• EFFECTS:  Analgesic (mild to moderate pain) Antipyretic NO anti-inflammatory action NO platelet action • THERAPEUTIC LEVEL: 10 – 30 mg/dL • ANTIDOTE: Acetlycysteine (Mucomyst)

ADVERSE EFFECTS: hepatotoxic

• • • STREPTOMYCIN/ GENTAMYCIN Obtain Peak and trough level o Peak level – 30 minutes after taking the drug o Trough level – 30 minutes before the next dose Adverse effects:  Neurotoxic

Ototoxic  therapeutic to Meniere’s disease to relieve from vertigo (but this is the last resort because it will lead to permanent deafness)  Nephrotoxic  Monitor BUN

3. ANESTHESIA • Epidural anesthesia  Hypotension • Spinal anesthesia  Spinal headache

Action Onset Use WARFARIN SODIUM (Coumadin) Blocks synthesis of vitamin K and clotting factors thus preventing prothrombin synthesis 2 to 5 days • Thrombosis and embolism • Atrial fibrillation with embolization • Adjunct in treatment of coronary occlusion Oral Milligrams Vitamin K/ Phytonadione (AquaMEPHYTON) Prothrombin time (PT) Normal value:11 to 13 seconds Long term therapy Slow HEPARIN (Hepalean) Blocks conversion of prothrombin to thrombin 30 seconds to 1 minute • Thrombosis and embolism • Prevention of clotting in heparin lock sets, blood samples and during dialysis • Treatment of disseminated intravascular coagulation SQ, IV (DO NOT give IM, may lead to hematoma and pain) Units Protamine sulfate Partial Thromboplastin Time (PTT) Normal value: 60 to 70 seconds; 2 to 2.5 times the control Activated Partial thromboplastin time (APTT) Normal value: 30 to 45 seconds; 1.5 to 2 times the control Short term therapy Quick

Route Expressed in Antidote Laboratory Test Usage Effect

Coumadin and Heparin CAN BE GIVEN together Heparin-induced side effect: thrombocytopenia 1 | TOP DRUGS

ANTIDEPRESSANTS • • • 2 weeks interval in shifting from one type of anti-depressant to another Antidepressant effect: 2 – 4 weeks Tricyclic Antidepressants (TCA) – increases norepinephrine and/or serotonin in CNS by blocking the reuptake of norepinephrine by presynaptic neurons 1. Garlic. Antibiotics 5G – Ginseng. Alcohol. coronary artery thrombosis. dry mouth  NURSING CONSIDERATIONS:  Check BP and PR  Give drug at BEDTIME  Changing from TCA to MAOI. serotonin) causing CNS stimulation 1. Fluoxetine (Prozac) 2. dry mouth. but not of norepinephrine 1. Imipramine (Tofranil) 2. MI  SIDE EFFECT: bleeding  Start therapy as soon as possible after thrombus appears as thrombi older than 7 days react poorly to streptokinase  Heparin is discontinued before streptokinase is started  IM injections are contraindicated  ANTIDIOTE: aminocaproic acid (Amicar)  Examples: streptokinase (Streptase) – PROTOTYPE. constipation. isocarboxazid (Marplan) 3. headaches. Amitriptyline (Elavil)  SIDE EFFECTS: hypotension. patient must discontinue MAOI for 2 weeks Changing from SSRI to MAOI. sedation • Selective Serotonin Reuptake Inhibitor (SSRI)  inhibits CNS neuron uptake of serotonin. deep vein thrombosis. sexual dysfunction  NURSING CONSIDERATIONS: o Give drug in the MORNING o Takes 4 weeks for full effect o Changing from MAOI to SSRI. reteplase (Retavase). Sertraline (Zoloft)  SIDE EFFECTS: hypotension. patient must discontinue SSRI for 5 weeks o Monitor for weight o Provide oral hygiene • Monoamine Oxidase Inhibitor (MAOI) – acts as a psychomotor stimulator or psychic energizers. Ginger. blurred vision. weight loss. urinary retention. phenelzine (Nardil)  SIDE EFFECTS: Hypertensive crisis – happens if the drug is taken with tyraminecontaining foods 2 | TOP DRUGS . agitation o Stupor. urokinase (Abbokinase). Antihistamines. arrhythmias. tenecteplase (TNKase). tranylcypromine (Parnate) 2. patient must discontinue TCA for 14 days  2 to 4 weeks needed before the full therapeutic effect happens  TCA OVERDOSE (anticholinergic toxicity): o Coma. Ginko biloba. Guiafenesin • • ANTICOGULANT – prevents clot formation THROMBOLYTICS – dissolves clot  USE: pulmonary embolism.• WHAT ARE THE DRUGS THAT ENHANCE THE EFFECTS OF ANTICOAGULANTS? 4A – Aspirin. insomnia. norepinephrine. arrhythmias. anistreplase (Eminase) 5. blocks oxidative deamination of naturally occurring monoamines (epinephrine. convulsion o Ataxia. alteplase (Activase).

