Benzodiazepines - ANS -Includes "Pams" Alprazolam, diazepam, lorazepam, oxazepam, clonazepam,

chlordiazepoxide, chlorazepate

Enhances GABA: increased GABA means decreased neuron activity

Treats anxiety, PTSD, seizures, alcohol withdrawal, muscle spasm, induction of anesthesia

Usually short term; if long term do NOT stop abruptly

Antidote is flumazenil

Side effects: CNS depression - sedation and respiratory depression, amnesia, dependency, and
withdrawal effects

Atypical anxiolytic - ANS -Buspirone

Can take 2-6 weeks to work, but can be long term!

Treats panic disorder, anxiety, OCD, and PTSD

Side effects: dizziness, nausea (take w/ food to relieve), headache (sedation and dependency is not seen
like in benzo)

Trick to remember difference between Benzodiazepine and buspirone - ANS -"Pam" has anxiety, so she
goes on a "benzo" and takes it for a long time but realizes that it is not healthy. So she takes a "bus" to a
"pier" to sit "alone" and decides to treat her anxiety long term with "buspirone"

Selective Serotonin Reuptake Inhibitors (SSRIs) - ANS -Usually end in "ine": paroxetine, sertraline,
citalopram, escitalopram, fluoxetine, fluvoxamine

Inhibits serotonin reuptake" increases serotonin

Treats anxiety, OCD, PTSD, and depression

Side effects: nausea, fatigue, sexual dysfunction, weight gain, insomnia (paroxetine), serotonin
syndrome (agitation, hallucinations, tremors, fever, diaphoresis)

Takes about four weeks after treatment begins to take full effect.

Atypical Antidepressants - ANS -Bupropion, Trazodone - more important

Others: Vilazodone, mirtazapine, reboxetine

Treats depression and aid for smoking cessation

Side effects: headache, GI distress, insomnia, nausea, weight loss, seizures

Tricyclic antidepressants - ANS -Amitriptyline

Treats depression, neuropathic pain, fibromyalgia, anxiety disorders, insomnia

Side effects: Anticholinergic effects, Sedation, Seizures, Sweating (SSS)

"Amy tripped over a tricycle in the desert."

Amitriptyline is a tricyclic antidepressant and causes effects that make you feel like you're in the desert.

Anticholinergic efffects - ANS -dry mouth, blurred vision, photophobia, urinary hesitancy or retention,
constipation, tachycardia

Monoamine oxidase inhibitors - ANS -Phenelzine (Prototype), Isocarboxazid, tranylcypromine, selegiline

Side effects: CNS stimulation, Orthostatic hypotension, hypertensive crisis (especially with phenelzine).

Tyramine rich foods can lead to hypertensive crisis

Foods that contain tyramine - ANS -aged cheese, pepperoni, salami, avocados, figs, bananas, smoked
fish, protein dietary supplements, soups, soy sauce, some beers, and red wine

Mood stabilizer - ANS -Lithium Carbonate

Treats bipolar disorder

Side effects: GI distress, fine hand tremors, polyuria, weight gain, renal toxicity, renal toxicity,
hypothyroidism, electrolyte imbalance

Lithium toxicity: occurs with levels over 1.5; presents with COARSE (not fine) hand tremors, confusion,
tinnitus, seizures, hypotension, coma, possibly death.

Do not give with diuretics, NSAIDs, or anticholinergics

Need a balance of sodium and water.

Mood - stabilizing antiepileptic - ANS -Carbamazepine, valproic acid

Treats Bipolar disorder and seizure disorder

Carbamazepine side effects: blood dyscrasias, hypo-osmolality

Valproic acid side effects: *hepatotoxicity,* pancreatitis, thrombocytopenia

Antipsychotics: First-generation (conventional) - ANS -Chlorpromazine, Haloperidol

TONS of side effects-will only list important ones

Extrapyramidal side effects: Acute dystonia- spasms of tongue, neck, face, or back; Parkinsonism-
rigidity, shuffling gait, drooling, tremors; akathisia- unable to sit or stand still; tardive dyskinesia -
involuntary movement of tongue and face

EPS effects may be able to be treated with anticholinergic medication if the patient does not have
anticholinergic side effects.

Neuroleptic Malignant Syndrome: sudden high grade fever, dysrhythmias, muscle rigidity

There is a long lasting injection for non-compliant patients.

Antipsychotics: second and third generation (atypical) - ANS -Risperidone and Clozapine - most
important

Often first line in treating schizophrenia

Treats negative and positive symptoms

Side effects: diabetes mellitus, weight gain, hypercholesterolemia, orthostatic hypotension,

anticholinergic effects

Do not take with alcohol.

IM every two weeks available for those who are not compliant

Central Nervous system stimulants - ANS -Methylphenidate and Amphetamine mixture

Treats ADHD and Conduct disorder

Can cause insomnia, decreased appetite, weight loss, and growth suppression

Do not give at night. Give immediately before or after a meal. Monitor weight.

Medications to support withdrawal from alcohol - ANS -Benzodiazepines:

Chlordiazepoxide, lorazepam, diazepam

First line treatment of alcohol withdrawal

Keeps vitals within expected limits, decreases risk of seizures

Clonidine and Propranolol depress autonomic response and decrease vitals

Carbamazepine Further decreases risk of seizure

Disulfiram - ANS -Daily oral medication to sustain abstinence of alcohol; type of aversion therapy

Causes nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed

Naltrexone - ANS -Suppresses the craving and pleasurable effects of alcohol.

Can have monthly IM injection

Acamprosate - ANS -Decreases unpleasant effects resulting from abstinence like dysphoria, anxiety,
restlessness

Medications to support withdrawal/abstinence from opiods - ANS -Methadone Substitution

Slow weening process

Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a
physical dependence

It prevents abstinence syndrome and removes the need for the client to obtain illegal substances.

Used for withdrawal and long term maintenance.

Withdrawal/abstinence from nicotine - ANS -Bupropion

Nicotie gum, patch, or nasal spray

Varenicline: a nicotine receptor agonist. Reduces cravings as well as withdrawal effects. Depression and
suicidal effects can occur.

Cholinesterase inhibitors - ANS -Neostigmine, Physostigmine, Edrophonium (dx MG)

Prevents the enzyme cholinesterase from inactivating acetylcholine thereby increasing the amount of
ACh available.

Treats myasthenia gravis and parkinson's

Reversal for neuromuscular blocking agents

Excessive muscarinic stimulation: increased GI motility, diaphoresis, increased salivation, bradycardia,

and urinary urgency (too moist)

Cholinergic crisis: give atropine!

Atropine reverses this!

Levodopa/Carbidopa - ANS -Giving together to increase dopamine

Used for parkinson's

Decreases tremors and muscle rigidity

Levodopa is converted to dopamine in the CNS and carbidopa prevents the breakdown of levodopa

Side effects: quite a few: nausea, vomiting, drowsiness, dyskinesia, orthostatic hypotension, darkening
of urine and sweat, possible psychosis

High protein meals decreases effectiveness.

