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increase the release of catecholamines

JOHN J. TEODORO PTRP, RN (NE from stored sites in nere terminals)
Block the re-uptake of dopamine & NE
following release into the synapse, &
inhibit the action of MAO
Increase stimulating effect on cerebral
cortex & RAS
Librium watch for signs of leukopenia,
Anticholinergic med
Equanil metabolizes extensively in the liver &
benztropine mesylate (Cogentin), biperiden
interferes w/ liver function tests.
HCl (Akineton) Trihexyphenidyl HCl (Artane),
- decreases PT if on coumadin
scopolamine, atropine
Atarax - does not cause tolerance & can be
*Block cholinergic receptors in the CNS,
thereby suppressing
temporarily when other anti-
acetylcholine activity
*A/R: blurred vision, dry mouth & secretions,
agents have been abused
urinary retention,
Serax useful for treating elderly clients. Does
constipation, restlessness & confusion
not rely on liver for metabolism
*Client to have regular eye check up for
increase in IOP
*Avoid aspirin, caffeine, smoking & ROH to
decrease gastric
*treat grandmal seizures ; tonic-clonic
*diazepam is DOC for Rx of STATUS
Beta adrenergic Blockers
*clorazepate is use w/ other
*Inhibit response to beta-adrenergic
antiepileptic agents to control partial seizures
*Block release of epi & NE thus decreasing HR
*Used to depress abnormal neuronal
& BP
charges & prevent spread of seizures
*Used for angina, dysrhythmias, prevention of
*also used to treat dysrhythmias
MI & glaucoma
*A/R: gingival hyperplasia, alopecia,
*A/R: bradycardia, hypotension, weakness &
hyperglycemia, blood dyscracias
*Seizure precaution & dental hygiene
*Hold if BP & HR not within parameters
*Give IV with normal saline & never
prescribed by MD
with dextrose
*Not to D/C meds abruptlyrebound HPN,
tachycardia, angina
*Early signs of hypoglycemia such as
tachycardia & nervousness can be masked by
these drugsmonitor blood sugar
BETA- BLOCKING AGENTS anesthetics to promote prolonged anesthetic
BLOCKING AGENTS decreased blood flow to area
-acebutolol (Sectral) Adrenergic Agonist
-atenolol (Tenormin, Atenol, isoproterenol (Isuprel)
Premorphine) *Stimulates beta receptors & used for cardiac
-metoprolol (apo-metoprolol, betaloc) stimulation &
BETA1 & 2 ADRENERGIC (nonselective) bronchodilation
BLOCKING AGENTS norepinephrine (Levophed)
-nadolol (corgard) *Stimulates heart in cardiac arrest
-pindolol (visken) *Vasoconstricts & increases BP during
-propranolol( inderal, novopranol) hypotension & shock
-timolol (blocadren, betin, temserin) *A/R: tachycardia, angina, restlessness
*If extravasation occurs, infiltrate with normal
Calcium channel blocker saline &
verapamil (Calan, Isoptin), nifedipine phentolamine (Regitine)
(Procardia) Antianginal meds
felodipine (Plendil), diltiazem (Cardizem) NITRATES
*Decrease cardiac contractility by relaxing nitroglycerin (Nitrostat, Nitrolingual)
smooth muscle nitroglycerin ointment 2% (Nitrol, Transderm-
and the workload of the heartthus Nitro)
decreasing need for O2 *Produce vasodilation & improved myocardial
*Promote vasodilation of coronary & O2 consumption
peripheral vessels *C/I in client with severe hypotension
*A/R: bradycardia, hypotension, dizziness & *A/R: H/A, orthostatic hypotension, dizziness,
lightheadedness weakness & faintness
*Instruct client how to take HR & to inform SUBLINGUAL:
MD if dizziness *Offer sips of H2O since dryness may inhibit
Persists absorption
*Leave under tongue until fully absorbed, not
Adrenergic agonist swallowed
dobutamine (Dobutrex) *Take 1 tab for pain ff q5 mins for a total of 3
*Increases myocardial force & C.O. through doses. If pain not relieved in 15 minutes, seek
beta receptors MD help.. may indicate MI
stimulation *Stinging/burning feeling means tablet is fresh
*Used in clients with CHF TOPICAL
dopamine (Intropin) *Remove ointment from previous dose, rotate
*Increases BP & C.O. & increases renal outflow sites & avoid
through its touching ointment & hairy areas
action on alpha & beta receptors *Squeeze ribbon into prescribed length on
*Treat mild renal failure due to decreased C.O. applicator paper
epinephrine (adrenalin) *Sites: chest, back, abdomen, upper arm &
*Cardiac stimulation during cardiac arrest, anterior thigh
bronchodilation TRANSDERMAL PATCH
asthma & allergy, mydriasis *Apply patch to hairless area, using new patch
*Promotes vasoconstriction when combined & different
with local site every day
*Remove patch after 12-14 hours, allowing 10- *Used for thrombosis, pulmonary embolism &
12 patch- MI
free hours daily to prevent tolerance *C/I in active bleeding except in disseminated
*Stand away from microwave ovens intravascular
Digitalis coagulation (DIC), bleeding disorders, ulcers
DIGITALIS TOXICITY *A/R: hemorrhage, hematuria, epistaxis,
* loss of apetite, nausea, extreme ecchymosis,
fatigue, weakness of the arms & legs, bleeding gums, thrombocytopenia
psychiatric disturbances (nightmares, heparin Na (Liquaemin Na)
agitation, listlessness, or hallucination) or *Prevents thrombin from converting
