Red Book Pharmacology Review PDF

Red Book Pharmacology Review I- Medication Affecting the Nervous Neuromuscular blocking agents System … 01 Muscle relaxants: direct acting Sedative hypnotic anxiolytics - benzodiazepines Muscle relaxants: Centrally acting (CNS) Atypical...

Red Book Pharmacology Review I- Medication Affecting the Nervous Neuromuscular blocking agents System … 01 Muscle relaxants: direct acting Sedative hypnotic anxiolytics - benzodiazepines Muscle relaxants: Centrally acting (CNS) Atypical anxiolytic / Nonbarbiturate anxiolytic Bone disorder – calcium supplements Selective Serotonin Reuptake inhibitor – SSRI Bone disorder – Hypocalcemic MEds Antidepressants Selective estrogen receptor modulator Serotonin-Norepinephrine Reuptake inhibitor Bisphosphonates Atypical antidepressants Antigout medication Tricyclic antidepressants - TCA Monoamine Oxidase Inhibitors - MAOI IV- Medication affecting Respiratory Bipolar disorder – mood stabilizer System … 11 Bipolar disorder – mood stabilizer antiepileptics Beta2 adrenergic agonists Antipsychotics: 1st, 2nd, 3rd Generation Methylxanthines CNS Stimulants – ADHD Inhaled Anticholinergics Alcohol Abuse – Abstinence maintenance Glucocorticoids Opioid’s abuse – abstinence from opioids Leukotriene modifiers Smoking Abuse – abstinence from nicotine Antitussives: opioids / non-opioids Alzheimer’s medication Expectorants Myasthenia Gravis - Cholinesterase Inhibitor Mucolytics Anti-Parkinson’s - Dopaminergic Decongestants Anti-Parkinson’s – anticholinergic Antihistamines Antiepileptics Topical beta blockers – for open-angle glaucoma V- Medication affecting Cardiovascular Alpha2 adrenergic agonists Prostaglandin analogs System … 13 Carbonic anhydrase inhibitor (systemic) Diuretics – High-Ceiling loop diuretics Cholinergic (direct acting) Diuretics – thiazide diuretics Hypnotic/Sedative - Insomnia Medications Diuretics – potassium-sparing diuretics Hypnotic/Sedative – barbiturates Diuretics – Osmotic diuretics General Anesthetic Meds Meds for BP – ACE Inhibitor Meds for BP – Angiotensin II receptor blockers Meds for BP – aldosterone antagonists II- Medication for Pain and Inflammation Meds for BP – direct renin inhibitor … 08 Meds for BP – calcium channel blockers Salicylate Meds for BP – Alpha adrenergic blockers Nonsteroidal anti-inflammatory drugs – cox1 & Meds for BP – Centrally acting alpha2 agonists Cox2 Inhibitor Medication for Hypertensive crisis Nonsteroidal anti-inflammatory drugs – Cox2 Beta Blockers – Beta 1 Inhibitor Beta Blockers – Nonselective (1-2) Acetaminophen Organic Nitrates – Antianginal Drugs Opioids agonist Cardiac glycosides Topical analgesic Antidysrhythmic medication Adrenergic agonists - Catecholamines III- Medication affecting Anticholinergic-antimuscarinic Musculoskeletal System … 09 Antilipemic agents – Cholesterol medication  Antiflatulent VI- Medication affecting BLOOD … 19 Pancreatic enzymes Anticoagulants – IV / Sq Anticoagulants – oral (Vit K Inhibitor) X- Medication affecting the Immune Direct thrombin Inhibitor System … 31 Direct inhibitor of factor Xa Chemo Agents - Antimetabolites Antiplatelets Immunosuppressant – polypeptide Thrombolytic medication Antirheumatic – antimalarial Fibrinolysis inhibitor Antitumor – anthracyclines Erythropoietic growth factor Antimitotic – vinca alkaloids Leukopoietic growth factor Antineoplastic – alkylating agents Colloid Prostate cancer medication Blood products Breast cancer medication Biologic response modifier VII- Vitamins and Minerals … 22 Magnesium XI- Medication affecting the Reproductive Iron System … 33 Vit b12 - cyanocobalamin Estrogens Folic acid Progesterone Calcium Androgen Potassium 5-alpha reductase inhibitor Alpha1 adrenergic antagonists VIII- Medication affecting Endocrine Erectile dysfunction – phosphodiesterase type 5 System … 23 Inhibitor Insulin Medication affecting labor Oral antidiabetics Hyperglycemic meds XII- Medication for Infection … 35 Thyroid hormone Penicillins Antithyroid – thionamides, Iodine Cephalosporins Anterior pituitary