Benztropine - ANS -Decreases Acetylcholine

Used for Parkinson's, helps with muscle rigidity and tremors

Side effects relate to too little acetylcholine which means we will have anticholinergic side effects
Teach to chew gum, wear sun glasses, increase fiber and fluids

Antiepileptics - ANS -Phenytoin, Carbmazepine, Valproic acid, lamotrigine

Phenytoin: Side effects: gingival hyperplasia!, diplopia, stigmas, rash, ataxia, hypotension

Closely monitor plasma levels! Narrow range! Range is 10-20 mcg/mL

Decreases effectiveness of oral contraceptives.

Neuromuscular Blocking Agent - ANS -Succinycholine and Pancuronium

Blocks acetylcholine at the neuromuscular junction resulting in muscle relaxation and hypotension. They
do not cross the blood brain barrier, so complete paralysis is achieved without loss of consciousness or
decreased pain sensation. Used in anesthesia.

Side effects: respiratory depression, prolonged apnea, muscle pain, and malignant hyperthermia (MH)

MH: muscle rigidity with increased temperature. Need to give oxygen at 100%, initiate cooling measures
and administer dantrolene.

Peripherally acting muscle relaxants - ANS -Dantrolene

Treats: spasticity related to cerebral palsy, spinal cord injury, and multiple sclerosis

Inhibits muscle contraction by preventing release of calcium in skeletal muscles.

Side effects: drowsiness, muscle weakness, hepatic toxicity

Centrally Acting muscle relaxants - ANS -Baclofen (diazepam, baclofen, cyclobenzaprine, tizanidine)

Used for muscle spasticity related to spinal injury cerebral palsy, multiple sclerosis, as well as malignant
hyperthermia

Enhances effect of GABA

Drowsiness, GI upset, constipation (increase fiber and fluid)

Urinary Tract Stimulant - ANS -Bethanechol (Cevimeline, pilocarpine, acetycholine)

"Beth has is shy and has a shy bladder"

Used for nonobstructed urinary retention. Stimulates the cholinergic receptors in GU tract.

Side effects: r/t cholinergic effects like flushing, sweating, urinary urgency, bradycardia, hypotension

One hour before or two hours after meal, not at meal time

Muscarinic antagonist - ANS -Oxybutynin

(darifenacin, solifenacin, tolterodine, fesoterodine, trospium)

Used for overactive bladder symptoms: frequency, urgency, nocturia

Inihibts muscarinic receptors

Side effects: Anticholinergic!

Nonbenzodiazepines for insomnia - ANS -Zolpidem

Enhances GABA

Can cause day time sleepiness and dizziness. Ensure they have eight hours of sleep.

Intravenous anesthetics - ANS -Pentobarbital: Barbiturate

Medazolam: Benzo

Propofol

Initiate or maintain anesthesia, conscious sedation, intubation

Depresses CNS, promote loss of consciousness

Side effects: respiratory/cardiac depression. Propofol: pain at IV site, high risk of infection. Use within six
hours

For all: have rescue equipment available and constantly monitor EKG and vitals.

Beta2-adrenergic agonist - ANS -Albuterol and salmeterol

Bronchodilation

Treats COPD and asthma

Side effects: Tachycardia, angina, tremors

Albuterol - short acting; salmeterol - long acting

If using with a glucocorticoid, use beta2-adrenergic agonist first to dilate the bronchioles

MethylXanthines - ANS -Theophylline

"Theo means God and if you use this, you may be seeing God sooner than you intended due to side
effects."

Can be used long term for asthma or COPD

Side effects: GI upset, fatal dysrhythmia, and seizures

Narrow therapeutic range: frequent blood draws: 5-15 mcg/mL

Inhaled anticholinergics - ANS -Ipratropium

Used for asthma or COPD; blocks acetylcholine to bronchodilate

Side effects: anticholinergic - dry mouth and hoarseness

Increase fluid intake and suck on sugarfree candy.

Inhaled Glucocorticoids - ANS -Beclomethasone

Used for asthma; can be used alone or with beta 2 agonist

Decrease inflammation locally

Side effects: hoarseness and candidiasis

Rinse mouth out after the medication is used

Oral glucocorticoids - ANS -*Prednisone*

Used for asthma, autoimmune disorders and a variety of inflammatory disorders

Suppresses inflammation and immune response

Side effects: weight gain, bone loss, immune suppression, fluid retention, hyperglycemia, hypocalcemia,
infection, muscle weakness, peptic ulcer disease, and adrenal gland suppresion

Periods of stress may require a higher dose

NEVER stop this medication abruptly, it will need to be tapered

Monitor for signs and symptoms of infection

Avoid NSAIDs

Leukotriene modifiers - ANS -Montelukast (Zafirlukast, Zileuton)

Treats exercise induced asthma

"Lukast will decrease the effect of Leukotrienes"

Reduces airway inflammation and bronchoconstriction by decreasing leukotrienes

Side effects: increased liver enzymes with Zafirlukast

Take in the evening or two hours before exercise

Antitussives: Opioid - ANS -Codeine (hydrocodone)

Used for non-productive cough

Decreases cough reflex

Side effects: sedation, respiratory depression, GI upset, possible dependency

Change positions slowly, increase fluid and fiber, and avoid alcohol

Expectorants - ANS -Guaifenesin

"Guaif sounds like cough"

Used for non-productive cough associated with respiratory infections; thins secretions to enable patient
to cough up mucous

Side effects: GI upset, possible rash, drowsiness

Want patient to drink more fluids to help liquefy secretions

Mucolytics - ANS -Acetylcysteine

Used for pulmonary disorders where there are thick mucous secretions such as in cystic fibrosis;
improves flow of secretions

Also used for acetaminophen toxicity

Side effects: bronchospasm, rash, nausea, vomiting

Use cautiously in patients with asthma

Decongestants - ANS -Phenylephrine (pseudoephedrine, ephedrine, naphazoline)

Used for rhinitis

Causes vasoconstriction and decreases mucous in nose

Side effects: agitation, nervousness, palpitations, increased heart rate, rebound congestion

Antihistamines - ANS -1st gen: diphenhydramine

2nd gen: Loratadine

Used for nasal congestion, mild allergic reactions, and motion sickness

Blocks histamine release which helps reduce mucous secretion

With 2nd gen - less side effects

Side effects with 1st gen: anticholinergic effects and sedation

Nasal glucocorticoids - ANS -Mometasone (fluticasone, triamcinolone, budesonide)

Used for rhinitis; decreases inflammation in nasal passages

Side effects: burning, headache, sore throat

Loop diuretics - ANS -Furosemide

Blocks re-absorption of sodium and water at ascending loop of henle causing rapid diuresis.

Used for pulmonary edema, heart failure, and hypertension

Side effects: hypotension, hyponatremia, and hypokalemia, ototoxicity, dehydration and hypergllycemia

Administered in the morning or during day, not at night

Infuse IV at 20 mg/min

Weigh daily

Monitor I&Os

Watch electrolyte labs

Encourage high potassium foods

Thiazide Diuretics - ANS -Hydroclorothiazide

Blocks re-absorption of water and sodium at distal convoluted tubule.

