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Abbreviations

A atrial AR allergic reaction AB resistance antibiotic resistance Al salts aluminium salts Mg magnesium salts ARF acute renal failure Adm administer Angioedema (swelling of face, eyes, lips, tongue and trachea that can interfere with breathing). ACH SE anticholinergic effects: OH, 4 cant: cantsee/pee/shit/spit (dry mouth, constipation, blurred vision, photosensitivity, dry eyes) impotence, HPT, tachycardia 7Ds: disorientation, dizziness, digestion problems (N/V), drowsiness, dancing (involuntary muscle spasms), dilated pupils.) BBB blood brain barrier BC bradycardia BL bleeding b/f before BF blood flow BP blood pressure BPH benigh prostatic hypertrophy BS - blood sugar CA cancer CNS central nervous system CSR central serous retinopathy CON constipation CK - creatinine CVS cardiovascular system cretinism (growth & mental retardation). DIZ - dizziness DM diabetes mellitus DTR deep tendon reflexes DROW drowsiness dis disorder/disease DN depression DUMBELLS: D, urination, miosis or muscle weakness, bronchorrhea (mucus running), bradycardia, emesis. EB virus Epstein Barr virus Elect imb electrolyte imbalance Esp especially EGFR Epithelial Growth Factor receptors EF ejection fraction EPS extra pyramidal SE (restlessness/anxiety/spasms face & neck) G- gram negative bacteria G+ gram positive bacteria GERD Gastroesophageal reflux disease GID gastrointestinal discomfort. GIU gastrointestinal upset Inj injection I&O input output HA headache HB heart block HF heart failure HTN hypertention HPT - hypotension HSV herpes simplex virus HG - hyperglycemia HPG - hypoglycemia HIT heparin induced thrombocytopenia ICP intracranial pressure IOP intraocular pressure MG myasthenia gravis MRSA methicillin-resistant enterococcus MI myocardial infarction myxedemia (intolerance to cold, lethargy, poor appetite, constipation)

NOT for contraindicated NFC not for children C> 6 children older than 6 years NMS neuroleptic malignant syndrome (severe EPS, hyperpyrexia (fever), autonomic dysfn) N/V/D nausea/vomiting/diarrhea OCD obsessive compulsive disorder OH orthostatic /postural hypotension OJ orange juice PVC premature ventricular contraction PE pulmonary embolism PID pelvic inflammatory disease PN peripheral neuropathy PUD - ulcer disease Preg X pregnancy category X PS photosensitivity RD respiratory depression RF renal failure RD respiratory depression

Suppr suppression SOB shortness of breath S&s signs & symptoms SED sedation SLUDGE: salivation, lacrimation, urination, D, GI upset, emesis. salicylate poisoning (aspirin): tinnitus>hearing loss, sweating, HA, DIZ TIA transit ischemic attack TC tachycardia

u/o urine output URI upper respiratory infection UR - urinary retention UC ulcerative colitis V ventricular VRE vancomycin resistant enterococcus VEGRFvascular endothelial growth factor receptors Vit vitamin VF ventricular fibrillation VT ventricular tachycardia VZV varicella zoster virus WG weight gain WL weight loss

KT kidney toxicity KD- kidney damage KDis kidney disease LT liver toxicity LD liver damage L Dis Liver disease LOC level of consciousness

increased decrease/decreased/reduce > Followed by , cause,


therefore

Drugs Table w classes/use/MOA/SE/AE/nursing applications/prefixes/roots/suffixes


Prefix, root, suffix -caine Subclass/category Drug class In alphabetic order examples Use, MOA, SE/AE, notes, nursing applications

Local anesthetic agents

Anesthesia Care

Ester

Chloroprocaine (Nesacaine)

Ester

Cocaine

For regional anesthesia. Block conduction of pain impulses in specific area (parenteral). No loss of consciousness. Used for dental work, minor surgery, labor & delivery, diagnostic procedures, skin & mucous membrane (topical).SE: CNS excitation-seizures RD unconsciousness, HPT & cardio suppr, AR, can prolong labor, risk of fetal BC & CNS depression, spinal HA, UR. For local infiltration, peripheral nerve block, epidural anesthesia. Blocks more sensory than motor nerves. Little systemic toxicity. Onset: rapid 6-12 min, duration: short acting 45-60 min. For topical anesthesia only, rarely used for other due to

Ester Amide

Tetracaine (Pontocaine) Lidocaine (Xylocaine)

Amide

Mepivacaine (Carbocaine)

Amide Amide

Bupivacaine (Marcaine, Sensorcaine) Ropivacaine (Naropin)

systemic toxicity and addictive potential. Provides vasoconstriction. May cause severeHR & BP. Used primarily for nasal intubations & nasopharyngeal surgery. Onset: rapid, duration: intermediate acting. Onset: slower 7-10 min, duration: long acting. Topical/Spinal block, not FDA approved in peds. For topical anesthesia/local infiltration. IV regional, peripheral nerve block, spinal & epidural block. Blocks motor & sensory nerves equally. Onset: rapid 5-15 min, duration: intermediate/depends on the dose & additives: 45-180 min & longer. For local infiltration, peripheral nerve/epidural block. Does not cause vasodilation. Onset: rapid to intermediate 3-20 min, duration: intermediate acting 120-200 min. For local infiltration, peripheral nerve block, spinal & epidural block. Onset: slower 5-15 min, duration: long 3-10 hrs. For epidural block. Onset: intermediate to fast. Duration: long acting, not as long as bupivacaine.

Neuromuscular blocking agents


Paralytic Depolarizing agents

Anesthesia Care
Succinylcholine (Anectine) Muscle relaxant for surgeries, ideal for short procedures, intubation. Onset: rapid 30-60 sec, duration: short 3-5 min, no reversal agents available. SE: look for BC, myalgia, MH trigger. Route of elimination: pseudochlinesterase (plasma cholinesterase). AE: hyperkalemia. If rigidity&T (NMS): antidote: Dantrolene (Dantrium) to slow metabolic activity of muscles. Duration: intermediate 45 min. Route of elimination: Hofmann elimination (hepatorenal independent degradation occurring spontaneously within plasma at a normal body T and PH) SE: slight histamine release, CV stability. Duration: intermediate 40-60 min. Route of elimination: Hofmann elimination. SE: no histamine release, CV stability. Duration: intermediate 20-40 min. Route of elimination: Hepatic. SE: no histamine release, CV stability. Duration: intermediate/dose dependent 12-67 min. Route of elimination: hepatic. Onset rapid to intermediate. SE: histamine release, pulmonary vascular resistance. Rare use. Duration: long 60-85 min. Route of elimination: renal. SE: no histamine release, vagolylic, TC. Rare use. Duration: long 100 min. Route of elimination: renal. SE: min to no histamine release, CV stability.

Nondepolarizing agents

Atracurium (Tracrium)

Cis-atracurium (Nimbex) Vecuronium (Norcuron) Rocuronium (Zemuron)

Pancuronium (Pavulon) Doxacurium (Nuromax)

Reversal agents for nondepolarizing muscle relaxants


-stigmine
Anticholinesterase drugs

Anesthesia Care

Neostigmine (Prostigmin)

Physostigmine Pyridostigmine

To improve muscle tone in MG, in anesthesia to reverse effects of non-depolarizing muscle relaxants. For UR (from general anesthesia) Parasympathomimetic that acts as reversible acetylcholinesterase inhibitor. Strong muscarinic effects. Onset: 6-8 min, duration: 60 min, usual dose o.5-2.5 mg IV. SE: dysrhythmias BC> cardiac monitoring is essential.

Anticholinergic drugs

Atropine 2.0 mg IV

Glycopyrrolate (Robinul) 1.0 mg IV

General Inhalation Anesthetics

Anesthesia Care

Ocular SE: HA, eye brow pain, blurred vision, retinal detachment (rare). Anticholinesterase drugs stimulate muscarinic receptors leading to BC, excessive salivation & bronchoconstriction. Given to counteract the SE of anticholinesterase drugs. Atropine rare use for reversal, onset: rapid, duration: 40 min. SE: tachydysrhythmias common, may cause central cholinergic syndrome as drug crosses BBB. Onset: slower, duration: 80 min. SE: lower incidence of dysrhythmias, slow change in HR, does not cross BBB. Produces loss of consciousness & sensation, relaxed muscles, memory loss. For surgical anesthetic, diagnostic procedures, cardiological procedures, pain relief, muscle relaxation. SE: HPT, RD & cardiac depression, malignant hyperthermia (muscle rigidity,body T, up to 43 C (109.4 F), LT, aspiration of gastric contents, risk of toxicity to OR personnel.

Inhalation Anesthesia

Anesthesia Care
Halothane
Malignant Hyperthermia is a complication of general anesthesia using Halothane can occur during induction or after. Signs: TC, dysrhythmias, muscle rigidity, v in O2 sats. Telemetry is essential to detect! For: along with inhalation anesthetics, induces & maintains anesthesia, causes amnesia, conscious SED, Ketamine used for children. Produce loss of consciousness & eliminates pain response. SE: RD& cardiac depression, HPT, bacterial infection, psychological reactions in children <15 & adults <65, hallucinations, dreams, mental confusion. Induction & maintenance of general anesthesia, SED for mechanically ventilated adults. Short acting. Is not analgesic>opioids (fentanyl) can be combined w propofol to alleviate pain. SE/AE: HPT (vasodilation), transient apnea, pain @ inj site> Tx w lidocaine; dystonia (neuro movement dis), euphoria, priapism (erect penis) NOT for RD, benzo use. Inhalation general anesthetic (human/veterenerian). Affects nerv system> anesthesia (unconsciousness), muscle relaxation,pain sensitivity by altering tissue excitability. SE:

Anesthetics

Anesthesia Care

General anesthetics Hypnotic agent

Propofol IV

-ane

General anesthetics Halogenated agents

Cyclohexane Isofluorane (Ethane)

HA, tremors, convulsions. Cyclohexane: mild eye& skin irritant>flush eyes w water. AE: Malignant hyperthermia. -caine Local anesthetics Bupivacaine Tetracaine (Pontocaine) Lidocaine (Xylocaine) Mepivacaine Procaine (Novocain) Cocaine
For dental/minor surgical/labor-epidural/diagnostic procedure. pain by blocking conduction of pain impulses in a circumscribed area. No loss of consciousness. SE/AE: CNS excitation (seizures followed by RD>unconsciousness), HPT, cardio suppr >BC, HB, cardiac arrest (spinal anesthesia), AR (procaine), prolonged labor & delivery/fetal BC (cross placenta), spinal HA, UR (spinal anesthesia). Lidocaine is given w epinephrine to v risk of systemic toxicity. Toxic effects of local anesthesia can cause seizure activity!!! To reverse: neostigmine (Prostigmin). neostigmine

curonium Neuromuscular

Vecuronium (Norcuron)

blocking agent

Pancuronium Pipecuronium Rocuronium

(Prostigmin): use w caution in bronchial asthma AE: bronchiolar constriction, bronchial secretions, bronchospasm, resp arrest, use w caution in cardiovascular disease AE: card dysrhythmias,BC. Caution in MG, used to diagnose and treat it AE: can develop if received a dose less than 4 hr prior to adm of the med during surgery. Caution in Seizures AE; seisures, weakness, DIZ. Onset 30 sec-2 min, Duration depends on dose & route. Dilute 0.4 mg (1 amp) w 9 ml of NS (0.04mg/ml) & adm ml per dose for desired effect. Reverses SED, RD, itching, N of opioids. Gold standard in pain management. Onset 5-10min IV, peak effects 20 min. Duration 1-2 hrs. No max dose. 100 more x potent than morphine. Onset 60-90 sec IV. Duration 30-60 min. Watch for chest wall rigidity w IV. 500-1000 x more potent than morphine. For induction & maintenance of anesthesia. Onset 1-3 min IV. 1/10 as potent as fentanyl, 10 x more potent than morphine. Onset <30 sec. High potency. Never adm by non-anesthesia personnel. Extremely short life. Initial loading dose must be followed by continuous infusion. 7.5 x stronger than morphine. Morphine 10 mg=1.5mg hydromorphone. Greater spectrum of drugs activity does not effectiveness. SE: GI D, thrush, vaginal yeast infection. AE: AR (angioedema, rash)>anaphylaxis, KD, hyperkalemia, dysrhythmias w high doses, PSEUDOMEMBRANOUS COLITIS, C. difficile. Probioticscolitis and restore normal flora. NOT for immunocompromised. #1 choice for most infections (URI, LRI, UTI, wound infection). Prevent bacteria from forming cell walls (make the wall loose, holes). We do not have cell walls>safe (preg)! More broad spectrum. SE (fewer): anaphylaxis, potential BL. AE: KD. 1-4 gen. killing power against G-,resistance to B lactamase, ability to reach CNS (SE). Broad spectrum, st bactericidal, most G+/some G-, surgical prophylaxis (1 gen, nd G+, staph&strep). G- anaerobic (2 gen), G- anaerobic rd th meningitis (3 gen), G-/+ (4 gen). Also: alternative in pts w mild allergy to penicillin. SE: hypersensitivity, Disulfiram reaction w alcohol, interfere w Vit K: cause excessive BL (DDI w warfarin). AB resistance: inactivated by B lactamase like penicillins. SE: GIANT: GI N/V/D, HG, AR/SOB > Anaphylaxis, thrombophlebitis, KT, thrombocytopenia PSEUDOMEMBRANOUS COLITIS. Take at least 1 hr b/f or 4 hr after iron and antacid (absorption). Older: ototoxicity, KT. Ceftriaxone (Rocephin) if urticaria & dyspnea>stop IV to prevent anaphylaxis. Ceftriaxone (Rocephin): NOT if allergy to penicillin

Reversal agent

Post Anesthesia Care


Naloxone (Narcan) IM/IV/endotracheal tube

Opioids

Post Anesthesia Care


Morphine 2mg Fentanyl (Sublimaze) 25 mcg Sufentanil (Sufenta) Alfentanil (Alfenta) Remifentanil (Ultiva)

Hydromorphone (Dilaudid) 0.5 mg IV/PCA/Epidural

Cell wall synthesis inhibitors (bactericidal)

Anti-Bacterial drugs

-cillin

Penicillin

Amoxicillin (Amoxil) Amoxicillin/Clavulanate (Augmentin) has shield to protect B lactam! 1st gen: Cefazolin (Ancef, Kefzol) Cephalexin (Biocef, Keflex) 2nd gen: Cefoxitin (Mefoxini) Cefuroxime (Ceftin, Kerufox) 3rd gen: Cefdinir (Omnicef) Cefixime (Suprax) Ceftriaxone (Rocephin) 4th gen: Cefepime (Maxipime)

CefCeph-

Cephalosporins

-enem

Carbapenems

Ertapenem (Invanz) IV Imipenem/cilastatin (Primaxin) IV Parenteral: Vancomycin (Vancocin)

-mycin

Monobactams

Very broad spectrum. For mixed infections (G+/G-, aerobi/anaerobic), resist to B lactamase and otherMDR organisms. AE: AR, hypersensitivity, N/V/D, KD suprainfection, CNS changes (confusion, seizures). NOT if allergy to penicillin Resistance to B lactamase. For serious infections: MRSA, CDAD. SE: N/V AE: CNS ototoxicity(hearing loss), red man syndrome (give it slowly), KD, cardiac AF, thrombophlebitis, infusion reactions (rashes, flushing, TACH, HPT). Therapeutic peak levels 30-40 mcg/ml. Use cautiously w KD.