visual disturbances ( hazy, or blurred vision, fibrinogen to fibrin
difficulty reading & green color) *Prevents thromboembolism
N.I. *Therapeutic dose does not dissolve clots, but
1. Take APICAL PULSE 1 full minute prevents
*dont give for Adult <60/min; new thrombus formation
child < 90 bts/min *Blood levels: normal APTT is 20-36 seconds;
*monitor potassium level maintain APTT is 1.5-2.5 times normal; APTT
specially diuretics therapy should be measured q 4-6H during
digoxin (Lanoxin) initial therapy & then daily
*Inhibit sodium-potassium pump
*positive inotropic action heparin Na
*negative chronotropic action *Monitor clotting time; normal is 8-15
*A/R: anorexia, N/V, visual disturbances minutes; maintain
*Monitor serum therapeutic level 0.5-2.0 clotting time 15-20 minutes
ng/ml; increased *Observe for signs of bleeding
risk of toxicity in clients with hypokalemia *Inject SQ into the abdomen with 25-28g at 90
*Used for CHF, atrial tachycardia, atrial degrees
fibrillation & flutter angle; dont aspirate or rub injection site
*Increase K+ rich food: fresh & dried fruits, *Antidote is protamine SO4
fruit juices, warfarin Na (Coumadin)
vegetables & potatoes *Decreases prothrombin activity & prevents
*Monitor HR & hold if below 60 & above 100 the use of vitamin K by the liver
(adults) *Used for long-term anticoagulation
*Antidote: digoxin immune FAB (Digibind) *Prolongs clotting time & monitor PT
*Life threatening toxicity: ventricular (prothrombin time)
tachycardia, fibrillation, severe sinus *Used mainly to prevent thromboembolitic
bradycardia conditions such
*80% DIGOXIN excreted by kidneys; half life is as thrombophlebitis, pulmonary embolism,
36-120H embolism
*90% DIGITOXIN metabolized by liver; half life caused by heart valve damage, atrial
is 120-210H fibrillation & MI
Anticoagulants *Given 2-3 months after an MI to prevent DVT
*Prevent the extension & formation of clots by warfarin Na (Coumadin)
inhibiting *Average PT is 9.6 to 11.8 seconds & normal
factors in the clotting cascade & decreasing INR is 1.3-2.0
blood Goal is to raise the INR to 2 to 3
coagulability *Observe for signs of bleeding
*Antidote: Vitamin K (AquaMEPHYTON)
THROMBOLYTIC MEDS Antacids and Mucousal Lining protectives
*Monitor for bleeding, hypotension &
tachycardia *react with gastric acid to produce neutral
*Avoid injections; apply pressure to puncture salts or salts of low
site for 20-30 minutes acidity
*Handle clients minimally & let clients use *inactivate pepsin and enhance mucosal
electric razors & brush teeth gently protection but do not coal ulcer to protect
*Antidote: aminocaproic acid (Amicar) from acid & pepsin
*used for patients with PUD & GRF
Respiratory Drugs (gastroesophageal reflex disease)
*antacid tablets should be chewed and
Bronchodilator followed with glass of H2O or milk
* Used for allergic rhinitis, acute *administer 1 hour apart from other meds to
bronchospasm, acute & chronic asthma, minimize the chance of drug interactions
bronchitis, COPD, emphysema
Caution with clients with glaucoma & sucralfate (Carafate)
HPN *creates a protective barrier against acid &
* A/R: palpitations, tachycardia, nervousness, pepsin
tremors, restlessness & HA *given po & on an empty stomach
Give RTC to maintain therapeutic *A/R: constipation, impede absorption of
blood level warfarin Na,
* Avoid caffeine products phenytoin, theophylline, digoxin & some
ANTIHISTAMINES administer 2 hours apart from these meds
astemizole (Hismanal), diphenylhydramine magnesium hydroxide (Milk of Magnesia)
(Benadryl) *rapid acting & A/R is diarrhea
loratadine (Claritin) *usually combined with aluminum hydroxide
*Histamine antagonists or H1 blockers; to counter diarrhea
compete with histamine (MAALOX)
for receptor sites preventing histamine aluminum hydroxide (Amphojel, Alu-cap)
response thus *slow acting & A/R: constipation
constricting smooth muscles *with significant Na contentcaution in clients
*Decrease nasopharyngeal secretions & with HPN &
decreases itching which heart failure; reduce effect of tetracyclines,
causes sneezing warfarin Na &
*Used for common colds, rhinitis, urticaria, digoxin
nausea & vomiting, *reduce phosphate absorption
motion sickness & sleep aid
*CNS depressant with ROH, narcotics, calcium carbonate (Tums)
barbiturates & sedatives *rapid acting & A/R: constipation
*Caution with COPD clients & Benadryl C/I in sodium bicarbonate
clients with *rapid onset
glaucoma *A/R: liberates CO2 & increases intra-
*A/R: dizziness, dry mouth, blurred vision abdominal pressure
causing flatulence, caution in clients with HPN
& heart
GIT DRUGS failure, systemic alkalosis in clients with renal

*suppress secretion of gastric acid

*indicated for PUD & heart burn & for GRF
cimetidine (Tagamet)
*taken on an empty stomach
*administered 1 hour apart from antacids
*crosses the blood-brain barrier & may cause
mental confusion, agitation, anxiety &
*dosages of these meds are reduced when
taken together:
warfarin Na, phenytoin, theophyllin &
ranitidine (Zantac)
*not affected by food
*S/E are uncommon & does not cross blood-
brain barrier