Used for Hypertension, edema

side effects: dehydration, hypokalemia, hyperglycemia

Admin during day, \

Monitor I&Os

Watch electrolyte labs

Encourage high potassium foods

Potassium sparing diuretics

(Aldosterone Antagonist) - ANS -Spironolactone

Blocks aldosterone promoting excretion of sodium and water ONLY

Used for heart failure, hypertension

Contraindication in severe kidney failure

Side effects: hyperkalemia, issues with menstruation, gynecomastia or impotence in men

Monitor potassium closely and avoid salt substitutes

Osmotic Diuretics - ANS -Mannitol

Treats Edema, increased ICP, increased IOP

Contraindicated in intracranial hemorrhage

"Oh man I had a bad headache because of increased cranial pressure, but man it all went away when I
took mannitol"

Reduces ICP and IOP by increasing serum osmolality

Side effects: Heart failure, pulmonary edema, renal failure, dehydration, electrolyte imbalances

Use filter needle and tubing when admintering

Monitor weight, I&Os, and electrolytes

Angiotensin - converting enzyme inhibitors - ANS -Captopril "-pril"s

Blocks conversion on angiotensin one into angiotensin two, which vasodilates

Treats HTN, HF, MI, diabetic retinopathy

Side effects: Angioedema, Cough, Elevated potassium (A.C.E.), rash, hypotension

Closely monitor blood pressure

Change position slowly

Angiotensin II Receptor Blockers - ANS -Losartan "Sartans"

Blocking action of angiotensin II; results in vasodilation

Heart failure, HTN, MI, diabetic retinopathy

Side effects: angioedema, GI upset, hypotension

Direct Renin Inhibitors - ANS -Aliskiren

Calcium Channel Blockers - ANS -Diltiazem, Nifedipine, Verapamil

Used for HTN and angina; block calcium channels in the blood vessels and heart cause vasodilation and
decreased heart rate

Side effects: hypotension, bradycardia, dysrhythmias, constipation, edema

Patient should NOT consume grapefruit juice

Monitor blood pressure and heart rate regularly

Alpha adrenergic blockers - ANS -Prazosin

Centrally Acting Alpha2 agonist - ANS -Clonidine (do not confuse with clonzapine)

Activate Alpha II receptors which cause decrease in heart rate and blood pressure

Treats HTN

Side effects: drowsiness and dry mouth

Beta Blockers - ANS -Metoprolol "lol"

HTN, angina, heart failure, MI; blocks beta 1 receptors in heart which decreases heart rate and blood
pressure

Side effects: hypotension, bradycardia, decrease output, fatigue, erectile dysfunction

Teach to take pulse and change position slowly.

If beta blocker is non-selective: it will cause bronchospasm and should not be used in asthma. These
include Propranolol and Nadoll

Hypertensive Crisis - ANS -Nitroprusside

Directly vasodialates arteries and veins which rapidly decreases blood pressure by acting on preload and
afterload

Side effects: hypotension, cyanide poisoning, thiocyanate toxicity

Cardiac glycocides - ANS -Digoxin

Used for heart failure and A-fib

Positive inotropic effect: increase in force and efficiency of heart contractions

Negative chronotropic effect: decreases heart rate

Side effects: dysrhythmias, bradycardia

Toxicity: GI upset, vision changes, and fatigue/weakness

Always check apical pulse for full minute before giving and hold if under 60

Monitor serum levels: should be between 0.5 - 2.0

Hypokalemia increases risk for digoxin toxicity

Treat bradycardia with atropine and overdose with activated charcoal, cholestyramine, or digoxin
immune Fab (digibind)

Adrenergic agonist - ANS -Epinephrine, dopamine, and dobutamine (PT: Catecholamines)

Epinephrine: Stimulates Alpha-1, Beta-1, and Beta-2 receptors.

Used for cardiac arrest or asthma. Bronchodilates, vasoconstriction, increased cardiac output, and
increases heart rate

Dopamine: Used for shock and heart failure. Increases renal blood flow at low to moderate doses.
Increase heart rate and cardiac output.

Dobutamine: Primarily stimulates Beta-1 receptors and acts on heart. Used for heart failure. Increases
cardiac output. Less effect on blood pressure and heart rate

Side effects: hypertensive crisis, dysrythmias, angina

Organic Nitrates - ANS -Nitroglycerin (NTG)

Used for angina by vasodilating to decrease preload and myocardial oxygen demand

Side effects: headache, orthostatic hypotension, reflex tachycardia

If someone is having chest pain you have them stop and sit down. You put one sublingual tablet under
tongue and rest for five minutes. If they are still have chest pain they should call an ambulance and take
a second. Five minutes later they can take a third but NO more!
If patch: place on hairless area and rotate sites. Remove old patch and clean with soap and water and
dry well before applying new patch.

Wear gloves when applying!

Antidysrhythmic medications

Class One - ANS -Procainamide, Lidocaine

Used for Supraventricular tachycardia (SVT), ventricular tachycardia, atrial flutter, atrial fibrillation. "If
you were 'ProMcCain' when he was running for President, you might have gotten really upset and
developed 'tachycardia' when he lost. Then you would need to take 'Procainamide'

Sodium channel blocker

Side effects: hypotension, lupus, leukopenia, thrombocytopenia, and arrhythmias

Antidysrhythmic Medications

Class Two - ANS -Propranolol

Non-selective beta blocker

A-fib, A-flutter, paroxysmal SVt, HTN, angina

Impact Beta-1 and Beta-2 receptors in both heart and lungs. Which means it can cause bronchspasm
and cannot be used in asthma

Side effects: hypotension, bronchospasm, fatigue, weakness

Antidysrhythmic Medications

Class Three - ANS -Amiodarone

Used for A-fib, A-Flutter, Ventricular fibrillation, Ventricular tachycardia

Potassium channel blocker. Very serious med with serious side effects

Side effects: hypotension, bradycardia, pulmonary toxicity, visual disturbances, liver toxicity, GI upset,
thyroid dysfunction
Antidysrhythmic Medications

Class Four - ANS -Verapamil, Diltiazem

Calcium channel blockers

Used for hypertension, A-fib, A-flutter, SVT, angina

Side effects: Hypotension, bradycardia, GI upset

HMG-CoA Reductase Inhibitors - ANS -(Statins) Atorvastatin

Lowers cholesterol and decreases risk of MI by increasing HDL and decreasing LDL.

Side effects: Hepatotoxicity, Muscle pain, GI upset, Rhabdomyolysis

Administer in the evening with a meal because cholesterol is synthesized at night

Monitor liver function and CK labs

Patient should avoid alcohol

Cholesterol Absorption Inhibitors - ANS -Ezetimibe

Lowers cholesterol by inhibiting absorption in small intestine

"eZetimibe causes cholesterol to Zip on through"

Side effects: hepatotoxicity and muscle pain

Monitor liver function and CK levels

Bile-acid Sequestrants - ANS -Colesevelam, Colestipol

Used to lower cholesterol by binding bile acids in intestine which causes more cholesterol to be pulled
from the blood stream to be used for new bile

Side effects: constipation!

