellular calcium. .remove the patch. quinapril. . Nitrostat) Mechanism of action: .apply the patch to a hairless area using a new patch and different site each day . Sublingual medications : .headache.- used in the prophylaxis of long-term complication following M. .produce vasodilatation including coronary artery.Do not administer if pulse is less than 60 bpm.Antidote : Digoxin Immune FAB NITRATES Prototype: . lisinopril Mechanism of actions: . anorexia. Transdermal patch . bradycardia and heart blocks . . confusion.offer sips of water before giving because dryness may inhibit absorption.instruct patient not to swallow the pill . if not relieved after 10 mins.protect the pills from light ANTI – HYPERTENSIVES ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS (DRUG NAMES END IN WITH “-PRIL”) Prototype : captopril (Capoten). . Indications: • use for CHF.stinging or burning sensation indicates that the tablet is fresh .
3.prevent peripheral vasoconstriction by blocking conversion of angiotensin I to angiotensin II decreasing peripheral resistance. Check client’s apical pulse rate before drug administration. DIURETICS . refer if below 60 bpm.atenolol (Tenormin). .Nifedipine (calcibloc.not to discontinue medications because it can cause rebound hypertension. hypertension.hypercalcemia . arrhythmias. Adverse effect : .reflex tachycardia. . Administer oral beta-blockers before meals and at a.hydrochlorothiazide . ADRENERGIC BLOCKING AGENTS Prototype: Beta blockers (drug names end with “-olol”) . constipation Nursing considerations: . Verapramil (Isoptin) Mechanism of action: . if insomnia occurs.Raynaud’s disease. Amlodipine (norvasc).induce chronic dry cough Nursing considerations : .orthostatic hypotension. peripheral circulation and CNS.blocks Na and K reabsorption.depression.bronchospasm and dyspnea. Change positions slowly to avoid orthostatic hypotension.hyperkalemia .avoid using K+ sparing diuretics. insomnia and vertigo . . propanolol (Inderal). glaucoma Adverse effects : .Administer between meals to enhance absorption. timolol ( Blocadren) Mechanism of actions : . adalat).hypertension. Withhold if pulse is below 60 bpm. pheochromocytoma. . CALCIUM-CHANNEL BLOCKERS Prototype : .angina. arrhythmia Adverse effects: . headache . CHF . metoprolol (Lopressor). hypotension. Indications: .compete with epinephrine in b-receptors in heart. pulmonary airways.it also promotes vasodilatation of the coronary and peripheral vessels. thus decreasing the need for O2 .Take client’s pulse rate before each dose.bradycardia. nasal stuffiness.m. Warn clients not to drive or operate dangerous machinery until he/she has adjusted to medications. angina. bradycardia. 2. reabsorb Ca .usually given at morning Thiazides . 4. mitral valve prolapse.Refer for signs of congestive heart failure. Indications : . cold extremities Nursing considerations : 1.decrease cardiac contractility and the workload of the heart.
Loratidine (Claritin) . . tremors . GLUCOCORTICOIDS (Corticosteroids) Prototype: . .xanthine bronchodilators. and rinse mouth after using.Spironolactone (Aldactone) .Diphenhydramine (Benadryl) Mechanism of action : . or uncontrolled seizure disorder.furosemide (Lasix) . .excrete Na and water but it reabsorbs K . dilate airways. cardiac dysrhythmia.anorexia.blocks Na.Take drugs with food. low in sodium.restlessness.Instruct client to avoid individuals with RTI. and Ca reabsorption .Eat foods high in potassium.Brompheniramine (Dimetapp) . Indications : .aminophylline .bronchospasm. as well as pulmonary edema.Loop diuretics . . Adverse effects : .hypocalcemia Potassium sparing diuretics .theophylline . Nursing considerations: . bronchitis. . dizziness. . salmeterol .sympathomimetic (β -receptor agonist) bronchodilators.hyperkalemia RESPIRATORY MEDICATIONS BRONCHODILATORS Prototype : Symphatomimetic Xanthines . K. salbutamol .terbutaline Mechanism of actions: .Avoid taking NSAIDs while taking steroids.prednisone Mechanism of actions : . ANTI-HISTAMINES (H-1 blockers) Prototype: .palpitations and tachycardia .Take inhaled bronchodilators first before taking inhaled steroids.Should be used with caution in patients with HPN and narrow-angle glaucoma.albuterol. headache. Adverse effects :Cushing’s syndrome. COPD. osteoporosis Nursing considerations : . stimulate CNS for respiration.Instruct client not to stop medication abruptly it should be tapered to prevent adrenal insufficiency . asthma.Contraindicated in hyperthyroidism. nervousness.isoproterenol. nausea and vomiting.act as anti-inflammatory agents and reduce edema of the airways. neutropenia.