hormone – growth hormone Carbapenems Antidiuretic hormone Glycopeptide antibiotic Adrenal hormone replacement Tetracyclines Mineralocorticoid Macrolides Hyperpituitarism Medication Lincosamides Aminoglycosides IX- Medication affecting GI … 27 Sulfonamides Antibiotics Urinary tract antiseptics Histamine2-receptor antagonist Fluoroquinolones Proton pump inhibitor Antiprotozoals Mucosal protectant Antifungals Antacids Topical antibacterial Prostaglandin e analog Topical fungal Antiemetics Psoriasis - topical Antidiarrheals Topical antiparasitic Laxatives Antitubercular medication Medication for Irritable Bowel Syndrome (IBS) Antiviral medication Medication for Inflammatory Bowel Disease Alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), midazolam (Versed), chlordiazepoxide (Librium) Use: Anxiety, seizures, muscle spasms, alcohol withdrawal, and induction and maintenance of anesthesia, Insomnia. Action: enhances GABA effects in the CNS. Relief from anxiety occurs rapidly. S/E: Sedation, amnesia, dependency/withdrawal, respiratory depression. Nurse: No grapefruit juice. Do not discontinue abruptly. Antidote: flumazenil. buspirone (Buspar) Use: Anxiety, panic disorder, OCD, PTSD. Action: Binds to serotonin and dopamine receptors in the brain. Increases N norepinephrine metabolism. Dependency is much less likely, and doesn’t cause ur sedation. Long-Term Use. Effects develop slowly (2-4 weeks) si S/E: Dizziness, nausea, headache, agitation. Nurse: Take with food. No grapefruit juice. Avoid Erythromycin, ketoconazole, ng St. John’s Wort Ex am paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac), citalopram, fluvoxamine Use: Anxiety, depression, OCD, PTSD, Panic disorders, Social Anxiety Su Action: Inhibits serotonin reuptake (increases serotonin). S/E: Sexual disfunction, weight gain, insomnia. cc Nurse: Watch for Serotonin Syndrome (agitation, confusion, hallucinations, fever, diaphoresis, tremors, myoclonus). Do not take with St. John’s wort, TCAs, or es MAOIs. Full effects not felt for up to 4 weeks. Taper Dose before Stopping. s venlafaxine (Effexor), duloxetine (Cymbalta), levomilnacipran (Fetzima) Use: Depression, Anxiety, Pain due to fibromyalgia, osteoarthritis, low-back pain, diabetic neuropathy. Action: Inhibits serotonin and norepinephrine reuptake (increases serotonin and norepinephrine). Similar effect to the SSRIs S/E: Nausea, weight loss, HT, Tachycardia, Dizziness, Sexual Disfunction, Serotonin Syndrome Nurse: Watch for Serotonin Syndrome (agitation, confusion, hallucinations, fever, diaphoresis, tremors, myoclonus). Avoid Alcohol and other CNS depressants. 1 bupropion (Wellbutrin, Zyban), trazodone (Oleptro), Vilazodone, Mirtazapine Use: Depression, Smoking cessation, alternative to SSRIs Action: Inhibits dopamine and norepinephrine uptake (Norepinephrine-Dopamine Reuptake Inhibitor). S/E: Headache, dry mouth, GI distress, weight loss, agitation, seizures, HT Nurse: MAOIs should be discontinued 2 weeks prior treatment. amitriptyline (Elavil), imipramine (Tofranil), Amoxapine, Doxepin, Clomipramine Use: Depression, neuropathic pain, fibromyalgia, anxiety, insomnia, ADHD, Bipolar N Action: Increases effect of serotonin and norepinephrine in the CNS by blocking reuptake of norepinephrine/serotonin. ur S/E: Sedation, orthostatic hypotension, anticholinergic effects (dry mouth, blurry si vision, Photophobia, urinary retention, constipation, Tachycardia), dysrhythmias, ng sweating, seizures. Nurse: To counteract anticholinergic side effects: chewing gums, wear sunglasses, Ex increase fluid (2-3L/day) and fiber intake. Take Med at Bedtime. am phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan) (PANAMA) Su Use: Depression, Bulimia, Panic Disorders, Anxiety, OCD, PTSD Action: Blocks MAOI enzymes in the brain, which increases levels of dopamine, cc norepinephrine, serotonin and tyramine in the body. S/E: Agitation, anxiety, orthostatic hypotension, hypertensive crisis. es Nurse: DO NOT eat foods rich in tyramine (aged cheese, avocados, bananas, red