Take with food and full glass of water

Can interfere with absorption of fat soluble vitamins (DEKA) and oral contraceptives
Nicotinic Acid - ANS -Niacin

Used to lower cholesterol by decreasing lipoprotein and triglyceride synthesis which lowers LDL and
triglycerides

Side effects: flushing, hepatotoxicity, GI distress, hyperglycemia

Monitor liver function and blood glucose

Fibrates - ANS -Gemfibrozil

Lowers cholesterol by decreasing triglyceride production and transport and increases HDL

Side effects: GI upset, Gallstones, hepatotoxicity, and muscle pain

Give 30 minutes before breakfast and dinner

Monitor liver function and CK levels

Parenteral Anticoagulation - ANS -Heparin, enoxaparin

Used for stroke, PE, DVT

Prevents new clots from forming but does not break up clots that are already formed

Side effects: BLEEDING, heparin induced thrombocytopenia (HIT), hypersensitivity

HIT- decreased platelets and formation of clots in the body

Monitor aPtt levels: Normally 30-40 seconds but therapeutic levels will be 1.5-2 times the baseline. Max
should be 80. If higher than 80, blood is way too thin

Antidote is protamine

Monitor for signs of bleeding like black tarry stools or coffee ground emesis

Use soft toothbrush and electric razor

Oral anticoagulants - ANS -Warfarin (Coumadin)

Used for Venous thrombosis, A-fib with thrombosis, prevention of TIA, PE, MI, and DVT

Antagonist of vitamin K which prevents the formation of several clotting factors

Side effects: BLEEDING, GI upset, hepititis

Monitor PT: 11-13 but 18-24 for therapy and INR: 2-3

It takes 3-5 days for therapeutic level to be achieved. This means that they will be on Warfarin and
heparin at the same time until warfarin can catch up.

Antidote: vitamin K

Maintain consistent intake of vitamin K

Monitor for signs of bleeding, use soft toothbrush, etc.

Direct inhibitor of factor Xa - ANS -Rivaroxaban (Xarelto)

"Make your blood flow like a river"

Prevention of DVT, PE, and stroke by selectively inhibiting factor Xa which blocks coagulation

Side effects: BLEEDING, elevated liver enzymes

Monitor liver enzymes, hemoglobin, and hematocrit levels

Antiplatelets - ANS -Aspirin, Abciximab, Clopidogrel

Inhibit platelet aggregation to prevent MI, strokes

Side effects: GI upset, BLEEDING, and with aspirin tinnitus

Do not give aspirin to children with fever do to risk of Reye's Syndrome

Do not give in patients with bleeding disorders

Thrombolytic medications - ANS -Alteplase (tPA) "-ase"

"If you're trying to break up clots you've come to the right "plase"

Break us clots by converting plasminogen to plasmin which breaks up fibrinogen

Used with MI, Stroke, PE, clogged PICC lines

Side effects: BLEEDING

Do not give with patients with internal bleeding, hemorrhagic stroke, recent trauma or surgery, or
severe HTN

Given within three hours of onset of symptoms of MI or stroke (ischemic only!)

Closely monitor labs and vitals

Limit venipunctures and IM injections

Epoetin alfa (Epogen) - ANS -Used in anemias to help increase production of RBCs in patients with
chronic kidney disease, chemotherapy, or HIV by stimulating bone marrow

Side effects: HTN (due to increased hematocrit), risk of DVT, stroke, or MI

Do not agitate vial

Monitor blood pressure for HTN

Monitor Hgb and Hct twice a week

Ensure the patient has sufficient iron levels or med will not work

Filgrastim - ANS -Used with neutropenia to increase production of neutrophils and decreases risk of
infection. Usually for those on chemo

Stimulates bone marrow to increase production of neutrophils

Side effects: bone pain, leukocytosis, enlarged spleen

Do not agitate vial

Monitor CBC twice a week

Types of Blood Products - ANS -Whole blood: Includes everything: RBCs, WBCs, Platelets, Plasma. Given
to those with blood loss due to trauma or surgery, dehydration, shock. Helps to bring overall blood
volume up

Packed Red Blood Cells: Administered to those with anemia who need the extra RBCs, not the extra
blood volume
Platelets: For thrombocytopenia or low platelets

Fresh Frozen Plasma: For missing clotting factors

Administration of Blood Products - ANS -Get baseline lab values. Get signed consent. Assess for risk of
fluid overload like HF. Get baseline vitals right before administration and Q15min for first hour and
every hour until infusion is complete. Use 20g or larger catheter. Use 0.9% NS. Always confirm with two
nurses. Document type of blood, blood bank number, total volume infused, time started, time finished,
any reactions, and vital signs. If whole blood or packed RBC: given in 2-4 hour period. Platelets are 15-30
minutes per unit. Fresh frozen plasma is 30-60 minutes.

Reactions to Blood Products - ANS -First STOP the infusion immediately. Disconnect existing tubing hook
them up to normal saline. Call provider. Send blood and tubing back to blood bank for analysis. Obtain
Urine specimen.

Acute hemolytic reaction: fever, low back pain, tachycardia, hypotension, tachypnea. Ensure you have
checked ABO type and Rh factors with extra nurse.

Febrile nonhemolytic reaction: Most common. Fever, chills, possible headache, fever will increase
greater than 1 degree of baseline.

Anaphylactic Reaction: Wheezing, shock, cardiac arrest. Do normal Rx protocol as well as initiate code,
give epi, intiate CPR

Mild allergic reaction: Have flushing, itching, urticaria. Can give antihistamine prior to transfussion if hx
of this reaction. May need to stop, notify provider, and continue infusion slowly after antihistamine is
given.

Circulatory overload: especially with CHF. Crackles, cough, SOB, HTN, tachycardia, distended neck veins.
Infuse slowly. Wait two hours before infusion of additional units. Sit patient upright with feet down.
Administer diuretics and oxygen as appropriate

Treatment of H.pylori - ANS -Leading cause of peptic ulcer disease

Antibiotics: (Two - three different types to increase effectiveness and prevent resistance) Amoxicillin,
Clarithromycin, metronidazole

H2 receptor Antagonist
Proton Pump Inhibitor

Mucous Protectant

Antacid

Histamine 2 Receptor Antagonists - ANS -Ranitidine and Famotidine

"If you take this medication, you will feel better when you 'dine'"

Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric
juices) by blocking H2 receptors in the stomach which reduces gastric acid secretion

Side effects: increases risk of bacterial colonization in stomach because of reduced pH.

