Unlocked

Pharmacology Study Guide
A comprehensive study guide that will supplement your pharmacology

lectures and readings
By: Barbara O.
Instagram: @yournursingeducator
E-mail: yournursingeducator@gmail.com
*Disclaimer: This PDF was created by cross referencing several resources. It is not meant to replace your pharmacology lecture/study notes or drug guide book but is
instead a supplementary resource to aid in studying. While all attempts were made to ensure accuracy, there is no guarantee of validity or accuracy. The purchaser of
this guide assumes all responsibility for the use of this material.
Prepared exclusively for kevinellikkal@gmail.com Transaction: 0059269519

Table of Contents
General Pharmacology Information …………………………………………………………………………………… 3
Autonomic Nervous System Drugs ……………………………………………..……………………………………… 5
Neurological + Neuromuscular Drugs ………………………………………………………………………………. 10
Analgesics ………………………………………..………………………………………………………………………………. 16
Cardiovascular Drugs ……………………………….…………………………………………………………………….… 19
Respiratory Drugs ………………………………………………………………………………..…………………………… 27
Gastrointestinal Drugs ……………………………………………………………………………………………………… 30
Genitourinary Drug ………………………………………………………..………………………………………………… 35
Hematology Drug …………………………………………………………..………………………………………………… 38
Endocrine Drugs ………………………………………………………..…………………………………………………..… 41
Mental Health Drugs ……………………………………….………..…………………………………………………..… 44
Substances of Addiction …………………………………………………………………………………………………… 49
Immune, Antibiotic/Antiviral, & Anti-Inflammatory Drugs ……………………………………………..… 52
Fluids and Electrolytes …………………………………………..…..…………………………………………………..… 57
Quick Overview of Drugs………………………………………………………..…….………………………………..… 59
Common Medication Prefixes and Suffixes………………………………………………………………………. 64
Medication Calculation ………………………………………………………..………………………………………..… 65

GENERAL PHARMACOLOGY INFORMATION
Classifications
Therapeutic class: broad purpose of drug (e.g. antihypertensive is used for HTN)
Pharmacologic class: specific pharmacological approach within the therapeutic class (e.g. beta blocker, calcium channel
blocker, etc. are within the antihypertensive therapeutic class)
Generic name: actual name of the drug (e.g. amlodipine)
Trade name: the name that the drug is marketed under; several different ways to name the generic drug (e.g. Norvasc)
FDA Pregnancy Categories

A: good studies show no risk of fetal abnormalities; good human research – no risk
B: safe in animals but not adequate enough studies in humans OR adverse effect in animal studies but human studies do
not show increased risk; safe in animals but no studies in humans or no harm in humans
C: adverse effect in animals but no good studies in humans OR no animal studies and no human studies; no evidence of
good or bad in humans
D: risk to fetus but benefits may outweigh risk; evidence of harm in humans
X: causes fetal abnormalities; should not be used during pregnancy
Routes of Administration
Enteral – through GI tract
1. Tablets/Capsules – some can be enteric coated (prevents digestion by stomach acids)
2. Sublingual/Buccal – drug goes directly into blood due to amount of blood vessels in this area
3. Nasogastric/Gastric (G-tube)
Topical – applied to intended site of action
1. Transdermal
2. Ophthalmic
3. Otic
4. Nasal
5. Respiratory – administered via inhalation
6. Vaginal or rectal – suppositories, ointments, creams, gels; for irritation or infection
Parenteral – involves needles penetrating skin
1. Intradermal – rapid absorption due to vasculature; local anaesthetics or allergy testing
2. Subcutaneous – insulin, heparin, vaccines; no more than 1 mL to be injected
3. Intramuscular – faster than ID or SC; proper landmarking needed; no more than 3 mL to be injected
4. Intravenous – very rapid onset; continuous infusion, intermittent infusion, IV push
Pharmacokinetics
Absorption → distribution → metabolism → excretion
1. Oral → Stomach/small intestine → Absorbed/Carried by Portal Vein/blood supply → Liver (Primary Site of
metabolism in body) → Two possibilities:
1. Systemic Circulation → Tissue (Heart/Brain/Muscle/Kidney)
2. Excretion (Biliary) (Gall bladder/Bile ducts) → small-large intestines → Excretion (feces)
2. Parenteral/ Other routes → Directly absorbed into Systemic Circulation → Two possibilities:
1. Systemic Circulation → Tissue (Heart/Brain/Muscle/Kidney)
2. Excretion (Biliary) (Gall bladder/Bile ducts) → small-large intestines → Excretion (feces)
Adverse Effects
Unintended & undesired responses from drugs
1. Side effects
• Secondary to main therapeutic effect of drug & are expected
• Often occur at normal doses & are often unavoidable
• Often due to poor specificity/selectivity of drug.

o E.g. antihistamines block H1 histamine receptors preventing allergy symptoms (runny nose, watery eyes).
Side effects include drowsiness, dry mouth & urinary retention
2. Drug toxicity: any severe adverse drug event
• Often mediated by overdose
• Reactions are often extensions of therapeutic effect
o E.g. patient taking too much insulin = hypoglycemia
3. Allergic Reactions: mediated by immune system
• Requires prior sensitization where patient is exposed to allergen (ie. drug)
• Upon subsequent exposure, an allergic reaction occurs → mast cells release chemical mediators such as
histamine
• Reactions can vary from itching rash to life threatening anaphylaxis (bronchospasm, edema, & severe
hypotension)
• Intensity is independent of dosage size (ie. small dose can produce severe allergy)
4. Idiosyncratic Reaction: reactions that occur rarely & unpredictably
• Genetic polymorphisms account for majority of idiosyncratic reactions
• Examples of genetic polymorphisms that cause idiosyncratic reactions:
▪ CYP2C9: polymorphism decreasing metabolism (15% Caucasians)
▪ CYP2D6: poor metabolizers (10% African American/Caucasian). Patients do not experience pain relief when
taking codeine (drug metabolized by CYP2D6 → morphine)
▪ Glucose 6-Phosphate dehydrogenase deficiency (G6PDH): enzyme important in red blood cell metabolism.
Deficiency common in African/Middle-Eastern. Patients w/ deficiency may have red blood cell hemolysis w/
certain analgesics (ie. Aspirin) or anti-malarial drugs.
5. Carcinogenic Effects: ability of a drug to cause cancer
• Few drugs are carcinogenic
• Diethylstilbestrol (DES) used to be given to prevent spontaneous abortion is high risk pregnancies. Years later →
female offspring = vaginal/uterine cancer
6. Mutagenic Effects: changes DNA & often carcinogenic or teratogenic
• Drugs that aren’t carcinogenic or teratogenic may receive approval for use from regulatory agencies if there is
sufficient evidence of safety from preclinical studies
7. Teratogenic Effects: produce birth defects or impair fertility
• Defects include behavioural & metabolic defects
• Sensitivity to teratogens changes during development.
• Gross malformation typically occurs in the 1st trimester
• Exposure during 2nd + 3rd trimesters usually disrupts function as opposed to gross anatomy
• Drug transfer across placenta is greatest in 3rd trimester (surface area for transfer between maternal & fetal
circulation increases as placenta develops)
Main Neurotransmitters to Know

Acetylcholine (Ach) – found throughout nervous system; sends + received information between the motor neurons and
voluntary muscles (muscles you have conscious control over). Every movement you make depends on the release of Ach
from your motor neurons to your muscles
Dopamine (DA) – used by neurons to make voluntary movements + movements in response to emotion. Also plays role in
pleasure/reward system in brain. Also crucial in focus + memory
Norepinephrine (NE) – regulates mood + arousal (known as the stress hormone); Used in fight or flight - NE increases O2
to brain, increases HR and BP when needed, shuts down metabolic processes in stressful events to preserve energy, etc.
Serotonin – plays large role in mood, sleep, wakefulness, and eating behaviours
GABA + Glutamate – These 2 are the most plentiful neurotransmitters in the brain. GABA produces an inhibitory
postsynaptic potential; it decreases the likelihood that a neuron will fire an action potential. Inhibitory = allows for us to
stay calm/not overwhelm ourselves Glutamate produces an excitatory postsynaptic potential; it increases the likelihood
that a neuron will fire an action potential. Excitatory = contributes to learning + memory

AUTONOMIC NERVOUS SYSTEM DRUGS
Autonomic nervous system (ANS) regulates involuntary functions including heart rate, respiratory rate, and
digestion by balancing sympathetic nervous system (SNS) and parasympathetic nervous system (PNS)
Cholinergic drugs
Promotes action of neurotransmitter acetylcholine (Ach) = increase in Ach
Stimulates PNS – rest & relaxation
1. Cholinergic agonist
• Mechanism of Action (MOA): stimulates cholinergic receptors (mimics action of Ach) → allows
body to ‘rest & relax’
• Produces these effects: salivation, bradycardia, dilated blood vessels, constriction of bronchioles,
increased GI activity, increased contraction of bladder muscles, and constriction of pupils
• Used for: weak bladder, abdominal distention, constriction of pupils/high eye pressure, and
hypofunction of salivary gland
• Side effects: nausea (N)/vomiting (V)/diarrhea (D), blurred vision, bradycardia, hypotension, SOB,
urinary frequency, increased salivation, diaphoresis, corneal clouding, abdo pain/cramps, and
flushing
• Rarely administered by IV/IM route due to immediate breakdown by cholinesterase and due to
potential of cholinergic crisis (extreme muscle weakness + possible paralysis of respiratory
muscles)
Cholinergic drugs
Drug Indication Nursing
Acetylcholine Constriction of pupil during ocular Instill into anterior chamber of eye
→ Miochol E surgery
Bethanechol Urinary retention Potential for influx infection if the sphincter
→ Urecholine doesn’t relax
Carbachol Glaucoma, inhibition of Instill to anterior chamber of eye.
→ Miostat perioperative intraocular pressure Contraindicated in inflammation of anterior
chamber
Pilocarpine Xerostomia (dry mouth) Inform pt that blurred vision can impair driving,
→ Isopto particularly @ night
Carpine, Pilocar
2. Anticholinesterase drugs
• MOA: normally, Ach is broken down by the enzyme acetylcholinesterase. By destroying this
enzyme, more Ach accumulates → allows body to ‘rest & relax’
• Used to: decrease eye pressure, increase bladder tone, improve peristalsis, promote contraction
in myasthenia gravis, diagnose myasthenia gravis, and temporarily improve dementia
• Side effects: arrhythmias, N/V/D, seizures, headache, anorexia, pruritius, urinary frequency,
induction of preterm labor, SOB
• Build-up of Ach can precipitate cholinergic crisis (S/S: abdo cramps, N/V/D, pupillary miosis,
hypotension, increased secretions/salivation/perspiration, bronchospasm, bradycardia)
• When quick effect is needed = use IV/IM route
Anticholinesterase drugs
Donepezil Alzheimer’s Disease Important to take daily at same time (usually
→ Aricept before bed)

Edrophonium Diagnosing Myasthenia Gravis (MG), If muscle weakness occurs during MG
→ Enlon reversing a nondepolarizing diagnosis test, discontinue drug and give
neuromuscular blocker atropine IV
Galantamine Alzheimer’s disease Administer twice daily (morning and evening)
→ Razadyne with food
Neostigmine Myasthenia Gravis, post-op distention or Contraindicated in peritonitis or mechanical
→Prostigmin urinary retention GI obstruction
Pyridostigmine Myasthenia Gravis, reversal of muscle Contraindicated in mechanical GI or urinary
→ Mestinon relaxants obstruction
Rivastigmine Alzheimer’s disease Take at regular intervals. Remind pt that drug
→ Exelon can cause dizziness; avoid driving
Tacrine Alzheimer’s disease Can cause hepatic impairment – monitor LFTs
→ Cognex
Anticholinergic drugs
Also known as cholinergic blockers
Interrupt PNS impulses; prevent Ach from stimulating cholinergic receptors = decrease in Ach
These drugs will do the OPPOSITE of above cholinergic drugs
• MOA: Competitively inhibits the action of Ach
• Used to: treat nausea, treat Parkinson’s, relax the GI and GU system, manage headaches, dilate the
lungs, dilate the eye, and increase heart rate
• Side effects: dry mouth, dry eyes, dry nasal passage, blurred vision, urinary hesitancy or retention,
constipation, tachycardia
• Contraindicated in: narrow angle glaucoma, hemorrhage, tachycardia, and myasthenia gravis
Anticholinergics
Drug Indications Nursing
Atropine Symptomatic sinus bradycardia Monitor ECG and heart rate (can cause
increased HR and ventricular ectopy). Also
monitor intake + output due to possible
retention
Ipratropium COPD, acute asthma exacerbation Administered via nebulizer or inhaler.
→ Atrovent If administered with other inhalers, administer
adrenergic bronchodilators first, followed by
ipratropium, then corticosteroids. Wait 5 min
between each
Scopolamine Nausea, vomiting, motion sickness Administered via transdermal patch, IV, IM, or
→ Scopace prophylaxis, chemotherapy induced N & V SC. Contraindicated in closed angle glaucoma
Glycopyrrolate Pre- and post- op reduction of saliva, drooling May increase GI lesions in patients taking oral
→ Robinul potassium chloride tablets. Monitor intake +
output – can cause retention
Benztropine Parkinsonism, drug-induced extrapyramidal PO dose to be taken with food. Therapeutic
→ Cogentin disorders (S/S: restlessness, rigidity, tremors, effects seen in 2-3 days. Frequent rinsing of
pill rolling, masklike face, shuffling gait, muscle mouth will decrease dryness.
spasms, twisting motions, difficulty speaking,
loss of balance)
Dicyclomine Irritable bowel syndrome (IBS) Administer 30 mins before meals and at
→ Bentyl bedtime. Monitor intake + output due to
possible retention. Monitor for drowsiness
Oxybutynin Overactive bladder (incontinence, frequency, Administered PO, transdermal patch, or
→ Ditropan urgency) transdermal gel. Contraindicated in glaucoma,
XL intestinal obstruction, and urinary retention
6

Tolterodine Overactive bladder (urge incontinence) Assess for rash during therapy; can cause
→ Detrol Stevens-Johnson syndrome. Stop medication if
accompanied with fever, general malaise,
fatigue, muscle or joint aches, blisters, oral
lesions, conjunctivitis, or hepatitis.
High doses can cause prolonged QT complex
Adrenergic drugs
Also called sympathomimetic drugs
Produce effects similar to SNS – fight or flight = increase in norepinephrine (NE)
• MOA: direct acting adrenergic = the drug directly stimulates adrenergic receptors. Indirect acting
adrenergic = drug stimulates the release of norepinephrine from nerve endings
• Receptor sites:
o Alpha1 adrenergic receptors = cause vasoconstriction, papillary dilation, closure of sphincter and
bladder
o Alpha2 adrenergic receptors = cause decreased SNS activity, reduced NE release, insulin release
o Beta1 adrenergic receptors = located in heart; cause increased HR and increased force of
contraction
o Beta2 adrenergic receptors = cause vasodilation, bronchodilation, increased release of glucagon
o Dopamine receptors
1. Catecholamines
• Primarily direct-acting adrenergics
• Produce these effects: constrict blood vessels, increase heart rate, increase blood pressure, and
dilate bronchi
• Catecholamines are positive inotropes (make heart contract more forcefully) and positive
chronotropes (make heart beat faster)
• These drugs aren’t taken PO due to quick destruction by digestive enzymes
• Side effects: dry mouth, N/V, CNS stimulation, appetite suppression, increased HR,
bronchodilation, decreased blood flow to GI, pupil dilation, increased glucose levels
• Contraindicated: uncorrected tachyarrhythmias
Catecholamines
Dobutamine Cardiac decompensation, low cardiac Stimulates beta1 receptors. Administer drug
→ Dobutrex output into large vein; monitor site for inflammation
+ pain. Perform independent double check
Dopamine Hypotension, low cardiac output, poor Stimulates dopaminergic and beta1
perfusion of vital organs receptors. Administer drug into large vein;
Low dose: increases urine output + renal monitor site for inflammation + pain.
blood flow Perform independent double check.
Medium dose: increases renal blood flow,
cardiac output, heart rate, and heart
contractility
High dose: increases BP, potential risk of
tachyarrhythmias
Epinephrine Cardiac arrest, hypotension due to septic Stimulates beta1 and beta2 receptor. Can
→ Adrenalin, shock, anaphylaxis, symptomatic cause paradoxical bronchospasm (wheezing)
Epi-Pen bradycardia, management of asthma and with overuse of inhaler. Teach pt using
COPD autoinjector about proper placement (into

thigh @ right angle to leg, hold for 10 sec).
Perform independent double check.
Norepinephrine Acute hypotension, cardiac arrest, septic Stimulates alpha receptors mostly; minor
→ Levophed shock beta activity. Overdose can result in severe
peripheral vasoconstriction with resultant
ischemia and necrosis of peripheral tissue
Isoproterenol Shock, bronchospasm during anesthesia Stimulates beta1 and beta2 receptors.
hydrochloride
2. Noncatecholamines
• Can be direct-acting, indirect-acing, or dual-acting
• Produce these effects: local or systemic vessel constriction, nasal/eye decongestion, dilation of
bronchi, and smooth muscle relaxation
• Can be taken orally, and have longer half life
• Contraindicated: Monoamine oxidase inhibitors (can cause severe hypertension), tricyclic
antidepressants (can cause hypertension + arrhythmias)
• Side effects: headache, irritability, trembling, seizures, hypertension, palpitations, tachycardia,
arrhythmias, flushing, angina
Noncatecholamines
Phenylephrine Severe hypotension/shock Stimulates alpha receptors. Can cause severe
bradycardia + decreased cardiac output due
to increase in afterload
Albuterol Bronchospasm Stimulates beta2 receptor. Can cause
→ Ventolin paradoxical bronchospasm with excessive
inhaler use
Salmeterol Asthma prevention and maintenance, Stimulates beta2 receptor. Do not use to treat
→ Serevent COPD maintenance, prevention of exercise acute symptoms. Should only be used for
Diskus induced asthma patients not adequately controlled on other
asthma controller medications; long term use
can increase risk of asthma-related death
Terbutaline Bronchospasm, pre-term labor (this drug Stimulates beta2 receptor. Should not be
will stop contractions) used in pregnancy for the prevention of
prolonged treatment (48-72 hr) of preterm
labor
Adrenergic blocking drugs

Also called sympatholytic drugs
Block the effects of SNS = decrease in NE
1. Alpha adrenergic blockers (alpha blockers)
• Interrupts action of epinephrine (E) and NE at alpha receptors
• MOA: blocks the synthesis/storage/release/reuptake of NE, or the drug will antagonize E, NE, or
adrenergic drug at alpha receptor site
• Produces: relaxed/dilated blood vessels, decreased BP
• Side effects: orthostatic hypotension, reflex tachycardia, nasal congestion
Alpha Blockers
Doxazosin Hypertension, BPH Inform pt that urine flow will increase. Monitor
→ Cardura BP and HR. Inform pt that medication is to be
taken even if feeling better
8

Prazosin Hypertension, BPH, Raynaud Monitor BP and HR
→ Minipress phenomenon
Tamsulosin BPH Pregnant women and women of childbearing
→ Flomax potential should not handle drug (drug is
cytotoxic)
Silodosin BPH, renal impairment Monitor BP and HR
→ Rapaflo
2. Beta adrenergic blocks (beta blockers)

