Download PHARMACOLOGY Anti Hypertensive: Tricyclic antidepressants

PHARMACOLOGY
Anti Hypertensive:
Tricyclic antidepressants = possible cardiac toxicity in patients w/hear disease
Thiazide diuretics -- may induce hyperglycemia
ACE Inhibitors - be cautious of a persistent cough (contact MD if present)
Diltiazem - CCB
Lisinopril: ACE inhibitor. 20-40mg/day. Can cause HA/dizziness/fatigue/tachycardia
Nimodipine - CCB; decreases spasm in cerebral blood vessels
Procardia - antianginal med (CCB) decreases myocardial O2 demand.
Dopamine – increases afterload
Triametrene: a potassium sparing diuretic
Decreased Na+ levels could be a development of dig toxicity.
Anticlotting:
Amicar: antifibrinolytic; prevents recurrence of subarachnoid hemorhage.
Any anti-clotting: Avoid herbal supps like ginsing, ginger, ginko, garlic (all the G's)
Vit C may decrease warfarin effects
Vit E may increase warfarin effects
Tamoxifen: increases the effects of Warfarin sodium
Ticlopidine (Ticlid) is used as a antiplatelet drug for Salicylate (Aspirin) sensitivity.
Respiratory:
Warn asthma pt about using aspirin. It can induce an asthma attack
Neostigmine (Prostgmin) is a cholinergic and can cause bronchoconstriction in asthmatic
patients
AntiCancer
Adriamycin – Cancer drug, blood; lymph system; bladder; breast; stomach; lung; ovaries;
thyroid; nerves; kidneys; bones; and soft tissues, including muscles and tendons.
Vincristine: SE: N/V/A, urinary retention, neurotox, alopecia
Bleomycin sulfate is an antineoplastic drug that can cause interstitial pneumonitis.
Pegfilgastrin (Neulasta) is a chemotherapeutic drug given to patients to increase the white blood
cells count
Cytarabine (Cytosar): Crosses the blood-brain barrier
Daunorucibin (cerubidine): for a client with leukemia is cardiotoxicity
Cyclophosphamide (Cytoxan): SE: metallic taste. Tx: lymphoma, multiple myeloma,
leukemia, mycosis fungoides, neuroblastoma, ovarian cancer, eye cancer and breast cancer.
Antianxiety:
Pain Medications:
Morphine: Contraindicated in pancreatitis or cholecystitis
Percodan - oxycodone and aspirin
Percocet - oxycodone and acetaminophen
Butorphanol Tartrate (Stadol)—analgesic for moderate/ severe pain; SE: change in BP,
bradycardia, respiratory depression.
Mental Health Medications
Clozapine (Clozaril) - antipsychotic, treats schizophrenia, potential to suppress bone marrow
and cause agranulocytosis (look for sore throat and fever)
dilantin => Urine may turn pink, red or brown
Cogentin: used to tx parkinsonian side effects of Thorazine (antipsychotic med)
Dilantin: Antiseizure. Causes bradycardia & HoTN
Ergometrine - Preventing or treating acute migraine headache with or without aura (flashing
lights, wavy lines, dark spots).
MAOIs = Non-Popular Meds – avoid stimulants/decongestants, opioids.
Nardil, Parnate, Marplan
Imipramine (Tofranil) => tricyclic antidepressant used to treat panic attacks
Succinylcholine (Anectine) is given before ECT (Electroconvulsive therapy)
... common tricylics USUALLY have 3 syllables (pamelor, elavil). (remember: tri = 3)
... common MAOI's USUALLY have two (nardil marplan)
DRUGSThorazine
Haldol
Inapsine
Risperdal
Mellaril
Olanzapine
Seroquel, Serentyl, Stelazine
Prolixin
Trilafon
Clozapine
S/E: Photosensitivity ( easily get burned)
Orthostatic Hypotension (dizzy, check BP, change position)
Sedation (makes u sleepy, take it @ night)
Anticholinergic (dry mouth, urinary retention,blurred vision, constipation)
Galactorrhea (milk from breast)
EPS (pseudoparkinsonism, akatisia, dystonia, tardive dyskinesia)
Antibiotics
Indomethacin = can cause ogliohydranamos. Monitor Amniotic fluid index.