Advis patient not to over eat, reduce stress, stop smoking, avoid aspirin and NSAIDs

Proton Pump Inhibitors - ANS -Omeprazole and Pantoprazole

Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric
juices) by inhibiting enzyme needed for gastric acid secretion

Side effects: GI upset, osteoporosis with long term use

Mucosal Protectant - ANS -Sucralfate (Carafate)

Used for duodenal ulcers. Reacts with stomach acid to form paste that cover ulcers

Side effects: Constipation

Want to give one hour before meals and at bedtime

Antacids - ANS -Magnesium Hydroxide, Sodium Bicarbonate, Aluminum Hydroxide, Calcium Carbonate
*Know All*

Used for peptic ulcer disease and GERD by neutralizing stomach acid

Side effects: Vary depending. Aluminum or Calcium can cause constipation. Mg based causes diarrhea.

One hour before and three hours after meals and at bedtime. Leave one hour before or after any
medications.
Prostaglandins - ANS -Misoprostol

Used to prevent gastric ulcers in patients taken NSAIDs long term and to induce labor by ripening cervix.
Decreases stomach acid production, increases protective mucous and bicarbonate.

Side effects: dysmenorrhea, miscarriage or GI upset.

DO NOT give in pregnancy or it causes miscarriage. Run pregnancy test first.

Antiemetics - ANS -Ondansetron - Used for nausea and vomiting for those receiving chemo, radiation,
and post-op by blocking serotonin receptors in the CTZ.

Side effects: headache, dizziness, GI upset.

If giving to patient receiving chemotherapy give prior to chemo treatment

Laxatives - ANS -Psyllium: Bulk forming, helps to soften stool and increase bulk

Docusate Sodium: Surfactant laxative, softens stool by increasing the water content

Bisacodyl: Stimulant laxative. Stimulates peristalsis. A little harsher than the rest.

Magnesium hydroxide: Osmotic laxative, draws water into the intestine and promotes peristalsis. Check
for Mg toxicity and dehydration

Key points: Constipation r/t bowel obstruction. Increase fiber, fluid, and exercise.

Lactulose - ANS -Laxative used for hepatic encephalopathy by decreasing ammonia levels and improve
the mental status. Lowers pH in colon to promote ammonia excretion.

Side effects: GI upset, electrolyte imbalances, hyperglycemia.

Treats encephalopathy and decreases ammonia levels!!!

Antidiarrheal agents - ANS -Loperamide and diphenoxylate/atropine

Stimulate opioid receptors in the intestines cause a decrease in motility and increased absorption of
water and sodium
Side effects: Constipation, drowsiness, Diphen/atropine at high doses causes opioid and anticholinergic
effects. (Put the two together to decrease abuse potential)

Prokinetic Agents - ANS -Metoclopramide (Reglan)

Used for nausea and vomiting as well as GERD and gastroparesis by accelerating gastric emptying and
blocks dopamine and serotonin receptor in CTZ

Side effects: Drowsiness, extrapyramidal symptoms

Irritable Bowel Syndrome with Diarrhea - ANS -You can have IBS with or without diarrhea

Alosetron: Blocks 5-HT3 receptors which increases firmness of stool and decreases urgency

Side effects: Constipation

Irritable Bowel Syndrome with Constipation - ANS -Lubiprostone

Increases fluid secretion in intestine and increase intestinal motility

Side effects: diarrhea or nausea

5-aminosalicylates - ANS -Sulfasalazine

Used for IBS, Crohn's disease, and ulcerative colitis

Inhibits prostaglandin synthesis which decreases colon inflammation

Side effects: Blood dyscrasia, GI upset, rash, headache

Iron Preparations - ANS -Ferrous Sulfate (Oral), Iron Dextran (IV or IM)

Used for iron deficiency anemia

Side effects: Oral: GI upset, constipation, teeth staining (use straw), dark green or black stool (harmless).
IV: Staining at IV site, hypotension, flushing

Vitamin C increases absorption. Take on empty stomach one hour before meals.

Increase fluid and fiber intake

If IM, use z-trac method

Keep out of reach of children

Increase intake of iron rich foods

B-12 - ANS -Cyanocobalamin

Treats Megaloblastic anemia if they are lacking intrinsic factor

Folic Acid - ANS -Given in pregnancy to prevent neural tube defects. Can also be given to alcoholics to
treat poor dietary intake. Used for megaloblastic anemia when issue is too little folic acid.

Never give to someone who is lacking in B-12

Potassium - ANS -Given for hypokalemia who are on diuretics, have prolonged vomiting or diarrhea

Watch for hyperkalemia

Never want to give a rapid infusion as it can cause fatal hyperkalemia

Magnesium - ANS -Can increase Mg levels

IV - stops preterm labor or anticonvulsant during labor and delivery

Watch for increased Mg: muscle weakness, paralysis, respiratory depression

Calcium Gluconate

Herbal Supplements - ANS -Black Cohosh: estrogen substitute, tx symptoms of menopause

Echinacea: Used to help stimulate immune system

***Garlic, Ginger, and Ginkgo Biloba: All start with G and increase bleeding. Antiplatelet qualities***
Glucosamine: Stimulates cells to make cartilage and synovial fluid. Can help patients with osteoarthritis

St. John's Wort: Mild depression

Saw Palmetto: Helps prostate symptoms

Valerian: increases GABA, helps anxiety

Estrogens - ANS -Conjugated equine estrogens and estradiol

Used for contraception in combination with progesterone or PMS symptoms, post menopausal
osteoporosis, dysmenorrhea, and prostate cancer

Side effects: increased risk of embolic effects: DVT, PE, MI, Stroke; risk for HTN, edema, weight gain, and
estrogen dependent cancer

Contraindicated patients who smoke***, HTN, and high risk for embolic effects or estrogen dependent
cancer

Progesterone - ANS -Norethindrone

Used in birth control pills, to maintain pregnancy, and counters some adverse effects of estrogen

Side effects: increased risk of embolic events, menstrual changes, edema, increase risk of breast cancer

Patients should delay conception for three months after progesterone therapy

Contraindicated in patient who have a high risk of embolic events

Birth control - ANS -Often estrogen and progesterone therapy

Side effects: same as estrogen and progesterone

If used properly it will prevent ovulation, thicken cervical mucous, and alter endometrial lining to reduce
chance of fertilization
Androgens - ANS -Testosterone

Used in boys with delayed puberty, hypogonadism, post-menopausal breast cancer

Side effects: acne, increased cholesterol, edema, liver dysfunction, polycythemia, premature epiphyseal
closure, deepening of voice and abnormal hair growth in women

Contraindicated in prostate cancer

High abuse potential

5-Alpha reductase inhibitors - ANS -Finasteride (Proscar)

Dutasteride (Avodart)

"Proscar looks like 'pro-car' and that guy has a 'fine ride' ... but he does have BPH.

Used to treat BPH or baldness

Prevents conversion of 5-alpha reductase which prevents conversion of testosterone

Side effects: erectile dysfunction and gynecomastia

Pregnant women and women of child bearing age should not come into contact with this medication

Alpha1- adrenergic antagonists - ANS -Tamsulosin (Flomax) "-osin"

Used for BPH. Antagonises alpha1-adrenergic receptors in prostate and veins. Relax smooth muscle of
bladder neck and prostate

Adverse effects: hypotension (relaxes veins), dizziness, nasal congestion, sleepiness, faintness,
ejaculation failure

Take 30 minutes after meals or same time every day

Monitor blood pressure

Phosphodiesterase type 5 inhibitors - ANS -Sildenafil (-afil)

"A fills up the penis"

Enhances the effects of nitric oxide released during sexual stimulation resulting in increased blood flow
in corpus
Side effects: prolonged erection, increase risk of MI

Do NOT take with of nitrates! and use cautiously in men with cardiovascular disease.