• Selective beta blockers affect just beta1 adrenergic sites
• Nonselective beta blockers affect both beta1 and beta2 adrenergic sites
• MOA: drug will occupy beta receptor site = prevents NE or E from occupying the site = decrease
in SNS
• Used for: HTN, arrhythmias, angina, narrow angle glaucoma
• Side effects: hypotension, bradycardia, bronchospasm
Beta Blockers
Atenolol HTN, angina, post-MI, SVT Ischemic heart disease and angina can be
→ Tenormin exacerbated after abrupt withdrawal of drug.
Contraindicated in AV block, bradycardia, and
shock. Monitor ECG, BP, and HR frequently.
Carvedilol CHF, HTN, angina, LV dysfunction after Contraindicated in bronchial asthma,
→ Coreg MI bronchospasm, COPD, AV block, shock, and
hepatic impairment. Abrupt withdrawal can
lead to arrhythmia, HTN, and myocardial
ischemia
Metoprolol HTN, acute MI, CHF, angina, acute Same as above.
→ Lopressor tachyarrhythmia
Nadolol HTN, angina, SVT, migraine Same as above. Contraindicated in
→ Corgard breastfeeding pt, AV block, COPD, bradycardia

NEUROLOGIC & NEUROMUSCULAR DRUGS
Nervous system = includes Central Nervous System (CNS) and Peripheral Nervous System (PNS)
• CNS = brain and spinal cord
• PNS = somatic and automatic nervous systems
Neuromuscular system = muscles of body (plus the nerves that supply these muscles)
Drugs include: skeletal muscle relaxants, neuromuscular blocking drugs, antiparkinsonian drugs, anticonvulsant
drugs, and antimigraine drugs
Skeletal muscle relaxants

Relieve MSK pain, spasms, spasticity (stiff movement), multiple sclerosis (MS), cerebral palsy, stroke
1. Centrally acting agents
• Treat acute muscle spasms due to anxiety, inflammation, pain, and trauma
• Also treat spasticity due to MS and cerebral palsy
• MOA: specifics are unknown, but the drugs are CNS depressants; skeletal relaxation is an effect from
the sedative effects of decreasing CNS stimulation
• Side effects: physical dependence, cessation can lead to withdrawal symptoms, dizziness,
drowsiness, bradycardia, N/V
Centrally Acting Drugs
Carisoprodol Muscle spasm associated with acute Should only be used for acute pain (not to
→ Soma painful MSK conditions exceed treatment of 2-3 weeks).
Chlorzoxazone MSK pain Contraindicated in impaired liver function
→ Lorzone
Cyclobenzaprine Muscle spams Monitor for serotonin syndrome (mental
→ Amrix changes, autonomic instability [tachycardia,
change in BP, hyperthermia], neuromuscular
changes [hyperreflexia, incoordination], and
GI changes
Metaxalone Muscle spasm from acute MSK pain Drug can cause dizziness/drowsiness – teach
→ Skelaxin pt to avoid driving
Methocarbamol Muscle spasm, tetanus Avoid in kidney injury pts. Can cause
→ Robaxin seizures as side effect
Orphenadrine Muscle spasm & pain Contraindicated in narrow angle glaucoma,
→ Norflex BPH, paralytic ileus, and toxic megacolon
Tizanidine Muscle spasticity Caution in kidney/liver failure pts
→ Zanaflex
2. Direct acting agents

• Dantrolene sodium is the only drug in this category
• Used for: spasticity in cerebral palsy, MS, spinal cord injury, and stroke
• MOA: acts directly on muscle; interferes with calcium release = weakens force of contractions
• Side effects: drowsiness, dizziness, muscle weakness
Direct Acting Drugs
Dantrolene Spasticity, malignant hyperthermia, Must monitor liver function – possible side effect
→ Dantrium neuroleptic malignant syndrome is hepatotoxicity
10

3. Others
• Baclofen
• Used for: spasticity in MS and spinal cord injury
• MOA: specifics are unknown; reduces nerve impulses in spinal cord to skeletal muscles = decreases
severity of muscle spasms
• Side effects: drowsiness, N, fatigue, muscle weakness
Other Skeletal Muscle Relaxants
Baclofen Spasticity from MS Abrupt discontinuation can lead to fever, change
→ Lioresal in mental status, and rebound spasticity + muscle
rigidity
Diazepam Muscle spasms, seizure disorder Promotes GABA (an inhibitory neurotransmitter)
→ Valium = lessens muscle contraction. Also used to treat
anxiety, alcohol withdrawal, and seizures
Neuromuscular blocking drugs

Disrupt transmission of nerve impulse at motor end plate = relaxation of skeletal muscles
Used to relax skeletal muscles during surgery, reduce muscle spasms in seizures, and manage patients fighting
ventilator in ICU
1. Nondepolarizing blocking drugs
• MOA: drug competes with Ach at cholinergic receptor site = blocks Ach action = prevents muscle
from contracting
• *Effect can be counteracted by anticholinesterase
• Used for: muscle relaxation to ease ET tube, muscle relaxation to help realignment of dislocated
bones, muscle relaxation for pt fighting mechanical ventilation, and prevent muscle relaxation
• Side effects: apnea, hypotension, bronchospasm, excessive salivation
• Neuromuscular blocking drugs do not affect consciousness or pain; anesthesia + analgesia should
always be used when neuromuscular blocking agents are used
Nondepolarizing Blocking Drugs
Atracurium Endotracheal intubation, mechanical Adequate ventilatory support is mandatory
→ Tracrium ventilation, skeletal muscle relaxation during
surgery
Cisatracurium Intubation Do not administer before unconsciousness.
→ Nimbex Bradycardia may occur
Pancuronium General anesthesia adjunct, endotracheal Adequate ventilatory support is mandatory
→ Pavulon intubation
Rocuronium Intubation Adequate ventilatory support is mandatory.
→ Zemuron Use cautiously in pt with liver disease
2. Depolarizing blocking drugs

• Succinylcholine is only drug in this category
• MOA: acts like acetylcholine but does NOT get inactivated by cholinesterase. Once administered, it
attaches to receptor sites on skeletal muscles = prevents repolarization of motor end plate = muscle
paralysis
• Drug of choice for short term relaxation during intubation
• Side effects: primary side effect is hypotension + prolonged apnea
11

Depolarizing Blocking Drugs
Succinylcholine Rapid onset and brief duration of muscle Adequate ventilatory support is mandatory.
→ Anectine relaxation needed during surgery or Administer sedative beforehand.
intubation
Anticonvulsant Drugs
Seizure = disturbed electrical activity in brain
1. Partial/focal = part of brain is affected
• Simple: experience some elements of aura, some twitching (usually in 1 limb)
• Complex: experience some elements of aura. Often consists of repeated movements, some
altered consciousness, autonomic, sensory & motor signs, confusion after seizure
2. Generalized = involves all of brain
• Absence (petit mal): starring + transient loss of responsiveness and then retrograde amnesia (not
remembering what happened)
• Atonic: short episodes where patient suddenly falls
• Tonic-clonic (grand mal): may experience some elements of aura, then tonic phase (muscle
contraction) then clonic phase (repeated contraction & relaxation), usually followed by deep
sleep (postictal state). Also has retrograde amnesia
3. Special cases
• Febrile seizures: tonic-clonic seizure related to rapid rise in body temperature
• Myoclonic seizures: large jerky body movements due to uncontrollable skeletal muscle
contraction
• Status epilepticus: seizure is repeated or prolonged (life-threatening due to risk of hypoxia)
Medications for seizures will decrease neuron excitability
Observe and record intensity, duration, and location of seizure activity
1. Barbiturates
• For generalized tonic clonic seizures
• MOA: stimulates gamma-aminobutyric acid (GABA) neurotransmitter (an inhibitory
neurotransmitter), which then inhibits brain activity; this is what causes the drowsy/calming effects
• Side effects: drowsiness, tolerance, dependence, respiratory depression, GI effects
• Contraindication: liver or kidney disease
• Medications are not to be stopped abruptly as this can cause seizure activity
Barbiturates
Phenobarbital Status epilepticus, seizures, sedation, Risk of toxicity increases when taken with CNS
→ Luminal hypnotic, insomnia depressants, valproic acid, chloramphenicol,
felbamate, cimetidine, or phenytoin
Therapeutic serum range: 15-40 mcg/mL
Primidone Seizures
→ Mysoline
2. Benzodiazepines
• For absence & myoclonic seizures
• MOA, side effects, and contraindications are same as above
• For IV injection, administer slowly to avoid bradycardia
• If there is an overdose on benzodiazepines = give flumazenil (Romazicon)
12

Benzodiazepines
Lorazepam Anxiety, status epilepticus, seizures Use with opioids can result in profound sedation,
→ Ativan respiratory depression, coma, and death
Therapeutic serum range: 50-240 ng/mL
Diazepam Anxiety, alcohol withdrawal, pre-op sedation, Use with opioids can result in profound sedation,
→ Valium seizure, muscle spasm, status epilepticus respiratory depression, coma, and death. Do not
use in pts with depressed respiration or patients
who recently received respiratory depressants.
3. Hydantoins (Phenytoin)
• For partial and tonic clonic seizures
• MOA: block Na+ influx = neurons are kept in absolute refractory for a longer time = less frequent
action potentials
• Side effects: dependence, respiratory depression, gingivitis, ataxia, dizziness, lethargy, alter vitamin K
metabolism, dysrhythmias, nystagmus
• Frequent bloodwork is needed to monitor drug levels
Hydantoins
Phenytoin Seizures Risk of hypotension and arrhythmia – monitor BP
→ Dilantin and HR. Monitor for change in mood – there is a
risk of suicidal ideation
4. Phenytoin-like drugs
• For absence, tonic-clonic seizures, bipolar, and migraines
• MOA same as above
• Side effects: increased bleeding times, photosensitivity, hepatotoxic, pancreatitis
Phenytoin-like
Valproic acid Seizures, bipolar mania, migraine Monitor for suicidal tendencies (especially early
→ Depakene prophylaxis on). Monitor for signs of pancreatitis (abdo
pain, N/V, anorexia). Monitor liver function
Carbamazepine Epilepsy, trigeminal neuralgia, bipolar Using an MAOI drug with carbamazepine may
→ Tegretol mania result in hyperpyrexia, hypertension, seizures,
and death
Zonisamide Seizures
→ Zonegran
5. Succinimides
• For absence seizures
• MOA: prevents Ca+2 entry through specialized T-type channels in thalamus = decreases neuron
excitability
• Side effects: anorexia, N/V, blood dyscrasia
Succinimides
Ethosuximide Absence seizures Do not discontinue rapidly; abrupt withdrawal
→ Zarontin can cause absence seizure
13

Antiparkinsonian Drugs
Parkinson’s disease = neurologic disorder characterized by:
1. Muscle rigidity
2. Akinesia (loss of voluntary movement)
3. Tremors at rest
4. Change in posture/balance
The above can also be known as extrapyramidal symptoms (restlessness, rigidity, tremors, pill rolling, masklike
face, shuffling gait, muscle spasms, twisting motions, difficulty speaking/ swallowing, loss of balance control)
Chemical imbalance with Parkinson’s: too little dopamine, too much Ach
Too much Ach = increased cholinergic activity = creates the involuntary movements/tremors
Goal of anti-Parkinson’s medication = symptom relief and improve mobility by either inhibiting Ach or enhancing
dopamine
1. Anticholinergic Drugs
• Also known as parasympatholytic drugs = inhibit action of Ach in parasympathetic nervous system
(PNS)
• MOA: inhibition of Ach at receptor sites = reduction of tremors; this category of drug reduces the
tremors + drooling but has minimal effect on the bradykinesia, rigidity, and balance abnormalities
• Side effects: anticholinergic effects = confusion, drowsiness, urine retention, blurred vision, N/V/C,
dry mouth/secretions, increased HR
• Contraindicated in: narrow angle glaucoma, BPH, GI obstructions, myasthenia gravis, dysrhythmias
• If discontinued abruptly, S/S of Parkinsonism can be intensified
Anticholinergic Drugs for Parkinson’s
Benztropine Parkinsonism Reduces rigidity + tremors. Avoid driving due to
→ Cogentin side effect of drowsiness/dizziness
2. Dopaminergic Drugs
• These drugs increase effects of dopamine
• MOA: increase in neurotransmission of dopamine
• Side effects: too much dopamine = uncontrolled + involuntary movements, muscle twitching,
spasmodic winking, orthostatic hypotension
• Interact with: TCAs, MAOIs, antihypertensives, antipsychotics, anticonvulsants, antacids
• Contraindicated in: cardiac, kidney & liver disease, narrow angle glaucoma, history of seizures
Dopaminergic Drugs
Carbidopa/Levodopa Parkinson Disease Avoid in narrow angle glaucoma. Avoid in pt
→ Sinemet taking MAOI (can cause hypertensive
reaction). Monitor for GI complications.
Divide total daily prescribed protein among
all meals (high protein diet interferes with
medication availability to CNS)
Amantadine Parkinson Disease, dyskinesia associated Avoid in narrow angle glaucoma and in
→ Osmolex with Parkinson Disease, drug-induced breastfeeding pts. Monitor for orthostatic
extrapyramidal symptoms hypotension and constipation
Selegiline Parkinson Disease Monitor for changes in behavior and
→ Eldepryl suicidal tendencies. Contraindicated in
concurrent use with SSRI or TCA
14

Ropinirole Parkinson Disease, restless leg syndrome Monitor for changes in behaviour. Monitor
→ Requip BP – risk of orthostatic hypotension
Anti-Migraine Drugs
Migraine = unilateral headache pain (pounding/pulsating/throbbing), sometimes preceded by aura
Other S/S = light/sound sensitivity, N/V/C/D
Migraine is due to vasodilation or due to release of vasoactive + inflammatory substances from nerves in
trigeminal system
Treatment = abort migraine after it has started OR prevent one from starting
o Abortive medications = analgesics, NSAIDs, ergotamine, serotonin agonists
o Preventative medications = beta blockers, TCAs, valproic acid, and NSAIDs
1. Serotonin Agonists
• Treatment for moderate to severe migraines
• MOA: serotonin agonist = cause constriction + reduction of inflammation in trigeminal nerve =
provides relief
• Side effects: tingling, flushing, dizziness, weakness, somnolence, chest pain, dry mouth, N
• Contraindicated: ischemic heart disease, stroke, CAD
Serotonin Agonists
Almotriptan, Eletriptan, Acute treatment of migraine Contraindicated in ischemic heart disease,
Frovatriptan, Naratriptan, attack with or without aura hypertension, or cerebrovascular syndrome.
Rizatriptan, Suma triptan, Overuse of medication can lead to exacerbation
Zolmitriptan of headache. Do not use within 24 hrs of
another serotonin agonist
2. Ergotamine
• For abortion of migraine
• MOA: blocks inflammation + partially acts as serotonin agonist
• Side effects: N/V, numbness, tingling, muscle pain, weakness
Ergotamine
Ergotamine Migraine, menopausal hot flashes Do not give with CYP3A4 inhibitor (e.g.
→ Ergomar erythromycin) – can lead to serious peripheral
ischemia due to high risk of vasospasm
15

ANALGESICS
Non-Opioid analgesics, Antipyretics, NSAIDs

• Control pain, control fever, and produce anti-inflammatory effects
• No physical dependence
1. Salicylates
• Used for pain control and reduction of fever + inflammation
• Most common salicylate = aspirin
• MOA: inhibits synthesis of prostaglandin (a chemical mediator that sensitizes nerves to pain) = relief
of pain. Stimulation of hypothalamus = blood vessel dilation = reduction of fever + increased
sweating (promotes cooling)
• Aspirin MOA also includes interference of thromboxane A2 production (necessary for platelet
aggregation) = inhibition of platelet aggregation = used to enhance blood flow during myocardial
infarction
• Side effects: N/V/D, bleeding tendency, dizziness, confusion, hearing loss if drug is taken for
prolonged time, and risk of Reye’s syndrome if given to children with chickenpox/flulike symptoms
Salicylates
Acetylsalicylic acid Pain, fever, acute coronary syndrome, Not to be given to pts with GI bleed, hemolytic
→ Aspirin ischemic stroke anemia, hemorrhoids, or thrombocytopenia.
Avoid use in children.
2. Acetaminophen
• MOA: reduces pain + fever but does not affect inflammation or platelet function. Inhibits
prostaglandin synthesis to reduce pain and acts on hypothalamus to reduce heat
• Side effects: liver toxicity
Acetaminophen
Acetaminophen Pain, fever Not to be given to pt with active liver disease.
→ Tylenol To minimize GI irritation, avoid alcohol when
taking medication
3. Nonselective NSAIDs
• Normally, inflammatory disorder produces/releases prostaglandins = causes pain
• MOA: inhibits prostaglandin synthesis by blocking COX-1 and COX-2 = decreased inflammation +
analgesic effect
o COX1 – prostaglandins in stomach lining; therefore produces GI side effects
o COX2 – prostaglandins that mediate inflammatory process
• Side effects: abdo pain + bleeding, diarrhea, N, ulcers, liver toxicity, drowsiness/confusion, tinnitus,
bladder infection, HTN
• Contraindicated for perioperative pain for CABG
• Take the drug with meals or milk to reduce GI side effects
Nonselective NSAIDs
Indomethacin Inflammatory/rheumatoid disorders, Risk of MI and stroke. Elderly pts are at greater
→ Indocin tendonitis, gouty arthritis, pain risk of GI side effects.
16

Ibuprofen Pain, fever, dysmenorrhea, inflammatory Risk of MI and stroke. Elderly pts are at greater
→ Advil, disease, osteoarthritis (OA), rheumatoid risk of GI side effects. Patients who have
Motrin arthritis (RA) asthma, aspirin-induced allergy, and nasal
polyps are at higher risk for developing
hypersensitivity reactions
Diclofenac RA, OA, ankylosing spondylitis, Same as above
→ Voltaren dysmenorrhea, mild-moderate acute pain,
acute migraine
Ketorolac Moderate-severe acute pain Same as above + contraindicated in L&D as it
→ Toradol can affect fetal circulation/inhibit uterine
contractions
Naproxen Pain, RA, OA, ankylosing spondylitis, Risk of MI and stroke. Elderly pts are at greater
→ Aleve dysmenorrhea, acute gout, migraine risk of GI side effects. Patients who have
asthma, aspirin-induced allergy, and nasal
polyps are at higher risk for developing
hypersensitivity reactions
Oxaprozin OA, RA Same as above
→ Daypro
4. Selective NSAIDs
• MOA: selectively blocks COX2 = decreases prostaglandin synthesis = decreases pain + inflammation
• Side effects: HTN, fluid retention, edema, dizziness, headache, GI ulcers (less than nonselective
NSAIDs)
Selective NSAIDs
Celecoxib Acute pain, dysmenorrhea, ankylosing Risk of MI and stroke. Elderly pts are at greater
→ Celebrex spondylitis, OA, RA risk of GI side effects.
Opioid Agonists + Antagonists