Protein synthesis inhibitors (bacteriostatic & bactericidal)


-micin -mycin Aminoglycosides

Anti-Bacterial drugs

Gentamicin (Gentamicin) Streptomycin (Tx of TB) Tobramycin sulfate

-mycin

Macrolides

Oral & IV: Azithromycin (Zithromax) Oral: Clarithromycin (Biaxin)

-mycin -cycline

Tetracyclines

Doxycyclines (Vibramycin) Tetracycline (Tetracon) Minocycline (Minocin)

-mycin

Others

Oral & parenteral: Clindamycin (Cleocin) Linezolid (Zyvox)

Metabolism inhibitors (bacteriostatic)

Anti-Bacterial drugs

Bactericidal. Narrow spectrum: G-, aerobic infections, combined w penicillin synergistic. DO NOT mix together in the same solution. SE: N/V, fever, lethargy, hypersensitivity>rash/pruritis/parethesia/urticaria. AE: ototoxicity, KT, neuromuscular blockade> RD. Tobramycin sulfate: DO NOT take w NSAIDs (Ibuprofen) can cause KT. Gentamicin (Gentamicin)AE: proteinuria/BUN due to KD/KT. Streptomycin: neurologic dis (peripheral neuritis, optic nerve dysfn, tingling/numbness feet/hands) nd 2 choice. Bactericidal/bacteriostatic depending on blood levels of drug & bacteria type. Broad spectrum: G+/Gaerobic, for allergic to penicillins/cephalosporins. SE: thrombophlebitis, N/V/D, loss of appetite, abd pain PS> Avoid SUN! LT (lethargy/jaundice).AE: dysrhythm (sudden death),metabolism, serious drug interaction (Digoxin, warfarin, oral contracep). Ototoxicity when taking w Loop diur. Not for LD. Bacteriostatic, broad spectrum: G+/G-, ONLY for pt w healthy immune system. For allergic to penicillins /cephalosporins. SE: N/V/D, sore tongue, rash, PS>avoid SUN! yellow/brown tooth discoloration & hypoplasia of tooth enamel, NOT for C<8 years/preg (prevents normal bone growth+teeth)! suprainfection: PSEUDOMEMBRANOUS COLITIS /yeast infections. ICP, KD/LD/LT. DO NOT take w milk (no absorp) Clindamycin (Cleocin): bacteriostatic/bactericidal w high doses G+. For acne (topical, pneumonia, peritonitis, cellulitis. SE: site irritation, thrombophlebeitis @ IV site. AE: v liver fn, v WBC, give slowly by IV (too fast: shock, cardiac arrest). Linezolid (Zyvox): reserved for severe/life-threatening infections not responding to other AB drugs (G+), VRE, MRSA, diabetic foot ulcer. SE: N/D, HA, HTN (vasoconstriction). DO NOT take w tyramine food!!! AE:WBC, damage to optic nerve. Stop bacteria making folic acid, does not kill- stop growth. Bacteriostatic/Bactericidal for UTI. Broad spectrum (G+/G-), treat some nonbacterial infections, UTI, mid-ear infection, pneumonia, infectious D.

Sulfonamides Trimethroprim Combination

Sulfadiazine Trimethroprim (Trimpex) Trimethroprim/Sulfametho xazole (SMX-TMP, Bactrim)

DNA synthesis inhibitors (bactericidal)


-floxacin Fluoroquinolones

Anti-Bacterial drugs

See below See below Inhibit growth by preventing synthesis of folic acid. SE: HA, fever, skin rash, PS>avoid SUN, N/V, itchiness. AE: form crystals in kidney> kidney stones & RF>fluid to prevent, blood dysgrasias, bone marrow suppr (anemia, infection), hypersensitivity> report vesicular crusty rash>STEVENJOHNSON syndrome, kernicterus (jaundice,bilirubin) hepatitis. Monitor for Sulfa allergies & G6PD deficiency blood dis in black/Mediterranean males (RBC breakdown). Older: Met. inhibitors +thiazide diuretics= anemia & BL Bactrim: drink 8-10 glasses of water to prevent KD from crystalluria. NOT for pts w Hx of caffeine/theophylline/steroids/amiodarone NOT for <18 years: retard growth. Inhibit production of DNA, preventing bacterial reproduction. Broad spectrum, bactericidal, for skin infections, UTI, RTI, infectious D, gonorrhea! Prevent & treat anthrax! SE: PHOTOTOXICITY> Avoid sun! rash, N/V/D, HA, abd pain, DIZ, change in taste, burning urination, changed BS. AE: serious heart dysrhythmias QT elongation (esp. hypokalemia), KT, PN, Steven-Johnson syndrome, suprainfection (thrush/yeast infection), achilles tendon rupture (older on steroids), caffeine and theophylline effects (seizure, cardiac arrest) Cipro: NOT for <18 years, NOT if taking aluminum-containing antacids or dairy products (absorption), w warfarin>toxicity. For PID & pseudomembranous colitis caused by Clostridium difficile, vaginitis caused by trichomonas vaginalis (STD). Anaerobic, bactericidal. SE: N/V/D, metallic taste in the mouth, darkened urine, numbness of extremities (PN), ataxia, seizures. AE: leukopenia, neutropenia, CNS toxicity. Take w large glass of water & food. NO alcohol>disulfiram reaction. NOT for preg. Common virus: antiviral drugs. Virustatic, retard viral growth. SE: AR (more serious if IV). Take exactly as prescribed to prevent recurrence and resistance. SE: Phlebitis/inflame @ inf site-adm slow! KDhydration! Granulocytopenia, thrombocytopenia take baseline CBC/platelets! Reproductive toxicity, N/D, HA. Slow viral reproduction by stopping viral DNA production. For EB virus, CMV, HSV1/2, VZV. SE: HA, DIZ, N/V, malaise (not feeling well). AE: v kidney fn: deposits if not hydrated> KD&KF> fluid intake. Stop viral reproduction by inhibiting the release of virus into resp epithelial cells to multiply. For influenza A viral infection. (Antihistamine SE)SE: DIZ, blurred vision, dry mouth, OH, hallucinations, DN, fast irregular HR. AE (amantadine): affects CNS, worsen glaucoma, UR, suicidal thoughts in mentally ill. Ramatadine has fewer nerv system SE, safer. Older: can

Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Moxifloxacin (Avelox)

-dazole

Antiprotozoa

Metronidazole (Flagyl)

Common Virus Antiviral therapy

AntiViral drugs

-ciclovir -cyclovir -tadine

Acyclovir Valacyclovir Amantadine Rimantadine

-vir-

Ribavirin

-mivir

Oselamivir (Tamiflu) Zanamivir

Retrovirus Antiviral therapy

AntiViral drugs

Entry Inhibitors Fusion Inhibitors -vir -dine NRTIs Nucleoside Analog Reverse Transcriptase Inhibitors Abacavir (Ziagen) Zidovudine (Retrovir)

-navir

NNRTIs Non-Nucleoside Analog Reverse Transcriptase Inhibitors Integrase Inhibitors

Amprenavir Indinavir Nelfinavir Ritonavir

Protease Inhibitors

Rifa-

AntiTubercular drugs

worsen HF &edema. Suppresses viral action and reproduction. For refractory VI, Hep A&C, west Nile virus, combine w interferon to treat RSV in peds w chronic Hep C. SE: N/V/D, flu-like symptoms, pain/irritation @ inj site. AE: teratogenic> preg DO NOT touch the drug! bone marrow suppr, damage heart/ears, LD/KD, CA. Take 1 hr b/f/2 hrs after antacids. Stop spreading virus in the resp tract by inhibiting the enzyme neuraminidase. To treat & prevent influenza A&B, swine flu. SE: N/V/D, DIZ, HA, HG, liver dysfn (oseltamivir) AE: breathing problems, confusion, seizures (zanamivir). Take st within 48hr of onset of 1 symptoms!! Retrovirus uses RNA as its genetic material, HIV, attack human immune system (CD4+, helper/inducer T-cell). HIV infected people NOT always have AIDS! AIDS pts have HIV infection. Retrovirus: antiretroviral drugs, virustatic, given in cocktails (multidrug). Drug resistance common due to missed drug doses. Be alert to AR. AE: AR(rash>anaphylaxis), LT, HG, interact w many drugs & food. Use 2 forms of birth control. Most antiretroviral drugs are recommended for HIV + preg women (cross placenta). If HIV: DO NOT breastfeed!!! Block CCR5 receptor on CD4+ T- cells. SE: muscle aches & pain, cough, D, DIZ, trouble sleeping. AE: HPT, LT. Older: OH Block viral docking protein from fusing w host cell. SE: reaction @ inj site, CON, trouble sleeping, DN, muscle aches. AE: PN, RI (bact pneumonia ), LT, fever, chills, rash, HPT. Inhibit reverse transcriptase & viral DNA production, slowing viral reproduction. SE: suppr bone marrow> can cause anemia>monitor Hg, lactic acidosis, N/V/D, hepatomegaly/fatty liver, depletion of WBC> limit exposure to infection, HA, GIU w fatty/fried foods (pancreatitis). AE: LT, PN w long term use. Peds: take as part of HAART. Older: PN. Disrupt HIV reproduction by binding to the reverse transcriptase to prevent it from converting viral RNA to DNA. SE: rash>STEVEN-JOHNSON syndrome, flu-like symptoms, HA, fatigue, GIU, HA, difficulty sleeping, vivid dreams/nightmares. AE: anemia, LT. Take 1 hr b/f or 2 hrs after antacids. Inhibit the enzyme integrase. Integrase inserter of viral DNA into human DNA. For HIV pts who r on HAART begin to haveviral load. SE: D AE: anemia (report), HG, RHABDOMYOLYSIS>report. Take w food. Protease clipper. Prevent viral replication & release of viral particles. SE: HA, GIU, DN, difficulty sleeping, WG. AE: DM/HG, hypersensitivity reaction, N/V, LT, lipid levels, thrombocytopenia>uncontrolled BL in pts w hemophilia, some impair electrical conduction (HB), some contain sulfa. TB caused by Mycobacterium tuberculosis, very slowgrowing bacteria, droplet/aerosol transmission, active TB by chest X-ray, blood test & sputum culture. Combination drug therapy works w strict adherence. RIPE drugs for TB!

Rifa-

First line therapy First line therapy First line therapy First line therapy

Rifampin (RIF) Isoniazid (INH) Pyrazinamide (PZA) Ethambutol (EMB)

Bactericidal/bacteristatic. SE: LT, PN, GIU, HA, insomnia. Take for 6 months as prescribed! Avoid alcohol. Drink at least 3 L water to prevent gout. SE: REDDISH-ORANGE URINE/body fluids, UR, LT, N/V. Soft contact lenses will become discolored. SE: enlarged breasts in MEN, difficulty concentrating, sore throat. AE: LT, PN in malnourished/DM/alcoholism Report if jaundice. SE: acne, PS, uric acid (gout) SE: ^uric acid (gout) AE: Optic neuritis (high doses). NOT for infants/NFC. For Tx malaria, RA, LE. Suppr immune system. SE: GIU, pruritis, HA, OH, nightmares, blurred vision. Fungus tough/thick cell walls, hard to rid. FI: superficial (thrush, yeast infection) & deep (internal organs). To live & reproduce: intact plasma membranes & cell walls (phospholipids & ergosterol). Antifungal drugs damage cell membranes & cell walls to prevent fungus reproduce/kill it. SE: taste changes, GIU, alopecia, AE: anemia, hypokalemia, LD/KD, severe rashes. Older: risk for DVT. More SE/AE than antibacterial. Infections for toenails/fingernails require systemic drugs, not topical. Target plasma membrane, ergosterol. No Grapefruit.SE: LD/KD/KT, hypokalemia>dysrhythmias, bone marrow suppr, PN, thrombophlebitis, DVT, infusion reactions (1-3 hrs after), SUN sensitivity>use sunscreen! For histoplasmosis. Target plasma membrane, ergosterol. Fungizone AE: LD/KD, monitor Cr/2nd day, Cr=3 reduce dose. AE: Infusion reaction (fever &chills), thrombophlebitis, KT, hypokalemia, bone marrow supp. Target plasma membrane, ergosterol. Lamisil AE: anemia. Block protein production. AE: anemia, PN. Glucan synthesis inhibitor. AE:PN, DVT, shake & bake calcium blood levels cause the parathyroid hormone to release calcitonin. For hypocalcemia, deficiency of parathyroid hormone/vit D/dietary calcium. SE/AE: hypercalcemia (>10.5), TC &HTN>BC &HPT, muscle weakness & hypotonia, CON, N/V/abd pain, lethargy & confusion. NOT for bone tumors/hyperthyroidism/KD

AntiParasitic drugs
-quine Antiparasitics Chloroquine Hydroxychloroquine

AntiFungal drugs

-azole

Azoles

Fluconazole (Diflucan) Ketoconazole (Extina) Clotrimazole (Lotrimin) Nystatin Amphotericin B (Fungizone) Terbinafine (Lamisil) Butenafine (Lotrimin Ultra) Flucytosin (Ancobon) Anidulafungin (Eraxis)

Polyenes

Allylamines Antimetabolites Echinocandins

-fundin

Drugs for Bone Disorder


-calciCalcium & vit D supplements Calcium carbonate (Tums) Calcium acetate (PhosLo) Calcium chloride Calcium gluconate Calciferol Calcitrol Ergocalciferol Raloxifen (Evista)

SERMs Selective estrogen receptor modulator Bisphosphonates

Alendronate sodium (Fosamax)

For female to prevent & treat postmenopausal osteoporosis & prevent spinal fractures, to protect against beast CA. SE/AE: risk PE/DVT, hot flashes. Report swelling/redness in calf/SOB. For prophylaxis of postmenopausal osteoporosis, male osteoporosis, Piagets dis of bone & hypercalcemia of

Ibandronate sodium (Boniva) Risedronate (Actonel)

Calci-

Calcitonin

Calcitonin salmon (Fortical, Miacalcin)

RA Drugs
DMARDs I Disease modifying antirheumatic drugs Major Nonbiologic

Bone & Joint conditions Drugs


Cytotoxic: Methotrexate (Rheumatrex Ieflunomide (Arava) Antimalarial agents: Hydroxyxhloroquine (Plaquenil)!!! Anti-inflammatory: Sulfasalazine (Azulfidine) Tetracycline antibiotic: Minocycline (Minocin) Biologic response modifiers: Etanercept (Enbrel) Infliximab (Remicade) Adalimumab (Humira) Rituximab (Rituxan) Abatacept (Orencia) Gold salts: Aurothioglucose (Solganal) Penicillamine (Cupimine, Depen) Cytotoxic : Azathioprine (Imuran) Cyclosporine (Neoral)

malignancy.# & action of osteoclasts> inhibit bone resorption.SE/AE: esophagitis, N/V/CON/dyspepsia, musculoskeletal pain, blurred vision, eye pain, risk for hyperparathyroidism. No breasfeeding. Fosamax: take in the morning b/f eating, drink full glass of water, avoid lying down after taking!!! (to prevent esophagitis) For postmenopausal osteoporosis, moderate to severe Piagets dis of bone & hypercalcemia caused by hyperthyroidism & cancer. v bone resorption by inhibiting the activity of osteoclasts in osteoporosis, renal calcium excretionby inhibiting tubular resorption. SE/AE: N, w intranasal route: nasal dryness& irritation. NOT for allergy to fish protein. RA chronic dis w autoimmune/inflammatory components. No cure! DMARDs slow joint degeneration & progression of RA. Cytotoxic SE/AE: risk infection (fever/sore throat), hepatic fibrosis, bone marrow suppr, GI ulcers, fetal death/congenital abnormalities. NOT for preg. Antimalarial agents SE/AE: Retinal damage>blindness. Sulfasalazine SE/AE: N/V/D, abd pain, hepatic dysfn, bone marrow suppr.

DMARDs II Major Biologic

DMARDs slow joint degeneration & progression of RA. Biologic response modifiers SE/AE: site irritation,risk of infection (esp TB), severe skin reactions, HF, blood dyscrasias, discontinue if BL/fever. Enbrel: monitor subcutaneous site for redness following injection.

DMARDs III Minor nonbiologic & biologic

-sone -solone

Glucocorticoids NSAIDs

Prednisone (Deltasone) Prednisolone (Prelone) Aspirin Ibuprophen Diclofenac (Voltaren) Indomethacin (Indocin) Meloxicam (Mobic)

DMARDs slow joint degeneration & progression of RA. Aurothioglucose SE/AE: Toxicity (severe pruritis, rashes STOMATITIS) KT (proteinuria), blood dyscrasias (thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia), hepatitis, N/V/abd pain. Report bruising/pruritis/stomatitis. Penicillamine SE/AE: bone marrow suppr, toxicity (severe pruritis, rashes) Cyclosporine SE/AE:risk of infection (fever/soar throat), LT (jaundice), KT, hirsutism. DO NOT drink grapefruit. DO NOT take w erythromycin (toxicity) Provide symptomatic relief of inflam & pain. AE/SE:risk of infection, osteoporosis, adrenal suppr, fluid retention, GID, HG, hypokalemia. Provide rapid/symptomatic relief of inflam & pain. SE: see antinlammation drugs.

