Opioids, NSAIDs, and Antibiotics

• Opioids and NSAIDs are used to treat pain but have different mechanisms and risks.

NSAIDs

• NSAIDs include ibuprofen, naproxen, diclofenac, indomethacin, meloxicam, celecoxib, and ketorolac.
• They treat mild to moderate pain, fever, rheumatoid arthritis, osteoarthritis, and dysmenorrhea.
• Contraindications include sulfa allergy (for celecoxib), GI bleed, renal or liver issues, and pregnancy.

Opioids

• Opioids include fentanyl, morphine, and hydromorphone.
• They treat severe pain and are used as anesthesia adjuncts.
• Risks include respiratory depression, constipation, sedation, and dependence.
• Monitor respiratory rate and hold if it is less than 8.
• Naloxone (Narcan) is the antidote for opioids.

Antibiotics

• Aminoglycosides (gentamicin) can cause nephrotoxicity and ototoxicity; monitor peak and trough levels.
• Penicillins and cephalosporins have a cross-allergy risk.
• Fluoroquinolones (ciprofloxacin) carry a black box warning for tendon rupture; avoid taking with antacids.
• Tetracyclines are not for children under 8, cause photosensitivity, and should be taken on an empty stomach.

Antivirals

• Antivirals (acyclovir, oseltamivir) typically end in "-vir"; monitor renal function.

Antifungals

• Azoles (-azole) can cause liver toxicity.
• Amphotericin B can cause nephrotoxicity; monitor BUN and creatinine.
• Nystatin is used orally or topically for candidiasis.

Narcotic Antagonists & Antidotes

• Naloxone (Narcan) is the antidote for opioid overdose.
• Flumazenil is the antidote for benzodiazepine overdose.
• Always assess airway, breathing, and circulation after administration of antagonists.

Adrenergic & Adrenergic Blocking Agents

• Adrenergic agonists (epinephrine, norepinephrine, dopamine) increase heart rate and blood pressure.
• Alpha blockers (-sin, e.g., tamsulosin) are used for benign prostatic hyperplasia (BPH).
• Beta blockers (-lol, e.g., propranolol) require monitoring of heart rate and blood pressure and are contraindicated in asthma, and watch for bradycardia, hypotension, and fatigue.

Psych Meds

• Typical antipsychotics (Haldol) carry a risk of extrapyramidal symptoms (EPS).
• Atypical antipsychotics (Risperdal, Abilify) can cause weight gain and QT prolongation.
• SSRIs (sertraline, fluoxetine) take 4–6 weeks to take effect and have an early risk of suicide.
• Lithium's therapeutic range is 0.6–1.2 mEq/L; monitor sodium levels and watch for toxicity symptoms.
• Benzodiazepines (diazepam, lorazepam) cause sedation and increase fall risk.

Muscle Relaxants

• Centrally acting muscle relaxants (cyclobenzaprine, baclofen) cause sedation and dizziness.
• Patients should avoid driving and should avoid alcohol and CNS depressants while taking these medications.

Antineoplastics (Chemo) Adverse Effects

• Myelosuppression can result in anemia, leukopenia, and thrombocytopenia.
• GI effects include nausea, vomiting, diarrhea, and mucositis; maintain oral hygiene and use antiemetics.
• Monitor labs and electrolytes for neuro, renal, and cardiac toxicity.
• Other effects include alopecia and sexual changes.

Med-Specific Nursing Considerations

• Vancomycin can cause Red Man Syndrome; slow the infusion to prevent this.
• Ciprofloxacin: Avoid antacids, risk of phototoxicity and tendon rupture.
• Aspirin carries a GI bleed risk and the risk of Reye’s syndrome in children.
• Donepezil is used for Alzheimer's; assess patient's orientation.

Other Meds

• Parkinson’s medications (Levodopa): Avoid high protein intake and take fall precautions.
• Alzheimer's medications (Donepezil): Assess orientation and ensure safety.
• Migraine medications (Sumatriptan): Take at the onset of a migraine and assess cardiac function.
• Seizure medications (phenytoin, valproic acid) have CNS side effects; monitor liver function.

Common Labs & Toxicities

• Lithium levels should be 0.6–1.2 mEq/L; monitor sodium and hydration.
• Valproic acid requires monitoring of liver enzymes.
• Carbamazepine requires monitoring of CBC and liver function.
• Amphotericin B requires monitoring of BUN and creatinine.

Miscellaneous & Priority Nursing Concepts

• The rights of medication administration: right patient, drug, dose, time, and route.
• Enteric-coated medications should not be crushed or chewed.
• Prioritize airway, breathing, and circulation (ABCs) first.
• When providing further teaching, look for incorrect statements to correct.