Opioid = drug that imitates natural narcotic
Opioid agonists = relieve or decrease pain
Opioid antagonists = NOT pain medication, but instead can reverse the side effects (CNS or respiratory
depression) produced by opioid agonist
1. Opioid agonist
• MOA: drug binds to opioid receptor in PNS and CNS = produces effects of analgesia + cough
suppression
• Side effects: decreased RR, flushing, hypotension, pupil constriction
• Risk of opioid addiction, abuse, and misuse MUST be assessed (can lead to overdose and death)
Opioid Agonists
Codeine Pain, cough Use cautiously in pts on MAO inhibitor.
Monitor RR. Regularly administered dose may
be more effective than PRN dose
Fentanyl General anesthesia, analgesia Risk of opioid addiction/abuse/misuse, which
can lead to overdose and death. Monitor for
respiratory depression. Prolonged use during
pregnancy can cause neonatal opioid
withdrawal syndrome. Avoid use in pt
receiving MAO inhibitor. Transdermal fentanyl
is for moderate-severe chronic pain, not for
17

the control of postoperative, mild,
intermittent, or short term pain
Hydrocodone Chronic pain Extended release tablet. Use cautiously in pts
→ Zohydro, on MAO inhibitor.
Hysingla
Hydromorphone Moderate to severe pain, moderate to Use cautiously in pts on MAO inhibitor.
→ Dilaudid severe chronic pain, cough Monitor RR. Rapid IV administration =
respiratory depression, hypotension,
circulatory collapse
Meperidine Moderate to severe pain, analgesic during Can cause seizures as side effect. Monitor RR.
→ Demerol labour, pre-op sedation, rigors Use cautiously in pts on MAO inhibitor. Risk of
toxicity increases with dose over 600 mg per
day, chronic administration (>2 days), and
kidney injury. IV Push – administer slowly over
5 minutes
Methadone Long term pain treatment, detoxification Not to be used with MAO inhibitors. Avoid use
of CNS depressants, benzodiazepines, or
alcohol as it can cause severe sedation, resp
depression, coma, or death
Morphine Acute pain, chronic severe pain Use cautiously in patients receiving MAO
inhibitors (can have severe reactions). Monitor
for respiratory depression
Oxycodone Moderate to severe pain Monitor for respiratory depression. If pt has
→ Oxycontin, liver failure, initial dose should be decreased.
Oxyneo Monitor BP, HR, and RR
Tramadol Moderate to severe pain Monitor for seizures (higher dose has higher
risk). Monitor for serotonin syndrome. Avoid
use in pts on MAO inhibitor.
2. Opioid Antagonist
• MOA: Attach to opioid receptors but do NOT stimulate them = prevention of opioid effects
• Used to reverse effects of opioids
• MOA: drug blocks the receptor site = opioid receptor cannot attach = no opioid effects
• Side effects: HTN, palpitation, shortness of breath, anxiety, diarrhea, N/V, thirst, urinary frequency
Opioid Antagonist
Naloxone Opioid overdose, reversal of respiratory Dilute 0.4mg ampule of naloxone in 10 mL of
→ Narcan depression NS and administer 0.5 mL (0.02 mg) by IV push
every 2 min. Monitor RR, rhythm, and depth;
HR, ECG, BP; and LOC frequently
18

CARDIOVASCULAR DRUGS
Cardiovascular system includes = heart, arteries, capillaries, veins, and lymphatics

Goal: promotes oxygen + nutrient delivery to cells and removal of metabolic waste
Types of drugs used to improve the cardiovascular system: inotropic, antiarrhythmic, antianginal,
antihypertensive, diuretics, and antilipemic
Inotropic Drugs
Inotrope = increases force of heart contraction (positive inotrope)
These drugs can prevent remodeling of L or R ventricle (common in heart failure)
1. Cardiac glycosides
• Positive inotrope, negative chronotrope (decreases HR)
• MOA: inhibits Na/K activated ATP = increase in intracellular levels of Na and Ca = increase in Ca will
strengthen myocardial contraction. These drugs also act on CNS to increase vagal tone = slowing of
HR by slowing the SA and AV nodes
• Used for: atrial fibrillation (controls the HR from being too fast), atrial flutter, heart failure, and
supraventricular tachycardia (SVT)
• Side effects: N/V/D, abdo pain, confusion, vision changes, bradycardia, complete heart block
• Herbals like St. John’s wort and ginseng can increase digoxin levels = increased risk of digoxin toxicity
Cardiac Glycoside
Digoxin Atrial fibrillation, heart failure Check HR before administration (ensure HR is
→ Lanoxin above 60 bpm). Monitor for bradycardia.
Monitor digoxin levels (digoxin has a narrow
therapeutic range)
2. Phosphodiesterase inhibitors
• Used for short term management of heart failure
• MOA: PDEI move Ca into cardiac cells = improve cardiac output by strengthening contractions. Also,
the drug relaxes smooth muscle = less vascular resistance and less amount of blood returning to
heart = decreased afterload + preload
• Side effects: arrhythmias, N/V, headache, chest pain, hypokalemia, increase in HR, hypotension
PDE Inhibitors
Milrinone Heart failure (HF) Monitor ECG during infusion. Ensure that HR is
controlled in atrial fib before administration
because this drug can increase HR
Antiarrhythmic Drugs
Benefits vs risks need to be weighed because these drugs can worsen arrhythmias
4 classes: I, II, III, IV
1. Class I
• Used for: atrial and ventricular arrhythmias
• MOA: block Na channels = interfere with conduction of cardiac impulses = slows action potential
• Side effects: N/V/D, anorexia, arrhythmias (conduction delays; AV blocks), hypotension, bradycardia,
palpitations
19

Class I Antiarrhythmics
Procainamide Arrhythmia Long term use can lead to positive ANA. Monitor
→ Pronestyl CBC. Contraindicated in AV heart block, SLE, and
torsades de pointes
Quinidine Arrhythmia May cause increased mortality in treatment of
→ Quinaglute afib/aflutter. Contraindicated in absence of atrial
activity, AV block, torsades, prolonged QTc, and
pregnancy
Mexiletine Life threatening ventricular Contraindicated in shock, AV block
arrhythmias
Lidocaine Ventricular arrhythmias, pulseless If IV route not available, use IO/ET. Monitor ECG
ventricular tachycardia and BP continuously. Contraindicated in SA/AV
block, CHF, and shock
Flecainide Prevention of arrhythmias (SVT, Not used for chronic afib. Increased risk of PVCs,
→ Tambocor paroxysmal afib, VT) ventricular tachycardia. Contraindicated in AV
block.
2. Class II
• MOA: block beta adrenergic receptor sites in conduction system of heart = SA node is slowed down =
reduction of electrical impulses
• Strength of contractions are reduced = heart beats less forcefully (negative inotrope) = heart does
not need as much oxygen to work
• Side effects: arrhythmias, bradycardia, heart failure, hypotension, N/V/D, bronchospasm, fatigue
Class II Antiarrhythmics
Propranolol HTN, migraine, angina, pheochromocytoma, Can exacerbate ischemic heart disease and
→ Inderal supraventricular arrhythmias, portal hypertension angina with abrupt withdrawal.
Contraindicated in asthma, COPD, severe
bradycardia, shock, and heart failure. If
giving via IV = constant ECG monitoring is
necessary. Monitor HR and BP
Esmolol Intraoperative tachycardia/HTN, SVT, Contraindicated in bradycardia, AV block,
→ Brevibloc hypertensive emergency heart failure
3. Class III
• Used for: ventricular arrhythmias
• MOA is not known; thought to delay repolarization & lengthen refractory period of action potential
• Side effects: hypotension, bradycardia, N, vision disturbance
Class III Antiarrhythmics
Amiodarone Stable monomorphic or polymorphic ventricular Constant ECG monitoring needed.
→ Pacerone tachycardia, pulseless ventricular Contraindicated in AV block and
tachycardia/ventricular fibrillation bradycardia. Avoid during breastfeeding
Dofetilide Converting afib/flutter to sinus rhythm Continuous ECG monitoring needed.
→ Tikosyn Contraindicated in prolonged QT complex
and bradycardia. Grapefruit juice may
increase levels.
20

4. Class IV
• Calcium channel blockers
• Used for supraventricular arrhythmias (SVT) with rapid HR, to relieve angina, and to relieve
hypertension
• MOA: inhibits Ca influx into cardiac muscle = decreased heart contractility and O2 demand. Also
dilates coronary arteries
• Side effects: bradycardia, AV block, heart failure, ventricular fibrillation, dizziness, headache,
hypotension
Class IV Antiarrhythmics
Verapamil Angina, HTN, SVT, afib/flutter, tardive dyskinesia Contraindicated in shock, HF, hypotension,
→ Isoptin AV block. Monitor ECG. Monitor daily
weight.
Diltiazem Angina, HTN, SVT, afib/flutter Contraindicated in hypotension, sick sinus
→ Cardizem syndrome, AV block, MI. Assess for signs of
HF (weight gain, SOB, crackles)
5. Adenosine
• Used for acute treatment of SVT
• MOA: adenosine suppresses SA node = reduces HR. AV node is unable to conduct impulse from atria
to ventricles = temporary pause in rhythm
• Side effects: facial flushing, shortness of breath, dizziness, dyspnea, chest discomfort
Adenosine
Adenosine SVT Contraindicated in AV block, sick sinus
syndrome, bradycardia. Used for
cardioversion. Monitor ECG continuously
Antianginal Drugs
Sign of angina = chest pain
These drugs work by increasing the O2 supply to the heart
1. Nitrates
• For acute angina
• Can be given sublingually, buccally, as tablets, aerosols, inhalation, transdermally, or via IV
• MOA: cause smooth muscle of veins and arteries to dilate = coronary arteries dilate = improvement
of O2 supply to myocardium. ALSO, the dilated blood vessels means there is less blood return to
heart = reduces preload = reduction of ventricular wall tension = reduces O2 requirements of heart
• Side effects: headache, hypotension, dizziness, and increased HR
• Have pt sit/lay when providing first dose
Nitrates
Isosorbide dinitrate Angina pectoris Contraindicated in pts taking PDE-5 inhibitors
→ Isordil (e.g. sildenafil), shock, and hypotension
Nitroglycerin Angina pectoris, Contraindicated in pts taking PDE-5 inhibitors
(e.g. sildenafil), shock, and hypotension
2. Beta blockers
• For long term prevention of angina
• MOA: block beta receptor sites in heart = decreased HR, force of contraction, BP = lower O2 demand
21

• Side effects: bradycardia, heart failure, arrhythmias (AV block), fainting, fluid retention, edema,
shock, N/V/D
• Assess apical pulse before administration; hold if <50 bpm
Beta Blockers
Atenolol HTN, angina, post-MI, SVT Ischemic heart disease and angina can be
→ Tenormin exacerbated after abrupt withdrawal of drug.
Contraindicated in AV block, bradycardia, and
Carvedilol CHF, HTN, angina, LV dysfunction after MI Contraindicated in bronchial asthma,
→ Coreg bronchospasm, COPD, AV block, shock, and
hepatic impairment. Abrupt withdrawal can lead
to arrhythmia, HTN, and myocardial ischemia
Metoprolol HTN, acute MI, CHF, angina, acute Same as above.
→ Lopressor tachyarrhythmia
Nadolol HTN, angina, SVT, migraine Same as above. Contraindicated in breastfeeding
→ Corgard pt, AV block, COPD, bradycardia
3. Calcium Channel Blockers

• Used when other drugs fail to prevent angina (also used as antiarrhythmic + for treatment of HTN)
• MOA: prevent Ca from coming into myocardial cell membrane = causes dilation of coronary +
peripheral arteries = decreased force of contractions + decreased afterload = decreased workload of
heart = decreased O2 demand
o No calcium = dilation
• Side effects: orthostatic hypotension, heart failure, bradycardia, AV block, dizziness, headache,
flushing, weakness
• Risk of angioedema
• Monitor I+O, daily weight
Calcium Channel Blockers
Amlodipine HTN, angina, CAD Assess BP and HR before administration. Educate
→ Norvasc pt on changing positions slowly to avoid
orthostatic hypotension
Diltiazem Angina, HTN, SVT, afib/flutter Contraindicated in AV block, acute MI,
→ Cardizem pulmonary congestion.
Nifedipine Angina, HTN, pulmonary HTN, Raynaud, Contraindicated in pts taking CYP3A4 inducers
→ Procardia anal fissures (reduces nifedipine efficacy). Contraindicated in
cardiogenic shock
Verapamil Angina, HTN, SVT, afib/flutter, tardive Contraindicated in shock, HF, symptomatic
→ Isoptin dyskinesia hypotension, AV block. Educate pt on informing
MD of irregular HR, swelling, dizziness.
Antihypertensive Drugs
HTN = elevation of systolic BP (SBP), diastolic BP (DBP), or both
1. Angiotensin-converting enzyme inhibitors (ACE inhibitors)
• Used for sodium + water retention and HTN
• MOA: inhibits ACE = prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor)
= decreases peripheral arterial resistance and promotes excretion of aldosterone (normally
promotes Na and water retention) = decrease in BP + reduction of Na and water
• Side effects: headache, fatigue, dry cough, N/V, increased K+, elevation of BUN + Cre
22

ACE inhibitors
Benazepril HTN Not to be used during pregnancy (causes
→ Lotensin oligohydramnios)
Captopril Acute HTN, HTN, CHF, LV dysfunction after MI, Same as above. May cause positive ANA – monitor
→ Capoten diabetic nephropathy CBC
Enalapril HTN, LV dysfunction, CHF Not to be used during pregnancy (causes
oligohydramnios)
Lisinopril Acute MI, HTN, CHF, diabetic nephropathy Same as above
→ Prinivil
Ramipril HTN, CHF, MI/stroke prevention, diabetic Same as above
→ Altace nephropathy
2. Angiotensin II receptor blocking agents (ARBs)

• MOA: Interferes with the renin angiotensin aldosterone system (RAAS) by blocking binding of
angiotensin II to the angiotensin II receptor = prevents vasoconstriction = also prevents aldosterone
secretion = decrease in BP
• Side effects: headache, fatigue, cough, N/V, elevation of BUN + Cre
• ARBs are not to be used during pregnancy
ARBs
Candesartan HTN, CHF Not to be used during pregnancy (causes
→ Atacand oligohydramnios). Contraindicated with severe
hepatic impairment. Use cautiously in pts with
hx of angioedema
Irbesartan HTN, nephropathy in T2DM Same as above
→ Avapro
Losartan HTN, diabetic nephropathy, HTN with LV Not to be used during pregnancy (causes
→ Cozaar hypertrophy oligohydramnios). Use cautiously in volume- or
Na-depleted pts (can cause symptomatic
hypotension)
Telmisartan HTN Same as above. Also contraindicated in bilateral
→ Micardis renal artery stenosis.
Valsartan HTN, CHF, post-MI Not to be used during pregnancy (causes
→ Diovan oligohydramnios). Use cautiously in pt with hx of
angioedema, volume depletion, hepatic/renal
failure
3. Beta blockers
• Used to treat HTN (and ocular HTN) and angina
• MOA: blocks beta receptor sites in heart = decreased HR, force of contraction, BP = lower O2
demand
• Side effects: bradycardia, heart failure, arrhythmias (AV block), fainting, fluid retention, edema,
shock, N/V/D
• Assess apical pulse before administration; hold if <50 bpm
• Betaxolol, carteolol, and timolol are used for ocular HTN
23

Beta Blockers
Atenolol, Carvedilol, HTN, angina, post-MI, SVT Ischemic heart disease and angina can be
Metoprolol, Nadolol, exacerbated after abrupt withdrawal of drug.
Bisoprolol Contraindicated in AV block, bradycardia, and
4. Calcium channel blockers

• Used for: HTN, arrhythmias, and angina
• MOA: prevent Ca from coming into myocardial cell membrane = causes dilation of coronary +
peripheral arteries = decreased force of contractions + decreased afterload = decreased workload of
heart = decreased O2 demand
• No calcium = dilation
• Side effects: orthostatic hypotension, heart failure, bradycardia, AV block, dizziness, headache,
flushing, weakness
• Monitor I+O, daily weight
Amlodipine HTN, angina, CAD Assess BP and HR before administration. Educate
→ Norvasc pt on changing positions slowly to avoid
Diltiazem Angina, HTN, SVT, afib/flutter Contraindicated in AV block, acute MI,
→ Cardizem pulmonary congestion.
Nifedipine Angina, HTN, pulmonary HTN, Raynaud, Contraindicated in pts taking CYP3A4 inducers
→ Procardia anal fissures (reduces nifedipine efficacy). Contraindicated in
cardiogenic shock
Verapamil Angina, HTN, SVT, afib/flutter, tardive Contraindicated in shock, HF, symptomatic
→ Isoptin dyskinesia hypotension, AV block. Educate pt on informing
HCP of irregular HR, swelling, dizziness.
5. Thiazides (hydrochlorothiazide)
• Used for: edema, HTN, diabetes insipidus
• MOA: reduce Na reabsorption by inhibiting Na+/Cl-cotransporter in the ascending loop of Henle =
prevent reabsorption of Na in kidneys = increased excretion of Na (and thus water). There is also an
increase in excretion of Cl, K, and bicarb
• Side effects: hypokalemia, hyperglycemia, hyperlipidemia, hyponatremia, hypercalcemia, low BP,
• Decreases responsiveness to oral hypoglycemics
Thiazide Diuretics
Hydrochlorothiazide HTN, edema Contraindicated in anuria. Use cautiously in
→ HCTZ, microzide pts with DM, fluid/electrolyte imbalance,
gout, hypotension, SLE, kidney/liver disease.
Indapamide HTN, edema Same as above
Metolazone HTN, edema Same as above. Avoid concurrent use with
→ Zaroxolyn lithium.
6. Loop diuretics
• Used for: hypercalcemia, hyperkalemia, pulmonary edema, CHF, HTN
24

• MOA: inhibits Na and Cl reabsorption in ascending loop of Henle = increases excretion of Na, Cl, and
water
• *very rapid effect
• Side effects: hyperglycemia, electrolyte imbalance, hypokalemia, hypovolemia, hypotension, ototoxic
Loop Diuretics
Furosemide HTN, edema, acute pulmonary edema, If given in excess can cause severe diuresis +
→ Lasix increased ICP, hyperkalemia in ALCS water/electrolyte depletion. Contraindicated in
anuria. Use cautiously in pts with kidney/liver
disease. Risk of ototoxicity. Monitor BUN and
Cre
Bumetanide HTN, edema Same as above
→ Bimex
7. Potassium sparing diuretics

• MOA: inhibition of aldosterone by canrenone = increases Na+ excretion, decreases K+ secretion &
excretion = Na+ excretion promotes water excretion
• Side effects: hyperkalemia
• Contraindication: hyperkalemia, renal insufficiency
K+ Sparing Diuretics
Spironolactone Hyperaldosteronism, edema, HTN, CHF, Contraindicated in Addison disease,
→ Aldactone hypokalemia, hirsutism, acne hyperkalemia, and co-administration with
eplerenone. Monitor serum K+
Amiloride CHF, HTN, thiazide-induced hypokalemia Take with food. Monitor serum K+ (may cause
→ Midamor hyperkalemia). Monitor BUN and Cre
8. Adrenergic agents
• To reduce BP, drugs in this category will inhibit/block the following receptors (thus producing an
opposite effect)
• Alpha 1 – causes peripheral vasoconstriction
• Alpha 2 – causes reduced sympathetic response (*drug to help with BP will agonize this receptor)
• Beta 1 – causes increased HR, conduction & contractility
• Beta 2 – causes increased HR, bronchodilation
Adrenergic Agents
Doxazosin HTN, BPH Alpha 1 antagonist = causes vasodilation. Side
→ Cardura effects: orthostatic hypotension, syncope, N/V,
hypothermia, dry mouth, tachycardia
Clonidine HTN, cancer pain, alcohol withdrawal, Alpha 2 agonist. Last choice for pts who don’t
→ Catapres restless legs syndrome, Tourette’s respond to other drugs. Reduces sympathetic
syndrome, menopausal flushing output but also increases Na & water retention
(usually given with diuretic). Side effects:
hypotension, dry mouth, edema
Atenolol, HTN, angina, post MI, SVT Beta 1 antagonist. Slows HR + reduces
metoprolol contractility = reduced cardiac output. Side
effects: bronchospasm, bradycardia,
hypotension. Contraindicated in bradycardia,
heart block, cardiogenic shock, COPD, asthma
25