Naproxen (Naprosyn) Celecoxib (Celebrex)

Antineoplastic

Cancer Drugs

-abine

Antimetabolites

Xeloda, 5-fu Cladribine Decitabine Gemcitabine Fludatabine Methotrexate (Rheumatrex)

-mycin -bicin -nib

Antitumor antibiotics

-taxel -ine

Antimitotics

-mustine -platin -mide

Alkylating agents

-tecan

Topoisomerase inhibitors

Bleomycin Plicamycin Adriamycin Mitomycin Doxorubicin Doxorubicin Epirubicin Valrubicin Idarubicin Valrubicin Dasatinib Erlotinib Imatinib Mitoxantrone Docetaxel Paclitaxel (breast) Vinblastine Vincristine Vinorelbine Etoposide Estramustine Carmustine Lomustine Carboplatin Oxaliplatin (colon) Ifosfamide (sarcoma) Cyclophosphamide Temozolomide Melphalan Altretamine Busulfan Irinotecan (lung) Topotecan (colon)

Metastasis sites: LUNG CA: brain, bone, liver. BREAST: brain, bone, liver, lung. PROSTATE: pelvis, bone, liver, lung. COLON: liver, lung Chemo: use plastic utensils to prevent metallic taste. Cells require metabolites to begin/continue the reaction. Chemo counterfeit metabolites, fool cancer cells. They disrupt cell growth. Chemo schedule based upon timing to max cancer cell death & min normal cell damage. SE: bone marrow suppr, neutropenia, flu-like symptoms, thrombocytopenia (BL precautiouns), anemia, N/V,alopecia (not all chemos), CHANGES IN COGNITIVE FN, fluid shifts & capillary leak, PN, hearing. Methotrexate: mucositis (in entire GI tract)/hyperurecemia. Avoid crowds during nadir (7-14 days after chemo immune system down). Wash fresh fruit/veggies, wear gloves and mask while working in the dirt (fungus infection). Brush teeth after each meal w soft brush. Flush twice first three days. DO NOT change cat litter. Condoms. Check T twice a day >100.5 call. If emesis: gloves + wash sheets twice in warm water. Methotrexate (Rheumatrex) Tx of severe psoriasis/RA/cancer (treats cancer by slowing the growth of cancer cells, psoriasis by slowing the growth of skin cells to stop scales from forming, RA bythe activity of the immune system). AE: stomatitis (sores in mouth) indicates toxicity>call Dr! Kill cancer cells by stopping the synthesis of RNA/DNA/proteins. MOA varies by agent. SE/AE: bone marrow suppr, N/V, extravasation can cause severe tissue damage, alopecia. Doxorubicin: acute cardio toxicity, dysrhythmias, cardiomyopathy, HF, may have delayed onset.

Interfere w formation of tubules so cells cannot separate during division. SE: in neuro endings of kidney, PN (weakness/paresthesia), extravasation of vesicants cause severe tissue damage, alopecia. Paclitaxel: anaphylaxis (HPT/dyspnea/rash), bone marrow suppr, BC, HB, MI, alopecia. Cross link DNA, two DNA strands bind tightly together preventing proper synthesis. SE/AE: bone marrow suppr, N/V. Cyclophosphamide: acute hemorrhagic cystitis, alopecia. Carmustine: pulmonary fibrosis, LT/KT, reproductive toxicity (congenital abnorm). Cisplatin: KT, hearing loss. Disrupt topoisomerase (enzyme that nicks and straighten DNA helix allowing it to be copied) needed for DNA cell

Misc.

Hormone manipulation

Arsenic Asparaginase Hydroxyurea Pegaspargase Dacarbazine Procarbazine Casodex Flutamide Faslodex Tamoxifen (SE:clots) Femara Arimidex

division & synthesis. SE/AE: bone marrow suppr, N/V, alopecia. MOA unknown

Immunotherapy

Targeted therapies -mab Monoclonal antibodies

Erbitux Avastin Rituximab Imatinib Trastuzumab

Anti-androgen block testosterone from enhancing growth does not kill CA cell, halts growth (Casodex, Flutamide) Anti-estrogen block estrogen from enhancing cell growth (Faslodex, Tamoxifen) Tamoxifen SE: menstrual irregularities, hot flashes (anti-estrogen), vaginal discharge/bleeding, endometrial CA, hypercalcemia, N/V, PE. Aromatase inhibitors block production of estrogen specific hormones (Femara, Arimidex). Modify pts biologic responses to tumor cells. Cytokines: small protein hormones made by WBCs make immune system work better. Interlukines/interferones. IL-1, 2, 6: charge up immune system, enhance attack on CA cells by macrophages, NKC & tumor-infiltrating lymphocytes. SE: rash, fever, inflam, flu-like symptoms. Combine effect of gene &immunotherapy, target & block growth factor receptors (EGFR & VEGFR). SE: acne,risk of BL. Work only if the CA overexpresses (aggressive CA) actual target substances. Block one or more steps in a pathway signal for turning on cell division does not reach the nucleus. Target only cells w receptors. Little SE: some AR. Not appropriate for edema caused by inflam/hypoproteinuria. Diuretics do not GFR. Gentle & sustained diuresis. Eliminate excess water and salt via urine. 1st line for HTN! SE: dehydration, AE: Hypokalemia, met alkalosis, dehydration, HPT, hyponatremia, hyperuremia (gout), HG. Eat K+ foods! thiazide+ digoxin=toxicity + hypokalemia! thiazide+ NSAIDs=effect thiazide+ beta blockers=difficulty manage BS thiazide+ steroids=hypokalemia For HTN, edema, CHF, renal insufficiency, hypercalcemia, effective in pts w KD. Produce aggressive & short lived diuresis. Slow down/turn off sodium pumps in the nephron tube in dif place, Na+/ K+/H2O excretion via urine. SE: dehydration, DIZ, light headedness, HPT, OH, syncope, hypokalemia, hyponatremia, hypomagnesimia, calcium loss. AE: Falling/fainting, muscle weakness, dysrhythmias, ototoxicity, HG. No alcohol/sun!!! PS!!! lasix+ digoxin=digoxin toxicity lasix+ NSAIDs=diuretic effect lasix+ beta blockers=difficulty manage BS lasix+ steroids=hypokalemia lasix+ aminoglycosides=risk of hearing loss Inhibit sodium & water resorption, K+ excretion. SE: DIZ, OH. AE: N, hyperkalemia!!! Fainting/falling, RF,

Diuretics
Thiazide #1

Cardiovascular Drugs
Hydrochlorothiazide (HCTZ, Microzide) Metolazone (Zaroxolyn) Hydrochlorothiazide (Hydrodiuril) Methychothiazide (Enduron) Furosemide (Lasix) Torsemide (Demadex) Bumetanide (Bumex) Ethacrynic acid (Edecrin)

-semide

Loop (most powerful diuretics)

-actone

Aldosterone blockers

Spironolactone

(Aldactone) Eplerenone (Inspra)

Potassium - sparing

Triamterene (Dyrenium) Spirolactone (Aldactone) Amiloride (Midamor)

Osmotic Diuretics

Mannitol (Osmitrol)

zolamide

Carbonic anhydrase inhibitors

Acetazolamide (Diamox) Brinzolamide Dorzolamide Methazolamide

-olol -lol -lol -olol

Beta Blockers (Sympatholytics)


Non-selective Beta (Class II Beta adrenergic blockers) (Beta 2 vascular &bronchial smooth muscle, response to stimulation> vasodilation of peripheral arterioles, bronchodilation) Selective Beta Blockers (Class II Beta adrenergic blockers) (Beta 1 cardiac tissue- response to stimulation> ^HR, ^conduction, ^contractility) Beta-Alpha Blockers (Alpha vessels of skin, muscles, kidneys

Cardiovascular Drugs
Propranolol (Inderal) Nadolol (Corgard) Labetalol (Normodyne) Pindolol (generic) Sotalol (Betapace) Timolol (generic)

gynecomastia, impotence, hyponatremia, hypercalcemia. Avoid K+ containing salt substitutes, avoid monosodium glutamate (keepsodium diet) Aldosterone blockers+ other K+ sparring, ACE I, angiotensin II receptor blockers= HYPERKALEMIA Aldosterone blockers+NSAIDs=diuretic effect Inhibits Na+/K+ pump, sodium & water excretion w/o K+ excretion. SE: OH, GIU, impotence, gynomastia, menstrual irregularities, PS. AE: fainting/falling, HYPERKALEMIA, HPT, hyponatremia, arrhythmia. DO NOT take K+ supplements/salt substitutes/ACE I (hyperkalemia). NSAIDsdiuretic effect. ICP & IOP by serum osmolality & drawing fluid back into vascular/extravascular space. Promote sodium retention. Prevent RF in hypovolemic shock & severe HPT. SE/AE: HF, pulm edema, RF, fluid & elect imb. If dyspnea (HF) > call Dr. Too rapid infusion of Mannitol can worsen/precipitate HF. Stop infusion, call Dr. For GLAUCOMA, epileptic seizures, for short term toaquous humor in the eye prior to surgery, Tx of mountain sickness (altitude: resp alkalosis), part of Tx of CHF.IOP. Promotes renal excretion of sodium, potassium, bicarbonate. Diuretic>monitor elec bal (met acidosis)! Carbonic anhydrase is a protein in the body. SE: N/V, anorexia, WL, DROW, paresthisias, confusion, HA, DIZ. For SVT, Afib, Aflutter, HTN, angina, MI, HF. Correct arrhythmias. AE: HB, DN, BS change, SOB, HA, N/V/D, DIZ impotence. For HTN, HF, angina, arrhythmia. Block the effect of epinephrine and norepinephrine throughout the body (beta 1 & 2), HR & force of contractions, dilate blood vessels and narrow airway passages! Beta2 SE/AE: HG (glucogenesis inhibited), bronchospasm. SE: OH, impotence, DIZ, SOB, wheezing, fatigue. AE: BC, CO, chest pain, dysrhythmias, HB (AV block)!!! dyspnea. NOT for asthma, COPD, HB, DM BC. DO NOT stop taking suddenly (rebound myocardium excitation). Take w food(absorption), call Dr if big change in HR, take apical pulse b/f each dose. For HTN, HF, angina, arrhythmia, MI. Works only on CVS (beta 1 only).BP via vasodilation. Beta1 SE/AE: BC, HB, OH, CO. SE: impotence, DIZ, DROW, insomnia, fatigue. AE: DN!!! difficulty breathing, chest pain, dysrhythmias, HG. NOT for BC, HB, DM. Atenolol(Tenormin): report Lightheadedness >HPT. Stay out of direct sun, dress warm in winter. OH. Masks sign of low sugar. Older: confusion. DO NOT stop taking suddenly. Esmolol: short life 9 min, Tx of supraventricular TC, such as Afib & Aflutter. For HTN, HF!! angina, arrhythmia. Combine the effects of alpha & beta blockers. Relax blood vessels like alpha blockers, slow HR and V force of contractions like beta

-lol -olol

Atenolol (Tenormin) Esmolol Metoprolol (Lopressor, Toprol) Metoprolol succinate (Toprol XL) Esmolol HCl (Brevibloc)

-lol -olol

Carvedilol (Coreg), Labetalol (Normodyne, trandate)

& intestines- response to stimulation: vasoconstriction of peripheral arterioles)

blockers, vasodilation and narrowing airways!! SE: DIZ, fatigue, swelling in the feet or ankles, WG, OH. AE: chest pain, BC, SOB, wheezing, impotence, HG, DN, mental status changes. NOT for HB, BC, DM. DO NOT stop taking suddenly.

Vasodialators
Vasodialators

Cardiovascular Drugs
Hydralazine (Apresoline) Minoxidil

Antianginals Short Acting Nitrates

Nitroglycerin (Nitrostat) Nicardipine (Cardene) Enalaprilat (Vasotec IV)

Sodium Nitroprusside (Nitropress)

Antianginals Long Acting Nitrates

Intravenous nitroglycerin (Tridil) Isosorbide mononitrate (Imdur) Isosorbide dinitrate (Isordil) Labetalol (Normodyne) Phentolamine (Regitine)

Alpha-Adrenergic Blockers

Vasoconstrictor

Vasopressin

Meds for hypertensive crisis. Vasoactive drugs: by causing peripheral vasodilation or constriction, impact CO by or v afterload. Dilate peripheral arteries (veins) leading to low BP. Hydralazine: very potent arterial dilator. SE: reflex TC, hypernatremia. Discontinue gradually, report persistant HRof more than 20 bpm, weigh, check for edema. Minoxidil: Steven-Johnsons syndrome!!! For angina, preop control of BP, HF from acute MI, venous return (preload). coronary BF by vasodilation. Relaxes vascular smooth muscle causing dilation of coronary arteries &SVR. SE: HPT, HA, OH, BC, lightheadedness, DIZ, flushing, reflex TC, TOLERANCE/DEPENDENCE> remove patch each evening: med free time of 12-14 hours b/f applying a new patch. AE: severe HPT, cyanide poisoning (HA& DROW >cardiac arrest). PO: large first pass (loss) effect. NOT for ICP, HPT, anemia. Do breaks. No alcohol (HPT crisis). Do not take with Viagra (Sildenafil). Must use infusion pump if IV. For HTN crisis, emergency Tx of HF, pulmonary edema. Requires arterial line monitoring if IV, must use infusion pump, keep infusion protected from light (foil wrap). SE: profound HPT>ischemia/infarction. Older: more sensitive to the effects. Metabolized to thiocyanate (cyanide toxicity: HA& DROW >cardiac arrest). For angina. Tridil for acute HF. Dilates blood vessels primarily VENOUS, also dilates coronary vessels. SE: HPT, HA, OH, lightheadedness, DIZ, flushing, TOLERANCE /DEPENDENCE, reflex TC. PO: large first pass (loss) effect. NOT for ICP, HPT, anemia. Do breaks. Imdur: DO NOT adm if systolic BP<90. No alcohol (HPT crisis). Imdur: if reflex TC adm Metoprolol. DO NOT take w Viagra (Sildenafil). Peripheral blockers of Alpha receptors in veins & arteries> vasodilation. SE: OH>syncope, long term therapy>fluid & water retention. Labetalol: for acute stroke & hypertensive emergencies, acute aortic dissection. Phentolamine: for control BP & sweating caused by pheochromocytoma (epinephrine secreting tumor that can arise from the adrenal medulla). For VF, pulseless VT, vasodilatory shock. Naturally occurring antidiuretic hormone. Peripheral vasoconstrictor at unnaturally high doses, directly stimulates smooth muscle. Extreme vasoconstriction can provoke myocardial ischemia & angina. NOT for responsive pts w angina, NOT for PALS. For HTN, HF, DM people. Vasodilation. Block production of angiotensin II (causes vasoconstriction, water/salt retention)>PVR. SE: OH, DRY COUGH, fatigue, GIU, taste disturbances (dysguesia), HA, DIZ. AE: neutropenia, PS, HPT,

Cardiovascular Drugs
-pril ACEI Angiotensin Converting Enzyme Lisinopril (Prinivil, Zestril) Ramipril (Altace) Enalapril (Vasotec) IV

Inhibitors

-sartan

ARB Angiotensin II Receptor Blockers

-pine -dipine

CCB Calcium Channel Blockers (Class IV drugs)

Benazepril (Lotensin) Perindopril (Aceon) Trandolapril (Mavik) Captopril (Capoten) oral rapid onset 1 hr Moexipril (Univasc) Quinapril (Accupril) Losartan (Cozaar) Valsartan (Diovan) Irbesartan (Avapro) Olmesartan (Benicar) Candesartan (Atacand) Telmisartan (Micardis) Eprosartan (Teveten) Amiodipine (Norvasc) Felodipine Nimodipine Nifedipine (Procardia) oral Nisoldipine Diltazem (Cardizem) Verapamil (Calan) Nicardipine (Cardene) IV

proteinuria, hyperkalemia>avoid salt substitutes! Angioedema. effects of diuretics & K+ sparing. NO alcohol. st 1 dose of Enalapril (Vasotec) risk of OH. Cautious in KD.