wine, s salami/pepperoni, chocolate, soy sauce). Full effects not felt for up to 4 weeks. Interaction with TCAs, SSRIs, ephedrine, amphetamines. lithium carbonate Use: Bipolar disorder. Controls episodes of Acute Mania Action: Produces neurochemical changes in brain, including serotonin receptor blockade. S/E: Fine hand tremors, polyuria, weight gain, kidney toxicity, electrolyte imbalances, fatigue, hypothyroidism, leukocytosis. Nurse: Administer with meals. Monitor for toxicity (plasma levels >1.5 mEq/L): coarse tremors, confusion, hypotension, seizures, tinnitus. No diuretics, anticholinergics, or NSAIDs. Contraindicated for patients with renal disease. Closely monitor sodium levels. Need adequate fluid and sodium intake. NursingExamSuccess 2 carbamazepine (Tegretol), valproic acid (Depakene), lamotrigine (Lamictal) Use: Treatment/Prevention of mania and depressive episodes. Carbamazepine Action: Decreases synaptic transmission in CNS. S/E: Blood dyscrasias (anemia, leukopenia, thrombocytopenia), vision issues (nystagmus, diplopia), hypo-osmolarity, rash, hepatotoxicity. Nurse: Monitor CBC levels. Administer at Bedtime, Valproic Acid: Action: It Increases GABA (inhibitor transmitter) in CNS. S/E: Hepatotoxicity, GI effects, pancreatitis, thrombocytopenia, hepatotoxicity Nurse: Monitor for liver function. Avoid in Children 66 lbs) NursingExamSuccess 17 atropine Use: for Sinus bradycardia, heart block Used to decrease secretions during surgery. Action: It inhibits ACh sites in the smooth muscles, secretory glands, and CNS. Decreases vagal stimulation of the heart, which allows for an increase in heart rate. S/E: Anticholinergic Side Effects (blurred vision, dry mouth, urinary retention, constipation, tachycardia) Nurse: Monitor urinary retention. Increase fluids and fiber intake to prevent constipation. HMG-CoA reductase Inhibitors (statins) atorvastatin (Lipitor), simvastatin (Zocor), Lovastatin, Pravastatin, Fluvastatin Use: for Hypercholesterolemia, prevention of coronary heart disease. Protects against MI. Action: It decreases production of LDL, increases production of HDL. N S/E: Hepatotoxicity, GI upset, muscle pain, rhabdomyolysis ur Nurse: Administer with EVENING meals (cholesterol is synthesized at night). Monitor liver function and CK levels. Avoid alcohol. No grapefruit juice. si ng Cholesterol Absorption Inhibitor ezetimibe (Zetia) Ex Use: Hypercholesterolemia Action: It inhibits absorption of cholesterol in the small intestine. am S/E: Hepatotoxicity, Myopathy, muscle pain Nurse: Monitor Liver function and CK levels. Su Bile-Acid Sequestrants colesevelam (Welchol), cholestyramine (Questran) cc Use: for Hypercholesterolemia. Action: It binds bile acids in intestine, causing increased excretions of cholesterol. Lowers LDL es cholesterol. S/E: Constipation GI Upset s Nurse: Increase fiber intake and fluid intake. Take with food and a full glass of water. Interferes with absorption of fat-soluble vit (ADEK) Fibrates gemfibrozil (Lopid), fenofibrate (Lipidil) Use: for Hypercholesterolemia. Action: It decreases triglyceride production and transport. Increases HDL levels. S/E: GI upset, gallstones, hepatotoxicity, muscle pain Nurse: Give 30 min bef breakfast and dinner. Monitor liver function Vitamin B3 niacin (Vit B3) Use: for Hypercholesterolemia. Action: It decreases lipoprotein and triglyceride synthesis (in large doses). S/E: Flushing of the face, GI upset, pruritis, hepatotoxicity, hyperglycemia. Nurse: Monitor Liver function. Use cautiously in patient with diabetes NursingExamSuccess 18 IV/SQ: heparin SQ (low molecular weight heparin): enoxaparin (Lovenox), Dalteparin Use: for Stroke, DVT, PE, and other thromboembolic disorders requiring fast anticoagulants. Action: It activates antithrombin, inhibit thrombus formation. Prevents new clots, does NOT break up existing clots. S/E: Bleeding, Heparin-Induced Thrombocytopenia, hypersensitivity Nurse: Monitor aPTT. Therapeutic aPTT: 1.5-2 times baseline. Antidote: Protamine. Monitor for bleeding (coffee ground