Oxytocics - ANS -Oxytocin (Pitocin)

Used to induce or enhance labor, deliver placenta, or stop postpartum hemorrhaging

Side effects: Painful contractions, uterine rupture

Closely monitor contractions: less than 60 seconds and every 2-3 minutes

Monitor maternal and fetal blood pressure and pulse

Magnesium can be used to relax the uterus.

Tocolytic medications - ANS -Terbutaline

Used for preterm labor

Delays but does not prevent labor. Also used for COPD and asthma because to activates beta 2
adrenergic receptors in uterus and lungs.

Side effects: angina, tachycardia, restlessness, tremor

Contraindicated in gestation of 34 weeks or greater (Risk outweighs benefits) and cervical dilation
greater than 6 cm.

Opioid analgesics (for pregnancy) - ANS -Fentanyl, Butorphanol, nalbuphine

Used for severe pain during labor by decreasing pain without causing significant respiratory depression
in mom or baby

Side effects: dry mouth, GI upset, sedation, hypotension, decrease fetal heartrate

Labor should be well established: cervix should be 4cm

With respiratory depression, administer naloxone

Hydroxychloroquine - ANS -Used for malaria

Side effect: retinal damage

Advise patient to have eye exams every six months

Medications that end in -mab - ANS -Infliximab, adalimumab

Immune suppressants for cancer or autoimmune

Infections are a huge risk

NSAIDs and prednisone can treat.... - ANS -Rheumatoid arthritis

NSAIDs: help with pain

Prednisone: suppresses immune response

Methotrexate - ANS -Used for rheumatoid arthritis, psoriasis, and some cancers

Inhibits folic acid production which inhibits cell reproduction which causes effects of rapidly replicating
cells and has immunosuppressive properties

Side effect: INFECTION, hepatotoxicity, bone marrow suppression and GI upset

Do not give them fresh fruits or veggies, use protective precautions

Notify the provider immediately if they have signs of infection

Monitor liver labs and CBC

Cyclosporine - ANS -Ulcerative colitis and rheumatoid arthritis, psoriasis, prevention of graft-versus-host
disease in transplant patients (transplant rejection)

inhibits normal immune response by blocking interleukon-2

Side effects: infection, hepatotoxicity, nephrotoxicity, unusual hair growth

Notify provider of signs of infection, monitor renal and liver function labs.

Calcium Citrate - ANS -Used in hypocalcemia

Ensure that patient has sufficient vitamin D - needed for absorption

Look for hypercalcemia: abdominal pain, fatigue, constipation, muscle weakness

Selective estrogen receptor modulators - ANS -Raloxafene

Used for postmenopausal osteoporosis and reduces risk of breast cancer by binding to estrogen
receptors and decreases bone reabsorption (keeps calcium inside the bone)

Side effects: increase risk of embolic events: PE, DVT, stroke, hot flashes, leg cramps

Encourage patient to increase calcium and vitamin D intake

Engage in weight bearing exercise

Monitor bone density through scans

"Raloxafene: I can 'relax' now that I am taking raloxafene for osteoporosis

Bisphosphonates - ANS -Alendronate

Used for post-menopausal osteoporosis, Paget's disease by preventing bone reabsorption by inhibiting
osteoclasts activity

Side effects: *esophagitis* GI upset, muscle pain, visual disturbances

Need to take on empty stomach in the morning with at least 8 ounces of water and you need to sit
upright for 30 minutes or more.

Encourage intake of calcium and vit D

Increase weight bearing exercises

Monitor bone density via scans

Calcitonin - ANS -Used for post-menopausal osteoporosis and hypercalcemia

Preventing bone reabsorption by inhibiting osteoclasts activity

Side effects: GI upset, nasal irritation

Encourage intake of calcium and vit D

Increase weight bearing exercises

Monitor bone density via scans

Monitor for hypocalcemia: (keeping calcium in the bone, may not have enough in the blood) positive
Trousseau's sign and Chvostek's sign

Nonsteroidal anti-inflammatory drugs - ANS -Aspirin, ibuprofen, naproxen, indomethacin

Used for mild-moderate pain, fever, inflammation

Inhibits prostaglandin synthesis and aspirin inhibits platelet aggregration

Side effects: GI upset, GI bleeding, renal toxicity, rash, tinnitus (aspirin)

Never give aspirin to child with fever

Do not give in peptic ulcer disease or bleeding disorders

Avoid alcohol

Monitor for salicylism: sweating, dizziness, headache, tinnitus, respiratory alkalosis

Acetaminophen - ANS -Used for mild - moderate pain, fever by inhibiting prostaglandin synthesis

Side effects: hepatotoxicity! in high doses

Limit patient's intake of Tylenol to less than 4 grams a day including certain combos of medications. Be
aware of all medications and ingredients

Many OTC drugs contain acetaminophen

Acetylcysteine is the antidote to acetaminophen overdose

Opioid agonists - ANS -Morphine, Fentanyl, and oxycodone

Used for moderate to severe pain and promotion of sedation by binding to opioid receptors in the CNS

Side effects: Sedation, respiratory depression, constipation, GI upset, hypotension, urinary retention

Naloxone is the antidote for opioid analgesics

Monitor pain level, vital signs, and respiratory status

Administer slowly

Administer around the clock for cancer pain

Increase fluid and fiber

Opioid antagonist - ANS -Naloxone

Used for opioid overdose by competitively blocking opioid receptors in the CNS

Side effects: HTN, angina, agitation, GI upset (everything is cranked back up)

Monitor respiratory status

Monitor pain (reverses analgesia)

Adjunct pain medications - ANS -Tricyclic Antidepressants: Amitriptyline can be used for neuropathic
pain

Anticonvulsants: carbamazepine can also be used for neuropathic pain

Medications used to treat gout - ANS -Colchicine: decreases inflammation and pain in acute gout attack.
Side effects: GI upset and thrombocytopenia

"Cool chicken - pecks your toe that has gout"

Probenecid: inhibits uric acid resorption and treats hyperuricemia r/t chronic gout

Side effects: GI upset and kidney stones "Probenecid will 'benefit' you with your gout."

Allopurinol: inhibits uric acid resorption and treats hyperuricemia r/t chronic gout

Side effects: GI upset, rash, hepatotoxicity, nephrotoxicity

"Allolpurinol will get rid of 'all' your uric acid production

Ergot Alkaloids - ANS -Ergotamine

Used for vascular headaches - migraine and cluster

Vasoconstriction of intercranial blood vessles

Side effects: GI upset, muscle pain, HTN, numbness, tingling

Advise patient to lay down in dark quiet place.

