Nursing Pharmacology Handouts (Mr. Balano) PDF

NURSING ORLAN D. BALANO  p-isobutylhydratropic acid Chemical name Ibuprofen Alaxan,Medicol, Advil, Genpril, Haltran, Ibuprin, Generic Menadol, Midol IB, Motrin, name Motrin IB, Nuprin, Brand/Trade...

NURSING ORLAN D. BALANO  p-isobutylhydratropic acid Chemical name Ibuprofen Alaxan,Medicol, Advil, Genpril, Haltran, Ibuprin, Generic Menadol, Midol IB, Motrin, name Motrin IB, Nuprin, Brand/Trade names LEGAL REGULATIONS RA 9165 – Comprehensive Dangerous Drugs Act of 2002 –RA 10640 RA 9502 – Cheaper and Quality Medicines PHARMACODYNAMICS How the drug affects the body interaction between medications and target cells, body system, and organs to produce an effect  Drug–Enzyme Interactions –interfering with the enzyme systems –e.g. Acetazolamide Selective Toxicity –ability of a drug to attack only those systems found in foreign cells –e.g. Penicillin PHARMACOKINETICS How the body acts on the drug movement of medications molecules in the body Factors affecting rate of medication metabolism: Weight Psychological Age Environmental Gender Tolerance Physiological Cumulation Pathological Interactions – Drug –drug Genetic – Drug –alternative therapy Immunological – – Drug – food Drug – Laboratory test  Children- safety Observe, report, teach undesirable effects Meds – no OTC w/o consultation Pregnancy/lactating are out w/ meds Liver must be intact Interactions –pharmacological, assess & teach Allergies- assess; Do not administer if allergic Nutrition must be considered; Compliance w/ time & taking full course Elderly- safety, evaluate outcomes for all meds  A Safety During Pregnancy B C D X Regardless of the designated Pregnancy Category or presumed safety, no drug should be administered during pregnancy unless it is clearly needed.  Basic Pharmacological Principles and Safe Administration of Medications  Drugs according to use/purpose: Hygienic / prophylactic Palliative Specific/curative Supportive /supplementary/ restorative Chemotherapeutic Diagnostic  Antidotes/reversal agents for the drug Activated charcoal Syrup of ipecac Gastric lavage S–I–R–E–S 4 S: Stick, Sniff, Suck, Soak  Routes of Administration  Oral or enteral (tablets, capsules, liquids, suspensions, elixirs) Sublingual (SL) – under the tongue Buccal – between gums and cheek  Transdermal – placement: flat, non hairy surface, rotate site to prevent irritation Topical – never apply with bare hands  Instillation (drops, ointments, sprays) – Eye – lower conjunctiva from inner to outer canthus – Ears – unaffected side, sitting or side-lying Child Adult – Nose – supine with head positioned to allow medication to enter  Inhalation – –MDI – shaken vigorously 5-6x prior to use, 2 -4 cm in front of the mouth –DPI – not shaken, mouthpiece placed between the lips  Nasogastric and gastrostomy  Rectal – L lateral –Suppositories –Enema  Vaginal – dorsal recumbent hips and knees flexed  Parenteral –tuberculin syringe (less than 1 ml) –needle lumen large – increased viscosity –bevel up –Avoid massage with Heparin or Z track –Two meds: vial (1st) and ampule (2nd) –Two meds: 2 vials – inject air to vial A then vial B, withdraw meds from vial B then A –Intradermal - G 25-27, ¼ - 5/8 inch needle, 1 ml tuberculin syringe 10-15˚ angle 1-2 mm depth bevel up Ventral forearm, scapula, upper chest –Subcutaneous (SC) – G 25, 5/8” (adults), 3/8, ½”” (child) 45˚ angle – thigh or arm 90˚ angle abdomen