For HTN, HF, stroke prevention DM NP. Block angiotensin II receptors and its effect (vasoconstriction & sodium water retention) in type 1 receptors, vasodilation and v water/salt retention. SE: DIZ, fatigue, HA, HPT, D, hyperkalemia. AE: dyspepsia, KF, LT, angioedema, NOT for preg (renal stenosis): fetal injury (2-3 trimester). effects of diuretics & K+ sparing For HTN, HF, coronary spasm (angina), arrhythmia, Verapamil/Diltazem for supraventricular TC caused by AV nodal reentry!!! Arterial vasodilators,the influx of calcium in the arterial resistance vessels. Block calcium from entering the muscle cells of heart & arteries causing v contraction & dilated arteries. Nifedipine (Procardia)SE: reflex TC, edema, toxicity. SE: HA, CON> dietary fiber, N, peripheral edema>wear stockings, flushing. AE: dysrhythmias, worsening HF, HPT, BC /TC. DO NOT eat grapefruit (toxicity!) DO NOT stop suddenly. Verapamil (Calan): if severe HPT Calcium chloride! If giving IV push adm slowly over 2-3 min. AVOID Verapamil/Diltazem in Afib of Wolff-Parkinson-White syndr. Control both V & supraV dysrhythmias at the AV node. MEMBRANE STABILIZER! Class IA: for recurrent VT/VF, #1 for stable VT w EF>40%. Stabilizes cell membrane &rate of impulse conduction, blocks both the fast sodium channels & phase 3 repolarization, prolonging action potential. in QRS duration and lengthening of QT interval. STOP Procainamide if widening of QRS of more than 50%/if dysrhythmia is suppressed/HPT develops. May depress myocardiac contractility. Class IA/IC: A&V arrhythmias. Class IB: for V ectopy (VF/VT), symptomatic PVCs. Suppresses V dysrhythmias. Have only moderate effect on Na+ channels & accelerate phase 3 repolarization to shorten nd the action potential duration. Slow conduction of heart. 2 line. Numbing constricts the blood vessels> pale look. Excessive doses> myocardial & circulatory depression. Toxicity: DROW, disorientation, twitching, seizures w extreme toxicity. Class IC: the most potent Na+ channel blockers & have little effect on repolarization.PR & QRS intervals. SE: confusion, resp arrest, DROW, HPT. AE: seizure, cause cardiac arrest!! St. Johns wort v effect. Report irregular rhythm, HR< 60 beats/min or >100, SOB, wheezing.

-mide

Sodium Channel Blockers

Class IA: Quinidine Procainamide (Pronestyl) Disopyramide Class IB: Lidocaine (CNS effects, resp arrest) Mexiletine Tocainide Class IC: Encainide Flecainide Propafenone

Potassium Channel Blockers (class III drugs)

Amiodarone (long half-life)

Replacement therapy

Magnesium sulfate

Potassium

Adenosine (short halflife<5 sec) -azosin Alpha adrenergic blockers (sympatholytics) Alpha 2 agonists Centrally Acting Doxazosin (Cardura) Prazosin (Minipress) Terazosin Clonidine (Catapres) Guanfacine HCl(Tenex) Methyldopa (Aldomet)

1 line drug! For uncontrolled A&V arrhythmias, VT/VF, w cardioversion of PSTV & A TC. Block potassium channels, leading to slowed conduction & prolonged refractoriness. Slows repolarization & prolongs the duration of action potential. SE: corneal deposits, GIU, photophobia, blurred vision, PN, tremor, hypothyroidism, sinus BC, HPT. AE: HF, AV block, pulm toxicity/fibrosis w extended use, ARDS, blindness, worsened arrhythmias, LT>monitor liver enzymes. NOT for BC, HB. Lung damage can persist for months after med stop (long life). For hypomagnesemia, VT/VF (Torsades de pointes) Normal levels help prevent some abnormal heart rhythms. SE: HPT, facial flushing,DTR, somnolence (sleepy). AE: report hypermagnesemia, caution w RF. Normal levels help prevent some abnor heart rhythms. SE: N/V/D, gas, abd discomf. IV potassium causes pain, irritation @site. Never give potassium IV push! DO NOT take potassium on empty stomach. Report s&s of GI BL, hyperkalemia. 1st line for narrow complex SVT. Depresses AV & SA node activity, terminates reentry dysrhythmias. SE: transient {chest pain, flushing, dyspnea}. For HTN (primary, causes arterial & venous dilation), BPH (relaxes smooth muscle of the prostatic capsule & bladder st neck). SE: 1 dose OH. Take at bedtime/w food. BP: For HTN (primary), severe CA pain, migraine. Act within CNS to v sympathetic outflow> v stimulation of Alpha/Beta receptors of heart/peripheral. SE/AE: DROW, SED, dry mouth, rebound HTN (discontinue gradually). Clonidine (Catapres): helps to abstinence from opioids. Watch for dry mouth. For HF and Afib.force of myocardial contraction, HR,CO. SE: fatigue, BC, abd pain N/V. AE: toxicity: anorexia, weakness/fatigue , GIU, yellow/green halos vision, dysrhythmias, cardiotoxicity>BC, confusion. NOT for HR<60 bpm/ hypokalemia. Very narrow therapeutic range (0.5-2 ng/mL). Check pulse & rhythm b/f adm. If toxicity hold drug & draw blood level for digoxin. Digibind is used for digoxin toxicity. Withhold cardiac glycosides prior to cardioversion> canV irritability &risk for V fib after the synchronized countershock of cardioversion. Inotropic agents improve CO by improving the force of myocardial contraction. For asystole, PEA, circulatory shock. afterload, SVR, BP, automaticity, HR, coronary &cerebral BF, myocardial contraction, myocardial O2 consumption. Simulate effects of SNS. SE: slows absorption of local anesthetics/fix superficial BL/ nasal congestion/ Tx of AV block & cardiac arrest. Vasoconstriction/HR/rate AV node/ bronchodilation. SE: HA, restlessness.AE: HTN >hypertensive crisis, dysrhythmias>V ectopy, angina >ischemia. Incompatible w sodium bicarbonate.

st

Cardiac Glycosides

Digoxin (Lanoxin, Digitek)

Drugs to CO
Cardiac Glycosides Adrenergic agonists Sympathomimetic agents Vasopressors

Cardiac drugs
Epinephrine (Adrealine)

Norepinephrine (Levophed)

Dobutamine (Dobutrex)

Milrinone lactate (Primacor) IV 50 mg/ml NS Dopamine (Intropin) IV 400 mg in 250 ml NS

For HPT (unstable/symptomatic) that does not respond to epinephrine/dopamine. Similar to epinephrine but lacks B2 effects of epinephrine. Used as vasopressor to BP in shock states (sepsis, septic shock).myocardial contractility/vasoconstriction. Strict BP monitoring via arterial line, myocardial O2 needs, may cause dysrhythmias, DO NOT give via peripheral line: tissue necrosis if extravasation>infiltrate w phentolamine 5-10 mg in 10-15 ml NS. Incompatible w sodium bicarbonate. For pulmonary congestion, v CO w no signs of shock- HF esp in HPT patients. CO/HR/rate AV node/ possible peripheral & coronary vasodilation. SE/AE: TC, arrhythmias, myocardial ischemia at high doses, HR. For severe HF/cardiogenic shock. Dose dependent positive inotrope & vasodilator w min chronotropic response,PCWP/SVR,CO. Precautions: V dysrhythmias, HPT. For shock/HF. For hemodynamically significant HPT: sys 70100 w signs of shock, symptomatic BC if atropine is ineffective & in the absence of pacer. Renal blood vessel dilation/HR/rate AV node/ vasoconstriction. Dose dependent: 1-2 mcg/kg/min-vasodilation of renal, mesenteric, cerebral arteries. 2-10 mcg/kg/min-CO, mild to moderate peripheral vasoconstriction. >10 mcg/kg/min-profoundin peripheral vasoconstriction, myocardiardial contractility & HR AE: extreme TACH>severe dysrhythmias esp if hypovolemic> optimize volume status first, myocardial O2 consumption at high doses>angina, tissue necrosis if extravasation. Incompatible w sodium bicarbonate. For urinary incontinence, for overactive bladder. ACH SE:reaction, AR> anaphylaxis. DO NOT exersice in hot weather> sweating>heat stroke. DO NOT crush tab, swallow whole. NOT for glaucoma, GI obstruction, UR, BPH,CON LD, UC. For acne. To treat severe recalcitrant nodular acne. It works by slowing the production of certain natural substances that can cause pimples to form. SE: Nose bleeds common, inflam of the eyes, skin rash, HA, hair loss, peeling of the skin from the palms/soles.TERATOGENIC, can cause miscarriage> NOT for preg! HPG: TC, palpitations, diaphoresis, shakiness, HA, tremors, weakness. Normal: glucose 90-130 mg/dl b/f meals, < 180 md/dl after meals. Oral, older: risk of HPG if beta blockers or Coumadin!!! Sweating early sign of HPG. Goal to keep HbA1c <7% (glycosylated Hg) Promotes cellular uptake of glucose, converts glucose to glycogen, moves potassium into cells along with glucose. DO

AntiCholinergic drugs
-fenacin Antimuscarinic (anticholinergics, antispasmodic) Darifenacin (Enablex) Solifenacin

Dermatologic drugs
-tretin tretinoin Retinoid, dermatologic agent Form of vit A Acitretin Alitretinoin Isotretinoin (Accutane)

Insulin products (sub Q)

AntiDiabetic drugs

Insulin

RapidIns. lispro/aspart: Humalog/Novolog/Apidra

(onset 15 mins, peak 1 hr, dur 4 hrs) Short Regular: Humulin R/Novolin R clear (onset 30-60
mins, peak 2-4 hrs, dur 5-7 hrs)

Intermediate NPH: Humulin N/Novolin N cloudy


(onset 1-2 hrs, peak 6-12 hrs, dur 1824 hrs)

NOT mix insulin glardine (Lantus) w any other insulin in the same syringe. SE/AE: HPG (too much insulin), lipohypertrophy (rotate inj site) 10 u of Humulin R w 40 u of NPH: 1) 40 u air (NPH) 2) 10 u of air (Humulin) 3) withdraw 10 u Humulin 4) withdraw 40 u NPH.

Long insulin glardine: Lantus/Levemir (onset 1 hr and


lasts 24 hrs w/o peaking)

Oral antidiabetic
-ride -zide Sulfonylureas

AntiDiabetic drugs
Glimeperide (Amaryl), Glipizide (Glucotrol), Glyburide (DiaBeta, Glynase) Chlorpropamide (Diabinese) Nateglinide (Starlix), Repaglinide (Prandin) Rosiglitazone (Avandia), Poiglitazone (Actos) Glucophage (Metformin)
Boosts production of insulin, Long acting, Type II, WG, photosensitivity, blurred vision, SE: HPG. AE: LD/KD, NFC, take in the a.m. Glipizide: NO alcohol> disulfiram -like reaction (N/V/flushing/palpitations)

-nide glitazone

Meglitinides Thiazolidinedione (TZD) Biguanide

AGI, alpha Glucosidase Inhibitor -gliptin -tide DPP-4 inhibitor Incretin mimetics GLP 1 Glucagonlikepeptide1 Amylin mimetics Synthetic analogue

Acarbose (Precose) Mignitol (Glyset) Sitagliptin (Januvia) Exenatide (Byetta) 2x a day Sub Q 1hr b/f am/pm meals Pramlintide (Symlin) Sub Q b/f meals

-tide

Hyperglycemic agent

Glucagon

Boosts production of insulin RAPIDLY, short acting, C>10 years, Type II, WG, flu like (URI) back pain, DIZ, AE:LD/KD, no meals no drug. Prandin: 30 min b/f meal. Reduces insulin resistance, Type II w/o HF, Longest Acting, NOT for HF. SE: fluid retention, WG, edema, LDL, LT. AE: HF, anemia, caution in older. Rosiglitazone v effectiveness of oral contraceptives. Works 3 ways, does not promote insulin release from the pancreas> do not cause HPG. less SE: N/V/anorexia, WL, AE: lactic acidosis do not use if abuse alcohol (prone to lactic acidosis), use of IV dye: withhold before & after 48 hrs. For HF patients, C>10 years old, NOT for >85 years. Enzyme inhibitor/inhibits carb breakdown, Type II,SE: GAS, D, WL, risk for anemia (v iron absorption) LT (if long term). NOT for renal dysfn, infl bowel dis, colonic ulceration or cirrhosis. Carry glucose tablets always. incretins,insulin release, glucagon. Works w insulin only! Type II, SE: infection, HA, AE: HPG, older w KD low dose. monitor s&s infection Mimics the effects of GLP 1> insulin secretion/ suppress glucagon production/GI motility, postprandial plasma glucose rise. SE: N/V/D, pancreatitis (report abd pain), Works w insulin only! Type II, WL, AE: severe HPG, older: worse SE/AE Mimics actions of Amylin (postprandial glucose by inhibiting glucagon secretion) peptide hormone in pancreas, deficient in DM,insulin demand. Insulin Independent!!! Type I + II. SE/AE: N, HPG, reaction @inj site. Take oral meds 1hr b/f inj (symlin delays meds absorption), discard open vials after 28 days. For emergency of HPG reactions/Insulin overdose. blood glucose levels by breakdown of glycogen into glucose, glycogen synthesis enhances synthesis of glucose.

Erectile dysfunction drugs


-afil PDE Phosphodiesterase inhibitor Sildenafil Tadalafil Vardenafil
Tx of erectile dysfn, pulm arterial HTN (PAH), altitude sickness. Safe in pt using antidepressants. AE: HA, flushing, dyspepsia, photophobia, blurred vision, HPT. NOT for nitroglycerin/CV risk factors, LD/KD, HPT, retinal dis, recent stroke/MI. Fleet enema- hypertonic. Can take every day! Soften fecal mass &bulk (like diet fiber) Metamucil: peak action 24-72 hrs. NOT for appendicitis. Short term. Retention of fluid in bowel, watery content.SE: abd distention, cramps, N/V/D, bloating, GAS, bowel obstr. AE: dehydration, HPT&falls in older, elec imb (hypernatremia, hypokalemia) causing dysrhythmias. Lactulose: promotes excretion of ammonia in LF (cirrhosis). NOT for HTN if sodium containing laxative. Magnesium Hydroxide AE: UTI. Coat surface of stool to retain water, making expulsion easier. SE: abd distention, cramps, N/V/D, bloating, GAS, bowel obstr. AE: dehydration, HPT&falls in older, elect imb (hypernatremia, hypokalemia) causing dysrhythmias. Add fatty substance (absorption of oil) to allow stool move easily. SE: abd distention, cramps, N/V/D, bloating, GAS, bowel obstruction. AE: HPT&falls in older, dehydration, elect imb (hypernatremia, hypokalemia) causing dysrhythmias. GI perilstalsis. SE: abd distention, cramps, N/V/D, bloating, GAS, bowel obstr. AE: HPT&falls in older, dehydration, elec imb (hypernatremia, hypokalemia) causing dysrhythmias. DO NOT take w milk>GI irritation. Slows perilstasis, water absorption (dry stool). Lomotil has ACH SE, structurally similar to Meperedine. SE: CON, bloating, gas, stool color change. AE: Toxic megacolon(fever/abd pain/rapid HR/dehydrat/shock) Have dual effect, binds w water and provides bulk & moisture for stool to easily pass. For D intestinal transit time > less frequent bowel movement. Also absorbs the substance that induces D in GI. SE: CON, bloating, gas, stool color change. AE: Intest obstr secretion of intestinal fluids and slow bacterial activity. SE: CON, bloating, gas, stool color change. Contains aspirin> BL & bruising. NOT for PUD, pre-/post- surgery due to aspirin content. NFC:Rye syndrom For pain in PUD use acetaminophen (Tylenol) acid production by blocking H2 on parietal cell in stomach. PH in stomach>risk of infection. ACH SE. AE: v libido, impotence, lethargy, depression, confusion, dysrhythmias, bone marrow suppr (anemia, neutropenia>report green sputum), agranulocytosis, thrombocytopenia>call dr if BL.