Mechanism of action: . Nursing considerations: .Ice chips or candy for dry mouth DECONGESTANTS . Nursing Considerations : .Given before or with meals .Avoid giving medications within 1-2 hrs of antacid administration (decreases absorption).diarrhea (magnesium). HISTAMINE-2 BLOCKERS (END WITH –IDINE) Prototype: .Precautions in handling machinery and driving while taking these drugs.sodium bicarbonate (Alka-Seltzer) . . Nursing considerations : - . . .Give 1 hr after meals.toform hydrochloric acid.Administer with food and drink. Nursing considerations: . ranitidine (Zantac). pantoprazole (Pantoloc). famotidine (Pepcid).metabolic alkalosis. PROTON – PUMP INHIBITORS (PPI) (END WITH –AZOLE) Prototype : .omeprazole (Losec). rhinitis.Avoid giving other drugs with cimetidine . . Adverse effects: . Mechanism of action : .Take fluids to flush after intake of antacid suspensions. Lansoprazole (Lanz).neutralize the stomach acidity. constipation (aluminum).blocks H2 receptors in the stomach. reducing acid secretions. nausea and vomiting. Mechanism of actions : . urticaria.aluminum/magnesium compounds (Maalox) .cimetidine (Tagamet). . nizatidine (Axid).magnesium hydroxide (Milk of Magnesia).electrolyte imbalance .Caution : do not use with clients with HPN DRUGS AFFECTING GASTROINTESTINAL SYSTEM ANTI-ULCER DRUGS ANTACIDS Prototype : . stone formation .Gynecomastia may develop with chronic use of cimetidine.common colds. allergies and as sleep aid.Monitor for changes of bowel patterns. Indications : .calcium carbonate (Tums) .inhibit the proton H+ to combine with Cl.pseudoephedrine (Sudafed) – adrenergic (sympathomimetic) agent .decrease nasopharyngeal secretions and decrease nasal itching by blocking histamine in H1-receptor.
.Given before meals preferably at morning. .coats the mucosa to prevent ulcerations. Na biphosphate (Fleet enema) & magnesium salt (Milk of Magnesia) . MUCOSAL BARRIERS Prototype : .lubricates & prevent colon absorption DRUGS AFFECTING THE ENDOCRINE SYSTEM THYROID AGENTS Prototype: • Synthroid (levothyroxine) Mechanism of action: .Diphenhydramine (Benadryl) – an antihistamie . Nursing consideration: . kaolin/pectin mixture (Kaopectate).Clay. .Misoprostol is contraindicated for pregnants.increase fecal bulk and water content e.decrease stomach motility and peristalsis. .Sucralfate cause constipation. Mechanism of actions : . bulk-forming laxative (Metamucil) . .Caution with coronary artery disease.retain fluid and distend intestine b.Metoclopramide (Reglan) – dopamine antagonist o Not available in Canada. loperamide (Imodium). Nursing considerations: . .diphenoxylate (Lomotil). . white or pale stool is common with kaopectate.Be cautious taking if with infectious diarrhea..emulsify fecal fat and water c. Nursing considerations : . used also for motion sickness .sucralfate (Carafate).function as natural or synthetic hormones. Osmotic : lactulose (Duphalac). Emollient/Lubricant : mineral oil . Stimulant : bisacodyl (Dulcolax) & senna (X-prep) .Given before meals. EPS side effects ANTI-DIARRHEAL AGENTS Prototype : .irritates intestinal mucosa and stimulates intestinal smooth muscles d. LAXATIVES a.Monitor for rebound constipation.Taken in the morning. Mechanism of action: . Fecal softeners : ducosate (Dialose) . ANTII-EMETICS (ANTI-VOMITING) .Monitor for signs of hyperthyroidism and refer for decreasing the dose.Monitor atropine toxicity with diphenoxylate. misoprostol (Cytotec).Dimenhydrinate (Gravol) – an anticholinergic. .