Antilipemic Drugs
Used to lower lipid levels (cholesterol, triglycerides, phospholipids)
High density lipoprotein (HDL) = good
• HDL transports fats from tissues to liver = cholesterol is used to form bile salts that are excreted
Low density lipoprotein (LDL) = bad
• LDL transports fats from liver to tissues for use or storage but some gets stored in lining of blood
vessels = atherosclerosis
1. Statins (HMG-CoA reductase inhibitors)
• Drops LDL and raises HDL levels (drug is taken for life)
• Used to: prevent atherosclerosis, reduce likelihood of CAD
• MOA: drug inhibits the enzyme that is responsible for converting HMG-CoA to mevalonate =
biosynthesis of cholesterol is limited
• Side effects: myopathy, muscle weakness, N/V
• Contraindication: grapefruit juice (reduces metabolism by liver), pregnancy, liver/kidney disease
HMG-CoA reductase Inhibitors
Atorvastatin, Lovastatin, Hyperlipidemia, cardiovascular Contraindicated in acute liver disease and
Simvastatin, Rosuvastatin disease prevention pregnancy. Risk of myopathy with lovastatin is
→ Lipitor, Altroprev, increased with concurrent use of strong CYP3A4
Zocor, Crestor inhibitor
2. Bile Acid Resins

• Used to: prevent atherosclerosis
• MOA: resins bind to bile acids (which contain cholesterol) in the GI system = this combo creates an
insoluble compound = leads to excretion. Decrease in bile acid triggers the liver to synthesize more bile
acid from its precursor, cholesterol = lower cholesterol levels
• Side effects: no systemic effects because drug stays in GI tract, N/V/D
• Take with liquid to avoid GI upset
• Contraindicated in pts with: ulcers, IBD, hemorrhoids, constipation
Bile Acid Resins
Cholestyramine Hyperlipidemia Always mix with fluids or food. Take before or
→ Questran with meals. Contraindicated in complete biliary
obstruction.
3. Fibric Acid Derivatives

• Used to: prevent atherosclerosis
• MOA: unknown mechanism lowers LDL + raises HDL
• Side effects: GI effects, gallstones
• Contraindicated in: gallbladder disease, biliary disease
Fibric Acid Derivatives
Gemfibrozil Hypertriglyceridemia, hypercholesterolemia Contraindicated in severe kidney/liver disease,
→ Lopid biliary cirrhosis, and gallbladder disease. If no
response after 3 mos, d/c drug
Fenofibrate Hypercholesterolemia, hypertriglyceridemia Contraindicated in kidney/liver disease,
→ Tricor gallbladder disease, and nursing mothers. Should
be used in conjunction with diet restrictions,
exercise, and cessation of smoking
26

RESPIRATORY DRUGS
Routes of medication administration:
Metered dose inhaler (MDI) = puffer
Dry powder inhaler (DPI) = inhalation activates release of fine powder into lungs
Nebulizer = liquid drug is vaporized for inhalation through a facemask
Goals of drugs for respiratory system = dilate bronchioles (stop bronchospasms) & reduce/prevent
inflammation
Beta2 Adrenergic Agonists

Used to treat: asthma and COPD
These drugs can either be short-acting or long acting
1. Short acting (immediate onset, lasts 5-6 hrs) = metaproterenol, terbutaline, pirbuterol, salbutamol
2. Long acting (delayed onset, lasts 8-12 hrs) = albuterol, levalbuterol, bitolterol, salmeterol
Short acting is drug of choice for fast relief of symptoms in asthmatic pts
MOA: stimulates beta2 receptors = relaxes smooth muscle in airway = allows increased airflow to the lungs
Side effects: paradoxical bronchospasm, tachycardia, palpitation, tremors, dry mouth, HTN
Contraindicated in: dysrhythmias, benign prostatic hyperplasia, palpitations
Short acting Beta2 Adrenergic Agonists

Albuterol Bronchospasm (acute, severe, or exercise- Avoid use in uncontrolled arrhythmias. Observe
→ Ventolin induced) for paradoxical bronchospasm (wheezing) –
most likely with first dose from new puffer
Levalbuterol Bronchospasm, asthma exacerbation Same as above.
→ Xopenex
Metaproterenol Bronchospasm, asthma exacerbation Contraindicated in tachycardia secondary to
heart condition. Risk of hypokalemia
Terbutaline Bronchospasm, preterm labor Risks outweigh benefits in pregnant women
→ Brethaire receiving prolonged treatment (>48hrs). Serious
side effects include tachycardia, hyperglycemia,
hypokalemia, arrhythmias, and MI
Long acting Beta2 Adrenergic Agonists

Albuterol Bronchospasm (acute, severe, or exercise- Avoid use in uncontrolled arrhythmias. Observe
→ Ventolin induced) for paradoxical bronchospasm (wheezing) –
most likely with first dose from new puffer
Salmeterol Asthma prevention and maintenance, COPD Can increase risk of asthma-related death (this
→ Serevent maintenance, prevention of exercise-induced drug should be used in pt’s who aren’t
Diskus asthma adequately controlled on other asthma
medication).
Anticholinergics
Competitively antagonize actions of Ach
Usually not used to treat asthma and COPD due to thickening of secretions, but, ipratropium is one drug in this
category that is used for COPD
Used in: pts with COPD to prevent wheezing, SOB, chest tightness, and cough
MOA: blocks PNS = inhibits muscarinic receptors = causes bronchodilation
Side effects: tachycardia, nervousness, N/V, dizziness, headache, paradoxical bronchospasm
Contraindicated in: benign prostatic hypertrophy, narrow angle glaucoma
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Anticholinergics for bronchodilation
Ipratropium COPD, adjunct for bronchospasm caused by If given with other inhalers - administer
→ Atrovent asthma adrenergic bronchodilators 1st, followed by
ipratropium, then corticosteroids. Wait 5 min
between medications.
Corticosteroids
Used for: long term prevention of asthma attacks
MOA: inhibit production of cytokines, leukotrienes, and prostaglandins + promote recruitment of eosinophils
and inflammatory mediators = reduce inflammation
These drugs will not help in an acute asthma attack
Side effects: mouth irritation, oral candidiasis, upper respiratory tract infection, cough. Oral corticosteroids =
hyperglycemia, N/V, headache, growth suppression in children
Contraindicated in: active infection, hypertension, CHF
Pt’s with diabetes will need closer monitoring of blood glucose due to side effect of hyperglycemia
Anticholinergics for bronchodilation
Beclomethasone Chronic asthma Contraindicated in primary treatment of status asthmaticus or
→ QVAR acute bronchospasm. Assess patients changing from systemic
corticosteroids to inhalation corticosteroids for signs of
adrenal insufficiency (anorexia, nausea, weakness, fatigue,
hypotension, hypoglycemia) during initial therapy + periods of
stress
Fluticasone Maintenance of asthma (not for Same as above
→ Flovent acute relief)
Prednisone Acute asthma, RA, advanced Contraindicated in untreated serious infections, varicella, and
pulmonary TB, autoimmune in administration of live or attenuated live vaccine. Monitor for
hepatitis Cushing syndrome and hyperglycemia. Prolonged use can
increase risk of infection
Leukotriene Modifiers
Used for: prevention of acute asthmatic episodes and long term control of mild asthma
Leukotrienes are pro-inflammatory and cause smooth muscle contraction
MOA: leukotriene receptors are blocked = smooth muscle relaxes + bronchodilation
Side effects: headache, dizziness, N/V, myalgia, cough
Contraindicated in: liver disease, active infections
Leukotriene Modifiers
Montelukast Prophylaxis and maintenance of asthma, Not to be given during an acute asthma attack.
→ Singulair exercise-induced bronchospasm, allergic Monitor for behaviour that could indicate depression
rhinitis or suicidal thought.
Zafirlukast Chronic asthma treatment and Not to be given during an acute asthma attack.
→ Accolate prophylaxis Behavioural changes are reported. Use with warfarin
can result in increased INR
Mast Cell Stabilizers

Used for: prevention & long term control of asthma
MOA: inhibits calcium (necessary for degranulation) = prevents histamine release by mast cells = reduction in
inflammation
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Not effective in asthma attack
Side effects: tracheal irritation, cough, wheeze, bronchospasm, headache
Mast Cell Stabilizers
Cromolyn Asthma, bronchospasm prophylaxis Not to be given during an acute asthma attack.
Symptoms may reoccur when withdrawing the drug
Expectorants
Used in cold and flu medications
MOA: Increases bronchial secretions = thins mucous = easier to cough up mucous = easier to clear the airway
Side effects: N/V/D, drowsiness, abdo pain, headache
Expectorants
Guaifenesin Cough Notify MD if no improvement in >7 days.
→ Robitussin,
Mucinex
Antitussives
Used to relieve a dry + nonproductive cough
MOA: suppress cough reflex by direct action on cough center in medulla
Side effects: N/V/C, sedation, dizziness
Contraindicated in: COPD (it is important to cough in COPD)
Expectorants
Hydrocodone bitartrate Cough Contraindicated in paralytic ileus, acute abdo conditions, and
→ Tussigon respiratory depression.
Dextromethorphan Cough Contraindicated in use with MAOI (can cause serotonin
→ Benylin, Buckley’s syndrome). Avoid OTC cough/cold medication while breast
feeding or to children <4 years.
Benzonatate Cough Risk of severe hypersensitivity reaction (bronchospasm,
→ Tessalon cardiovascular collapse). Keep away from children. Risk of
mental confusion/hallucinations.
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GASTROINTESTINAL SYSTEM DRUGS
GI tract: mouth - pharynx - esophagus - cardiac sphincter - stomach - pyloric sphincter - duodenum - jejunum -
ileum - ascending - transverse - descending - sigmoid - rectum
Peptic ulcer disease (PUD): Acid irritates lining of the stomach or small intestine (SI)
Stomach produces mucous, SI produces bicarb = this protects the lining from acid
85% of cases of PUD are due to H. pylori = irritates epithelial cells and is toxic = lining becomes less able to
protect itself. If irritation is severe enough = bleeding occurs = manifested as blood and vomit, or as coffee
ground appearance.
Antiulcer Drugs
Used to eradicate H. pylori or restore balance between acid and pepsin secretions in GI mucosa
Patient teaching = elevate HOB, don’t lie down 1-2 hours after eating, decrease intake of fat; chocolate; citrus;
coffee; and alcohol, avoid smoking, take medications with water to avoid stomach irritation, exercise regularly
1. Systemic Antibiotics
• H. pylori is a gram -ve bacteria
• Eradicate bacteria = promote ulcer healing and decrease recurrence
• Usually combined with proton pump inhibitor or H2 antagonist
• Side effects: mild GI disturbance, abnormal taste, diarrhea
Systemic Antibiotics
Amoxicillin ENT infections, GU tract infections, skin Monitor bowel function. Report diarrhea, abdo
→ Amoxil infections, lower respiratory tract cramping, fever, and bloody stools (can be sign of
infections, H. pylori, infective endocarditis c.diff)
Clarithromycin Acute exacerbation of chronic bronchitis, Concurrent use with pimozide can prolong the QT
→ Biaxin acute maxillary sinusitis, mycobacterial interval and increase risk of arrhythmias.
infection, PUD, pharyngitis, CAP, skin Contraindicated in co-administration with
infection, pertussis, endocarditis colchicine in patients with liver/kidney disease.
Increased risk of rhabdomyolysis with lovastatin
and simvastatin.
Metronidazole Anaerobic bacterial infections, STI, Possible carcinogenic effect. Contraindicated in 1st
→ Flagyl colorectal surgical infection, trimester patients with trichomoniasis.
trichomoniasis, Gardnerella infection, H. Superinfection may occur with prolonged use.
pylori infection, pelvic inflammatory Avoid alcohol while taking medication and for at
disease, Crohn disease least three days after discontinuation.
Tetracyclines Gram negative bacteria, specific bacterial Monitor bowel function. Report diarrhea, abdo
(e.g. infections, respiratory tract infections, cramping, fever, and bloody stools (can be sign of
doxycycline) STIs, periodontal disease, rosacea, c.diff). This is not the drug of choice for any staph
→ Vibramycin anthrax, malaria, infective endocarditis, infection. If given during last half of pregnancy or
cellulitis from MRSA in pediatric patients, it may cause yellow/brown
discoloration and softening of teeth and bones.
2. Antacids
• Used for: PUD and GERD
• Alkalines (calcium, magnesium, aluminum, sodium carbonates & hydroxides) that neutralize pH of
stomach
• MOA: neutralize acid in GI tract = allows peptic ulcers time to heal
• Pepsin (digestive enzyme) acts more effectively when acidity in stomach is higher. By reducing
acidity, pepsin is reduced.
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• Side effects: constipation (Ca), diarrhea (Mg, Al), bloating, electrolyte imbalance, aluminum
accumulation
Antacids
Aluminum Heartburn Use cautiously in kidney failure
hydroxide/magnesium
carbonate
→ Gaviscon
Calcium carbonate GI distress, calcium supplementation Contraindicated in hypercalciuria, renal calculi,
→ Tums hypophosphatemia, hypercalcemia.
Magnesium hydroxide Constipation, acid indigestion Contraindicated in kidney failure, electrolyte
→ Milk of magnesia imbalance, appendicitis, fecal impaction, and
intestinal obstruction. Use cautiously in kidney
disease
3. H2-receptor antagonist
• Used for: PUD and GERD
• In stomach, histamine binds to H2 receptors (on parietal cells) = stimulates acid secretion
• MOA: blocks H2 receptors = prevents stimulation for acid secretion
• Side effects: D, headaches, decreased liver function, loss of vitamin B12 absorption
H2 Receptor Antagonist
Cimetidine Benign gastric ulcer, duodenal ulcer, This drug is an antiandrogen and may cause
→ Tagamet erosive GERD, heartburn feminization & sexual dysfunction in males
Ranitidine GERD, benign gastric ulcer, erosive If GERD is not improved after 6 weeks, switch to
→ Zantac esophagitis a PPI. Can lead to Vit B12 deficiency. Use
cautiously in renal/liver disease.
Famotidine Duodenal ulcer, benign gastric ulcer, Side effects include confusion, delirium,
→ Pepcid GERD, heartburn hallucinations, disorientation, agitation
4. Proton Pump Inhibitors (PPI)

• Used for: short-term relief of PUD & GERD
• MOA: blocks last step in gastric acid secretion by combining with H+, K+, and ATP in parietal cells of
stomach
• Enteric coated = bypasses stomach and will dissolve in small intestine
• Side effects: abdo pain, N/V/D
• Take before eating. Pantoprazole can be taken with or without food
• Swallow the tablets or capsules whole; don’t crush or chew them
Proton Pump Inhibitors
Pantoprazole, Erosive esophagitis associated with Monitor bowel function. Report diarrhea, abdo
→ Protonix, GERD, short term treatment of GERD, cramping, fever, and bloody stools (can be sign
Pantoloc, Tecta Zollinger-Ellison syndrome, PUD, of c.diff). Use cautiously in liver failure.
Omeprazole Duodenal ulcer, H. pylori, gastric ulcer, Same as above
→ Prilosec GERD, Zollinger-Ellison syndrome
Lansoprazole Duodenal ulcer, gastric ulcer, GERD, Same as above
→ Prevacid erosive esophagitis, Zollinger-Ellison
syndrome, H. pylori infection,
heartburn
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Adsorbent Drugs
These drugs are antidotes for ingestion of toxins that can lead to OD or poisoning
Most commonly prescribed = charcoal
MOA: drug attracts/binds to toxins = inhibits toxins from being absorbed from GI tract = toxin is excreted with
the activated charcoal (body does not metabolize this)
*These drugs don’t prevent the toxic effect brought on before the adsorbent drug was administered; it is
important to administer charcoal as soon after the toxic ingestion as possible
Adsorbent Drugs
Activated charcoal Overdose, poisoning Shake vigorously before use. Contraindicated in
intestinal obstruction and unprotected airway
(risk of aspiration). Vomiting may occur.
Anti-diarrheal and Laxative Drugs

Goal of anti-diarrheals = treat primary condition, then reduce frequency of bowel movement by inhibiting
peristaltic movements
In constipation, there is a decrease in frequency + fluidity of bowel movements = stools can become hard & dry
= difficult to pass. After giving meds for constipation, use bowel sounds as an indicator that peristalsis is
occurring
All laxatives are contraindicated in obstructions or fecal impactions
1. Opioid-related anti-diarrheals
• Used for: diarrhea
• MOA: decrease peristalsis by depressing the muscles in the large and small intestines = prolongs
transmit of GI contents
• Side effects: N/V, abdo distention, fatigue, CNS depression, tachycardia, paralytic ileus
Opioid-related anti-diarrheals
Diphenoxylate Diarrhea Contraindicated in obstructive jaundice. Use
with atropine cautiously in pts with respiratory depression or
→ Lomotil coma as the drug can cause CNS depression
Loperamide Acute diarrhea, chronic diarrhea Contraindicated in pt’s younger than 2 yo.
→ Imodium Overdose of this drug can lead to torsades de
pointes and cardiac arrest.
2. Non-opioid related anti-diarrheals

• Used for: diarrhea
• MOA: acts as adsorbents (bind to bacteria/irritants) = excreted in feces
• Side effects: constipation
• Monitor for fluid and electrolyte imbalance
• Contraindicated in: dehydration, electrolyte imbalance, kidney/liver disease, glaucoma
Non-opioid-related anti-diarrheals
Bismuth Diarrhea, gas, upset stomach, Contraindicated in infectious diarrhea, von
Subsalicylate indigestion, heartburn, nausea, H. Willebrand disease, hemorrhage, GI bleed, and
→ Pepto Bismol pylori hemophilia. Can cause black stool.
3. Bulk forming laxatives