Drugs for CON


Bulk forming laxatives Osmotic laxatives

Gastrointestinal Drugs
Methylcellulose (Citrucel) Psyllium (Metamucil) Lactulose, Lactose, Magnesium Hydroxide (milk of magnesia), Polyethylene glycol (GoLYTELY, MiraLax) sodium phosphate (Fleet edema) Castor oil

Lubricants

Stool softeners

Docusate (Colace)

Stimulants

Bisacodyl (Dulcolax)

AntiDiarrheal Drugs
Antimotility drugs

Gastrointestinal Drugs
Loperamide (Imodium) max dose 16 mg Diphenoxylate with atropine (Lomotil) Calcium polycarbophil (FiberCon)

Adsorbent/Absorbent

Antisecretory

Pepto Bismol

Drugs GERD & PUD


-tidine Histamine H2 Blockers

Gastrointestinal Drugs
Ranitidine (Zantac) Cimentidine (Tagamet) Nizatidine (Axid)

-prazole

PPI Proton Pump Inhibitors Antacids

Lansoprazole (Prevacid), Omeprazole (Prilosec) Esomeprazole (Nexium)

Magnesium/Aluminium Hydroxide/Simethicone (Maalox, Milk of Magnesia Calcium Carbonate (TUMS) Prostaglandin E analog Misoprostol (Cytotec)

Cimentidine (Tagamet) incompatible w Cefazolin. Cimentidine w Warfarin monitor PT. Ranitidine (Zantac) impairs absorp of Vit B12 >do not take together. NO smoking w PUD meds!! Less effective. Meals 6 x/ day. acid production by blocking proton pump located in parietal cells in stomach. Long term use of infection (older), AE: anemia due to B12 & iron malabsorbtion. Omeprazole (Prilosec)+Phenytoin= EE Phenytoin. Neutralize stomach acid. SE rare: CON (Ca, Al salts) D(Mg salts), fluid retention (if w sodium).

Cytoprotectives

Bismuth Subsalicycate (Pepto Bismol) Sucralfate (Carafate) Clarithromycin Metronidazole Tetracycline Amoxicillin

Antibiotics for H pillory infection

For pt taking long term NSAIDs to prevent ulcers, for preg to induce labor by causing cervical ripening. acid secretion/secretion of bicarbonate & protective mucus. SE/AE: D, abd pain, dysmenorrheal/spotting. NOT for preg. Avoid taking antacid w Mg>diarrhea Coating the mucosal lining, thick coating. Inhibit H pylori bacteria penetrating the lining. SE: CON, Bismuth: black stools, grayish tongue, stool impaction (infants). Sucralfate (Carafate): if combined w phenytoin (Dilantin) to control seizures allow 2hrs bw meds! Eradication of H. pylori infection.

AntiEmetic drugs
-azine
Phenothiazines

Gastrointestinal drugs
Promethazine (Phenergan) Prochlorperazine (Comprazine) Scopolamine (L-hyoscine) Meclizines (Antivert, Bonamine, Dramamine) Metochlopramide (Reglan)

ACH SE (CON), tardive dyskinesia Phenergan Older: acute confusion, balance disturbance, SED, risk for falls! Causes depression of XTZ in medulla. ACH SE. NOT for glaucoma, BPH, UR, CON, DN. NFC & older: EPS. Prochlorperazine SE: tardive dyskinesia. ACH SE, OH, HTN, SED, DN. AE: NMS, tardive dyskinesia, neutropenia, RD. Block action of histamine at H1 site, For N/V, vertigo. ACH SE. NOT for glaucoma, BPH, UR, CON, DN. Block dopamine from binding leading to GI motility. ACH SE. SE/AE: EPS!!! HPT, D, SED. NOT for glaucoma, BPH, UR, CON, DN. Reglan: NOT if intest obstr. Block serotonin receptor in intestinal tract & brain. SE: CON. For chemotherapy N best works as combination of antiemetic drugs. For angina, TIA, claudication, post stent thrombosis, prevent AMI/stroke. Work at initial step in coagulation by block platelets from clumping to form clots. Work well in arterial circulation where other anticoagulants are not effective.SE: BL, bruising, N/V/D, dyspepsia, gas, HA, rash, itching. AE: hemorrhagic stroke, tinnitus> hearing loss or salicylate poisoning (aspirin). DO NOT take w NSAIDs/alcohol (BL).

-mine -zine -mine -dine

Anticholinergics Antihistanimes H1 blockers! Dopamine Antagonists (or promotility drugs used for GERD) 5HT3 receptor antagonists

-setron

Ondansetron (Zofran) Panolosetron Dolasetron

AntiCoagulants
Antiplatelets

Hematologic Drugs
Aspirin Clopidagrel (Plavix) Ticlodipine Eptifibatide

-aparine -parin

Anticoagulants

Warfarin(Coumadin)preg X PT 18-24 sec INR 2-3 x the control Heparin: PTT (60-80 sec) aPPT 1.5-2 x the control Enoxaparin (Lovenox) Fondaparinux (Arixtra)

-ase

Thrombolytics (clot busters)

Alteplase (Activase) Eminase Retaplase (Retavase) Streptokinase (Streptase) Tenecteplase (TNKase) Tissue plasminogen activator (t-PA)

Stop 1 week b/f surgery /dental. Monitor for coffee-ground emesis/black tarry stools. Take w food to v SE. Antidote: protamine sulfate. Peds: Reyes syndrome! Brain fn damage/LD. Prevent & treat DVT, PE, prosthetic heart valve/post cardiac procedures, prevent stroke in pt w Afib. No effect on formed clot! Inhibit certain clotting factors/prevent formation of fibrin. SE: BL. AE: hemorrhage, thrombocytopenia (HIT): Warfarin-induced skin necrosis. Be consistent w vit K intake, same amount of green leafy veg (dark green leafy vegetables, cabbage, cauliflower, soybeans). NOT for hemophilia. Warfarin antidote: vit K (phytonadione). Warfarin NOT for preg X. Warfarin: full therapeutic effect 3-5 days. Heparin antidote: protamine sulfate. Adm Protamine sulfate slowly IV, no faster than 50 mg in 10 minutes. Stop Heparin if thrombocytopenia (platelets<100,000). For acute MI, DVT, massive PE, ischemic stroke. NOT for active BL, recent (7 days) surgery/trauma, severe HTN, preg. Clots are dissolved by conversion of plasminogen to plasmin (destroy clotting factors) AE: serious risk of BL (brain, puncture site), HPT, AR. Aminocaproic acid (Amicar) reverses trombolytic effects. Monitor for changes in LOC (cranial BL).

Stimulants
Erythropoetic growth factors

Hematologic drugs
Epoetin alfa (Epogen, Procrit) Sub Q/ IV Darbepoetin alfa (Aranesp) Methoxy polyethylene glycol (MGEG) (long acting)
For anemia related to CRF, after chemotherapy. Stimulates bone marrow to produce RBC. Takes 2-4 weeks to start working. SE/AE: HTN (if elevation in hematocrit too rapidly > HTN & seizures),risk MI/stroke/cardiac arrest (win Hg>12). NOT for HTN pt. Blood tests to monitor response. No additional iron Vits required, and be consistent w diet of dark green vegies, meat, yokes & poultry (Iron). AE: 1-10 % report s&s of fluid retention (swelling in legs.) the risk of infection in pt w neutropenia (from cancer). Stimulates bone marrow to produce neutrophils. SE/AE: bone pain, leukocytosis. NOT if sensitive to E-coli protein. DO NOT shake med, discard open vial after use. To hasten bone marrow fn after bone marrow transplant,Tx of failed bone marrow transplant. Acts on bone marrow to produce WBC. SE/AE: D, weakness, rash, malaise, bone pain, leukocytosis, thrombocytosis. NOT if allergic to yeast. Tothrombocytopenia & the need for platelet transfusions in pt receiving chemotherapy.production of platelets. SE/AE: fluid retention (peripheral edema, dyspnea on exertion), dysrhythmias, blurring of vision, AR>anaphylaxis. Monitor thrombocyte count (>50,000) to see effectiveness. DO NOT take w milk> v absorption. Vit C absorption. Absorption is best when taken on empty stomach. Eat fiber foods to prevent CON SE of iron. For immunodeficiency, CLL, Bone marrow transplantation, Hep A & B exposure, MMR/chicken pox exposure. AE: HA,

Leukopoetic growth factors Granulocyte macrophage colony stimulating factor Thrombopoetic growth factors

Figrastim (Neupogen) Pegfilgrastim (Neulasta) Sargamostim (Leukine)

Oprelvekin (Interleukin-11)

Supplements

Iron supplements

Immune System Drugs


Immune globulin Ig G (Gamma globulin G) Deep IM/IV

Immunostimulants

Interferon Alfa, Aldeslukin (Interleukin 2) Sub Q/IM

-limus

Immunostimulants G- SCF Platelets production stimulant Immunosuppressants

Filgrastim (Neupogen) Sub Q Oprelvekin (Interleukin 11) Calcineurin inhibitors: Cyclosporine (Sandimmune, Gengraf, Neoral) Glucocorticoids: Prednisone Cytotoxics: Azathioprine (Imuran) Tacrolimus (Prograf) Methotrexate (Rheumatrex)

pruritis, adenopathy (swelling of the lymph nodes) local reaction, erythema, swelling, pain, AR /anaphylaxis are rare: watch for facial edema! Preg C. Provides passive immunity (temporary) & antibodies. For hairy cell leukemia, CML, malignant melanoma, AIDS related Kaposis Sarcoma. Enhance host immune responses & proliferation of cancer cells. SE: flu like symptoms, bone marrow suppr, alopecia, cardiotoxicity, KT, HPT. DO NOT shake vial, store in refrigerator, monitor for cell proliferation (effectiveness). G- SCF: granulocyte stimulating colony factor. Teach selfinjection. SE: N/V, anemia. Report if bone pain. Stimulates production of platelets in clients receiving chemotherapy. For autoimmune disorders (RA, SLE, MG), prevent organ rejection in transplants (lifelong therapy). Act on helper T lymphocytes to suppress production of immune response resulting in suppr of the proliferation of B cells and cytotoxic T cells. Cyclosporine SE: LT/KT. Initial cyclosporine over 2-6 hours, mix cyclosporine w milk/OJ (NO grapefruit while on therapy). Report s/s rejection. Cytotoxics SE: bone marrow suppr. Inflam nonspecific, does not always mean infection is present, can be allergy/injury. Local s&s: redness, swelling, warm, pain, v fn. Systemic s&s: fever, pus. inflam by counteracting the cyclooxygenase(COX) enzymes & preventing prostaglandins production (PG2, pain). COX 1: GI tract normal cells, COX 2: inflammatory cells at site. COX 1 binding drugs v clotting for a week> GI BL. SE: GI ulcers/pain, fluid retention, HTN (v renal BF) AE: KD, exacerbation of asthma & AR. Herbs: DO NOT take aspirin with Coumadin/Willow bark. Take after meal w full glass water/milk. NOT for 1st 3 months preg (pre-close ductus arteriosus). Celecoxib (Celebrex) the only drug does not kill COX 1. Ketorolac (Toradol) check for bruising!

Pimecrolimus Sirolimus

Inflammation drugs Antinflammatory


-fenac -profen 1. NSAIDs Nonselective COX inhib: Oral: Aspirin, Ibuprofen (Advil, Motrin) Naproxen (Aleve, Anaprox, Naprosyn) Oxaprozin (Daypro) Indomethacin (Indameth) Nabumetone (Relafen) Oral/Parenteral: Ketorolac (Toradol) COX 2 inhibitors: Celecoxib (Celebrex) for RA Nasal spray: Budesonide (Rhinocort, Pulmicort) Fluticosone (Flonase, Flovent) Memetasone furoate (Nasonex, Asmanex) Oral (mineralocorticoids): Prednisone Prednisolone Parenteral (mineralocort):

-sone -solone -cort-predPred-

2. Steroids

inflam to prevent damage. Glucocorticoids (cortisol) control carb/fat/protein metabolism & are anti-inflam by preventing mediator production. Most powerful drug. Glucocorticoids SE: CUSHINGS syndrome 6B3W2S2MHA: HTN, HG (DM), buffalo hump, BL/bruises, bloated (swell from sodium and water retention), WG, weak immune system, wasted muscle and mass (osteoporosis), sleeping problem due to nervous feeling, stretch marks, mood swings (anxiety, DN), moon face, hair loss, acne (bold with pimples). Mineralocorticoids (aldosterone) control electrolyte & water levels by promoting sodium retention in kidney. Mineralocorticoids SE: HTN, hypokalemia(cardiac issues, hypernatremia (neural issues), healing impaired

-mine -iramine -zine -dine -tadine

3. Antihistamines

-luk-leu-

4. Leukotriene modifiers (inhibitors)

Dexamethasone (Decadron) Hydrocortisone (Solucortef) Methylprednisolone (SoluMedrol) 1st gen (more sedating): Diphenhydramine (Benadryl) 2nd gen (less sedating): Loratadine (Claritin) Fexofenadine (Allegra) Desloratadine (Clarinex) Cetirizine (Zyrtec) Zafirlukast (Accolate) Motelukast (Singular) Zileuton (Zyflo)

(immunosuppr effects)AE: vision loss, cataract, CSR, adrenal insufficiency. DO NOT stop suddenly! Take w food. Avoid crowds. Prednisone causes demineralization of bones> osteoporosis & stress fractures. Toinflam by stopping histamine effect. SE: sleepiness, dry mouth, blurred vision, TC, UR. AE: seizures (rare), IOP. NOT for BPH, HTN, glaucoma. DO NOT take when having acute asthma attack make too drowsy to work on breathing. ACH SE.

inflam by preventing Leukotriene from binding to its receptors, block eosinophil infiltration. SE: HA, abd pain. AE: LD, AR (hives & anaphylaxis) Zileuton (Zyflo) is leukotriene modifier NOT BLOCKER! Lower LDL. SE: gas, CON, muscle aches, GIU, AE: myopathy>rhabdomyolysis, ARF, liver fn, LT, PN. Take at bedtime (body makes cholesterol at night). Take w meal (absorp). No grapefruit juice! Liver tests /6 months. Takes 4-6 weeks to work. Lipitor: monitor Cr level rise in response to enzyme released w muscle injury. Preg X , NOT for breastfeeding. Expect therapy to be lifelong. Lower LDL, binds w cholesterol in the intestine to prevent reabsorption. Inhibits absorption of fat soluble drugs and vits (A, D, E, K)(give vits 1 hr bf/4hrs after), GID, gas, CON>older: stool softener), BL w Coumadin (effect). fluid intake/fiber. Peds: risk intestinal obstr. Colesevelam (Welchol): oral tab-do not need to be mixed in water. Avoid Digoxin, Thiazides, Tetracyclines (take 1 hr b/f/4 hr after) Lower triglycerides, SE: GID, hyperuricemia (itching), dilated blood vessels, OH, neck/face flushing, AE: BL, gout, HG, LT. NOT for PUD, HTN, LDis, active BL. Stop b/f surgery/dental Lower triglycerides, SE: GID, gallstones, myopathy. AE: rhabdomyolysis, LT/LD, BL (w Coumadin), Cr levels in pt w KD. LD: liver tests /6 months. warfarin and statins effects. Gemfibrozil (Lopid): periodic liver fn tests. If jaundice call Dr. Inhibits absorption of diet cholesterol, SE: myopathy, GID, back and joint pain, infections, AE: angioedema, Hep/LD!!! Zetia+Fibrates=gallstones Zetia+Resins= EE Zetia+Statins= EE & LT No cure! AD v neurotransmitter levels/activity (acetylcholine: memory, attention, circulation), irreversible. Risk: age, genetics. Pneumonia #1 reason they die. For mild to moderate AD. Only donepezil for advanced AD. Keep neurotransmitter levels higher, inhibit breakdown of

AntiLipidemic drugs
-statin Statins, HMG CoA reductase inhibitors Atorvastatin (Lipitor) Rosuvastatin (Crestor) Simvastatin (Zocor) Lovastatin (Mevacor)