beer) o Smoked fish. Amantadine (Symmetrel) 2. chicken and beef liver o Drinks that are fermented (wine. swiss). Benadryl • 8. Artane 4. Neck stiffness Tachycardia Constipation Orthostatic hypotension Photophobia. Levodopa (L-dopa) 3. Levodopa-Carbidopa (Sinemet) Anticholinergic Drugs (decrease Acetylcholine) 1. yeast ALLOW: cottage and cream cheese Monitor BP Therapeutic effect are achieved within 10 days to 4 weeks    6. abdominal cramps NURSING CONSIDERATIONS:  DO NOT give IM or SQ. Chlorpromazine (Thorazine) • SIDE EFFECTS:  HYPOtension  leukopenia (sore throat) 3 | TOP DRUGS . clients with calcium oxalate calculi o SIDE EFFECTS: hepatotoxic PROBENECID (Benemid)/ SULFINPYRAZONE (Anturane) – uricosuric agents: reduces uric acid in the blood by increasing its renal excretion • 7. ANTI-GOUT • COLCHICINE (Novocolchine)  anti-inflammatory o o SIDE EFFECTS. Haloperidol (Haldol) 2. ANTI-PARKINSONS • Dopaminergic Drugs (increase dopamine) 1. Akineton 2. this may lead to irritation  Administer drug after meals  No more than 12 tablets should be given in a 24 hour period • ALLOPURINOL (Zyloprim)  prevent production of uric acid by inhibiting the enzyme xanthine oxidose o USE: prophylactic for attacks of gout.o o o o o  Sweating Headache. sausage o Pickled foods (herring) o Overripe foods o Raisins o Tea o Yogurt. diarrhea. Cogentin 3. HPN Urinary retention Nausea. dilated pupils Agranulocytosis AVOID tyramine or tryptophan containing foods: o Aged meat. avocado o Banana. ANTI-PSYCHOTIC (MAJOR TRANQUILIZERS) • USE: Schizophrenia 1. soy sauce. cheese (cheddar. coffee. aged. beans o Chocolates. sour cream.

high risk for bleeding AVOID Aspirin in patients with viral infection to prevent Reye’s Syndrome AVOID Aspirin with OHA  causes hypoglycemia ATROPINE SULFATE (Atropair. renal and liver functions DO NOT give with any anticoagulant (Coumadin. Kawasaki disease. nadolol (Corgard). HYPERtension) pink-red urine (normal: thorazine) 9. metoprolol (Lopressor). pinolol (Visken). AtroPen) • • • block neurotransmitter acetylcholine and inhibits parasympathetic actions USE: pre-op medication to reduce secretions and bradycardia. It may cause additive effect. timolol (Blocadren). rheumatoid arthritis Antipyretic  fever Analgesic  mild to moderate pain Aspirin toxicity  Tinnitus – early sign of salicylism  Metabolic acidosis – late sign of salicylism  Epistaxis.BRONCHODILATOR • • USE: bronchospasms. Prothrombin time. aminophylline (Truphylline) THERAPEUTIC LEVEL OF THEOPHYLLINE: 10 – 20 mcg/ml (mg/dl) SIGN OF THEOPHYLLINE TOXICITY:  Tachycardia 4 | TOP DRUGS • • . ANTIDOTE: activated charcoal (can also give Ipecac syrup to induce vomiting of aspirin) Give the drug with full stomach after meals Aspirin is ulcerogenic Monitor CBC. prostatic hypertrophy B 11. • BETABLOCKERS Example: propanolol (Inderal). Ventolin). produces mydriasis CONTRAINDICATED in acute glaucoma. timolol maleate (Timoptic) • MODE OF ACTION: inhibit sympathetic stimulation of beta receptors in the –  HEART – decreasing myocardial oxygen consumption and demand by: decreases heart rate and *** decreases force of myocardial contraction  EYES – decreases intraocular pressure (IOP) by  decreasing aqueous humor formation and increases aqueous humor outflow Change of position gradually Take pulse before taking drug***   • • 12.  NEUROLEPTIC MALIGNANT SYNDROME (HYPERthermia/ diaphoresis. metaproterenol (Alupent)  XANTHINES: theophylline (Theo-Dur) – PROTOTYPE. nephrotoxic • • • • • • • 10. Heparin). ASPIRIN/ SALICYLATES/ ACETYLSALICYLIC ACID • EFFECTS:  Antiplatelets  reduce risk of myocardial infarction and transient ischemic attack    • Anti-inflammatory  rheumatic fever. asthma EXAMPLES:  BETA-ADRENERGIC: abuterol (Proventil.