• Used for: constipation
• MOA: fiber not absorbed by bowel = creates bulk that passes quickly through bowel
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• Should be taken with water
• Side effects: flatulence, sensation of abdo fullness, intestinal obstruction, fecal impaction, severe
diarrhea
Bulk Forming Laxatives
Psyllium Constipation, fiber supplementation Contraindicated in GI obstruction, fecal
→ Metamucil impaction. Mix the powder with water or juice.
4. Stool softeners
• MOA: surfactant lowers stool surface tension = water moves more easily into stool = stool is easier
to pass
• Side effects: diarrhea, throat irritation, abdo cramps
Stool Softeners
Docusate Sodium Stool softener Can be given PO or PR. This med does not
→ Colace stimulate peristalsis. May take 3-5 days for a
result
5. Stimulant Laxatives
• MOA: irritates bowel = promotes peristalsis + secretion of water into bowel = movement of feces
increases and softens
• Rapid effect (used as prep prior to surgery)
• Side effects: weakness, N, abdo cramps, mild inflammation of rectum
Stimulant Laxatives
Bisacodyl Constipation Can be given PO or PR (enema or suppository).
→ Dulcolax Should only be used for short term therapy (no
longer than 1 week).
Senna Constipation, bowel preparation Contraindicated in GI obstruction, ulcerative
→ Senokot colitis, fecal impaction, and GI bleed
6. Osmotic Laxatives
• Used for constipation
• MOA: osmotically draws water into bowel
• Risk of dehydration
• Side effects: weakness, fatigue, abdo distention, N/V/D, electrolyte imbalance, weakness,
dehydration
Osmotic Laxatives
Lactulose Constipation, portal systemic Contraindicated in impaction. Monitor for
→ Enulose encephalopathy electrolyte imbalance with long-term use. Avoid
using other laxatives concomitantly.
Glycerin Constipation Same as above.
→ Fleet glycerin
suppository
Polyethylene glycol Constipation, colonoscopy bowel Same as above.
→ PEG prep
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Anti-emetic and Anti-nausea Drugs
Nausea (N) leads to vomiting (V)
Excessive N/V can lead to metabolic alkalosis, dehydration, and electrolyte imbalances
1. Antiemetics
• Ondansetron (Zofran) is the medication of choice
• MOA varies on the drug;
o Antihistamines – block H1 receptor = prevents Ach from binding to receptor
o Phenothiazines – block dopaminergic receptors in chemoreceptor trigger zone (normally
stimulates vomiting)
o Serotonin receptor antagonist – blocks serotonin stimulation in chemoreceptor trigger zone
and in vagal nerve terminals (both of these normally stimulate vomiting)
• Side effects:
o Antihistamines: drowsiness
o Phenothiazines + serotonin receptor antagonists: confusion, anxiety, agitation, depression,
headache, restlessness, weakness
o Anticholinergic effects of antiemetics: constipation, dry mouth, urine retention
Antiemetics
Dimenhydrinate Antihistamine; prevention of motion Contraindicated in lower respiratory disease
→ Dramamine, sickness (asthma) and nursing women. Can cause driving
Gravol impairment.
Chlorpromazine Phenothiazine; N/V, schizophrenia, Not approved for pt’s with dementia-related
→ Thorazine intraoperative sedation, migraine psychosis. Contraindicated in lactation.
headache
Ondansetron Serotonin receptor antagonist; Use according to schedule, not PRN. Use with
→ Zofran chemotherapy or radiation-induced N/V, apomorphine increases the risk of severe
post-op N/V, hyperemesis gravidarum hypotension and loss of consciousness. Monitor
for signs of serotonin syndrome.
34

GENITOURINARY DRUGS
GU system: reproductive system + urinary system (kidneys, ureters, bladder, urethra)

Kidneys: dispose of wastes in the form of urine, filter blood, maintain fluid/electrolyte balance, produce
hormones + enzymes, convert vitamin D to a more active form, and help regulate BP + volume by secreting
renin
Diuretics
1. Thiazides (hydrochlorothiazide)
• Used for: edema, HTN, diabetes insipidus
• MOA: reduce Na reabsorption by inhibiting Na+/Cl- cotransporter in the ascending loop of Henle =
prevent reabsorption of Na in kidneys = increased excretion of Na (and thus water). There is also an
increase in excretion of Cl, K, and bicarb
• Side effects: hypokalemia, hyperglycemia, hyperlipidemia, hyponatremia, hypercalcemia, low BP,
• Decreases responsiveness to oral hypoglycemics
Thiazide Diuretics
Hydrochlorothiazide HTN, edema Contraindicated in anuria. Use cautiously in
→ HCTZ, microzide pts with DM, fluid/electrolyte imbalance,
gout, hypotension, SLE, kidney/liver disease.
Indapamide HTN, edema Same as above
Metolazone HTN, edema Same as above. Avoid concurrent use with
→ Zaroxolyn lithium.
2. Loop diuretics
• Used for: hypercalcemia, hyperkalemia, pulmonary edema, CHF, HTN
• MOA: inhibits Na and Cl reabsorption in ascending loop of Henle = increases excretion of Na, Cl, and
water
• *very rapid effect
• Side effects: hyperglycemia, electrolyte imbalance, hypokalemia, hypovolemia, hypotension, ototoxic
Loop Diuretics
Furosemide HTN, edema, acute pulmonary edema, If given in excess can cause severe diuresis +
→ Lasix increased ICP, hyperkalemia in ACLS water/electrolyte depletion. Contraindicated in
anuria. Use cautiously in pts with kidney/liver
disease. Risk of ototoxicity. Monitor BUN and
Cre
Bumetanide HTN, edema Same as above
→ Bimex
3. Potassium sparing diuretics

• MOA: inhibition of aldosterone by canrenone = increases Na+ excretion, decreases K+ secretion &
excretion = Na+ excretion promotes water excretion
• Side effects: hyperkalemia
• Contraindication: hyperkalemia, renal insufficiency
K+ Sparing Diuretics
35

Spironolactone Hyperaldosteronism, edema, HTN, CHF, Contraindicated in Addison disease,
→ Aldactone hypokalemia, hirsutism, acne hyperkalemia, and co-administration with
eplerenone. Monitor serum K+
Amiloride CHF, HTN, thiazide-induced hypokalemia Take with food. Monitor serum K+ (may cause
→ Midamor hyperkalemia). Monitor BUN and Cre
Urinary Tract Antispasmodics

These drugs help decrease urinary tract muscle spasms
Used for: overactive bladder, urge incontinence, neurogenic bladder
MOA: drug inhibits PNS = relieves smooth muscle spasm by relaxing detrusor and urinary muscles
Side effects: blurred vision, headache, urinary retention, dry mouth, N/V/C, weight gain, glaucoma
Monitor voids and assess for S/S of overactive bladder (urgency, incontinence, and frequency)
If co-administered with strong CYP3A4 inhibitors, drug should be given at reduced dosage
Urinary Tract Antispasmodics
Darifenacin Overactive bladder Contraindicated in urinary retention, narrow
→ Enablex angle glaucoma, liver failure, GI/GU obstruction.
If angioedema occurs, d/c medication. Avoid use
in patients with myasthenia gravis because of
decreased cholinergic activity
Flavoxate Overactive bladder, dysuria Same as above
Oxybutynin Overactive bladder with neurogenic bladder Same as above
→ Ditropan
Solifenacin Overactive bladder Same as above
→ Vesicare
Tolterodine Overactive bladder, urge incontinence Same as above
→ Detrol
Erectile Dysfunction Drugs (Phosphodiesterase 5 Enzyme Inhibitors)

Erectile dysfunction = due to lack of blood flowing through corpus cavernosum
MOA: drug selectively inhibits phosphodiesterase type 5 receptors = causes increase in nitric oxide = activation
of cGMP enzyme = relaxation of smooth muscle = increased blood flow to corpus cavernosum = erection
Side effects: (sildenafil = hypotension, MI, cerebrovascular hemorrhage), headache, dizziness, flushing,
dyspepsia, vision change
Drug is to be taken 30 minutes-4 hours before sexual activity
If the erection lasts >4 hours, medical intervention is needed
Do not take erectile dysfunction drugs if also on nitrates or beta blockers for HTN or angina
These drugs have no effect without the presence of sexual stimulation
Erectile Dysfunction Drugs
Sildenafil Erectile dysfunction, pulmonary arterial HTN Co-administration with soluble guanylate
→ Viagra cyclase stimulators (e.g. riociguat) or nitrates
can cause severe hypotension. Sudden
decrease/loss of hearing can occur.
Tadalafil Erectile dysfunction, BPH Same as above
→ Adcirca
Vardenafil Erectile dysfunction Same as above. Co-administration with Class I
→ Levitra antiarrhythmics (e.g. quinidine or procainamide)
or Class III antiarrhythmics (e.g. amiodarone )
increases the risk of serious arrhythmias
36

Hormonal Contraceptive Drugs
These drugs inhibit ovulation
MOA: suppresses gonadotropins = inhibits ovulation
• Estrogen (E) = suppresses follicle stimulating hormone = blocks follicular development + ovulation
• Progestin (P) = suppresses secretion of luteinizing hormone = prevents ovulation even if follicle develops
• Progestin = thickens cervical mucous = interferes with sperm migration + implantation of fertilized egg
Side effects: arterial thrombosis, thrombophlebitis, PE, MI, HTN, gallbladder disease, acne, bleeding between
periods, bloating, breast tenderness, change in libido, weight fluctuation
1. Oral Contraceptive
• Usually a combo of P + E
• Taken for 21 of 28 days with 7 days of placebos
• If pt misses one day, double up on the next day
• Monophasic = constant amounts of P & E
• Biphasic = E is constant but P changes to better thicken endometrium
• Triphasic = P & E both vary during cycle
2. Non-Oral Contraceptive
• IM injections of medroxyprogesterone (depo-provera) = 3 months of contraception
• Norplant system; silastic capsules containing levonorgestrel that are implanted into skin = up to 5
years of contraception
• Transdermal patch (E&P); Orthoevra = change patch once a week for 3 weeks, then no patch
• Nuva ring; vaginal ring containing P&E that’s changed once per cycle
Pregnancy Drugs
1. Oxytocic’s
• Used to: promote uterine contraction
• MOA: activates G-protein-coupled receptors that trigger increases in intracellular calcium levels in
uterine myofibrils = stimulates uterine smooth muscle = promotes uterine contractions
• Also has vasopressor and antidiuretic effects
• Oxytocin is contraindicated for contractions closer than two minutes apart
• Monitor pt’s for HTN
Oxytocic Drug
Oxytocin Postpartum hemorrhage, labour induction, Monitor intrauterine pressure, FHR, maternal
→ Pitocin incomplete abortion BP + HR. Contraindicated in unfavorable fetal
positions, fetal distress, hypertonic uterus, and
in elective labor induction.
2. Tocolytic’s
• Used to: block uterine contractions
Tocolytic Drug
Terbutaline Bronchospasm, pre-term labor Beta blocker. Monitor maternal HR and BP,
→ Brethaire frequency and duration of contractions, and
FHR. Maternal side effects include tachycardia,
palpitations, tremor, anxiety, and headache
Magnesium sulfate Hypomagnesemia, torsades de Monitor HR, BP, RR, and ECG frequently.
pointes, preterm labour Monitor newborn for hypotension,
hyporeflexia, and respiratory depression.
37

HEMATOLOGY DRUGS
Hematology system = plasma (liquid component of blood) and blood cells (RBC, WBC, platelets)
Hematinic Drugs
Aid in RBC production (which then also increases hgb = increases oxygen transportation)
Used for: microcytic and macrocytic anemia
1. Iron
• Treats the most common form of anemia = iron deficiency anemia
• Most important role of iron = production of hgb by increased erythropoiesis (production of RBC)
• Pregnant pt’s should take iron due to fetus using up the iron
• Iron absorption is reduced by: spinach, whole-grains, coffee, tea, eggs, and milk products
• Side effects: gastric irritation, constipation, dark stool
Iron Drugs
Ferrous fumarate, ferrous Prevention/treatment of iron- Oral iron can decrease the absorption of
gluconate, ferrous sulfate deficiency anemia tetracyclines, fluoroquinolones, or
→ Feostat, Fergon, penicillamine.
Feosol Oral preparations are most effectively absorbed
if administered 1 hr before or 2 hr after meals
Iron sucrose, iron dextran Prevention/treatment of iron- Given via injection. Monitor BP and HR
→ Venofer, DexFerrum deficiency anemia frequently.
2. Vitamin B12
• Used to: treat pernicious anemia
• B12 is necessary for cell growth + replication and for maintenance of myelin in nervous system
o HCl acid and intrinsic factor from the parietal cells of gastric mucosa are necessary for
absorption of Vitamin B12
• Pernicious anemia = decreased gastric production of HCl acid + deficiency of intrinsic factor
• Side of effects of parenteral B12: itching, rash, hives, hypokalemia, polycythemia vera, heart failure,
pulmonary edema, anaphylaxis
• Assess pt for S/S of vitamin B12 deficiency (pallor; neuropathy; psychosis; red + inflamed tongue)
Vitamin B12 Drugs
Cyanocobalamin, B12 deficiency, pernicious anemia Water soluble vitamin. Pt’s with small-bowel
hydroxocobalamin disease, malabsorption syndrome, or
→ Nascobal, gastric/ileal resections require parenteral, not
cyanokit PO, administration. With PO route, administer
med with meals to increase absorption.
3. Folic Acid
• Used to: treat megaloblastic anemia caused by folic acid deficiency
• Usually occurs in pediatric, pregnant, elderly, or alcoholic patients
• Folic acid is necessary in RBC production + growth
• Large doses of folic acid can counteract effects of anticonvulsants
• Side effects: erythema, itching, rash, anorexia, N, difficulty concentrating, irritability
38

Folic Acid Drugs
Folic Acid Folic acid deficiency, neural tube defects Phenytoin (& other anticonvulsants) may
→ Folvite prophylaxis decrease folic acid absorption.
4. Epoetin Alfa
• Erythropoietin forms in kidneys when there is hypoxia + anemia; it stimulates erythropoiesis in bone
marrow (RBC production)
• These drugs are given to pts with decreased erythropoietin production
• Side effects: HTN is most common, headache, N/V/D, edema, fatigue, dizziness, chest pain, skin
reaction
Epoetin Alfa Drugs
Epoetin Alfa Chronic kidney disease-associated Contraindicated in cancer pt’s whose anemia is
→ Epogen anemia, chemotherapy-related due to factors other than chemo and in pt’s with
anemia uncontrolled HTN. Additional heparin may be
needed to prevent blood clotting if the patient is
on dialysis.
Darbepoetin Alfa Same as above Same as above
→ Aranesp
Anticoagulant Drugs
These drugs reduce the ability of the blood to clot
Assess for S/S of bleeding or hemorrhage: bleeding gums, nosebleed, bruising, black tarry stools, hematuria
1. Heparin & Heparin Derivatives
• Used to: prevent clot formation
• Does not dissolve already formed clots
• MOA: drug activates antithrombin 3 = prevents formation of thrombin + fibrin
• Thrombin time and PTT are prolonged in pt taking heparin
• Low molecular weight heparin = used for DVT prevention
• Side effects: few side effects. Bleeding, bruising, hematoma
• PTT is maintained at 1.5-2x the normal
• Antidote for heparin is protamine sulfate
Heparin & Heparin Induced Derivatives
Heparin DVT, PE, ACS, anticoagulation, High alert drug – can cause fatal hemorrhage.
catheter patency Contraindicated in uncontrolled active bleed
(except DIC). Heparin-induced thrombocytopenia
can occur. Monitor PTT
Dalteparin, Prevention of DVT and/or PE Low molecular weight heparin. Contraindicated
Enoxaparin in active bleed, history of heparin-induced
→ Fragmin, Lovenox thrombocytopenia, and in pt’s who had epidural
neuraxial anesthesia. Do not give via IM route.
2. Oral anticoagulants
• Main drug in this category = warfarin
• Rapid absorption, but effects are not seen for 36-48 hrs
• MOA: inhibits Vitamin K dependent activation of clotting factors
• Side effects: minor bleeding, bruising, hematoma
39

• The effects of warfarin can be reversed with Vitamin K
• Monitor INR
Oral anticoagulants
Warfarin Prophylaxis and treatment of venous Instruct pt not to drink alcohol or take
→ Coumadin thrombosis, PE, afib with embolization, OTC/herbal medication, especially those
and cardiac valve replacement containing ASA or NSAIDs.
3. Antiplatelets
• Used to: prevent arterial thromboembolism (used in pt’s at risk for MI, stroke, and arteriosclerosis)
• Absorbed quickly + reaches peak in 1-2 hours
• MOA: drug blocks synthesis of prostaglandin = prevents formation of platelet-aggregating substance,
thromboxane A2
• Side effects: bleeding is most common side effect. Others include stomach pain, heartburn, N/D/C
• Contraindicated in active bleeding
Antiplatelets
Aspirin ACS, pain + fever, ischemic stroke, RA, Teach pt to avoid alcohol when taking aspirin – it
→ ASA OA, MI prophylaxis increases risk of GI bleed.
Clopidogrel ACS, MI, stroke, CAD Monitor patient for signs of thrombotic
→ Plavix thrombocytic purpura. Prolonged bleeding time
is expected – monitor CBC and platelet count.
Thrombolytic Drugs
These drugs dissolve existing clots
MOA: drug converts plasminogen to plasmin = dissolves thrombi + fibrinogen
These drugs are most effective when given within 6 hrs of onset of symptoms
Side effects: bleeding
Contraindicated in active bleed
Maintain bleeding precautions during administration
Thrombolytic Drugs
Alteplase Acute MI, PE, acute ischemic stroke, Must be administered within 3-4.5 hr of onset of
→ TPA, alteplase peripheral artery occlusion, restoration ischemic stroke. Avoid IM injections on pt’s
of patency in clotted IV access taking alteplase.
40

ENDOCRINE DRUGS
Insulin: pancreatic hormone that increases activity + production of glucose transporter, helps move glucose into
cells and out of blood, promotes storage of carbs, lipids & proteins
• Insulin decreases blood glucose levels
Glucagon: promotes conversion of stored carbs, lipids and proteins into glucose; releases glucose into blood
• Glucagon increases blood glucose levels
Type 1 Diabetes Mellitus:
• Due to genetic, immunologic factors
• Adequate amounts of insulin are not produced = pt requires insulin injections on a daily basis
• S/S: polyuria, polydipsia, polyphagia, hyperglycemia, glycosuria
Type 2 Diabetes Mellitus:
• Onset is usually during middle age
• Insulin is produced but not enough to compensate for hyperglycemia
• Treatment = diet, exercise, oral hypoglycemics, insulin
Antidiabetic Drugs + Glucagon

1. Insulin
• Used for: type 1 diabetics, adjunct treatment for type 2 diabetics, and for diabetic ketoacidosis (DKA)
• 4 types of insulin – rapid acting (e.g. lispro), short acting (e.g. regular insulin), intermediate acting
(e.g. NPH), long acting (glargine)
Insulin
Type Onset Peak Duration
Rapid acting <15 minutes 1-2 hrs 3-6 hrs
(Lispro, Aspart, Glulisine)
Short acting 30-60 minutes 2-4 hrs 6-10 hrs
(Regular)
Intermediate acting 2-4 hrs 4-8 hrs 10-18 hrs
(NPH)
Long acting 1-2 hrs NO PEAK Up to 24 hrs
(Glargine, Detemir)
• S/S of hypoglycemia: Cold, clammy, irritable, pale, weak, diaphoretic
• S/S of hyperglycemia: Polyphagia, polyuria, polydipsia, blurred vision, fruity breath, hot + dry
• Side effects: hypoglycemia, somogyi effect (hypoglycemia followed by rebound hyperglycemia),
lipodystrophy (disturbance in fat deposition), and insulin resistance
• When mixing regular insulin with NPH, always draw up regular insulin (clear) into the syringe first
• Treat hypoglycemia with oral glucose tablets, glucagon, or IV glucose
2. Oral antidiabetic drugs

• Used for: type 2 diabetics
• MOA: stimulates insulin release from beta cells in pancreas & reduces glucose output by liver
• Side effects: hypoglycemia is the main side effect
• Pt may need insulin during times of bodily stress (e.g. infection, fever, surgery, trauma)
• Metformin, acarbose, miglitol ,and thiazolidinediones don’t cause hypoglycemia when
taken alone but may increase the hypoglycemic effect of other hypoglycemic agents
41