ColeChole-

Resins, Bile acid sequestrants

Cholestyramine (Questran) Colesevelam (Welchol) Colestipol (Colestid)

NiaFibr-

Niacin (Vitamin B3), Nicotinic acid agents Fibrates, Fibric acid

Niacin (Niacor) Fenofibrate (Tricor), Gemfibrozil (Lopid) Ezetimibe (Zetia, Ezetrol)

Cholesterol Absorption inhibitors

Drugs for Alzheimers Disease


-mine Cholinesterase/Acetyl cholinesterase

Mental Drugs
Donepezil (Aricept) Rivastigmine (Exelon)

Inhibitors

Galantamine (Razadyne)

-tine

NMDA Blocker (glutamate blocker) (anti-influenza agent)

Memantine (Namenda)

Risperidone (Risperidal) Olzapine (Zyprexa) Haldol

acetylcholine &concentration in the brain. SE: SLUDGE, DUMBELLS AE: arrhythmias, GI BL, dysuria, seizures. Rivastigmine (Exelon) CAUTIOUSLY w asthma, COPD (bronchoconstriction). Donepezil (Aricept) report dyspnea!!! Glutamate is released when brain cells are damaged by AD & cause further brain cell damage. NMDA blocker prevent overstimulation of receptors in brain, excitement. SE: GIU, DIZ, HA, fatigue, restlessness. AE: hallucinations, confusion, cerebrovascular events, movement difficulties, cognitive decline. Short acting. Management of neuropsychiatric s&s. rate of psychosis & agitation in AD. Long acting. Helps w agitation. NOT for long-term. Serotonin: sex/appetite/aggression Norepinephrine: concentration/interest/motivation Both: depressive mood/anxiety/irritability/thought process. SE: HTN!!! SE: impotence, insomnia, withdrawal syndrome, rash, GI BL, bruxism, sleepiness, older (hyponatremia), Serotonin syndrome: Cognitive effects: mental confusion, hypomania, hallucinations, agitation, HA, coma. Autonomic effects: shivering, sweating, fever, HTN, TC, N/D. Somatic effects: myoclonus/clonus (muscle twitching), hyperreflexia, tremor. Drug interaction w St.JohnsWort, antidepressants MAOI/TCA, opioids, CNS stimulants, illicit drugs. Fluoxetine (Prozac) suppr platelets aggregation when used w NSAIDs & anticoagulants >risk for BL. Prozac: if fever>stop&call Dr (serotonin syndrome) Inhibit the uptake pumps for norepinephrine & serotonin>more serotonin around. SE/AE: OH, dry mouth, ACH SE, SED, toxicity, seizures, sweating. DO NOT take w coumadin/aspirin/antihistamines /alcohol. Prior to start Amitriptyline (Elavil) ECG ordered for older cardiovascular SE. NOT for seizure dis/BPH/DM/LD. Elavil: photophobia>wear sun glasses For atypical DN, bulimia nervosa, OCD. Block MAO-A in the brain,norepinephrine /dopamine/ serotonin. SE: OH, local rash, HTN crisis, stroke. Avoid aged&fermented foods. DO NOT take w SSRIs/HF/ renal insufficiency. DO NOT use w vasopressors (caffeine) >HTN. Antidepressant, bipolar, insomnia. SE: less ACH SE & impotence than TCAs. AE: HA, N/V/D/CON, bad taste, stomach pain, tinnitus, ACH SE. report rash>AR For depression, generalized anxiety dis, DM NP pain, fibromyalgia, stress urinary incontinence. AE: N, somnolence/ insomnia, HA, DIZ, mydriasis (dilation of pupils). NOT for MAOI users, glaucoma. For DN/aid to quit smoking/prevention of SAD. Inhibit dopamine reuptake. SE/AE: HA, dry mouth, CON, HR, N,

Antidepressant

Mental drugs

-pram -mine -tine -line

SSRI Selective Serotonin Reuptake Inhibitors

Paroxetine (Paxil) Sertraline (Zoloft) Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox)

triptyline pramine -pine

TCA Tricyclic Antidepressants

Amitriptyline (Elavil) sun! Imipramine (Tofranil) Nortriptyline (Pamelor) Cyclobenzaprine (Flexaril) muscle relaxant Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (Eldepryl, Emsam Tranylcypromine (Parnate) Nefazodone (Serzone) Trazadone (Desyrel) sleepy Duloxetine (Cymbalta) Venafaxine (Effexor)

-line -mine -zine

MAOI Monoamine Oxidase Inhibitors

-done

-xine -tine

SARI Serotonin Antagonist & Reuptake Inhibitors SNRI Serotonin Norepinephrine Reuptake Inhibitors Atypical

Bupropion (Zyban,

Antidepressants NDRI (Norepinephrine Dopamine Reuptake Inhibitors)

Wellbutrin)

restlessness, insomnia, suppr appetite>WL, seizures. DO NOT take w MAOIs (toxicity)/seizure dis. Takes 2-3 months to work.

Mood Stabilizers (AKA euthymics)


Antimania

Mental drugs
Lithium (Eskalith, Lithobid)
For bipolar dis, alcoholism, bulimia, schizophrenia. Check b/f: renal, thyroid, ECG, CBC, fasting BS. SE & toxicity: WG, cardiac changes.AE: tremors, fatigue, HA, mental dullness, lethargy, aches, rashes, thyroid dysfn (goiter & hypothyroidism), GI, renal. Narrow therap. range: -0.6 to 1.4mEq/L. Signs of lithium toxicity: slurred speech (early), anorexia, N/V, hand tremor, muscle twitching, hyperactive DTR, ataxia, vertigo, weakness, DROW, polyuria, tinnitus, blurred vision, HPT>coma/death. Signs of lithium intoxication: fever,UO,BP, irregular pulse, ECG changes, altered level of consciousness, seizures, coma, death.sodium> lithium excretion> toxicity. Avoid aerobic activity in hot weather (cause water/sodium depletion). For mixed mania/rapid cycling bipolar dis. Enhance the effects of the inhibitory neurotransmitter GABA & desensitizing the kindling effect of stress, trauma & street drugs. Carbamazepine SE/AE: nystagmus, double vision, vertigo, staggering gait, HA, blood dyscrasias (leukopenia, anemia, thrombocytopenia), teratogenic >NOT for preg, Divalproex (Depakote) can be lethal in overdose. Promotes secretion of ADH> retain water> HF, skin dis (dermatitis, rash, STEVEN-JOHNSON syndrome), N/V. Carbamazepine (Tegretol) cause agranulocytosis & lethal in overdose. DO NOT drink grapefruit juice. NO Coumadin. Valproic acid (Depakene): thrombocyte count/amylase levels/L fn tests (thrombocytopenia, pancreatitis, LD).

Anticolvulsants (Antiepileptic drugs)

Valproic acid (Depakene) Valproate (Depacon) Divalproex (Depakote) Lamotrigine (Lamictal) Carbamazepine (Tegretol) Gabapentin (Neurontin) Oxcarbazepine (Trileptal) Topiramate (Topamax) Tiagabine (Gabitril)

-lam -pam

Atypical Antipsychotics Benzodiazepines

-pine -mil

CCB Calcium Channel Blockers

Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Clorazepate (Tranxene) Diazepam (Valium) Halazepam (Paxipam) Lorazepam (Ativan) Oxazepam (Serax) Verapamil (Calan) Nifedipine (Adalat, Procardia) Nimodipine (Nimotop) Amlopidine (Norvasc)

SE: dose related/short term/harmless, DROW, SED, ataxia, DIZ, feeling of detachment, irritability/hostility, anterograde amnesia, cognitive effects w long term use, tolerance/dependency, rebound insomnia/anxiety, rarely N, HA, confusion, DN. Use in 1st trimester intrauterine growth retardation. Chlordiazepoxide (Librium) to prevent delirium tremens in acute alcohol withdrawal. Modulate mood by inhibiting calcium channels in the postsynaptic neuron, action similar to Lithium. Can use in pts w HTN/supraventricular arrhythmias/preg. SE: see cardiac drugs.

Antianxiety &

Mental drugs

Sedative/Anxiolytic
-lam -pam Benzodiazepines Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Clorazepate (Tranxene) Diazepam (Valium) Halazepam (Paxipam) Lorazepam (Ativan) Oxazepam (Serax) Midazolam
For short term use (2-6 weeks). When used as hypnotics, they induce sleep rapidly, & effect should be gone by morning. Because they are in the same class as alcohol, can be used to suppress alcohol withdrawal, short term alcohol detoxification.SE: dose related/short term/harmless, DROW, SED, ataxia, DIZ, feeling of detachment, irritability/hostility, anterograde amnesia, cognitive effects w long term use, tolerance/dependency, rebound insomnia/anxiety, rarely N, HA, confusion, DN. Use in 1st trimester intrauterine growth retardation. Midazolam (Versed)/ Diazepam (Valium) AE: RD> adm antidote Flumazenil (Romazicon). Chlordiazepoxide (Librium) prevents delirium tremens in acute alcohol withdrawal. Bind more selectively to neuronal receptors involved in inducing sleep (benzodiazepine-1 receptors on BZ/GABA receptor complex) Antianxiety, anticonvulsant, skeletal muscle relaxant, for sleep dis/insomnia. Generally well tolerated. SE: CNS depression (somnolence, DIZ, ataxia, HA, lethargy) tolerance/ dependence. AE: RD, anterograde amnesia. NOT for ataxia, glaucoma, LD, sleep apnea, MG, severe DN, alcohol use, preg. Risk for falls!! Sometimes used as sedative-hypnotic agents for SED effects. NOT usually as effective as BZs but DO NOT cause physical dependence/abuse. For generalized anxiety dis, OCD, panic dis, bulimia, seasonal affective dis, PTSD, premenstrual dysphoric dis. Significant sedating effects. Paroxetine (Paxil) can cause insomnia. Avoid alcohol, take in a.m w food. Desyrel preffered antidepressant for insomnia, offers SED w few cholinergic effects, much greater safety profile in overdose compared to trycyclic antidepressants. SE: OH, sex dysfn, bruxism, WG, withdrawal syndrome, older> hyponatremia. DO NOT take Paroxetine (Paxil) & MAOI/TCAs> Serotonin synd: Cognitive effects: mental confusion, hypomania, hallucinations, agitation, HA, coma. Autonomic effects: shivering, sweating, fever, HTN, TC, N/D. Somatic effects: myoclonus/clonus (muscle twitching), hyperreflexia, tremor. Drug interaction w St.JohnsWort, antidepressants, opioids, CNS stimulants, illicit drugs. Rarely used. For epilepsy, temp Tx insomnia, anesthesia for short procedures w min pain. Anesthetic, anticonvulsant, SED & hypnotic. SE: somnolence, DIZ, N, AR, anxiety. Addictive> withdrawal symptoms. For off-label Tx of anxiety. Block peripheral/central noradrenergic (norepinephrine) activity, anxiety (tremor, palpitations, TC, sweating). For off-label Tx of anxiety. Block peripheral/central

-lam -pam

Nonbenzodiazepine Sedative-hypnotics agents Sedative-hypnotics (benzodiazepine derivatives)

Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) Estazolam (ProSom) Flurozepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Quazepam (Doral) Diphenhydramine (Benadryl) Hydroxyzine (Atarax, Vistaril) Paroxetine (Paxil) Sertraline (Zoloft) Fluoxetine (Prozac) Ventafaxine (Effexor) Trazodone (Desyrel)

Nonbenzodiazepine Antihistamines (also used for sleep) Nonbenzodiazepine Antidepressants (SSRI)

-barbital

Nonbenzodiazepine Barbiturates Nonbenzodiazepine Beta Blocker Nonbenzodiazepine

Secobarbital Pentobarbital Propranolol Clonadine (Catapres)

-lol -olol

Alpha 2 Blocker Atypical Anxiolytic/ Nonbarbiturate Anxiolytic Buspirone (Buspar) Ramelteon (Rozerem)

Antipsychotics

Mental drugs

Typical/Traditional or Conventional Antipsychotics

Phenothiazines: Chlorpromazine (Thorazine Thiothixene (Navane) Butyrophenone: Haloperidol (Haldol)

-done -pine

Atypical: 5-HT2A antagonists Serotonin/Dopamine Antagonists

Risperidone (Risperdal Consta, M-Tabs) Clozapine (Clozaril) Paliperidone (Invega) Olazapine (Zyprexa, Zydis) Quetiapine (Seroquel) Ziprasidone (Geodon)

noradrenergic (norepinephrine) activity, anxiety (tremor, palpitations, TC, sweating). For panic dis, OCD, social anxiety dis, PTSD. Interaction w CNS depressants: sedative-hypnotic properties, does not exhibit muscle relaxant/anticonvulsant activity. New nonscheduled sleep aid, specific melatonin agonist.SE: DIZ, N, HA, agitation. Take w food (v N), avoid grapefruit/erythromycin/ketoconazole(effects) For schizophrenia + symptoms: delusions, hallucinations, thought dis, disorganized speech, bizarre behavior, inappropriate affect. - symptoms: affective flattening, alogia (lack of content in speech), avolition/apathy, anhedonia (lack of pleasure), asociality, attentional deficit. Mood symptoms: dysphoria, suicidality, hopelessness. Less expensive, BUT do not treat negative s, EPS (pseudoparkinsonism, opisthotonos (arching back like in tetanus), oculogyric crisis (rotating of eyeballs), akathisia (unable to sit still), tardive dyskinesia), ACH SE, lower seizure threshold. Report: agranulocytosis, NMS. Watch for neck spasms. Thorazine: if extreme restlessness & involuntary mov-ts>tx w Amantadine (Symmetrel) antiparkinsonian drug to treat EPS. 1st line!! Diminishes + &- symptoms of schizophrenia, less SE encourage med compliance, v suicidal behavior, improves s&s of DN & anxiety. BUT: WG, metabolic abnormalities, may cause mild EPS (tremor), ACH SE, OH, hypercholesteremia, loss of BS control in DM. Clozapine (Clozaril) watch for WBC count (agranulocytosis). Chronic pain: daily for 6 months. Change the perception of pain. Inhibit prostaglandins synthesis preventing pain sensation. Analgesic and antipyretic effects. For mild pain, moderate: combined w opioids. AE: permanent LD/KD. Monitor renal and hepatic fn, adm with a full glass of water. Avoid alcohol. Abd pain may indicate overdose. Antidote: acetylcysteine (Mucomyst), IV, <24hrs. Advantages over Aspirin: not associated with GIU, tinnitus or GI BL. Safe to use when client is taking anticoagulants. Safe for children, not associated with Reye's Syndrome. Disadvantages: does not have anti-inflam or antiplatelet qualities. Suppress inflammatory induced pain, act at the injury site. Do not change perception of pain. Inhibits prostaglandin synthesis. For mild to moderate@bone/cancer/soft tissue trauma, antipyretic. SE: N/V, irritation GI (PUD/GERD)> give w meals /after meal, v clotting, bruise, BL, renal dysfn (u/o, fluid retention>WG/HTN/HF, bone marrow depr, anemia, thrombocytopenia. AE: induction of asthma, salicylism - aspirin only (tinnitus, sweating, HA, DIZ, resp alkalosis). NOT for last 3 months preg (pre-close ductus

Pain Drugs
Non-Opioid Analgesics Acetaminophen Acetaminophen (Tylenol)

-fenac -profen

NSAIDs Nonsteroidal Anti inflammatory Drugs

1st gen NSAIDs (COX 1&2 inhibitors): Aspirin Ibuprofen (Motrin, Advil) Naproxen (Naprosyn) Indomethacin (Indocin) Ketorolac (Toradol) Diclofenac (Voltaren)

-codone -phine -tanyl morphon e

Opioid Agonists Hydrophillic

Lipophillic Opioids (Opioid Agonists)

Nepafenac Fenoprofen Ketoprofen Bromfenac 2nd gen NSAIDs (selective COX 2 inhibitors) Meloxicam (Mobic) Celecoxib (Celebrex) for RA 1. Short Acting: Tramadol (Ultram) Codeine (Paveral) Morphine (Roxanol) Hydromorphone (Dilaudid) Meperedine (Demerol) Oxycodone w acetaminophen (Endocet, Percodan) Oxymorphone (Opana, Numorphan) 2. Long Acting: Morphine (MS Contin) Oxycodone (OxyContin) Hydrocodone (Lortab, Vicodin) Hydrocodone w/ tylenol (Vicodin) Always long acting! Fentanyl Transdermal (Duragesic) Methadone