Zosyn and gentamycin IV mixing is contraindicated: wait at least an hour to decrease the risk
of gentamycin inactivation.
Amphoteracin B (Fungizone) should be mixed with D5W ONLY!!!
If allergic to sulfonamides dont take acetazolamide (Diamox)
Endocrine
Aldactone: can cause persistent gynecomastia.
Black Cohosh = used to treat menopausal symptoms. When taken with an antihypertensive, it
may cause hypotension.
Desmopressin Acetate (DDAVP): synthetic form of ADH that causes reabsorbtion of H2O.
increase in urine osmolality, decrease in serium osmolality; fluid restored.
Levothyrosine (Synthroid): synthetic thyroid hormone. Given in the morning as single dose.
Same time each day.
Boniva: prevention of postmenapausal osteoporosis. SE: CxP, muscle pain, numbness.
Prednisone: costicosteroid. Can cause adrenal atrophy. Before surgery, dose may be increased.
Propylthiouracil: used to treat hyperthyroidism. May convert patient to hypothyroid state.
Salicylates may interact with insulin causing hypoglycemia
Corticosteroids: may produce an altered effect of a vaccine.
Corticosteroids: should be taken in the morning with food.
Calci-Tonin increases Calcium in the BONE
PTHPuts
The calcium in the
Heme (blood)
Indocin - Treating moderate to severe rheumatoid arthritis, osteoarthritis, and ankylosing
spondylitis. Nonsteroidal anti-inflammatory drugs (NSAIDs).
Glyburide=30 mins before breakfast
Repaglinide – rapid acting oral hypoglycemic agent.
Neostigmine (prostigmin): parasympathomimetic used to treat myasthenia gravis and is an
antidote for nondepolarizing neuromuscular blocking agents. DE: bronchioconstriction, HoTN,
increases action of morphine.
Prednisone, Prograf, and Cellcept helps to prevent kidney rejection
Oral Contraceptives: decrease the effectiveness of insulin.
Hyperthyroidism Medications
• Antithyroids:Methimazole (Tapazole)
• Iodine: Lugol’s solution
• Radiation: Radioactive Iodine 131
Topical Corticosteroids: can be absorbed into systemic circulation. Absorbtion higher in
regions where skin is expecially permeable, and lower where permeability is poor (back, palms,
soles).
Gasterointestine Medications
Amphojel: = SE is constipation
Librium-antianxiety used to tx symptoms of acute alcohol withdrawal.
phenazopyridine ( pyridium) Used to treat UTI
Allopurinol - for chronic gout
Colchicine - for acute gout attack
Sodium Phosphate (Neurta-Phos): Avoid spinach, rhbarb, bran and whole grains (they can
interfere with absorbtion).
Motion Sicknness medications:
Imenhydrinate (Dramamine)
Scopolamine (Transderm-Scop)
Promethazine (Phenergan)
Prochlorperazine (Compazine)
Pregnancy
Hemabate (prostaglandin): can be given intra-uterinlly.
Methergine = contrainticaded when BP > 140/90
Terbutaline = tx preterm labor. SE = tachycardia. Best route = SQ
Sulfasalazine: Sulfa- antibiotic. decreases the absorbtion of folic acid. Increase supplementation.
Folate Dosage:
 Planning Pregnancy: 400 mcg
 Post/intrapartum: 300 mcg.
RhoGam = post partum 300 mcg.
Ergonovine (Ergotrate): causes uterine contractions. Only give to normotensive pts.
Methotrexate - dont take supplemental folic acid and please dont take while pregnant..can cause
premature labor and bleeding.
Newborn Vit K Dose = 0.5 – 1.0 mg
PCN = RX for Group B Beta Strep.
