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Pharmacology- Drug Cards (Index Cards)

Pharmacology- Drug Cards (Index Cards)

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Lab Values

Hematocrit (packed cell Blood Urea Nitrogen(BUN)
5-23 mg/ 100mL volume PCV) Female= 38%-47% Male= 40%-54%

Creatinine
0.6-1.5 mg / 100mL 24-32 mEq/L

Carbon dioxide content PCO2
35-43 mmHg

Hemoglobin
Female= 12-16g / 100mL Male=13-18g/100 mL Newborn 14-20g/ 100mL

PO2 PH

75-100 mmHg (breathing room air) 7.35-7.45

Iron
50-150 mcg/100mL

Platelet count

150,000-400,000/mm3

Red blood cell count
Female 4.2-5.4 million/mm3 Male 4.5-6.2 million/mm3

White blood cell count
4500-11,000/mm3

60%-70% of total

Neutrophills

Lab Values (con’t)
Albumin
3.5-5g/100mL

Potassium
3.8-5.1mEq/L

Creatinine
0.6-1.5mg/100mL

Specific Gravity
1.058

Glucose

Calcium
8.4-10.5mg/100mL

70-110mg/1oomL(fasting)

Coagulation time (glass tube)
5-15 Min.

Cholesterol total
120-220mg/100mL >40mg/100mL

High-density cholesterol Low-density cholesterol
<80mg/100mL

Sodium

136-145 mEq/L

Chloride
96-107 meq/L

Drug Therapy: Insulin Preparation, Time Course of Action
INSULIN TYPE APPEARAN CE ONSET PEAK DURATION

RAPIDACTING Humalog NovoLog SHORTACTING Humulin R, Novolin R

Clear Clear

< 15 minutes <15 minutes 30 mins 1 hour

1-2 hours 1-2 hours 2-3 hours

3-4 hours 3-4 hours

Clear

3-6 hours

INTERMEDIAT E-ACTING

NPH insulin LONGACTING Lantus

Cloudy

2-4 hours

4-10 hours Does not peak

10-16 hours 20-24 hours

Cloudy

1-2 hours

slow) growth of microorganism .Effect of Breakfast InsulinLunch on Blood 150 Glucose Levels Dinner Bedtime 130 90 Short-acting insulin 70 CBG Intermediate-acting insulin Mg/gL Long-acting insulin ANTIINFECTIVES *Fight infection -Bacteriostatic: retard (limit.

fungi.-Bacteriocidal: kill microorganisms *Bacteria. overgrow and get out of control because the antibiotic also killed the organisms that would have kept them under control *Culture & Sensitivity: diagnostic test to find out the specific bacteria and what drug will be effective against it . For example: MRSA. VRE *Super-infections: when other organisms that are not sensitive to prescribed antibiotic (for example. viruses. yeast) are able to multiply. effective against only a few organisms *Bacterial Resistance: after multiple exposure to a medication. protozoa *Spectrum: the number of organism that medication is effective against -Broad Spectrum: will kill everything -Narrow Spectrum: is used for specific infections. the bacteria will mutate and become infective against the drug.

mouth. pyelitis & pyelonephritis ADVERSE REACTION -N/V/D. Lesions appear as red wheals or blisters often starting on face. thrombocytopenia INTERACTIONS Drug: anticoagulantsincrease bleeding Food: Taken on empty stomach Herbal: encourage cranberry juice to prevent & relieve UTI symptoms NURSING PRECAUTIONS . headache. Sulfasalazin) ACTION • Antibacterial USES -Acute & chronic UTI caused by E. coli -Cystitis. pruititis. fever. lips -Leukopenia. cough.Sulfonamides Pg. aches/pains. 1205 & 1331 (Silver Sulfadiazine. urticara *urine & skin take on orange-yellow color *crystalluria: crystals in urine (increase fluid) *photosensitivity *Toxic-Epidermal Necrolysis (TEN) *Stevens-Johnson Syndrome (SJS) -lesions. Bactrim.

Septicemia. jaundice. STDs. Ampicillin. Meningitis. neuropathy. aspirin. leucopenia. Amoxicillin. • Antibacterial USES *UTIs. thiazides & sulfonylurea *Discontinue if pt’s urinary output is decreased or rash develops *Have patients avoid the sun *Encourage adequate fluid intake to avoid crystalluria *Empty stomach=hour before. renal/hepatic failure in high-risk patients Penicillins Pg. Nafcillin) ACTION infections *Can be used as a prophylaxis (prevention) for rheumatic fever & chronic ear infections ADVERSE REACTIONS -N/V/D. 2 hours after with a full glass of water *watch for signs/symptoms of blood dyscrasias. utricara. Augmentin. angioedema (swelling of skin/mucous membranes). thrombocytopenia. Unasyn. Pneumonia & other respiratory . rash.*Any allergies to sulfa drugs. bone marrow depression. Dixloacillin. anaphylaxis -anemia. 958 (Penicillin.

(Ancef. hypersensitivity to procaine or tartrazine *Give on EMPTY stomach *Frequent skin care-avoid harsh soap/lotions *After administering PCN IM in outpatient setting.phlebitis *Super-infection & pseudomembranous colitis INTERACTIONS Drug: oral contraceptivesdecrease effectiveness of contraceptive Tetracyclinesdecreases effect of PCN Anticoagulantsincreased bleeding risk Beta-adrenergic blockersmay increase risk of anaphylactic shock Antacidsdecrease absorption of PCNs *PCN may change results of some lab tests* Food: affects absorption of most PCNs NURSING PRECAUTIONS *Prior PCN allergy. ask patient to wait 30 minutes to assess for anaphylactic reactions *Watch for severe diarrhea and sign/symptoms of super-infection *Recommend soft-bristled toothbrush and frequent mouth care 282. Rocephin. asthma. 286 Cephalosporins Pg. Maxipime) . 279. Keflex.

heartburn *Pruritus. sweating and hypotension) NURSING PRECAUTIONS *10% of PCN allergy patients will be allergic to cephalosporins *May be TAKEN WITH FOOD reduce GI upset **Cedax should NOT be taken with food** . dizziness. malaise. fever. urticara. thrombophletbitis with IV use INTERACTIONS Drugs: Aminoglycosides (anti- infective)will increase risk of nephrotoxicity Anticoagulants  increase risk for bleeding Loop diureticsincrease cephalosporin blood level Food: Alcohol consumed within 72 hours after administration will produce an Antabuse-like reaction (vomiting. dyspnea. nephrotoxicity *phletbitis.ACTION • Antibacterial USES *Treatment of infections caused by bacteria -Respiratory -Otitis media -Bone/joint -Genitourinary *May be used as a prophylaxis (prevention) after surgery ADVERSE REACTIONS *N/V/D. TEN & SJS (death of epidermal layer of skin).

typhus fever -Intestinal amebiasis -Skin/soft tissue infections.*Inpatients should be assessed Q4 hours for skin redness. early sign=decrease urine output (daily output < 500 mL call MD) *Watch sign/symptoms of superinfection *Should be taken around the clock to keep an adequate amount of drug in the body *Finish full course of drug regimen Tetracyclines Pg. minocycline least likely to produce a reaction) INTERACTIONS Drug: Digoxin increase risk digitalis . Doryx. epigastic distress. blister/red wheals *Risk of nephrotoxicity. 1155 (Declormycin. Sumycin. severe acne -Cervical/rectal infections -Infection caused by helicobacter pylori (bacterium in stomach causes peptic ulcers) ADVERSE REACTIONS *N/V/D. stomatitis *photosensitivity (demeclocycline most severe reaction. Tygacil) ACTION • Antibacterial when PCN is contraindicated USES • Treats infections caused by: -Rocky Mnt Spotted Fever. rash. lesion.

gentamicin. may cause permanent teeth discoloration & prolonged/repeated-use may result in resistance ➢ Blood glucose levels should be monitored frequently with diabetic during tetracycline therapy *on an empty stomach with a full glass of water (exceptions: Minocin and Terramycin) *Avoid calcium-rich foods: cheese. ice cream Aminoglycosides Pg. neomycin. streptomycin & tobramycin) ACTION .toxicity Antacids decrease effectiveness of tetracycline Anticoagulantsincrease risk for bleeding Oral contraceptivesdecrease effectiveness of contraceptives Food: Calcium-rich foodsimpairs tetracycline absorption NURSING PRECAUTIONS ➢ Children younger than 9— tetracyclines should NOT be given. milk. yogurt. Kantrex. 140 (Amikin. cream.

tingling. tremors INTERACTIONS Drug: Cephalosporinsincrease risk nephrotoxicity Loop Diureticsincrease risk ototoxicity Pavulon or Anectine (Anesthesia)increase risk of neuromuscular blockade NURSING PRECATIONS *Hypersensitivity to patients with preexisting hearing loss.• Antibacetial USES • May be used to reduce normal flora in bowel prior to abdominal surgery (bowel preparation) ADVERSE REACTION *N/V. rash. utritcaria *Nephrotoxicityproteinuria. dizziness. vertigo *Neurotoxicity: numbness. sign/symptoms=tinnitus. Decrease in urine ouput *Ototoxicity: damage to hearing organs. anorexia. increase in blood urea nitrogen (BUN) level. hematuria. myasthenia gravis (condition characterized by weakness & muscle fatigue) & Parkinsonism *Oral administration of Amingolycosides: enteric-coated erythromycin given with neomycin *Drug delivery timing is critical for optimal response of suppression of intestinal .

Hemophilus influenza Upper Respiratory infections ADVERSE REACTIONS *N/V/D. Ketex) ACTION • Antibacterial USES *Used as prophylaxis before dental or other procedures in patients allergic to PCN *Acne vulgaris. 49 (Zithromax. chloramphenicol  decreased therapeutic activity of macrolides Theophyline (asthma medication)  increased serum theophyline level NURSING PRECAUTIONS . skin infections . lincomysi. Pseudomembranous colitis. abdominal cramping or pain *visual disturbances: changes in eye’s accommodation to light INTERACTIONS Drug: Antacidsdecease absorption and effectiveness of macrolides Digoxinincrease serum levels of cardiac medication Anticoagulants risk for bleeding Clindamyclin.bacteria when preparing a patient for surgery with kanamycin or neomycin* Macrolides Pg. Z pack. erythromycin.

*Pseudomembranous colitis *Blood dyscrasias (an abnormality of the blood cell structure or function) . Dirthromycin. 317 (clindamycin. Erythromycin* Lincosamides Pg. abdominal pain. lincomycin) ACTION • Antibacteral USES • Treating serious infections in which PCN or erythromycin is NOT effective ADVERSE REACTION *N/V/D.*Hypersensitivity in patients with pre-existing liver disease *Telithromycin (Ketek) should NOT be ordered if a patient is taking cisapride (Proulsid) or pimozide (Orap) *Oral administration for Macrolides: -Administered without regard to meals and with milk *Exceptions: Azithromycin.

Maxaquin. Tequin. Vacomycin) .INTERACTIONS Drug: Kaolin (Al based antacid) decreases absorption of lincosamides Neuromuscular Blocking drugs increased action of neuromuscular blocking drug that can lead to severe respiratory depression NURSING PRECAUTIONS • Contraindicated in infants younger than 1 month of age *Patients taking cisapride (Propulsid) or antipsychotic drug pimozide (Orap) *Oral administration for Lincosamides: -Food impairs absorption -Patient should NOT take anything by mouth for 1 to 2 hours before/after meals -Give clindamycin with food or a full glass of water Fluoroquinolones Pg. Avelox & Floxin. 557 (Cipro.

during pregnancy. children younger than 18 years old. who cannot follow precautions regarding photosensitivity . Zn)  decreases absorption of the antibiotic Nonsteroidal Anti-Inflammatory Drug (NSAIDs)  risk of seizure activity NURSING PRECAUTIONS *Monitor VS for adverse reactions during first 48 hours *Patients with a history of hypersensitivity. headache. salts. STDs • Infections of the skin ADVERSE REACTIONS *N/V/D. dizziness *abdominal pain/discomfort *Photosensitivity: more serious with lomefloxacin & sparfloxacin INTERACTIONS Drug: Theophyllineincrease theophylline levels Cimetidine interferes with eliminations of the antibiotic Oral Anticoagulants increased risk of bleeding Antacids (Fe.ACTION • Antibacterial USES • Lower respiratory infections • Bone/Joint infections • UTIs.

tissue sloughing or phletitis at the injection site INTERACTIONS Drug: The excretion of . 496 (Merrum. 49. septicemia ADVERSE REACTIONS * N/V/D. history of seizures. bacterial meningitis • Imipenem-cilastatin (Primaxin) used to treat serious infections.*Used cautiously in patient with: renal impairment. bacterial community-acquired pneumonia ACTION • Antibacterial USES • Meropenem (Merrem) used for intra-abdominal infections. abscess. Ertapenem) Ertapenem  used to treat serious infections. endocarditis. geriatric patients and patients on dialysis • Carbapenems Pg. Primaxin. rash.

allergic to cephalosporins & penicillin -have renal failure -children younger than 3 years old .carbapenems is inhibited when the drug is administered to a patient also taking probenecid (Benemid) NURSING PRECAUTIONS *Contraindicated in patients who are: .

Diff) ADVERSE REACTIONS *Nausea. during pregnancy/lactation Interaction *Should NOT be used with other drugs that can cause ototoxicity and nephrotoxicity .Vancomycin Pg. rash *Nephrotoxicity. urtiicaria. fever. ototoxicity CONTRINDICATIONS *Contraindicated in patient who have known sensitivity to the drug *Used cautiously in patients with renal or hearing impairment. sudden fall in BP with parenteral administration. 1215 (Vacocin) ACTION • Antibacterial USES • Serious gram-positive infections that do not response to treatment with other anti-infectives • Anti-infective associated pseudomembranous colitis caused by Clostridium difficile (C. chills.

Signs/symptoms include decrease BP. 752 (Zyvox) ACTION • Antibacterial USES • Vancomycin-resistant enterococcus (VRE) • Health care and communityacquired pneumonias • Skin and skin structure infections ADVERSE REACTIONS *N/V/D. nervousness.NURSING PRECAUTIONS The nurse should administer each IV dose of Vancomycin over 60 minutes—too rapid an infusion may result in a sudden and profound fall in blood pressure and shock. Linezolid Pg. rash -Less common: fatigue. photosensitivity *Pseudomembranous colitis and Thrombocytopenia CONTRAINDICATIONS *Contraindications in patients who are . depression. fever. back pain or red neck. insomnia. known as red-man syndrome. chills. headache and dizziness. throbbing neck.

caffeinated beverages. NSAIDs. yogurt. or patients who phenylnetonuria *Used cautiously in patients with: *Bone marrow depression *hepatic dysfunction*Renal impairment *Hypertension/hyperthryroidism INTERACTIONS Drug: Anti-platelet drugs (Aspirin. pepperoni) Spectinomycin (Trobicin) ACTION *Antibacterial USES .allergic to the drug. chocolate. Plavix)  Increased risk of bleeding & low platelets MAOI Antidepressants  Decreased effectiveness Food: Large amounts of food containing tyramine risk of severe hypertension **Tyramine foods: aged cheese. red wine. beer. pregnant (Category C) or lactating.

chills. fever & hypersensitivity reactions INTERACTIONS/NURSING PRECAUTIONS *Contraindicated in patients with known hypersensitivity to the drug **No known safe use with pregnancy/lactating women and infants/children** ***Interaction: No significant drug or food interactions are known*** Aztronam (Azactam) ACTION . rash. urticaria. dizziness.*Used for treating gonorrhea in patients who are allergic to penicillins. cephalosporins or probenecid (Benemid) ADVERSE REACTIONS *Soreness at injection site.

• Differs structurally from penicillin and cephalosporins in having a monocyclic rather than a bicyclic nucels. hypotension. rash. primarily in aerobic gram-negative bacteria USES • Gram-negative bacteria infections such as: -urinary tract -lower respiratory tract -skin/skin structures -intraabdominal -septicemia ADVERSE REACTIONS *N/V/D. during pregnancy/lactation (Category B) *Used cautiously in patients with patients with renal or hepatic impairment . headache. cephalosporins or carbapenemcross sensitivity NURSING PRECUATIONS *Contraindicated in patients with known hypersensitivity. Acts by inhibiting synthesis of bacterial wall. pseudomembranous colitis INTERACTIONS Drug: patient’s sensitive to penicillins.

rash. pseudomembranous colitis INTERACTIONS Drug: potential increased risk of myopathy with statin drugs NURSING PRECAUTIONS *Contraindicated in patients with known hypersensitivity to the drug and during pregnancy/lactation (Category B) *Used cautiously in patients taking warfarin (Coumadin) . 376 (Cubicin) ACTION Antibacterial • USES • Complicated skin and skin structure infections ADVERSE REACTIONS *N/V/D. headache.Daptomycin Pg. hypotension.

incompatibility with saline or heparin flush solutions. 1049 (Synercid) ACTION • Antibacterial against gram-positive pathogens including VREF USES • Serious and life-threatening infections associated with vancomycinresistant Enterococcus faecium (VREF) • Complicated skin/skin structure infections caused by staphylococcus aureus ADVERSE REACTIONS • Irritation in the vein. N/V/D INTERACTION Drug: serum levels of the following drugs may increase: -Antiretrovirals -Anti-neoplastic -Immunosuppressants -Calcuim channel blockers -Benzodiazepines -Cisapride .Quinupristin/Dalfopristin Pg.

pregnancy/lactation (Category B) .CONTRAINIDCATIONS/NURSING PRECAUTIONS *Contraindicated in patients with known sensitivity to the drug.

skin eruptions. if GI upset may take with meals *Isoniazid solution tends to crystallize at low temperatures.Isoniazid Pg. 705 (INH. let it warm to room temperature before injecting *Rotate injection sites *Monitor BP during dosage adjustment: some experience orthostatic . Nydrazid) ACTION • Antibacterial USES • Used to treat Active Tuberculosis ADVERSE REACTIONS *N/D. jaundice  Toxicity = peripheral neuropathy and severe & sometimes fatal hepatitis) INTERACTIONS Drug: Aluminum salts reduced absorption of isoniazid Anticoagulants increased risk for bleeding Phenytoin (Dilantin)  increased serum level of Dilantin Food: Alcohol higher incidence of drugrelated hepatitis NURSING PRECAUTIONS *Give on empty stomach.

vertigo. tears. sputum) *Call the MD immediately if patient becomes jaundice of skin & eyes = ABNORMAL INTERACTIONS Drug: Digoxin  decreases digoxin serum levels Oral contraceptives  decreases contraceptives effectiveness Antiretroviral for HIV (efavirenz. nevirapine)  decreases level of antiretroviral Isoniazid (INH for TB)  higher risk of hepatotoxicity Rifampin Pg. 1066 (Rifadin. sweat. saliva. heartburn. Rimactant) ACTION • Antibacterial USES • Used to treat Active Tuberculosis ADVERSE REACTIONS .hypotension *Monitor diabetics for abnormal blood sugar results *Avoid tyramine & histaminecontaining foods causes hypertension *N/V. reddishorange discoloration of body fluids (urine.

59 Acyclovir (Zovirax) for Herpes Simplex 1 & 2. 2 (genital) and Herpes Zoster (Shingles) • HIV . *REPORT JAUNDICE immediately *Do NOT interrupt dosage regimen ANTIVIRALS Pg. given with/ or without food *Explain coloration of bodily fluids (soft contact lenses may be permanently stained). Varicella zoster (Chicken pox) Oseltamivir (Tamiflu) for prevention and treatment of Influenza A &B Valacyclovir (Valtrex) for Herpes ACTION *Combats viral infections  does NOT kill viruses *Can be toxic to human cells *Herbal alert: Lemon Balm USES • CMV in transplant patients • Herpes simplex virsus 1.Anticoagulants  increased risk for bleeding Hypoglycemics  decreases effectiveness of hypoglycemia. Zoster (Shingles). patients become hyperglycemic NURSING PRECAUTIONS FOR ANTITUBERCULAR DRUGS *Rotate injection sites *Monitor for gastric upset.

just like a virus -To control the disease effectively. headache. rash. a number of drugs are used (a cocktail) *highly active antiretroviral therapy (HAART): multidrug therapy USES • Used in the treatment of HIV/AIDs . fever *Cidofovir (Vistide)  contraindicated for patients on other nephrotoxic meds. 1349-1351 ACTION • Retrovirsus: attack host cells.• • Influenza A & B Hepatitis B & C ADVERSE REACTIONS *N/V/D. like aminoglycosides *Ribavirin contraindicated for patients with unstable cardiac disease INTERACTIONS Drug: Probenecid (for gout) increase levels of the antivirals Cimetidine (for peptic ulcers)  increases levels of antiviral valacyclovir Ibruprofen  increases level of antiviral devoir NURSING PRECAUTIONS *Monitor I/Os & hydration status *Refrain from sex if signs/symptoms of herpes persists *Do not breast feed while taking this drug ANTIRETROVIRALS Pg.

monitor respiratory function *Help reduce effects of nausea. altered taste *numbness &tingling around the mouth or peripherally CONTRAINDICATIONS *Patients who are lactating *Patients also taking cisapride. primozide. Hyperosmotic Laxative .ADVERSE REACTIONS *N/V/D. midazolam or ergot derivative INTERACTIONS Drug: Antifungals increases levels of antiretroviral Clarithromycin  increases levels of BOTH drugs Sildenafil (Viagra)  increase levels of sildenafil Opiod analgesics  risk of toxicity with ritonavir Anticoagulants/anticonvulsant/antiparas itics decrease effectiveness of antiretroviral if taking ritonavir Interleukins  risk of antiretroviral toxicity Fentantyl  increases level of fentanyl Oral contraceptives  decreases effectiveness of contraceptive NURSING PRECAUTIONS *Observe patients on Amantadine for adverse effects *Ribavirin: Pregnancy Category X. odorfree environment *Monitor for skin lesions Fleets (Magnesium/Saline enema) ACTION • Enema. triazolam.

fainting CONTRINDICATIONS *Safe use during pregnancy or lactation is not established (Category C) *DO NOT use in presence of abdominal pain/N/V *Consult physician regarding fluid intake in patients receiving drug for elevated intraocular pressure INTERATIONS Drug: other laxatives effectiveness of laxatives NURSING PRECAUTIONS *May cause hyperglycemia in diabetics *Evacuation usually comes 15-30 min after administration of enema *Do not breast feed while taking this drug without consulting physician *Place patient in Sims’ position *Lubricate tip of bottle *Instruct patient to retain enema for 5-10 minutes prior to expelling fluid . flatulence.USES • Relief of constipation • Stimulates peristalsis by acting as an irritant ADVERSE REACTIONS *N/V/D. bloating. cramping. perianal irritation.

dark urine. heartburn • GI Bleeding ADVERSE RACTIONS *Headache. severely ill. Zantac 75) Pg. somnolence. pruritius. elderly or debilitated patients. distress)  decreased absorption of the H2 antagonists Carmustine (anticancer)  decreases WBC Opioid Analgesics  increased risk of respiratory depression Anticoagulants  increased risk of bleeding digoxin  may decrease digoxin levels NURSING PRECAUTIONS *BIG risk of potential toxicity from decreased elimination in older adults or patients with hepatic or renal dysfunction *Monitor liver function tests & early signs of hepatoxicity -jaundice. yellow sclera and skin . diarrhea CONTRAINICATIONS *Hypersensitivity to the drug *Cautiously used in patients with renal/hepatic impairment.*Used cautiously in diabetic patients *Pregnancy Category B INTERACTIONS Drug: Antacids & metoclopramide (GI Ranitidine (Zantac.623 ACTION • Anti-ulcer drug USES • Gastric/duodenal ulcers • GERD.

unconsciousness. rapid & weak pulse NPH (Isophane Insulin) (Humulin 70/30. Pepto  reduces Zantac absorption) *Do NOT SMOKE *Do NOT breast feed without consulting MD • Intermediate-acting insulin hormone that decreases blood glucose levels USES • To control hyperglycemia in diabetic patients ADVERSE REACTIONS *Hypoglycemia: sudden onset. 683 ACTION CONTRAINICATIONS . thirst/nausea/vomiting.*Long-term therapy may lead to vitamin B12 deficiency *Remember to provide pain relief through the night *Do NOT supplement with OTC gastric distress remedies (Mylanta. deep rapid respirations. agitation. tingling of lips/tongue *Hyperglycemia: gradual onset. dry/flushed warm skin. numbness. pale/moist/cool/diaphoretic skin. weakness. hunger/nausea. convulsions. Novolin N) Pg. dizziness. drowsiness. Normal to shallow respirations. dim vision. nervousness. Novolin 70/30. fatigue.

anabolic steroids. . epinephrine. unconsciousness. dizziness. corticosteroids. HIV antivirals. lithium. sweating. estrogens. calcium. Normal to shallow respirations. morphine Drugs that increased the effect (less insulin may be required) ACE inhibitors. sulfonamides. MAOIs. agitation. diuretics. nervousness. Novolin R) Pg. convulsions. alcohol. contraceptives. tetracyclines weakness. weakness. fatigue. renal/hepatic impairment and older adults *Hypersensitivity to animal products (beef or pork) INTERACTIONS Drug: Drugs that decrease the effect (more insulin may be required) Albuterol. oral anti-diabetic. isoniazid. salicylates.*Pregnancy Category B.681 ACTION • Short-acting insulin hormone that decreases blood glucose levels USES • To control hyperglycemia in diabetic patients ADVERSE REACTIONS *Hypoglycemia: sudden onset. glucagon. after dinner snack Regular Insulin (Humulin R. NURSING PRECAUTIONS *Learn signs/symptoms of hypo & hyperglycemia *Suspect hypoglycemia if fatigue. tremor or nervousness occur *Advise mid-afternoon. diltiazem.

sweating. tremor or nervousness occur *Advise mid-afternoon. Nitrate Vasodilator USES . dim vision. dry/flushed warm skin. numbness. after dinner snack Nitroglycerin (Paste. alcohol. 892 ACTION • Cardiovascular . morphine Drugs that increased the effect (less insulin may NURSING PRECAUTIONS *Learn signs/symptoms of hypo & hyperglycemia *Suspect hypoglycemia if fatigue. thirst/nausea/vomiting. patch or sublingual) Pg. renal/hepatic impairment and older adults *Hypersensitivity to animal products (beef or pork) INTERACTIONS Drug: Drugs that decrease the effect (more insulin may be required) Albuterol. corticosteroids. diuretics. isoniazid. glucagon. tingling of lips/tongue *Hyperglycemia: gradual onset. rapid & weak pulse be required) ACE inhibitors. deep rapid respirations. epinephrine. salicylates. pale/moist/cool/diaphoretic skin. contraceptives. HIV antivirals. weakness. tetracyclines CONTRAINICATIONS *Pregnancy Category B. diltiazem. MAOIs. drowsiness. lithium.hunger/nausea. anabolic steroids. oral anti-diabetic. calcium. estrogens. sulfonamides.

.• Angina. faintness. it will be absorbed into their skin & causes a severe headache *Sublingual nitro may be repeated Q 5 mins until pain is relieved or patient has received 3 doses in a 15-minute period.cool. Preventative of MI ADVERSE REACTIONS *headache. weakness. *Heart rate MUST be above 60 Keep in a dark. vertigo. hypotension *circulatory collapse CONTRAINDICATIONS *Patients with severe anemia. severe head trauma and hypothyroidism INTERACTIONS Drug: Aspirin  increases nitrate concentration Calcium Channel Blockers  increases symptomatic orthostatic hypotension Dihydroergotamine (migrate medicine)  Increases risk of hypertension heparin  decreased effect of heparin Erectile dysfunction meds severe hypotension & cardiovascular collapse may occur Alcohol  severe hypotension & cardiovascular collapse because of it’s a vasodilator NURSING PRECAUTIONS *Nurse should NOT rub nitro ointment into patient’s skin. dizziness. cerebral hemorrhage *Used cautiously in the following patients: severe hepatic/renal disease.airtight container.

.

patients with history of seizures and patients who are pregnant (Category C) INTERACTIONS Drug: Adrenergic drugs  possible additive adrenergic effects Tricyclics (anti-depressives) possible hypotension Beta-adrenergic blockers (hypertension)  inhibits the cardiac. tremor.Albuterol (Ventolin. hyperactivity. shakiness. Proventil. bronchodilating & vasodilating effects of the adrenergic methyldopa (hypertensive med)  possible hypotension oxytocic drugs  possible severe hypotension theophylline (asthma/COPD med)  increased risk for cardiotoxicity NURSING PRECAUTIONS . Volmax. vertigo CONTRAINIDATIONS *Contraindicated in patients with cardiac arrhythmias associated with tachycardia. tachycardia. nervousness. emphysema • Acute & Chronic bronchial asthma ADVERSE REACTIONS *Headache. dizziness. Provenil) Pg. palpitations. 120 ACTION • Bronchodilator USES • Bronchospasm. organic brain damage & cerebral arteriosclerosis. bronchitis.

excitement. rash. 587 ACTION • Antihypertensive • Loop Diuretics INTERACTIONS Drug: Cisplatin (cancer med) AND . tachycardia. N/V. Furosemide (Lasix) Pg. pulse oximetry and pulmonary function *Avoid contact of inhalation drug with eyes *Do not use OTC drugs without physician approval. including cold medicine USES • Edema due to heart failure. insomnia. dizziness.*Monitor for signs/symptoms of fine tremor in fingers. CNS stimulation (particularly in children 2-6 y). GI symptoms *Lab tests: periodic ABGs. nervousness. photosensitivity. acute pulmonary edema and hypertension ADVERSE REACTIONS *Electrolyte and hematologic imbalances. renal disease. anorexia. cirrhosis of the liver. severe kidney or liver dysfunction and anuria (cessation of urine production). orthostatic hypotension CONTRAINIDCATIONS *Patients with electrolyte imbalances.

mucosal congestion and acute sinusitis • Prolonged anesthetics and anaphylactic reactions ADVERSE REACTIONS . heart block. watch for hypokalemia (K+ between 3. quicken reflexes.aminoglycosides increased risk of ototoxicity anticoagulants or thrombolytic (increases risk of bleeding) digitalis increased risk of arrhythmias lithium  increased risk of Li toxicity hydantoins (seizure med)  decreases effectiveness of diuretic NSAIDs  decreases effectiveness of diuretic NURSING PRECAUTIONS *Closely monitor BP and vital signs *Monitor potassium levels.480 ACTION • Autonomic Nervous System Agent • Central Nervous System (wakefulness. increases heart rate) USES • Treatment & prophylaxis of cardiac arrest. quick reaction to stimuli.5 -5) *Be careful of electrolyte imbalance *Monitor I/Os & voiding pattern *Lasix may cause hyperglycemia *Excessive dehydration occurs in older adults *Hold if BP if less 100/60 Epinephrine (EpiPen) Pg.

pulse and respirations *Call MD if any change in input/output ratio *Use cardiac monitor with patients receiving epinephrine IV. flushing.*Anxiety. Have full crash cart immediately available *Check BP first 5 mins then every 3-5 mins until stabilized *Advise patient to report bronchial irritation. nausea. headache. and as a local anesthetic adjunct in fingers and toes INTERACTIONS Drug: Antidepressants increased sympathomimetic effect Oxytocin  increased risk of hypertension Bretylium (severe cardiac med)  increased risk of arrhythmias NURSING PRECAUTIONS *Monitor BP. lightheadedness. tachycardia CONTRAINDICATIONS *Patients with narrow-angle glaucoma. nervousness or sleeplessness . sweating. dizziness. vomiting.

A positive skin test does not necessarily mean that a person has .TB/Mantoux A negative reaction (no induration) or a size of hard swelling that falls below the cutoff for each risk group may mean that you have not been infected with the bacteria that cause TB. A small reaction (5 mm of firm swelling at the site) is considered to be positive in people: • • • Who have HIV Who are taking steroid therapy Who have been in close contact with a person who has active TB Larger reactions (greater than or equal to 10 mm) are considered positive in: • • • People with diabetes or kidney failure Health care workers Injection drug users There is a very small risk of severe redness and swelling of the arm in people who have had a previous positive PPD test and who have the test again. The results of the test depend on the size of the skin reaction and on the person being tested. There also have been a few cases of this reaction in people who have not been tested before.

provide lubrication & protection in a variety of conditions. temporary blurred vision. More tests must be done to check whether there is active disease. surgery or removal of a foreign body. decreased corneal sensitivity. 1351 ACTION • Utilizes isotonic solutions & wetting agents in the management of dry eyes due to the lack of tears USES • Keeps the eye moist • Lubrication for artificial eyes. ADVERSE REACTIONS None known Artificial Tears (Ocular Lubricants) Pg.active tuberculosis. including exposure keratitis. lid edema. & eye discomfort NURSING PRECAUTIONS Adults & children 1-2 drops 3-4 times per day instilled into the conjunctiva . corneal erosions. during/following ocular CONTRAINIDCATIONS May alter effects of other concurrently administered ophthalmic medications Photophobia. stinging.

perianal irritation CONTRATINDIATIONS *Not advised for patients with persistent abdominal pain. cramping. nausea. nausea.*Diarrhea. vomiting. pregnant woman and during lactation (Pregnancy Category C). used only during pregnancy when the benefits outweigh risks INTERACTIONS Drugs: Mineral Oil  impairs GI absorption of fat-soluble vitamin (A. 223 ACTION • Laxatives USES • Relief of constipation ADVERSE REACTIONS . D. flatulence. or vomiting of unknown causes or signs of acute appendicitis *Used cautiously in patients with rectal bleeding. E and K) *Laxatives reduce absorption of other drugs present in GI tract Bisacodyl (Dulcolax) Pg. bloating.

histamine H2 antagonists & proton pump inhibitors should NOT be administered 1 to 2 hours before bisacodyl Tablets because enteric coating may dissolve early. may result in decreased absorption of vitamin K. resulting in gastric lining irritation NURSING PRECAUTIONS *Evaluate patient’s need to continue. *Add high-fiber foods slowly to avoid gas and diarrhea . dulcolax usually produces 1 or 2 soft formed stools daily *Monitor patients receiving anticoagulants.*Milk. antacid.