Oral Antidiabetic Drugs
Glimepiride, glipizide, glyburide T2DM 2nd generation sulfonylureas. Contraindicated in T1Dm and
→ Amaryl, Glucotrol, DiaBeta DKA
Pioglitazone, Rosiglitazone T2DM Thiazolidinedione drug. This drug can cause or exacerbate
→ Actos, Avandia CHF - assess for S/S of CHF after initiation and dose increases.
Contraindicated in DKA and CHF
Metformin T2DM Biguanide drug. This drug can cause lactic acidosis, especially
→ Glucophage in pt’s with kidney disease (elevated lactate, decreased blood
pH, EL disturbance). S/S of lactic acidosis: chills, D, dizziness,
hypotension, muscle pain, abdo pain, sleepiness, bradycardia,
dyspnea, or weakness
Acarbose, miglitol T2DM Alpha-glucosidase inhibitor drug. Contraindicated in DKA,
→ Precose, Glyset cirrhosis, inflammatory bowel disease, GI impairment.
Repaglinide T2DM Meglitinide drug. Contraindicated in DKA, T1DM, and in co-
→ Prandin administration with gemfibrozil (can lead to severe
hypoglycemia)
Sitagliptin T2DM Incretin modifier drug. Use cautiously in CHF. Not effective in
→ Januvia DKA or T1DM
3. Glucagon
• A hormone normally produced by alpha cells in the pancreas
• This drug raises blood glucose levels
• Used for: emergency treatment of severe hypoglycemia
• MOA: promotes glycogenolysis (conversion of glycogen into glucose), gluconeogenesis (formation of
glucose from fatty acids + protein), and lipolysis (release of fatty acids to be converted into glucose)
• Side effects: rarely any
Thyroid Drugs
1. Thyroid drugs
• Used to: treat hypothyroidism
• These drugs contain triiodothyronine (T3), thyroxine (T4), or both
• MOA: stimulates metabolism of all body tissue by accelerating rate of cellular oxidation
o Thyroid stimulates protein synthesis, gluconeogenesis, and increases glycogen storage
• Levothyroxine is the drug of choice
• Side effects: D, abdo cramps, weight loss, palpitations, HTN, headache, tremor, heat intolerance
Thyroid Drugs
Levothyroxine Hypothyroidism, myxedema coma Contains T4. Not used for treatment of obesity.
→ Synthroid The dose needs to be properly titrated and
monitored. Monitor for tachyarrhythmias.
Thyroid USP Hypothyroidism Contains T3 and T4. Use cautiously in angina,
cardiovascular disease, and HTN.
2. Thyroid Antagonist
• Used to: treat hyperthyroidism
• MOA: blocks iodine’s ability to combine with tyrosine = prevents thyroid synthesis
• Side effects: granulocytopenia
42

Thyroid Antagonist Drugs
Propylthiouracil, Hyperthyroidism, Graves Disease Thioamide drugs. Agranulocytosis can develop
methimazole quickly and usually occurs during first 2 mos. Closely
→ PropylThyracil, monitor for liver injury in first 6 mos. Propylthiouracil
Tapazole is used over methimazole in pregnant pt’s because
the drug does not cross the placenta (methimazole
can cause congenital abnormalities)
43

MENTAL HEALTH DRUGS
Antidepressant Drugs
S/S of depression: sleep disturbances, extreme fatigue, abnormal eating patterns, vague physical symptoms,
inability to focus attention, death-obsessed, avoiding personal interactions, lack of interest in sex/personal
appearance, delusions/hallucinations
1. SSRIs
• Used to: treat major depression, panic disorders, eating disorders, personality disorders, and anxiety
• Drug of choice for depression
• MOA: drug inhibits neuronal reuptake of serotonin = increase in serotonin levels
• Abrupt discontinuation can lead to SSRI discontinuation syndrome (S/S: lowered mood, lethargy,
irritability, paresthesia)
• Side effects: anxiety, insomnia, somnolence, palpitations, sexual dysfunction, orthostatic
hypotension, increased suicidal ideation
• Drug needs to be taken for 2-4 weeks for relief of symptoms to be seen
SSRI Drugs
Citalopram Depression Do not administer to pt taking MAOI (increases
→ Celexa risk of serotonin syndrome). S/S of serotonin
syndrome: mental changes (agitation,
hallucinations, coma), autonomic instability
(tachycardia, labile BP, hyperthermia),
hyperreflexia, incoordination, and/or GI
symptoms (N/V/D). Monitor for suicidal ideation.
Use cautiously in pregnancy (risk of pulmonary
HTN of newborn)
Escitalopram Major depressive disorder, generalized Same as above.
→ Lexapro anxiety disorder, OCD, insomnia
secondary to panic disorder, PTSD
Fluoxetine Major depressive disorder, OCD, bulimia Same as above. Monitor for neuroleptic
→ Prozac nervosa, panic disorder, premenstrual malignant syndrome (S/S: fever, resp distress,
dysphoric disorder tachycardia, seizures, diaphoresis, arrhythmias,
HTN or hypotension, pallor, tiredness, muscle
stiffness, loss of bladder control)
Paroxetine Depression, OCD, panic disorder, social Same as above. Monitor for serotonin syndrome
→ Paxil phobia, generalized anxiety disorder, + neuroleptic malignant syndrome
PTSD, premenstrual dysphoric disorder,
menopausal vasomotor symptoms
Sertraline Major depressive disorder, OCD, panic Do not administer to pt taking MAOI (increases
→ Zoloft disorder, PTSD, social anxiety disorder, risk of serotonin syndrome). S/S of serotonin
premenstrual dysphoric disorder syndrome: mental changes (agitation,
hallucinations, coma), autonomic instability
(tachycardia, labile BP, hyperthermia),
hyperreflexia, incoordination, and/or GI
symptoms (N/V/D). Monitor for suicidal ideation.
Use cautiously in pregnancy (risk of pulmonary
HTN of newborn)
2. Monoamine oxidase Inhibitors (MAOIs)

• Used to: treat depression, panic disorder, eating disorder, PTSD
44

• Used when a pt does not respond to SSRI or TCA
• MOA: inhibits monoamine oxidase (normally metabolizes neurotransmitters like serotonin and
norepinephrine) = increases the amount of neurotransmitters (serotonin, dopamine,
norepinephrine)
• MAOI taken with amphetamines, methylphenidate, levodopa, or sympathomimetics may increase
catecholamine release = causes hypertensive crisis
• Stop an MAOI 2 weeks before starting another antidepressant
• Avoid foods high in tyramine (aged cheese, red wine, beer, avocado, chocolate) and caffeine = can
lead to hypertensive crisis
• Side effects: hypertensive crisis, orthostatic hypotension, restlessness, drowsiness, dizziness,
headache, N/V/C, dry mouth, blurred vision, urine retention
MAOI Drugs
Phenelzine Depression Monitor BP. Monitor for suicidal ideation.
→ Nardil Contraindicated in pheochromocytoma, CHF,
HTN, liver/kidney disease
Tranylcypromine Major depressive disorder Abrupt discontinuation can lead to withdrawal
→ Parnate effects (including delirium). Monitor for suicidal
ideation. Contraindicated in pheochromocytoma,
CHF, HTN, liver/kidney disease, schizophrenia
3. Tricyclic antidepressants (TCAs)

• Used to: treat major depression
• 2nd choice of drug after SSRI
• MOA: inhibits reuptake of NE & serotonin, but not dopamine (also blocks acetylcholine and
histamine receptors)
• Side effects: orthostatic hypotension, cardiac dysrhythmias, anticholinergic effects (dry mouth,
blurred vision, tachycardia, C, restlessness), sedation, weight gain, respiratory depression
TCA Drugs
Amitriptyline Depression, migraine prophylaxis, eating Monitor for suicidal ideation (SI). Not to be used
→ Elvail disorder in pediatric pts. Pt’s with cardiovascular hx or
those taking a high dose should have ECG
monitored. Contraindicated in pt’s taking MAOI
Amoxapine Depression Monitor for SI. Not to be used in pediatric pts.
→ Asendin Contraindicated in narrow angle glaucoma,
severe cardiovascular disease, and with MAOI
use.
Clomipramine OCD Same as above
→ Anafranil
Desipramine Depression Same as above
→ Norpramin
Doxepin Depression, anxiety, insomnia Same as above
→ Silenor
Nortriptyline Depression, ADHD, chronic neurogenic Same as above. Monitor ECG - may prolong PR +
→ Pamelor pain QT intervals, and may flatten T waves.
Trimipramine Depression Monitor for SI. Not to be used in pediatric pts.
Contraindicated in severe cardiovascular disease,
narrow angle glaucoma, and MAOI use
45

4. Atypical Antidepressants
• Trazodone: serotonin antagonist and reuptake inhibitor (SARI); increases serotonin release
• Buproprion: NE & dopamine reuptake inhibitors (NDRI)
• Venlafaxine & Duloxetine: serotonin & NE reuptake inhibitors (SNRIs); used in pt’s that aren’t
responsive to SSRIs and for patients that suffer from chronic pain as a symptom of depression (in
combo with TCAs)
• Mirtazapine: similar to SNRIs but also antagonizes H1 histamine receptors (produces sedation,
increased appetite and weight gain as side effects)
Bipolar Drugs
Bipolar = cyclic episodes of mania & depression
Mania: due to excess excitatory neurotransmitters or deficit of inhibitory neurotransmitters (such as GABA)
In bipolar, pt has episodes of excessive catecholamine stimulation and diminished catecholamine stimulation
MOA: exact mechanism is unknown. Alters levels of NE, serotonin, and dopamine.
S/S of mania: insomnia, activity without fatigue, agitated, aggressive, overconfidence, seeking others, unusual
interest in sex, substance abuse, denial of problem
A pt on a severe salt-restricted diet is susceptible to lithium toxicity. Increased intake of Na+ may reduce the
therapeutic effects of lithium
Bipolar Drugs
Lithium Bipolar disorder Take with plenty of water and after meals to
→ Eskalith, Lithobid minimize GI upset. Monitor lithium levels
(narrow therapeutic index); S/S of toxicity:
diarrhea, vomiting, tremor, drowsiness, muscle
weakness, and ataxia
Antipsychotic Drugs
These drugs control psychotic symptoms – delusions, hallucinations, thought disorder
Used for: schizophrenia, mania, and psychosis
S/S of schizophrenia: hallucinations, delusions, paranoia, indifference/detachment from surroundings,
deteriorating performance of basic skills, withdrawal from social interaction, strange communication
behaviours, irregular moods
• Positive symptoms = add on to normal behavior; hallucinations, delusions, disorganized
thought/communication
• Negative symptoms = subtract from normal behavior; lack of interest in daily activities, lack of
motivation, lack of responsiveness
1. Typical Antipsychotics
• Include phenothiazines and nonphenothiazines
• Block positive symptoms by antagonizing dopamine & serotonin
• Side effects: anticholinergic, sexual dysfunction, sedation, orthostatic hypotension, weight gain,
extrapyramidal effects (acute dystonia, akathisia, Parkinsonism, tardive dyskinesia), neuroleptic
malignant syndrome (fever, muscle rigidity, unstable BP, sweating, dyspnea)
• Contraindicated in: Parkinson’s, CNS depression, bone marrow depression, alcohol withdrawal
syndrome, Reye’s syndrome, COPD
Typical Antipsychotic Drugs
Haloperidol Schizophrenia, psychosis, Tourette Monitor ECG and QT interval (risk of QT
→ Haldol disorder prolongation). Monitor for neuroleptic malignant
syndrome. Not to be used for dementia-related
46

psychosis. Haloperidol decanoate should not be
administered via IV route. Contraindicated in
severe CNS depression, Parkinson’s, and
dementia with Lewy bodies
Loxapine Schizophrenia Not to be used in dementia-related psychosis.
→ Loxitane This drug can cause bronchospasm + respiratory
distress. Contraindicated in CNS depression,
neuroleptic malignant syndrome, and seizure
disorder
Chlorpromazine Schizophrenia, psychotic disorder, Primarily causes sedation + anticholinergic
→ Thorazine intraoperative sedation, migraine effects. Not to be used in dementia-related
headache psychosis. Do not use in lactating pts.
Fluphenazine Psychotic disorders Primarily cause extrapyramidal reactions. Not to
→ Modecate be used in dementia-related psychosis. Do not
use in lactating pts.
Thioridazine Schizophrenia, depressive disorder Primarily cause sedation, anticholinergic, and
→ Mellaril cardiac effects. Not to be used in dementia-
related psychosis. Do not use in lactating pts.
2. Atypical Antipsychotics
• Blocks positive & negative symptoms by blocking dopamine, serotonin, ACh and alpha adrenergic
receptors (these drugs don’t block the receptors as much as the typical antipsychotics = less side
effects)
• Drug group of choice
• Side effects: weight gain, decreased libido, risk of type II diabetes due to altered glucose metabolism,
bone marrow depression, few motor (EPS) side effects
• Contraindicated in: epilepsy, leucopenia, CNS depression, hypotension
Atypical Antipsychotic Drugs
Clozapine Schizophrenia, suicidal behaviour in Monitor for signs of myocarditis (fatigue,
→ Clozaril schizophrenia dyspnea, tachypnea, fever, chest pain,
palpitations, heart failure, ECG changes,
arrhythmias). This drug lowers the seizure
threshold (institute seizure precautions for pts
with hx of seizures). Monitor for neuroleptic
malignant syndrome. Monitor WBC and ANC
before and during treatment (stop the drug if
there is clozapine-induced neutropenia – can
lead to serious infection and death)
Olanzapine Schizophrenia, bipolar mania, agitation Not to be used in dementia-related psychosis.
→ Zyprexa with schizophrenia and bipolar, bipolar Risk of severe sedation. Monitor for change in
depression mental status, and for neuroleptic malignant
syndrome
Risperidone Schizophrenia, bipolar disorder Not to be used in dementia-related psychosis.
→ Risperdal Monitor for suicidal ideation and neuroleptic
malignant syndrome.
Quetiapine Schizophrenia, bipolar disorder, major Same as above. Not to be used in pts under 10
→ Seroquel depressive disorder years.
Aripiprazole Schizophrenia, bipolar mania, major Not to be used in dementia-related psychosis.
→ Abilify depressive disorder Monitor for suicidal ideation.
47

Stimulants
These drugs treat ADHD (inattention, impulsiveness, hyperactivity)
MOA: drug increases levels of dopamine and NE by blocking reuptake of dopamine + NE
Stimulants shouldn’t be used with MAOI
Side effects: risk of drug abuse, restlessness, tremor, insomnia, tachycardia, palpitations, arrhythmias, dizziness
These drugs should be given at least 6 hours before bedtime to avoid sleep interference
Pts should avoid caffeine as it increases the effects of amphetamines
Stimulant Drugs
Dextroamphetamine ADHD, narcolepsy High potential for abuse and dependence.
→ Dexedrine Contraindicated in glaucoma, HTN, hx of
drug abuse, MAOIs
Amphetamine/Dextroamphetamine ADHD, narcolepsy Same as above
→ Adderall
Methylphenidate ADHD, narcolepsy Focuses attention by promoting alertness.
→ Ritalin Used in children (less effective in adults).
Monitor for growth inhibition. Chronic
abuse can lead to high tolerance and
dependence. Used as cognitive enhancer in
university.
48

SUBSTANCES OF ADDICTION
Dependence: unable to stop taking drug due to satisfaction/pleasure from taking drug → linked to dopamine
receptor stimulation in limbic system providing a sense of euphoria
Tolerance: higher dose needed to produce same response due to repeated exposure to drug
Withdrawal symptoms = opposite to the effects of the drug
CNS Depressants
Produce feeling of sedation/relaxation
1. Sedatives
• Used for: sleep disorders, epilepsy, anxiety
• Barbiturates and benzodiazepines
• MOA: stimulates GABA receptors, which then inhibits brain activity; this is what causes the
drowsy/calming effects
• Overdose = suppresses respiratory system
• Contraindications: airway obstruction, narrow angle glaucoma
• Benzodiazepines produce more mild effects while barbiturates have more intense effects
including dependence and potential for lethality
• Benzodiazepine antagonist = flumazenil
• Barbiturates antagonist = megimide
Barbiturates
Phenobarbital Status epilepticus, seizures, sedation, Risk of toxicity increases when taken with CNS
→ Luminal hypnotic, insomnia depressants, valproic acid, chloramphenicol,
felbamate, cimetidine, or phenytoin
Primidone Seizures
→ Mysoline
Benzodiazepines
Lorazepam Anxiety, status epilepticus, seizures Use with opioids can result in profound
→ Ativan sedation, respiratory depression, coma, and
death
Diazepam Anxiety, alcohol withdrawal, pre-op Use with opioids can result in profound
→ Valium sedation, seizure, muscle spasm, status sedation, respiratory depression, coma, and
epilepticus death. Do not use in pts with depressed
respirations or patients who recently received
respiratory depressants
2. Opioids
• Used for: pain, cough, diarrhea, and anesthesia support
• Sedation can occur after the initial “rush”: constricted pupils, respiratory depression, increased
pain tolerance, analgesia, tranquility, euphoria
• MOA: opioids bind to mu opioid receptors on neurons in nervous system + immune system;
produces these effects → pain relief, mood alteration (euphoria and decreased anxiety),
respiratory depression, decreased GI motility, cough suppression, pinpoint pupils (miosis), N/V,
pruritis
• During withdrawal you give = methadone (reduces withdrawal symptoms)
• When injected or inhaled, levels in the brain rise rapidly = causing a rush
49

Opioids
Heroin Narcotic Derived from morphine. When used via IV
route, it is 3-5x more potent
Morphine Acute pain, chronic severe pain Use cautiously in patients receiving MAO
inhibitors (can have severe reactions). Monitor
for respiratory depression
Fentanyl General anesthesia, analgesia Risk of opioid addiction/abuse/misuse, which
→ Sublimaze can lead to overdose and death. Monitor for
respiratory depression. Prolonged use during
pregnancy can cause neonatal opioid
withdrawal syndrome. Avoid use in pt receiving
MAO inhibitor. Transdermal fentanyl is for
moderate-severe chronic pain, not for the
control of postoperative, mild, intermittent, or
short-term pain
Codeine Pain, cough Use cautiously in pts on MAO inhibitor. Monitor
RR. Regularly administered dose may be more
effective than PRN dose
Oxycodone Moderate to severe pain Monitor for respiratory depression. If pt has
→ Oxycontin, liver failure, initial dose should be decreased.
Oxyneo Monitor BP, HR, and RR
Hydromorphone Moderate to severe pain, moderate Use cautiously in pts on MAO inhibitor. Monitor
→ Dilaudid to severe chronic pain, cough RR. Rapid IV administration = respiratory
depression, hypotension, circulatory collapse
Meperidine Moderate to severe pain, analgesic Can cause seizures as side effect. Monitor RR.
→ Demerol during labour, pre-op sedation, Use cautiously in pts on MAO inhibitor. Risk of
rigors toxicity increases with dose over 600 mg per
day, chronic administration (>2 days), and
kidney injury. IV Push – administer slowly over
5 minutes
3. Ethanol (Alcohol)
• Absorbed orally, detoxified in stomach by alcohol dehydrogenase
• MOA: increases activity of GABA system
o GABA is the major inhibitory neurotransmitter in the brain (decreases activity in nervous
system)
• Effect depends on dose. Side effects: loss of motor coordination, slurred speech, sleep
• Liver detoxifies alcohol at rate of 10 – 15 mL/hour; long term abuse = cirrhosis
Cannabinoids
• MOA: release of central biogenic amines including NE
• Side effects: dizziness, fatigue, slows motor activity, less coordination, paranoia, euphoria, food cravings,
red eyes due to dilated blood vessels
• Therapeutic effect: decreased pain and spasticity
• Active ingredient: delta 9 THC
Cannabinoids
Cannabidiol Spasticity in multiple sclerosis, neuropathic Avoid alcohol use
→ Sativex pain in MS or advanced cancer patients
50