clonazepam (Klonopin). potatoes. prunes. triazolam (Halcion). midazolam (Versed). Triamterene CAI. nuts. arrhythmia. lorazepam (Ativan) 14. activities that requires alertness • May cause physical dependence • Oral form should be given BEFORE MEALS • Examples: alprazolam (Xanax). chlordiazepoxide (Librium). Midamor) Triamterene (Dyrenium) Hydrochlorothiazide Chlorothiazide (Diuril) Metolazone INDICATIONS Meniere’s disease. tomatoes. sign of hypokalemia (weakness. broccoli. • DIGOXIN (Lanoxin) Effects: o o (+) inotropic – increases FORCE OF CONTRATION  increase cardiac output (-) chronotropic – decreases HEART RATE  decrease oxygen demand of the heart muscles • • Digoxin toxicity – nausea. OPEN glaucoma Potent diuretic Increased ICP Warm solution to avoid crystallization Avoid potassium-rich foods (banana. muscle cramps) Antidote: Digibind 15. Oranges. HPN Thiazide and Thiazide-like Proximal tubule HPN (Not effective for immediate dieresis) • • K-sparing: K-wasting: Spironolactone. • • DIAZEPAM (Valium) USE: Drug of choice for status epilepticus EFFECTS:  Anxiolytic  Anti-convulsant  Muscle relaxant • DO NOT MIX with other drugs • DO NOT withdraw abruptly • AVOID alcohol. spinach. smoking. DIURETICS SITE OF ACTION Proximal tubule Loop of Henle Glomerul us Distal tubule EXAMPLES Acetazolamide (Diamox) Furosemide (Lasix) Bumetanide (Bumex) Mannitol Osmitrol Glycerin Urea Spironolactone (Aldactone) Amiloride (Modiuretic. CHF. yellow color vision. Amiloride. Osmotic Thiazides 5 | TOP DRUGS . peaches) SPECIAL NURSING INTERVENTIONS CLASSIFICATIONS Carbonic Anhydrase Inhibitors Loop Diuretics Osmotic Diuretics Potassium Sparing Mild diuretic.•  nausea and vomiting FOODS TO BE AVOID  ICE TEA – caffeine and caffeine containing foods because Theophylline is a xanthine derivative which has same effect with caffeine D 13. Loop. flurazepam (Dalmane). clorazepate (Tranxene).