Nystatin (Cream. abdominal/joint/muscle pain. oral swish/swallow or swish/spit) Pg. dissolve troche in mouth (about 30 mins). do NOT chew or swallow. take after meals and at bedtime *If taking orally. rash. anorexia and malaise CONTRAINDICATIONS *Contraindicated during pregnancy & lactation & ONLY used when situation is life-threatening and outweigh the risk to the fetus *Patients renal dysfunction/hepatic impairment INTERACTIONS No known interactions NURSING PRECAUTIONS *This drug may cause dermatitis. under breasts. 181-184 ACTION • Antifungal USES • Fungal infections • Most likely to occur in groin area. folds of stomach in obese patients ADERVSE REACTIONS *D/N/V. Avoid food and drink during period of . if it does it should be stopped and call MD *It taken for treatment of trush. headache. powder.

dust shoes and stockings as well as feet *Wash skin before topical use *Do not breast feed while taking this drug without consulting MD *If sublingual. bottle must be air-tight away from sunlight .dissolving and for 30 mins after treatment *If powder.

Hydrocortisone Cream (Cortisol) Pg. moon face.350 ACTION • Glucocorticoid • Anti-inflammatory Drug USES • Allergic reactions • Dermatologic conditions ADVERSE REACTIONS *Buffalo hump. purple striae on the abdomen and hips. osteoporosis. fungal and antibiotic resistant infections) *Used cautiously in patients with renal/hepatic disease. hypothyroidism. oily skin and acne. altered skin pigmentation and weight gain CONTRAINDICATIONS *Patients with serious infections (such as TB. ulcers/diverticulitis INTERACTIONS Drug: Barbiturates  decrease effect of steroid Oral contraceptives  steroid concentration may be increased and clearance decreased Estrogen  steroid clearance decreased Digitalis  possibility of digitalis toxicity Loop Diuretics  hypokalemia Antiinfectives decrease effectiveness of antiinfective .

NURSING PRECAUTIONS *Monitor electrolytes and blood glucose level *Monitor for persistent backache or chest pain or fractures of long bones *Monitor change in mood or behavior in longterm therapy *Be alert to possible masked infections and delayed healing *One time or short term use do NOT produce withdrawal symptoms when discontinued .

up & back *Cerumen is thicker in the elderly *Allow solution to stay in ear canal for 5 . in adult. W *When administering in a child’s ear. discharge. if eardrum is perforated or after ear surgery INTERACTIONS *No known drug interactions NURSING PRECAUTIONS *When assessing an infant. itching. look for the infant to pull.Carbamide Peroxicde (Debrox) ACTION • Otic preparation USES • Aids in removing cerumen by softening and breaking up the wax ADVERSE REACTIONS *Ear irritation. pull the pinna down and back. pain or irritation is present. burning CONTRAINDICATIONS *Used cautiously during pregnancy and lactation *Otic drugs available in dropper bottles may be dangerous if ingested *Stored safety out of reach of children and pets *DO NOT USE if ear drainage. grab or tug on ears.

used cautiously INTERACTIONS Drug: Increase levels leading to digitalis . patients with ventricular failure. cardiac tamponade or AV block *Given cautiously in patients with electrolyte imbalance (especially hypokalemia). *Pregnancy Category C. arrhythmias CONTRAINDIATIONS *Contraindicated in the presence of digitalis toxicity.412 ACTION • Cardiovascular medication USES • Heart Failure • Atrial Fibrillation ADVERSE REACTIONS *Headache. nausea. tachycardia. severe pulmonary disease. weakness. visual disturbances. vomiting. impaired renal/hepatic function. thyroid disorders.minutes *Do use for more than 4 days Digoxin (Digitek. anorexia. Lanoxin) Pg. drowsiness.

propafenone.814 ACTION • β-Adrenergic Blocking Drug (Beta Blocker) • Decreases stimulation of sympathetic nervous system by: ○ Decreasing excitability of heart ○ Decreasing cardiac workload and oxygen consumption ○ Provides membrane-stabilizing effects USES • Hypertension • Angina • Myocardial Infraction • Heart Failure activated charcoal. Antacids *Hold if BP is less than 100/60 OR greater than 140/90. leading to toxicity *Signs/symptoms of toxicity: levels above 2. indomethacin. abdominal pain. itraconazole. quinidine. OR HR less than 60 Decrease levels of digitalis: anticancer agents. Toprol-XL) Pg. visual disturbance.toxicity: amiodarone. nausea. Metoprolol (Lopressor. macrolides. cholestyramine. tetracyclines. benzodiazepines. and arrhythmias . spironolactone. vomiting. anorexia. aminoglycoside. Neomycin and rifampin NURSING PRECAUTIONS *Labs need to be drawn to monitor drug level *Hypokalemia makes muscles more sensitive to digitalis.0 nanograms/ML. verapamil. colestipol.

OR HR less than 60 *Monitor BP. nausea. cardiac arrhythmia. thyrotoxicosis or peptic ulcer. bradycardia NSAIDs decreased effect of beta blocker Loop Diuretic  increased risk of hypotension Clonidine increased risk of paradoxical hypertensive effect Cimetidine higher risk of B-blocker toxicity Iidocaine  higher risk of B-blocker toxicity NURSING PRECAUTIONS *Take apical pulse and BP before administration *Hold if BP is less than 100/60 OR greater than 140/90.ADVERSE REACTIONS *Dizziness. second or third degree heart block. diarrhea CONTRAINIDICATIONS *Contraindicated in patients with sinus bradycardia. heart failure and in those with asthma. HR and ECG carefully during IV administration Heparin Pg. emphysema or hypotension. 616 ACTION • Anticoagulant USES . *B-blockers are recommended for pregnant woman over other hypertensive because of the risk to the fetus is less with these drugs INTERACTIONS Drug: Antidepressants  increased effect of Beta blocker. heart failure. hypotension. *Used cautiously in patients with diabetes. vomiting.

baseline blood coagulation tests.5 times normal control level *Monitor vital signs *Observe all needle sites daily for hematoma and signs of inflammation . urticaria. hemophilia. advanced kidney or liver disease. chills. open wound. dosage is adjusted to keep APTT between 1. hematoma or bruising at the injection site (SubQ injection) CONTRAINDICATIONS *If patient has an active bleed. mild pain. valerian may potentiate bleeding NURSING PRECAUTIONS *Lab tests: PT/INR. ginkgo. ginger. fever. local irritation. brain. H/H *Monitor APTT levels closely *In general. erythema. spinal cord or spinal tap or shock INTERACTIONS Drug: Aspirin & anticoagulants increased bleeding Nitroglycerin  decrease anticoagulant Protamine  antagonizes effect of heparin Herbal: Feverfew.• • • Thrombosis/embolism Preventative of DVT Clotting prevention ADVERSE REACTIONS *Bleeding. severe hypertension or recent surgery or eye.5-2.

282 (Cefotan) ACTION • Antibacterial USES *Treatment of moderate to severe infections *May be used as a prophylaxis (prevention) after surgery ADVERSE REACTIONS *N/V/D. fever. dizziness. Specific heparin antagonist Cefotetan Disodium Pg. nephrotoxicity *phletbitis.*Antidote: have on hand Protamine sulfate. urticara. heartburn *Pruritus. thrombophletbitis with IV use INTERACTIONS Drugs: Aminoglycosides (antiinfective)will increase risk of nephrotoxicity Anticoagulants  increase risk for bleeding Loop diureticsincrease cephalosporin blood level Food: Alcohol consumed within 72 hours after administration will produce an Antabuse-like reaction (vomiting. malaise. TEN & SJS (death of epidermal layer of skin). sweating and hypotension) NURSING PRECAUTIONS . dyspnea.

pulmonary embolisms and atria fibrillation with embolization • Coronary occlusion • Cerebral Transient Ischemic Attacks (TIA ADVERSE REACTIONS *Bleeding. 1245 ACTION • Oral anticoagulant. blister/red wheals *Risk of nephrotoxicity. early sign=decrease urine output (daily output < 500 mL call MD) *Watch sign/symptoms of superinfection *Should be taken around the clock to keep an adequate amount of drug in the body *Finish full course of drug regimen Warfarin Sodium (Coumadin) Pg. uncontrolled .*10% of PCN allergy patients will be allergic to cephalosporins *May be TAKEN WITH FOOD reduce GI upset *Inpatients should be assessed Q4 hours for skin redness. tuberculosis. rash. leukemia. abdominal cramping CONTRATINDICATIONS *Patients with an active bleed (except when caused by DIC). blood thinner USES • Prophylaxis & treatment of DVTs. hemorrhagic disease. lesion. fatigue. dizziness.

aminoglycodies. psychotic or alcoholic patients  may present serious noncompliance problems *Avoid straight-edge razor use *Risk bleeding up to 1 month if received flu vaccine Enoxaparin (Lovenox) Pg. NSAIDs. chloral hydrate  increase risk of bleeding Penicillin.hypertension. isoniazid. 619 ACTION • Parenteral (SubQ) Anticoagulant. blood thinner USES . GI ulcers. stool guaiac & liver function tests *Monitor older adults. barbiturates decreased effectiveness of anticoagulant NURSING PRECAUTIONS *Use during pregnancy CAN CAUSE fetal death (pregnancy category X) INTERACTIONS Drug: Aspirin. acetaminophen. tetracyclines & cephalosporins  increased risk for bleeding Beta blockers/loop diuretics increased risk for bleeding disulfiram & cimetidine  increased risk for bleeding oral contraceptives. recent surgery of eye or central nervous system. *Lab tests: PT/INR. vitamin K. periodic urinalyses.

warfarin increased risk of bleeding Herbal: . presurgical prophylaxis.• DVTS. feverfew. platelet count. bruising. hemophilia. Pulmonary embolism treatment. gingko. unstable angina/non-Q-wave MI Garlic. NSAIDs. ginger. fever. rash. heparin-induced thrombocytopenia *Pregnancy category B INTERACTIONS Drug: Aspirin. erythema and irritation at site of injection CONTRAINDICATIONS *Patients with an active bleed. horse chestnut  increased risk of bleeding NURSING PRECAUTIONS *Lab tests: periodic CBC. heparin sensitivity. urine and stool for occult blood *Monitor platelet count closely *Renal sufficient patients are at higher risk for thrombocytopenia *Monitor for signs/symptoms of unexplained bleeding *Consult MD before taking any OTC meds *Do not breast feed while taking medication without consulting MD ADVERSE REACTIONS *Bleeding.

renal disease INTERACTIONS Drug: Hypercalcemia increases the risk of digoxin toxicity. Renal calculi. Use cautiously in pt. phenytoin.arrhythmias. hypercalciuria USES ADVERSE REACTIONS CONTRAINIDICATIONS NURSING PRECAUTIONS Monitor blood pressure. bradycardia GI. fluoroquinolones. or rhubarb may decrease absorption of calcium supplements ACTION • • • • • • • • Mineral & electrolyte replacements/supplements Replacement of calcium in deficiency End-stage renal disease/ control hyperphosphatemia Antacid CNS.s receiving digitalis glycosides. frequently.Constipation. tingling CV. severe respiratory insufficiency. . PO ingestion decreases absorption of tetracyclines. ventricular fibrillation. Drug/Food: Cereals.syncope(IV only). 256 Hypercalcemia. spinach. & iron salts.V GU-Calculi. concurrent use with diuretics may result in hypercalcemia.Calcium Carbonate Pg. Excessive amounts may decrease effectiveness of calcium channel blockers. pulse. N.

rashes CONTRAINDICATIONS Hypersensitivity. 442 ACTION • Stool softener USES INTERACTIONS Drug: None significant NURSING PRECAUTIONS . Labs: monitor serum calcium.s and pt. especially when associated with fever or other signs of an acute abdomen Docusate (Colace) Pg.May cause vasodilation & hypotension. magnesium. albumin. arrhythmias.V. & cardiac arrest.s with hypertension. indigestion. & parathyroid hormone(PTH) • Prevention of constipation by incorporating water into the stool.mild cramps Derm. & abdominal pain. sodium. abdominal pain. ADVERSE REACTIONS EENT. resulting in a softer fecal mass. Especially in elderly pt.throat irritation GI. bradycardia. N. When use with an antacid assess for heartburn. potassium.

N. epigastric pain. USES Prevention/Treatment of iron deficiency ADVERSE REACTIONS CNS. In courage pt.s that laxatives should be used for short-term therapy. Longterm use may cause an electrolyte imbalance & dependence. and amount of stool produced. Assess the color. distension. spleen. hypertension.N. syncope CV.dizziness. bowel sounds. to increase intake of fluids and mobility. tachycardia GI. or fever is present. & bone marrow where it is separated out & becomes part of iron stores.V. consistency. 700 ACTION • Essential mineral found in hemoglobin.Assess for abdominal pain. dark stools.V. Advise pt. it is sent into the bloodstream into the liver. they should also avoid using laxatives when abdominal pain. Ferrous Sulfate (Iron supplements) Pg. headache.s with cardiac issues should be informed not to strain during a bowel movement (Vasovagal Syncope). and usual pattern for bowel function.D constipation. Pt.hypotension. GI bleeding CONTRAINDICATIONS .

wheezing) notify physician if these occur. transferring. . for signs and symptoms of anaphylaxis (rash.Hypersensitivity. 1017 ACTION • Gastrointestinal Agent • Antiemetic • Antivertigo USES • Treatment of various allergic conditions & motion sickness. fluoroquinolones. & penicillamine. purities. hematocrit. laryngeal edema. Phenadoz (Promethazine) Pg. Assess bowel function Labs: hemoglobin. **Etc. ferritin & plasma iron values periodically INTERACTIONS Drug: Decrease absorption of tetracycline’s. chloramphenicol & vitamin E may decrease hematologic response to iron therapy. NURSING PRECAUTIONS Assess Pt. Anemia’s not due to iron deficiency Assess nutritional status & dietary history. reticulocyte.

PO may be given with food. opioid analgesics. including alcohol. milk to minimize GI upset.bradycardia..constipation. nervousness EENT-blurred vision. fatigue. Watch for signs & symptoms of an allergic reaction (rhinitis. MAO inhibitors may cause increased sedation NURSING PRECAUTIONS Monitor blood pressure. other antihistamines. for IV monitor site frequently. extrapyramidal reactions). dizziness. antidepressants. drug induced hepatitis. sedatives. water. hypertension.• Preoperative sedation.. tachycardia GI. hypotension. may cause seizures when used with seizure medications. hives) ADVERSE REACTIONS CNS. disorientation. sedation. diplopia. treatment and prevention of N. dry mouth Derm. haloperidol. insomnia. rashes Hemat. tinnitus CV.V. & severe tissue necrosis upon infiltration at IV site.photosensitivity. pulse & respirations. adjunct to anesthesia and analgesia INTERACTIONS Drug: Additive CNS depression when used with other CNS depressants.Neuroleptic malignant syndrome(confusion.blood dyscrasias .

vertigo. gingivitis Neuro. paresthesia. concentration difficulties. altered reflexes.ataxia. chamomile may increase CNS depression NURSING PRECAUTIONS Monitor for seizures. including alcohol. or anxiety. & sedatives. malaise. morphine may increase serum levels and cause toxicity Drug/Food: kava kava. UNLABELED USESchronic pain. increased risk of CNS depression when used with other CNS depressants. facial edema INTERACTIONS Drug: Antacids may decrease absorption. Recommend . drowsiness. dizziness. anxiety ADVERSE REACTIONS CNS-confusion. weakness EENT.Gabapentin (Neurontin) Pg. anorexia.weight gain. anxiety. valerian. hyperkinesia/ MISC. pain. hostility.abnormal vision CV. depression. confusion. bi-polar disorder. 591 ACTION • Central Nervous System Agent USES • Partial seizures. sedation. flatulence.hypertension/ GI. dizziness. prevention of migraines. opioids. post-herpetic neuralgia. antihistamines.

and end-stage organ or system failure. Aleve. Analgesics and Pain Relief *Analgesics: drugs used to relieve pain Salicylates: Aspirin. rheumatoid arthritis and osteoarthritis. Chronic Pain *Acute pain: is brief and lasts less than 3 to 6 months. Celebrex . Bayer. Alka-Seltzer with Aspirin Nonsalicylates: Acetaminophen (Tylenol) Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Advil. such as cancer. procedural or traumatic pain -Usually subsides when the injury is healed *Chronic pain: lasts more than 6 months and is often associated with specific disease. Causes: Various neuropathic and musculoskeletal disorders such as headache. are also causes of chronic pain. ANALGESICS Acute v. fibromyalgia. sickle cell anemia. Advise female PT. Causes: range from sunburn to postoperative.s to notify the physician if she plans to become pregnant or is pregnant or is breastfeeding an infant.that the patient not drive or operate machinery until response to the medication is known.

• Opioids: general term used for the opium-derived or synthetic analgesic used in pain control Narcotic: term referring to the properties of a drug to produce numbness or stupor-like state Opioid and narcotic were once interchangeable. law enforcement agencies have generalized the term narcotic to mean a drug that is addictive and abusive or used illegally ○ Health care providers use the term opioid to describe the drugs used in pain relief .

anti-inflammatory effects. Alka-Seltzer with Aspirin) ACTION • • Lowers body temperature. allergic/anaphylactic reactions. epigastic distress. prolongs bleeding time Salicylates *N/V. GI bleeding. 1087 (Aspirin. tinnitus. salicylism with overuse CONTRAINDICATIONS *Patients with bleeding disorders or GI bleed: children with chickenpox or influenza Reye’s syndrome (a lifethreatening condition characterized by vomiting & lethargy progressing to coma) *Pregnancy Category D (aspirin) and C and should be used cautiously during pregnancy/lactation INTERACTIONS Drug: Anticoagulant  increased risk of bleeding NSAIDs  increased serum of levels of NSAIDs Activated charcoal  decreases absorption of salicylates Antacids  decreases effects of salicylates Carbonic anhydrase inhibitors  increased risk for salicylism Herbal: USES pain • • • Mild  moderate Antipyretic Decreases risk of MI • Reduces risk of TIA stroke by inhibiting clotting (particularly in men) ADVERSE REACTIONS . Bayer.Aspirin (ASA) Pg.

impaired hearing. urticaria (hives). Antipyretic USES • Mild to moderate pain • Reducing elevated body temperature (fever) ADVERSE REACTIONS *Skin eruptions. garlic. hyperventilation. GI discomfort of bleeding *Avoid other aspirin containing medications without consulting MD *Do not breast feed while taking medication Analgesic.Feverfew. ginger.000 mg or 3 g/day *Child no more than 3.6 g/day *Lab tests: PT/INR. hepatoxicity & hepatic failure CONTRAINDICIATIONS *Habitual alcohol user at risk for hepatotoxicity *Safe for short-term use ONLY *Pregnancy Category B INTERACTIONS Drug: Barbituratesincreases possibility of toxicity and decreases effect of Tylenol hydantoins (anticonvulsants) increases possibility of toxicity and decreases effect of Tylenol & Rifampin  increases possibility of toxicity Acetaminophen (Tylenol) Pg. liver function tests. agitation *Discontinue use if ringing or buzzing in ears. 107 ACTION . urine ketones. more frequent CBGs with diabetes *Monitor children for salicylate toxicity  dehydration. ginkgomay increase bleeding risk NURSING PRECAUTIONS • *Adult no more than 4. fever.600 mg or 3. anemia *Pancytopenia (a reduction in all blood components) *Hypoglycemia *Jaundice. dizziness. pregnancy tests.

ulceration & perforation *Do NOT take other cold medications that contain acetaminophen without MD advice *Adult < 4. 654 ACTION • Non-steroidal Anti-Inflammatory Drugs (NSAIDs) USES • Mild moderate pain • Rheumatoid disorders • Fever ADVERSE REACTIONS *Nausea. skin eruptions. first sign of internal bleeding Ibuprofen (Advil. reduction in blood cell components. dizziness.600 mg or 2. GI bleeding. dysuria. rash. prolonged bleeding. cystitis. lightheadedness. stroke (most common in elderly). oliguria. follow-up treatment sulfa based to continue through GI system and absorb residual Tylenol *Avoid use of 1 week before/after surgery ➢ Observe signs of salicylism (overdose) ○ Levels greater than 400 mcg: result in respiratory alkalosis. headache.000 mg or 4 g/day *Child < 2. vertigo. hematuria. during ALL . decrease/increase in blood pressure.and decreases effect of Tylenol Loop Diuretics decreases effectiveness of diuretics NURSING PRECAUTIONS *Asses alcohol use *Long-term use can lead to serious GI toxicity can cause bleeding. polyuria. hemorrhage *Tinnitus/impaired hearing hold next dose. Motrin) Pg. gastric or duodenal ulcer. dyspepsia.6 g/day *Overdose  treat with activated charcoal & N-acetylcysteine (Mucomyst). SJS CONTRAINIDICATIONS *Hypersensitivity to aspirin. erythema. irritation.

cyanosis. blurred. should be avoided with ulcers (no spicy foods). NSAID use on long-term basis *Report any changes in vision. dizziness *Do not give to children younger than 3 months or for longer than 2 days without calling MD *Do not take aspirin concurrently with ibuprofen Naproxen Pg. renal/hepatic function *Symptoms of acute toxicity in children: apnea. patients with hypertension (lowers effects of antihypertensive). peptic ulceration/GI bleed INTERACTIONS Drug: Anticoagulants  increased risk of bleeding Lithium (mood stabilizer)  increased effectiveness & possible toxicity of lithium Cyclosporine (immunosuppressive)  increased effectiveness of cyclosporine Hydantoins (anticonvulsant)  increased effectiveness of anticonvulsant Diuretics  decreased effectiveness of diuretic Antihypertensives decreased effectiveness of antihypertensive Acetaminophen (in long-term use) increased risk of renal impairment Herbal: Capsicum (hot pepper) used to dilate blood vessels and increase supply of nutrients to injured joints. response only to painful stimuli. 864 (Aleve) . enteric coding  GI upset *Elderly are more vulnerable to GI bleed due to higher incidence of rheumatoid arthritis and osteoarthritis. diminished vision or change in color vision **caution when driving or task requiring alertness** *Lab tests: Hemoglobin levels.trimesters of pregnancy & lactation. NURSING PRECAUTIONS *Take with food.

diminished vision or change in color vision **caution when driving or task requiring alertness** Cyclosporine (immunosuppressive)  . vomiting. enteric coding  GI upset *Elderly are more vulnerable to GI bleed due to higher incidence of rheumatoid arthritis and osteoarthritis. juvenile and osteoarthritis • Mild  moderate pain • Dysmenorrhea • General aches and fever ADVERSE REACTIONS *Dizziness. nausea. should be avoided with ulcers (no spicy foods). headache. blurred.ACTION • Non-steroidal Anti-Inflammatory Drugs (NSAIDs) USES • Rheumatoid. peptic ulceration/GI bleed INTERACTIONS Drug: Anticoagulants  increased risk of bleeding Lithium (mood stabilizer)  increased effectiveness & possible toxicity of lithium increased effectiveness of cyclosporine Hydantoins (anticonvulsant)  increased effectiveness of anticonvulsant Diuretics  decreased effectiveness of diuretic Antihypertensives decreased effectiveness of antihypertensive Acetaminophen (in long-term use) increased risk of renal impairment Herbal: Capsicum (hot pepper) used to dilate blood vessels and increase supply of nutrients to injured joints. GI bleeding CONTRAINDICATIONS *Hypersensitivity to NSAIDs. NURSING PRECAUTIONS *Take with food. patients with hypertension (lowers effects of antihypertensive). NSAID use on long-term basis *Report any changes in vision. during ALL trimesters of pregnancy & lactation. gastric or duodenal ulcer.

cyanosis. dizziness *Do not give to children younger than 3 months or for longer than 2 days without calling MD *Do not take Aleve concurrently with ibuprofen . renal/hepatic function *Symptoms of acute toxicity in children: apnea. response only to painful stimuli.*Lab tests: Hemoglobin levels.

NURSING PRECAUTIONS *Administered with: food (tastes bad) *Elderly are more vulnerable to GI bleed due to . should be avoided in patients with ulcers (no spicy foods). 278 & 1326 (Celebrex) ACTION • Non-steroidal Anti-Inflammatory Drugs (NSAIDs) USES • Acute pain • Rheumatoid arthritis & osteoartithris ADVERSE REACTIONS *Headache. prolong bleeding CONTRAINIDICATIONS *Contraindicated in patients allergic to sulfonamides or history of cardiac disease or stroke. GI distress. should NOT be used to relieve postoperative pain from coronary bypass graft NTERACTIONS Drug. rash and change in BP. dyspepsia.Celecoxib Pg. Anticoagulants  increased risk of bleeding Lithium (mood stabilizer)  increased effectiveness & possible toxicity of lithium Cyclosporine (immunosuppressive)  increased effectiveness of cyclosporine Hydantoins (anticonvulsant)  increased effectiveness of anticonvulsant Diuretics  decreased effectiveness of diuretic Antihypertensives decreased effectiveness of antihypertensive Acetaminophen (in long-term use) increased risk of renal impairment Herbal: Capsicum (hot pepper) used to dilate blood vessels and increase supply of nutrients to injured joints.

emphysema. renal and hepatic function *Do not take concurrently with aspirin Codeine Pg. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. 330 ACTION • Attach to the many different receptor sites to produce the analgesic. diminished vision or change in color vision **caution when driving or task requiring alertness** *Lab tests: Hemoglobin levels. lightheadedness CONTRAINIDICATIONS *Patients with acute bronchial asthma. hypotension. blurred. dizziness. confusion. antidepressants. sedative and euphoric effect USES • Moderate  severe pain • Persistent cough ADVERSE REACTIONS *Constipation *CNS sedation. sweating. patients who are opioid naïve. patients with head injury or increased intracranial pressure. antihistamines. sedatives. sedation Herbal: . NSAID use on long-term basis *Report any changes in vision. inhibits all receptors causing withdrawal Barbiturates  resp.higher incidence of rheumatoid arthritis and osteoarthritis. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. lethargy. depression. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. lactating woman. or upper airway obstruction. headache.

Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. sedative and euphoric effect USES • Moderate  severe pain ADVERSE REACTIONS *Constipation *lightheadedness. 1347 . dizziness. rest & sleep. respiratory rate. in large doses may cause CNS depression (30 mg Codeine / 300mg Acetaminophen) ACTION • Attach to the many different receptor sites to produce the analgesic. HR. pain rating *Reassess pain: oral  30-60 minutes IM/IV check every 1520 minutes *Hold: if respiratory rate less than 10. DO NOT drink until you know how medicine affects you *Avoid ETOH & other meds that slows your actions/reactions *Obtain: BP. emphysema. or upper airway obstruction. sweating. significant drop in BP (systolic < 100) *Monitor bowel movements. patients who are opioid NURSING PRECAUTIONS *Drink plenty of non-caffeinated beverages *May be habit-forming with long term use *> 65 years old could have more side effects *Impairs alertness. CNS sedation. vomiting. significant change in HR. watch for constipation Tylenol #3 Pg. patients with head injury or increased intracranial pressure. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. nausea. respiratory depression CONTRAINIDICATIONS *Patients with acute bronchial asthma.

depression. antidepressants. IM. inhibits all receptors causing withdrawal Barbiturates  resp. avoid/limit <3 drinks/day *Be careful if G6PD deficiency. in large doses may cause CNS depression *Obtain: BP. watch for constipation *Monitor daily Tylenol levels and PRN Tylenol usage Fentanyl Pg. management of cancer pain NURSING PRECAUTIONS *Geriatric: drug should be titrated to appropriate analgesic effect *May be taken with food *Excess ETOH may increase risk of acetaminophen-induced hepatoxicity. rest & sleep. HR. sedatives. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol.naïve. significant drop in BP (systolic < 100) *Monitor bowel movements. respiratory rate. 540 & 542 (Patch . pain rating *Reassess pain: oral  30-60 minutes IM/IV check every 15-20 minutes *Hold: if respiratory rate less than 10. lactating woman. IV. sedative and euphoric effect USES • Severe pain. hypotension. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. significant change in HR. anemia may occur *Take good care of teeth . antihistamines. Buccal & Lozenge) ACTION • Attach to the many different receptor sites to produce the analgesic. sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation.

emphysema. or upper airway obstruction. in large doses may cause CNS depression NURSING PRECAUTIONS *Avoid drinking large quantities of grapefruit juice *Maintain good oral hygiene risk dental carries *Patch: avoid heating pads/blankets.ADVERSE REACTIONS *Constipation *CNS sedation. rest & sleep. sweating. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. lightheadedness. headache. hot tubs *Report dizziness. headache. sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. lactating woman. inhibits all receptors causing withdrawal Barbiturates  respiratory depression. lethargy. antihistamines. sedatives. confusion. hypotension. significant drop in BP (systolic < 100) . significant change in HR. antidepressants. confusion or change in mental status *Patch: clean & dry area. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. if leaking wash area DO NOT USE SOAP *If MRI scan: remove patch  causes burns *Reassess pain: oral  30-60 minutes IM/IV check every 1520 minutes *Hold: if respiratory rate less than 10. vomiting CONTRAINIDICATIONS *Patients with acute bronchial asthma. patients who are opioid naïve. hold for 30 seconds. nausea. patients with head injury or increased intracranial pressure. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. use damaged/leaking patches. vertigo. DO NOT cut. chest pain. slow or rapid HR.

lightheadedness. Epidural. sedatives. patients with head injury or increased intracranial pressure. antidepressants. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. sedative and euphoric effect USES • Moderate  severe pain ADVERSE REACTIONS *Constipation *CNS sedation. patients who are opioid naïve. lactating woman. in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly.Hydomorphone Pg. hypotension. in large doses may cause CNS depression NURSING PRECAUTIONS *Parenteral doses are up to 5x more potent *Obtain: BP. HR. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms.640. Not recommended . nausea. sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. inhibits all receptors causing withdrawal Barbiturates  respiratory depression. IV. 1372. antihistamines. pain rating *Assess pt’s physical/psychological dependency ACTION • Attach to the many different receptor sites to produce the analgesic. vomiting CONTRAINIDICATIONS *Patients with acute bronchial asthma. IM. 1374 (Dilaudid) Rectal Oral. rest & sleep. SubQ. emphysema. lethargy. PCA. vertigo. confusion. or upper airway obstruction. respiratory rate.

significant drop in BP (systolic < 100) USES • Acute Moderate  severe pain • Preoperative sedation. emphysema. or upper airway obstruction. chew or dissolve *Discontinue slowly after prolong use *Teratogenic in some animal studies  crosses placenta *In opioid naïve patients  risk for respiratory depression AND in elderly *Reassess pain: oral  30-60 minutes IM/IV check every 15-20 minutes *Hold: if respiratory rate less than 10. antidepressants. nausea. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. dizziness. significant change in HR. patients with head injury or increased intracranial pressure. sedatives. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. IM ACTION • Attach to the many different receptor sites to produce the analgesic. antihistamines. break. 784 & 1373 (Demerol) IV. sedative and euphoric effect . phenothiazines  increased risk CNS depression Meperodome Pg. lactating woman. patients who are opioid naïve.*Inpatient: implement safety measures to prevent fall *DO NOT crush. anesthetics adjunct ADVERSE REACTIONS *Constipation *Lightheadedness. vomiting. oral. respiratory depression CONTRAINIDICATIONS *Patients with acute bronchial asthma.

vomiting. other opioids are preferred *NOT recommended for management of chronic pain *Discontinue slowly after prolong use to avoid withdrawals *Inpatient: implement safety measures to prevent fall *Obtain: BP. in large doses may cause CNS depression NURSING PRECAUTIONS IM/IV check every 15-20 minutes *Hold: if respiratory rate less than 10. respiratory rate. nausea. significant change in HR. rest & sleep. CONTRAINIDICATIONS *Debilitated patients: potential for critical respiratory depression. sedative and euphoric effect USES • Severe pain • Treatment of opioid dependence ADVERSE REACTIONS *Constipation *Lightheadedness.Opioid agonist-antagonist opioid withdrawal symptoms. pain rating *Reassess pain: oral  30-60 minutes . HR. even at therapeutic changes *Avoid use in elderly: may cause confusion. hypotension. sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. inhibits all receptors causing withdrawal Barbiturates  respiratory depression. dizziness. significant drop in BP (systolic < 100) Methadone 795 & 1372 (Dolophine) ACTION • Attach to the many different receptor sites to produce the analgesic.

sedatives. pain rating *Hold: if respiratory rate less than 10. emphysema.*Patients with acute bronchial asthma. lactating woman. hypotension and sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. significant drop in BP (systolic < 100) *Wait 48 hours after last dose of levomthadyl before administering first dose of methadone . patients with head injury or increased intracranial pressure. rest & sleep. respiratory rate. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. or upper airway obstruction. inhibits all receptors causing withdrawal Barbiturates  respiratory depression. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. patients who are opioid naïve. HR. antihistamines. then annually or more often if syncope or seizure occurs (evaluate QT interval) *Obtain: BP. significant change in HR. antidepressants. it is difficult to titrate *NOT considered first drug of choice in elderly *Teratogenic effects in animal studies *Appears in breast milk 4-5 hours after oral dose *Obtain baseline ECG. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. in large doses may cause CNS depression NURSING PRECAUTIONS *Because long half-life.

dizziness.hypotension.Confusion. clomipramine. cimetidine may decrease metabolism & may increase effects. sweating Misc.constipation. dysphoria. barbiturates. sedatives. Drug/Food: kava kava. headache. chamomile may increase CNS depression NURSING PRECAUTIONS Assess levels of consciousness. antidepressants. valerian. 843 ACTION • Analgesic-Narcotic USES • Severe pain • Pulmonary edema • Pain associated with MI ADVERSE REACTIONS CNS.Roxanol (Morphine) Pg. unusual dreams EENT. bradycardia GI. N.V GU. pulse (apical) & respirations . ANTAGONIST OPIOIDS!(can cause sudden withdrawal). antihistamines. euphoria. psychological dependence. hallucinations. May increase the effects of warfarin.blurred vision. tolerance INTERACTIONS Drug: USE WITH EXTREME CAUTION FOR PTs WITH MAO INHIBITOR. Increased CNS depression with alcohol. blood pressure.flushing. miosis Resp-RESPIRATORY DEPRESSION CV. diplopia. sedation.physical dependence.urinary retention Derm.. itching.

before/during administration. 843. hypotension & sedation . respiratory depression. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. increased sweating. inhibits all receptors causing withdrawal Barbiturates  resp. antidepressants. notify physician! Monitor VS every 15-30 min. patients with head injury or increased intracranial pressure. if resp. MS Contin) ACTION • Attach to the many different receptor sites to produce the analgesic. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. lactating woman. patients with undiagnosed abdominal pain Morphine Pg. patients who are opioid naïve. antihistamines. preoperative sedatives • Dyspnea ADVERSE REACTIONS *Constipation INTERACTIONS Drug: Alcohol. sedatives. sedative and euphoric effect USES • Acute/chronic pain. emphysema. itching CONTRAINIDICATIONS *Patients with acute bronchial asthma. depression. nausea. 13721374 (timed release. drowsiness. vomiting. dry mouth. *If an antagonist is needed to reverse adverse effects (narcan) is the antidote *CNS sedation. dizziness. hypotension. rate is <10 per min. or upper airway obstruction.

