Download File - Rachel Krogstie

CNS Drugs
0 Drugs for ADHD
0 Anti-Anxiety
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(Benzodiazepines)
Alzheimer’s Disease Drugs
Parkinson’s Disease Drugs
Epilepsy Drugs
Multiple Sclerosis drugs
Migraine Suppressants
Supplements
Drugs for Attention
Deficit/Hyperactive Disorder
0 Drugs with proven efficacy include methylphenidate,
dexmethylphenidate, dextroamphetamine, and amphetamine
mixture. There are no data to support use of one stimulant over
another.
0 Accordingly, stimulants cannot give a child good study skills and
other appropriate behaviors. Rather, these must be learned once
the disruptive behavior is no longer an impediment.
0 Several nonstimulants are used for ADHD, although only three of
them––atomoxetine, guanfacine, and clonidine––are FDA
approved for this use. The nonstimulants are less effective than
the stimulants, and hence are considered second-choice drugs.
0 Atomoxetine is a selective inhibitor of NE reuptake and hence
causes NE to accumulate at synapses.
0 Drug examples: atomoxetine
Drugs for Attention
Deficit/Hyperactive Disorder
0 atomoxetine (Strattera)
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: SUICIDAL
THOUGHTS , ALLERGIC REACTIONS INCLUDING
ANGIONEUROTIC EDEMA AND ANAPHYLAXIS.
0 Contraindications: Glaucoma
0 High Risk Populations: Pre- existing psychiatric
illness, cardiovascular disease
0 Assessments and Lab Tests: CYP2D6
Benzodiazepines
(Sedative/Hypnotic)
0 The benzodiazepines have three principal indications: (1)
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anxiety, (2) insomnia, and (3) seizure disorders.
Benzodiazepines are drugs of first choice for anxiety and
insomnia.
Lower potential for abuse.
Less tolerance and physical dependence and are subject to fewer
drug interactions.
With increasing dosage, effects progress from sedation to
hypnosis to stupor.
0 Drug examples: diazepam, lorazepam
Benzodiazepines
(Sedative/Hypnotic)
0 diazepam (Valium, Diastat)
0 Pregnancy Category D Sch IV
0 antianxiety agents, Anticonvulsants,
sedative/hypnotics, skeletal muscle relaxants (centrally
acting)
0 Side Effects/Adverse Drug Events: RESPIRATORY
DEPRESSION, dizziness, drowsiness, lethargy
0 Contraindications: Comatose patients, Severe
pulmonary impairment, Sleep apnea, Severe
hepatic/renal dysfunction, Pre-existing CNS depression
0 High Risk Populations: History of Suicide, OB, Pedi, Lact
0 Assessments and Lab Tests: CYP2C19, BP, hepatic and
renal function, CBC
Benzodiazepines
(Sedative/Hypnotic)
0 LORazepam (Ativan)
0 Pregnancy Category D Sch IV
0 antianxiety agents, analgesic adjuncts, sedative/hypnotics
0 Side Effects/Adverse Drug Events: APNEA, CARDIAC ARREST,
bradycardia, hypotension, dizziness, drowsiness, lethargy
0 Contraindications: Comatose patients, Severe pulmonary
impairment, Sleep apnea, Pre-existing CNS depression,
OB/LACT
0 High Risk Populations: History of Suicide, Severe
hepatic/renal dysfunction, Pedi
0 Assessments and Lab Tests: CYP2C19, BP, hepatic and renal
function, CBC
Benzodiazepines
(Sedative/Hypnotic)
diazepam (Valium)
0 Drug-Drug: Alcohol
and other CNS
depressants
(antidepressants,
antihistamines,
opioid analgesics,
etc.)—concurrent use
results in additive
CNS depression.
LORazepam (Ativan)
0 Oral
contraceptives may
↓ levels.
0 May ↓ the efficacy
of levodopa
0 Drug-Natural:
Concomitant use of
kava-kava, valerian,
or chamomile can ↑
CNS depression.
Alzheimer’s Disease
0 Progressive memory loss, impaired thinking,
neuropsychiatric symptoms, and inability to perform
routine tasks of daily living.
0 Affects about 5.3 million older Americans and kills about
100,000 each year, fourth leading cause of death in adults
0 ACh is critical to forming memories, and its decline has
been linked to memory loss.