Opioid Agonist Antagonists

Butorphanol (Stadol) Nalbuphine (Nabain) Buprenorphine Hydrochloride (Buprenex)

Opioid Antagonists

Naloxone (Narcan)

arteriosus). Inhibition of COX1: v platelet aggregation/KD. Inhibition of COX 2: v inflam/fever/pain. Aspirin NFC : Reye syndrome. Celecoxib: NOT for allergy to sulfonamides. Ketorolac (Toradol) is effective post op pain med, concurrent use w morphine sulfate analgesia w no risks of opioid SE. Salicylate specific allergies: tinnitus, confusion, liver, and kidney, Reyes syndrome. Hypersensitivity (allergies) skin rash, angioedema, urticaria, dyspnea. Not for preg. Stop 2448 hr b/f surgery. Do not take with Warfarin/Glucocosteroid. For moderate to severe pain (postop, MI, cancer), SED, of bowel motility. Codeine: cough suppr. MOA: bind to opioid receptor sites in brain, altering perception of pain & anxiety, opioid agonists. Do nothing at the site of damage! Act on mu receptors to produce analgesia, RD, euphoria and SED. Act on kappa receptors to produce analgesia, SED and GI motility. SE: UR, CON, GIU (reduced), DROW, SED, cough suppr, OH!! Miosis. AE: RD!!! biliary colic, emesis, coma, smaller pupils. Addiction/dependence/tolerance. Withdrawal. Opioids: NO breasfeeding!! Avoid meperidine (Demerol). Demerol: use >48 hrs results in accumulation of normeperidine>seizures, KT. Does not occur w other opioids. Call provider if RR<12/BPM. Antidote: Narcan. Adm IV opioids slowly over 45 min. Assess for bladder distension, hypoactive bowel sounds, I&O, auscultate lung sounds and encourage TCDB. Dilaudid SE: shallow breathing, slow heartbeat, cold/clammy skin, confusion, fainting, feeling lightheaded. Methadone (Dolophine): for opioid withdrawal. Available as transdermal patch! None of the other opioids is available in this form. Should only be used in clients who already receiving opioid therapy, who have demonstrated opioid tolerance. For persistent, moderate to severe chronic pain that: required continuous, around the clock opioid adm for an extended period of time; cannot be managed by other means such as NSAIDs, opioid combination products or immediate-release opioids. Antagonistic block mu receptors effects of euphoria, analgesia, respiratory depression, sedation, physical dependence, & GI motility. Agonistic Act on Kappa receptors producing analgesia, SED & GI, motility. In high does, anxiety, restlessness and mental confusion can occur. Adjunct drug for surgery/labor (epidural), migraine (intranasal spray). For moderate to severe. Low potential for abuse (little euphoria), less RD, less analgesic effect. SE/AE: Abstinence syndrome (cramping, HTN, vomiting, anxiousness), SED, RD, DIZ,ICP, HA. Opioid agonist antagonists differ from pure opioid agonists that they may cause abstinence syndrome in pt physically dependent to opioids. For opioid overdose/reversal of RD. Compete w opioids for opioid receptors. Have no effect in the absence of opioids.

Azo Dye

Phenazopyridine hydrochloride (Pyridium)

Adjuvant Drugs

Pain Drugs

Anticolvulsants (not for acute!) Adjuvant drugs

Gabapentin (Neurontin) 1st choice, but 4 wks to work Pregabalin (Lyrica) 1 wk to work Carbamazepine (Tegretol) Dilantin Amitriptyline (Elavil) Nortriptyline Sertraline Gabapentin (Neurontin) Pregabalin (Lyrica) Lamotrigine (Lamictal) Valproic acid (Depakote) Carbamazepine (Carbamax, Tegretol) Clonazepam (Klonopin, Rivotril) Decadron Deltasone
Didronel Aredia

-line -tine -xine

Antidepressants Adjuvant drugs

SE/AE: TC/tachypnea, abstinence syndrome (cramping, HTN, vomiting), pulmonary edema. Used in conjunction w antibiotics for cystitis. Local analgesic effect on urinary tract. Treats pain, burning, urination SE: turns urine into orange/red color. DO NOT wear contact lenses. HA, GIU> take w food, DIZ. Report jaundice/N/V/blue purple skin color. WG NOT for LD, DM, G6PD deficiency. Enhance the effects of opioids. Used in combination with but not a substitute for opioids. Helps to the dosage of opioids by 50% without altering effect. Used for neuropathic pain (sharp/burning) and cancer-related conditions. NOT for visceral/bone/muscle pain. Change the way sodium & calcium travel across the surface of sensory nerve cells in the brain. The nerve cells send fewer pain signals to the brain. For chronic, migraines, trigeminal, fibromyalgia, DM NEUROPATHIC PAIN, CA pain. SE: DROW, confusion, blurred vision, clumsiness, muscle aches, weakness, ataxia (cant walk the drunk test). Peds: cause aggressive behavior (paradox). Gabapentin/ carbamazepine SE/AE: bone marrow suppr. N/V/D. For neuropathic pain, CA pain /chronic (arthritis, DM neuropathy, migraine, fibromyalgia, low back pain). Chronic pain patients are depressed. Take 1-2 wks to work. Amitriptyline (Elavil) SE: ACH SE, IOP, OH, SED. Hand tremors (call Dr) sign of allergy! Older: heart problems, worsen UR/glaucoma,risk for falls. Valproic acid (Depakote): LT>monitor ASTL/ALT liver fn, thrombocytopenia> monitor platelets.

Adjuvant Clutcocorticoids Adjuvant Biphosphates

To ICP & relive spinal cord compression. SE: adrenal insufficiency, osteoporosis, hypokalemia, glucose intolerance, PUD. For CA induced bone pain. SE: Flu-like symptoms, venous irritation @ inj site. Prevent inflam/dilation of the intracranial blood vessels> relieving migraine pain. For acute attack/prevention. 1 tablet should be taken immediately after the onset of aura/HA. SE/AE: N/V, ergotism (muscle pain, parethesias in fingers & toes, cold/pale extremeties), physical dependence, fetal abortion. NOT for preg. If migraine: identify & avoid triggers, lie down in a dark quiet room at the onset, avoid foods containing tyramine. See antinflammatory drugs For migraines. Most effective if taken at the onset of symptoms. Relief should occur in 30-50 min of oral dosing. If st nd the response to 1 dose is not effective, a 2 dose can be taken after 2 hrs. SE: tightness in the chest (expected), NOT

Migraine
-ergotErgotamines (anti-migraine)

Pain Drugs
Ergotamine Dehydroxyergotamine
Cafergot

-triptan

NSAIDS Triptans

Advil, ASA Sumatripan (Imitrex) Relpax

Antiemetics Butalbital combinations

Opiates

Compazine Reglan Medications that combine the sedative butalbital with ASA or acetaminophen Codeine

for angina pectoris, MI, Hx of ischemic heart dis> it is vasoconstrictor. See antiemetic drugs

Parkinsons Disease Drugs

-dopa

Dopaminergics

# 1 choice Caridopa/Levodopa (Sinemet, Sinemet CR)

-ole

Dopamine Agonist

#2 Pramipexole (Mirapex) Ropinirole (Requip) Apomorphine (Apokin) Piribedil (Trivastan) Bromocriptine (Parlodel) Benzotropine (Cogentin) Benadryl, Artane Entacapone (Comtan)

-pine -pone

Anticholinergics COMT Inhibitors

-line

MAO-B Inhibitors

Rasagiline (Azilect) Pargyline (Eutonyl)

2 Neurodegenerative disorder after AD. Death of dopamine-containing cells in the substantia nigra (midbrain),dopamine (motivation drive hormone) levels in CNS. Motor related, tremors at rest, rigidity, bradykinesia, postural instability and gait. Risk: age, genetics, environment,if tobacco use! No cure. More effective. For later onset. dopamine activity in the brain. Levodopa precursor can enter the BBB (5-10% cross) and convert to dopamine > work on the brain. 90-95 % metabolized in peripheral. Sinemet: Carbidopa has no AE of its own. Any AE from Sinemet are due to potentiating the effects of levodopa. When levodopa is combined with carbidopa, abnor movements and psychiatric disturbances may occur sooner and may be more intense than when levodopa is employed alone. SE/AE: N/V, OH, DROW, DYSKINESIA, head bobbing, tics, tremors, stiff joint, DN w suicide, TC, palpitations, irregular heartbeat, neutropenia, NMS, punding OCD, fluctuations in response: on/off state. Psychosis (hallucinations, nightmares), discolored sweat & urine, activation of malignant melanoma. Lowprotein diet for breakfast and lunch or take levodopa 30 min b/f meals, same time each day. Avoidprotein meals (amino acids interfere w levodopa absorption). DO NOT stop suddenly (NMS). Do drug holiday (dyskinesia). Med holiday: clients immobility>risk for pressure ulcers, DVT, aspiration pneumonia> potential for impaired skin integrity during holiday. Less effective. For initial motor symptoms to delay motor complications + complimentary therapy w on/off fluctuations and dyskinesias from levodopa in late PD. SE: DROW, hallucinations, insomnia, N, CON, water retention, OH!!! AE: impulse control disorders (compulsive gambling, eating, sex, shopping). Mirapex SE: sleep attacks & daytime sleepiness, OH, psychosis, dyskinesias, N. Block cholinergic nerve impulses that help control muscles, tremors. Benzotropine (Congentin) SE:N/V, ACH SE, SED & DROW. Allow more levodopa to reach brain. Work both on CNS and peripheral. COMT is enzymes that degrade dopamine, epinephrine, norepinephrine. Prevent COMT from metabolizing levodopa. SE/AE: muscle aches, RHABDOMYOLISIS, NMS, LT. Inhibit monoamine oxidase B that breaks down dopamine in brain. To improve motor symptoms, delay the need for

nd

Antiviral

Selegline (Deprenyl) Lazabemide (Pakio, Tempium) Amantadine (Simmetrel)

levodopa in early stage, effective in advanced stage too. Less effective than levodopa + more AE. SE: confusion, restlessness, DIZ, ACH SE, discoloration of skin, livedo reticularis (mottled reticulated vascular pattern that appears like a lace-like purplish discoloration of the lower extremities. The discoloration is caused by swelling of the medium veins in the skin, which makes them more visible). Most r combinations of estrogens & progestins. Small doses prevent conceptions by blocking ovulation progesterone effect, cycle control estrogen effect. Act by providing negative feedback to pituitary (shuts down secretion of LH & FSH). Thicken cervical mucus to slow sperm passage/alter endometrial lining to prevent implantation/inhibit ovulation. ONLY antibiotics that impact effectiveness RIFAMPIN & GRISEOFLUVIN. Carbamazepine (Tegretol) causes an accelerated inactivation of oral contraceptives due to action on hepatic med-metabolizing enzymes. Vit C can breakthrough bleeds. SOB (chest pain, calf pain)> thromboembolism!!avoid caffeine > mayCNS stimulation. For postpartum women that lactate. Produce thick/viscous mucus at entrance to uterus, discourages penetration by sperm. SE: BP. Can mimic symptoms of pregnancy (breast tenderness, N, bloating) mayrisk of breast CA. Monitor for thrombophlebitis. As contraceptive, for improvement in menstrual-cycle regularity, to incidence of dysmenorrheal. MOA: inhibit release of FSH & LH, thus preventing ovulation. AE: HTN, edema, N, abd cramps, dysmenorrheal, breast CA/tenderness, fatigue, skin rash, acne, HA, WG, vaginal candidiasis, mid-cycle breakthrough BL, photosensitivity, thromboembolic events more common in smokers. May be adm within 72 hrs after unprotected sex. Prevent implantation of fertilized egg. SE: exaggerated SE see above.

Oral contraceptives

Reproductive System Drugs


Estrogens & progestins r For contraception, hormonal deficiencies, postmenopausal osteoporosis. NOT for: pregnancy, CVA, CHD, thromboembolic disorders. SE: WG, N/V, HTN, DVT. Teaching: breast exam, report calf pain, no smoking.

Progestin- only contraceptives

Hormonal contraceptives

Ethinyl estradiol w norethindrone (Ortho-Novum 1/35)

Emergency contraceptives

Emergency contraceptives

Plan B (levonorgestrel in 2 doses, 12 hrs apart) Preven (comb of ethinyl estradiol & levonorgestrel) Mifepristone (Mifeprex, RU-486) Misoprostol (Cytotec)

To abort implanted embryo. Prostaglandins.

Drugs for Preterm Labor


Tocolytics

Reproductive System Drugs


Magnesium sulfate Nifedipine (Adalat, Procardia) Terbutaline sulfate (Brethine)
Slow uterine contractions to delay labor. For clients w premature labor. Magnesium displaces calcium. Monitor closely for breathing. AE: HB, circulatory collapse, respiratory paralysis, depression of DTR, u/o, N/V/D, lethargy, weakness, blurred vision, HA. Magnesium toxicity results in CNS depression (LOC)

Drugs for Infertility

Reproductive System Drugs


Clomiphene (Clomid,
#1 choice for female infertility. Stimulate release of LH,

Serophene) Choriogonadotropin (Ovidrel)

Drugs for Labor


Oxytocics Uterine stimulants

Reproductive System Drugs


Oxytocin (Pitocin, Syntocinon) Methylergonovine (Methergine)

Ergot alkaloids Prostaglandins

Ergonovine maleate (Ergotrate) Miseprostol (Cytotec)

results in maturation of# of ovarian follicles.in LH level sufficient to induce ovulation in 90% of treated women. NOT for uncontrolled thyroid/adrenal dysfn, unexpected utherine BL, ovarian cyst/ovarian enlargement, pituitary tumor, preg> can cause premature labor, postpartum fever, spontaneous abortion. Oxytocics - natural hormone secreted by posterior pituitary, stimulate uterine contractions to induce labor. Suckling stimulates release of oxytocin. # 1 choice to induce labor/fetal stress test, for promotion of breast milk ejection. To induce labor by frequency & force of uterine contractions. Discontinue if fetal distress, hypertensive crisis may occur if combined w local/regional anesthesia. SE: TC, anxiety, maternal dyspnea, HPT/HTN, N/V, neonatal jaundice, maternal/fetal dysrhythmias. AE: fetal dysrhythmias/intracranial hemorrhage, mother uterine rupture, seizures, coma. Risk for imbalanced fluid volume (excess, related to water intoxication from drugs antidiuretic hormone effects). Methylergonovine (Methergine) AE: HTN crisis. NOT for previous uterine surgery, unengaged fetal head, cephalopelvic disproportion. Monitor frequency/duration of contractions, BP. AE: N/V, uterine cramping AE: N/V/D, HA, chills, uterine cramping, uterine lacerations/perforation due to intense contractions. Hemorrhaging that occurs on noncyclic basis or in abnormal amounts. Common reason for hysterectomy. Often an imb bw estrogen & progesterone. Estrogen causes proliferation of endometrium; progesterone limits & stabilizes endometrial growth. HTN is potential AE of androgen Tx of enmetriousis. Danazole (Danocrine): HTN, thromboembolism, risk of CAD. # 1 choice to treat uterine abnormalities (dysfn uterine BL, secondary amenorrhea, contraception). Inhibit effects of estrogen on uterus. Restores normal hormonal balance. AE: breakthrough BL, breast CA/tenderness, edema (WG), jaundice, migraine HA, DN, HTN, N/V, dysmenorrheal, vaginal candidiasis, PS, pruritis,risk for thromboembolic dis>MI, PE, CVA!!! DO NOT smoke (trombophlebitis)!! For premenstrual syndrome if 1 line is ineffective, v physical effects associated. 1st line for premenstrual syndrome is Zoloft & Prozac (phsycologycal effects of it). SE: v libido, hot flashes, vaginal dryness. AE: after the use for 36 months osteoporosis, suppl estrogen & progestin might be prescribed. Teratogenic! Estrogen-progestin combinations used during/after menopause.LT use has serious AE. To treat unpleasant symptoms of menopause. Prevents LT consequences of estrogen loss. Replacement of female sex hormones. Prevents osteoporotic
st

Drugs for Dysfunctional Uterine bleeding

Reproductive System Drugs

-trel

Progestins

Ovulation suppressant

Medroxyprogesterone (Provera) Desogestrel Etonogestrel Levonorgestrel Norethindrone (Micronor) Megestrol acetate (Megace Leuprolide (Lupron)

Hormone Replacement Therapy


HTR

Reproductive System Drugs


Conjugated estrogens

(Premarin) Conjugated estrogens w medroxyprogesterone (Prempro)

Respiratory Drugs
Antitussives (URI) Opioids Antitussives (URI) Non opioids Codeine Hydrocodone Dextrometrophan (DM/DMX) Benzonatate (Tessalon) Dephenhydramine (Benadryl) Nasal: Phenylephrine (Neo-Synephrine) Oxymetasoline(Afrin) Oral: Pseudoephredrine (Sudafed) Nasal (prophylaxis): budesonide (Rhinocort, Pulmicort) Fluticasone (Flonase, Flovent) Beclomethasone (QVAR) Oral (acute attack): Prednisone, Prednisolone

bone loss. risk: cardiac problems, stroke, CA. Tx<5 years! AE: N, fluid retention, edema, breast tenderness, abd cramps & bloating, acute pancreatitis, acne, mental depression, libido, HA, fatigue, nervousness, WG. DO NOT smoke (trombophlebitis)!! Estrogens warfarin EE. Nasal drops for allergic rhinitis should be adm in position: lateral w head in low position for best effect. For dry, non-productive hacky cough, NOT productive cough!! SE: DROW, DIZ, SED, GIU, N/V, CON, RD. No alcohol SED. NOT for chronic bronchitis/COPD could worsen hypoxia due to RD & R distress caused by viscosity of secretions. For dry, non-productive hacky cough, NOT productive cough!! SE: DROW, DIZ, SED, GIU, N, dyspnea, HTN. No alcohol SED. Fever if w MAOI.