HR. 926 & 1372 (timed release. patients who are opioid naïve. lactating woman. significant change in HR. sweating. pain rating *Call MD if analgesic is ineffective *Reassess pain: oral  30-60 minutes IM/IV check every 15-20 minutes *Hold: if respiratory rate less than 10. respiratory depression CONTRAINIDICATIONS *Patients with: CNS depression.Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. significant drop in BP (systolic < 100) *Monitor bowel movements. respiratory rate. dizziness. vomiting. sedative and euphoric effect USES • Moderate  severe pain ADVERSE REACTIONS *Constipation *lightheadedness. rest & sleep. OxyContin) ACTION • Attach to the many different receptor sites to produce the analgesic. patients with undiagnosed abdominal pain NURSING PRECAUTIONS *Be consistent when taking with or without meals *Elderly more sensitive to adverse effects *ETOH disrupts extended-release characteristics *Growth & behavioral abnormalities in offspring  crosses placenta *Some quinolones produce false positive urine screening results for opiates *DO NOT crush or chew controlled releases tablets or caps. *Obtain: BP. hypotension and phenanthrene hypersensitivity *Cautiously used in elderly. watch for constipation . nausea. CNS sedation. in large doses may cause CNS depression Oxycodone Pg.

prophylactic use of laxative to be considered Percocet Pg.INTERACTIONS Drug: Alcohol. significant drop in BP (systolic < 100) *Monitor bowel movements. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. significant change in HR. sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. sedatives. rest & sleep. respiratory rate. 926 (5 mg Oxycodone / 325mg Acetaminophen) ACTION • Attach to the many different receptor sites to produce the analgesic. antidepressants. antihistamines. pain rating *Call MD if analgesic is ineffective *Reassess pain: oral  30-60 minutes IM/IV check every 1520 minutes *Hold: if respiratory rate less than 10. inhibits all receptors causing withdrawal Barbiturates  respiratory depression. in large doses may cause CNS depression NURSING PRECAUTIONS *Blood level of 5 mg/L associated with fatality *Wax matrix from controlled release tablets may appear in stool *Obtain: BP. sedative and euphoric effect USES • Moderate  severe pain . watch for constipation. HR. hypotension.

CNS sedation. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. inhibits all receptors causing withdrawal Barbiturates  resp. respiratory depression CONTRAINIDICATIONS *Patients with acute bronchial asthma. sweating. significant change in HR. nausea. antihistamines. rest & sleep. hypotension & sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. sedatives. or upper airway obstruction. in large doses may cause CNS depression NURSING PRECAUTIONS *Obtain: BP. depression. antidepressants. pain rating *Reassess pain: oral  30-60 minutes IM/IV check every 15-20 minutes *Hold: if respiratory rate less than 10. limit <3 days/day . emphysema. respiratory rate. lactating woman. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. watch for constipation *Monitor daily Tylenol levels and PRN Tylenol usage. significant drop in BP (systolic < 100) *Monitor bowel movements. patients with head injury or increased intracranial pressure. vomiting. maximum daily based on acetaminophen *Duration of action maybe increased in elderly *Avoid ETOH. dizziness. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. patients who are opioid naïve. HR. <4 g/day acetaminophen *Avoid OTCs containing Tylenol *Initial dose based on oxycodone content.ADVERSE REACTIONS *Constipation *lightheadedness.

sweating. nausea. hypotension & sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. in large doses may cause CNS depression ACTION • Attach to the many different receptor sites to produce the analgesic. dizziness. 637 & 1348 Vicodin (5 mg Hydrocodone / 500 Acetaminophen) Vicodin ES (7. antihistamines. sedative and euphoric effect USES • Moderate  severe pain ADVERSE REACTIONS *Constipation *lightheadedness. respiratory rate. depression. Not recommended in pregnancy or labor  travels through to NURSING PRECAUTIONS *Obtain: BP. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. HR. pain rating *Reassess pain: oral  30-60 minutes IM/IV check every 15-20 minutes . respiratory depression CONTRAINIDICATIONS *Patients with acute bronchial asthma. patients who are opioid naïve. CNS sedation. inhibits all receptors causing withdrawal Barbiturates  resp. vomiting. patients with head injury or increased intracranial pressure. or upper airway obstruction. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. rest & sleep.Vicodin Pg. emphysema. antidepressants. sedatives. lactating woman.5 mg Hydrocodone / 750 Acetaminophen) placenta to baby *Cautiously used in elderly.

antihistamines. 929 & 1372 (Opana) ACTION • Attach to the many different receptor sites to produce the analgesic. or upper airway obstruction. emphysema. nausea. sedatives. limit <3 days/day Oxymorphone Pg. lactating woman. sweating. significant change in HR. watch for constipation *Monitor daily Tylenol levels and PRN Tylenol usage. CNS sedation. patients with head injury or increased intracranial pressure. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. vomiting. sedative and euphoric effect USES • Moderate  severe pain.*Hold: if respiratory rate less than 10. <4 g/day acetaminophen *Avoid OTCs containing Tylenol *Duration of action maybe increased in elderly *Avoid ETOH. respiratory depression CONTRAINIDICATIONS *Patients with acute bronchial asthma. patients who are opioid naïve. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. antidepressants. preoperative sedation. significant drop in BP (systolic < 100) *Monitor bowel movements. phenothiazines  increased risk CNS depression . obstetric analgesia ADVERSE REACTIONS *Constipation *lightheadedness. dizziness.

Opioid agonist-antagonist opioid withdrawal symptoms. respiratory rate. significant change in HR. in large doses may cause CNS depression *High risk of withdrawal. hypotension & sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. vomiting. inhibits all receptors causing withdrawal Barbiturates  resp. CNS sedation. 1196 (Ultram) ACTION • Synthetic Opioids. sweating. respiratory depression CONTRAINIDICATIONS *Patients with acute bronchial asthma. significant drop in BP (systolic < 100) *Monitor bowel movements. if missed dose *Plasma levels 40% higher in elderly Tramadol Pg. HR. watch for constipation *Immediate & extended release. take 1 hour before or 2 hours after eating *Not suitable as PRN analgesic . manufactured analgesic with properties & actions similar to natural opioids USES • Moderate  severe chronic pain • Patients with a sensitivity to natural opioids ADVERSE REACTIONS *Constipation *lightheadedness. emphysema. dizziness. NURSING PRECAUTIONS *Obtain: BP. pain rating *Call MD if analgesic is ineffective *Reassess pain: oral  30-60 minutes IM/IV check every 15-20 minutes *Hold: if respiratory rate less than 10. nausea. or upper airway obstruction. depression. rest & sleep.

antidepressants. significant drop in BP (systolic < 100) Naloxone Pg. in large doses may cause CNS depression *Avoid use with MAO inhibits. Not recommended in pregnancy or labor  travels through to placenta to baby *Cautiously used in elderly. respiratory rate. patients with undiagnosed abdominal pain INTERACTIONS Drug: Alcohol. IV. inhibits all receptors causing withdrawal Barbiturates  resp. depression. SSRIs/serotonergic agents *Patients age >75 years old may be more sensitive to adverse effects *Ultram stays in breast milk for 16 hours following a single dose of 100 mg/ via IV *May interfere with urine detection of PCP and gives a false positive *Reassess pain: oral  30-60 minutes IM/IV check every 15-20 minutes *Hold: if respiratory rate less than 10. 862 (Narcan) ACTION IM. intranasal (adults only). lactating woman. sedatives.patients with head injury or increased intracranial pressure. HR. pain rating *Increased suicide risk in patient’s taking tranquilizers and/or antidepressants . significant change in HR. rest & sleep. patients who are opioid naïve. phenothiazines  increased risk CNS depression Opioid agonist-antagonist opioid withdrawal symptoms. hypotension & sedation Herbal: Passion flower (sometimes mixed in teas with chamomile & hops) used for relaxation. antihistamines. SubQ NURSING PRECAUTIONS *Obtain: BP.

sweating. PAIN CONTRAINDICATIONS dependent mothers. vomiting. suspected acute opioid over-dosage ADVERSE REACTION *Nausea. seizures. increased blood pressure. infants of opioid- USES • Postoperative acute respiratory depression • Opioid adverse effects. patients with opioid dependency.• • Opioid antagonists displaces narcotic at receptor sites Complete/partial reversal of opioid drug effects (pain will return) *Pregnancy category B. tremors (increased CNS effects). cardiovascular disease and lactation *Withdrawal symptoms: opioid dependent NURSING PRECAUTIONS *Monitor vital signs every 5-15 minutes after patient responsive and is stable -continue until effects of opioid wears off *Short duration of action: narcotic symptoms start to diminish 20-40 minutes after administration and . tachycardia.

open area & mucous membrane  Example: Emalcreme ○ Local Infiltration Anesthesia  Injection of anesthesia into tissue • Dental procedures. making an incision into a small area ○ Regional anesthesia  Injection of anesthesia around nerves to prevent sending pain signals • Spinal anesthesia: injection of anesthesia into the subarachnoid space of the spinal cord • Conduction blocks: injection of anesthesia into or nerve trunk (block) ○ Nursing Precautions *Take patient’s allergy history . suturing small wounds. suction equipment made available *Assess pain & monitor I/Os *Excessive doses of Narcan in preoperative period may cause an increased BP and reversal of anesthesia ANESTHESIA *Induced by various drugs to bring about partial or complete loss of sensation Types of Anesthesia  Loss anesthesia  General anesthesia LOCAL ANESTHESIA ➢ Topical Anesthesia Application of the anesthesia to surface of skin.usually disappear within 90 minutes *Repeated dose needed if results from initial dose unsatisfactory *Cardiac monitoring. artificial ventilation.

system being operated on ○ Anticipated length of the surgical procedure ➢ Stages of General Anesthesia ✔ Stage 1. 822 (Versed) ACTION • Anesthetic • CNS depressant USES • Local anesthetic procedures: cataract surgery or colonoscopy ADVERSE REACTIONS *Some experience amnesia (general unaware their memory is impaired).*Prepare area too be anesthetized: -cleaning area antiseptically then shave Administering Local Anesthesia -Mixed with epinephrine to cause local vasoconstriction Pre-Anesthetic Drugs (Anti-Anxiety) *Given before administration of anesthesia *May consist of one drug or a combination of drugs *Diazepam (Valium) used for preoperative sedation GENERAL ANETHESIA  The choice of anesthetic drug depends on: ○ General physical condition of the patient ○ Area. long-term use of Benzos associated with long-lasting deficits of memory.delirium ✔ Stage 3.surgical analgesia ✔ Stage 4. organ.respiratory paralysis (need to be intubated) • After general anesthesia: takes 1-2 hours to recover fully Misazolam Pg. .analgesia (pain relief) ✔ Stage 2.

” sleepiness. cognitive functions *Sedation.1 to 9. BP. HR Q 5-15 mins . potential fall *Check airway for patency. increase length of ventilator support needed *May impair gait. *”Hungover effects. increase HR & hypotension INTERACTIONS Drug: Fluvoxamine increased effects of midazolam Itraconazole increased effects of midazolam and the elimination half-life 2-fold Ketoconazole ) increased effects of midazolam Nefazodone  increased effects of midazolam Rifampicin  significantly increased the systemic and oral clearance of midazolam Saquinavir decreased the clearance of IV midazolam and increased its elimination half-life from 4. depression.Children & elderly or pt’s with history of ETOH abuse and/or aggressive behavior/anger are at increased risk of paradoxical effects. impaired psychomotor.5 hours Food: Grapefruit juice NURSING PRECAUTIONS *If given too quickly  hypotension occurs.

nervousness. Extreme psychological dependency may also occur. center of the brain &   cardiovascular system ○ Caffeine. ○ Pediatric: an increase risk of suicidal ideation in children & adolescents have been found when using the drug Strattera. Ritalin Anorexiants: drugs used to suppress appetite ○ Meridia ➢ Amphetamines & Anorexiants have abuse and addiction potential. Patients with ADHD started on Strattera should be monitored carefully for changes in behavior. These drugs are recommended only for short-term use in selected patients for treatment of obesity. Long-term use of amphetamines for obesity may result in tolerance to the drug and a tendency to increase the dose.CENTRAL NERVOUS SYSTEM STIMULANTS  Analeptics: drugs that stimulate the resp. Modafinil Amphetamines: used to treat children with ADHD ○ Adderall. . ○ Gerontology: older adults are especially sensitive to the effects of the CNS stimulants and may exhibit excessive anxiety.

apprehension. hyperactivity. palpitation CONTRAINIDCATIONS *Patients with convulsive disorders. nausea. severe hypertension & hyperthyroidism INTERACTIONS Drug: Anesthetics  increased risk of cardiac arrhythmias . 837 (Provigil) ACTION • Cardiac stimulate: dilates coronary and peripheral blood vessels • Constriction of cerebral blood vessels • Skeletal muscle stimulation USES • Narcolepsy • Obstructive Sleep Apnea ADVERSE REACTIONS *Excessive CNS stimulation. Modafinil Pg. may be worsened by the CNS stimulant. tachycardia. Cardiovascular disorders. headache. common in the older adult. dizziness.insomnia and mental confusion. disorientation. ventilation mechanism disorders *Nurses should NOT administer CNS stimulants to patients with cardiac problems.

seizure disorders . patients with anxiety. restlessness CONTRAINDICATIONS *Hypersensitivity to caffeine. BP (especially patients with hypertension) *If used for ADHD. insomnia. cardiovascular disease. evaluate cardiovascular risk monitor HR. vomiting. drowsiness • Respiratory Depression ADVERSE REACTIONS *Palpations. ECG *Potential for abuse • • Diuretic Seizure Induction during ECT Caffeine ACTION • CNS Stimulant USES • Fatigue. nausea. carbonated beverages containing caffeine *Avoid/limit ETOH+ *Food delays absorption but does not affect bioavailability *Monitor levels of sleepiness.Theophyline  increased risk of hyperactive behaviors Oral contraceptives  decreases effectiveness of contraceptives NURSING PRECAUTIONS *Avoid coffee. BP. tachycardia. GI disease/peptic ulcer/GERD. tea.

side effects & symptoms to report *Maintain adequate hydration Amphetamine/Dextoamp hetamine (Adderall) Pg.INTERACTIONS Drug: Adenosine  may diminish the therapeutic effect of Adenosine Cannabinoids may enhance tachycardic effect Formoterol  may enhance the adverse/toxic effect of Formoterol.158 ACTION • Amphetamine • CNS Stimulant USES • Narcolepsy • ADHD ADVERSE REACTIONS . Caffeine may enhance the hypokalemic effect of Formoterol Sympathomimetics  may enhance the adverse/toxic effect of other s ympathomimetics NURSING PRECAUTIONS *Assess potential for interactions with other prescriptions. OTC meds or herbal products *Assess knowledge/teach patient appropriate use.

may increase CNS depression NURSING PRECAUTIONS *Monitor CNS activity. juices. dizziness. hyperthyroidism. tachycardia. BP and consider obtaining ECG prior to initiation Methylphenidate Pg. agitated states and patients with a history of drug abuse INTERACTIONS Drug: Opioid Analgesics  enhances the analgesic effect Antacida may decrease the excretion of amphetamines Antihistamines  may diminish the sedative effect of antihistamines Antipsychotics  may diminish stimulatory effect of amphetamines Cannabinoids  may enhance tachycardic effect of sympathomimetics MAO Inhibitors  with or within 14 days following MAO inhibitors (hypertensive crisis) Food: Acidic foods. Vit. appetite and signs/symptoms of tolerance or dependence *When used for treatment of ADHD. headache. 808 (Ritalin) Immediate & Extended release ACTION . symptomatic cardiovascular disease. nervousness.*Insomnia. excitement CONTRAINDICATIONS *Hypersensitivity to amphetamine. advanced arteriosclerosis. BP. thoroughly evaluate for cardiovascular risk *Monitor HR. moderatesevere hypertension. C  adderall serum levels may be altered Caffeine  should be avoided Alcohol  should be avoided. anorexia. pulse. glaucoma.

anorexia. glaucoma. abdominal pain CONTRAINDICATIONS *Idiosyncratic reactions to sympathomimetics .• • CNS Stimulant Amphetamine adverse/toxic effect of USES • ADHD • Narcolepsy • Depression ADVERSE REACTIONS *Insomnia. tension & agitation. may cause CNS depression Herbal: Ephedra may cause hypertension or arrhythmias Yohimbe  CNS stimulatory activity NURSING PRECAUTIONS *May cause false-positive amphetamine in urine test . family history or diagnoses of Tourette’s syndrome or tics INTERACTIONS Drug:Antacids  may increase absorption of Methylphenidate. dizziness. as well as antipsychotic Cannabinoids  may enhance tachycardic effect of Sympthomimetics MAO Inhibitors may enhance hypertensive effect Proton Pump Inhibitors  may increase the absorption of Methylphenidate Vitamin K Antagonists (ex. headache. food and high-fat meals delays early peak Alcohol  should be avoided. Warfarin)  may increase the serum concentration of Vitamin K Antagonists Food: Food may increase oral absorption. marked anxiety. use during or within 14 days following MAO inhibitor therapy. specifically extended-release capsules Antihypertensives  may diminish the antihypertensive effect Antipsychotics  may enhance the adverse/toxic effects of Methylphenidate.

*Monitor BP. signs/symptoms of depression. long-term use can result in dependence. tremor and sensory disturbances (such as parasthesias. concentration difficulties. growth rate in children & signs of CNS stimulation *Assess history of addiction. aggression or hostility *Monitor CBC. abuse or tolerance *Taper off slowly when discontinuing ANTI-ANXIETY OR ANXIOLYTICS • Benzodiazepines: long term use can result in physical dependence or physiological addiction ➢ Symptoms of benzodiazepine withdrawal include: anxiety. photophobia. HR. The drug may accumulate in the blood. hypersomnia and metaliic taste)  Benzos are excreted more slowly in older adults causing a prolonged drug effect. resulting in an increase in adverse reactions or toxicity . differential and platelet counts *Liver function tests.

CNS depression. depression. patients with narrow-angle glaucoma. Alprazolam Pg. diarrhea. pregnant. has been associated with anterograde amnesia. paradoxical reactions (hyperactivity or aggressive behavior particularly in adolescent/pediatric or psychiatric patients). 131 (Xanax) ACTION • Benzodiazepine USES • Anxiety disorders (short-term relief of anxiety) • Panic Attacks . headache.• Lorazepam & oxazepam are relatively safe for older adults when given in normal dosages Non-benzodiazepines: useful anti-anxiety medication without addictive quality  ADVERSE REACTION *Transient mild drowsiness. constipation. lightheadedness. dry mouth CONTRAINIDCATIONS *Hypersensitivity to benzodiazepines.

sedatives. tolerance . lightheadedness. valerian. headache. dry mouth CONTRAINIDCATIONS *Hypersensitivity to benzodiazepines. kava kava. constipation. Johns Wort. depression.*Drug abuse or acute alcoholism *Use caution in patients with respiratory disease INTERACTIONS Drug: Analgesis  increased risk for CNS depression Tricyclic antidepressants  increased risk for sedation and respiratory depression Antipsychotics  increased risk for sedation and respiratory depression Digoxin  increased risk for digitalis toxicity Food: Alcohol  increased risk for CNS depression or convulsions Cigarette smoking  may decrease aplrozolam concentration up to 50% Herbal: St. patients with narrow-angle glaucoma. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent *If inpatient: institute safety measures and monitor for adverse reactions *Taper slowly when discontinuing *Avoid ETOH. OTC meds such as pain medication. antihistamines or hypnotics *Do NOT stop medication abruptly Chlordiazepoxide Pg. abuse. long-term use dependence. 298 (Librium) ACTION • Benzodiazepine USES • Anxiety disorders (short-term relief of anxiety) • Acute Alcohol Withdrawal ADVERSE REACTION *Transient mild drowsiness. pregnant NURSING PRECAUTIONS *Assess for signs of CNS depression *Assess for history of addiction. diarrhea.

*Use caution in patients with depression. Johns Wort. abuse. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent NURSING PRECAUTIONS *Assess for signs of CNS depression *Assess for history of addiction. valerian. particularly if suicidal ideation is present *Drug abuse or alcoholism: risk for drug dependency *Use caution in patients with respiratory disease INTERACTIONS Drug: Analgesis  increased risk for CNS depression Oral contraceptives (Progestins)  may increase concentration of benzo Oral contraceptives (Estrogens) may decrease the metabolism of benzo MAO Inhibitors  may enhance orthostatic hypotensive effect Tricyclic antidepressants  increased risk for sedation and respiratory depression Antipsychotics  increased risk for sedation and respiratory depression Digoxin  increased risk for digitalis toxicity Food: Alcohol  increased risk for CNS depression or convulsions Cigarette smoking  may decrease aplrozolam concentration up to 50% Herbal: St. kava kava. withdrawal symptoms *Taper slowly when discontinuing *Avoid ETOH. sedatives. long-term use dependence. OTC meds such as pain medication. 762 (Ativan) . tolerance *If inpatient: institute safety measures and monitor for adverse reactions *Maintain adequate hydration *If preventative ETOH withdrawal: monitor for tremors. antihistamines or hypnotics *Do NOT stop medication abruptly Lorazepam Pg. seizures.

abuse or tolerance . diarrhea. constipation. CNS depression. valerian. longterm use can result in dependence. patients who are a fall risk INTERACTIONS Drug: CNS depressants  enhances adverse/toxic effect of other CNS depressants Analgesis  increased risk for CNS depression Tricyclic antidepressants  increased risk for sedation and respiratory depression Antipsychotics  increased risk for sedation and respiratory depression Digoxin  increased risk for digitalis toxicity Food: Alcohol  increased risk for CNS depression or convulsions Herbal: St. headache. Johns Wort. kava kava. depression. lightheadedness.ACTION • Benzodiazepines • Sedative USES • Anxiety disorders (short term relief of anxiety) • Pre-anesthetic ADVERSE REACTIONS *Transient mild drowsiness. patients with sleep apnea. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent NURSING PRECAUTIONS *Oral: assess history of addiction. anterograde amnesia. severe respiratory insuifficency. dry mouth CONTRAINICATIONS *Hypersensitivity to benzos.

*Avoid alcohol. constipation. diarrhea.) and ability to void Clonazepam Pg. patients with significant liver disease. dry mouth CONTRAINICATIONS *Hypersensitivity to benzos.V. narrow-angle glaucoma. sedatives. lightheadedness. depression. OTC medications (especially pain medication. pregnancy *Patients with active suicidal ideation show increase risk of suicidal thoughts/behaviors INTERACTIONS Drug: CNS depressants  enhances adverse/toxic effect of other CNS depressants Analgesis  increased risk for CNS depression Tricyclic antidepressants  increased risk for sedation and respiratory depression Antipsychotics  increased risk for sedation and respiratory depression Digoxin  increased risk for digitalis toxicity Food: . antihistamines and hypnotics) *Maintain adequate hydration *IM/IV: monitor vital signs and CNS status (possible retrograde amnesia with I. headache. 320 (Klonopin) ACTION • Benzodiazepines • Sedative USES • Panic disorders • Anticonvulsant ADVERSE REACTIONS *Transient mild drowsiness.

respiratory depression. headache.Alcohol  increased risk for CNS depression or convulsions Herbal: St. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent NURING PRECAUTIONS *Monitor CBC. myasthenia gravis. liver function tests *Observe patient for excess sedation. behavioral changes) *Risk of addiction *Taper dosage slowly when discontinuing *Take exactly as direction. severe hepatic insufficiency. dry mouth CONTRAINICATIONS *Hypersensitivity to benzos. severe respiratory insufficiency. 404 (Valium) ACTION USES • Anxiety disorders (short term relief of anxiety) • Acute alcohol withdrawal • Anticovulsant • Preoperative muscle relaxant ADVERSE REACTIONS *Transient mild drowsiness. depression. sleep apnea syndrome. valerian. kava kava. do NOT increase dose or frequency • • Benzodiazepines Sedative Diazepam Pg. acute narrow-angle glaucoma. not for use in children under 6 months of age *Narcotic dosages should be reduced by approximately 1/3 when valium is added *Fall risk: use extreme caution in patients . constipation. depression. suicidality (example: suicidal thoughts. diarrhea. lightheadedness. Johns Wort.

kava kava. . do NOT increase dose/frequency Hydroxyzine Pg. suicidality (example: suicidal thoughts. transitory drowsiness. valerian.who are at risk of falls INTERACTIONS Drug: CNS depressants  enhances adverse/toxic effect of other CNS depressants Analgesis  increased risk for CNS depression Tricyclic antidepressants  increased risk for sedation and respiratory depression Antipsychotics  increased risk for sedation and respiratory depression Digoxin  increased risk for digitalis toxicity Food: Alcohol  increased risk for CNS depression or convulsions Herbal: St. involuntary motor activity NURING PRECAUTIONS *Monitor CBC. Atarax) ACTION • Nonbenzodiazepines • Antimetic • Antihistamine USES • Anxiety and tension associated with psychoneurosis • Pruritus • Preanesthetiic sedative ADVERSE REACTIONS *Dry mouth. Johns Wort. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent depression. 644 (Vistaril. respiratory depression. liver function tests *Observe patient for excess sedation. behavioral changes) *Risk of addiction *Taper dosage slowly when discontinuing *Take exactly as direction.

tranquilizers. Johns Wort. valerian.CONTRAINICATIONS *Early pregnancy. seizure activity. 243 (BuSpar) ACTION • Nonbenzodiazepines USES • Anxiety disorders (short-term relief of anxiety) • Generalized Anxiety Disorder (GAD) . tremors. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent NURING PRECAUTIONS *Monitor relief of symptoms. kava kava. the elderly (may be inappropriate in this age group due to potent anticholinergic effects. glaucoma. mental status and blood pressure *Ensure patient safety precautions *Will cause drowsiness (do not use other sedative.) INTERACTIONS Drug: Amphetamines  may enhance the sedative effect of antihistamine Anti-cholinergics  may enhance the adverse/toxic effect of other anticholinergic Food: Alcohol  CNS depressants may enhance the CNS depressant effect of alcohol Herbal: St. involuntary movements or loss of sensation Buspirone Pg. antihistamines or pain meds) *Report hallucinations. patients with CNS depression. respiratory disease.

ADVERSE REACTIONS *Dizziness, drowsiness CONTRAINICATIONS *Patients with cognitive/motor impairments, restlessness syndrome INTERACTIONS Drug: SSRI antidepressants  may enhance the serotonergic effect of antidepressants CNS depressants may enhance the adverse/toxic effects of other CNS depressants Macrolide antibiotics  may decrease the metabolism of Buspirone Food: Alcohol  CNS depressants may enhance the CNS depressant effect of alcohol Grapefruit juice may cause increased buspirone concentrations Herbal:

St. Johns Wort, valerian, kava kava, gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent NURING PRECAUTIONS *Monitor mental status, symptoms of anxiety *May take 2-3 weeks to see full effect *Avoid large quantities of grapefruit juice *Maintain adequate hydration *Has little potential for abuse *Needs continuous use because of slow onset, not appropriate for PRN

Doxepin Pg. 452
(Sinequan)
ACTION • Nonbenzodiazepines

USES • Anxiety disorders • Depression ADVERSE REACTIONS *Dizziness, drowsiness, orthostatic hypotension CONTRAINICATIONS *Patients with hypersensitivity to drugs similar chemical class, narrow-angle glaucoma, urinary retention, use of MAO inhibitors within 14 days, patients with active suicidal thinking/behavior *May worsen psychosis in some patients or precipitate a shift to mania in bipolar patients INTERACTIONS

Barbiturates  may increase the metabolism of tricyclic antidepressants Lithium  may enhance the neurotoxic effect MAO inhibitors  enhances serotonergic effect and orthostatic hypotensive effect NSAIDs  increase risk of bleeding SSRI antidepressants may enhance adverse/toxic effect of tricyclic antidepressant Food: Alcohol  CNS depressants may enhance the CNS depressant effect of alcohol Grapefruit juice may cause increased buspirone concentrations Herbal: St. Johns Wort, valerian, kava kava, gotu kola increases CNS depression & sedation Kava kava, SAMe  may diminish the therapeutic effect of anti-anxiety agent

Drug: Amphetamines may enhance the stimulatory effect of amphetamines and cardiovascular effects Anticholingerics  may enhance the adverse/toxic effect of other anticholinergics Aspirin  may enhance the anti-platelet effect of aspirin

NURING PRECAUTIONS *Monitor BP, HR, mental status, suicidal ideation, weight, ECG in older adults *Assess for insomnia (re-evaluate diagnosis if insomnia does not remit within 7-10 days of treatment) *Taper dosage slowly when discontinuing

SEDATIVE AND HYPNOTICS ➢ Benzaodiazepines, Nonbenzodiazepines (Lunesta and Ambien) and Barbiturates  Childbearing Women: women taking barbiturates or benzos should be
warned of the potential risk to the fetus so that contraceptive methods may be instituted, if necessary. A child born to a mother taking benzos may experience withdrawal symptoms during the postnatal period.  Gerontology: the older adult is at greatest risk for oversedation, dizziness, confusion or ataxia (unsteady gait) when taking a sedative or hypnotic. The nurse checks elderly and debilitated patients for a paradoxical reaction, such as marked excitement or confusion. If excitement or confusion occurs, the nurse observes the patient at frequent intervals (as often as every 5-10 minutes may be necessary) for the duration of the occurrence and institutes safety measures to prevent injury. If over sedation, extreme dizziness or ataxia occurs, the nurse notified the primary health care provider Barbiturates: have little to no analgesic action, so the nurse does not give these drugs if the patient has pain and cannot sleep. Barbiturates when given in the presence of pain, may cause restlessness, excitement and delirium. HOLD medication if respiration rate is 10 breaths/min or below or if patient is lethargic

 

Sedative: a drug that produces a relaxing, calming effect. Sedatives are usually given during daytime hours, and although they may make the patient drowsy, they usually do NOT produce sleep Hypnotic: a drug for short-term use to promote sleep. It induces drowsiness or sleep, it allows the patient to fall asleep and stay sleep. Hypnotics are given at night or bedtime  Gerontology: elderly patients may require smaller hypnotic dose and in some instances, a sedative dose produced sleep.