0 Five drugs have been approved for the treatment of
Alzheimer’s dementia, and none of them is very effective,
0 Drug examples: donepezil, memantine,
(neostigmine)
NMDA Receptor Antagonists
0 memantine (Namenda)
0 Pregnancy Category B
0 Side Effects/Adverse Drug Events: dizziness,
fatigue, headache, sedation, hypertension, rash,
diarrhea, weight gain, urinary frequency, anemia.
0 High Risk Populations: Severe renal impairment,
Concurrent use of other NMDA antagonists,
Concurrent use of drugs or diets that cause alkaline
urine, Conditions that ↑ urine pH,
OB/Lactation/Pedi: Safety not established.
0 Assessments and Lab Tests: May cause anemia,
Assess cognitive function
0 Caution patient and caregiver that memantine may
cause dizziness.
Cholinesterase Inhibitors
0 donepezil(Aricept)
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: headache,
diarrhea, nausea
0 High Risk Populations: Underlying cardiac disease,
History of ulcer disease or currently taking NSAIDs,
History of seizures, History of asthma or obstructive
pulmonary disease, OB/Lactation/Pedi: Discontinue
drug or bottle-feed.
0 Assessments and Lab Tests: cognitive function. Monitor
heart rate.
0 Do not confuse Aricept with Aciphex or Azilect.
0 Drug-Natural: Jimson weed and scopolia may
antagonize cholinergic effects.
Myasthenia gravis (MG)
0 Myasthenia gravis (MG) is a neuromuscular disorder
characterized by fluctuating muscle weakness and a
predisposition to rapid fatigue.
0 Common symptoms include ptosis (drooping eyelids),
difficulty swallowing, and weakness of skeletal
muscles.
0 Patients with severe MG may have difficulty breathing
owing to weakness of the muscles of respiration.
Myasthenia gravis (MG)
0 neostigmine (Bloxiverz, Prostigmin)
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: SEIZURES,
bronchospasm, excess secretions, bradycardia, abdominal
cramps, diarrhea, excess salivation, nausea, vomiting,
sweating
0 Contraindications: Mechanical obstruction of the GI or GU
tract, Lactation
0 High Risk Populations: History of asthma, Ulcer disease,
Cardiovascular disease, Seizure disorder, Hyperthyroidism,
OB: May cause uterine irritability after IV administration near
term, newborns may display muscle weakness.
0 Assessments and Lab Tests: Assess pulse, respiratory rate,
and BP prior to administration
Parkinson’s Disease Drugs
0 Two types of drugs are used:
0 (1) dopamine agonists (i.e., drugs that directly
or indirectly cause activation of dopamine
receptors)
0 levodopa-carbidopa
0 (2) anticholinergic agents (i.e., drugs that block
receptors for ACh).
0 selegiline
Parkinson’s Disease Drugs
0 levodopa-carbidopa (Sinemet)
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: involuntary movements,
urges (gambling, sexual), nausea, vomiting, darkening of urine
or sweat.
0 Contraindications: glaucoma, MAOI, Malignant melanoma,
Undiagnosed skin lesions, tartrazine, phenylalanine, or
aspartame and should be avoided in patients with known
hypersensitivity
0 High Risk Populations: History of cardiac, psychiatric, or ulcer
disease, OB/Pedi/Lactation: May ↓ serum prolactin.
0 Assessments and Lab Tests: blood glucose, hepatic and renal
function, CBC
0 Do not confuse Sinemet with Janumet
Parkinson’s Disease Drugs
0 selegiline (Zelapar, Eldepryl)
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: urges (gambling, sexual),
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vivid dreams, nausea, dry mouth
Contraindications: Concurrent meperidine, opioid analgesic ,
SSRIs or tricyclic antidepressants.
High Risk Populations: tyramine-containing foods and some
medications, History of peptic ulcer disease
May initially ↑ risk of side effects
of levodopa/carbidopa (dose of levodopa/carbidopa may
need to be ↓ by 10–30%).
Do not confuse selegiline with Salagen (pilocarpine). Do not
confuse Zelapar (selegiline) with Zyprexa (olanzapine).