Lateral aspect of upper arm, anterior thigh, abdomen (1 inch away from umbilicus, back (scapular area) – Intramuscular – G21-22, 1-2 inch needle (maximum volume 5 ml) –90˚ angle –ventrogluteal, dorsogluteal, deltoid (for small doses less than 2 ml), vastus lateralis (pediatric) –Z track – G20-22, 2-3 inches long Dorsogluteal Iron preparation   Intravenous – rapid onset Intermittent therapy – Heparin lock  S – Saline = flush 2ml  A – Administer meds  S – saline = flush 2ml  H – Heparin = flush 10-100 units  Secondary piggy back/add-a-line IV push Electronic regulators »Syringe infusers »Infusion pumps/controllers  Medication Calculation: Dosage/Stock Available Dosage/Stock Available X Volume of Diluent Weight in Kg X Dosage (mg/kg/day) IV Fluids: gtts/min = TVI x DF H 60 min/H Pediatric dosage: Pediatric dosage:  Medication Calculation: Dosage/Stock Available Dosage/Stock Available X Volume of Diluent Weight in Kg X Dosage (mg/kg/day) IV Fluids: gtts/min = TVI x DF H 60 min/H Doctor's order says: "Infuse 1500 mL of Lactated Ringer’s over 12 hours." Drip factor: 15 gtt/mL 1. 31 gtt/min 2. 32 gtt/min 3. 95 gtt/min 4. 15 gtt/min Doctor's order says: "2L of D5 1/2 Normal Saline with 50 meq Potassium Chloride to infuse over 48 hours." Drip factor: 15 gtt/mL 1. 50 gtt/min 2. 20 gtt/min 3. 10 gtt/min 4. 16 gtt/min 6. 1.2 ________ml. 3.4 ________ml  0.97 ________ml  DRUG EFFECTS DRUG-INDUCED TISSUE AND ORGAN DAMAGE Classification of Medications by Body Systems: CHEMOTHERAPEUTIC AGENTS ANTI-INFECTIVES  Anti-infectives treats systemic infection and prophylaxis Bactericidal Bacteriostatic  ANTIBIOTICS, ANTIVIRALS, ANTIFUNGALS, ANTIPARASITICS  AMINOGLYCOSIDES Bactericidal Gentamycin Amikacin Kanamycin Neomycin Streptomycin* Tobramycin  GI effect- nausea, vomiting, diarrhea  CNS effect-dizziness,confusion  One can’t feel..neurotoxicity  One can’t hear..ototoxicity*  One can’t pee..nephrotoxicity  CARBAPENEMS Bactericidal Doripenem Ertapenem Imipenem-cilastin Meropenem CEPHALOSPORINS – similar to the penicillins in structure and in activity – both bactericidal and bacteriostatic 1st generation – Cefadroxil, Cephalexin (Keflex), Cepharadine (Velosef), Cefazolin (Ancef), Cephalothin Na (Keflin), Cephapirin Na (Cefadyl)  2nd generation – Cefproxil, Cefaclor (Ceclor), Cefoxitin (Mefoxin), Cefuroxime (Ceftin), Cefamandole naftate (Mandol) 3rd generation – Cefdinir, Cefotaxime (Claforan), Ceftriaxone (Rocephin), Ceftazidime (Fortaz), Cefpodoxime (Vantin), CEftibuten (Cedax), Ceftizoxime (Cefizox) 4th generation – Cefepime (Maxipime), Cefditoren (Spectracef), Ceftaroline (Teflaro) FLUOROQUINOLONES Synthetic class of antibiotics, broad spectrum activity Ciprofloxacin Gemifloxacin Levofloxacin Norfloxacin Ofloxacin Moxifloxacin (2001) Anthrax prevention Effective against Typhoid fever  Ketolides –Telithromycin Lincosamides –Clindamycin (Cleocin) –Lincomycin (Lincocin) Lipoglycopeptides –Televancin  MACROLIDES AZITHROMYCIN (Zithromax) Clarithromycin, Dirithromycin, Erythromycin cross the placenta and enter the breast milk used as prophylaxis for endocarditis  GI disturbances IV site-check for irritation Reduces activity if given with acids (fruit juices) or food Liver function tests  MONOBACTAM Aztreonam (Azactam)  PENICILLINS penicillin G benzathine (Bicillin) penicillin G potassium (Pfizerpen) penicillin G procaine (Wycillin) penicillin V (Veetids)  Penicillinase –Resistant Antibiotics - Methicillin, Nafcillin, Oxacillin Aminopenicillin – Ampicillin, Amoxicillin trihydrate (Amoxil, Trimox) Extended -Spectrum Penicillins – Carbenicillin, Piperacillin Na Penicillin/Beta-Lactamase Inhibitor combinations – Amoxicillin/potassium clavulanate (Augmentin), Piperacillin/Tazobactam (Zosyn)  SULFONAMIDES Inhibits FOLIC ACID synthesis Sulfadiazine Sulfisoxazole (Gantrisin) Sulfasalazine (Azulfidine) Cotrimoxazole (Septra, Bactrim)  TETRACYCLINES Demeclocycline Doxycycline Minocycline Oxytetracycline Interactions with OC: DECREASES EFFECTIVENESS Increases DIGOXIN toxicity  ANTIMYCOBACTERIALS AntiTB drugs Firs line: –RIFAMPICIN –ISONIAZID –PYRAZINAMIDE –ETHAMBUTOL –STREPTOMYCIN  Second Line –Capreomycin –Cycloserine –Ethionamide –Rifabutin  Leprostatic –Dapsone ANTIVIRALS Agents for Influenza A and Respiratory Viruses Amantadine (Symmetrel) Oseltamivir (Tamiflu)* Ribavirin (Virazole) Rimantadine (Flumadine) Zanamivir (Relenza) *effective tx H1N1 and avian flu Agents for Herpes Virus and Cytomegalovirus Acyclovir (Zovirax) Cidofovir Famciclovir Foscarnet Ganciclovir (Cytovene) Valacyclovir Valganciclovir Agents for HIV and AIDS Nonnucleoside Reverse Transcriptase Inhibitors – have direct effects on the HIV virus activities within the cell Delavirdine Efavirenz Etravirine Nevirapine Rilpivirine Nucleoside Reverse Transcriptase Inhibitors – first class of drugs developed to treat HIV infections – compete with the naturally occurring nucleosides within a human cell that the virus would need to develop Abacavir Didanosine (Videx) Emtricitabine Lamivudine (Epivir) Stavudine Tenofovir Zidovudine (retrovir) Protease Inhibitors Atazanavir Darunavir Proto fosamprenavir Indinavir Lopinavir Nelfinavir Ritonavir Saquinavir Tipranavir Fusion Inhibitor - Enfuvirtide CCR5 Coreceptor Antagonist - Maraviroc Integrase Inhibitor - Raltegravir Anti–Hepatitis B Agents Adefovir (Hepsera) Entecavir Telbivudine Anti–Hepatitis C Agents Boceprevir Telaprevir Locally Active Antiviral Agents Docosanol Ganciclovir Imiquimod Penciclovir Trifluridine  ANTIFUNGALS Systemic: Amphotericin B, Fluconazole (Diflucan), Ketoconazole (Nizoral), Griseofulvin, Nystatin (Mycostatin, Nilstat), Terbinafine (Lamisil) Topical: Clotrimazole, Miconazole, Ketoconazole, Terbinafine (Lamisil) Others: Gentian violet  Z OLE – many drug interactions can occur O bserve hygiene measures to control infection L iver Function Tests – monitor E ducate to take with food Topical-local irritation /burning Systemic-Phlebitis ANTIPARASITIC ANTIPROTOZOAL: AMEBICIDE Metronidazole (Flagyl) F lushing A LCOHOL will cause these effects I ncreased vomiting-unpleasant taste N ausea T achycardia If Flagyl is mixed w/ alcohol, there will be a disulfiram-like reaction  ANTIMALARIAL Quinine (Qualaquin) Chloroquine (Aralen Phosphate) Primaquine Pyrimethamine (Daraprim)  ANTIHELMINTHIC Mebendazole (Vermox) Albendazole Ivermectin Pyrantel Praziquantel (Biltricide)  ANTINEOPLASTICS (CYTOTOXIC, ANTIPROLIFERATIVE AGENTS)  UNDESIRABLE EFFECTS FROM ANTICANCER DRUGS B one marrow depression A lopecia, Anorexia R etching- nausea/vomiting F ear and anxiety S tomatitis  C BC, platelets- monitor A ntiemetics before drug N ephrotoxicity- UE C ounseling regarding reproduction issues E ncourage handwashing, avoid crowds R ecommend a wig for alopecia CLASSIFICATION OF CHEMOTHERAPEUTIC AGENTS CELL CYCLE-SPECIFIC GROUP destroy cancer cells at specific stage of cell division –Antimetabolites –Antitumor antibiotics –Vinca Alkaloids –Topoisomerase inhibitors –Taxanes –Miscellaneous  ANTIMETABOLITES interfere w/ biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis S Phase – Cytarabine (Ara – C, Cytosar) – 5 Flourouracil (5-FU) – 6 – Mercaptopurine (6-MP, Purinethol) – Methotrexate (Mexate) – 6 –Thioguanine (6 – TG) – Fludarabine (Fludara) – Pentostatin (Nipent) ANTITUMOR ANTIBIOTICS interfere with DNA synthesis by binding DNA; prevent RNA synthesis – Chlorambucil (Leukeran) – Bleomycin (Blenoxane) – Dactinomycin (Cosmegen) – Daunurobicin (Cenubidine) – Doxorubicin (Adriamycin) – Idarubicin (Idamycin) – Mitomycin C (Mitomycin) – Mitoxantrome (Novantrone) – Plicamycin (Mithracin)  VINCA ALKALOIDS Mitotic inhibitor – arrest metaphase by inhibiting mitotic tubular formation (spindle)l inhibit DNA and protein synthesis – M Phase Vinorelbine (Navelbine) Vincristine (Oncovine) Vinblastine (Velban) EIPODOPYLLOTOXINS – TOPOISOMERASE INHIBITORS Topoisomerase – enzyme needed for DNA synthesis and cell division –Etoposide (VP -16) –Teniposide (VM-26, Vumon)  TAXANES Mitotic inhibitor M phase –Paclitaxel (taxol)  Protein Tyrosine Kinase Inhibitors – Imatinib (Gleevec) Epidermal Growth Factor Inhibitor – Erlotinib (Tarceva) Proteasome Inhibitor – Bortezomib (Valcade)  Miscellaneous –L-Asparaginase –Hydroxyurea (Hydra) –Talc Powder (Sclerosol) –Topotecan (Hycamtin) –Tretinoin (Vesanoid) CELL CYCLE NON-SPECIFIC GROUP destroy cancer cells at any stage of cell division –Alkalyting Agents –Hormonal therapy –Nitrosureas  ALKALYTING AGENTS alter DNA structure by misreading DNA code, initiating breaks in DNA molecule, cross-linking of DNA strands – Busulfan (Myleran) – Carboplatin (Paraplatin) – Cisplatin (CDDP, Platinol – AO) – Cyclophosphamine (Cytoxan) – Ifosfamide (lfex) – Mechlorethamine HCI (Mustargen) – Thiopeta  HORMONAL THERAPY bind to hormone receptor sites that alter cellular growth block binding of estrogens to receptor sites (antiestrogens) inhibit RNA synthesis suppress aromatase of P450 system which decreases estrogen stage specific G1  Glucocoticods –Prednisone (Deltasone) –Methyprednisolone (Solu-Medrol, Medrol) –Dexamethasone (Decadron)  Estrogens –Chlorotrianisene (Tace) –Diethylstilbestrol (DES) –Estradiol (Estrace)  Antiestrogens – Hormone antagonist –block hormones on hormone- binding tumors ie: breast, prostate, endometrium; cause tumor regression Tamoxifen (Nolvadex)  Progestins – Depo-Provera – Megestrol acetate (Megace) – Leoprolide (Lupron) Nitrosoureas similar to alkylating agents; cross the blood-brain barrier – Carmustine (BCNU) – Lomustine (CCNU) – Streptozocin (Zanosar)  LUNGS Busulfan LUNGS HEART Bleomycin Doxorubicine HEART Daunomyci KIDNEY Cytoxan LIVER Mercaptopurine n BRAIN Vincristine HEART BRAIN Daunorubicin Velban LIVER Methotrexat TRUSH KIDNEY ORAL5FU Ara-C e KIDNEY Cisplatin KIDNEY BRAIN Cytarabine Vinca alkaloids Drugs affecting the cardiovascular system DRUGS AFFECTING BLOOD PRESSURE ANTIHYPERTENSIVE DRUGS Angiotensin-Converting Enzyme (ACE) Inhibitors Angiotensin II–Receptor Blockers Calcium Channel Blockers Vasodilators Vasodilators for Pulmonary Artery Hypertension Other Antihypertensive Agents  act in the LUNGS to prevent ACE from converting angiotensin I to angiotensin II = VASOCONSTRICTOR Benazepril (Lotensil) Captopril (Capoten) Enalapril (Vasotec) Enalaprilat Fosinopril Lisinopril Moexipril Perindopril