Eszopiclone Pg. 514
(Lunesta)
ACTION  Nonbenzodiazepine USES  Chronic insomnia ADVERSE REACTIONS

*Headache, somnolence, taste changes, chest pain, migraine, edema CONTRAINIDCATIONS *Patients with hypersensitivity to sedative or hypnotics. *DO NOT administer to comatose patients, those with severe respiratory problem, those with history of drug/alcohol habitual use or pregnant/lactating women. *Used cautiously in patients who are lactation, patients with hepatic/renal impairment and mental health problems

INTERACTIONS

Drug: Antidepressants  increased sedative effect Opioid Analgesics/Antihistamines  increased sedative Phenothiazines (Thorazine) increased sedative effect Cimtidine (gastric upset med) increased sedative effect Alcohol  increased sedative effect Herbal: Melatonin (released by pineal gland, can be added in teas/supplements)  increased drowsiness, depression, some allergic reactions Valerian, lemon balm & chamomile (used for sedative effects, anxiety & restlessness) increases drowsiness, alters mood & sleep patterns and may experience withdrawal symptoms is stopped abruptly.

*When taking as a sedative, be aware that the drug can impair the mental/physical abilities required for performing potentially dangerous tasks, such as driving car or operating machinery. *Observe caution with getting out of bed at night, never drive or perform hazardous tasks *DO NOT use with OTC cold, cough, allergy or sleep medication

Zolpidem Pg. 1262
(Ambien, Ambien Controlled Release)
ACTION  Nonbenzodiazepine USES  Transient insomnia ADVERSE REACTIONS *Drowsiness, headache, myalgia, nausea CONTRAINIDCATIONS

NURSING PRECAUTIONS *Avoid alcohol 2 hour before or 8 hours after taking medication

never drive or perform hazardous tasks *DO NOT use with OTC cold. can be added in teas/supplements)  increased drowsiness.*Patients with hypersensitivity to sedative or hypnotics. *May cause memory loss or amnesia. be aware that the drug can impair the mental/physical abilities required for performing potentially dangerous tasks. *Observe caution with getting out of bed at night. such as driving car or operating machinery. driving. These drugs should be taken when a person plans for 78 hours of sleep. those with severe respiratory problem. *DO NOT administer to comatose patients. depression. A person may not remember getting up out of bed. those with history of drug/alcohol habitual use or pregnant/lactating women. *Used cautiously in patients who are lactation. cough. some allergic reactions Valerian. alters mood & sleep patterns and may experience withdrawal symptoms is stopped abruptly. NURSING PRECAUTIONS INTERACTIONS Drug: Antidepressants  increased sedative effect Opioid Analgesics/Antihistamines  increased sedative effect Phenothiazines (Thorazine) increased sedative effect Cimtidine (gastric upset med) increased sedative effect Alcohol  increased sedative effect Herbal: Melatonin (released by pineal gland. or eating. patients with hepatic/renal impairment and mental health problems drowsiness. anxiety & restlessness) increases *Avoid alcohol 2 hour before or 8 hours after taking medication *When taking as a sedative. allergy or sleep medication . lemon balm & chamomile (used for sedative effects.

ANTIDEPRESSANTS ○ Depression: A major depressive episode or a depressed or dysphoric (extreme or exaggerated sadness. anxiety or unhappiness) mood that interferes with daily function. The symptoms of clinical depression are not the result of normal bereavement. Zoloft . -Hopeless -Significant weight loss/gain -Insomnia or hypersomnia -Decrease in interested/engagement -Fatigue or loss of energy -Agitation/restlessness/irritability -Feelings of worthlessness -Excessive/inappropriate guilt -Changes in concentration -Recurrent thoughts of death/suicide (or suicide attempt)  Tricyclic antidepressants (TCAs) *Sinequan. Prozac. such as a loss of a loved one or another disease. Paxil. amitriptyline. nortiptylein  Selective serotonin reuptake inhibitors (SSRIs) *Celexa. five or more of the symptoms need to occur daily or nearly every day for a period of 2 weeks or more. Lexapro. For a classification of clinical depression.

narrow-angle glaucoma or increased intraocular pressure. Parnate.  Monoamine oxidase inhibitors (MAOIs) *Nardil. patients with recent MI. use of MAO inhibitors within 14 days. Pamelor) ACTION • Antidepressant USES • Depressive episodes • Bipolar disorder. depression accompanied by anxiety disorders • Obsessive-compulsive disorders • Chronic neuropathic pain • Enuresis ADVERSE REACTIONS *Sedation. urinary retention). constipation CONTRAINICATIONS *Patients with hypersensitivity to drugs similar chemical class. urinary retention and risk of suicidal ideation behavior INTERACTIONS Drug: . Effexor Tricyclic Antidepressants Doxepine (Sinequan) Amitriptyline Nortiptylein (Aventyl. hyperthyroid disease. anticholinergic effects (dry mouth. *Doxepin is contraindicated in patients with glaucoma or in those with a tendency for urinary retention *TCAs should be used cautiously in patients with cardiac disease. Marplan Atypical antidepressants *Wellbutrin. Cymbalta. history of seizure activity. hepatic or renal impairment. to children or lactating mothers. dry eyes.

Tardive dyskinesia is a syndrome of involuntary movements that may be irreversible. nervousness. anorexia. the drug amoxapine has been associated with tardive dyskinesia and neuroleptic malignant syndrome (NMS). anxiety. Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram (Celexa) Escitalopram (Lexapro) Fluxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) ACTION • Antidepressant USES • Depressive episodes • Obsessive-compulsive disorders • Bulimia nervous ADVERSE REACTIONS *Nausea. These syndromes tend to occur more readily in elderly women. sweating.Adrengeric agents increased risk for arrhythmias and hypertension Sedatives/hypnotics/analgesics  increased risk for respiratory & nervous system depression MAO inhibitors  increased risk for hypertensive episodes. Symptoms of NMS are similar and include muscle rigidity. insomnia. The nurse therefore gives these drugs with caution to the person with preexisting cardiac disease. *TCAs can cause cardiac-related adverse reactions. such as tachycardia and heart block. the drug should be discontinued. the primary health care provider notified immediately & treatment of adverse effects begun quickly. altered mental status and autonomic system problems (such as tachycardia or sweating). . diarrhea. dry mouth. severe convulsions & hyperpyretic episodes NURING PRECAUTIONS *Although the TCAs are not considered antipsychotic agents. and to the elderly.

patients taking cisapride (Propulsid). constipation. headache. Patients should NOT be switched to an SSRI within 2 weeks of stopping an MAOI antidepressant INTERACTION Drug: Other antidepressants  increased risk of toxic effects Cimetidine  increased anticholingeric symptoms (dry mouth. John’s wort  increased risk for a severe sedative effect NURSING PRECAUTIONS *Watch closely for worsening of depression or suicidal ideation *Monitor therapeutic levels: 1-4 weeks may be needed before improvement is noted *Monitor HR and BP and cardiac status in known or suspect cardiac disease *Monitor adverse effect especially with doses>20mg *Avoid alcohol *Do not breast feed while taking medication Monoamine Oxidase Inhibitors (MAOIs) Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazid (Marplan) ACTION • Antidepressant . pimozide (Orap) or carbamazepine (Tegretol) should not take with Prozac. blurred vision) NSAIDs  increased risk for GI bleeding Lithium  increased risk of Li toxicity Herbal: St. during pregnancy. *Used cautiously in patients with diabetes mellitus. sexual dysfunction.tremor. urinary retention. ejaculatory disturbances CONTRAINDICATIONS *Patients with hypersensitivity to antidepressants. impaired liver/kidney function and risk for suicidal ideation or behavior. cardiac disease.

fever. coma Food: Tyamine or tryptophan  hypertensive crisis. hypertensive crisis CONTRAINICATIONS *In the elderly. diarrhea. history of headaches or CHF. jerking motions to leg. alcoholic beverages. If a hypertensive crisis occurs. which may occur up to 2 weeks after the MAOI is discontinued NURSING PRECAUTIONS INTERACTIONS Drug: Sedatives/hypnotics/analgesics increased risk for adverse reactions during surgery *One of the earliest symptoms of hypertensive crisis is headache (usually occipital). dizziness. nausea. beef/chicken livers. fava beans. diabetes. pickled herring. chest pain. salami. restlessness. bananas. chocolate. caffeinated beverage. yogurt. fever. soy sauce . constipation. Thiazide diuretic  increased hypotensive effects of MAOI Adrenergic agents  increased risk for cardiac arrhythmias and hypertension Antitussives (relieve cough)  hypotension. certain fruits & vegetables (avocado. hypertension. history of seizures. cerebrovascular disease. dilated pupils and bradycardia or tachycardia. Stroked and death have been reported. sweating. fermented meats (pepperoni. raisins. figs. headache. nausea. sauerkraut). yeast extracts. followed by a stiff or sore neck. immediate intervention is necessary to reduce the blood pressure. dry mouth. vomiting. patients with liver/kidney disease. nausea. sour cream. hyperthyroidism or risk of suicidal or behavior. Slim-Jims). vertigo. *Avoid drug-food interactions with MAOIs -aged cheese.USES • Depressive episodes used in conjunction with psychotherapy in severe cases • Seasonal affective disorder ADVERSE REACTIONS *Orthostatic hypotension. parkinsonian symptoms. blurred vision. *Used cautiously in patients with impaired liver function.

tachycardia. bitter taste. John’s Wort  potential for adverse reaction when taken with antidepressants NURSING PRECAUTIONS CONTRAINIDCATIONS *Safe use during pregnancy has NOT been established *Monitor for therapeutic effectiveness: may take four or more week. dizziness. INTERACTION Drug: Sedative/hypnotics/analgesics  increased risk of respiratory and nervous system depression Warfarin  increased risk of bleeding Antihypertensive agents  increased risk for hypotension MAOIs  increased risk for hypertensive episode. or risk of suicidal ideation or behavior. photosensitivity. dry mouth. hypotension. agitation. nervousness. tremor. blurred vision. severe convulsions & hyperpyretic episodes Herbal: St. lightheadedness. migraine headache. palpitations *Should not be used with patients who have a seizure disorder or during the acute phase of a MI *Used cautiously in patient with cardiac disease. insomnia. vertigo.Atypical Antidepressants Bupropion (Wellbutrin) Duloxetine (Cymbalta) Venlafaxine (Effexor) ACTION • Antidepressant USES • Depressive episodes • Depression accompanied by anxiety disorders • Diabetic peripheral neuropathic pain • Smoking cessation ADVERSE REACTION *Somnolence. hyperthyroid disease. renal/hepatic impairment. thirst. close observe for worsening depression *Use extreme caution when administering drug to patient with seizures or cranial trauma .

electrolyte disturbances. hypokalemia. Thiazide USES • Hypertension • Edema (dieresis) ADVERSE REACTIONS *Orthostatic hypotension. anxiety. renal decomposition or pregnancy INTERACTIONS Drug: . Hydrochlorothiazide (HCTZ) (Microzide) Pg 434 ACTION • Diuretic. patients with Sulfa allergies.*Report significant restlessness. photosensitivity. agitation. Smokers should NOT use Zyban if they are currently taking Wellbutrin for management of depression. because of the possibility of overdose. psychotic episodes. insomnia *Monitor & report delusions. epigastric distress CONTRAINDICATIONS *Hypersensitivity to diuretics. photosensitivity. hallucinations. confusion and paranoia *Take at the same time each day *Monitor weight weekly *Avoid alcohol *Do NOT breast feed *The smoking cessation product Zyban is a form of Wellbutrin. anuria. thiazides.

Barbiturates. somnolence. narrow-angle .743 (Carbidopa. Antihypertensive.Ace Inhibitors. Antidiabetic agents. saliva. Opioid Analgesics. BP. use of MAO inhibitor therapy with/in prior 14 days. I/Os. brown. BUN & creatinine *May be administered with food *Take early in day to avoid nocturia *Take last dose of multiple doses no later than 6PM unless instructed otherwise *May need to increase intake of high K+ foods (bananas and/or OJ) *If diabetic: monitor CBG closely Levodopa Pg. body fluid discoloration (urine. MAO Inhibitors  enhance hypotensive effect Corticosteroids  enhance hypokalemic effect Lithium  decrease Li excretion NSAIDs  diminish diuretic effect NURSING PRECAUTIONS *Assess weight. black in color) CONTRAINIDCATIONS *Hypersensitivity to Anti-Parkinsons. Stalevo) ACTION • Anti-Parkinson’s Agent USES • Dopamine Precursor ADVERSE REACTIONS *Diarrhea. melanoma. Alcohol. sweat  red. Entacapone. serum electrolytes. hallucinations.

1222 (Effexor.glaucoma. break or chew *May result in false-negative for glucsouria Venlafaxine Pg. undiagnosed skin lesions or history of melanoma *Monitor CBC. BP. S/S neuroleptic malignant syndrome *Monitor iron levels in anemic patients *Monitor IOP in patients with glaucoma INTERACTIONS Drug: Alcohol  enhance CNS depressant effect Antipsychotics  diminish antiParkinson’s agent CNS depressants MAO inhibitors  enhance toxic/adverse effects NURSING PRECAUTIONS *Swallow tablet whole: do NOT crush. mental status. Effexor XR) ACTION • Antidepressant • SSRI USES • General Anxiety Disorder (GAD) • Panic or Social Anxiety Disorder . liver & renal function tests.

hypertension. use of MAO inhibitors within 14 days. somnolence. should not initiate MAO inhibitor within 7 days of discontinuing Effexor I NTERACTIONS Drug: Alcohol. suicidal thinking. Contents of capsule may be sprinkled on a spoonful of applesauce & swallowed immediately without chewing: followed with a glass of water *May produce a false-positive of PCP in urine *BP should be monitored regularly. especially in patients with high baseline BP *May cause mean increase in HR of 49 bpm *Monitor mental status chance. nervousness. headache. abnormal ejaculation/orgasm CONTRAINIDICATIONS *Hypersensitivity to SSRIs. CNS depressants  enhance CNS depressant effect . NURSING PRECAUTIONS *Swallow capsule or tablet whole: do NOT crush or chew. CNS depression. anxiety & panic attacks ADVERSE REACTIONS *Bleeding risk. insomnia. dizziness.• • Obsessive-Compulsive Disorder Post-traumatic Stress Disorder (PTSD) MAO inhibitors  enhance serotonin reuptake & orthostatic hypotensive effects.

constipation. aspirin or other NSAIDs that increase risk of bleeding *Events have generally been noted within the first 3 months of therapy & may occur with initial dose CONTRAINDICATIONS *Patients with pancreatitis. angioedema. osteosrthritis .*Avoid alcohol. heart failure. nausea. 1112 (Januvia) ACTION • Oral Antidiabetic Agent USES • Type 2 Diabetes ADVERSE REACTIONS *Hypersensitivity to oral hypoglycemic. hypoglycemia. diarrhea. caffeine. peripheral edema. hepatic/renal impairment INTERACTIONS Drug: ACE inhibitors  enhance adverse effects of ACE inhibitors Corticosteroids  diminish hypoglycemic effect Digoxin  increase digoxin concentration Thiazide diuretics diminish effect of anti-diabetic medication NURSING PRECAUTIONS Sitagliptin Pg. SJS.

*Do not chew or crush tablet *Follow dietary & lifestyle recommendations *Monitor HbA1C serum glucose. upper respiratory infections CONTRAINDICATIONS *Patients with fractures. diarrhea. headache. 1082 (Avandia) ACTION • Oral Antidiabetic Agent USES INTERACTIONS Drug: Corticosteroids  diminish hypoglycemic effect Insulin may enhance fluid-retaining effect of anti-diabetic agent . fractures. anemia. hypoglycemia. renal function prior to initiation and periodically during treatment *If uses insulin: added risk of hypoglycemia • Type 2 Diabetes ADVERSE REACTIONS *Edema. heart failure/cardiac effects *Higher risk for hypoglycemia in patients with combination therapies Rosiglitazone Pg.

headache. 170 . hyperkalemia. garlic. Zestril) ACTION • Angiotension-Converting Enzyme (ACE) Inhibitor USES • Hypertension • Heart Failure ADVERSE REACTIONS *Cough. hypotension/syncope. bitter melon. ginseng. upper respiratory infection CONTRAINDICATIONS *Used cautiously in patients with chloestatic jaundice. D/N/V. neutropenia. hyperkalemia.Rifampin  may increase metabolism of anti-diabetic agent Thiazide diuretics diminish effect of antidiabetic medication Vasodilators may enhance adverse/toxic effects of Avandia Food: Aloe. ginger. dizziness. renal function prior to initiation and periodically during treatment *Monitor weight & fluid retention Lisinopril Pg. marshmallow (Prinivil. celery. Orthostatic hypotension. renal function deterioration NURSING PRECAUTIONS *Protect from light *May be administered with/out food *Do not chew or crush tablet *Follow dietary & lifestyle recommendations *Monitor HbA1C serum glucose.

INTERACTIONS Drug: Antacids  decrease ACE inhibitors concentration Lithium  increase concentration of Li Loop Diuretics. thiazide diuretics enhance hypotensive effect NSAIDs & Salicylates diminish antihypertensive effect K+ salts: enhance hyperkalemic effect with renal dysfunction or those maintained on K+ supplements or K+ sparing diuretics *Take first dose at bedtime Glipizide Pg. blurred vision. patients . anxiety. antihypertensives. anorexia. MAO inhibitors. diaphoresis CONTRAINDICATIONS NURSING PRECAUTIONS *Medication & herbals that may impact fluid balance or cardiac status *Patients taking diuretics should have them discontinued 2-3 days prior to initiating lisinopril if possible. N/V/D. depression. eczema. *Use K+ containing salt substitutes cautiously in patients with diabetes.648 (Glucotrol) ACTION • Oral Anti-diabetic Agent USES • Type 2 Diabetes ADVERSE REACTIONS *Edema.

headache or nausea. hypoglycemia. Beta-Blockers enhance hypoglycemic effect NURSING PRECAUTIONS *Administer immediate release tablets 30 minutes before a meal to achieve greatest reduction in postprandial hyperglycemia *Extended release tablets should be given with breakfast *Patients that are NPO or require decreased caloric intake may need doses held to avoid hypoglycemia *Monitor CBG & HbA1C *Take medication at the same times everyday *Avoid alcohol while taking medication *You may experience more sensitivity to sunlight. Simvastatin Pg. Salicylates. sulfonamide allergies INTERACTIONS Drug: Alcohola flushing reaction may occur Corticosteroids & Thiazide Diuretics diminish hypoglycemic effect Cyclic Antidepressants. 629 (Zocor) ACTION • Antilipemic Agent USES • To lower LDL-cholesterol levels .*Patients with cardiovascular issues.

4 mg lovastatin per 600 mg rice *Avoid alcohol consumption &closely monitor Liver function *Teach proper diet/exercise regimen *Take same time/each day in evening with/without food *Report unusual muscle cramping/weakness. pregnancy. Warfarin) may enhance anticoagulant effect Food: Grapefruit juice & Green Tea decrease antilipemic metabolism Herbal: St. easy bruising/bleeding or unusual fatigue Cholecalciferol Pg.ADVERSE REACTIONS *Atrial fibrillation. vertigo. abdominal pain. headache. edema. breast-feeding or patients with myopathy *Should not be used on patients who hepatic impairment and/or ethanol use INTERACTIONS Drug: Antacids decrease antilipemic concentration Diltiazem increase concentration of diltiazem Niacin enhance adverse/toxic effect of antilipemic agent Vitamin K Antagonist (ex. yellow of skin/eyes. 1236 . eczema CONTRAINICATIONS *Patients with acute liver disease. Johns Wort increase metabolism of antilipemic agent NURSING PRECAUTIONS *Red yeast rice contains an estimated 2.

bone pain. malabsorption syndrome. abdominal pain. polydipsia. resulting in headache. polyuria. evidence of vitamin D toxicity INTERACTIONS Drug: Vitamin D Analogs  may enhance adverse/toxic effect of other Vit D analogs Food: Olestra impairs absorption of Vitamin D NURSING PRECAUTIONS *Vitamin D supplementation has been shown to increase muscle function and strength. confusion. N/V.(Vitamin D3) ACTION • Dietary Supplement USES • Treatment of Vitamine D Deficiency • Prophylaxis of deficiency ADVERSE REACTIONS *Hypervitaminosis D: signs/symptoms: hypercalcemia. cardiac arrhythmias CONTRAINIDCATIONS *Hypercalcemia. lethargy. weakness. as well as improve balance *Patients at risk for falls should have vitamin D serum concentrations measured and be evaluated for supplementation . sluggishness.

urine & fecal matter from contacting skin. D and E. Ideal for sensitive skin. while zinc oxide provides broad spectrum UVA and UVB protection. Rubs in clear to permit easy monitoring of skin. INZO allows the skin to breathe without being occlusive. Ideal for around ostomy sites or peri wound skin to protect skin from maceration damage. Enhanced formula:Vitamins A. nourish the skin. INZO leaves a non-greasy.• • SOOTHE & COOL® (INZO Zinc Oxide Barrier Cream) ACTION Ideal for under tape. • Protective barrier to relieve and guard the skin from harsh irritants. Nonpetrolatum formula won’t obstruct brief pores. Unique formula: silicone-based barrier that also moisturizes the skin. • USES • Designed to prevent moisture. ADVERSE REACTIONS . along with aloe. invisible barrier.

lips. tightness in the chest. antacids or other calcium supplements. INTERACTIONS Calcium carbonate may interact with or make it harder for your body to absorb certain drugs. or stinging. swelling of the mouth. 256 ACTION • Maintain cell membrane and capillary permeability . face. or tongue). severe or persistent itching.Seek medical attention right away if any of these SEVERE side effects occur: Severe allergic reactions (rash. worsening dryness. skin irritation. urinating more than usual. or stinging. difficulty breathing. especially: digoxin (Lanoxin. burning. decreased appetite. ADVERSE REACTIONS *nausea or vomiting. burning. Lanoxicaps). dry mouth or increased thirst. itching. USES • Calcium carbonate is used to prevent and to treat calcium deficiencies. hives. *Tell your doctor about all other medications you take.calcitriol Oyster Shell Calcium 500 (Calcium Carbonate) Pg. constipation.Mild itching.

and others).s receiving digitalis. renal disease. NURSING PRECAUTIONS Use cautiously in patients with hypercalcemia. ventricular fibrillation. swelling of your face. lips. ora tetracycline antibiotic such as tetracycline (Sumycin. doxycycline (Vibramycin. Myralax Pg.(Rocaltrol) or vitamin D supplements. and others). drawing water into the lumen of the GI tract USES Treatment of occasional constipation ADVERSE REACTIONS . or oxytetracycline (Terramycin. demeclocycline (Declomycin). tongue. Dynacin. Doxy. Monodox. and others). Pt. cardiac disease *Get emergency medical help if you have any of these signs of an allergic reaction: hives. difficulty breathing. renal calculi. or throat. minocycline (Minocin. Achromycin V.991 (Polyethylene glycol-electrolyte solution) ACTION Polyethylene glycol acts as a osmotic agent. severe respiratory insufficiency. and others). glycosides.

000 mg ACTION • Oral Antidiabetic Agent .GI: Abdominal bloating. flatulence. Megacolon INTERACTIONS None significant NURSING PRECAUTIONS Use cautiously in abdominal pain of uncertain cause. cramping. Toxic colitis. or children Avandamet (combo drug) Rosiglitazone (Avandia)/ Meformin 1 mg/500 mg. 2 mg/500 mg. particularly if accompanied by fever. 4mg/500 mg 2 mg/1. nausea CONTRAINIDCATIONS GI obstruction. gastric retention.000 mg. 4 mg/1. pregnancy.

Fortamet. marshmallow NURSING PRECAUTIONS *Protect from light *May be administered with/out food *Do not chew or crush tablet *Follow dietary & lifestyle recommendations *Monitor HbA1C serum glucose. anemia. diarrhea.USES • Type 2 Diabetes ADVERSE REACTIONS *Edema. celery. ginger. heart failure/cardiac effects *Higher risk for hypoglycemia in patients with combination therapies INTERACTIONS Drug: Corticosteroids  diminish hypoglycemic effect Insulin may enhance fluid-retaining effect of anti-diabetic agent Rifampin  may increase metabolism of antidiabetic agent Thiazide diuretics diminish effect of antidiabetic medication Vasodilators may enhance adverse/toxic effects of Avandia Food: Aloe. upper respiratory infections CONTRAINDICATIONS *Patients with fractures. renal function prior to initiation and periodically during treatment *Monitor weight & fluid retention Metformin Pg. garlic. headache. bitter melon. fractures. Riomet) ACTION • Oral Antidiabetic Agent USES . 793 (Glucophage. ginseng. hypoglycemia.

flatulence. vomiting.• Type 2 Diabetes ADVERSE REACTIONS *Nausea. celery. diarrhea. asthenia CONTRAINIDCATIONS *Patients with heart failure. bitter melon. garlic. marshmallow INTERACTIONS Drug: Corticosteroids  increased risk of lactic acidosis Insulin may enhance fluid-retaining effect of anti-diabetic agent NURSING PRECAUTIONS *Protect from light *May be administered with/out food *Do not chew or crush tablet *Follow dietary & lifestyle recommendations *Monitor HbA1C serum glucose. 629 . ginseng. *Stopped 48 hours before and after radiologic studies using iodinated material Rifampin  may increase metabolism of antidiabetic agent Thiazide diuretics diminish effect of antidiabetic medication Vasodilators may enhance adverse/toxic effects of Avandia Food: Aloe. ginger. renal function prior to initiation and periodically during treatment *Monitor weight & fluid retention Atorvastatin (Lipitor) Pg. renal disease. acute/chronic metabolic acidosis (including ketoacidosis) *Temporarily discontinued for surgical procedures & restarted when patient’s oral intake has been resumed and renal function is normal.

insomnia.ACTION • HMG-CoA Reductase Inhibitor (Statin Drug) • Lowers blood levels of cholesterol. abdominal pain. LDLs and trigylerides USES • Antihyerlipidemic Drug ADVERSE REACTIONS *Headache. John’s wort causing a decrease in statin effectiveness NURSING PRECAUTIONS *Statin drugs have an addictive effect when used . diarrhea. erythromycin. dizziness. sinusitis. flatulence. nausea CONTRAINDICATIONS *Patients with serious liver disorders and during pregnancy (category X) and lactation INTERACTIONS Drug: Macrolides. constipation. cramping. clarithromycin  increased risk of severe myopathy or rhabdomyolysis Amiodarone  increased risk of myopathy Niacin  increased risk of severe myopathy or rhabdomyolysis Protease inhibitors elevated plasmas levels of statins Verapamil  increased risk of myopathy Warfarin increased anticoagulant effect Herbal: St.

2/3 atrioventricular (AV) block (except with a functioning pacemaker) *Patients with hypotension (systolic pressure less than 90 mm Hg). anorexia CONTRAINIDCATIONS *Patients with sick sinus syndrome. syncope *Upper respiratory infections and cough *Abdominal pain.with bile acid resins. 151 ACTION • Calcium Channel Blocker USES • Antihypertensive Drug • Chronic Stable Angina • Vasospastic angina INTERACTION Drug: Cimetidine or rantidine (GI disorders)  increased effect of CCblocker Theophyllinetoxic effect of theophylline Digoxinincreased risk digitalis toxicity . fatigue. nausea. depression. diarrhea. which may provide an added benefit in treating high cholesterol that does not respond to a single-drug regimen. Cholesterol total Highdensity cholesterol 120-220mg/100mL >40mg/100mL Low-density cholesterol <80mg/100mL ADVERSE REACTIONS *Headache. dizziness. ventricular dysfunction or cardiogenic shock Amlodipine (Norvasc) Pg. constipation.

tremor.Rifampin (TB med)  decreased effect of CCblocker MAOIs. ejaculatory disturbances CONTRAINDICATIONS *Patients with hypersensitivity to antidepressants. antihistamines. *Used cautiously in patients with diabetes . sexual dysfunction. 1327 ACTION • Selective Serotonin Reuptake Inhibitor (SSRI) • Antidepressant USES • Depressive episodes • Obsessive-compulsive disorders • Bulimia nervous ADVERSE REACTIONS *Nausea. report any swelling or face or extremities *Be careful for postural hypotension *Report shortness of breath or irregular HR Sertraline (Zoloft) Pg. during pregnancy. sweating. anorexia. insomnia. nervousness. constipation. diarrhea. 1103. headache. sympathomimetic bronchodilators  decreased effectiveness of CCblocker Diuretics increased risk of hypotension Herbal: Hawthronincreased sedation & CNS depression NURSING PRECAUTIONS *Take BP and HR prior to administration *Monitor for signs/symptoms of edema. patients taking cisapride (Propulsid). anxiety. pimozide (Orap) or carbamazepine (Tegretol) should not take with Prozac. dry mouth.

blurred vision) NSAIDs  increased risk for GI bleeding Lithium  increased risk of Li toxicity Herbal: St. urinary retention.mellitus. 324 ACTION • Anticoagulant • Antiplatelet Agent USES • Recent MI • Stroke . impaired liver/kidney function and risk for suicidal ideation or behavior. John’s wort  increased risk for a severe s edative effect NURSING PRECAUTIONS *Watch closely for worsening of depression or suicidal ideation *Monitor therapeutic levels: 1-4 weeks may be needed before improvement is noted *Monitor HR and BP and cardiac status in known or suspect cardiac disease *Monitor adverse effect especially with doses>20mg *Avoid alcohol *Do not breast feed while taking medication Clopidogrel (Plavix) Pg. cardiac disease. *Patients should NOT be switched to an SSRI within 2 weeks of stopping an MAOI antidepressant INTERACTION Drug: Other antidepressants  increased risk of toxic effects Cimetidine  increased anticholingeric symptoms (dry mouth.

5 times normal control level *Monitor vital signs *Observe all needle sites daily for . skin rash. valerian may potentiate bleeding NURSING PRECAUTIONS *Lab tests: PT/INR.• Acute Coronary Syndrome Macrolide antibiotics increased effectiveness ADVERSE REACTIONS *Dizziness. ginkgo. dyspepsia CONTRAINDICATIONS *Patients with CHF. dosage is adjusted to keep APTT between 1. constipation *Heart palpitation. bleeding. H/H *Monitor APTT levels closely *In general.5-2. thrombotic thrombocytopenia purpura (TTP) *Should be used cautiously in elderly patients & those with renal or hepatic impairment INTERACTIONS Drug: Aspirin & NSAIDs  increased risk of bleeding of anti-infective Digoxin decreased digoxin levels Phenytoin increased phenytoin levels Herbal: Feverfew. baseline blood coagulation tests. ginger. chest pain. active bleeding.

severe head trauma. postural (orthostatic) hypotension. hypotension. 707 *Patients with severe anemia. rash CONTRAINDICATIONS Pg. head trauma. hypothryroidism INTERACTIONS Drug: Aspirin  increases nitrate concentration Calcium Channel Blockers  increases symptomatic orthostatic hypotension Dihydroergotamine (migrate medicine)  Increases risk of hypertension heparin  decreased effect of heparin Erectile dysfunction meds severe hypotension & cardiovascular collapse may occur . closedangle glaucoma.hematoma and signs of inflammation Isosorbide Mononitrate (ISMO) (Monoket) ACTION • Antianginal Drug USES • Treatment and prevention of angina pectoris ADVERSE REACTIONS *Headache. restlessness. cerebral hemorrhage (may increase intracranial hemorrhage) *Patients taking drugs for erectile dysfunction should NOT take nitrates *Used cautiously in the following patients: severe hepatic or renal disease. dizziness. weakness. flushing.

it may precipitate acute angina ADRENERGIC DRUGS Peripheral Nervous System Autonomic Nervous System Sympathetic v. This branch of system is based on the neurohormone adrenalin (epinephrine) and norepinephrine (neurotransmitter). hypotension. Parasympathetic nervous system branches Sympathetic (Adrenergic) = regulated by involuntary control. such as danger. intense emotion or severe illness. blurred vision. light-headedness. dyspnea *Do NOT withdraw drug abruptly.Alcohol  severe hypotension & cardiovascular collapse because of it’s a vasodilator NURSING PRECAUTIONS *Heart rate MUST be above 60 *Do NOT crush or chew tablets *Report S&S of toxicity. In other words. . a person does NOT have control over what this system does. Fight-or-Flight response is activated when the body is confronted with stressful situations. Controls person’s heart rate. breathing rate and ability to divert blood to skeletal muscles.

adrenergic drugs produce activity similar to the neurotransmitter norepinephrine. Midodrine (ProAmatine) In the sympathetic branch of ANS. The adrenergic drugs produce pharmacologic effects similar to the effects that occur in the body when the sympathetic nervous (norepinephrine) and the medulla (epinephrine) are stimulated. The primary effects of these drugs occur on the heart. DO NOT MIX DOPMINE WITH OTHER DRUGS ➢ Norepinephrine & dopamine are administered ONLY via IV route Shock Patients: monitor VS. Another name for these drugs is sympathomimetic (for example: mimicking the actions of the sympathetic nervous system) drugs. the blood vessels and the smooth muscles.✔ ✔   Examples: Dobutamine. especially a progressive fall in BP & cardiac output (HR & stroke volume) Dobutamine (Dobutrex) ACTION • Adrenergic (Sympathomimetic) Drug . epinephrine (EpiPen). such as the bronchi of the lungs.