Drugs for Epilepsy
0 Nearly all AEDs act through four basic mechanisms:
0 suppression of sodium influx,
0 suppression of calcium influx,
0 blockade of receptors for glutamate,
0 potentiation of gamma-aminobutyric acid (GABA).
0 Monitor closely for emergence or worsening of
suicidal thoughts or behavior or depression.
0 Drug Examples: topiramate, phenytoin, gabapentin,
carbamazepine, pregabalin, phenobarbital,
valproic acid
Anti-Epileptics
0 " ABCDEFGH "
0 Ataxia
0 Blood dyscrasia
0 Cleft lip
0 Dupuytrens /
Vit. D deficiency
0 Exfoliation of skin
& Stevens Johnson's
0 GI upset/Gum
hypertrophy
0 Hepatitis/ Hairy
Drugs for Epilepsy
0 topiramate (Topamax, Trokendi XR)
0 Pregnancy Category D
0 Side Effects/Adverse Drug Events: ↑SEIZURES, SUICIDAL
THOUGHTS
0 Contraindications: Lactation
0 High Risk Populations: All patients (may ↑ risk of
suicidal thoughts/behaviors); Renal /Hepatic
impairment; Patients predisposed to metabolic acidosis;
Patients allergic to sulfa; OB, Pedi, Geri
0 Assessments and Lab Tests: CBC w/diff, LFT, metabolic
acidosis
Drugs for Epilepsy
0 phenytoin (Dilantin, Phenytek)
0 Pregnancy Category D
0 Side Effects/Adverse Drug Events: SUICIDAL THOUGHTS,
AGRANULOCYTOSIS, APLASTIC ANEMIA, ALLERGIC
REACTIONS INCLUDING STEVENS-JOHNSON SYNDROME
0 Contraindications: Alcohol intolerance, Sinus bradycardia,
sinoatrial block, 2nd- or 3rd-degree heart block, or StokesAdams syndrome.
0 High Risk Populations: All patients (may ↑ risk of suicidal
thoughts/behaviors); Hepatic /renal disease, severe cardiac
or respiratory disease OB, Pedi
0 Assessments and Lab Tests: HLA-B*1502
" PHENYTOIN "
0 P: Fetal hydantoin
syndrome
0 H: Hirsutism, Hypersens
itivity
0 ENY: Anemia
0 T: Thick gums
0 0: Osteomalacia
0 I: Inhibits insulin
0 N: Neutropenia
Drugs for Epilepsy
0 gabapentin (Gralise, Horizant, Neurontin)
0 Pregnancy Category C
0 Partial seizures, Restless legs syndrome (Horizant only)
0 Side Effects/Adverse Drug Events: SUICIDAL
THOUGHTS, MULTI-ORGAN HYPERSENSITIVITY
REACTIONS
0 High Risk Populations: all patients (may ↑ risk of
suicidal thoughts/behaviors); Renal insufficiency,
OB/Ped/Lac
0 Do not confuse Neurontin with Noroxin (norfloxacin).
Drugs for Epilepsy
0 carBAMazepine (Carbatrol, TEGretol, Teril)
0 Pregnancy Category D
0 Side Effects/Adverse Drug Events: SUICIDAL THOUGHTS,
STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL
NECROLYSIS, AGRANULOCYTOSIS, APLASTIC
ANEMIA, THROMBOCYTOPENIA
0 Contraindications: Bone marrow suppression; use within 14
days of MAO inhibitors; use of nefazodone; OB, Lact
0 High Risk Populations: Cardiac or hepatic disease; Renal
failure; glaucoma; Geri: prostatic hyperplasia
0 Assessments and Lab Tests: HLA-B*1502, CBC
0 Drug-Food: Grapefruit juice
0 Do not confuse carbamazepine with oxcarbazepine. Do not
confuse Tegretol with Trental or Tegretol XR.
Drugs for Epilepsy
0 Pregabalin (Lyrica)
0 Pregnancy Category C Sch V
0 Side Effects/Adverse Drug Events: SUICIDAL
THOUGHTS, dizziness, drowsiness, edema, dry mouth,
0 Contraindications: Myopathy; Lactation.
0 High Risk Populations: All patients; Renal impairment; HF;
History of drug dependence/drug-seeking behavior; OB,
Ped, Geri
0 Assessments and Lab Tests: May cause ↑ creatine kinase
levels. May cause↓ platelet count
0 Interactions: Antacids, Kava-kava, valerian, or chamomile
0 Do not confuse Lyrica (pregabalin) with Lopressor
(metoprolol).