Quinapril (Accupril) Ramipril Trandolapril  Angiotensin II–Receptor Blockers Azilsartan Candesartan Eprosartan Irbesartan Losartan Olmesartan Telmisartan Valsartan Calcium Channel Blockers  Amlodipine (Norvasc)  Clevidipine  Diltiazem (Cardizem)  Felodipine  Isradipine  Nicardipine  Nifedipine (Procardia)  Nisoldipine  Verapamil (Calan)  Vasodilators Hydralazine (Apresoline) Minoxidil Nitroprusside (Nitropress)  Vasodilators for Pulmonary Artery Hypertension Ambrisentan Bosentan Epoprostenol Iloprost Sildenafil Tadalafil Treprostinil  Other Antihypertensive Agents Diuretic Agents Thiazide and Thiazide-Like Diuretics – Bendroflumethiazide – Chlorothiazide (Diuril) – Hydrochlorothiazide – Hydroflumethiazide – Methyclothiazide – Chlorthalidone – Indapamide – Metolazone Potassium-Sparing Diuretics Amiloride (Midamor) Spironolactone (Aldactone) Triamterene (Dyrenium)  Renin Inhibitor – Aliskiren Sympathetic Nervous System Drugs Beta-Blockers Acebutolol Atenolol (Tenormin) Betaxolol Bisoprolol Carteolol Metoprolol (Lopressor) Nadolol (Corgard) Nebivolol Penbutolol Pindolol Propranolol (Inderal) Timolol  Bradycardia Lipidemia (inc);Libido (decrease) brOnchospasm CHF; Conduction abnormalities Konstriction peripheral vascular Exhaustion; Emotional depression Reduces recognition of hypoglycemia  Alpha- and Beta-Blockers –Carvedilol Labetalol (Normodyne) –Guanabenz Alpha-Adrenergic Blockers –Phenoxybenzamine –Phentolamine (Regitine)  Alpha 1-Blockers – Doxazosin (Cardura) – Prazosin (Minipress) – Terazosin Alpha 2-Blockers – Clonidine (Catapres) – Guanfacine – Methyldopa  ANTIHYPOTENSIVE AGENTS Sympathetic Adrenergic Agonists or Vasopressors – Dobutamine (Dobutrex) – Dopamine (Intropin) – Ephedrine – Epinephrine (Adrenalin, EpiPen) – Isoproterenol (Isuprel) – Norepinephrine (Levophed) – Phenylephrine (Neo-Synephrine) Alpha-Specific Adrenergic Agent - Midodrine CARDIOTONIC AGENTS –increases the contractility of the heart muscle CARDIAC GLYCOSIDES : DIGOXIN (LANOXIN) D- Digoxin level 0.5 – 1.5 ng/ml I- increases myocardial contractility G- GI or CNS sign indicate adverse effects Digoxin Antidote- Digoxin immune Fab Check for headache, weakness, drowsiness & vision changes(a yellow halo around objects) Check apical pulse for 1 full min  Digoxin Dobutamine Diuretics (+)Inotropic _____ (+)Inotropic _____ AM Taken_______ (-) Chronotropic _____ (+) Chronotropic _____ Wt Monitor patient’s ______ Daily Bradycardia - Withhold the medication K+- Wasting F urusemide Adult: Quinidine (Quinaglute) > Metoprolol (Lopressor) Contraindicated : AV Block > Carvedilol (Coreg) Group I-B (suppresses > Atenolol (Tenormin) automatinicity in the bundle of His-Purkinje system) > Lidocaine (Xylocaine) Group III Group IV Potassium-Channel Blockers Calcium -Channel Blockers > Amiodarone (Cordarone) “VERY NICE DRUG” > Verapamil (Isoptin) > Nefedipine (Procardia) > Diltiazem (Cardizem)  ANTIANGINAL AGENTS improve blood delivery to the heart muscle in one of two ways (1) by dilating blood vessels or (2) by decreasing the work of the heart  Nitrates act directly on smooth muscle to cause relaxation and to depress muscle tone Amyl nitrate Isosorbide dinitrate (Isordil) Isosorbide mononitrate (Imdur, Monoket) Nitroglycerin (Nitrobid, Nitrostat)  Beta-Blockers – Metoprolol – Nadolol – Propranolol Calcium Channel Blockers – Amlodipine (Norvasc) – Diltiazem (Cardizem) – Nicardipine (Cardene) – Nifedipine (Adalat, Procardia) – Verapamil (Calan, Isoptin) Piperazineacetamide – treats chronic angina – Ranolazine ANTILIPEMIC (LIPID- LOWERING AGENTS) BILE- ACID SEQUESTRANT  Decrease plasma cholesterol levels Cholestyramine (Questran) Colesevelam Cholestipol (Colestid)  HMG CoA (hydroxymethylglutaryl- coenzyme A) INHIBITOR Atorvastatin (Lipitor) Simvastatin (Zocor) Fluvastatin Lovastatin Pitavastatin Pravastatin Rosuvastatin CHOLESTEROL ABSORPTION INHIBITOR Ezetimibe FIBRATES Fenofibrate Fenofibric acid  Gemfibrozil (Lopid)  ANTIHYPERLIPIDEMIC HMG-CoA reductase inhibitors Fibric Acid Derivatives Bile acid Sequestrants  Atorvastatin (Lipitor) - Decrease Triglycerides - Lipid bind with Fats then  Lovastatin (Mevacor) excreted through stool.  Rosuvastatin (Crestor)  FenoFIBRate (Antara,  Simvastatin (Zocor) Lipofen, Tricor, Triglide)  Cholestyramine  GenFIBRrozil (Lopid) (questran) Sips of water.  Colestipol (Colestid) Taken at HS Aching muscle (rhabdomyolysis) Watch out for: Annual Eye exam  Decrease A.D.E.K Teratogenic absorbtion (fat soluble Increase HDL, decrease LDL vitamins) Normal liver function test must be established. (hepatotoxic) VASO-OCCLUSION MEDICATIONS ANTIPLATELETS THROMBOLYTICS  Dipyridamole (Persantine)  StreptoKINASE (Streptase)  Clopidogrel (Plavix)  UroKINASE (Kinlytic)  Aspirin / Abciximab  AlteplASE (Activase)  Ticlopidine (Ticlid) ANTIDOTE: Aminocaproic Acid (Amicar) DRUGS AFFECTING BLOOD COAGULATION  Antiplatelet Agents decrease the formation of the platelet plug – Abciximab (ReoPro) – Anagrelide (Agrylin) – Aspirin – Cilostazol (Pletal) – Clopidogrel (Plavix) – Dipyridamole (Persantine) – Eptifibatide – Ticlopidine (Ticlid) – Ticagrelor – Tirofiban ANTICOAGULANTS  Antithrombin argatroban Bivalirudin dabigatran Desirudin fondaparinux Heparin rivaroxaban Warfarin (Coumadin)  Thrombolytic Agents Alteplase (Activase) Reteplase Tenecteplase Urokinase  ANTICOAGULANTS Heparin Warfarin Enoxaparin (Lovenox) Coumadine NORMAL THERAPEUTIC NORMAL THERAPEUTIC LAB Partial Thromboplastin time Prothrombin Time TESTS (aPTT) 20-36 (aPTT) 60-80 (PT) 9-12 (PT)< 30 seconds Seconds seconds seconds Clotting 5-15 Clotting 16-20 INR 1 INR 2-3 minutes minutes ANTIDOTE Protamine Sulfate Vitamin K *Fondapari nux (Arixtra) OTHER DRUGS AFFECTING CLOT FORMATION Low-molecular-weight heparins – Enoxaparin (Lovenox) – Dalteparin (Fragmin) Anticoagulant adjunctive therapy – Protamine sulfate – Vitamin K Hemorrheologic agent – Pentoxifylline (Trental) DRUGS USED TO CONTROL BLEEDING  Antihemophilic agents antihemophilic factor antiinhibitor coagulant complex coagulation factor VIIa factor IX factor IX complex factor XIII concentrate  Hemostatic Agents Systemic - Aminocaproic acid (Amicar) Topical absorbable gelatin (Gelfoam) human fibrin sealant microfi brillar collagen thrombin thrombin, recombinant DRUGS USED TO TREAT ANEMIAS  Erythropoiesis Stimulating Agents darbepoetin alfa epoetin alfa (Epogen, Procrit) Peginesatide (Omontys)  Agents Used for Iron Deficiency Anemia Ferrous fumarate ferrous gluconate Ferrous sulfate ferrous sulfate exsiccated ferumoxytol iron dextran Iron sucrose sodium ferric gluconate complex  Agents Used for Other Anemias Agents for Megaloblastic Anemias – Folic Acid Derivatives – Folic acid (Folvite) – Leucovorin (Wellcovorin) – Levoleucovorin – Vitamin B12 cyanocobalamin – Hydroxocobalamin Agent for Sickle Cell Anemia – Hydroxyurea DRUGS AFFECTING THE ENDOC SYSTEM  Drugs Affecting