NURSING 1.5 ml (1/2 tsp) 4 ml (3/4 tsp) ½ tablet 1 tab 5 ml (1 tsp) 7. • • • • HERBAL DRUGS that causs BLEEDING GINKO BILOBA GINGER GARLIC GINSENG I 17.5tsp) DROPS Ferrous sulphate 25 (25 mg elemental iron per ml) 0.000 IU 200. IMCI DRUG: VITAMIN A AGE VITAMIN A CAPSULES 100. • IMCI DRUGS: IRON 1 dose daily x 14 days TABLET Ferrous sulphate 200mg + 250 mcg Folate (60 mg elemental iron) THY SYRUP Ferrous sulphate 150 mg per 5 ml (6 mg elemental iron per ml) 2.5 ml 2 ml AGE or WEIGHT 2 to 4 months (4 to <6 kg) 4 to 12 months (6 to <10 kg) 1 to 3 years (10 to <14 kg) 3 to 5 years (14 to <19 kg) 18. 3.6 ml 1 ml 1. IMCI DRUG: MEBENDAZOLE/ ALBENDAZOLE Albendazole 400 mg tablet ½ or 200 mg tablet 1 Mebendazole 500 mg tablet 1 1 AGE or WEIGHT 12 months to 24 months 24 months to 59 months 6 | TOP DRUGS . INTERVENTION Monitor blood pressure (first/ before) and weight (second/ after) Administer in the MORNING Administer with FOOD EVALUATION: for effectiveness of therapy • Weight loss • Increased urine output • Resolution of edema • Decreased congestion • Normal BP H 16.000 IU 1 ½ capsule 2 capsules 1 capsules 6 months to 12 months 12 months to 5 years 19. 2.5 ml (1.

20. Stress. IRON SUPPLEMENTS • SIDE EFFECTS: dark stools (tarry stool). Humulin R INTERMEDIATE-ACTING: NPH/ Neutral Protamine Hagedorn (Insulin Isophane Suspension). • INSULIN MODE OF ACTION: decreases blood sugar by –  Increasing glucose transport across cell membranes  Enhancing conversion of glucose to glycogen TYPE RAPID-ACTING: Regular. Inject air 1st – cloudy) Inject air to NPH Inject air to Regular Aspirate Regular Aspirate NPH Most common used: U100 (1) U40 (2) 21. DO NOT massage • BEST given with empty stomach • Citrus juice is AVOIDED with iron elixir preparation 7 | TOP DRUGS . Gently roll vial in between palms  Cold insulin  lipodystrophy STORAGE:  In room temperature – last for 1 month  Refrigerated once opened – last for 3 months ADJUSMENT OF DOSE:  increase insulin requirement  Infection. constipation. Illness  decrease insulin requirement  Breast feeding (Antidiabetic effect) Mixing of insulin: (Aspirate 1st – clear. Humulin N LONG-ACTING: Ultralente (extended insulin zinc suspension) Humulin U DESCRIPTION Color: Clear Route: IV. SQ Color: Cloudy Route: SQ Color: Cloudy Route: SQ ONSET 30 min – 1 hr 1 – 2 hrs PEAK 2 – 4 hrs 6 – 8 hrs DURATION 6 – 8 hrs 18 – 24 hrs 3 – 4 hrs 16 – 20 hrs 30 to 36 hrs • • • • • • • • • • (1) (2) (3) (4) • PEAK TIME – time of hypoglycemic episodes 1ml of tuberculin = 100 units of insulin U100 insulin syringe is – 100 units Administer insulin in room temperature ROUTE: SQ  Administer insulin at either 45 degree (for skinny patient) or 90 degrees (for fat patients) Area:  Abdomen – fastest absorption  Deltoid  thigh  buttocks AVOID:  massage and apply compression (increase absorption)  aspirate after injection  shake. tomato) and straw IM: Z-track method. tomato) Liquid: give with citrus juice (orange. abdominal cramps • Tablet: give with citrus juice (orange.

5 – 1. • • MAGNESIUM SULFATE • tocolytic agent USE: premature labor. • • • • LITHIUM Anti-mania Therapeutic Level: 0. anticonvulsants in pregnancy induced hypertension (PIH) Check: o deep tendon reflex (DTR) – FIRST reflex lost with CNS toxicity o Check RR (at least >12 breaths/ min o Check urine output (at least 30 mL/ hr) ANTIDOTE: calcium gluconate • 25.MORPHINE SULFATE (Duramorph) • EFFECT: induce sedation. diarrhea) PREPARATIONS: o Tablets: 300. pain relief in myocardial infarction • • • DECREASES preload and afterload DECREASES workload SIDE EFFECTS of Morphine SO4  Miosis  Orthostatic hypotension  Respiratory depression  Produces tolerance and dependence  Hyperglycemia  Increase urinary retention/ constipation. and 600 mg. and 450mg. o Syrup: 300 mg/5 ml Maintain: o increase fluid (3L/day) o Increase Na (3 gm/day) • M 24.5 mEq/L Lithium toxicity (n/c. CEPHULAC) Laxative SIDE EFFECT: ammonia binder (therapeutic to patient with hepatic encephalopathy) 23.  Nausea and vomiting  Euphoria  Sedation/ dizziness 8 | TOP DRUGS . analgesia and euphoria • INDICATION: moderate to severe pain. • • METRONIDAZOLE (FLAGYL) Anti-amoeba AVOID alcohol (Metronidazole + Alcohol = Disulfiram-like effect) 26. o Capsules: 150.L 22. abdominal cramps. • • LACTULOSE (DUPHALAC. 300. anorexia.