-rine -line

Decongestants (Upper) vasoconstrictors

For sinusitis relieving nasal stuffiness, nasal is better than oral because of systemic effect related to oral. Sympathomimetics - work by constricting blood vessels. AE: HTN, cardiac disorders, oral form generalized vasoconstriction & TC, anxiety (systemic effects). DO NOT use longer 3-5 days. When used over 5 days> rebound nasal congestion. 1st line asthma prophylaxis therapy!! Acute attacks of severe COPD. Suppress inflam by v histamine release/vascular permeability (edema)/eosinophil infiltration. WBC count!!! Nasal SE: cataract/glaucoma, oropharyngeal candidiasis (rinse mouth after), dysphonia (use spacer). Extra calcium and vit D required. Oral SE: HG, growth suppr, PUD, appetite, WG, fluid retention, osteoporosis. NOT for adren suppr, immune fn, osteoporosis, PUD. Prednisone: body responses to vaccines risk of infection from live vaccines> wait until completed med. For allergic rhinitis, toinflam/insomnia/anaphylaxis/ motion sickness. Block H 1 receptor on the surface of basophils and mast cells, blocking of histamine release in the small blood vessels, capillaries & nerves during AR. 1st gen SE: SED, DROW, DIZ, ACH SE, N/V. AE: acute toxicity. NOT for BPH and glaucoma. Benadryl overdose can produce TC, hallucinations, seizures, coma. No alcohol-SED. nd 2 gen SE: HA, fatigue, AE: HPT/HTN, palpitations, TC. AE: ACH SE. No alcohol-SED. Peds paradox reaction. NOT for preg/breastfeeding. viscosity of mucus, water content of mucus. For productive COPD, CF, pneumonia, bronchitis. SE: GIU, HA, DIZ, DROW, AR>rash. Humidifier, lots of fluids. NFC<4 years Lyses protein bonds in mucus, expensive, for short term relief in bronchitis. For CF, antedote for acetaminophen overdose. SE: N/V, AE: irritate airways, leading to bronchospasm/aspiration, TC, HPT, DROW. NFC<5 years

-sone, -nide -solone -predPred-

Steroids Glucocorticoids

-mine -dine -zine -tadine

Antihistamines H 1 blocker

1st gen (more sedating): Diphenhydramine (Benadryl) 2nd gen (less sedating): Loratadine (Claritin) Fexofenadine (Allegra)

Expectorants

Guaifenesin (Musinex) Acetylcyteine (Mucomyst)

Mycolytics

-terol

SABA bronchodialators Beta 2 agonists

Albuterol (Proventil) Levalbuterol (Xopenex)

-terol

LABA bronchodialators Beta agonists

Formoterol ( Foradil) Salmeterol (Serevent)

-tropium

Anticholinergic Bronchodialators (Inhaled)

Ipratropium (Atrovent) Tiotropium (Spirivia)

-phylline

Xanthine Bronchodialators (methylxanthines)

Theophylline Amynophylline

-luk-leu-

Leukotriene modifiers (inhibitors)

Zafirlukast (Accolate) Motelukast (Singular) Zileuton (Zyflo) Cromolyn Sodium (Intal, NasalCrom) Omalizumab (Xolair) Epinephrine (Adrenaline)

Mast Cell Stabilizers Anti-inflammatories Monoclonal antibody

For Asthma. Short acting Rapid onset. Acute Attack. Stimulate B receptors in lungs & relax smooth muscle. Wait at least 5 min bw different drugs. Always give bronchodilator 1st. If use> 2x week call Dr b/c asthma is not under control. SE: dry mouth, skeletal muscle tremor, nervousness, HA,N, TC, insomnia, muscle cramps, palpitations, anxiety, HTN, BS AE: hypersensitivity, bronchospasm(paradox), MI, angina, hypokalemia, arrhythmias, seizures. For Asthma & COPD. Long acting. Prophylaxis. Relax smooth muscle. No anti inflam action. SE: tremors, nervousness, HA, BP&HR, insomnia, dry mouth, bad taste in mouth, may aggravate DM. AE: angina, heart attack, dysrhythmias, seizures. For Asthma. Blocks constriction of airway smooth muscle & blocks production of mucus. 1st line for COPD. Prophylaxis. NOT for peanut allergy (inhaled aerosol contains soya lecithin) SE: local ACH SE, nasal dryness, hoarsness, cough, taste perversion, epitaxis. Few AE because syst absorption is poor: ACH SE For Asthma, Prophylaxis. Cause cAMP build up (smooth muscle relaxant,mucus secretion, mediator release from mast cells) CNS stimulant. Less potent than Beta agonists, slower onset of action. Theophylline toxicity>20 mcg/ml: TC, tremors. SE: N, HPT, nervousness, insomnia, HA, restlessness. AE: GI ulcers, LT, irritability, seizures, cardiac arrhythmias, GI BL. NOT for PUD, cardiac dis (TC), KD, LD. For Asthma prophylaxis. Can v bronchoconstriction. Block bronchoconstriction and eosinophil infiltration mucus production and airway edema. For C>6 years. Take once in p.m, report need for bronchodilator. Zileuton (Zyflo)& Zafirlukast (Accolate )SE: LD Mediator release inhibitor, prophylaxis, NO bronchodilation. Give 15 min prior to exercise! Safest of all asthma meds. Antagonism of Ig E, allergy mediated asthma, 2nd line drug, SE: URI, viral infection, pharyngitis, sinusitis, HA, malignancy, anaphylaxis, CA 1 For severe Asthma attack, anaphylaxis. CNS stimulant, used to relax bronchial smooth muscle & dilate airway. AE: TC & HTN For Tonic-clonic seizures, partial seizures. CNS SE: adultsDROW, confusion, anxiety; children-irritability, hyperactivity.Toxicity: nystagmus, pinpoint pupils, ataxia, RD, coma, HPT, death. For all seizures except absence. SE: CNS effects, gingival hyperplasia> let the dentist know about this med, skin rash, teratogenic effects (cleft palate, heart defects), cardiovascular (dysrhythmias, HPT), endocrine effects. effect of oral contraceptives/Warfarin (Coumadin)/ glucocorticoids.phenytoin levels w alcohol, diazepam,

Seizures Drugs
Phenobarbital (Luminal)

Phenytoin (Dilantin)

Carbamazepine (Tegretol)

Ethosuximide (Zarontin) Valproic acid (Depakote)

Gabapentin (Neurontin) Diazepam (Valium)

Insomnia
Benzodiazepine agonists (#1)or nonBenzo

Sleep Drugs
Zolpidem (Ambien) Eszopiclone (Lunesta) Zaleplon (Sonata) Trazodone (Desyrel)

cimetidine & valproic acid.phenytoin levels w chronic alcohol use, carbamazepine & phenobarbital. Additive CNS depression with barbiturates & alcohol. Keep a seizure frequency chart to determine the effectiveness. For partial seizures, tonic-clonic seizures, bipolar dis, trigeminal & glossopharyngeal neuralgias. SE: CNS effects, blood dyscrasias (leukopenia, anemia, thrombocytopenia), teratogenesis, hypo-osmolarity that puts CHF clients at risk for fluid overload, skin disorders.effects of oral contraceptives & Warfarin. Grapefruit inhibits drug metabolism, leading toserum drug levels. Phenytoin & phenobarbitaleffects of carbamazepine.e For absence seizures only. SE:N/V, indigestion, CNS effects. For Tonic-clonic seizures, absence seizures, partial seizures, bipolar dis, migraine HA. SE: N/V, indigestion, LT, pancreatitis, thrombocytopenia. levels of phenytoin & phenobarbital. For partial seizures, neuropathic pain, migraine HA prevention. SE: CNS effects For static epilepticusmedical emergency. SE: RD, anterograde amnesia, teratogenic Sedative hypnotics # 1 choice. Act on neurotransmitter gamma-aminobutyric acid (GABA-A) receptor sites in the brain to induce sleep. Short acting /short term use (7-10 days). Improve both sleep maintenance & daytime alertness. SE: day time sleepiness, DIZ, fatigue, HA, GIU, SLEEP-RELATED BEHAVIOR (sleep driving, phone calling, eating, sleepwalking) NO alcohol (CNS depressants). Zolpidem (Ambien) for older : confusion!!! For anxiety/seizure dis/insomnia/muscle spasm/alcohol withdrawal/panic dis/anesthesia. Addictive. SE: RD (IV), anterograde amnesia, daytime sleepiness, SLEEP-RELATED BEHAVIOR. Older: falls & urinary incontinence. DO NOT stop suddenly (withdrawal, dependence, insomnia, anxiety). DO NOT use CNS depressants>additive effects. Temazepam (Restoril): schedule IV drug low potential for abuse. Used as mild sleep inducers. SE: next day DROW, unrestful sleep, daytime sleepiness, cognitive impairment, DIZ, blurred vision, dry mouth. NOT for angina, heart arrhythmias, glaucoma, UR. Used for secondary insomnia caused be DN. NOT for elder: risk for SE (daytime sleepiness, DIZ) and drug interaction. Can help mild insomnia w/o daytime sleepiness. It the time to fall asleep & the time spent asleep. SE: sleepiness, DIZ, fatigue. AE: hormonal effects (amenorrhea, libido, infertility, galactorrhea) NOT for preg. DO NOT eat high fat foods (absorption). If libido> report T3/T4, TSH, hyponatremia, hyperkalemia, HPG. Slow metabolism, goiter, myxedemia. Congenital causes cretinism. S&S: BC, CON, WG, slow speech/ memory/DTR, irritability, fatigue, arthralgias, dry skin, edema face/hands.

-pam -lam

Benzodiazepine (sedative hypnotics)

Temazepam (Restoril) Clonazepam (Klonopin) Lorazepam (Ativan) Alprazolam (Xanax) Chlordiazepoxide (Librium) Diphenhydramine (Benadryl) Hydroxyzine (Atarax, Vistaril) Trazodone (Desyrel) Tylenol PM Melatonin Ramelteon (Rozerem)

-mine -zine

Antihistamines

Sedating Antidepressants Pain Relievers Supplement

Hypothyrodism

Thyroid problems drugs

Work like pt own TH, lifelong therapy. SE: TC, HTN, warm skin, insomnia, D, risk of BL w Coumadin. AE: angina, heart attack, HF, seizures. Same time, same brand, DO NOT substitute. Take it after breastfeeding. Tx is effective if TSH =0.5 to 2. Takes weeks to work. Dose: start low go slow. Calcium suppl interfere with absorption!!! If dry/itchy skin dosage need to be. Hyperthyrodism Thyroid problems drugs T3/T4,TSH, hyprenatremia, hypokalemia, HG. Faster metabolism, goiter. Thyroid crisis untreated thyroitoxicosis. Etiology: high dose amidarone. s&s: palpitation (TACH),RR, WL,appetite/BM/DTR, insomnia, anxiety, nervousness, muscle weakness, heat intolerance, moist skin, EXOPHTALMOS!! Systolic BP of 170 is indicative of thyroid storm> report Inhibit thyroid hormone synthesis. For those not candidates Anti-thyroid drugs Methimazole (Tapazole) for radiation/prior to surgery & radiation. Due to Propylthiiouracil (PTU) overmedication signs of hypothyroidism (intolerance to cold, edema, BC, WG, DN). SE: rash, N, HA, muscle/joint aches. AE: bone marrow suppr (low RBC/WBC/platelets, infection, anemia, bruising), LT, inhance effect of coumadin, AGRANULOCYTOSIS (WBC die). Avoid crowds, monitor jaundice. EE:HR (opposite of hyperthyroidism). ToTC & tremors in pt w hyperthyroidism. Block Beta Blockers Propranolol (Inderal) sympathetic nerve system effect fight or flight. SE: (Nonselective) impotence, DIZ, SOB, wheezing, fatigue. AE: BC, chest pain, dysrhythmias, HG, HB! dyspnea, bronchospasm. NOT for asthma, COPD, HB, BC, DM. DO NOT stop taking suddenly. SE/AE: radiation sickness, bone marrow depression, Radioactive Iodine Radioactive Iodine hypothyroidism (intolerance to cold, edema, BC, WG, DN). Sole use of bathroom, flush twice, no kissing/sex for 5 days, dont share utensils, no crowds. NOT for preg. If thyroid CA, thyroidectomy Surgical intervention D5LR Dextrose 5% in lactated Ringers - HYPERTONIC solution. D5W Dextrose 5% in water ISOTONIC solution. LR Lactated Ringers ISOTONIC solution to expand blood volume>prevent shock Tyramine-rich foods: aged cheese, pepperoni, salami, avocado, figs, bananas, smoked fish, protein dieteary supplements, soups, soy sauce, some beers, red wine. Green leafy veg Vit K (dark green leafy vegetables, cabbage, cauliflower, soybeans) 1 cup of low-fat yogurt 314 mg of calcium, cheddar cheese 1 oz 214 mg of calcium, 1 artichoke 135 mg of calcium, cup of spinach 122 mg of calcium. Calcium decreased peristalsis>constipation. Vit D helps increase absorption of calcium. Brown rice has least sodium. Baked Potatoes have the highest glycemic index 85. Pinto beans plant protein, incomplete protein, meatcomplete (animal) protein. Yogurt provides 9 essential amino acids. Caffeine can aggravate diarrhea. Swimming is not weight bearing exercise. Well-seasoned/hot (T) food can worsen nausea. Diet high in fiber improves cholesterol levels. Chicken liver source of folate. DM 1: limit sauted/breaded/fried foods, limit creams/thickened soups and premade salads. Mashed potatoes are good choice. Chemotherapy reciepients: discard leftover food after 3 days. Cirrhosis & ascites: limit your sodium intake to 1-2 g/day to decrease fluid retention. Do not eat 1-2 hrs b/f radiation Tx. Individuals exposed to pertussis should be treated prophylactically with erythromycin for 7 days.Only Hep B vaccine is given at birth, DTap 5 doses starting at 2 months. Investigating health hazards of local community is a component of the public health core fn of assessment. Prevalence proportion can be calculated given how many people were affected at a given time and the total population. 300 people living w asthma in a town of 4000. Incidence proportion, attack rate. 3500 calories a week (500 cal a day) = 1 lb weight gain. During lactation your caloric intake by 300-400 cal /day.

TH Replacement Therapy

Levothyroxin (Synthroid)