emesis, tarry stools) warfarin (Coumadin) Use: Prevention and treatment of thromboembolic disorders (DVT, PE, AFIB with thrombus). Preventions of complications following a MI. N Action: It antagonizes Vit K, which prevents formation of several clotting factors. S/E: Bleeding, GI Upset, hepatitis ur Nurse: Monitor PT/INR. Therapeutic INR: 2-3 (it takes 3-5 days to get to therapeutic level). si Antidote: Vit K ng Ex dabigatran (Pradaxa), argatroban, Bivalirudin, desirudin am Use: Prevention and Treatment of Thrombosis (DVT), prevent strokes or embolisms. Action: It blocks thrombin receptors, which prevents the activation of clotting factors Su and decreases thrombus (clot) formation. S/E: Argatroban: Bleeding, hypotension. Dabigatran: Bleeding, GI upset, angioedema Nurse: Assess for bleeding cc es s rivaroxaban (Xarelto), apixaban (Eliquis) Use: Prevention of Stroke, DVT, PE. Treatment of DVT or PE. Action: Inhibits factor Xa to prevent formation of thrombin. S/E: Bleeding, elevated liver enzymes (ALT, AST, GGt). Nurse: Monitor liver function, hemoglobin, and hematocrit during therapy. NursingExamSuccess clopidogrel (Plavix), abciximab (Reopro), Ticagrelor, Dipyridamole, Aspirin → Pain/Inflammation Section Use: Prevention MI, Ischemic Stroke or TIA, Intermittent Claudication. Action: It inhibits platelet aggregation. S/E: Clopidogrel: Bleeding, GI upset, rash. Abciximab: Bleeding, hypotension, dysrhythmias. Nurse: Assess for bleeding. Monitor EKG and V/S for abciximab. 19 alteplase (Activase, tPA), streptokinase (Streptase), reteplase (Retavase) Use: Treatment Acute MI, ischemic stroke, PE, and occluded central IVs. Action: It converts plasminogen to plasmin, which breaks up fibrinogen. S/E: Bleeding. Contraindicated in patients who have had a hemorrhagic stroke, internal bleeding, recent trauma/surgery, severe hypertension. Nurse: For an ischemic stroke, administer within 3 hours of symptoms. Monitor labs and VS. Limit venipunctures and IM injections. aminocaproic acid (Amicar) Use: for Hemorrhage. Antidote for thrombolytic Medication (streptokinase). Action: It inhibits the activation of plasminogen, which inhibits fibrinolysis and enables clot formation. S/E: GI upset, hypotension N Nurse: Assess for bleeding or thromboembolism (hypercoagulation is a risk). ur si ng epoetin alfa: erythropoietin, darbepoetin alfa (long-acting) Use: for Anemia r/t chronic kidney disease, HIV, chemotherapy. Action: It stimulates bone marrow to increase production of red blood cells. Ex S/E: Hypertension (due to increase in Hct). Increased risk of DVT, stroke, MI and seizures. am Nurse: DO NOT agitate vial. Monitor BP and Hgb/Hct during therapy. Ensure sufficient Iron levels. IV or SQ bolus injection. Su cc filgrastim (Neupogen), Pegfilgrastin Use: Decreases risk of infection in Neutropenia (cancer, chemo, other es conditions) Action: It causes bone marrow to increase production of neutrophils. s S/E: Bone pain, leukocytosis (high WBC levels), splenomegaly. Nurse: DO NOT agitate vial. Monitor CBC twice a week. albumin Use: Hypovolemia, Shock, hemorrhage, burns, hemolytic disease in newborn. Action: Expands circulating blood volume by exerting oncotic pressure. S/E: circulatory overload, pulmonary edema, hypertension, sepsis, hyperkalemia. Nurse: Assess for signs of fluid overload. Contraindicated for HF patients. NursingExamSuccess 20 Whole Blood Use: Replacement therapy for acute blood loss, volume expansion Action: Increases circulating blood volume. S/E: Acute Hemolytic Reaction, Anaphylactic, Hyperkalemia, Sepsis, Circulatory Overload. Nurse: Assess VS during first 15-30 min (stay with patient). Administer Acetaminophen for Fever. If reactions, STOP transfusion. Have Epinephrine ready for IM or IV Injection. Check K Levels (K: 3.5-5) Packed Red Blood Cells (PRBCs) Use: Severe Anemia, Hemoglobinopathies, Erythroblastosis fetalis. Action: Increases the number of RBCs. N S/E: Acute Hemolytic Reaction, Anaphylactic, Hyperkalemia, Sepsis ur si Platelet Concentrate ng Use: Thrombocytopenia (