Hallucinogens
• No medical use
• MOA: acts on serotonin receptors in brain (serotonin agonist); causes change in mood (usually
euphoria), change in pain, perception, personality, sexual activity, feelings of intimacy/empathy
Hallucinogens
Drug Produces these effects:
LSD Altered perception (can lead to dangerous behaviour), increased BP/HR/T, dizziness, sleepiness,
loss of appetite, sweating, numbness/weakness
Psilocybin Relaxation, paranoia, panic reaction, spiritual experience
→ Mushrooms
Mescaline Increased HR and T, ataxia (uncoordinated movement), sweating, flushing
→ Peyote
PCP Poor coordination, rapid eye movements, slurred speech, confusion, stupor, rigid muscles,
→ Phencyclidine irregular HR, low BP, decreased RR
Ketamine Powerful anesthetic, increased HR/BP, confusion, agitation, delirium, feelings of paralysis,
→ Special K urinary frequency, abdominal cramps
MDMA Increased energy, involuntary teeth clenching, high T, depression, lack of appetite, detachment
→ Ecstasy from oneself, disorganized thoughts, restless legs, sweating
CNS Stimulants
• Increase in neurotransmitter NE; known as cognitive enhancers
• MOA: stimulates NE = increased CNS stimulation
• Side effects: increase in BP, increase in RR, reduced appetite, feelings of exhilaration, mental alertness,
dilates pupils, abdo pain, irritability, headache
CNS Stimulants
Amphetamines Narcolepsy (excessive sleepiness), obesity, For narcolepsy, lowest dose should be
→ Evekeo, ADHD administered. Dextroamphetamine is used for
Adderall appetite suppression (obesity). Avoid
administration to pts taking MAOI (can result in
hypertensive crisis)
Cocaine Medical use: topical anesthesia When used recreationally: “high” is reached
quickly and more intensely. Can cause delirium,
hyperactivity, psychosis, arrhythmias,
hypertension, stroke, vasoconstriction
Methylphenidate ADHD, narcolepsy Focuses attention by promoting alertness. Used in
→ Ritalin children (less effective in adults). Monitor for
growth inhibition. Chronic abuse can lead to high
tolerance and dependence. Used as cognitive
enhancer in university.
Caffeine Fatigue, drowsiness, respiratory failure, Withdrawal symptoms include headaches, fatigue,
diuretic depression, impaired performance of skills. Used
as cognitive enhancer in university. Not to be given
to pts with anxiety, agitation, or tremors.
51

IMMUNE, ANTIBIOTIC/ANTIVIRAL, AND ANTIINFLAMMATORY DRUGS
Bacterial Infection Drugs (Antibiotics)

Classified by ability to live in O2 (aerobic, anaerobic), shape (spiral, cocci, bacilli), and gram +/- (gram - is more
difficult to treat)
It is ideal to do a culture + sensitivity to determine the bacteria you’re dealing with before initiating therapy
Antibiotics can be bacteriostatic (ABX prevents further growth/reproduction of bacteria) or bactericidal (ABX
kills the bacteria)
1. Penicillin
• Used for: gram positive bacteria
• MOA: bactericidal; drug binds to penicillin-binding proteins (PBPs), which are involved in cell wall
synthesis + cell division = prevents the proper development of the bacterial cell well (no cell wall =
membrane is exposed = lysis of bacterial membrane)
• Side effects: skin rash, anaphylactic reactions
• Contraindications: allergy to penicillin
• These drugs can produce c.diff diarrhea
• Take the drug exactly as prescribed; complete the entire prescribed regimen
• Drugs in this category: penicillin G benzathine, penicillin G sodium, dicloxacillin, cloxacillin sodium,
amoxicillin, ampicillin, amoxicillin-clavulanate potassium
2. Cephalosporins
• Used for: primarily gram negative bacteria
• First gen = Gram positive
• Second gen = intermediate coverage, more potent, more resistant to lactamase
• Third gen = broad spectrum, resistant to beta-lactamase, can cross BBB
• Fourth gen = broad spectrum, can handle bacteria resistant to 1st & 2nd generation cephalosporins
and can cross BBB
• MOA: bactericidal; inhibits cell wall synthesis
• Side effects: confusion, seizures, N/V/D
• Drugs in this category: cefadroxil, cefazolin sodium, cephradine, cefaclor, cefuroxime sodium,
cefdinir, cefixime, ceftazidime, cefepime hydrochloride
3. Tetracyclines
• Used for: a broad spectrum of bacteria (+, -, spirochetes)
• MOA: bacteriostatic; bind to 30S subunit = prevent protein synthesis (required for maintenance of
bacterial cell)
• Side effects: superinfection, N/V/D, abdo distention, tooth discoloration of pediatric patients,
impaired fetal skeletal development if taken during pregnancy
• Contraindications: pregnancy, nursing, children under age of 8, kidney disease
• Drugs in this category: demeclocycline hydrochloride, tetracycline hydrochloride, doxycycline,
minocycline
4. Macrolides
• Used for: upper resp tract infx, lower resp tract infx., skin infx., legionella, Chlamydia, listeria,
campylobacter, opportunistic infections
• MOA: bacteriostatic; inhibit RNA-dependent protein synthesis
• Side effects: N/V/D, rash, fever
• Drugs in this category: erythromycin, azithromycin, clarithromycin
5. Aminoglycosides
• Used for: primarily gram - bacteria and resistant bacteria
52

• MOA: bacteriostatic; bind to 30S ribosomal subunit = prevents protein synthesis; also damages cell
wall = tends to be synergistic with beta-lactams
• Not used during pregnancy or during nursing
• Should not be given with other nephrotoxic drugs
• Trough concentration must be at or below certain value to decrease risk of ototoxicity and
nephrotoxicity
• Side effects: neuromuscular reactions, ototoxicity, nephrotoxicity, N/V/D
• Drugs in this category: amikacin, gentamicin, kanamycin, neomycin, streptomycin, tobramycin
6. Fluoroquinolones
• Used for: broad spectrum (primarily gram - but also gram +)
• MOA: bacteriostatic; inhibit DNA gyrase & topoisomerase (necessary for DNA synthesis) = DNA is
unable to reproduce
• Side effects: dizziness, N/V/D, abdo pain, fever, chills, blurred vision, tinnitus
• Drugs in this category: ciprofloxacin, levofloxacin, moxifloxacin hydrochloride, norfloxacin, ofloxacin
7. Sulfonamides
• Used for: UTIs
• MOA: bacteriostatic; alters folic acid metabolism (necessary for modification of bacterial proteins)
• Side effects: allergy, skin rash, crystalluria, oliguria, acute kidney failure
• Drugs in this category: trimethoprim, sulfadiazine, sulfasalazine
8. Vancomycin
• Used for: MRSA, MRSE, gram + infections, c. diff, enterococci
• Given PO for enterococci and c.diff, otherwise given parenterally
• MOA: binds to and weakens cell wall = makes cell membrane more susceptible to lysis
• Side effects: hypersensitivity, eosinophilia, neutropenia, hearing loss, red man syndrome
• Drugs in this category: vancomycin hydrochloride
Anti-Viral Drugs
1. Synthetic Nucleosides
• Used for: various viral syndromes including HSV and cytomegalovirus
• MOA: Interferes with DNA synthesis + inhibits viral multiplication
• Side effects: kidney injury, headache, N/V/D, hypersensitivity
• Monitor kidney and liver function
• Drugs in this category: acyclovir, famciclovir, ganciclovir, valacyclovir
2. Influenza A and syncytial virus drugs
• MOA: inhibits viral replication
• Side effects: confusion, depression, fatigue, insomnia, irritability, N, nervousness
• Drugs in this category: amantadine hydrochloride, ribavirin, rimantadine hydrochloride, oseltamivir
phosphate, zanamivir
3. Nucleoside reverse transcriptase inhibitors (NRTI)
• Used for: advanced HIV infections
• MOA: mimics thymidine = reverse transcriptase (RT) incorporates it into DNA strand = ends up being
non-functional = not incorporated into host DNA
• Side effects: headache, fever, dizziness, muscle pain, N/V/D
• Drugs in this category: zidovudine, didanosine, zalcitabine, abacavir sulfate, lamivudine, stavudine,
emtricitabine, tenofovir
4. Non-nucleoside reverse transcriptase inhibitors (NNRTI)
• Used in combination with other anti-vrials to treat HIV infection
53

• MOA: direct inhibitor of RT = prevents HIV replication
• Side effects: hepatotoxic (monitor liver enzymes), skin rash, N/V/D, headache
• Drugs in this category: delavirdine mesylate, efavirenz, etravirine, nevirapine
5. Protease inhibitor
• Used for: HIV
• MOA: inhibit activity of HIV protease = prevents cleavage of viral polyproteins
• Side effects: N/V/D, kidney and liver toxicity, kidney stones, paresthesia
• Drugs in this category: saquinavir mesylate, nelfinavir mesylate, ritonavir, indinavir sulfate, lopinavir
Lines of defense when there is injury to our body:

1st line of defense: innate immunity (barriers, antibodies, acid in stomach; things that prevent bacteria from
penetrating our skin)
2nd line of defense: Inflammation (vascular component: histamine, bradykinin, prostaglandins, and cellular
component [neutrophils, monocytes/macrophages (antigen-presenting cells), lymphocytes; these are attracted
to sites of injury by chemokines])
3rd line of defense: cell mediated/specific. Largely coordinated by T4 helper cells. These will connect with CD8
and B cells. They will use chemical signals such as interleukin-2. This will help to stimulate the proper B cells and
CD8 cells. B cells produce plasma cells and memory cells. Plasma cells produce antibodies (IgG in particular) and
memory cells prepare for the next situation of infection (the next time we see those antigens we see a quick
and large secondary response).
Antihistamines: block the effects of histamine on target tissues
Corticosteroids: suppress immune responses and reduce inflammation
Immunosuppressants (non-corticosteroids): prevent rejection of transplanted organs + can be used to treat
autoimmune diseases
Uricosurics: control gouty arthritis attacks.
Vaccines
Expose our immune system to small amounts of antigens so that it can create a primary response.
1. Microbes that have been killed (organisms are intact but not alive/functional)
2. Attenuated microbes (weakened thus cannot produce disease) alive but cannot cause disease
3. Toxoids (modified bacterial toxins that do not have hazardous properties) pieces of protein or viruses
have been isolated and can be used to create a secondary response
Contraindications: allergies to egg products, fever, concurrent infections
Antihistamines
Primarily block the effects of an allergic reaction/type 1 hypersensitivity reaction
1. Histamine-1 receptor antagonists
• Used for: S/S of type 1 hypersensitivity (allergic rhinitis, allergic conjunctivitis, urticaria, angioedema)
• MOA: drug competes with histamine for the H1 effector cell sites (these cells cause S/S of allergic
reaction) = blocks histamine from its effects. The drug does not displace the histamine that’s already
bound to receptors
• The following are the effects of blocking H1 receptor sites:
o Blocking action of histamine on small blood vessels
o Decreasing arteriole dilation and tissue engorgement
o Reducing leakage of plasma proteins + fluids out of the capillaries = less edema
o Inhibiting smooth-muscle responses to histamine (blocking the constriction of bronchial, GI,
and vascular smooth muscle)
54

o Acting on the terminal nerve endings in the skin that flare/itch = relief of symptoms
• Side effects: dizziness, fatigue, muscle weakness, N/V/D/C, arrhythmias
Antihistamine Drugs
Dimenhydrinate Motion sickness Contraindicated in lower respiratory disease (e.g.
→ Dramamine, Gravol asthma), neonates, and nursing women. May
impair ability to drive.
Diphenhydramine Allergic reaction, insomnia, cough, Same as above
→ Benadryl motion sickness, Parkinsonism
Brompheniramine Allergies, seasonal allergies Same as above
→ Dimetane
Promethazine Allergies, N/V, motion sickness, pre-op IV administration can cause severe tissue injury;
→ Phenergan sedation IM route is preferred. Contraindicated in
newborns, SC or intra-arterial route, and in
treatment of lower respiratory disease (e.g.
asthma). May impair ability to drive. Monitor for
neuroleptic malignant syndrome
Loratadine Allergic rhinitis, urticaria May cause drowsiness
→ Claritin
Meclizine Motion sickness, vertigo May cause drowsiness
→ Bonine
Corticosteroids
These drugs suppress the immune response + reduce inflammation
1. Glucocorticoids
• Used for: adrenocortical insufficiency, anti-inflammatory, immunosuppressive, or antineoplastic
activity
• MOA: not entirely known, but these drugs suppress hypersensitivity + immune responses
• Side effects: these drugs affect almost every system; insomnia, increased water retention, increased
K+ excretion, suppressed immune response, peptic ulcers, impaired wound healing, HTN, increased
susceptibility to infx, DM, hyperlipidemia
• Do not administer live vaccines to pts on large corticosteroid dose
Glucocorticoid Drugs
Beclomethasone Chronic asthma (puffer version), Do not use as a primary treatment for status
→ QVAR RediHaler (puffer), allergic rhinitis (intranasal version) asthmaticus or acute asthma attack.
Beconase (intranasal) Monitor for vision change
Dexamethasone Inflammation, acute exacerbation Contraindicated in systemic fungal infx (can
→ Decadron of MS, cerebral edema, shock, exacerbate the infx)
asthma, dermatitis, allergic
rhinitis, altitude sickness,
Hydrocortisone Inflammation, status asthmaticus, Contraindicated in serious infx.
→ A-Hydrocort acute adrenal crisis, chronic renal
insufficiency
Methylprednisolone Allergy, acute exacerbation of MS Same as above. Avoid grapefruit juice.
→ Medrol
Prednisone Acute asthma, giant cell arteritis, Take with meal. High dose can cause
→ Deltasone idiopathic thrombocytopenic insomnia. Contraindicated in serious
purpura, RA, advanced TB, infection and varicella. Monitor for
autoimmune hepatitis hyperglycemia.
55

2. Mineralocorticoids
• These affect electrolyte + water balance
• Used for: replacement therapy for pts with adrenocortical insufficiency
• MOA: act on distal tubule to increase Na+ reabsorption and K+ secretion
• Side effects are similar to those of glucocorticoids
Mineralocorticoid Drugs
Fludrocortisone Addison disease, salt-losing forms of Contraindicated in systemic fungal infx. Abrupt
→ Florinef congenital adrenogenital syndrome discontinuation can lead to Addisonian crisis.
Immunosuppressants
These drugs are used to prevent rejection of a transplant
MOA: Inhibit cell-mediated immune responses by different mechanisms
Do not administer this drug to a patient with an infection
Monitor for S/S of infection – WBC, fever, sputum, urine
Lifelong drug administration is needed to prevent transplant rejection
Side effects: bone marrow suppression, N/V, liver and kidney disease, infection, HTN, tachycardia, edema,
reduced WBC, weakness
Immunosuppressant Drugs
Azathioprine Kidney transplant, RA, lupus nephritis, Not to be taken by pregnant/lactating pt. Long
→ Azasan Crohn disease, ulcerative colitis term use increases the risk of neoplasia
Cyclosporine Solid organ transplant, RA, psoriasis, ALS, Not to be taken by pregnant/lactating pt.
→ Neoral lung transplant Monitor for gingival hyperplasia, infx, and HTN.
Avoid grapefruit juice
Mycophenolate Kidney transplant, heart transplant, liver Not to be taken by pregnant/lactating pt. Assess
→ CellCept, Myfortic transplant for S/S of progressive multifocal
leukoencephalopathy (hemiparesis, apathy,
confusion, cognitive deficiency, ataxia)
Tacrolimus Kidney transplant, heart transplant, liver Risk of serious infx/malignancies including
→ Prograf transplant lymphoma and skin malignancies
Uricosurics
Increased uric acid in blood = gout
Normally, uric acid is excreted by the kidneys
MOA: reduce reabsorption of uric acid @ proximal convoluted tubule of kidney = increased excretion of uric
acid in urine = reduced uric acid levels
Side effects: headache, anorexia, N/V, GI pain, indigestion
Uricosuric Drugs
Probenecid Gout, pelvic inflammatory disease, Should not be given during an acute gouty attack (this
→ Benemid gonorrhea drug will actually prolong the inflammation) – give
colchicine instead. Monitor kidney function. Give drug
with milk, food, or antacid to minimize GI distress
Allopurinol Gout, antineoplastic-induced Helps prevent acute gout attacks. Continue taking
→ Zyloprim, Aloprim hyperuricemia allopurinol along with an NSAID or colchicine during
an acute attack of gout
Colchicine Acute gout Co-administration with CY3A4 inhibitor can increase
→ Colcrys levels of toxicity (need to decrease the colchicine
dose). Do not give to liver/kidney disease pt
56

FLUIDS AND ELECTROLYTES
Electrolyte Replacement
Electrolyte (EL) = element that carries an electric charge when dissolved in water; helps maintain homeostasis
1. Potassium (K+)
• Primary intracellular EL
• Body can’t store K+, so it needs to be ingested daily (if not, then K+ replacement is necessary)
• K+ is necessary for proper nerve function, muscle function, tissue growth + repair, and maintenance
of acid-base balance
• Hypokalemia is common in: V/D, NG suction, excessive urination, kidney disease, burns, excessive
antidiuretic hormone, laxative abuse, starvation
• Monitor K+ levels; S/S of hyperkalemia: abdo cramp, N/D, tall T waves, hypotension, muscle
weakness
• When giving IV K+, always dilute; never give as in IV bolus or IM injection
• Give PO K+ with or after meals to minimize GI effects
2. Calcium (Ca2+)
• 99% of Ca is stored in bone
• Function of Ca: nerve and muscle excitability; function of heart, kidney, lungs; blood coagulation;
neurotransmitter; bone + tooth formation
• Ca is helpful in treating magnesium intoxication and helps strengthen myocardial tissue after
defibrillation or poor response to epinephrine
• Hypocalcemia is common in: tetany, cardiac arrest, vitamin D deficiency, parathyroid surgery,
alkalosis
• Monitor Ca levels; S/S of hypercalcemia: drowsiness, lethargy, muscle weakness, headache, C, ECG
changes (short QT), heart block
• When giving PO calcium, don’t take with foods that interfere with absorption (e.g. spinach, rhubarb,
whole grain cereal, fresh fruit + vegetables)
3. Magnesium (Mg+)
• Function of Mg: transmits nerve impulses to muscle, activates enzymes for carb + protein
metabolism, stimulates parathyroid secretion, aids in cell metabolism
• Used to prevent deficiency, control seizures, treat/prevent preeclampsia, and treat ventricular
arrhythmias
• Hypomagnesemia is common in: malabsorption, chronic D, prolonged diuretic use, NG suction,
hyperaldosteronism, hypoparathyroidism, excessive release of adrenocortical hormones
• Mg taken with digoxin = can lead to heart block
• Monitor Mg levels; S/S of hypermagnesemia: hypotension, circulatory collapse, flushing, depressed
reflexes, respiratory paralysis
• Administering IV Mg too quickly can lead to cardiac arrest
4. Sodium (Na+)
• Major cation in extracellular fluid
• Function of Na: maintains osmotic pressure, acid-base balance, water balance; aids in nerve
conduction and neuromuscular function; aids in glandular secretion
• Hyponatremia is seen in: anorexia, excessive GI loss, excessive perspiration, overuse of diuretics,
trauma, SIADH
• To replace Na, sodium chloride IV is usually given
• Side effects: pulmonary edema, hypernatremia, and K+ loss
• S/S of pulmonary edema = SOB, cough, anxiety, wheezing, pallor
57