Hypothalamic Hormones Agonists Goserelin Histrelin Leuprolide Nafarelin Tesamorelin Antagonists Degarelix Ganirelix  Drugs Affecting Anterior Pituitary Hormones Growth Hormone Agonists Somatropin (Humatrope) Somatropin rDNA origin Growth Hormone Antagonists Bromocriptine mesylate (Parlodel) Lanreotide Octreotide acetate (Sandostatin) Pegvisomant  Drugs Affecting Other Anterior Pituitary Hormones chorionic gonadotropin chorionic gonadotropin alpha corticotropin cosyntropin menotropins (Pergonal) thyrotropin alpha  Drugs Affecting Posterior Pituitary Hormones Conivaptan Desmopressin Tolvaptan  Adrenocortical Agents Glucocorticoids – Beclomethasone (Beclovent) Betamethasone(Celestone) – Budesonide (Rhinocort) – Cortisone – Dexamethasone (Decadron) – Flunisolide (Aerobid) – Hydrocortisone (Cortef) – Methylprednisolone (Medrol) – Prednisolone (Delta-Cortef) – Prednisone (Deltasone) – Triamcinolone (Aristocort) Mineralocorticoids Cortisone Fludrocortisone (Florinef) Hydrocortisone  Thyroid Agents Thyroid Hormones Levothyroxine (Synthroid) Liothyronine (Cytomel) Liotrix Thyroid desiccated  Antithyroid Agents Thioamides Methimazole (Tapazole) Propylthiouracil Iodine Solutions Sodium iodide I131 Strong iodine solution Potassium iodide  Parathyroid Agents Antihypocalcemic Agents Calcitriol Teriparatide  Parathyroid Agents Antihypercalcemic Agents Bisphosphonates – Alendronate (Fosamax) Etidronate – Ibandronate Pamidronate – Risedronate Tiludronate – Zoledronic acid Calcitonins – Calcitonin salmon AGENTS TO CONTROL BLOOD GLUCOSE LEVELS  Insulin Insulin Analog or Lispro (Humalog) Insulin aspart (Novolog) Insulin glargine (Lantus) Insulin glulisine (Apidra) Insulin detemir (Levemir) Regular insulin (Humulin R) NPH insulin (Humulin N)  Sulfonylureas and Other Antidiabetic Agents Sulfonylureas First-Generation Sulfonylureas – Chlorpropamide Tolazamide – Tolbutamide Second-Generation Sulfonylureas – Glimepiride Glipizide – Glyburide  Other Antidiabetic Agents Alpha-Glucosidase Inhibitors – Acarbose Miglitol Biguanide - Metformin Dipeptidyl Peptidase-4 Inhibitor – Linagliptin Saxagliptin – Sitagliptin  Human Amylin - Pramlintide Incretin Mimetic – Exenatide Liraglutide Meglitinides – Nateglinide Repaglinide Thiazolidinediones – Pioglitazone Rosiglitazone Glucose-Elevating Agents Diazoxide Glucagon  PHARMACOLOGIC TREATMENT INSULIN TYPE OF EXAMPLE ONSET PEAK DURATION INSULIN RAPID ACTING “log” HUMALOG 10-15 mins 1 hour 3 hour NOVOLOG APIDRA LISPRO SHORT ACTING REGULAR “R” INSULIN HUMALIN-R 1/2-1 hour 2-3 hours 4-6 hours NOVOLIN-R INTERMIDIATE NPH “N” “LENTE” ACTING HUMALIN-N 2-4 hours 6-12 hours 16-20 hours NOVOLIN-N LONG ACTING ULTRALENTE “U” 6-8 hours 12-16 hours 20-30 hours HUMALIN-U VERY LONG GLARGINE (LANTUS) 1 hour Continuous 24 hours ACTING  SULFONYLUREAS NON-SULFONYLUREAS (-mide,-ride,-zide) Promote insulin secretion by the pancreas; may ALPHA GLUCOSIDASE INHIBITOR also increase tissue response to insulin. -Delay carbohydrate digestion and absorption, thereby decreasing the postprandial rise in blood Acethexamide (Dymelor) glucose Chlorpropamide (Diabenese) Acarbose (Precose) Glimeperide (Amaryl) Miglitol (Glyset) Glipizide (Glucontrol) BIGUANIDE Glyburide (DiaBeta, Micronase) - Decreases glucose production by the liver; Tolazamide (Tolinase) increases tissue response to insulin Tolbutamide (Orinase) SULFONYLUREAS Metformin (Glucophages) MEGLITINIDE -Promote insulin secretion by the