USES • Cardiac decompensation due to depressed contractility caused by organic heart disease or cardiac procedures ADVERSE REACTIONS *Headache. CONTRAINDICATIONS • Used cautiously in patients with coronary insufficiency. irregular heart rate. especially cardiac arrhythmias • Monitor BP every 2 minutes from beginning of therapy until the desired BP and pulse rate at frequent intervals. occlusive vascular disease or prostatic hypertrophy. cardiac arrhythmias. • Patients with diabetes may require an increased dosage of insulin INTERACTIONS Drug: Oxytocin  increased risk of hypertension Bretylium (cardiac med)  increased risk of arrhythmias Herbal: Ephedra hypertension. palpitations. nausea. usually every 5 to 15 minutes • Regardless of the actual numeric reading of the blood pressure. angina pectoris. diabetes. heart attack NURSING INTERVENTIONS • Older adult are vulnerable to adverse reactions. angina and nonspecific chest pain. stroke. hyperthyroidism. increased heart rate. a progressive decrease in blood pressure IS SERIOUS. Report a decrease in systolic BP below 100 mm Hg or any decrease of 20 mm Hg or more of the patient’s normal blood pressure Antidepressants increased sympathomimetic effect . increase in systolic blood pressure.

stroke.• Disturbed sleep patterns may occur r/t nervousness to the drug and the environment pectoris. occlusive vascular disease or prostatic hypertrophy. Patients with diabetes may require an increased dosage of insulin Epinephrine (EpiPen) ACTION • Adrenergic (Sympathomimetic) Drugs Used for Vasopressor Effects USES • Ventricular standstill • Treatment & prophylaxis of cardiac arrest. irregular heart rate. dysuria. lightheadedness. restlessness. heart attack NURSING INTERVENTIONS • Used cautiously in patients with coronary insufficiency. nausea. mucosal congestion and acute sinusitis • Prolong regional/local anesthetics • Anaphylactic reactions ADVERSE REACTIONS *Anxiety. cardiac arrhythmias. angina • The older adult is especially vulnerable to adverse reactions and is more likely to . diabetes. headache. pallor CONTRAINDICATIONS • INTERACTIONS Drug: Antidepressants increased sympathomimetic effect Oxytocin  increased risk of hypertension Bretylium (cardiac med)  increased risk of arrhythmias Herbal: Ephedra hypertension. heart block. dizziness. hyperthyroidism.

Nurse NEEDS TO MONITOR all elderly patients and report any changes in pulse rate or rhythm immediately. chills CONTRAINDICATIONS • Used cautiously in patients with coronary insufficiency. dizziness. diabetes. angina pectoris. piloerection. to counteract the marked pressor effect of large doses Midodrine (ProAmatine) ACTION • Adrenergic (Sympathomimetic) drugs used primarily for Vasopressor Effects USES • Orthostatic hypotension (only when patient is considered impaired) ADVERSE REACTIONS *Paresthesias. pruritus. • In patients with Parkinson disease. such as nitrates and alpha blockers. headache. occlusive vascular disease or prostatic hypertrophy. • Patients with diabetes may require an increased dosage of insulin . supine hypertension. pain.have preexisting cardiovascular disease that predisposes them to potentially serious cardiac arrhythmias. cardiac arrhythmias. bradycardia. drug increases rigidity and tremor • Drug of choice in emergency treatment of acute anaphylactic reactions • In blood pressure increases sharply. dysuria. give rapid-acting vasodilators. hyperthyroidism.

The drug should be given only to patients whose lives are impaired despite standard treatment offered. heart attack NURSING INTERVENTIONS *Supine hypertension is a potentially dangerous adverse reaction in the patient taking midodrine. take doses in 3-hour intervals and within 4-hours of bedtime. *Important to take the drug during daytime hours. The following is a suggested dosing schedule for the administration of midodrine: shortly before arising in the morning. and late afternoon (not after 6:00 PM). “Fight or Flight”): tends to . Parasympathetic nervous system branches ○ Sympathetic Nervous System (Adrenergic Branch. if needed to control symptoms *Sleep with head of bed elevated ADRENERGIC BLOCKING DRUGS Peripheral Nervous System Autonomic Nervous System Sympathetic v. stroke. irregular heart rate.INTERACTIONS Drug: Antidepressants increased sympathomimetic effect Oxytocin  increased risk of hypertension Bretylium (cardiac med)  increased risk of arrhythmias Herbal: Ephedra hypertension. The nurse can minimize this reaction by administrating midodrine during the day while the patient is in an upright position. Drug therapy should continue only in the patient whose orthostatic hypotension improves during the initial treatment. midday.

Anti-adrenergic or Adrenergic Blocking medications block or inhibit the system and sympathetic nervous system. Toprol XL).β adrenergic blocking drugs: blocks both α AND β adrenergic receptors and effects the nerve fibers Example: Carvedilol (Coreg) Anti-adrenergic drugs: prevents the release of neurotransmitter norepinephrine and blocks the adrenergic nerve impulse in both central & peripheral nervous systems . primarily the β receptors of the heart. Propranolol α.➢ ➢ ➢ ➢ regulate the expenditure of energy and is operative when the organism is confronted with stressful situations. Alpha-adrenergic blocking drugs: produce their greatest effect on the alpha-receptors of the adrenergic nerves that control the vascular system. decreasing heart rate and dilates the blood vessels. One of the major body systems impacted by adrenergic blocking drugs is the heart and vascular system. Some of the drugs are also used to treat hypertension. Examples: Atenolol. causing vasodilation and relaxing the smooth muscle of blood vessels (also used to constrict pupil). Example: Phentolamin (Regitine) Beta-adrenergic blocking drugs (Beta Blockers): blocks β-adrenergic receptors and their effect on β receptors. Metoprolol (Lopressor.

nervousness CONTRAINICATIONS Antidepressants (MAOIs. N/V/D. emphysema or hypotension. *Used cautiously in patients with diabetes. SSRIs)  increased effect of β-blocker. INTERACTIONS Drugs: USES • Hypertension • Angina • Acute MI ADVERSE REACTIONS *Bradycardia. dizziness. * β-Blockers are recommended for pregnant women over other hypertensive drugs because of the risk to the fetus is less with these drugs. hypotension. heart failure and those with asthma.Example: Clonidine (Catapres) Atenolol (Tenormin. thyrotoxicosis or peptic ulcer. bradycardia NSAIDs decreased effect of β-blocker Loop diuretics increased risk of hypotension Clonidine  increased risk of paradoxical hypertensive effect Cimetidine (GI problems)  increased serum level of β-blocker & higher risk of β-blocker toxicity Lidocaine increased serum level of β-blocker & higher risk of β-blocker toxicity NURSING INTERVENTIONS . Tenoretic) ACTION • β-Adrenergic Blocking Drug (Beta Blocker) • Decreases stimulation of sympathetic nervous system by: ○ Decreasing excitability of heart ○ Decreasing cardiac workload and oxygen consumption ○ Provides membrane-stabilizing effects *Patients with sinus bradycardia. second or third degree heart block. fatigue. weakness.

The nurse should monitor older adults closely for confusion.*Older adults are at an increased risk for adverse reactions when taking β-blockers. or systolic BP less than 90 mm Hg ○ USES • Cardiac arrhythmias • MI. emphysema or hypotension. thyrotoxicosis or peptic ulcer. bradycardia Propranolol (Inderal) ACTION • β-Adrenergic Blocking Drug (Beta Blocker) • Decreases stimulation of sympathetic nervous system by: ○ Decreasing excitability of heart ○ Decreasing cardiac workload and oxygen consumption . * β-Blockers are recommended for pregnant women over other hypertensive drugs because of the risk to the fetus is less with these drugs. weak peripheral pulses). pulmonary edema CONTRAINICATIONS *Patients with sinus bradycardia. *Used cautiously in patients with diabetes. N/V/D. INTERACTIONS Drugs: Antidepressants (MAOIs. paresthesia of the hands. dizziness. angina • Hypertension • Migraine prophylaxis • Hypertrophic Sub-aortic stenosis • Pheochromocytoma • Essential Tremor Provides membrane-stabilizing effects ADVERSE REACTIONS *Bradycardia. *Beta-blockers may mask tachycardia caused by hyperthyroidism *Beta-blockers may mask signs/symptoms of hypoglycemia in diabetic patients *With-hold medication is HR is less than 60 bpm. bronchospasm. hyperglycemia. SSRIs)  increased effect of β-blocker. worsening of angina. heart failure and those with asthma. shortness of breath and peripheral vascular insufficiency (examples: cold extremities. heart failure. hypotension. second or third degree heart block.

N/V/D CONTRAINICATIONS . Toprol-XL) ACTION • β-Adrenergic Blocking Drug (Beta Blocker) • Decreases stimulation of sympathetic nervous system by: ○ Decreasing excitability of heart ○ Decreasing cardiac workload and oxygen consumption ○ Provides membranestabilizing effects USES • Hypertension • Angina • MI. The nurse should monitor older adults closely for confusion. shortness of breath and peripheral vascular insufficiency (examples: cold extremities. cardiac arrhythmias. weak peripheral pulses). heart failure. hypotension. discontinue slowly *Beta-blockers may mask signs/symptoms of hypoglycemia in diabetic patients *With-hold medication is HR is less than 60 bpm.NSAIDs decreased effect of β-blocker Loop diuretics increased risk of hypotension Clonidine  increased risk of paradoxical hypertensive effect Cimetidine (GI problems)  increased serum level of β-blocker & higher risk of β-blocker toxicity Lidocaine increased serum level of β-blocker & higher risk of β-blocker toxicity NURSING INTERVENTIONS *Instruct patient to take drug with food *Older adults are at an increased risk for adverse reactions when taking β-blockers. paresthesia of the hands. *Abrupt withdrawal of drug may cause exacerbation of angina or MI. Heart Failure ADVERSE REACTIONS *Dizziness. or systolic BO is less than 90 mm Hg Metoprolol (Lopressor. HF. worsening of angina.

bradycardia NSAIDs decreased effect of beta blocker Loop Diuretic  increased risk of hypotension Clonidine increased risk of paradoxical hypertensive effect NURSING PRECAUTIONS *Take apical pulse and BP before administration *Hold if BP is less than 100/60 OR greater than 140/90.*Patients with sinus bradycardia. * β-Blockers are recommended for pregnant women over other hypertensive drugs because of the risk to the fetus is less with these drugs. OR HR less than 60 *Monitor BP. HR and ECG carefully during IV administration Carvedilol (Coreg) ACTION • α. second or third degree heart block. heart failure and those with asthma.β Adrenergic Blocking Drug ○ Blocks both α. INTERACTIONS Drug: Antidepressants  increased effect of Beta blocker.β receptors resulting in peripheral vasodilation USES • Hypertension . Cimetidine higher risk of B-blocker toxicity Iidocaine  higher risk of B-blocker toxicity *Used cautiously in patients with diabetes. emphysema or hypotension. thyrotoxicosis or peptic ulcer.

chronic bronchitis or impaired hepatic or cardiac function. risk of toxicity NURSING INTERVENTIONS *Monitor patient with heart failure for worsening condition. diarrhea CONTRAINIDCATIONS *Patients with bronchial asthma. INTERACTION Drug: Antidepressants (tricyclics. in those with diabetes and during pregnancy or lactation.• • HF Left ventricular dysfunction ADVERSE REACTIONS *Bradycardia. diuretics may need to be increased *If drug must be stopped. fatigue. if possible *If patient is jaundice. STOP medication IMMEDIATELY hepatic injury *Observe patient for dizziness for lightheadedness for 1 hour after giving each new dose *Monitor elderly patients carefully. do so gradually over 1-2 weeks. *Used cautiously in patient with drugcontrolled HF. hypotension. decompensated heart failure and severe bradycardia. drug levels are about 50% higher in elderly patients than in younger patients *Inform patients who wear contact lenses that their eyes may feel dry . renal failure or fluid retention. SSRIs)  increased risk of tremors Cimetidine  increase effect of the adrenergic blocker Halothane  increase effect of the adrenergic blocker Clonidine  increased effect of the clonidine (big drop in BP) Digoxin  increased levels of digoxin. cardiac insufficiency. dizziness.

dizziness. constipation. syncope. hypotension Anesthetic agents increased effect of the anesthetic β-blockers  increased risk of hypertension Lithiumincreased risk for lithium toxicity Haloperidol  increased risk of psychotic behavior NURSING INTERVENTIONS *B/P.*Take medication with food. dreams. dry mouth. rash CONTRAINDICATION *Patients in active hepatic disease and patients on MAOIs *Used cautiously in patients with a history of liver disease or renal impairment and during pregnancy and lactation INTERACTIONS Drug: Adrenergic drugs  increased risk of hypertension Levodopa  decreased effect of levodopa. sedation. chewed or divided Clonidine (Catapres) ACTION • Anti-Adrenergic Drugs (Centrallyacting) ○ Inhibits the release of norepinephrine and acts in the Central Nervous System  Affects the sympathetic nervous system USES • Hypertension • Severe pain in patients with cancer ADVERSE REACTIONS *Drowsiness. pulse prior to administration . capsules should NOT BE crushed.

Functional activity of the autonomic nervous system is not controlled consciously (the activity is automatic). insomnia. ➢ . cold or allergy) medications unless approved by MD *Rise slowly to prevent drop in BP *May cause dry mouth. nausea. recommend hard candy or frequent mouth rinsing CHOLINERGIC (PARASYMPATHOMIMETIC) MEDICATIONS ➢ Acetylcholine (ACh) is the substance that transmits nerve impulses across the parasympathetic branch of the Autonomic Nervous System. sweating *DO NOT use OTC (cough. shivering & dilated pupils *Monitor I/Os and edema *Give last dose at bedtime *Discontinuing abruptly may result in anxiety. ○ Autonomic Nervous System: is concerned with functions essential to the survival of the organism. cramps. increased BP. gastrointestinal activity and glandular secretions. headache. digested food and eliminating bodily wastes. heart rate. This system controls blood pressure.*If prescribed for opiate withdrawal: monitor for N/V/D. “Rest & Digest”): help conserve body energy and is partly responsible for such activities as slowing the heart rate. insomnia. Parasympathetic Nervous System (Cholinergic Branch. Cholinergic drugs that enhance neurotransmission and anticholinergic drugs block transmission. tremors. increased pulse.

  Bethanechol (Duvoid. This opens the blocked channel and allows the normal passage of aqueous humor.○ ○ ○ Muscarinic Receptors stimulates smooth muscle Nicotinic Receptors  stimulates skeletal muscle Direct Acting Cholinergics: cholinergic drugs that act like the neurotransmitter ACh and acts on the ANS that controls the process of micturition (voiding of urine) by constricting the muscle and relaxing the bladder sphincter. Indirect Acting (Anticholinesterase) Muscle Stimulants: these medications are used to treat myasthenia gravis (disease that rapidly fatigues skeletal muscles because of the lack of ACh released) and promote muscle contraction. Urecholine) ACTION • Direct Acting Cholinergic Drug ○ Acts like the neurotransmitter ACh and controls the process of micturition (voiding of urine) by . Topical Ophthalmics: as indirect-acting cholinergic drugs that produce miosis (constriction of the iris) that are used in the treatment of glaucoma. thereby reducing intraocular pressure.

*To avoid N/V. The usual dosage of atropine is 0. cardiac arrhythmias.4 to 0. recent coronary occlusion and megacolon. salivation. *Patients with asthmas. rigidity and spasm and clenching of the jaw. contact MD immediately.6 mg IV *Signs of under dosage of the drug include the disease itself. *Used cautiously in patients with hypertension. INTERACTIONS Drugs: constricting the muscle and relaxing the bladder sphincter. Patients exhibiting these symptoms require immediate medical treatment. urgency CONTRAINIDICATIONS *Patients with mechanical obstruction of the GI or genitourinary tracts. and their condition must be reported immediately to MD. Aminoglycoside antibiotics increased neuromuscular blocking effect Corticosteroids  decreased effect of cholinergic problems NURSING INTERVENTIONS *Symptoms of cholinergic crisis (Cholinergic drug toxicity) include severe abdominal cramping. an antidote such as atropine is administered and other treatment also may be prescribed. 1 hr AC or 2 hours PC . excessive salivation. bradycardia. diarrhea. headache. namely. nausea. drooping of the eyelids and difficulty breathing. diarrhea. muscle weakness. rapid fatigability of the muscles. If symptoms of drug over OR under-dosage. *In case of over-dosage.USES • Acute Non-obstructive Urinary Retention • Neurogenic Urinary Bladder (causing retention) ADVERSE REACTIONS *Abdominal discomfort. take on an empty stomach *Monitor I/Os *Take medication exactly as prescribed. coronary artery disease and hyperthyroidism. epilepsy. peptic ulcer disease.

bradycardia. *Used cautiously in patients with hypertension. peptic ulcer disease. rigidity and spasm and clenching of the jaw. Patients exhibiting these symptoms require immediate medical treatment. diarrhea. cardiac arrhythmias. coronary artery disease and hyperthyroidism. INTERACTIONS Drugs: Aminoglycoside antibiotics increased neuromuscular blocking effect Corticosteroids  decreased effect of cholinergic problems NURSING INTERVENTIONS *Symptoms of cholinergic crisis (Cholinergic drug toxicity) include severe abdominal cramping. recent coronary occlusion and megacolon. cardiac arrhythmias. epilepsy.Ambenonium (Mytelase) ACTION • Indirect Acting (Anticholinesterase) Muscle Stimulant Drug ○ Prolongs the activity of ACh by inhibiting the release of AChE (anticholinesterase)and promotes muscle contraction USES • Myasthenia gravis (a disease that rapidly fatigues skeletal muscles because of the lack of AChl released) ADVERSE REACTIONS *Increased bronchial secretions. *Patients with asthmas. excessive salivation. urinary frequency CONTRAINIDICATIONS *Patients with mechanical obstruction of the GI or genitourinary tracts. muscle weakness. muscle weakness. and their condition must be reported immediately to MD. .

4 to 0. rapid fatigability of the muscles. stinging. namely. burning. contact MD immediately. an antidote such as atropine is administered and other treatment also may be prescribed. drooping of the eyelids and difficulty breathing. corneal abrasion or any acute inflammatory disease of the eye should NOT use the ophthalmic cholinergic preparation. thereby reducing intraocular pressure USES • Glaucoma ADVERSE REACTIONS *Headache. tachycardia. The usual dosage of atropine is 0. humor. epilepsy. *Used cautiously in patients with hypertension. cardiac Pilocarpine (Pilopine) ACTION • Topical Indirect-acting Cholinergic Ophthalmics: that opens the blocked channel and allows the normal passage of aqueous .*In case of over-dosage. *Patients with mechanical obstruction of the GI or genitourinary tracts. If symptoms of drug over OR underdosage. bitter taste CONTRAINIDICATIONS *Patients with secondary glaucoma. iritis.6 mg IV *Signs of under dosage of the drug include the disease itself.

*Patients with asthmas. recent coronary occlusion and megacolon. “Rest & Digest”): help conserve body energy and is partly responsible for such activities as slowing the heart rate. blurring or dryness of eye area *Store medication at room temperature away from light ANTICHOLINEGIC (CHOLINERGIC BLOCKERS/PARASYMPATHOLYTIC) MEDICATIONS ➢ Acetylcholine (Ach) is the substance that transmits nerve impulses across the parasympathetic branch of the Autonomic Nervous System. peptic ulcer disease. coronary artery disease and hyperthyroidism. INTERACTIONS Drugs: Aminoglycoside antibiotics increased neuromuscular blocking effect Corticosteroids  decreased effect of cholinergic problems NURSING INTERVENTIONS *How to instill drops *Teach the patient that the medication my cause burning.  Parasympathetic Nervous System (Cholinergic Branch. digested food and eliminating bodily wastes. itching.arrhythmias. . bradycardia.

○ Anti-Cholinergic/ Cholinergic Blocking Drugs: block the action of ACh in the parasympathetic nervous system.Cholinergic drugs that enhance neurotransmission and anticholinergic drugs block transmission. Belladonna. working either on the:  Muscarinic receptors: treating overactive bladders  Nicotinic receptors: as an antispasmodic drug Examples: Atropine. Oxybutynin Atropine (AtroPen) ACTION • Cholinergic Blocking (Anti-Cholinergic) Medication USES • Pylorospasm . Scopolamine.

• • •

Reduction of bronchial & oral secretions Excessive Vagal-Induced bradycardia Ureteral & Biliary Colic

ADVERSE REACTIONS *Drowsiness, blurred vision, tachycardia, dry mouth, urinary hesitancy CONTRAINICATIONS
*Patients with glaucoma, myasthenia gravis, tachyarrhythmias, myocardial infarction and congestive heart failure (unless bradycardia is present) *Used cautiously in patients with GI infections, benign prostatic hypertrophy, urinary retention, hyperthyroidism, hepatic/renal disease and hypertension. *Atropine should be used cautiously in patients with asthma

INTERACTIONS Drug: Antibiotics/antifungals  decreases effectiveness of anti-infective drug

Meperidine, flurazepam, phenothiazine (sedation)  increased effect of cholinergic blocker Tricyclic antidepressants  increased effect of cholinergic blocker Haloperidol  decreased effectiveness of antipsychotic drug Digoxin increased serum levels of digoxin OTC: Some Allergy, Cold-Symptom & Sleep-Aids already contain atropine, scopolamine or other cholinergic blocking dugsread label NURSING INTERVENTIONS *I&Os, check for urinary retention (including bowel soundsconstipation) *Respiratory status: rate, rhythm, cyanosis, wheezing, dyspnea, engorged neck veins *Increased intraocular pressure: S/S blurred vision, increased tearing *Do not perform strenuous activity in high temperatures; heat stroke may result *DO NOT SKIP A DOSE

Belladonna
ACTION • Cholinergic Blocking (Anti-Cholinergic) Medication USES • Peptic Ulcer • Digestive Disorders • Diverticulitis • Pancreatitis • Diarrhea ADVERSE REACTIONS *Drowsiness, blurred vision, tachycardia, dry mouth, urinary hesitancy CONTRAINICATIONS *Patients with glaucoma, myasthenia gravis, tachyarrhythmias, myocardial infarction and congestive heart failure (unless bradycardia is present) *Used cautiously in patients with GI infections, benign prostatic hypertrophy, urinary retention, hyperthyroidism, hepatic/renal disease and hypertension.

*Atropine should be used cautiously in patients with asthma INTERACTIONS

Drug: Antibiotics/antifungals  decreases effectiveness of anti-infective drug Meperidine, flurazepam, phenothiazine (sedation)  increased effect of cholinergic blocker Tricyclic antidepressants  increased effect of cholinergic blocker Haloperidol  decreased effectiveness of antipsychotic drug Digoxin increased serum levels of digoxin OTC: Some Allergy, Cold-Symptom & Sleep-Aids already contain atropine, scopolamine or other cholinergic blocking dugsread label NURSING INTERVENTIONS *I&Os, check for urinary retention (including bowel soundsconstipation) *Respiratory status: rate, rhythm, cyanosis, wheezing, dyspnea, engorged neck veins *Increased intraocular pressure: S/S blurred vision, increased tearing

*Do not perform strenuous activity in high temperatures; heat stroke may result *DO NOT SKIP A DOSE

Scopolamine
ACTION • Cholinergic Blocking (Anti-Cholinergic) Medication USES • Preanesthetic Sedation • Motion Sickness ADVERSE REACTIONS *Confusion, dry mouth, constipation, urinary hesitancy, urinary retention, blurred vision CONTRAINICATIONS *Patients with glaucoma, myasthenia gravis, tachyarrhythmias, myocardial infarction and congestive heart failure (unless bradycardia is present) *Used cautiously in patients with GI infections, benign prostatic hypertrophy,

urinary retention, hyperthyroidism, hepatic/renal disease and hypertension. *Atropine should be used cautiously in patients with asthma INTERACTIONS
Drug: Antibiotics/antifungals  decreases effectiveness of anti-infective drug Meperidine, flurazepam, phenothiazine (sedation)  increased effect of cholinergic blocker Tricyclic antidepressants  increased effect of cholinergic blocker Haloperidol decreased effectiveness of antipsychotic drug Digoxin increased serum levels of digoxin OTC: Some Allergy, Cold-Symptom & Sleep-Aids already contain atropine, scopolamine or other cholinergic blocking dugsread label NURSING INTERVENTIONS

*I&Os; retention commonly causes decreased urinary output *Watch for shuffling gait, muscle rigidity, involuntary movements *Constipation: increase fluids, bulk, exercise *Mental status change, altered mood, CNS depression/symptoms can worsen on this medication

*Administer parenteral dose slowly; stay in bed for at least 1 hr after dose *Give at bedtime to avoid daytime drowsiness *Hard candy, frequent drinks, sugarless gum to relieve dry mouth *Takes 1 week to taper off, if discontinued

Oxybutynin
(Ditropan)
ACTION • Cholinergic Blocking Urinary Antispasmodics USES • Overactive Bladder • Neurogenic Bladder ADVERSE REACTIONS *Dry mouth, nausea, headache, drowsiness, constipation, urinary retention CONTRAINICATIONS

*Patients with glaucoma, myasthenia gravis, tachyarrhythmias, myocardial infarction and congestive heart failure (unless bradycardia is present) *Used cautiously in patients with GI infections, benign prostatic hypertrophy, urinary retention, hyperthyroidism, hepatic/renal disease and hypertension. *Atropine should be used cautiously in patients with asthma INTERACTIONS Drug: Antibiotics/antifungals  decreases effectiveness of anti-infective drug

Meperidine, flurazepam, phenothiazine (sedation)  increased effect of cholinergic blocker Tricyclic antidepressants  increased effect of cholinergic blocker Haloperidol  decreased effectiveness of antipsychotic drug Digoxin increased serum levels of digoxin OTC: Some Allergy, Cold-Symptom & Sleep-Aids already contain atropine, scopolamine or other cholinergic blocking dugsread label

NURSING INTERVENTIONS *Assess urinary patters: distention, nocturia, frequency *Monitor CNS effects: confusion, anxiety, ESPECIALLY in the elderly *Avoid hazardous activities due to dizziness/blurred vision *To prevent photophobic, wear sunglasses *Avoid hot weather, strenuous activity, drug decreased perspiration

CHOLINESTERASE INHIBITORS Acetylcholine is the transmitter in the cholinergic neuropathways. Individuals with early Alzheimer’s disease (AD) experience degeneration of these cholinergic neuro-pathways. As a result, the patient experience problems with memory and thinking.

and Q 3 months after that ○ Abrupt discontinuation may cause a decline in cognitive function Donepezil (Aricept) ACTION .• Cholinesterase Inhibitors: act to increase the level of acetylcholine in the central nervous system (CNS) by inhibiting its breakdown and slowing neural destruction. Examples: Donepezil (Aricept) and Tacrine (Cognex) ○ Report immediately any elevated ATL (alanine amino-transferase) level. danger of hepatoxicity ○ Levels should be obtained at least 4-16 weeks.

muscle cramps CONTRAINIDCATIONS *Patients who are pregnant. bladder obstruction. and patients on anticoagulants NURSING INTERVENTIONS . seizure disorder.• Cholinesterase Inhibitor ○ Slows down degenerati on of cholinergic neuropathways Mild to moderate dementia due to Alzheimer’s disease (AD) *In individuals with a history of ulcer disease. gastrointestinal (GI) bleed and asthma. Drug: Anticholinergics (decrease bodily secretions) decreased effectiveness of anticholinergic NSAIDs  increased risk of GI bleeding Theophylilne  increased risk of theophyliline toxicity Herbal: Ginseng  contraindicated in patients who are pregnant or have hypertension Ginkgo  excessively large doses have been reported to cause N/V/D and restlessness. N/D. used cautiously in patients with renal/hepatic disease. sick sinus syndrome. insomnia. It is contraindicated in patients taking MAOIs because of risk of toxic reactions. bleeding may occur INTERACTIONS USES • ADVERSE REACTIONS *Headache.

bleeding may occur *Tacrine is particularly damaging to the liver and can result in hepatoxicity. headache. danger of hepatoxicity -Abrupt discontinuation may cause a decline in cognitive function *Administer between meals: may be given with meals for GI symptoms *Assist with ambulation during beginning therapy. *In individuals with a history of ulcer disease. N/V. used cautiously in patients with renal/hepatic disease. sick sinus syndrome. bladder obstruction. it relieves symptoms USES neuropathways • Mild to moderate dementia due to Alzheimer’s disease (AD) ADVERSE REACTIONS *N/V/D.*Report immediately any elevated ATL(alanine aminotransferase) level . ataxia may occur *Report twitching. dizziness. sweating= indicates overdose *This drug is NOT a cure. dizziness. gastrointestinal (GI) bleed and asthma. elevated liver function CONTRAINIDCATIONS *Patients who are pregnant. seizure disorder. -Patients should have blood drawn periodically for liver function tests Tacrine (Cognex) ACTION • Cholinesterase Inhibitor ○ Slows down degenerati on of cholinergic INTERACTIONS Drug: .

rigidity and slow movement (bradykinesia). ataxia may occur *Report twitching or eye spasms = indicates overdose NURSING INTERVENTIONS *Report immediately any elevated ATL(alanine aminotransferase) level . slurred speech. It is contraindicated in patients taking MAOIs because of risk of toxic reactions. and patients on anticoagulants danger of hepatoxicity -Levels should be obtained at least 416 weeks.Anticholinergics (decrease bodily secretions)decreased effectiveness of anticholinergic NSAIDs  increased risk of GI bleeding Theophylilne  increased risk of theophyliline toxicity Herbal: Ginseng  contraindicated in patients who are pregnant or have hypertension Ginkgo  excessively large doses have been reported to cause N/V/D and restlessness. may be given with meals for GI symptoms *Assist with ambulation during beginning therapy. ○ Tremors. . dizziness. and Q 3 months after that -Abrupt discontinuation may cause a decline in cognitive function *Administer between meals. ANTI-PARKINSON MEDICATION  Parkinsonism: is a term that refers to a group of symptoms involving motor movements.

• Dopaminergic Drugs or MAOIs: drugs that supplement the dopamine in the brain Examples: amantadine (Symmetrel). masklike or emotionless facial expressions. with the upper body bent slightly forward ○ Although Parkinson-like symptoms may be seen with the use of certain drugs. selegiline • Anticholinergics: Blocks excess acetylcholine (Ach) for better transmission of nerve impulses occur Examples: benztropine (Cogentin). diphenhydramine (Benadryl) . difficulty chewing/swallowing. head injuries and encephalitis. Drugs used to treat the symptoms associated with parkinsonism are called Antiparkinsonism drugs. but Parkinson’s disease is the most common form of parkinsonism. levodopa. unsteady or shuffled gait.

drowsiness or blurred vision occurs. history of epilepsy or other seizures. dry mouth. orthostatic hypotension. nausea. confusion. CHF INTERACTIONS Drug: Tricyclic antidepressants  increased risk of hypertension & dyskinesia NURSING PRECAUTIONS *If dizziness.Amantadine (Symmetrel) ACTION • Antiparkinsonism medication • Dopaminergic (Dopamine supplement) drug USES • Parkinson’s disease • Drug-induced extra-pyramidal syndrome (EPS) • Prevention and treatment of infection with influenza A virus ADVERSE REACTIONS *Lightheadedness. dizziness. constipation. insomnia. depression CONTRAINDICATIONS *Patients who are pregnant. avoid driving or hazardous activities .

hallucinations. use of MAO inhibitor therapy with/in prior 14 days. melanoma. saliva. body fluid discoloration (urine.*Relieve dry mouth by sucking on hard candy *Monitor for orthostatic hypotension *Hallucinations occur more often in the older adult than in the younger adult receiving antiparkinsonism drugs. sweat  red.743 (Carbidopa. especially dopamine receptor agonists. Stalevo) ACTION • Anti-Parkinson’s Agent USES • Dopamine Precursor Alcohol  enhance CNS depressant effect Antipsychotics  diminish anti-Parkinson’s agent CNS depressants MAO inhibitors  enhance toxic/adverse effects NURSING PRECAUTIONS . somnolence. brown. narrow-angle glaucoma. black in color) CONTRAINIDCATIONS *Hypersensitivity to Anti-Parkinsons. undiagnosed skin lesions or history of melanoma INTERACTIONS Drug: Levodopa Pg. ADVERSE REACTIONS *Diarrhea. Entacapone. The incidence of hallucinations appears to increase with age.

*Swallow tablet whole: do NOT crush, break/chew *May result in false-negative for glucsouria *Monitor CBC, liver & renal function tests, BP, mental status, S/S neuroleptic malignant syndrome *Monitor iron levels in anemic patients *Monitor IOP in patients with glaucoma **Monitor for choreiform and dystonic movements such as facial grimacing, protruding tongue, exaggerated chewing motion and head movements, jerking movement of arms and legs. If these occur, hold the next dose and notify MD

*Do not abruptly discontinue use of levodopa, a neuroleptic malignant-like syndrome may occur or when dosage is reduced. Observe for muscular rigidity, elevated body temperature and mental changes. *When taking levodopa, avoid Vit B6 (pyridoxine) because this vitamin may interfere with the action of levodopa.