Maximum Pitocin Rx = 20 mili Units
Premarin - Treating certain symptoms of menopause.
Cervidil: Cervical ripening agent
No birth control pills with antiseizure meds....lowers the birth control pill effects
Skin Medications
Coal Tar: used to treat psoriasas. Unplesant odor, stains, can cause phototoxicity.
Clotrimazole: antifungal; treats rashes.
Cyprofloxacin: use with caution on patients with renal disease,CNS,and seizure disoders
Sodium hypochlorite: solution used to irrigate wounds. Cant be used to pack. Solution loses its
potentcy during storage.
Lindane: Tx for scabies. Applied and removed 12 hrs later. One application necessary
HEENT Medications
Timoptic- Timolol ophthalmic (for the eyes) is a beta-blocker that also reduces pressure inside
the eye. Timolol ophthalmic is used to treat open-angle glaucoma and other causes of high
pressure inside the eye.
Topiramate (Topamax)— an anticonvulsant. Should drink 2000-3000ml of fluid daily to prevent
kidney stones. Side effects: orthostatic hypotension, ocular symptoms, blindness, and decrease
effects of hormonal contraceptives.
Protamine sulfate = comes from the sperm of salmon and other fish so don't use if allergic to
fish
Nimotop (Nimodipine) is calcium channel blocker that is given to patients with ruptured
cerebral aneurysm.
Mydratics: (big word, big pupil) treats cataracts
Miotics: (small word, small pupil) treats glaucoma
Filgrastim (Neupogen) - increase NEUtrophil count
Epoietin alfa (Epogen) - increase RBC/erythrocytes
Theohylline: OD = irriatibility. RX is minetabolized by the liver into caffeine.
Phenobarbital (Luminal): is commonly used to treat and prevent recurrent seizures in infants
and young children
Ezetimibe (Zetia): Lowers LDL, triglycerides and apolipoprotein B. Blocks absorbtion in GI
tract. Minimimal adverse effects.
Calcium Supplements: 1-1.5 hrs after meals.
Antihymocyte globulin is used to prevent transplant rejection. The nurse should skin test a dose
before IV administration to identify hypersensitivity to the medication. Premedication with
acetaminophen (Tylenol) and or dephenhydramine (Benadryl) may be prescribed to prevent
reaction to the dose.
Muromonab-CD3 (Orthoclone OKT3) is can cause fatal anaphylactic reactions. S/Sx = include
pulmonary edema, cardiovascular collapse and cardiac or respiratory arrest. Assessing lung
sounds is a priority.
-mycins - if fever, notify MD
Sucrofate (carafate): coats stomach – attaches to ulcer. Give 1st.
Tetracycline can cause staining of the teeth
Adverse Affects of Psychotics = SHANCE
S – Sunlight Sensitivity
H – Helatotoxitity
A – Agranulocytosis
N – Neuroleptic Maligant Syndrome
C – Circulatory Problems
E – Extra Pyramidal Symptoms
Sources of Potassium
P - potatoes,pork,beef,veel
O-oranges
T-tomatoes
A-avacado,banana,carrots,cantaloupe
S- spinach
S-strawberries,raisins
I- fIsh
U
M-mushrooms
Withdrawl:
Amphetamine = depression, disturbed sleep, restlessness, disorientation
Barbituates = N/V, seizures, course tremors, tachycardia.
Cocaine = severe cravings, depression, hypersomnia, fatigue.