• First Generation: Chlorpropamide (Diabenase) . then long or intermediate (cloudy). don’t aspirate. Alpha-glucosidase inhibitors • delay carbohydrate absorption in the intestinal system • Acarbose (Precose) – side effect is diarrhea 4. . . Biguanides • facilitates insulin action on the peripheral receptor site • Metformin and Glucophage (Glucovance) .Roll the bottle in palm of hands. . needle-up.Usually given before meals.Alcohol is recommended for cleansing bottle but not with skin.Effective only for type II DM .Given before meals . . 4-6 ounce of fruit juice or regular soda c.Pinch skin. .Rotate the injection site an inch a part.5 – 1h 2-4 h 6-12 h 10-30 h 4-8 h Duration 5h 5-7 h 18-24 h 24-36 h 25 h Nursing considerations: .short acting last (clear).g Rosiglitazone (Avandia) – already discontinued Nursing considerations: . 3-4 commercially prepared glucose tablet b. .M.Aspirate short acting first.disulfiram precautions • Second Generation: Glypizide. Thiazolinidine • increase tissue sensitivity of insulin. Sulfonylureas • stimulate insulin secretions and increase tissue sensitivity to insulin. D50-50 IV. Glucagon 1 gm SQ or IM e. . .Prefilled syringes are stored vertically. treat with: a. NPH 70%) Onset 15 min 30 min-1h 1-3 h 4-6 h 0.side effect is lactic acidosis 3.Contraindicated to pregnant & breastfeeding. . don’t shake.5 h Peak 0.Monitor for acute hypoglycemia. avoid I. e. unused bottle stored in refrigerator. 2-3 teaspoons of honey d.Used bottles stored in room temperature.Monitor for signs of hypoglycemia. Glymepiride 2. .Inject amount of air that is equal to each dose into the bottle.May increase dose during illnesses.ANTIDIABETICS ORAL HYPOGLYCEMIC AGENTS (OHA) 1. . Insulin Type of Insulin Immediate Short-acting (regular) Intermediate (NPH) Long-acting Mixed (regular 30%. .
Quinolones .insomnia 4. metronidazole (Flagyl) Adverse effects : 1. cloxacillin b. DNA synthesis inhibitors a. .pen G. norfloxacin b.Steven-Johnson’s syndrome. penicillins . aminoglycosides . glycopeptide – vancomycin 2. gentamycin b. Sulfonamides . tachycardia . Keep clients in cool environment. parkinsonism. Collect appropriate specimen for C & S before starting antibiotics. For GI spasticity. Encourage clients to increase fluid intake and use of sugarless gum/candy for dry mouth. Check client’s history of allergies. ileus. 2.treat spasticity of GI or urinary tract. vomiting & diarrhea DRUGS with MULTIPLE USES CHOLINERGIC BLOCKING AGENTS (Parasympatholytics.use for treatment of bradycardia. Antimetabolites . asthma.hepatitis Nursing considerations: 1. Aminoglycoside . .use for antidote in organophosphate poisoning (insecticide) Adverse effects: .blocks folic acid synthesis a. administer 30 minutes before meals and at bedtime. Cell wall inhibitors a. 3. Tetracyclines . amoxicillin.ciprofloxacin. photosensitivity (remember the client vacationing in Mexico????) 3. 3.use preoperatively to dry up secretions. 2. quinolones .block the binding of acetylcholine in the receptors of parasympathetic nerves. tetracycline’s 3. heat stroke Nursing considerations: 1.nephrotoxicity & ototoxicity 2.bone problems 5. Erythromycin . Anticholinergics) Prototype: atropine Mechanism of actions: . Watch out for signs of heatstroke and dehydration. 4.cephalexin. . Sulfonamides – cotrimoxazole 4.DRUGS FOR TREATING INFECTION ANTIBACTERIAL AGENTS 1. Protein synthesis inhibitors a. cephalosphorins . ADRENERGIC AGENTS (Sympathomimetics) Prototype: .amikacin. macrolide – erythromycin c.urinary retention. cefaclor c. dilatation of pupils. Monitor adverse effects: ALL antibiotics can cause nausea.dry mouth . Indications: .
cardiopulmonary arrest. angina. Monitor vital signs and advice precautions MISCELLANEOUS DRUGS ANTI-GOUT . Morphine sulfate . hypotension . Digitalis – Digoxin Immune FAB 2. colchicine .restlessness.palpitations. Warfarin. insomnia. HPN Nursing considerations: 1. 2. albuterol. phenylephrine. tachycardia.COPD and asthma.Naloxone Hydrochloride 4. terbutaline.Protamine Sulfate 3.Vitamin K . Contraindicated in clients w/ hyperthyroidism.stimulate alpha and beta adrenergic receptor directly or trigger the release of catecholamines indirectly causing sympathetic effects. nasal congestions .allergic reaction. pheochromocytoma & cardiovascular disease. isoproterenol.Acute attacks : phenylbutazone (an NSAID). Indications: . tremors.Maintenance : allopurinol Drugs and their Antidotes 1. Mechanism of actions: . anaphylactic shock Adverse effects: . Heparin . nausea ..epinephrine.
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