Drugs for Epilepsy
0 PHENobarbital (Luminal)
0 Pregnancy Category D Sch IV barbiturates
0 Side Effects/Adverse Drug Events: LARYNGOSPASM,
HYPERSENSITIVITY REACTIONS INCLUDING ANGIOEDEMA
AND SERUM SICKNESS
0 Contraindications: Comatose patients, pre-existing CNS
depression; Severe respiratory disease; Uncontrolled severe
pain; Known alcohol intolerance, Lactation
0 High Risk: Hepatic/Renal impairment; History of suicide
attempt or drug abuse; Chronic use may lead to
dependence; OB: drug dependency in the infant
0 Assessments and Lab Tests: Monitor respiratory status, pulse,
BP and angioedema. Equipment for resuscitation and artificial
ventilation should be readily available. Geri: marked
excitement, depression, and confusion. LFT and CBC
0 Do not confuse phenobarbital with pentobarbital.
Drugs for Epilepsy
0 Valproic Acid (Depakene, Stavzor, Depakote)
0 Pregnancy Category D, X (migraines)
0 Side Effects/Adverse Drug Events: SUICIDAL THOUGHTS,
HEPATOTOXICITY, PANCREATITIS, HYPERAMMONEMIA,
HYPOTHERMIA
0 Contraindications: Hepatic impairment, urea cycle disorders
0 High Risk Populations: All patients (may ↑ risk of suicidal
thoughts/behaviors); Bleeding disorders; History of liver
disease; Organic brain disease; Bone marrow depression;
Renal impairment; OB, Lactation, Pedi: Children, especially <2
yr
0 Assessments and Lab Tests: Monitor hepatic function (LDH,
AST, ALT, and bilirubin) and serum ammonia concentrations,
CBC, platelet count, and bleeding time
"VALPROATE"
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Vomiting
Alopecia
Liver toxicity
Pancreatitis/Pancytopenia
Retention of fat / Reduced
sleep
Oedema
Allergic reactions / Abd
cramps/ Appetite ↑
Tremor
/ Thrombocytopenia
Enzyme inducer (liver)
Drugs for Multiple Sclerosis
0 Mechanism appears to be autoimmune.
0 MS has four subtypes—relapsing-remitting, secondary
progressive, primary progressive, and progressiverelapsing—which are defined by the clinical course
the disease follows.
0 Drug examples: azathioprine (Approved in Germany,
not in US)
0 Multiple Sclerosis Association of America
Drugs for Multiple Sclerosis
0 azaTHIOprine (Azasan, Imuran)
0 Pregnancy Category D
0 Side Effects/Adverse Drug Events: MALIGNANCY (INCLUDING
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POST-TRANSPLANT LYMPHOMA, HSTCL, AND SKIN
CANCER), SERUM SICKNESS
Contraindications: Concurrent use of mycophenolate; OB: Has
been shown to cause fetal harm; Lactation
High Risk Populations: Infection; Malignancies; ↓ bone
marrow reserve; radiation therapy; Severe renal impairment;
TPMT enzyme OB, Ped
Assessments and Lab Tests: Assess for infection, vital signs,
WBC, and Renal, hepatic, hematologic functions.
Do not confuse azaTHIOprine with azaCITIDine
Drug-Natural Products: echinacea and melatonin
Migraine Suppressants
0 Migraine is a neurovascular disorder involving
dilation and inflammation of intracranial arteries.
0 For mild to moderate symptoms, an aspirin-like drug
may be sufficient.
0 For moderate to severe symptoms, patients should
take a migraine-specific drug—either an ergot
alkaloid or a serotonin1B/1D agonist.