Avoid tyramine rich foods and alcohol

Triptans - ANS -Sumatripan "-tripan_

Used for acute attacks of vascular headaches. Works by vasoconstriction of intracranial arteries.

Side effects: warm tingling sensation, dizziness, angina, injection site discomfort

Advise patient to lay down in dark quiet place.

Avoid tyramine rich foods and alcohol

Lidocaine - ANS -Local anesthetic that can be used topically or parenteraly

Topically: decrease pain that involve puncture of skin

Parenteraly: decrease pain in minor surgical procedure, epidurals, or biopsies

Blocks conduction of pain impulses within certain radias

Side effects: hypotension, bradycardia, prolonged labor, spinal headaches, allergic reactions

If using cream: apply one hour before procedure and cover with occlusive dressing

Insulin: Rapid Acting - ANS -Lispro or Humalog

Onset: less that 15 minutes

Peak: 30 min - 1 hour

Duration: 3 hours (three letters in log)

Make sure patients food is right in front of them

Insulin: Short acting - ANS -Regular or Humulin R

Lin is just a regular short person

Onset: 30 mins - 1 hour

Peak: 2-3 hours

Duration: 5-7 hours (7 letters in regular)

Give about thirty minutes prior to meal

Intermediate Acting Insulin - ANS -NPH Humulin N

NPH Neal Patrick Harris he is of intermediate height and is a hard working actor. So if you call him, he
will come onset in 1-2 hours and will stay for 18-24 hours!

Onset: 1-2 hours

Peak: 4-12 hours

Duration: 18-24 hours

Long acting insulin - ANS -Insulin Glargine or Lantus

Onset: 1 hour

No peak

Duration is 24 hours

Overall notes about insulin - ANS -We can give insulin to type one or type two diabetics

Type one: will always get insulin

Type two: can sometimes be managed with oral medications

Side effects: hypoglycemia (tachycardia, diaphoresis, shakiness, weakness, headache) lipohyperthrophy

(if injected into same spot over and over again.

Patients dose may need to increase in times of illnesses

For hypoglycemia in a fully conscious patient, give 15 grams of glucose (4 oz of orange juice). If
unconscious give IM glucagone

When mixing draw short acting before long acting.

Clear before cloudy.

Inject air into long acting vial, inject air into faster acting insulin, draw up faster acting insulin, then draw
up long acting insulin

Never mix insulin glargine with anything else

For suspension, gently rotate (For NPH)

If short acting looks cloudy, discard

Sulfonylureas - ANS -Glipizide and glyburide

Used for type two diabetes to bring blood sugar down by increased insulin release from pancreas

Side effects: hypoglycemia, photosensitivity, GI upset

Take med 30 minutes before meal

Do not drink alcohol

Use sunscreen

"Glipizide, Glyburide, riding and sliding down slides. Blood sugars are going down. Outside in the sun"

Meglitinides - ANS -Repaglinide

Used for type two diabetes

Increases release of insulin from pancreas

Side effects: hypoglycemia, angina

Take three times a day, eat within thirty minutes of dose

Biguanides - ANS -Metformin

Used for type two diabetes, controls BS levels

Decreases glucose production in the liver and increases glucose uptake

Side effects: GI upset, B-12 deficiency, lactic acidosis, metallic taste

Take with a meal

Do not drink alcohol

If B-12 issue, you may need supplement and discontinue use of metformin if it requires NPO or contrast
dye

Monitor for signs of lactic acidosis (diarrhea, dizziness, hypotension, bradycardia, weakness)

Thiazolidinediones - ANS -Pioglitizone

Used for type two diabetes

Decreases insulin resistance, increases glucose uptake, decreases glucose production

Side effects: fluid retention, increased LDL, hepatotoxicity

Contraindicated in heart failure

Take once a day with or without food

Alpha-glucosidase inhibitors - ANS -Acarbose

Used for type two diabetes

Inhibits glucose absorption in GI tract

Side effects: GI upset, anemia, hepatotoxicity

Contraindicated for GI disorders

Taken three times a day, with meals, with the first bite of food
Hyperglycemic Agent - ANS -Glucagon

Used for severe hypoglycemia when patient cannot take oral glucose (unconscious, swallowing issues)

Stimulates breakdown of glycogen into glucose

Side effects: GI upset

Administer SQ or IM

Provide food as soon as they can swallow

"When all the glucose is gone, you take glucagon"

Levothyroxine - ANS -Hypothyroidism

Acts as a synthetic form of T3, T4

Side effects: r/t too high of a dose. GI upset, anxiety, heat intolerance, weight loss, sweating

While patient is on therapy, monitor levels of TSH and T4

Should be taken on an empty stomach with a full glass of water in the morning

Life long terapy

Propylthiouracil - ANS -Used for graves disease (hyperthyroidism) or preparation of thyroidectomy

Blocks synthesis of thyroid hormone

Side effects: agranulocytosis, GI upset, rash, hepatotoxicity, if too high: hypothyroidism signs like cold
intolerance, lethargy, weight gain, depression

Make take 1-2 weeks to work

Important to monitor CBC and liver function

PTU: Prevents Thyroid from being Up

Radioactive Iodine - ANS -Used for hyperthyroidism and thyroid cancer

Absorbed by thyroid and destroys its cells

Side effects: radiation sickness, bone marrow suppression and hypothyroidism

Increase fluid intake and void frequency

Limit contact with other, maintain safe distance, do not share dishware, flush twice

Strong Iodine Solution - ANS -Used for hyperthyoidism and in preparation for thyroidectomy

Inhibits thyroid production and release due to high levels of iodine

Side effects: GI upset, iodism: metallic taste, stomatitis, sore throat/gums; hypersensitivity

Have patient increase fluid intake

Mix solution with juice to improve taste

Avoid foods high in iodine such as seafood

Somatropin - ANS -Treats growth hormone deficiencies in Peds and Adult

Acts by mimicing naturally occurring growth hormones. Helps stimulate growth and protein synthesis

Side effects: hyperglycemia

Want to administer via IM or SQ and rotate sites

*Stop treatment prior to epiphyseal closure* Closely monitor patient's growth rate in order to know
when to stop medication

Antidiuretic Hormone - ANS -Vasopressin

Desmopressin

Treats diabetes insipidus

(peeing out too much urine)

Mimics ADH to reaborption water in the kidneys which decreases urine output and increase urine
osmolality

Side effects: over hydration, headache

Decrease fluid intake during therapy

Monitor I&Os carefully and urine specific gravity

Make sure urine output is between 1.5-2.0 L in 25 hour period

"Will help to 'suppress' all that urine"

Adrenal hormone replacement - ANS -Hydrocortisone

Steroid

Used for adrenal cortical insufficiency in Addison's disease by mimicking naturally occurring cortisol
which maintains blood pressure, regulate metabolism

Side effects: **Bone loss, peptic ulcer, infection, GI upset, weight gain, adrenal suppression, and skin
fragility**

Monitor for signs of peptic ulcer (coffee ground emesis or tarry stools)

Never stop suddenly! Taper slowly

Increase patients dose during times of stress

Monitor for s/s of infection

May need calcium and vit D supplement

Avoid NSAIDs and alcohol during use

Antitumor Antibodies - ANS -Doxorubicin

Treats solid tumors. Binds to DNA and inhibits DNA and RNA synthesis. Kills rapidly growing cells

Side effects: Cardiac toxicity, GI upset, alopecia, bone marrow suppression, red discoloration of urine,
sweat and tears

Monitor for infection or BMS

Administer antiemetics, monitor cardiac function, monitor CBC

Antimitotic - ANS -Vincristine

Used for tumors and cancers. Stops cell division during mitosis. M phase specific.