ANTICONVULSANTS
activity

 A seizure is defined as periodic disturbances of the brain’s electrical  Convulsion and seizure are interchangeable  Seizure Disorders are categorized as idiopathic, hereditary or
acquired. Seizures caused by disease, such as epilepsy, may be a permanent, recurrent seizure

disorder. Examples of the known causes of epilepsy include brain injury at birth, head injuries, inborn errors of metabolism and sometimes are never determined. Each seizure disorder is characterized by a specific pattern of events, as well as a different pattern of motor or sensory manifestations.

 Anticonvulsants are used in the management of seizure disorders.
Examples: Phenytoin (Dilantin), Phenobarbital (Luminal), Diazepam (Valium), Lorazepam (Ativan)

Partial seizures: most common type of epileptic seizure, localized in the brain; motor seizures with uncontrolled stiffening or jerking in one part of the body such as the finger, mouth, hand or foot that may progress to the entire limb. They may present as flashing lights or a change in taste or speech (somatosensory seizure). Generalized seizures: involve a loss of consciousness and may or may not include convulsive movements. Manifestations of a generalized tonic-clonic seizure include alternate contraction and relaxation of muscles, a loss of consciousness and abnormal behavior. Myoclonic seizures involve sudden, forceful contractions of single of multiple groups of muscles.

Phenytoin
(Dilantin) ACTION
• • • • Anticonvulsant medication

*Patients with bradycardia, AV blocks, hepatic abnormalities, glaucoma or increased intraocular pressure. *Should not be given to pregnant patients, increased risk children will be born with birth defects INTERACTIONS
Drug: Antibiotics/antifungals  increased effect of anticonvulsant Tricyclic antidepressants  increased effect of
anticonvulsant

USED
Tonic-clonic seizures Status Epilepticus Prophylactic seizures prevention

ADVERSE REACTIONS
*Ataxia, CNS depression, headache, hypotension, nystagmus (constant involuntary eye movement), mental confusion, slurred speech, dizziness, drowsiness, N/V, gingival hyperplasia (overgrowth of gum tissue), rash

CONTRAINDICATIONS

Salicylates  increased effect of anticonvulsant Cimetidine  increased effect of anticonvulsant Theophylline  decreased serum levels of anticonvulsant Antiseizure medication  may increase seizure activity Oral contraceptives  decreased effectiveness of birth control, resulting in bleeding or pregnancy

Analgesic or alcohol  increased depressant effect Antidiabetic medication increased blood glucose levels

ACTION • Anticonvulsant medication USED • Status epilepticus • Cortical Focal seizures • Tonic-clonic seizures ADVERSE REACTIONS *Somnolence, agitation, confusion, ataxia, CNS depression, nervousness, N/V/D, constipation, rash CONTRAINDICATIONS *Patients with bradycardia, AV blocks, hepatic abnormalities, glaucoma or increased intraocular pressure. *Should not be given to pregnant patients, increased risk children will be born with birth defects

NURSING PRECAUTIONS *Status epliepticus may result from abrupt discontinuation *Phenyotin is usually discontinued if a skin reaction occurs: red rash with scaling of skin, pupuric small hemorrhages or bruising or bullous (skin vesicles with fluid, blisters). *Phenyotin can cause hematologic changes (aplastic anemia, leucopenia and thrombocytopenia). S/S of thrombocytopenia: bleeding gums, easy bruising, increased menses, tarry stools. S/S of leucopenia: sore throat, chills, swollen glands, excessive fatigue, SOB. *Signs of drug toxicity: slurred speech, ataxia, lethargy, dizziness, N/V, nystagmus & mental status changes. Levels should be between 10-20 mcg/mL.

Phenobarbital
(Luminal)

INTERACTIONS Drug:

Antibiotics/antifungals  increased effect of anticonvulsant

Tricyclic antidepressants  increased effect of anticonvulsant Salicylates  increased effect of anticonvulsant Cimetidine  increased effect of anticonvulsant Theophylline  decreased serum levels of anticonvulsant
Antiseizure medication  may increase seizure activity

*May cause daytime drowsiness, avoid driving and other hazardous tasks *Avoid alcohol or other CNS depressants *Use alternative form of birth control *Take VS prior to administration

Diazepam Pg. 404
(Valium)
ACTION • Benzodiazepines • Sedative USES • Anxiety disorders (short term relief of anxiety) • Acute alcohol withdrawal • Anticovulsant • Preoperative muscle relaxant ADVERSE REACTIONS *Transient mild drowsiness, lightheadedness, headache, depression, constipation, diarrhea, dry mouth CONTRAINICATIONS

Oral contraceptives  decreased effectiveness of birth control, resulting in bleeding or pregnancy Analgesic or alcohol  increased depressant effect Antidiabetic medication increased blood glucose levels NURSING PRECAUTIONS *Take missed doses as soon as remembered if not almost time for next dose: DO NOT double doses

762 (Ativan) ACTION • Benzodiazepines • Sedative USES . respiratory depression. acute narrow-angle glaucoma. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent NURING PRECAUTIONS *Monitor CBC. Johns Wort. valerian. liver function tests *Observe patient for excess sedation. myasthenia gravis. severe hepatic insufficiency. not for use in children under 6 months of age *Narcotic dosages should be reduced by approximately 1/3 when valium is added *Fall risk: use extreme caution in patients who are at risk of falls INTERACTIONS St. behavioral changes) *Risk of addiction *Taper dosage slowly when discontinuing *Take exactly as direction. severe respiratory insufficiency. do NOT increase dose/frequency Drug: CNS depressants  enhances adverse/toxic effect of other CNS depressants Analgesis  increased risk for CNS depression Tricyclic antidepressants  increased risk for sedation and respiratory depression Antipsychotics  increased risk for sedation and respiratory depression Digoxin  increased risk for digitalis toxicity Food: Alcohol  increased risk for CNS depression or convulsions Herbal: Lorazepam Pg. suicidality (example: suicidal thoughts. kava kava. depression.*Hypersensitivity to benzos. sleep apnea syndrome.

valerian. Johns Wort. patients who are a fall risk INTERACTIONS Drug: CNS depressants  enhances adverse/toxic effect of other CNS depressants Analgesis  increased risk for CNS depression Tricyclic antidepressants  increased risk for sedation and respiratory depression Antipsychotics  increased risk for sedation and respiratory depression Digoxin  increased risk for digitalis toxicity Food: Alcohol  increased risk for CNS depression or convulsions Herbal: St. kava kava.V. abuse or tolerance *Avoid alcohol.• Anxiety disorders (short term relief of anxiety) • Pre-anesthetic ADVERSE REACTIONS *Transient mild drowsiness. severe respiratory insuifficency. depression. CNS depression.) and ability to void . headache. patients with sleep apnea. antihistamines and hypnotics) *Maintain adequate hydration *IM/IV: monitor vital signs and CNS status (possible retrograde amnesia with I. sedatives. diarrhea. lightheadedness. OTC medications (especially pain medication. longterm use can result in dependence. constipation. anterograde amnesia. gotu kola increases CNS depression Yohimbine  may diminish the therapeutic effect of anti-anxiety agent NURSING PRECAUTIONS *Oral: assess history of addiction. dry mouth CONTRAINICATIONS *Hypersensitivity to benzos.

SKELETAL MUSCLE RELAXANTS  A variety of drugs are used in treating musculoskeletal (bone and muscle) injuries and disorders. ○ Many of these drugs do not directly relax skeletal muscles. as strain and sprains are repaired. thereby reducing muscle spasm  Carisoprodol (Soma) provides relief of discomfort from acute musculoskeletal pain . but their ability to relieve acute painful musculoskeletal conditions may be due to their sedative actions  Cyclobenzaprine (Flexeril) appears to have an effect on muscle tone. Skeletal muscle relaxants are used to assist in the relaxing certain muscle groups.

constipation CONTRAINDICATIONS *Used cautiously in patients with CVS. dry mouth. dizziness. pregnancy or seizure disorder *Used with caution in patients with cardiovascular disease INTERACTIONS Drug: CNS depressants/alcohol/antihistamines/ opiates/sedativesincrease CNS depression MAOIs  risk for high fever and convulsions Haloperidol  increased psychosis . Amrix) ACTION  Skeletal Muscle Relaxant USES  Relief of discomfort due to acute. cerebral palsy. nausea. parkinsonism .Cyclobenzaprine (Flexeril. painful musculoskeletal conditions ADVERSE REACTIONS *Drowsiness.

drowsiness. Do NOT use longer than 2 -3 weeks *Avoid alcohol and other CNS depressants while taking drug  Musculoskeletal Relaxant USES  Relief of discomfort due to acute. Do not drive or other hazardous tasks *This drug is for short-term use. *Contraindicated within 14 days of a MAOI *Used cautiously in patients with severe liver or kidney disease and during pregnancy Carisoprodol (Soma) ACTION . cardiac conduction disorder and hyperthyroidism.Antihypertensives  increased risk of hypotension NURSING PRECAUTIONS *This drug may cause drowsiness. vomiting CONTRAINDICATIONS *In patients with recent MI. tachycardia. painful musculoskeletal conditions ADVERSE REACTIONS *Dizziness. nausea.

Paget’s disease and bone cancers. Do NOT use longer than 2 -3 weeks *Avoid alcohol and other CNS depressants while taking drug BONE RESORPTION INHIBITORS: Bisphosphonates  Bisphosphonates are drugs used to treat musculoskeletal disorders such as osteoporosis. .INTERACTIONS Drug: CNS depressants/alcohol/antihistamines/ opiates/sedativesincrease CNS depression MAOIs  risk for high fever and convulsions Haloperidol  increased psychosis Antihypertensives  increased risk of hypotension NURSING PRECAUTIONS *This drug may cause drowsiness. Do not drive or other hazardous tasks *This drug is for short-term use.

○ They act primarily on the bone by inhibiting normal and abnormal bone resorption. ibandronate (Boniva) Alendronate (Fosamax) .  Example: Alendronate (Fosamax). This results in increased bone mineral density. reversing the progression of osteoporosis.

esophageal reflux Therophylline increased risk of theophylline toxicity CONTRAINDICATIONS *In patients with hypocalcemia. Concurrent use of these drugs with hormone replacement therapy is NOT recommended *Used cautiously in patients with GI disorders or renal impairment. INTERACTIONS Drug: Ca+ supplements or Antacids  decreased effectiveness of bisphosphonates Aspirin  increased risk of GI bleed ADVERSE REACTIONS *Abdominal pain.ACTION  Bone Resorption Inhibitors: Bisphosphonates USES     Treatment and prevention of postmenopausal osteoporosis Glucocorticoid-steroid induced osteoporosis Osteoporosis in men Paget’s disease impairment. patients with delayed esophageal emptying or renal NURSING PRECAUTIONS *Take these drugs with 6-8 oz of water first thing in the morning *Do not lie down for at least 30 minutes after taking the drug and wait at least 30 mins before taking any other food or drink *Take supplement calcium and vitamin D if dietary intake is inadequate .

redness. which in turn decreases the body’s autoimmune response. joint deformity) of gout. swelling. The deposit or collection or urate crystals in the joints causes the symptoms (pain. . Example: Methotrexate (MTX) (Rheumatrex) • DMARDs may also be used for other purpose. (2) corticosteroids and (3) DMARDs  Disease-Modifying Antirheymatic Drugs: have properties to produce immunosuppression.ANTI-RHEUMATIC & URIC ACID INHIBITORS Anti-Rheumatic Drugs  Rheumatoid Arthritis is a chronic disorder (an autoimmune disease) involving the inflammation and accumulation of fluid in joints ○ This condition is typically treated using three classification of drugs (1) NSAIDs. such as cancer therapy Uric Acid Inhibitors (Gout) Drugs  Gout is a condition in which uric acid accumulates in increased amounts in the blood and often is deposited in the joints.

pancytopenia. and hepatitis B and C *Women should not become pregnant. or folate deficiency *Used cautiously in patients with obesity. and sexual partners should use barrier contraception to prevent transmission of the drug by semen INTERACTIONS . alopecia Methotrexate (MTX) (Rheumatrex) ACTION • Anti-Rheumatic medication • Disease-Modifying Anti-Rheumatic medication USES • Rheumatoid Arthritis • Cancer chemotherapy ADVERSE REACTIONS CONTRAINDICATIONS *Patients with renal insufficiency. Example: Allopurinol (Zyloprim) and Colchicine *Nausea. This probably accounts for its ability to relieve the severe pain of acute gout. liver disease.○ These medications reduce the production of uric acid. alcohol abuse. stomatitis. thereby decreasing serum uric acid levels and the deposit of urate crystals in joints. diabetes.

*When taking methotrexate. fever. abdominal pain. use a calendar or some memory device to remember to take the drug on the same day each week. renal. sore throat. N/V/D. easy bruising. or cardiac disorder and those with blood dyscrasias . rash or itching Colchicine ACTION • Uric Acid Inhibitor USES • Relief of acute attacks of gout • Prevention of gout attacks ADVERSE REACTIONS *N/V/D. hepatic. such as a cold or open sore—even these can become life threatening.Drug: Sulfa Antibiotics increased risk of methotrexate toxicity Aspirin and NSAIDs  increased risk of methotrexate toxicity NURSING PRECAUTIONS *Because DMARDs are designed to produce immunosuppression. bone marrow depression CONTRAINDICATIONS *In patients with serious GI. Instruct patients to report any problems. patients need to be monitored routinely for infections. *Call MD immediately if you have: sore mouth or sores in the mouth. no matter how minor.

It acts on areas such as the vascular system .*Used cautiously in older adults INTERACTIONS Drug: Ampicillin  increased risk of rash Theophylline  increased risk of theophylline toxicity Al-based antacids  decreased effectiveness of medication NURSING PRECAUTIONS *Drink at least 10 glasses of water/day until the acute attack has subsided *Take this drug with food to minimize GI upset *If drowsiness occurs. avoid driving or performing hazardous tasks *Acute gout—notify MD if symptoms are not relieved in a few days *Call MD if rash occurs ANTIHISTAMINES & DECONGESTANTS  Antihistamines: histamines are produced in response to an allergic reactions or tissue injury.

and smooth muscle. fexofendaine (Allegra) and cetirizine (Zyrtec)  Decongestants: are drugs that reduces swelling of the nasal passages. which in turn. sinusitis and other respiratory allergies. • Antihistamines are used to block the cell receptors. loratatine (Claritin). hay fever. Examples: diphenhydramine (Benadryl). opens clogged nasal passages and enhances drainage of the sinuses. These drugs are used for the temporary relief of nasal congestion caused by the common cold. Examples: pseudoephedrine (Sudafed) . this counteracting the effects of histamine on body organs and structures. producing dilating of arterioles and an increased permeability of capillaries and venules.

blurred vision. pt taking MAOIs. anorexia. stenosing peptic ulcer. premature infants and nursing mothers. dry mouth.Diphenhydramine (Benadryl) ACTION USES *Contraindicated in newborns. pts with angle-closure glaucoma. symptomatic prostatic hypertrophy and bladder neck obstruction INTERACTIONS Drug: Rifapin  may reduce absorption of antihistamins MAOIs increase anticholinergic & sedative effect CNS depressants  possible additive CNS depressant effect Beta-Blockers  risk for increased cardiovascular effects Al or Mg antacids  decreased concentrations of drug in blood • • • Antihistamine Allergic symptoms Hypersensitivity reactions • • • • • ○ Anaphylaxis Transfusion reactions Motion sickness Sleep aid Antitussive Antiparkinsomism effects ADVERSE REACTIONS *Drowsiness. urinary frequency CONTRAINDICATIONS NURSING PRECAUTIONS .

dry mouth. stenosing peptic ulcer. glossitis. sedation. dizziness.*Older adults are more likely to experience anticholinergic effects (dry mouth. visual impairment. nose bleeds. premature infants and nursing mothers. pts with angleclosure glaucoma. throat. sedation. fatigue CONTRAINDICATIONS *Contraindicated in newborns. nose. somnolence. dizziness. hypotension & confusion) *Monitor older adult for sensorimotor deficits: hearing loss. pt taking MAOIs. symptomatic prostatic hypertrophy and bladder neck obstruction Cetirizine Loratadine (Zrytec) (Claritin) Fexofenadine Levocetirizine (Allergra) ACTION • (Xyzal) Antihistamine INTERACTIONS . unsteady gait USES • • • Seasonal rhinitis Urticaria Allergic rhinitis *Do not perform hazardous tasks: watch for drowsiness *Avoid alcohol ADVERSE REACTIONS *Drowsiness. headache.

unsteady gait *Do not perform hazardous tasks: watch for drowsiness *Avoid alcohol *Loratadine should be taken on an empty stomach . NURSING PRECAUTIONS *Older adults are more likely to experience anticholinergic effects (dry mouth. Used cautiously in patients with: thyroid disease. nausea. dizziness. vomiting. hypotension & confusion) *Monitor older adult for sensorimotor deficits: hearing loss. throat. blurred vision CONTRAINDICATIONS *Pts taking MAOIs or patients younger than 12 years old. CV disease. arrhythmias. nose. nervousness. anorexia. diabetes mellitus. visual impairment. sedation. restlessness.Drug: Rifapin  may reduce absorption of antihistamins MAOIs increase anticholinergic & sedative effect CNS depressants  possible additive CNS depressant effect Beta-Blockers  risk for increased cardiovascular effects Al or Mg antacids  decreased concentrations of drug in blood Pseudoephedrine (Sudafed) ACTION • Decongestant USES • Nasal Decongestant ADVERSE REACTIONS *Anxiety.

anti-inflammatory . *Patients old than 60 years old are at greater risk for experiencing side effects *Over-dosages may cause hallucinations. glaucoma INTERACTIONS Drug: MAOIs severe headache. call MD Mometasone furoate monohydrate (Nasonex) Pg. nurses need to stress importance of patient checking with the MD first before taking if history of heart disease. 343 ACTION • Glucocorticoid USES • Antiasthmatic. CAD. hypertension. glaucoma and diabetes. PVD. hypertension. hypertension and possible hypertensive crisis Beta-blockersinitial hypertension episode followed by bradycardia NURSING PRECAUTIONS *Because it is OTC.prostatic hypertrophy. hyperthyroidism. convulsion and CNS depression *If symptoms do not improve in 7 days or are accompanied by a high fever.

oral and pharyngeal candidiasis. throat tightness. recent septal ulcers.ADVERSE REACTIONS CNS: Headache. growth suppression. nasal irritation. *Notify prescriber immediately if patient has bronchospasm after mometasone oral inhalation. nasal surgery. pain. myalgia. or nasal trauma. otitis media. vomiting. ocular herpes simplex. GU: Dysmenorrhea MS: Arthralgia. lassitude. dyspepsia. glaucoma. Report oropharyngeal candidiasis. rhinitis. bronchospasm. *Monitor patient for symptoms of systemically active corticosteroid withdrawal such as joint and muscle pain. and expect patient to receive appropriate antifungal therapy. decreased bone mineral density. nausea. conjunctivitis. earache. pharyngitis. status *Use cautiously if patient has tubercular infection. unpleasant taste. bacterial. sinusitis. or systemic viral infection. increased cough. upper respiratory tract infection. CV: Chest pain EENT: Cataracts. . epistaxis. untreated fungal. dry mouth. GI: Diarrhea. Other: Angioedema. and expect to administer a fast-acting inhaled bronchodilator. RESP: Asthma. viral infection asthmaticus or other asthma episodes that require emergency care INTERACTIONS Drug: Ketoconazoleincreased levels of Mometasone NURSING PRECAUTIONS CONTRAINDICATIONS Hypersensitivity to mometasone or its components. and depression despite maintenance or even improvement of respiratory symptoms. bronchitis. ENDO: Adrenal insufficiency. flulike symptoms. wheezing SKIN: Urticaria.

tablets but to swallow them . *Advise patient not to break. persistent headache. headache GI: Nausea and vomiting (with large doses) SKIN: Rash. fever. and rash. give liquid forms of guaifenesin to children. such as cough that lasts longer than 1 week. 610 ACTION • Glyceryl guaiacolate Expectorant USES • To relieve cough.Guaifenesin (Mucinex) Pg.R. when secretions are thick ADVERSE REACTIONS CNS: Dizziness. *Watch for signs of more serious condition. crush. urticaria CONTRAINDICATIONS *Hypersensitivity to guaifenesin INTERACTIONS Drug: None significant NURSING PRECAUTIONS *As prescribed and as appropriate. or chew E. *Instruct patient to take each dose with a full glass of water.

*Advise patient not to take drug longer than 1 week and to notify prescriber about fever. persistent headache. or rash.whole. *Instruct patient to increase fluid intake (unless contraindicated) to help thin secretions. .

which. bronchoconstriction results. which decreases the amount of air taken into the lungs with each breath. . During bronchodilation.BRONCHODILATORS  Bronchodilators: (two types of bronchodilators) When bronchospasm occurs. β-adrenergic receptors are stimulated. A decrease in the amount of air taken into the lungs results in respiratory distress. Use of a bronchodilating drug opens the bronchi by relaxing the smooth muscle and allows more air to enter the lungs. ○ β2 Adrenergic agonists (sympathomimetics: When the sympathetic system in the lungs are stimulated. in turn completely or partially relieves respiratory distress. there is a decrease in the lumen of the bronchi.

Provenil) • ACTION • Bronchodilator • Inhaler USES • Bronchospasm. They stimulate the central nervous system to promote bronchodilation. Proventil. The cause direct relaxation of the smooth muscles of the bronchi. Volmax.○ Short-acting: Albuterol (Proventil. (Ventolin. bronchitis. Ventolin) and Terbutaline (Brethine) • Long-acting: Salmeterol (Serevent Diskus) Xanthine Derivative Bronchodilator: (also called methylxanthines). emphysema • Acute & Chronic bronchial asthma Albuterol .

tachycardia.ADVERSE REACTIONS *Headache. vertigo CONTRAINIDATIONS *Contraindicated in patients with cardiac arrhythmias associated with tachycardia. nervousness. tremor. organic brain damage & cerebral arteriosclerosis. GI symptoms *Lab tests: periodic ABGs. shakiness. palpitations. insomnia. CNS stimulation (particularly in children 2-6 y). dizziness. excitement. hyperactivity. nervousness. pulse oximetry and pulmonary function *Avoid contact of inhalation drug with eyes *Do not use OTC drugs without physician approval. patients with history of seizures and patients who are pregnant INTERACTIONS Beta-adrenergic blockers (hypertension)  inhibits the cardiac. bronchodilating & vasodilating effects of the adrenergic methyldopa (hypertensive med)  possible hypotension oxytocic drugs  possible severe hypotension theophylline (asthma/COPD med)  increased risk for cardiotoxicity NURSING PRECAUTIONS *Monitor for signs/symptoms of fine tremor in fingers. tachycardia. including cold medicine Drug: Adrenergic drugs  possible additive adrenergic effects Tricyclics (anti-depressives) possible hypotension Levalbuterol HCl (Xopenex) ACTION .

cardiac arrhythmias CONTRAINDICATIONS *Hypersensitivity to other sympathomimetic amines * Use levalbuterol cautiously in patients with arrhythmias. INTERACTIONS Drug: Beta blockers  blocks effect of both drugs Digoxin  decreased blood digoxin levels Diuretics increased risk of hypokalemia MAOI & tricyclic antidepressants  increased risk of adverse cardiovascular effects NURSING PRECAUTIONS *Monitor the patient’s pulse and BP before and after nebulizer treatment * Because drug may provoke paradoxical bronchospasm. dizziness. and explain the need to do .• • Bronchodi lator Inhaler USES • Treat and prevent bronchospasm ADVERSE REACTIONS *Tachycardia. nervousness. hyperthyroidism. anxiety. wheezing. cough. and increased coughing. hypertension. pain. or a history of seizures. observe for dyspnea. diabetes mellitus. rhinitis. * Show patient how to clean nebulizer or inhaler.

organic brain damage. tachyarrhythmias INTERACTIONS Drug: Beta blockers  increased risk of bronchospasm Metaproterenol Sulfate (Alupent) ACTION • Bronchodilator • Inhaler & Tablets USES • Asthma • Bronchospasm ADVERSE REACTIONS *Tachycardia. labor. tremor. hypersensitivity to metaproterenol or its components. vomiting MAOIs & Tricyclic antidepressants  possibly potentiated cardiovascular effects Other sympathomimetics  possibly additive effects of both drugs & risk of toxicity Theophylline  increased risk arrhythmias NURSING PRECAUTIONS . shakiness.so at least once weekly CONTRAINDICATIONS * Angina. heart block from digitalis toxicity. nervousness. cerebral arteriosclerosis. nausea. dilated heart failure. local anesthesia.

to maximize airway opening and drug effects * Caution patient not to use metaproterenol inhaler or nebulizer more often than prescribed. vomiting. *Signs of toxicity: diarrhea. increased shortness of breath. and assess for chest pain.* Anticipate that a single dose of nebulized metaproterenol may not completely stop an acute asthma attack. nausea. ACTION • Bronchodilator • Inhaler. headache. tremor. SubQ USES • Treat & Prevent bronchospasm ADVERSE REACTIONS *Palpitations. vertigo. if prescribed. INTERACTIONS Drug: Terbutaline Sulfate (Brethine) antihypertensives. or irregular heartbeat occur * Advise patient to use metaproterenol 5 minutes before using corticosteroid inhaler. diuretics  Decreased antihypertensive effect beta blockers  increased risk of bronchospasm . nervousness. dizziness. shakiness. gastrointestinal (GI) upset CONTRAINDICATIONS * Use terbutaline cautiously in patients with cardiovascular disease because drug can adversely affect cardiovascular function. Monitor patient’s heart rate and rhythm and blood pressure. drowsiness. insomnia.

hypertension. tricyclic antidepressants headache. risk of coronary insufficiency in patients with coronary artery disease xanthines (theophylline) Increased CNS stimulation and other additive toxic effects * Inform patient that she may experience transient nervousness or tremors during terbutaline therapy * Assess patient’s respiratory rate. possibly digitalis toxicity halogenated anesthetics Possibly ventricular arrhythmias MAOIs. oxygen saturation Salmeterol Xinafoate (Serevent Diskus) ACTION • Bronchodilator • Oral inhalation powder USES • Long-term treatment & prevention or bronchospasm ADVERSE REACTIONS *Tremor. including prolonged QT interval thyroid hormones Increased effects of either drug. including ischemic cardiac disease. hyperpyrexia. possible hypertensive crisis Nitrates Decreased effectiveness of nitrates Ritodrine Increased effects of either drug and potential for adverse effects Sympathomimetics Increased CNS stimulation and risk of adverse cardiovascular effects. cough CONTRAINDICATIONS * Watch for arrhythmias and changes in blood pressure after use in patients with cardiovascular disorders. hypertension.CNS stimulants  Additive CNS stimulation Digoxin Increased risk of arrhythmias. and Foods: Caffeine Increased CNS stimulation and other additive toxic effects NURSING PRECAUTIONS * For subcutaneous use. headache. inject into lateral deltoid area . depth. and quality.

saquinavir. ritonavir. because of drug’s betaadrenergic effects INTERACTIONS Drug: atazanavir. Advise him to exhale immediately before using the diskus and then to place mouthpiece to his lips and inhale through his mouth. hold his breath for at least 10 seconds. Risk is greatest with first use of a new canister or vial used as an inhalant * Teach patient how to use the diskus by instructing him to slide the lever only once when preparing dose to avoid wasting doses. not his nose. nelfinavir. Then he should remove mouthpiece from his mouth. such as hypertensive crisis NURSING PRECAUTIONS * Be aware that salmeterol shouldn’t be used to relieve bronchospasm quickly because of its prolonged onset of action and that patients already taking drug twice daily shouldn’t take additional doses for exercise-induced bronchospasm * Be aware that Serevent Diskus delivers full dose of salmeterol in only one inhalation * Stop salmeterol immediately and notify prescriber if patient develops paradoxical bronchospasm. indinavir. clarithromycin. itraconazole. telithromycin increased risk of adverse cardio effects beta blockers Mutual inhibition of therapeutic effects loop or thiazide diureticsIncreased risk of hypokalemia & potentially life-threatening arrhythmias MAO inhibitors. nefazodone. tricyclic antidepressants Potentiated adverse vascular effects.arrhythmias. ketoconazole. and exhale slowly Aminophylline .

cimetidine. thiabendazole Increased serum theophylline level benzodiazepinesincreased sedative effects of benzodiazepines beta agonistsIncreased effects of aminophylline and beta agonist carbamazepine. INTERACTIONS Drug: activated charcoal. charcoalbroiled beef Increased theophylline elimination and shortened aminophylline half-life Smoking  increases effect of aminophylline Alcohol  decreases effect of aminophylline . vomiting. restlessness. sulfinpyrazone. tremors. aminophylline. macrolides. or ondansetron into the Y-port of a continuous infusion of aminophylline. mexiletine. influenza virus vaccine. rifampin. hydralazine. ephedrine. low-protein diet  Decreased theophylline elimination and prolonged aminophylline half-life low-carbohydrate. isoniazid. headache. nervousness.R. tablets and rectal suppository ACTION • Bronchodilator • Xanthine Derivative USES • Symptomatic relief or prevention of bronchial asthma • Reversible bronchospasm of chronic bronchitis & emphysema ADVERSE REACTIONS *Nausea. oral liquid. diltiazem. rectal or lower intestine irritation or infection (suppository form). Don't mix aminophylline in same syringe with doxapram. high-protein diet. leading to toxicity high-carbohydrate. aminoglutethimide. dobutamine. calcium channel blockers. sympathomimetics Decreased serum theophylline level allopurinol. palpitations. cardiac arrhythmias CONTRAINDICATIONS * Active peptic ulcer disease. ketoconazole. tachycardia. oral contraceptives. cipro-floxacin. corticosteroids. electrocardiography changes.(Truphylline) -ER tablets. disulfiram. hypersensitivity to aminophylline. hyperglycemia. loop diureticsAltered serum theophylline level halothane  Increased risk of cardiotoxicity hydantoins  Decreased serum hydantoin level ketamine Increased risk of seizures lithium Decreased serum lithium level nondepolarizing muscle relaxants  Reversed neuromuscular blockade propofol  increased sedative effects of propofol tetracyclines  Enhanced adverse effects of theophylline Foods all foodsAltered bioavailability and absorption of E. quinolones. underlying seizure disorder INCOMPATIBILITIES *Don't add other drugs to prepared bag or bottle of aminophylline. Also avoid administering amiodarone. barbiturates. nonselective beta blockers. interferon.

phenylbutazone. hyperglycemia. headache. interferon alpha (human recombinant). including insomnia. peptic ulcer disease.). vomiting. ciprofloxacin. theobromine. tacrine. and nervousness halothane anesthetics Increased risk of ventricular arrhythmias ketamine Lowered seizure threshold lithium  Decreased lithium effectiveness Theophylline (Theo-Dur. Oral Soultion. oral contraceptives (containing estrogen). disulfiram. phenobarbital. Theolair. propafenone. ticlopidine. seizures). restlessness. verapamil Increased blood theophylline level and risk of toxicity aminoglutethimide. Tablets. carbamazepine. clarithromycin. electrocardiography changes. propranolol. probenecid.R. draw blood sample 15 to 30 minutes after administering I. cimetidine. Unipyl) -Capsules. palpitations. Give E. soft drinks. Syrup. restlessness.V. nervousness. methotrexate. nausea. troleandomycin. furosemide.NURSING PRECAUTIONS * watch for evidence of toxicity (tachycardia. phenytoin. cardiac arrhythmias CONTRAINDICATIONS * Hypersensitivity to theophylline or its components. uncontrolled seizure disorder INTERACTIONS Drug: adenosine Decreased adenosine effectiveness allopurinol. erythromycin. nausea. and chocolate can alter serum theophylline result * Give immediate-release and liquid forms with food to reduce GI upset. tachycardia. tremors. Elixir. enoxacin. mexiletine. form 1 hour before or 2 hours after meals because food can alter drug absorption *Aminophylline has a narrow therapeutic window (10 to 20 mcg/ml) * To determine peak serum theophylline level. fluvoxamine. *Keep in mind that acetaminophen. Slo-bid. moricizine. thiabendazole. IV ACTION • Bronchodilator • Xanthine Derivative USES • Symptomatic relief or prevention of bronchial asthma . loading dose • Reversible bronchospasm of chronic bronchitis & emphysema ADVERSE REACTIONS *Nausea. tea. coffee. vomiting. isoproterenol (I. rifampin  Decreased blood theophylline level and possibly drug effectiveness benzodiazepines Possibly reversal of benzodiazepine sedation beta blockers Possibly decreased bronchodilator effect of theophylline ephedrine  Increased adverse effects.V. pentoxifylline. tachypnea.