Heroin = runny nose, yawning, fever, muscle/joint pain, diarrhea (flu-like)
Insulin:
Rapid: (Lispro) Onset: <15min Peak: 1hr Duration : 3hr
Short: (Regular) Onset: 1/2hr-1hr Peak: 2-3 hr Duration: 4-6 hr
Intermediate: (NPH or Lente) Onset: 2hr Peak: 6-12 Duration: 16-24
Long Acting: (Ultralente) Onset: 4-6 hr Peak: 12-16hr Duration: >24 hrs
Very Long: (Lantus) Onset: 1 hr Peak: NONE Duration: 24 hr continuous
Peak hours:
• Regular insulin- 2-4 hours
• Insulin Aspart (Novolog)- 1-3 hours
• Inslulin lispro (Humalog)- 1 hour
• NPH/Humulin N- 6-12 hours
• Insulin Zinc (Lente)- 8-12 hours
• Ultralente- 18-24 hours
• Insulin glargine- 5 hours
• Humulin 70/30 4-8 hours
For TB Drugs think SPRITE
S- Streptomycin (Monitor for ototoxic, nephrotoxic and neurotoxic rxn)
P-Pyrazinamide ( Photosensitivity-- so avoid sunlight or UV rays)
R- Rifampin ( Red orange urine is normal.. think about R for rifampin and R for red urine)
I- INH ( SE is Vit B6 deficiency so pt needs inj. and avoid tyramine containing foods)
T- Tubasal aka Aminosalicylate sodium ( avoid aspirin with this med)
E- Ethambutol ( E for eye problems- assess visual acuity and color discrimination esp to green)
Cycloserine is an antituburculan and needs weekly drug levels
Drugs that can cause Nephrotoxicity
Acetaminophen ( high doses, acute)
Acyclovir, parenteral ( Zovirax)
Aminoglycocides
Amphotericin B, parenteral ( Fungizone)
Analgesic combinations containing (acetaminophen, asprin, or other salicylates in high doses)
Ciprofloxacin
Cisplatin (Platinol)
Foscarnet (Foscavir)
Methotrexate (high doses)
Nonsteriodal anti-inflammatory drugs ( NSAIDs)
Rifampin
Sulfonamides
Tetracyclines ( exceptions are doxycline and minocycline)
Vancomycin, parenteral (Vancocin)
Drugs that can cause Hepatotoxicity
ACE inhibitors
Acetaminophen
Alcohol
Iron overdose
Erythromycins
Estrogens
Fluconazole ( Diflucan)
Isoniazid ( INH)
Itraconazole ( Sporanox)
Ketoconazole ( Nizoral)
Nonsterodial anti-inflammatory drugs ( NSAIDs)
Phenothiazines
Phenytoin ( Dilantin)
Rifampin ( Rifadin)
Sulfamethooxazole and trimethoprin ( Bactrin, Septra)
Sulfonamides
Zarfirlukast (Accolate)
Ototoxic drugs:
Loop diuretics (Lasix)
NSAIDs
Cisplatin (Platinol-AQ)
Aminoglycosides
Antimyobacterials
Thiazides
Antineoplastics
PHARMACOLOGY MISC:
Celebrex is contraindicted in pts with a history of cirrhosis
Chromium: is helpful in maintaining glucose homeostasis by enhancing the activity of insulin.
Take statins with at night with meals.
Give ampicillin on empt stomach (penicillin can be given without regards to meals)
Give captopril one hour before meals.
Dont take cytoxan while pregnant or dont handle the drug while pregnant.
Isotretinoin (Accutane): Can elevate triglyceride levels.
Methotrexate therapy=in 2 weeks expect to see signs of bone marrow depression
Mafenide acetate: can suppress renal excretion of acid-cause acidosis. Monitor for
hyperventilation.
Cipro treats anthrax
Pyrazinamide (PZA) = DC if big toe pain; means Hyperuricemia ;Gout
Humera: tx Rheumatoid arthritis, Chrohn’s if other meds no help, psoriasis. To prevent further
damage to bones/joints. Get a TB test done before starting humera.
MineralCorticoids: increase reabsorbtion of Na+ by increasing H+ and K+ excretion in the distal
tubule.
GlucoCorticoids: decrease inflammation by suppressing leukocyte migration and modifying the
body’s immune response.
Pancreatic enzyme should be administered in cold medium such as applesauce to
maintain medication integrity
The usual gauge (size of the needle) for an IM injection is 19-23
Less viscous IM = 1” 25g
More viscous IM = 1” 20g