notify physician immediately  SIGN OF POTENCY: burning sensation under tongue  Drink water first BEFORE taking drug OINTMENT  applied to a hairless or clipped/ shaved area  new site should be used with each new dose  use ruled applicator paper that comes with ointment to measure dose  wear gloves during application  leave applicator on site and cover it with plastic wrap and secure it with tape TRANSDERMAL PATCH Apply a patch once a day only Rotate site Place patch in non-hairy area Determine a base region and remove the old patch Wear gloves during application IV form: 5 mcg/ min  dilute IV nitroglycerine in 5% dextrose or 0. It will discontinue with long term use. • • NONI JUICE Morinda citrifolia High in fibers O 9 | TOP DRUGS . AVOID alcohol. alcoholic beverages.6 mg  No more than 3 tablets should be taken in a 15 minute period (one tablet every 5 minutes). hot baths Carry drug at all times DO NOT administer nitrates with sildenafil (Viagra). • NITRATES AND NITROGLYCERINE (Nitro-bid.15 – 0. smoking. dizziness Other Related drugs: isosorbide dinitrate (Isordil). both drugs are vosadilator which may lead to HYPOTENSON N • •      • •    •      28. sedatives. muscle relaxants • Change position gradually 27.• • • Assess client’s pain before giving medication Check before and after the respiration May lead to tolerance  FIRST SIGN of tolerance is decrease duration of effect of the analgesic • AVOID activities that require alertness. date bottle when opening discard after 6 months NURSING CONSIDERATIONS: Change position gradually to prevent dizziness HEADACHE is a sign that the drug is taking effect. flushing.9% sodium chloride and titrate every 3 to 5 minutes STORAGE: store in original dark glass container in a cool. CNS depressants. if pain not relieved after 15 minutes and 3 tablets. Nitrostat IV) • • • • MODE OF ACTION: vasodilator USE: angina pectoris and hypertension SIDE EFFECTS OF NITRATES: headache. Nitrodur. isosorbide mononitrate (Imdur) SUBLINGUAL form: 0. orthostatic hypotension. dry place.

• Sandostatin LAR® is given by intramuscular injection. This medication is generally given once every 4 weeks. • • • • PANCREATIC ENZYMES USE: aid in digestion.OCTREOTIDE (SANDOSTATIN) • • Inhibits GROWTH HORMONE. may turn urine pink. tachycardia. arrhythmias. or red-brown ADVERSE EFFECTS: hepatotoxic. Use soft.C. labor induction ADVERSE EFFECTS: uterine hyperstimulation. The preferred site for injection is the hip. Steven-Johnson’s syndrome DO NOT administer IM Give drug with NSS BEFORE AND AFTER (flushing) drug administration Provide oral hygiene. cystic fibrosis Give WITH MEALS*** Expected outcome of the drug is absence of steatorrhea EXAMPLES: pancreatin (Dizymes). bristled toothbrush Takes 7 to 10 days to achieve therapeutic serum level Therapeutic level: 10 – 20 mg/ dl • • • • 33.29. GLUCAGON. This medication may also be given intravenously. The injection sites should be rotated regularly. because it is painful given into the arm. • COMMON SIDE EFFECT: constipation 30.PHENYTOIN (Dilantin) • • • • USE: seizure SIDE EFFECT: gingival hyperplasia. INSULIN 2 formulations  Sandostatin®is a short acting version  Sandostatin LAR®is a long acting version. • Sandostatin LAR® should NOT be given by S. • Sandostatin® is given by subcutaneous injection  It may be necessary to take the shot several times a day. • • • • OXYTOCIN (Pitocin) • stimulate uterine contraction USE: postpartum bleeding. IV via piggyback and delivered with an infusion pump Observe fetal hypoxia or distress P 31. pancrelipase (Cotazym) 32. hypertension Given IM or IV. or IV routes. • STEROIDS EFFECTS:  Anti-inflammatory  Hormonal replacement S 10 | TOP DRUGS . red.