and be prepared to obtain blood theophylline level * Instruct patient to take drug with a full glass of water on an empty s tomach (30 to 60 minutes before meals or 2 hours after meals). hypothyroidism. *Advise patient to notify prescriber if she develops a fever. prolonged fever. influenza vaccination. However. shock. decreased drug effectiveness NURSING PRECAUTIONS * Be aware that E. to gauge therapeutic level and detect toxicity * Frequently assess heart rate and rhythm because theophylline can exacerbate existing arrhythmias * Be especially alert for signs of toxicity in patient with acute pulmonary edema.R. high-protein diet. . ICS and LABA drugs may be combined to ease administration of the medications and produce positive outcomes in management of asthma. or starts or stops smoking or taking other drugs because these factors may alter blood theophylline level ANTIASTHMAS  Inhaled Corticosteroids: ICSs are the most consistently effective long-term control medication at all steps of care for persistent asthma. *Encourage patient to take drug at the same times every day. low-protein diet Possibly decreased theophylline elimination low-carbohydrate. sepsis with multiple organ failure. capsules and tablets shouldn’t be used for oral loading doses * Monitor blood theophylline level. or viral pulmonary infection because of decreased drug clearance * Suspect toxicity if patient experiences vomiting. as ordered. daily intake of charbroiled beef Possibly increased theophylline elimination Activities alcohol use  Increased blood theophylline level and risk of toxicity smoking  Increased drug clearance. makes a significant dietary change.neuromuscular blockers  Possibly antagonized neuromuscular blockade sucralfate  Decreased absorption of oral theophylline Foods high-carbohydrate. suggest that she take drug with food or antacids if GI distress occurs.

preventing airway edema and facilitating bronchodilation.Example: Fluticasone (Flovent. Example: Montelukast (Singulair) Fluticasone . These medications are considered leukotriene receptor antagonists because they inhibit leukotriene receptor sites in the respiratory tract. Flonase)  ICS/LABA Combination: Anti-inflammatory medication that reduce airway hyper-responsiveness. Fluticasone/Salmeterol (Advair)  Leukotriene Receptor Antagonists: Asthma attacks are often triggered by allergens or exercise. Examples: Budesonide/formoterol (Symbicort). reduce the number of mast cells in the airways and block reaction to allergens. Inflammatory substance called leukotrienes are one of the several substances that are released by mast cells during an asthma attack.

parasitic. or other electrolytedepleting conditions or procedures. vomiting. weakness) early in therapy and when patient has infection. surgery. Notify prescriber immediately if signs or symptoms develop * Urge patient to use fluticasone regularly. nasal suspension ACTION • Antiasthma drug • Inhaled Corticosteroid USES • Prophylatic maintenance & treatment of asthma ADVERSE REACTIONS *Oral. pulmonary tuberculosis. fungal. Flovent Diskus. pharyngeal irritation. . suppression of HPA function CONTRAINDICATIONS *Hypersensitivity to fluticasone or its components. fungal infections.(Flovent. assess for adrenal insufficiency (fatigue. especially if patient has severe allergy to milk *Use fluticasone cautiously in patients with ocular herpes simplex. monitor patient closely at start of therapy. ritonavir and other strong cytochrome Possibly increased fluticasone level and increased risk of reduced serum cortisol level NURSING PRECAUTIONS * If patient is switched from systemic corticosteroid to fluticasone. hypotension. as prescribed. laryngeal. or viral infection INTERACTIONS Drug: ketoconazole. lassitude. untreated nasal mucosal infection (nasal suspension) * Although anaphylaxis is rare. stress. Flonase) -Inhaled aerosol. primary treatment of status asthmaticus or other acute asthma episodes that require intensive measures. trauma. or untreated systemic bacterial. nausea.

increasing the risk of infection. Nebulized. ketoconazole  Possibly increased blood budesonide level NURSING PRECAUTIONS * Assess patient who switches from a systemic corticosteroid to inhaled budesonide for adrenal insufficiency (fatigue. hypotension. erythromycin. if exposed. itraconazole. recent septal ulcers or nasal surgery or trauma (nasal spray). suppression of HPA function INTERACTIONS Drug: clarithromycin. Hypothalamic-pituitary-adrenal axis function may take several months to recover after systemic corticosteroids stop. pharyngeal irritation. nausea. Oral. measles. to contact prescriber immediately Budesonide/Formoterol (Symbicort) -Nasal. laryngeal. status asthmaticus or other acute asthma episodes (oral inhalation) * Use budesonide cautiously if patient has tubercular infection. Instruct patient to notify prescriber about exposure to chickenpox. vomiting. weakness). lassitude. or systemic viral infection. or other infections because additional treatment may be needed CONTRAINDICATIONS *Hypersensitivity to budesonide or its components. which may be lifethreatening. fungal infections. Stopping budesonide abruptly may cause adrenal insufficiency * Closely monitor a child's growth pattern. untreated fungal.but not for acute bronchospasm * Caution patient to avoid contact with people who have infections because fluticasone suppresses the immune system. budesonide may stunt growth . bacterial. Capsules ACTION • Antiasthma drug • Inhaled Corticosteroid & LABA Combination drug USES • Long-term maintenance of asthma ADVERSE REACTIONS *Oral. or ocular herpes simplex * Caution patient to avoid exposure to chickenpox and measles and.

eczema. pointing toward inner corner of eye. laryngeal. monitor patient closely at start of therapy.* Assess patient for effectiveness of budesonide therapy. conjunctivitis. primary treatment of status asthmaticus or other acute asthma episodes that require intensive measures. pharyngeal irritation. Then have her repeat in the other nostril * Advise patient to rinse her mouth with water after each dose and to spit the water out. untreated nasal mucosal infection (nasal suspension) * Although anaphylaxis is rare. suppression of HPA function CONTRAINDICATIONS *Hypersensitivity to fluticasone or its components. or arthritis—notify MD * Instruct patient who uses nasal spray to shake container before each use. an eosinophilic condition. Instruct her to blow her nose. Tell her to hold the other nostril closed and spray while inhaling gently. fungal infections. Tell her to contact her prescriber if she develops a mouth or throat infection -Inhaled granules ACTION • Antiasthma drug • Inhaled Corticosteroid/LABA Combination drug USES • Long-term maintenance of asthma • COPD ADVERSE REACTIONS *Oral. If patient has increased symptoms of asthma or an immunologic condition previously suppressed by the systemic corticosteroid—such as rhinitis. and insert tube into a nostril. tilt her head slightly forward. especially if patient has severe allergy to milk Fluticasone/Salmeterol (Advair) . away from nasal septum. especially if patient is being weaned from a systemic corticosteroid.

fungal. On first use. measles. * If patient uses more than 1 inhaler. parasitic. or viral infection INTERACTIONS Drug: ketoconazole. but not for acute bronchospasm * Instruct patient to shake canister and to use inhaler according to package insert instructions. it will need to be primed again by shaking well and then releasing 1 test spray into the air (away from her face). as ordered.*Use fluticasone cautiously in patients with ocular herpes simplex. instruct them to use fluticasone last. ritonavir and other strong cytochrome Possibly increased fluticasone level and increased risk of reduced serum cortisol level NURSING PRECAUTIONS * Urge patient to use fluticasone regularly. chewable tablets. or untreated systemic bacterial. at least 5 minutes after previous inhaler * Caution patient to avoid contact with people who have infections because fluticasone suppresses the immune system. If inhaler hasn’t been used for more than 7 days or it’s dropped. tablets ACTION • Antiasthma drug • Leukotriene Receptor Antagonists USES • Prophylaxis & Treatment of chronic asthmas in adults & pediatric patients 12 months of age and older . pulmonary tuberculosis. or other infections because additional treatment may be needed Montelukast (Singulair) -Oral granules. Instruct patient to notify prescriber about exposure to chickenpox. advise her to spray 4 times into the air. increasing the risk of infection.

carrots.• Seasonal allergic rhinitis in adults & pediatric patients 2 years of age and older ADVERSE REACTIONS *Headache. in patient undergoing corticosteroid withdrawal. Montelukast may not effectively reduce bronchospasm in such a patient INTERACTIONS Drug: Phenobarbital Decreased amount of circulating montelukast NURSING PRECAUTIONS *Monitor patient for adverse reactions. or rice— but not liquids or other foods—just before administration. make sure he has appropriate short-acting rescue drug available *Tell parents administering oral granules to pour contents directly into the child’s mouth or mix with ice cream or cold or room temperature applesauce. and vasculitis. the full dose must be administered within 15 minutes. such as cardiac and pulmonary symptoms. Liquids may be given after drug has been administered. Once packet is opened. influenza-like symptoms CONTRAINIDCATIONS *Be aware that drug shouldn’t be given for acute asthma attack or status asthmaticus *Caution patient with aspirin sensitivity to avoid aspirin and NSAIDs during montelukast therapy. eosinophilia. Drug must not be stored for future use if mixed with food . even when he feels well. Urge him not to decrease dosage or stop taking other prescribed asthma drugs unless instructed by prescriber *Caution patient not to use drug for acute asthma attack or status asthmaticus. if so call MD *Watch patient closely for suicidal tendencies throughout montelukast therapy *Advise patient to take montelukast daily as ordered.

Elevation of one or both of these occur in hyperlipidemia • Serum cholesterol levels above 240 mg/dL • Triglyceride levels above 150 mg/dL ○ HMG-CoA Reductase Inhibitors (Statins): these medications inhibit the manufacture of cholesterol and promote the breakdown of cholesterol. Simvastatin (Zocor).ANTIHYPERLIPIDEMIC MEDICATIONS  Hyperlipidemia is an increase in lipids in the blood. Example: Atorvastatin (Lipitor). LDLs and serum triglycerides. Rosuvastatin (Crestor) . Cholesterol and the triglycerides are the two lipids in the blood. Both actions lower the blood levels of choelestrol.

constipation. sinusitis. diarrhea. clarithromycin increased risk of severe myopathy or rhabdomyolysis Amiodarone  increased risk of myopathy Niacin  increased risk of severe myopathy or rhabdomyolysis . abdominal pain. dizziness.Atorvastatin (Lipitor) ACTION • Antihyperlipidemic Medication • HMG-CoA Reductase Inhibitor (Statin Drug) USES • Reduce risk of CHD event • Hyperlipidemia • Hypercholesterolemia ADVERSE REACTIONS *Headache. cramping. nausea CONTRAINDICATIONS *Patients with serious liver disorders and during pregnancy (category X) and lactation INTERACTIONS Drug: Macrolides. insomnia. erythromycin. flatulence.

headache. vertigo. edema. or weakness. If it's almost time for his next dose.Protease inhibitors elevated plasmas levels of statins Verapamil  increased risk of myopathy Warfarin increased anticoagulant effect Herbal: St. smoker. abdominal pain. John’s wort causing a decrease in statineffectiveness * Advise patient to notify prescriber immediately if he develops unexplained muscle pain. and to repeat periodically until lipid levels are within desired range * Instruct patient to take a missed dose as soon as possible. or family history of early CAD). angina * Expect to measure lipid levels 2 to 4 weeks after therapy starts. Drug is used to reduce risk of MI. to adjust dosage as directed. history of hypertension or low HDL level. tenderness. Tell him not to double the dose . eczema CONTRAINICATIONS * Expect atorvastatin to be used in patients without obvious coronary artery disease (CAD) but with multiple risk factors (such as age 55 or over. he should skip the missed dose. especially if accompanied by fatigue or fever NURSING PRECAUTIONS Simvastatin (Zocor) ACTION • Antihyperlipidemic Medication • HMG-CoA Reductase Inhibitor (Statins) USES • Reduce risk of CHD event • Hyperlipidemia • Hypercholesterolemia ADVERSE REACTIONS *Atrial fibrillation.

Take same time/each day in evening with/without food *Report unusual muscle cramping/weakness. risk of drug toxicity Herbal: St. yellow of skin/eyes. Warfarin) may enhance anticoagulant effect Food: Grapefruit juice & Green Tea decrease antilipemic metabolism. to evaluate response to therapy * Urge patient to take drug in the evening. easy bruising/bleeding or unusual fatigue * Encourage patient to follow a low fat. breast-feeding or patients with myopathy *Should not be used on patients who hepatic impairment and/or ethanol use INTERACTIONS Drug: Antacids decrease antilipemic concentration Diltiazem increase concentration of diltiazem Niacin enhance adverse/toxic effect of antilipemic agent Vitamin K Antagonist (ex. as ordered. tenderness.*Patients with acute liver disease. or weakness and other symptoms of myopathy NURSING PRECAUTIONS Rosuvastin (Crestor) ACTION • Antihyperlipidemic Medication . Johns Wort increase metabolism of antilipemic agent *Red yeast rice contains an estimated 2. pregnancy. cholesterol-lowering diet * Urge patient to notify prescriber immediately about muscle pain.4 mg lovastatin per 600 mg rice *Avoid alcohol consumption * Expect to monitor liver function test results every 3 to 6 months for abnormal elevations * Monitor serum lipoprotein level.

hypersensitivity to rosuvastatin or its components. hypotension. such as sepsis. or electrolyte disorders * Notify prescriber if proteinuria or hematuria appears on patient’s routine urinalysis because rosuvastatin dosage . other lipid-lowering drugs  Increased blood rosuvastatin level and risk of myopathy oral contraceptives  Increased blood ethinyl estradiol and norgestrel levels warfarin  Increased INR NURSING PRECAUTIONS * Obtain baseline liver function test results and expect to monitor them every 3 months for abnormal elevations. gemfibrozil. If ALT or AST levels increase to more than three times the normal range. to evaluate patient’s response to therapy * Expect rosuvastatin to be temporarily withheld if patient develops any condition that may be related to myopathy or that predisposes her to renal failure. unexplained persistent elevations of serum transaminase levels * Use rosuvastatin cautiously in patients who consume large quantities of alcohol or have a history of liver disease because drug is contraindicated in patients with active liver disease or unexplained persistent elevations of transaminase levels * Also use cautiously in patients with risk factors for myopathy. trauma. or severe metabolic. pregnancy.• HMG-CoA Reductase Inhibitor (Statin Drug) Drug: USES • Hyperlipid emia ADVERSE REACTIONS *Headache CONTRAINDICATIONS * Active liver disease. lopinavir/ritonavir. expect dosage to be reduced or drug discontinued * Monitor serum lipoprotein levels. Notify prescriber if elevations occur. major surgery. advanced age. endocrine. as ordered. uncontrolled seizures. breast-feeding. and hypothyroidism INTERACTIONS Antacids  Decreased blood rosuvastatin level if given within 2 hours of rosuvastatin cyclosporine. niacin. such as renal impairment.

may need to be reduced * Encourage patient to follow a low-fat. high alcohol consumption. and pregnancy. INTERACTIONS Food: Niacin (Nicotinic Acid) (Niaspan. tenderness. gout. nausea. Niacor) ACTION • Antihyperl ipidemic Medicatio n Used in adjunction USES • . abdominal pain CONTRAINIDCATIONS *Pts with active peptic ulcer. low cholesterol diet * Tell patient to wait at least 2 hours after taking rosuvastatin before taking antacids * Instruct patient to notify prescriber immediately about muscle pain. hepatic dysfunction and arterial bleeding. *Used cautiously in patients with renal dysfunction. severe itching and tingling. or weakness. unstable angina. especially if accompanied by malaise or fever with other medicatio n to treat hyperlipid emia ADVERSE REACTIONS *Generalized flushing sensation of warmth. vomiting.

-Loop Diuretics: Fuosemide (Lasix) -Thiazide & Sulfonamide Diuretics: Hydrochlorothiazide (HCTZ) . Diuretics: indirectly reduce blood pressure by producing sodium and water loss and lowering the tone or rigidity of the arteries. There are (5) types of antihypertensive medication: 1. low cholesterol diet * Monitor serum lipoprotein levels. brain and kidneys. as ordered. Aspirin may be recommended before taking niacin to reduce adverse reactions.Garlic mild stomach upset and irritation. increased risk of bleeding NURSING PRECAUTIONS *The nurse should advise the patient to contact PCP if the skin reactions are severe or cause extreme discomfort. Research has shown that blood pressure above 140/90mmHg are associated with accelerated vascular damage of the heart. * Encourage patient to follow a lowfat. to evaluate patient’s response to therapy ANTIHYPERTENSIVE MEDICATIONS  Hypertension is a disorder in which that patient’s blood pressure is elevated above normal values for their age.

Minozidil (Loniten) Calcium Channel Blocking Agents: selectively limit the passage of extracellular calcium ions through specific ion channels of the cell membrane in cardiac. vascular and smooth muscle cells. This causes a lowered peripheral vascular resistance and a fall in systolic and diastolic blood pressure. If a patient is in shock. Nifedipine (Procardia) and Verapamil (Calan 4. it may help lead to the high blood pressure found in hypertension. Angiotension-converting enzyme (ACE) inhibitors act on the rennin-angiotension system to promote a decrease in the work of the heart (vascular afterload and preload) through vasodilation (vascular opening) when angiotension II is inhibited. 3. 5. this renin-angiotensin reaction is important in saving sodium and water to keep the blood pressure up but at other times. -Potassium-Sparing: Spironolacton (Aldactone) Adrenergic Antagonists: are nervous system stimulants and inhibitors that assist in lowering cardiac output and/or peripheral resistance Examples: Clonidine (Catapres. Duraclon). Examples: Benazepril (Lotensin). Angiotensin II is a powerful vasoconstrictor that acts on the adrenal cortex to increase aldosterone secretion. Metoprolol (Lopressor Topol XL) ACE Inhibitors: affect the renin-angiotensin system of the kidneys. ) . Examples: Amlodipine (Norvasc).2. thus lowering peripheral resistance. Examples: Hydralazine (Apresoline). Lisinopril (Zestril)) Vasodilators: Vasodilators reduce systolic and diastolic blood pressure by direct relaxation of vascular smooth muscle. Diltiazem (Cardizem).

renal disease. cirrhosis of the liver. If patient receives once-daily dosing. INTERACTIONS Drug: Cisplatin (cancer med) AND aminoglycosidesincreased risk of ototoxicity anticoagulants or thrombolytic (increases risk of bleeding) digitalis increased risk of arrhythmias lithium  increased risk of Li toxicity hydantoins (seizure med)  decreases effectiveness of diuretic NSAIDs  decreases effectiveness of diuretic NURSING PRECAUTIONS * Obtain patient’s weight before and periodically during furosemide therapy to monitor fluid loss. photosensitivity. advise her to take the dose in the morning to avoid sleep disturbance caused by nocturia . buzzing. Drug may need to be discontinued * Instruct patient to take the last dose of furosemide several hours before bedtime to avoid sleep interruption from diuresis. dizziness. N/V. rash. electrolyte. and serum creatinine. acute pulmonary edema and hypertension ADVERSE REACTIONS *Electrolyte and hematologic imbalances. give potassium supplements along with furosemide. vertigo. or sense of fullness in her ears. orthostatic hypotension CONTRAINIDCATIONS *Patients with electrolyte imbalances. * Monitor blood pressure and hepatic and renal function as well as BUN. as prescribed * Call MD if patient experiences hearing loss. and uric acid levels.Furosemide (Lasix) ACTION • Antihypertensive • Loop Diuretics USES • Edema due to heart failure. severe kidney or liver dysfunction and anuria (cessation of urine production). or ringing. as appropriate * Be aware that elderly patients are more susceptible to hypotensive and electrolyte-altering effects and thus are at greater risk for shock and thromboembolism * If patient is at high risk for hypokalemia. anorexia. blood glucose.

vomiting. or their components. Microzide) ACTION • Antihypertensive Medication • Loop Diuretic USES • Edema due to HF • Cirrhosis of the liver • Renal disease • Acute pulmonary edema ADVERSE REACTIONS *Electrolyte and hematologic imbalances. dizziness. other thiazides. expect an increased risk of gout attacks during therapy INTERACTIONS Drug: ACTH.* Advise patient to change position slowly to minimize effects of orthostatic hypotension and to take furosemide with food or milk to reduce GI distress * Caution patient about drinking alcoholic beverages. especially potassium Amantadine  Possibly increased blood level and risk of toxicity of amantadine Amiodarone Increased risk of arrhythmias from hypokalemia Antihypertensives  Increased antihypertensive effects barbiturates. sulfonamide derivatives. standing for prolonged periods. nausea. opioids Possibly orthostatic hypotension calcium: Possibly increased serum calcium level cholestyramine. rash. colestipol Reduced GI absorption of hydrochlorothiazide diazoxide Increased antihypertensive and hyperglycemic effects of hydrochlorothiazide diflunisal Possibly increased blood hydrochlorothiazide level digoxin Increased risk of digitalis toxicity from hypokalemia dopamine Possibly increased diuretic effects of both drugs . amphotericin B. orthostatic hypotension. and exercising in hot weather because these actions increase the hypotensive effect of furosemide * Inform diabetic patient that furosemide may increase blood glucose level. anorexia. photosensitivity. glycosuria CONTRAINDICATIONS * Anuria. renal failure * If patient has gouty arthritis. hypersensitivity to hydrochlorothiazide. corticosteroids  Increased electrolyte depletion. and advise her to check her blood glucose level frequently Hydrochlorothiazide (HCTZ) (HydroDIURIL.

daily weight.9 kg) per day or 5 lb (2. Toprol-XL) ACTION • β-Adrenergic Blocking Drug (Beta Blocker) • Decreases stimulation of sympathetic nervous system by: ○ Decreasing excitability of heart ○ Decreasing cardiac workload and oxygen consumption ○ Provides membrane-stabilizing effects USES • Hypertension • Angina • Myocardial Infraction NURSING PRECAUTIONS *Give hydrochlorothiazide in the morning and early in the evening to avoid nocturia. blood pressure.3 kg) per week • Heart Failure ADVERSE REACTIONS *Dizziness. oral antidiabetic drugsPossibly increased blood glucose level lithiumDecreased lithium clearance. including citrus fruits. increased risk of renal failure oral anticoagulantsPossibly decreased anticoagulant effects sympathomimeticsPossibly decreased antihypertensive effect of HCTZ vitamin Dncreased risk of hypercalcemia Activities: alcohol usePossibly orthostatic hypotension *Instruct patient to eat a diet high in potassium rich food. bananas. hypotension. BUN & creatinine *Assess for signs of hypokalemia. increased risk of lithium toxicity neuromuscular blockersPossibly enhanced neuromuscular blockade from hypokalemia nondeplarizing skeletal muscle relaxantsPossibly increased response to muscle relaxants NSAIDsDecreased diuretic effect of hydrochlorothiazide. diarrhea CONTRAINIDICATIONS * Use metoprolol with extreme caution in patients with bronchospastic disease who don’t respond to or can’t tolerate other . unusual bleeding or bruising *Frequently monitor blood glucose level as ordered in diabetic patients. and dates *Advise patient to change position slowly to minimize effects of orthostatic hypotension Metoprolol (Lopressor. such as muscle spasms & weakness. heart failure. cardiac arrhythmia.insulin. tomatoes. *Monitor fluid intake and output. vomiting. and serum levels of electrolytes. especially potassium. as needed *Tell patient to weigh herself at the same time each day wearing the same amount of clothing and to notify prescriber if she gains more than 2 lb (0. nausea. and expect to increase antidiabetic drug dosage.

and tremor * Expect to taper dosage when drug is discontinued.antihypertensive therapy. second or third degree heart block. Expect to give smaller doses more often to avoid higher plasma levels that occur with longer dosage intervals * Use cautiously in patients with hypertension or angina who have congestive heart failure because beta blockers such as metoprolol can further depress myocardial contractility. emphysema or hypotension. tablets. stopping abruptly can cause myocardial ischemia. Metoprolol may interfere with therapeutic effects of insulin and oral antidiabetic drugs. especially in patients with cardiac disease * Instruct patient to take metoprolol with food at the same time each day—once daily for E. *B-blockers are recommended for pregnant woman over other hypertensive because of the risk to the fetus is less with these drugs INTERACTIONS Drug: Antidepressants  increased effect of Beta blocker. Monitor patient for signs and symptoms of worsening heart failure during dosage increases. tachycardia. as prescribed. or severe hypertension. thyrotoxicosis or peptic ulcer. causing heart failure to worsen *Contraindicated in patients with sinus bradycardia. It also may mask evidence of hypoglycemia. Be aware that the metoprolol dosage shouldn’t be increased until signs and symptoms of worsening heart failure have been stabilized * If dosage exceeds 400 mg daily.R. Inform them that they may halve tablets but not chew or crush them * Advise patient to notify prescriber if pulse rate falls below 60 beats/minute or is significantly lower than usual Amlodipine (Norvasc) ACTION • Calcium Channel Blocker USES • Antihypertensive Drug • Chronic Stable Angina . heart failure and in those with asthma. ventricular arrhythmias. MI. *Used cautiously in patients with diabetes. such as palpitations. monitor patient for bronchospasm and dyspnea because metoprolol competitively blocks beta2-adrenergic receptors in bronchial and vascular smooth muscles * Check for signs of poor glucose control in patient with diabetes mellitus. If heart failure worsens. bradycardia NSAIDs decreased effect of beta blocker Loop Diuretic  increased risk of hypotension Clonidine increased risk of paradoxical hypertensive effect Cimetidine higher risk of B-blocker toxicity Iidocaine  higher risk of B-blocker toxicity NURSING PRECAUTIONS *Be aware that the metoprolol dosage for heart failure is highly individualized. expect to increase the diuretic dosage and possibly decrease the metoprolol dosage or temporarily discontinue drug.

heart failure. especially in patients with heart failure or severe aortic stenosis *Hold medication is systolic BP is less than 100 or HR is less than 60 * Tell patient to take missed dose as soon as it's remembered and next dose in 24 hours * Tell patient to immediately notify prescriber of dizziness. ventricular dysfunction or cardiogenic shock INTERACTION Drug: Cimetidine or rantidine (GI disorders)  increased effect of CCblocker Theophyllinetoxic effect of theophylline Digoxinincreased risk digitalis toxicity Rifampin (TB med)  decreased effect of CCblocker MAOIs. anorexia CONTRAINIDCATIONS *Patients with sick sinus syndrome. or rash * Suggest taking amlodipine with food to reduce GI upset * Advise patient to routinely have blood pressure checked for possible hypotension . antihistamines. nausea. 2/3 atrioventricular (AV) block (except with a functioning pacemaker) *Patients with hypotension (systolic pressure less than 90 mm Hg). dizziness. or severe aortic stenosis * Monitor blood pressure while adjusting dosage. diarrhea. hives. hepatic disorder. sympathomimetic bronchodilators decreased effectiveness of CCblocker Diuretics increased risk of hypotension Herbal: Hawthronincreased sedation & CNS depression NURSING PRECAUTIONS *Use amlodipine cautiously in patients with heart block.• Vasospastic angina ADVERSE REACTIONS *Headache. arm or leg swelling. depression. impaired renal function. difficulty breathing. syncope *Upper respiratory infections and cough *Abdominal pain. fatigue. constipation.

syncope. constipation. dizziness. hypotension Anesthetic agents increased effect of the anesthetic β-blockers  increased risk of hypertension Lithiumincreased risk for lithium toxicity Haloperidol  increased risk of psychotic behavior NURSING INTERVENTIONS *B/P. sedation. dreams.Clonidine (Catapres) ACTION • Anti-Adrenergic Drugs (Centrallyacting) ○ Inhibits the release of norepinephrine and acts in the Central Nervous System  Affects the sympathetic nervous system USES • Hypertension • Severe pain in patients with cancer ADVERSE REACTIONS *Drowsiness. pulse prior to administration . rash CONTRAINDICATION *Patients in active hepatic disease and patients on MAOIs *Used cautiously in patients with a history of liver disease or renal impairment and during pregnancy and lactation INTERACTIONS Drug: Adrenergic drugs  increased risk of hypertension Levodopa  decreased effect of levodopa. dry mouth.

tremors.*If prescribed for opiate withdrawal: monitor for N/V/D. nausea. sweating *DO NOT use OTC (cough. recommend hard candy or frequent mouth rinsing . insomnia. cramps. increased BP. insomnia. cold or allergy) medications unless approved by MD *Rise slowly to prevent drop in BP *May cause dry mouth. headache. increased pulse. shivering & dilated pupils *Monitor I/Os and edema *Give last dose at bedtime *Discontinuing abruptly may result in anxiety.

*Used cautiously in patients with coronary or cerebrovascular insufficiency and those receiving diuretic therapy or dialysis. as prescribed. which may contain potassium. before therapy * Be alert for angioedema. salt or volume depletion. fatigue CONTRAINDICATIONS *Pts with impaired renal function. to monitor drug's effectiveness * Monitor urine output and BUN and serum creatinine levels. especially after first dose. during pregnancy or lactation. as n eeded. and discontinue benazepril * Monitor WBC count periodically to detect neutropenia and agranulocytosis * Monitor serum potassium and other electrolyte levels to detect electrolyte imbalances * Strongly urge patient to contact prescriber before using any OTC salt substitutes. or . dizziness. Drug: NSAIDs  reduced hypotensive effects of the ACEI Rifampin  decreased effects of ACEI Allopurinol (antigout med)  higher risk of hypersensitivity Digoxin  increased or decreased digoxin levels Loop diuretics  decreased diuretic effects NURSING PRECAUTIONS * Take ortho BPs before initiating benazepril and then every 4 to 8 hours. prepare to give epinephrine subcutaneously immediately. as appropriate. bilateral stenosis. HF. If it extends to larynx and patient has laryngeal stridor or signs of airway obstruction.INTERACTIONS Benazapril (Lotensin) ACTION • Antihypertensive medication • ACE Inhibitor USES • Hypertension ADVERSE REACTIONS *Headache. or angioedema.

dizziness. renal function deterioration INTERACTIONS Drug: Antacids  decrease ACE inhibitors concentration Lithium  increase concentration of Li Diuretics. lips. eyes. chloestatic jaundice. such as swelling of the face. If cough becomes bothersome or interferes with her sleep or activities. D/N/V. or tongue * Caution women of childbearing age to use a reliable form of contraception and to notify prescriber immediately if pregnancy is suspected because benazepril may cause fetal harm and should be discontinued • Heart Failure ADVERSE REACTIONS *Cough.potassium supplements. heart failure. impaired renal function. Zestril) ACTION • Antihypertensive medication • Angiotension-Converting Enzyme (ACE) Inhibitor USES • Hypertension . instruct her to notify prescriber * Instruct patient to contact prescriber immediately if she experiences signs of angioedema. neutropenia. MAO inhibitors. These substances increase the risk of hyperkalemia * Inform patient that a persistent dry cough may develop and may not subside unless benazepril is discontinued. upper respiratory infection CONTRAINDICATIONS * Use lisinopril cautiously in patients with fluid volume deficit. hypotension/syncope. antihypertensives  enhance hypotensive effect Lisinopril (Prinivil. or sodium depletion. hyperkalemia. hyperkalemia. headache. Orthostatic hypotension.

lupus erythematosus cell preparation. palpitations. especially early in treatment. promptly give 0. glottis. tachycardia. larynx. hypersensitivity to hydralazine or its components. lips. patients with renal dysfunction or those maintained on K+ supplements or K+ sparing diuretics *Take first dose at bedtime Hydralazine (Apresoline) ACTION • Antihypertensive medication • Vasodilator USES • Primary hypertension (oral) • When need to lower BP is urgent (parenteral) ADVERSE REACTIONS *Dizziness.5 ml of epinephrine 1:1. mitral valve disease * Monitor CBC. Be aware that diarrhea and vomiting can cause dehydration * If patient takes insulin or an oral antidiabetic. and ANA titer before therapy and periodically as appropriate during long-term treatment INTERACTIONS Drug: . especially during the first month of therapy *Use K+ containing salt substitutes cautiously in patients with diabetes. as prescribed * Monitor for dehydration. which can lead to hypotension. If airway obstruction threatens. monitor blood glucose level closely because risk of hypoglycemia increases.NSAIDs & Salicylates diminish antihypertensive effect K+ salts: enhance hyperkalemic effect NURSING PRECAUTIONS * Monitor blood pressure often.3 to 0. If excessive hypotension develops. or tongue. numb/tingling in legs. expect to withhold drug for several days * If angioedema affects face. limbs. mucous membranes. 000 solution subcutaneously. notify prescriber immediately and expect to stop lisinopril and start appropriate therapy at once. nasal congestion CONTRAINDICATIONS * Coronary artery disease.

beta blockers  Increased effects of both drugs diazoxide. MAO inhibitors. and sore throat. Expect orthostatic hypotension to be most common in the morning. myalgia. Consult pharmacist if color change occurs *Monitor blood pressure and pulse rate regularly and weigh patient daily during therapy *Watch for signs of orthostatic hypotension. and splenomegaly *Expect prescriber to withdraw hydralazine gradually to avoid a rapid increase in blood pressure *Instruct patient to take hydralazine tablets with food *Caution patients hot showers may increase hypotension *Report any fever. muscle and joint aches. numbness and tingling in her limbs to MD Diltiazem (Cardizem) ACTION • Antihypertensive medication • Calcium Channel Blocker USES • Hypertension • Chronic stable angina • Atrial Fibrilation/flutter • Paroxysmal superventricular tachycardia . pharyngitis. such as arthralgia. other antihypertensives Risk of severe hypotension epinephrine  Possibly decreased vasopressor effect of epinephrine NSAIDs Decreased hydralazine effects Sympathomimetics  Possibly decreased antihypertensive effect of hydralazine Foods: all foods Possibly increased bioavailability of hydralazine NURSING PRECAUTIONS *Anticipate that drug may change color in solution. and with exercise *Expect to discontinue drug immediately if patient experiences lupus-like symptoms. fever. during hot weather.