Electrolyte Relationships:
Sodium/Potassium – inverse; high Na = low K
Calcium/Phosphorus – inverse; high Ca = low Phos
Calcium/Vitamin D – similar; high Ca = high Vit D
Magnesium/Calcium – similar; low Mg = low Ca
Magnesium/Potassium – similar; low Mg = low K
Magnesium/Phosphorus – inverse; low Mg = high Phos
58

QUICK OVERVIEW
Anti-Alzheimer’s
o Increase Ach in CNS by inhibiting cholinesterase
o Cholinergic effects = excessive salivation, cramps, D, blurred vision, bradycardia
o Desired outcome: temporary improvement in cognitive function
Anti-anemics
o Iron is needed for production of hgb, which is necessary for O2 transport to cells
o Desired outcome: resolution of anemia
Anti-anginals
o Nitrates are used in acute treatment of angina pectoris; calcium channel blockers + beta blockers are
used in long term management
o Nitrates dilate coronary arteries and cause systemic vasodilation
o Monitor for hypotension
o Desired outcome: decrease in frequency + severity of anginal attacks, increase in activity tolerance
Anti-anxiety medications
o Causes generalized CNS depression
o Avoid use in pregnant patients
o Monitor for suicidal ideation
o Desired outcome: decrease in anxiety level
Antiarrhythmics
o Class 1A (quinidine, procainamide, disopyramide), class 1B (lidocaine, phenytoin, mexiletine), class 1C
(flecainide, propafenone) class 2 (esmolol, propranolol, metoprolol), class 3 (amiodarone, ibutilide,
sotalol) class 4 (diltiazem, verapamil), adenosine, atropine, and digoxin
o Assess apical pulse before administration
o Desired outcome: resolution of arrhythmia
Antiasthmatics
o Includes adrenergic bronchodilators, corticosteroids, anticholinergics, leukotriene receptor antagonists,
and mast cell stabilizers
o Do not use corticosteroids, long acting adrenergics, or mast cell stabilizers during an acute asthma attack
o Desired outcome: prevention of and reduction in symptoms of asthma
Anticholinergics
o Atropine for bradyarrhythmia’s, ipratropium for bronchospasm, scopolamine for N/V r/t motion
sickness, glycopyrrolate for gastric secretions, benztropine for Parkinson’s disease, oxybutynin +
tolterodine for urinary spasms
o Contraindicated in narrow angle glaucoma, severe hemorrhage, tachycardia, and myasthenia gravis
o Anticholinergic effects = dry mouth, dry eyes, blurred vision, constipation
o Desired outcome: increased HR, decreased N/V, dry mouth, dilated pupils, decreased GI motility, and
resolution of S/S of Parkinson’s
Anticoagulants
o Prevent and treat clot formation (DVT, PE, and atrial fibrillation); they do NOT dissolve clots
o Pregnant patient should not take warfarin
o Monitor for signs of bleeding (bleeding gums, nosebleed, unusual bruise, black stool, hematuria)
o Monitor PTT (heparin) and INR (warfarin)
o Heparin OD = protamine sulfate; warfarin OD = vitamin K
o Desired outcome: prevention of clotting without signs of hemorrhage; prevention of stroke, MI, and
death in patient’s at risk
Anticonvulsants
o Act by depressing abnormal neuronal discharges in the CNS
59

o Fetal hydantoin syndrome can occur in offspring of patient receiving phenytoin during pregnancy
o Monitor serum drug levels routinely
o Do not discontinue abruptly – can precipitate status epilepticus
o Desired outcome: decrease or cessation of seizures without excessive sedation
Antidepressants
o Prevents the reuptake of dopamine, norepinephrine, and serotonin
o Should not be used in narrow angle glaucoma or in pregnant/lactating patient
o Tricyclic antidepressants have anticholinergic side effects (dry eyes, dry mouth, blurred vision, C)
o Taking an MAOI with tyramine containing food can lead to hypertensive crisis
o Avoid alcohol and other CNS depressants
o Desired outcome: resolution of depression, decrease in anxiety, management of chronic neurogenic
pain
Antidiabetics
o Insulin is used in T1DM whereas oral agents are used primarily in T2DM
o Insulin lowers blood glucose by increased transport of glucose into cells + promotes conversion of
glucose to glycogen
o Patient’s exposed to stress, fever, trauma, infx, or surgery may need a change in insulin dose
o Desired outcome: control of blood glucose without hypo/hyperglycemia
Antidiarrheals
o Slows intestinal motility and propulsion
o Desired outcome: decrease in diarrhea
Antiemetics
o Inhibit N/V and diminish motion sickness
o Phenothiazines are to be used cautiously in children with viral illness
o Desired outcome: prevention or decrease in N/V
Antifungals
o Affect the permeability of the fungal cell membrane or protein synthesis within the fungal cell
o Use cautiously in patient with depressed bone marrow
o Full course needs to be taken
o Desired outcome: resolution of S/S of infx
Antihistamines
o Block the effects of histamine at the H1 receptor
o Also have anticholinergic properties (dry eyes, dry mouth, blurred vision, C)
o If used with opioid analgesic, monitor for increased sedation
o Desired outcomes: decrease in allergic symptoms, decreased N/V, decreased anxiety, relief of pruritis
Antihypertensives
o Includes alpha agonists, beta blockers, vasodilators, ACE inhibitor, ARBs, CCB, and diuretics
o ACE inhibitors and ARBs should be avoided in pregnant patients
o Abrupt discontinuation can lead to rebound HTN
o Encourage weight reduction, low sodium diet, regular exercise, cessation of smoking + alcohol use
o Desired outcome: decrease in BP
Anti-infectives
o Kill or inhibit growth of bacteria
o Culture and sensitivity should be done before to optimize treatment
o Prolonged use can lead to superinfection or resistant bacteria
o Full course needs to be taken
o Desired outcome: resolution of S/S of infx
Antiparkinsonian drugs
60

o Aims to balance Ach and dopamine (there is a lack of dopamine and excess of Ach in Parkinson’s)
o May cause drowsiness/dizziness
o Desired outcome: resolution of parkinsonian and extrapyramidal S/S
Antiplatelets
o Treat and prevent thromboembolic events (stroke, MI) by inhibiting platelet aggregation and prolonging
bleeding time
o Desired outcome: prevention of stroke and MI
Antipsychotics
o Block dopamine receptors in brain
o Atypical antipsychotics have fewer side effects compared to typical antipsychotics
o Not to be used in patients with narrow angle glaucoma or CNS depression
o Can cause neuroleptic malignant syndrome (fever, resp distress, tachycardia, convulsions, diaphoresis,
BP change, pallor, muscle stiffness, loss of bladder control)
o Desired outcome: decrease in excitable/paranoid/withdrawn behaviour
Antipyretics
o Inhibit prostaglandins. Most antipyretics also affect platelet function
o May cause Reye’s syndrome if ASA is given to children with varicella or viral illness
o Desired outcome: reduction in fever
Antiretrovirals
o Goal for HIV is to improve CD4 cell count and decreased viral load; these drugs do not cure HIV nor does
it decrease the risk of transmission
o Desired outcome: decrease in viral load + increase in CD4 count
Antirheumatics
o Manage symptoms of RA (pain + swelling)
o Corticosteroids are reserved for advanced symptoms due to the side effects
o Do not use corticosteroid in patient with active untreated infx
o Desired outcome: improvement in S/S of RA
Antiulcer drugs
o H2 receptor antagonists + proton pump inhibitors
o Contraindicated in pregnancy
o Administer antacids 1 hr before or after other oral medications
o Desired outcome: decrease in GI pain/irritation, prevention of GI bleeding, healing of ulcers, decreased
GERD S/S
Antivirals
o Used for management of herpes virus infxs, chickenpox management, prevention of influenza infx,
treatment of cytomegalovirus, treatment of ophthalmic viral infx
o Inhibits viral replication
o Need to take full course of therapy
o Desired outcome: prevention/resolution of S/S of viral infx
Beta Blockers
o Used for HTN, angina, tachyarrhythmias, migraines, MI, glaucoma, and heart failure
o Beta1 receptor sites = located in heart; stimulation results in increased HR and contractility
o Beta2 receptor sites = located in bronchial and vascular smooth muscle + uterus; stimulation produces
vasodilation, bronchodilation, and uterine relaxation
o Monitor BP, HR, intake + output, and daily weight
o Abrupt withdrawal can lead to rebound HTN + tachycardia
o Desired outcome: decreased BP, decrease in frequency/severity of angina, arrhythmia control,
prevention of MI, prevention of migraines
61

Bronchodilators
o Beta2 agonists
o Therapeutic effects can be antagonized by beta blockers
o Desired outcome: decreased bronchospasm, increased ease of breathing
o For HTN, angina, and coronary artery spasm; blocks calcium entry into cells of vascular smooth muscle
and myocardium = dilates coronary arteries
o Safety in pregnancy is not established
o Do not crush/open sustained-release capsules
o Monitor for orthostatic hypotension
o Desired outcomes: decreased BP, decrease in frequency/severity of angina, increase in activity tolerance
Central Nervous System Stimulants
o Used for narcolepsy and management of ADHD; increases levels of neurotransmitters in CNS (respiratory
stimulation, dilated pupils, increased alertness, diminished sense of fatigue)
o If used with MAOI, can cause hypertensive crisis
o Avoid in patients with psychotic personalities
o Abrupt cessation can lead to extreme fatigue and mental depression
o Desired outcome: decreased narcoleptic episodes, improved attention span
Corticosteroids
o Treat adrenocortical insufficiency. Also used for the anti-inflammatory, immunosuppressive, and
antineoplastic activity
o Contraindicated in serious infections
o Desired outcome: suppressed inflammatory and immune response, replacement therapy in adrenal
insufficiency, and resolution of skin inflammation
Diuretics
o Used for HTN, edema, and heart failure
o Safety in pregnancy is not established
o Hypokalemia can increase the risk of digoxin toxicity
o Monitor daily weight, intake + output, edema, lung sounds, skin turgor
o Monitor for orthostatic hypotension
o Desired outcome: decreased BP, decreased urine output, decreased edema, reduced ICP
Immunosuppressants
o Used to prevent transplant rejection
o Use cautiously in patient with infx. Safety in pregnancy is not established
o Monitor for infx (vitals, WBC, urine, sputum)
o Lifelong therapy is needed to prevent transplant rejection
o Desired outcome: prevention or reversal of rejection of transplanted organ
Laxatives
o Treat constipation (and prep the bowel for procedures); includes stimulants, stool softeners, bulk
forming drugs, and osmotic cathartics
o Should only be used on a short-term basis
o Desired outcome: soft + formed BM, evacuation of the colon
Lipid lowering drugs
o Decreases cholesterol levels
o HMG-CoA reductase inhibitors are not to be used in pregnant patients
o Patient should also be making changes to diet, exercise, and smoking/alcohol when taking this drug
o Desired outcome: decreased LDL, increased HDL
Nonopioid Analgesics
62

o Controls mild-moderate pain and/or fever
o Avoid alcohol use (increases risk of GI bleed with salicylates and NSAIDs)
o Desired outcome: relief or mild-moderate pain, reduction of fever
Nonsteroidal Anti-Inflammatory drugs
o Control mild-moderate pain, fever, and inflammation (RA, OA); analgesic + anti-inflammatory processes
is due to inhibition of prostaglandins. Antipyretic process is due to vasodilation + inhibition of
prostaglandin syntheses in CNS
o Use cautiously in patients with bleeding disorder
o Avoid alcohol use
o Desired outcome: relief of mild-moderate pain, reduction of fever
Opioid Analgesics
o Controls moderate-severe pain
o Smaller dose should be used for older patients and those with respiratory diseases
o Monitor respiratory rate
o Opioid overdose = naloxone is the antidote
o Desired outcome: decreased severity of pain without significant change in LOC or RR
Sedatives
o Cause generalized CNS depression; there is no analgesic effect with these drugs
o Avoid use in pregnant patients and in those with CNS depression
o Can cause daytime drowsiness
o Desired outcome: improved sleep, controlled seizures, decreased muscle spasm
Thrombolytics
o Used for management of STEMI, PE, and acute ischemic stroke; converts plasminogen to plasmin =
degrades fibrin in the clots = results in lysis of clots
o To be given within 3-4.5 hours of onset of acute ischemic stroke symptoms
o If local bleeding occurs = apply pressure, discontinue infusion, infuse packed RBCs
o Teach patient to avoid shaving and vigorous tooth brushing. Minimal handling will also decrease risk of
bleeding
o Desired outcome: lysis of clot + restoration of blood flow, prevention of neurological damage in acute
ischemic stroke, catheter patency
63

COMMON MEDICATION PREFIXES AND SUFFIXES
Prefix, root, suffix Drug category Prefix, root, suffix Drug category
-afil (e.g. sildenafil) Phosphodiesterase -asone (e.g. Corticosteroid
inhibitor betamethasone)
-bital (e.g. phenobarbital) Barbiturate -caine (e.g. lidocaine) Local anesthetic
Cef- (e.g. cefaclor) Cephalosporin ABX -cillin (e.g. amoxicillin) Penicillin antibiotic
Cort (e.g. hydrocortisone) Corticosteroid -cycline (e.g. doxycycline) Tetracycline ABX
-dipine (e.g. amlodipine) Calcium channel blocker -dronate (e.g. Bone resorption inhibitor
alendronate)
-eprazole (e.g. Proton pump inhibitor -fenac (e.g. diclofenac) NSAID
omeprazole)
-floxacin (.e.g. Quinolone ABX -gliptin (e.g. sitagliptin) Antidiabetic
ciprofloxacin)
-mysin (e.g. ABX -olol (e.g. metoprolol) Beta blocker
azithromycin)
-olone (e.g. Corticosteroid -onide (e.g. budesonide) Corticosteroid
prednisolone)
-oprazole (e.g. Proton pump inhibitor -parin (e.g. Dalteparin) Anticoagulant
pantoprazole)
-phylline (e.g. Bronchodilator -pramine (e.g. Tricyclic antidepressant
theophylline) clomipramine)
Pred- (e.g. prednisone) Corticosteroid -pril (e.g. ramipril) ACE inhibitor
-profen (e.g. ibuprofen) NSAID -sartan (e.g. candesartan) Angiotensin 2 receptor
antagonist
-setron (e.g. ondasetron) Serotonin receptor -statin (e.g. atorvastatin) HMG-CoA reductase
antagonist inhibitor (statin)
-tadine (e.g. loratadine) Antihistamine -terol (e.g. albuterol) Beta agonist;
bronchodilator
-vir (e.g. acyclovir) Antiviral -zepam (e.g. lorazepam) Benzodiazepine
-zolam (e.g. midazolam) Benzodiazepine -zosin (e.g. prazosin) Alpha blocker
64

MEDICATION CALCULATION
Conversions
1 teaspoon (t) = 5 ml 1 oz = 30 ml 1 quart = 2 pints
1 tablespoon (T) = 3 t = 15 ml 1 cup = 8oz 1 pint = 2cups
1 gram (g) = 1,000 mg 1 kilogram (kg) = 2.2 lbs 1 lb = 16oz
1 mcg = 0.000001 g 1 mg = 1000 mcg or 0.001 g
*Always convert everything to the same units before solving the calculation.
Generic dose calculation

Dose required X Quantity = x
Dose on Hand
E.g. Metoprolol (Lopressor), 25 mg PO, is ordered. Metoprolol is available as 50 mg tablets. How many tablets would the
nurse administer?
25 mg/50 mg x 1 tablet = 0.5 tablets
Infusion Time
Total Volume
mL/hr
E.g. Infuse 1 L of NS at 125 mL/hr. How many hours total will the infusion run for?
1000 mL/125 mL per hour = 8 hours
mL/hr
Total Volume (mL)
Total Time (hr)
E.g. Infuse 250 mL over the next 120 minutes by infusion pump
250 mL/2 hrs = 125 mL/hr
Drops per minute

total volume X drop factor
total time (min)
mL/hr X drop factor

time (60 min)
E.g. Calculate the IV flow rate for 1200 mL of NS to be infused in 6 hours. The infusion set is calibrated for a drop factor
of 15 gtts/mL
1200 mL x 15gtt per mL /360 min = 50 drops per minute
Drug Dosage and Flow Rate

D (desired amount in dose [mcg, mg, units] / time [min or hr] X Q (quantity in IV bag)
H (what you have available in the IV bag)
= x (mL/min, mL/hr)
E.g. Give patient 500 mg of dopamine in 250 mL of D5W to infuse at 20 mg/hr. Calculate the flow rate in mL/hr.
20 mg per hr/500mg x 250 mL = 10 mL/hr
65

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Pharmacology Study Guide

A comprehensive study guide that will supplement your pharmacology

Prepared exclusively for kevinellikkal@gmail.com Transaction: 0059269519

General Pharmacology Information …………………………………………………………………………………… 3

Autonomic Nervous System Drugs ……………………………………………..……………………………………… 5

Neurological + Neuromuscular Drugs ………………………………………………………………………………. 10

Cardiovascular Drugs ……………………………….…………………………………………………………………….… 19

Respiratory Drugs ………………………………………………………………………………..…………………………… 27

Gastrointestinal Drugs ……………………………………………………………………………………………………… 30

Genitourinary Drug ………………………………………………………..………………………………………………… 35

Hematology Drug …………………………………………………………..………………………………………………… 38

Endocrine Drugs ………………………………………………………..…………………………………………………..… 41

Mental Health Drugs ……………………………………….………..…………………………………………………..… 44

Substances of Addiction …………………………………………………………………………………………………… 49

Immune, Antibiotic/Antiviral, & Anti-Inflammatory Drugs ……………………………………………..… 52

Fluids and Electrolytes …………………………………………..…..…………………………………………………..… 57

Quick Overview of Drugs………………………………………………………..…….………………………………..… 59

Common Medication Prefixes and Suffixes………………………………………………………………………. 64

Medication Calculation ………………………………………………………..………………………………………..… 65

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FDA Pregnancy Categories

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Main Neurotransmitters to Know

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Adrenergic blocking drugs

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2. Beta adrenergic blocks (beta blockers)

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Skeletal muscle relaxants

2. Direct acting agents

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Neuromuscular blocking drugs

2. Depolarizing blocking drugs

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Non-Opioid analgesics, Antipyretics, NSAIDs

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Opioid Agonists + Antagonists

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Cardiovascular system includes = heart, arteries, capillaries, veins, and lymphatics

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3. Calcium Channel Blockers

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2. Angiotensin II receptor blocking agents (ARBs)

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4. Calcium channel blockers

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7. Potassium sparing diuretics

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2. Bile Acid Resins

3. Fibric Acid Derivatives

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Beta2 Adrenergic Agonists

Short acting Beta2 Adrenergic Agonists