alcohol and caffeine. RR. methylprednisone (Solu. multiple sclerosis. dexamethasone (Decadron). BP (Increase) peristalsis. Rheumatoid arthritis. hypokalemia. 34.• • USE: USE: bronchial asthma. UO. prednisone (Strap red). osteoporosis  Short term: Immunosuppresant. Addison’s disease. SYMPATHETIC AND PARSYMPATHETIC SYMPATHETIC SNS (Adrenergic) Dumping Syndrome. contact health care provider. edema • Give with food • Watch out for infection • Taper the dose (abrupt withdrawal may lead to acute adrenal crisis) • Parenteral form: Give IM avoid SQ Oral form: Give it WITH food or milk. betamethasone (Celestone) • SIDE EFFECTS:  Cushing’s syndrome  Immunosuppression  therapeutic to AUTOIMMUNE DISEASES 9 like nephrotic syndrome. GERD Prostigmine Anticholinesterase “Sleep and digest” response Acetylcholine – slowly release but long acting (Decrease) HR. SLE. allergies)  causes GI irritation and ulceration  Long term: Adrenal insufficiency***. hypocalcemia. hyperthyroidism. people with infections or crowded place AVOID immobility to prevent osteoporosis AVOID crowd • DIET: Restrict sodium. BP (Decrease) peristalsis. secretions Pupil dilation (mydriasis) Bronchodilation Hyperglycemia PARASYMPATHETIC PNS (Cholinergic) Glaucoma. secretions Pupil constriction (miosis) Bronchoconstriction Diarrhea Urinary frequency Miosis (constriction) Bradycardia Bronchoconstriction Erection/ emesis L Salivation 11 | TOP DRUGS . UO. Take medication with breakfast (corresponds to biorhythms and reduces gastric irritation) • Wear medic alert bracelet • Isolation precaution • AVOID sunlight.medrol). • Adjust medications during periods of acute or chronic stress such as pregnancy or infections. for organ transplant. MG Atropine Cholinesterase “fight or flight” response (BIOAMINE THEORY) Epinephrine (Adrenaline) – faster release but short acting Norepinephrine Dopamine Serotonin (Increase) HR. high potassium foods • Carry extra medication during travel. allergies Examples: hydrocortisone (Cortisol). may cause gastric irritation Topical creams: DO NOT apply in broken skin and near eyes • Administer in the morning (before 9 am). RR.

decrease vascularity of the thyroid gland (for thyroidectomy preparation) Examples: Potassium Iodide Saturated Solution (Lugol’s solution)  Give at least 10 day before surgery  SIDE EFFECTS: o agranulocytosis (sore throat) o paresthesias o bleeding (inhibits vitamin K) Taper the dose Monitor vital signs (temperature. Peas.T 35. BP. Propyl-Thyracil). Propacil. IODIDES – inhibit secretion/ release of thyroid hormone. turnips  Spinach • THYROID ANTAGONISTS – used to decrease blood thyroid hormones A. iodine containing foods and sea foods ORAL form: dilute with water or juice (to improve taste) and use straw (to prevent discoloration) Examples: propylthiouracil (PTU. diarrhea  Taper the dose  Monitor vital signs (temperature. Pears  Raddish. cretinism (congenital hypothyroidism)  SIDE EFFECTS: insomnia. PR)  Give the drug in the morning (due to insomnia side effect)  CONTRAINDICATIONS:  Cabbage. Cauliflower  Peaches. methimazole (Tapazole)     12 | TOP DRUGS . ANTITHYROID DRUGS – inhibit synthesis of thyroid hormones B. BP. PR) AVOID iodine. • THYROID AND ANTI-THYROID DRUGS THYROID AGONISTS – used to increase blood thyroid hormones  LEVOTHYROXINE (Synthroid)  USE: hypothyroidism (myxedema). tachycardia.

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