Side effects: peripheral neuropathy, phlebitis, GI upset, balding

Administer antiemetics, monitor for signs of neuropathy, use central line

Does not cause bone marrow suppression!

"If you drink too much Vino, you can't feel your arms and legs"

Alkylating Agents - ANS -Cyclophosphamide

Used for tumors/cancers

Inhibits protein synthesis by interfering which DNA and RNA synthesis

Side effects: bone marrow suppression, GI upset, hemorrhagic cystitis, alopecia

Increase fluid intake, monitor blood in patient's urine, monitor CBC, give antiemetic

Leuprolide - ANS -For Prostate cancers

Works by decreasing the amount of testosterone produced

Side effects: hot flashes, gynecomastia, decreased libido, bone loss

Increase calcium and vitamin D

Monitor PSA and testosterone levels

"Leuprolide makes libido luke warm"

Tamoxifen - ANS -Used for breast cancer: competes with estrogen for binding sites within the breast
stopping growth of dependent cancers

Side effects: hot flashes, GI upset, hypercalcemia, increased risk of endometrial cancer, increased risk of
pulmonary cancer

Interferon alfa 2b - ANS -Biologic response modifier.

Used for cancers and viral infections like hepatitis. Interferons are like proteins that increase immune
response to tumors or viruses and decrease tumor cell production

Side effects: flu like symptoms, bone marrow suppression, cardiotoxicity, neurotoxicity, alopecia, GI
upset, psychiatric disorders

Interferon interferes with tumor cell production, but it also interferes with you life
Penicillins - ANS -Amoxicillin, Penicillin G, Pipercillin tazobactum

Work by weakening bacterial cell wall which leads to cell death

Side effects: possible **allergic reaction, GI upset, renal toxicity

Check for history of reaction to penicillins or cephalosporin

Cephalosporins - ANS -Cephalexin, cefazolin, and ceftriaxone

Work by weakening the bacterial cell wall which leads to cell death

Side effect: allergies, GI upset, superinfection

Don't give in allergic reaction

Should not consume any alcohol

Take with food

Carbapenems - ANS -Imipenem-cilastatin, meropenem

Treats serious bacterial infections. Destroys bacterial cell wall causing cell death

Side effects: GI upset, rash, superinfection

If allergic to penicillin or cephalosporin may also have a response to carbapenems

Vancomycin - ANS -Serious infections and C-Diff

Destroys bacterial cell wall causing cell death

Side effects: ototoxicity and renal toxicity, infusion reactions, and phlebitis

If long term, central line is given

*Monitor Vanc. though and peak levels.

Dose may need to be adjusted due to creatnine levels.

"Some is in a Van and the music is way too loud that it hurts their ears, and they have no air and aren't
drinking water, so they hurt their kidneys"
Tetracycline - ANS -Doxycycline

Treats bacterial infection, acne, lyme disease, rocky mountain spotted fever. Prevent proteein synthesis
which inhibits bacterial growth. "Static"

Side effects: GI upset, tooth discoloration in children and fetuses, hepatotoxicity, photosensitivity, and
superinfections

Never give to pregnant women or children under 8.

Tell patient to wear sunscreen

Take on empty stomach with full glass of water

Can decrease effectiveness of oral contraceptives

Do not take with milk or antacids because it decreases aborption

Macrolides - ANS -Erythro'mycin'

Used for bacterial infections

Inhibits protein synthesis which slows bacterial growth

Side effects: GI upset, dysrythmias, ototoxicity

Administer on empty stomach with full glass of water.

Aminoglycosides - ANS -Gentamicin

Used for serious bacterial infections. Destroys bacteria by inhibiting protein synthesis

Side effects: ototoxicity, nephrotoxicity, vertigo, and ataxia

Monitor for hearing loss

Monitor kidney function

Give IV or IM and monitor peak and though levels

Narrow therapeutic range

Sulfonamides and trimethoprim - ANS -Sulfamethoxazole-trimethoprim

Inhibits bacteria folic acid synthesis

Side effects: hypersensitivity, GI upset, blood dyscrasias, cyrstaluria

Advise patients to increase fluid intake!

Nitrofurantoin - ANS -Urinary tract antiseptic

Works by damaging bacterial DNA

Side effects: GI upset, hypersensitivity, blood dyscrasias, peripheral neuropathy, brown discoloration
(expected)

Ciprofloxacin - ANS -prevents bacterial DNA replication

Side effects: GI upset, photosensitivity, superinfections, Achilles tendon rupture

Phenazopyridine - ANS -Urinary tract analgesia

Helps with burning, pain, etc. of UTI

Acts as a local anesthetic

Side effects: orange discoloration of urine - can stain clothes

TB medications - ANS -(R.I.P.E.)

Rifampine: orange colored secretions "ripe orange" Can decrease effectiveness of oral contraceptives

Isoniazid: neuropathy, do not drink alcohol

Pyrazinamide

Ethambutol: Result in changes in patients vision. E for Eye

Treatment will be six months to a year

All of these are very harsh on the liver, best not to drink alcohol

Monitor for s/s of liver damage

Test family members

Sputum cultures will be needed every 2-4 weeks and will no longer be infectious after 3 negative
sputum samples. Will have to wear N-95 out in public

Antiprotozoals - ANS -Metronidazole

Effective against protozoal infections. Effective in anaerobic bacteria.

Side effects: GI upset, metalic taste, dark urine, dizziness, headache

Patient should not drink alcohol

"Car broke down, so she has to take the metro, gets a metallic taste in her mouth. She starts getting sick
on the metro so she has to find the restroom on the metro and sees that her urine is dark. And she is
like 'oh this is great, I can't even have a drink when I get home.'"

Antifungals - ANS -Amphotericin B, Ketoconazole

Used for systemic fungal infections

"Amphoterrible"

Side effects: hepatotoxicity, GI upset, nephrotoxicity, bone marrow suppression, phlebitis

Often test dose is administered

Monitor closely for any liver or renal dysfunction

Ketoconaole: Not as bad, but still has liver toxicity and GI upset

Antivirals - ANS -Acyclovir "-vir"

Acyclovir: used for symptoms of herpes and varicella

Ganciclovir: cytomegalovirus

Both work by preventing viral DNA synthesis

Side effects: phlebitis, GI upset and nephrotoxicity, bone marrow suppression in ganciclovir

These medications do not cure the conditions!

For ganciclovir, monitor CBC and infection