difficulty breathing. and heart rate and rhythm by continuous ECG as appropriate during therapy. diltiazem is metabolized mainly in the liver and excreted by the kidneys INTERACTIONS Drug: Cimetidine or rantidine (GI meds)  increased effects of Ca+ channel blocker Theophylline (asthma med)  increased toxic effects of theophylline Digoxin  increased risk for digitalis toxicity Rifampindecreased effect of Ca+ channel blocker * Monitor patient’s blood pressure. and monitor liver and renal function test results. or swollen ankles * Instruct patient to maintain good oral hygiene. dizziness. persist * Tell patient that stopping drug suddenly may cause life-threatening effects * Urge patient to report chest pain. rash. bradycardia. usually transient. edema. rhinitis CONTRAINDICATIONS * Use diltiazem cautiously in patients with impaired hepatic or renal function. vomiting. watch for signs of digitalis toxicity.ADVRESE REACTIONS *Headache. dyspnea. fainting. halo vision. Keep emergency equipment and drugs available * Assess patient for signs and symptoms of heart failure * If patient takes digoxin. perform gum massage. pulse rate. atroventricular block. such as nausea. and see a dentist every 6 months to prevent gingival bleeding and hyperplasia and gingivitis NURSING PRECAUTIONS . as appropriate. and elevated serum digoxin level * Expect to discontinue drug if adverse skin reactions. irregular heartbeat. dizziness.

sick sinus syndrome INTERACTIONS Drug: Cimetidine or rantidine (GI meds)  increased effects of Ca+ channel blocker Theophylline (asthma med)  increased toxic effects of theophylline Digoxin  increased risk for digitalis toxicity Rifampin decreased effect of Ca+ channel blocker Food: grapefruit. fluid retention may lead to heart failure. second. muscle cramps. wheexing CONTRAINDICATIONS * Hypersensitivity to a calcium channel blocker. such as . nausea.Nifedipine (Procardia) ACTION • Antihypertensive medication • Calcium Channel Blocker USES • Hypertension (sustained-release only) • Vasopastic Angina • Chronic Stable Angina ADVERSE REACTIONS *Headache. dosage may be increased 10 mg every 4 to 6 hours to control chest pain * Because of drug’s negative inotropic effect on some patients. Also assess for signs of heart failure. edema. dizziness. frequently monitor heart rate and rhythm and blood pressure in patients who take a beta blocker or have heart failure or significant left ventricular dysfunction * Monitor fluid intake and output and daily weight. nasal congestion.or third-degree AV block without artificial pacemaker. weakness. grapefruit juice Possibly increased bioavailability of nifedipine high-fat meals Possibly delayed nifedipine absorption NURSING PRECAUTIONS * For closely monitored hospitalized patient with angina. cough.

jugular vein distention. hypotension. peripheral edema. verapamil). sick sinus syndrome or second.crackles. Urge her not to alter the amount of grapefruit in her diet without consulting prescriber * Caution patient against stopping nifedipine abruptly because angina or dangerously high blood pressure could result. Isoptin. Inform her that their empty shells may appear in stool * Urge patient not to take drug within 1 hour of a high-fat meal or grapefruit. or break them. tablets whole. severe heart failure unless secondary to supraventricular tachycardia that responds to verapamil. constipation CONTRAINDICATIONS * Cardiogenic shock. ventricular tachycardia (with I. not to crush. dyspnea. verapamil) Verapamil (Calan. Verelan) ACTION • Antihypertensive medication • Calcium Channel Blocker USES • Hypertension INTERACTIONS Drug: Cimetidine or rantidine (GI meds)  increased effects of Ca+ channel blocker Theophylline (asthma med)  increased toxic effects of theophylline Digoxin  increased risk for digitalis toxicity Rifampin decreased effect of Ca+ channel blocker Food: grapefruit juiceIncreased concentrations of verapamil . chew.V. severe left ventricular dysfunction. concomitant use of beta blockers (with I. hypersensitivity to verapamil or its components. • • • • Chronic stable angina Vasospastaic angina Chronic atrial flutter Paroxysmal syperventricular tachycardia ADVERSE REACTIONS *Headache. and weight gain * Instruct patient to swallow E.V.R.or third-degree heart block unless artificial pacemaker is in place.

tablets or capsules.R. as prescribed * Instruct patient not to crush or chew verapamil E. including a high-fiber diet and a stool softener.Activities: alcohol use Increased blood alcohol level and prolonged CNS effects NURSING PRECAUTIONS * Maintain continuous ECG monitoring and keep emergency resuscitative equipment and drugs readily available during I. Inform her that she may break E. therapy * Assess patient with hypertrophic cardiomyopathy for early development of hypotension and pulmonary edema because second-degree AV block and sinus arrest can result * Assess for bradycardia and hypotension. tablets in half if necessary to aid swallowing .V. and notify prescriber if heart rate or blood pressure declines significantly * Be aware that disopyramide or flecainide shouldn’t be given within 48 hours before or 24 hours after verapamil because additive negative inotropic effects can result * Institute measures to prevent constipation.R.

on which renal function depends INTERACTIONS: Drug: Fluconazole (Antifungal) increased antihypertensive and adverse effects Indomethacin (pain relief) decreased hypotensive effect NURSING PRECAUTIONS *Be aware that patients who have severe heart failure or renal artery stenosis may experience acute renal failure from losartan therapy because losartan inhibits the angiotensin-aldosterone system. URI symptoms . on which renal function depends.CONTRAINDICATIONS Lorsartan Potassium (Cozarr) ACTION • • Antihypert ensive Angiotens in II receptor anatagoni st * Be aware that patients who have severe heart failure or renal artery stenosis may experience acute renal failure from losartan therapy because losartan inhibits the angiotensinaldosterone system. USES • Hypertension • Hypertension with LVD • Diabetic Nephropathy (for Type II patients) ADVERSE REACTIONS *Dizziness. *Monitor patient’s blood pressure and renal function studies to evaluate drug effectiveness.

the pain of angina or peripheral vascular disease is felt. whereas vasodilating agents are used for peripheral vascular disease. *Monitor patient for muscle pain. The use of beta blockers and calcium channel blockers may also play a role in treating angina. rhabdomyolysis develops in patients taking other angiotensin II receptor blockers.*Periodically monitor patient’s serum potassium level. ➢ Nitrates are the best dry for treating coronary artery disease. rarely. . * Instruct patient taking losartan to avoid potassium-containing salt substitutes because thay may increase the risk of hyperkalemia. nausea. instruct her to notify prescriber if she experiences prolonged diarrhea. *Advise patient to avoid exercising in hot weather and drinking excessive amounts of alcohol. as appropriate. When there is a lack of blood supply to being oxygen and nutrients to the heart or to peripheral tissues. to detect hyperkalemia. although concern about their possible role in changes to the heart (which may lead to heart failure) in patients who have had a myocardial infarction has limited their use. or vomiting ANTIANGINAL MEDICATION  Angina is pain caused by narrowing or constriction of the smooth muscle in the coronary arteries and the peripheral vascular system that reduces the amount of blood carried to the heart.

The effect is felt in both the arterial and venous circulation. Diltiazem (Cardizem). nitrates increase the use of the other small blood vessels in the heart (collaterals) so that there is better oxygen supply to the inner layers of the heart muscle Examples: Nitroglycerin. patch or sublingual) ACTION • Antiangial medicaiton • Nitrate Vasodilator USES • Angina • Preventative of MI . Nitrate products have a direct action on vascular smooth muscle and cause it to relax. In addition. Amlodipine (Norvasc). Nifedipine (Procardia) and Verapamil (Calan) Nitroglycerin (Paste.

ADVERSE REACTIONS *headache, weakness, vertigo, dizziness, faintness, hypotension, circulatory collapse CONTRAINDICATIONS *Patients with severe anemia, cerebral hemorrhage *Used cautiously in the following patients: severe hepatic/renal disease, severe head trauma and hypothyroidism INTERACTIONS Drug: Acetylcholine, norepinephrine Possibly decreased therapeutic effects of these drugs Aspirin  increases nitrate concentration Calcium Channel Blockers 

increases symptomatic orthostatic hypotension Dihydroergotamine (migrate medicine) Increases risk of hypertension heparin  decreased effect of heparin Erectile dysfunction meds severe hypotension & cardiovascular collapse may occur Food: Alcohol  severe hypotension & cardiovascular collapse because of it’s a vasodilator

NURSING PRECAUTIONS * Use nitroglycerin cautiously in elderly patients, especially those who are volume depleted or taking several medications, because of the increased risk of hypotension

and falls. Hypotension may be accompanied by angina and paradoxical slowing of the heart rate. Notify prescriber if these occur, and provide appropriate treatment, as ordered *For sublingual or buccal use, advise patient to place a tablet under her tongue or in her buccal pouch when angina starts and then to sit or lie down. Instruct her not to swallow drug, but to let it dissolve. Explain that moisture in her mouth helps drug absorption. If angina doesn’t subside, instruct patient to place another tablet under her tongue or in her buccal pouch after 5 minutes and to repeat, if needed, for three doses total. If pain doesn’t subside after 20 minutes, urge patient to call 911 or another emergency service * When applying transdermal ointment, apply correct amount on dose-measuring paper. Then place paper on hairless area of body and spread in a thin even layer over an area at least 2 inches by 3 inches. Don’t place on cuts or irritated areas. Wash your hands after application. Rotate sites. Store at room temperature

* Open transdermal patch package immediately before use. Apply patch to hairless area, and press edges to seal. *Rotate sites. Store at room temperature. If patient needs cardioversion or defibrillation, remove transdermal patch * Be aware that I.V. nitroglycerin should be diluted only in D5W or normal saline solution and shouldn’t be mixed with other infusions. The pharmacist should add drug to a glass bottle, not a container made of polyvinyl chloride. Don’t use a filter because plastic absorbs drug. Administer with infusion pump * Frequently monitor heart and breath sounds, level of consciousness, fluid intake and output, and pulmonary artery wedge pressure, if possible * Assess patient for signs and symptoms of overdose, such as confusion, diaphoresis, dyspnea, flushing, headache, hypotension, nausea, palpitations, tachycardia, vertigo, vision changes, and

vomiting. Treat as prescribed by removing nitroglycerin source, if possible; elevating the legs above heart level; and administering an alpha-adrenergic agonist, such as phenylephrine, as prescribed, to treat severe hypotension *Nurse should NOT rub nitro ointment into

patient’s skin, it will be absorbed into their skin & causes a severe headache *Heart rate MUST be above 60

ANTICOAGULANTS & THROMBOLYTIC MEDICATION
Hematologic products act in the formation, repair or function of red blood cells. They include the anticoagulants (heparin and Coumadin) and the heparin antagonist protamine sulfate. Thrombolytic agents and antiplatelet factors also have a major influence on blood clotting. Related vitamin and minerals that are needed for red blood cell development are iron, vitamin K, vitamin B12 and folic acid. Anticoagulants: Warfarin (Coumadin), Heparin, Enoxparin (Lovenox) Warfarin (Coumadin): limit formation of blood coagulants factors in the liver by interfering with vitamin K. These drugs do not destroy existing blood clots; however, they may limit the extension of existing blood clots or thrombi. Heparin: acts at multiple sites in coagulation to stop reactions that lead to the clotting of blood and the formation of fibrin cloths. It increases coagulation factors to slow new clot development. Heparin does not dissolve existing clots either, although thrombolytic agents do.

Protamine & Phytonadione (Vitamin K): are proteins that act as a heparin antagonist to neutralize (reverse) the actions of heparin. However, it may also serve as an anticoagulant when used as the sole medication. In the presence of heparin, results will occur almost immediately and may persist for 2 hours or more Thrombolyric Agents: convert plasminogen to the enzyme plasmin, which degrades or breaks down fibrin cloths, fibrinogen and other plasma proteins. The products are used for lysis or dissolving of thrombi. Examples: Streptokinase (Streptase)  Antiplatelet Agents: through a variety of mechanisms, these products act to limit or inhibit platelet aggregation (clumping) and thus reduce thrombus formation. ASA reduces the incidence of myocardial infarction-related deaths in mean older than 50 years old. ASA is the drug of choice in ischemic stroke; it plays no role in hemorrhagic stroke. Clospidogrel (Plavix) is used for myocardial infarction prophylaxis for men and as additional or adjunct therapy with thrombolytics in preventing infarction or stroke.

Protamine
ACTION

Anticoagulant Antagonist

USES • Treatment of heparin overdose

ADVERSE REACTIONS *Flushing and warm feeling, dyspnea, bradycardia, hypotension CONTRAINDICATIONS * Allergy to fish, hypersensitivity to protamine or its components. IMCOMPATIBILITIES * Don’t mix protamine sulfate in same syringe with other drugs unless they’re known to be compatible. Several cephalosporins, penicillins, and other antibiotics are incompatible INTERACTIONS Drug: Heparin Neutralized anticoagulant effect of both drugs NURSING PRECAUTIONS

* Be aware that rapid delivery may cause severe hypotension and anaphylaxis * Be prepared to obtain coagulation studies (APTT, activated clotting time) 5 to 15 minutes after administering drug and to repeat studies in 2 to 8 hours to assess for heparinrebound hypotension, shock, and bleeding * Monitor vital signs, hemodynamic parameters, and fluid intake and output, and assess for flushing sensation * Have fluids—epinephrine 1:1,000, dobutamine, or dopamine—available for allergic or hypotensive reactions * Be aware that vasectomized males have an increased risk of hypersensitivity reaction because of possible accumulation of antiprotamine antibodies

valproic acid Possibly hypoprothrombinemia and increased risk of severe hemorrhage corticosteroids. cefoperazone. and INR. cefotetan. platelet aggregation inhibitors  increased risk of bleeding antifibrinolyticsAntagonized effects of both drugs antihypertensives Increased risk of severe hypotension. hypersensitivity to streptokinase or its components. don’t shake drug during reconstitution . heparin. APTT.Streptokinase (Streptase) ACTION • Thrombolytic USES • Acute MI • DVT • Pulmonary Embolism • Embolism ADVERSE REACTIONS *Minor bleeding (superficial and surface) and major bleeding (internal and severe) CONTRAINDICATIONS * Active internal bleeding. platelet count. ethacrynic acid. salicylates Possibly GI ulceration or bleeding NURSING PRECAUTIONS *Obtain hematocrit. especially when streptokinase is administered rapidly to treat coronary artery occlusion cefamandole. severe uncontrolled hypertension INTERACTIONS Drug: anticoagulants. plicamycin. as ordered. enoxaparin. bleeding diathesis. PT. intracranial cancer. before giving streptokinase *To prevent foaming. AV malformation or aneurysm. NSAIDs. history of stroke or intracranial or intraspinal surgery within the previous 2 months.

Perform neurologic assessment to detect intracranial bleeding *Monitor heart rate and rhythm by continuous ECG. These drugs are also call cardiac glycodsides. When cardiac . as ordered *Treat fever with acetaminophen.V.*Check requently for bleeding at I. All cardiotonic have the following two acitons: -They increase the strength or force of the contraction (or pumping) of the heart muscle (myocardium). rather than aspirin to reduce the risk of bleeding *Explain to patient that they’ll be on bed rest during streptokinase therapy *Advise patient to wear or carry medical alert identification stating that he takes streptokinase CARDIOTONIC MEDICATION  Cardiotonics make the heart beat stronger and slower. If the heart is weak. site and for blood in urine and stool. -They slow the heart rate ➢ The normal heart pumps oxygenated blood from the left ventricle out through the body. less oxygenated blood can be pumped out with each contraction or beat of the heart. as prescribed.

Example: Digoxin (Digitek. output (the amount of blood pumped out with each heartbeat x HR) decreases. reemergence of atrial fibrillation or HF . Digoxin Immune Fab (Digitibind) ACTION • Digoxin-Specific Antidote USES • Antidote for massive digoxin overdose ADVERSE REACTIONS *Hypokalemia. other organs are affected. It binds with digoxin or digitoxin molecules. Lanoxin) Digoxin-Specific Antidote: Digoxin Immune Fab (Digibind) given for massive digoxin overose. The resulting complex is excreted through the kidneys.

test for allergic reaction.CONTRAINDICATIONS *Hypersensitivity to the drug INTERACTIONS Drug: None NURSING PRECAUTIONS * Before administering digoxin immune Fab to high-risk patient. if more of the drug must be given. After 20 minutes. and prepare to respond to anaphylaxis. Test is considered positive if it produces a wheal surrounded by erythema. apply tourniquet above test site. . expect prescriber to pretreat patient with corticosteroids and diphenhydramine. additional drug shouldn’t be given unless essential. especially during first few hours of therapy. If test causes a systemic reaction. Be aware that if a skin or systemic reaction occurs. Prescriber should be on standby to treat anaphylaxis * When administering to a child. expect a faster onset but watch closely for febrile reaction * Monitor serum potassium level often. observe for an urticarial wheal surrounded by erythema. notify prescriber. The potassium level may drop rapidly GASTROINTESTINAL MEDICATIONS  There are 3 major types of GI medications. watch for fluid volume overload * When giving a large dose.

The third major type of GI drugs also affect motility.○ ○ ○ The first major type includes the products designed to help restore or maintain the lining that protects the GI tract. which act to neutralize or reduce aciditiy of the gastric contents • Histamine H2-receptor antagonists. • Proton pump inhibitors. These medications include: • Anticholinergics and antispasmodics. These drugs include: • Antacids. or movement. which reduce gastric acid secretion by limiting the action of histamine at the H2 receptors in the stomach. which reduce gastric acid by blocking the proton pump. of the GI tract. These are the laxative agents. • Antidiarrheals. These prepareations . which not only reduce gastric motility by also decrease the amount of acid secreted by the stomach. A second major type of GI medication affects the general motility. which help reduce diarrhea by slowing the intestinal peristalsis. but their action is primarily in the colon.

or produce increase peristalsis through local tissue irritation or by direction action on the intestine.promote bowel emptying in a variety of ways. Mylanta) ACTION • • Acid Neutralize r Symptom atic relief of peptic ulcer and ADVERSE REACTIONS *Acid rebound CONTRAINDICATIONS stomach hyperacidi ty Calcium deficienci es (osteopor osis) USES • . They may increase intestinal bulk. lubricate the intestinal walls. Calcium Carbonate (Tums. soften the fecal mass by retaining water.

this is normal *Do not use the maximum dose for more than 2 weeks Digoxin. always check with MD for other drug interactions *Antacids may change the color of stool (white. during lactation. isoniaszid. *Do not use an antacid indiscriminately. white streaks). *Used cautiously in patients with respiratory insufficiency. no oral drugs should be administered within 1 or 2 hours of an antacid.*Contradindicated in patients with severe abdominal pain. and patients with renal calculi or hypercalcemia. renal impairment or cardiac disease INTERACTIONS Drug: drugs. phenytoin & chlorpromazine decreased absorption of the results in a decreased effect of those drugs Tetracycline decreased effectiveness of antiinfective Corticosteroidsdecreased antiinflammatory properties Salicylatespain reliever is excreted more rapidly in the urine Magnesium Hydroxide (Milk of Magnesia) ACTION • Acid Neutralizers USES • Symptomatic relief of peptic ulcer and stomach hyperacidity • Constipation Quinidine & Amphetamines  drugs are excreted more slowly in the urine NURSING PRECAUTIONS *Because of the possibility of an antacid interfering with the activity of other oral .

always check with MD for other drug interactions *Antacids may change the color of stool (white. hypermagnesemia (nausea. white streaks). decreased respirations) CONTRAINDICATIONS *Used cautiously in patients with decreased kidney function and patients with severe abdominal pain INTERACTIONS Drug: Quinidine & Amphetamines  drugs are excreted more slowly in the urine NURSING PRECAUTIONS *Because of the possibility of an antacid interfering with the activity of other oral drugs. phenytoin & chlorpromazine decreased absorption of the results in a decreased effect of those drugs Tetracycline decreased effectiveness of antiinfective Corticosteroidsdecreased antiinflammatory properties Salicylatespain reliever is excreted more rapidly in the urine Cimetidine (Tagamet) . isoniaszid. no oral drugs should be administered within 1 or 2 hours of an antacid. vomiting.ADVERSE REACTIONS *Diarrhea. *Do not use an antacid indiscriminately. dehydration. this is normal *Do not use the maximum dose for more than 2 weeks Digoxin. bone loss in patients with chronic renal failure. hypotension.

tricyclic antidepressants. sulfonylureas. quinine. dizziness. propranolol. Antacids & metoclopramidedecreased absorption of H2 antagonist Carmustine  decreased WBC count Opioid analgesics increased risk of respiratory depression Oral anticoagulants  increased risk of bleeding Digoxin may decrease digoxin levels benzodiazepines. possibly toxicity from these drugs Foods Caffeine Reduced metabolism and increased blood level and effects of caffeine Alcohol Possibly increased blood alcohol levels NURSING PRECAUTIONS *Be aware that rapid administration of cimetidine can increase the patient’s risk of developing arrhythmias and hypotension * Instruct patient to avoid taking antacids within 1 hour of taking cimetidine * Warn patient that cigarette smoking increases gastric acid secretion and can worsen gastric disease INTERACTIONS Drug: . *Used cautiously in diabetic patients.ACTION • Histamine H2 Antagonist • Acid Reducer USES • Gastric/duodenal ulcers • GERD • Gastric hypersecretory conditions • GI bleeding • Heartburn ADVERE REACTIONS *Headache. calcium channel blockers. tacrine. lidocaine. moricizine. labetalol. pentoxifylline. valproic acid. severely ill. elderly. warfarin Reduced metabolism and increased blood levels and effects of these drugs. or debilitated patients. carbamazepine. metronidazole. phenytoin. confusion CONTRAINDICATIONS *Used cautiously in patients with renal or hepatic impairment. metoprolol. chloroquine. diarrhea. triamterene. reversible impotence. somnolence. theophyllines. propafenone. quinidine. patients who are pregnant or lactating.

diarrhea CONTRAINICATIONS *Hypersensitivity to the drug *Cautiously used in patients with renal/hepatic impairment. NURSING PRECAUTIONS *BIG risk of potential toxicity from decreased elimination in older adults or patients with hepatic or renal dysfunction *Monitor liver function tests & early signs of hepatoxicity . severely ill. *Used cautiously in diabetic patients *Pregnancy Category B Famotidine (Pepcid) ACTION INTERACTIONS Drug: Antacids & metoclopramide (GI distress)  decreased absorption of the H2 antagonists Carmustine (anticancer)  decreases WBC Opioid Analgesics  increased risk of respiratory depression Anticoagulants  increased risk of bleeding digoxin  may decrease digoxin levels • • Histamine H2 Antagonist Acid Reducer USES • Gastric/duodenal ulcers • GERD. unless prescribed elderly or debilitated patients. heartburn • GI Bleeding ADVERSE RACTIONS *Headache.* Caution patient not to take drug for more than 14 days. somnolence.

INTERACTIONS Drug: Sucralfate  decreased absorption of PPI Esomeprazole Omeprazole (Nexium) (Prilosec) Lansoprazole (Prevacid) ACTION • Proton Pump Inhibitor • Acid Reducer USES . diarrhea. nausea. Prolonged treatments may decrease the body’s ability to absorb vitamin B12 resulting in anemia.-jaundice. Zantac  reduces pepcid absorption) *Do NOT SMOKE *Do NOT breast feed without consulting MD • • • • Erosive easophagitis GERD H. abdominal pain CONTRAINCATIONS *Used cautiously in older adults and patients with hepatic impairment. yellow sclera and skin *Long-term therapy may lead to vitamin B12 deficiency *Remember to provide pain relief through the night *Do NOT supplement with OTC gastric distress remedies (Mylanta. dark urine. Pepto. pylori eradication NSAID-associated gastric ulcers ADVERSE REACTIONS *Headache. pruritius.

cerebral arteriosclerosis. blood dyscrasias. bone marrow depression. severe hypertension or hypotension. hypotension. dry mouth. coronary artery disease. weight less than 9 kg (20 lbs) . severe CNS depression. nasal congestion CONTRAINDICATIONS * Age less than 2 years. Obtain stool cultures. pediatric surgery. myeloproliferative disorders. pylori–related ulcer. Tell them not to chew pellets and to discard any unused pellets Digoxin  increased absorption of digoxin Benzos & Phenytoin  risk for toxic level of antiseizure medication Clarithromycin risk for increase in plasma level of both drugs NURSING PRECAUTIONS *Give at least 1 hour before meals because food decreases bioavail-ability * If patient takes drug with amoxicillin or clarithromycin for H. as ordered * If patient has trouble swallowing esomeprazole capsules.Ketoconazole & Ampicillin  decreased WBC Oral Anticoagulant  increased risk of bleeding applesauce. hypersensitivity to phenothiazines. coma. use of large quantities of CNS depressants. tell him to open capsule and sprinkle pellets into a tablespoon of cool Prochlorperazine (Compazine) ACTION • Antiemetic USES • Control of nausea & vomiting ADVERSE REACTIONS *Drowsiness. severe diarrhea may indicate pseudomembranous colitis. subcortical brain damage. hepatic dysfunction.

and trembling * Urge patient to avoid alcohol and OTC drugs that may contain CNS depressants * Instruct patient to avoid excessive sun exposure and to wear sunscreen outdoors opioid analgesics Increased risk of CNS and respiratory depression. *Avoid contact between skin and solution forms of prochlorperazine because contact dermatitis could result * Expect antipsychotic effects to occur in 2 to 3 weeks. increased excretion of Li. tricyclic anti-depressants Possibly prolonged and intensified anticholinergic and sedative effects. maprotiline. irreversible retinopathy. antidiarrhealPossibly inhibited absorption of oral prochlorperazine amantadine. doing so may lead to such adverse reactions as nausea. possibly masking of early symptoms of lithium toxicity MAO inhibitors. anticholinergics.or Mg-containing antacids. and tardive dyskinesia CNS depressants Additive CNS depression Dopamine peripheral vasoconstriction levodopa Inhibited antidyskinetic effect of levodopa LithiumReduced absorption of oral prochlorperazine. increased blood antidepressant levels. increased extrapyramidal effects. although the range is days to months * Instruct patient using a suppository to refrigerate it for 30 minutes or hold it under running cold water before removing the wrapper if it softens during storage * Caution patient on long-term therapy not to stop taking prochlorperazine abruptly. and increased risk of neuroleptic malignant syndrome related psychosis in the elderly because of an increased mortality risk. arrhythmias. and urine retention phenytoin Possibly inhibited phenytoin metabolism & increased risk of phenytoin toxicity Ondansetron (Zofran) ACTION • Antiemetic thiazide diuretics Possibly potentiated hyponatremia and water intoxication NURSING PRECAUTIONS *Prochlorperazine shouldn’t be used to treat dementia- . severe constipation.INTERACTIONS Drug: Al. antihistaminePossibly intensified anticholinergic adverse effects amphetamines Decreased stimulant effect of amphetamines. decreased antipsychotic effect of prochlorperazine anticonvulsants Lowered seizure threshold beta blockers Increased risk of additive hypotensive effects. antidyskinetics. orthostatic hypotension. vomiting.

including mood and physical sedation NURSING PRECAUTIONS * Be aware that oral disintegrating tablets may contain aspartame. drowsiness. fatigue. sedation. It dissolves in seconds . cyclophosphamide Possibly altered blood levels of these drugs Alcohol  Increased stimulant and sedative effects. which is metabolized to phenylalanine and must be used cautiously in patients with phenylketonuria * Place disintegrating tablet on patient’s tongue immediately after opening package. constipation. hypoxia CONTRAINDICATIONS *none INTERACTIONS Drug: cisplatin.USES • Prevention of chemotherapyinduced & posteroperative nausea & vomiting • Bulimia • Spinal analgesic-induced pruritus • Levodopa-induced psychosis ADVERSE REACITONS *Headache.

constipation. nausea. or is diarrhea persists for more than 2 days. obstructive jaundice. *Used cautiously in patients with severe hepatic impairment or IBD. Pink Bismuth) ACTION • Antidiarrheal USES • Nausea • Diarrhea • Abdominal cramps • H. sedatives or hypnotics increased risk of CNS depression Antidepressants increased cholinergic blocking adverse reactions MAOIs increased risk hypertensive crisis . salmonella and shigella. coli. lightheadedness CONTRAINDICATIONS *In patients with diarrhea associated with E. opioids. patients with pseudomembranous colitis. INTERACTIONS Drug: Antihistamines.Bismuth (Pepto-Bismol. pylori infection with duodenal ulcer ADVERSE REACTIONS *Dry skin and mucous membranes. children younger than 2 years of age.

 Psychosis refers to a group of symptoms that affect mood and behavior ✔ Hallucinations (false sensation or perceptions have no basis in reality) ✔ Delusions (false beliefs that cannot be changed with reason) ✔ Disorganized speech ✔ Behavior disturbances. Zyprexa. Abilify. ➢ ANTIPSYCHOTIC DRUGS (Lithium.NURSING PRECAUTIONS *Do not exceed the recommended dosage *If diarrhea persists for more than 2 days. call MD. Compazine. Seroquel. social withdrawal ✔ Flatten affect (absence of an emotional response to any situation/condition) . Risperdal) ○ Antipsychotic medications are administered to patients experiencing a psychotic disorder. Haldol.

which can lead to bizarre delusions Antipsychotic diminished the frequency and intensity of hyperactive (manic) episodes ✔ . the person experiences altered thought processes.○ ○ Anhedonia (finding no pleasure in activities that are normally pleasurable Antipsychotics are usually given to bipolar disorder patients during an manic phase:  During the manic phase.

lethargy.Lithium Haloperidol Prochlorperazine Aprpiprazole (Haldol) (Compazine) (Abilify) Olanzapine Quetiapine Risperidone (Zyprexa) (Seroquel) (Risperdal) ACTION • Antipsychotic USES • Acute & Chronic psychoses. mouth or jaw and sometimes the extremities. urticaria. promotes smooth and uninterrupted movement of carious muscle groups. photophobia. such as schizophrenia • Bipolar (manic-depressive) illness • Agitated behaviors associated with dementia ADVERSE REACTIONS *Sedation. hyperactivity. characterized by: rhythmic. Causes abnormal muscles movements: ○ Parkinson-like symptoms: fine tremors. muscle rigidity. face. involuntary dyskinetic movements. slowness of movement. involuntary movements of the tongue. masklike appearance of face. photosensitivity *Possible behavioral changes: possible increase of intensity of psychotic symptoms (paradoxical effects). paranoid reactions. slurred speech and unsteady gait ○ ○ Akathsia: extreme restlessness and increased motor activity Dystonia: facial grimacing and twisting of the neck into unnatural positions ✔ Tardive Dyskinesia (TD): a syndrome consisting of irreversible. hypotension. dry mouth. headache. The tongue may protrude and there may be chewing . nasal congestion. agitation and confusion ✔ Extrapyramidal Syndrome (EPS): a group of adverse reactions that affects posture.

liver impairment. decreased renal function and peptic ulcer disease. those who are severely depressed. have bone marrow depression. involuntary movements + fever = NMS (FATAL) movements. it is best to use the smallest dose & shortest duration of treatment that produces satisfactory clinical response. since increased urination & fluid removal Li combined with other antipsychotics  increased risk of Li toxicity Alcohol  increased risk for CNS depression CONTRAINICATIONS *Comatose patients. once the drug is discontinued recover occurs within 7-10 days. characterized by a combination of EPS effects. ○ Shaking. It typically occurs within 1 month after the ○ antipsychotic drug regimen is begun. INTERACTIONS Drug: Anticholingeric drugs  increased risk for TD & psychotic symptoms Antacids decreased effectiveness of lithium Loop Diuretics  increased risk for lithium toxicity. pucking of the mouth and facial grimacing. disease. glaucoma. coronary artery disease. epilepsy.Because of the risk of TD. NMS is p otentially fatal and requires intensive symptomatic treatment. or severe hypo OR hypertension *Antipsychotics should be used only when clearly needed and when the potential benefit outweighs any potential harm to the fetus *Used cautiously in patients with respiratory disorders. Pakinson’s NURSING PRECAUTIONS *In combative patients or those who have serious manifestations of acute psychosis (example: hallucinations or lost of contact with reality). hyperthermia and autonomic disturbances. ✔ Neuroleptic Malignant Syndrome (NMS): a rare reaction. parenteral administration . prostate hypertrophy.

Special Considerations for Lithium *It is rapidly absorbed after oral administration. lack of coordination  2-3 mEq/L= Giddiness. vomiting. confusion. thirst and polyuria. tinnitus.2 mEq/L • Lithium Toxicity  1. twitching of limbs  >3 mEq/L= multiple organ/system failure.may be repeated every 1 to 4 hours until the desired effects are obtained. blurred vision. hypotension. spasticity. -Because drug metabolism and excretion are altered in elderly or debilitated patients. *Desirable serum Li levels = 0. weakness. agitation/manic behavior. drowsiness. The nurse monitors the patient closely for cardiac arrhythmias or rhythm changes or hypotension *Gerontology: older adults are at increased risk for Li toxicity because of a decreased rate of excretion. vertigo. nausea. doses may be instituted at one-half to one-third the recommended dose for younger adults and increased more gradually than in younger adults. seizures.5-2 mEq/L = N/V/D. Lower dosages may be necessary to decrease the risk of toxicity.6 – 1. muscle group twitching. *Most common adverse reactions include: tremors. arrhythmias. coma .

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