0 If these agents fail to relieve pain, an opioid analgesic
may be needed
0 Drug examples: Sumatriptan, Ergotamine, Valproic
Acid
Migraine Suppressants
0 SUMAtriptan (Imitrex, Sumavel DosePro)
0 Pregnancy Category C
0 Side Effects: dizziness, vertigo, tingling, warm sensation,
injection site reaction
0 Contraindications: Ischemic heart disease, Prinzmetal's
angina, uncontrolled hypertension; Stroke or transient
ischemic attack; Peripheral vascular disease; MAOI;
Hemiplegic or basilar migraine; ergotamine-containing or
ergot-type drugs or other 5HT1 agonists; Severe hepatic
impairment
0 High Risk Populations: OB, Lactation, Ped, Cardiovascular risk
factors (hypertension, hypercholesterolemia, smoking, obesity,
diabetes, family history, women or men >40 yr)
0 Assessments and Lab Tests: Monitor for serotonin syndrome
in patients taking SSRIs or SNRIs concurrently with
sumatriptan.
Migraine Suppressants
0 Ergotamine (Ergomar)
0 Pregnancy Category X
0 Side Effects/Adverse Drug Events: MYOCARDIAL
INFARCTION
0 Contraindications: Peripheral vascular disease; Ischemic
heart disease; Uncontrolled hypertension; Severe renal
or liver disease ; Malnutrition; Pregnancy; Lactation.
0 High Risk Populations: Illnesses associated with
peripheral vascular pathology such as diabetes mellitus;
Concurrent administration of other vasoconstricting
agents; Pedi: Children <6 yr
0 Assessments and Lab Tests: Monitor BP and peripheral
pulses. Report any increases in BP. Assess for signs of
ergotism. Assess for nausea and vomiting.
Magnesium Sulfate
0 Pregnancy Category B
0 Uses: Treatment/prevention of hypomagnesemia. Treatment of
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hypertension. Anticonvulsant associated with severe eclampsia, preeclampsia, or acute nephritis.
Side Effects/Adverse Drug Events: drowsiness, ↓ respiratory rate,
arrhythmias, bradycardia, hypotension, diarrhea, muscle weakness,
Contraindications: Hypermagnesaemia; Hypocalcemia; Anuria;
Heart block; OB
High Risk Populations: Renal insufficiency
Assessments and Lab Tests: Monitor pulse, BP, respirations, and ECG,
Respirations should be at least 16/min before each dose. Patellar
reflex, Monitor intake and output ratios.
High Alert: Have second practitioner independently double-check
original order, dose calculations, and infusion pump settings
Coenzyme Q10
coQ10, ubiquinol, ubiquinone
0 Common Uses: Heart failure. Coenzyme Q–10 deficiency.
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Mitochondrial disorders. Muscular dystrophy. Immune
stimulant in HIV infection. Parkinson's disease, Migraine
Side Effects: Dizziness, hypotension, rash, nausea,
vomiting, diarrhea, heartburn, decreased appetite.
Contraindications: Pregnancy and lactation
High Risk Populations: Hypotension; Surgery
Assessments and Lab Tests: Monitor BP, coagulation
studies, lipid levels, serum lactate
Instruct patient to take with a meal containing fat, as
directed.
May cause dizziness. Caution patient to avoid driving or
other activities requiring alertness until response to
medication is known
PNS Drugs
0 Muscarinic Antagonists
0 Neuromuscular Blockers
0 Indirect Acting Anti-
Adrenergic
Autonomic Nervous
System
Cholinergic
(Parasympathomimetics)
(Anti- Adrenergic)
Indirect Anti-Adrenergic
Anticholinergic
(Sympathomimetic)
Anti-muscarinic
(muscarinic antagonists)
Neuromuscular Blocker
Muscarinic Antagonists
0 Muscarinic antagonists competitively block the
actions of acetylcholine at muscarinic receptors.
0 Other names for these agents are antimuscarinic
drugs, muscarinic blockers, and anticholinergic
drugs.
0 When a drug is characterized as anticholinergic, this
means that it produces selective muscarinic
blockade—not blockade of all cholinergic receptors.
0 Drug examples: Atropine, Dicyclomine
Muscarinic Antagonists
0 Atropine (Atro- Pen)
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: drowsiness, blurred vision,
tachycardia, dry mouth, urinary hesitancy, impotency,
tachypnea, pulmonary edema, flushing
0 Contraindications: glaucoma, Acute hemorrhage, Tachycardia
secondary to cardiac insufficiency or thyrotoxicosis,
Obstructive disease of the GI tract
0 High Risk Populations: Chronic renal, hepatic, pulmonary, or
cardiac disease, Infants with Down syndrome, children with
spastic paralysis or brain damage
0 Assessments and Lab Tests: Vital signs, ECG tracings,
intake/output ratios in elderly & surgical patients, abdominal
distention, bowel sounds
Nicotinic Cholinergic Blockers
0 Neuromuscular blocking agents prevent acetylcholine
from activating nicotinic receptors on skeletal
muscles.
0 Neuromuscular blockers fall into two major groups:
competitive (nondepolarizing) agents and depolarizing
agents.
0 Drug examples: Succinylcholine, Pancuronium
Nicotinic Cholinergic Blockers
0 Succinylcholine (Anectine, Quelicin)
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: APNEA, HYPERKALEMIA,
RHABDOMYOLYSIS, ANAPHYLAXIS,MALIGNANT
HYPERTHERMIA
0 Contraindications: Plasma pseudocholinesterase deficiency,
Children and neonates, Personal history of malignant
hyperthermia.
0 High Risk Populations: anaphylaxis to other neuromuscular
blockers, History of pulmonary disease, renal or liver
impairment, Glaucoma, digoxin, Myasthenia gravis
0 Assessments and Lab Tests: respiratory status, ECG, heart
rate, and BP
Nicotinic Cholinergic Blockers
0 Pancuronium (Pavulon)
0 Skeletal muscle paralysis and facilitation of intubation
0 Pregnancy Category C
0 Side Effects/Adverse Drug Events: bronchospasm,
hypertension, tachycardia, excessive salivation, ANAPHYLAXIS
0 Contraindications: Hypersensitivity
0 High Risk Populations: Low plasma pseudocholinesterase
levels, Obese patients, Shock, Dehydration, Renal/Hepatic
Impairment, MYASTHENIA GRAVIS
0 Assessments and Lab Tests: respiratory status, ECG, heart
rate, and BP
Indirect Acting Anti-Adrenergic
0 The indirect-acting antiadrenergic agents
prevent the activation of peripheral
adrenergic receptors by mechanisms that do
not involve direct interaction with peripheral
receptors.
0 Centrally acting alpha2 agonists, or drugs that
act within the central nervous system (CNS) to
reduce the outflow of impulses along
sympathetic neurons.
0 Drug examples: clonidine
Indirect Acting Anti-Adrenergic
0 Clonidine (Catapres, Doraclon)
0 Pregnancy Category C
0 Antihypertensive (ADHD)
0 Side Effects/Adverse Drug Events: Dry mouth,
drowsiness, depression, nightmares, erectile
dysfunction
0 Contraindications: anticoagulant therapy
0 High Risk Populations: Cardiac/cardiovascular disease,
0 Assessments and Lab Tests: Monitor input/output ratio,
Assess pain location
CAUTION!!
0 High Alert
0 Magnesium Sulfate
0 Pancuronium
0 Succinylcholine
0 BEERS List
0 Diazepam
0 REMS
0 topiramate
References
FDA and ISMP Lists of Look-Alike Drug Names with Recommended Tall
Man Letters. (n.d.). Retrieved from
http://www.ismp.org/tools/tallmanletters.pdf
Institutional High-Alert Medications. (n.d.). Retrieved September 13,
2014, from http://www.ismp.org/tools/institutionalhighAlert.asp
ISMP List of High-Alert Medications in Community/Ambulatory
Healthcare. (n.d.). Retrieved September 13, 2014, from
http://www.ismp.org/communityRx/tools/ambulatoryhighalert.as
p
ISMP’s List of Confused Drug Names. (n.d.). Retrieved from
http://www.ismp.org/tools/confuseddrugnames.pdf
Lehne, R. A., & Rosenthal, L. (2014). Pharmacology for Nursing Care
(8th Edition.). Elsevier Health Sciences.
Part, M. (2014). Gregory J. Hughes and Judith L. Beizer OUTLINE
Objectives Test Questions Pharmacokinetic Changes in the Elderly.
Ham’s Primary Care Geriatrics: A Case-Based Approach, 67.
Vallerand, A. H., & Sanoski, C. A. (2012). Davis’s Drug Guide for Nurses
(13 edition.). F.A. Davis Company. Retrieved from
www.drugguide.com