pancreas Nateglinide (Stalix) Repaglinide (Prandin) THIOZOLIDINEDIONES - Decrease insulin resistance, and thereby increase glucose uptake by muscle and adipose tissue and decrease glucose production by the liver. Pioglitazone (Actos) Rosiglitazone (Avandia) The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. a. Insomnia b. Weight loss c. Bradycardia d. Constipation e. Mild heat intolerance The nurse is teaching a client how to mix regular insulin and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching? a. Withdraws the NPH insulin first b. Withdraws the regular insulin first c. Injects air into NPH insulin vial first d. Injects an amount of air equal to the desired dose of insulin into each vial A nurse is caring for several clients with type 1 diabetes, and they each have a prescription for a specific type of insulin. Which insulin does the nurse conclude has the fastest onset of action? a. Insulin lispro (Humalog) b. Insulin glargine (Lantus) c. NPH insulin (Novolin N) d. Regular insulin (Novolin R) DRUGS AFFECTING GASTROINTESTINAL SYSTEM ANTI-ULCER MEDICATIONS  MECHANISM OF HCL Proton Pump STOMAC Inhibitor H FOOD STIMULI H+ K+ H2 Receptor HISTAMINE PARIETAL CELL Proton ATPase Pump Acetylcholine Gastrin H2 Receptor HCL ANTACID -to neutralized the acid BLOCKER Injury to the Mucosal = Lining ULCER GASTROINTESTINAL MEDICATIONS ANTACIDS H2-RECEPTOR PROTON-PUMP CYTOPROTECTIVE AGENTS BLOCKER INHIBITORD CARAFATE CYTOTEC Example Aluminum hydroxi “tidine” “Prazole” Sucralfate Cytotec (Amphojel) Cimetidine (Tagamet) Pantroprazole (Carafate) (Misoprostol) Magnesium hydroxide Ranitidine (Zantac) (Protonix) (Milk of Magnesia) Famotidine (Pepcid) Omeprazole MAALOX (Prilosec) Esomeprazole (Nexium) Action Neutralized or buffer ↓ HCL ACID Production Coat the ulcer ↑ Mucosal Lining HCL acid Best After Meal With Meals Before Meal Before Meal With Meal Time to (1-3 hours pc) HS (1 hour ac) Take Side Aluminum hydroxide Nausea & Vomiting Nausea & Vomiting Constipation A/E: Birth defect, Effect -CONSTIPATION Anorexia Anorexia Abortifacient Magnesium hydroxide Diarrhea Diarrhea effect (Milk of Magnesia) Abdominal Cramps Abdominal Cramps -DIARRHEA A/E: ANXIETY  H2 HISTAMINE ANTAGONISTS CIMETIDINE FAMOTIDINE NIZATIDINE RANITIDINE *Blocks the release of acid*  D on’t take w/ antacids I nform provider of bleeding N o smoking, alcohol or NSAIDs E levate head of bed *Give drugs with or before meals and at bedtime *  Antacids Aluminum salts Calcium salts Magaldrate Magnesium salts Sodium bicarbonate  PROTON PUMP INHIBITORS Dexlansoprazole Esomeprazole (Nexium) Lansoprazole Omeprazole Pantoprazole Rabeprazole  GI PROTECTANT ANTIPEPTIC – PEPSIN INHIBITOR Sucralfate (Carafate) Protect the eroded ulcer site from further damage by acid PROSTAGLANDIN E ANALOG Misoprostol (Cytotec) For long term NSAID therapy to prevent gastric ulcers CI: pregnancy – causes: cervical ripening  Drugs Used to Treat Digestive Enzyme Dysfunction PANCREATIC ENZYMES  Pancreatin (Dizymes)  Pancrelipase (Cotazym) DRUGS AFFECTING GASTROINTESTINAL MOTILITY Laxatives Chemical Stimulants –Bisacodyl (Dulcolax) –Cascara –Castor oil –Senna (Senokot) Bulk Stimulants – Lactulose (Chronolac) – Magnesium citrate – Magnesium hydroxide (MOM) – Magnesium sulfate (Epsom salts) – Polycarbophil (FiberCon) – Polyethylene glycol- electrolyte solution (GoLYTELY) – Psyllium (Metamucil)  Lubricants –Docusate (Colace) –Glycerin –Mineral oil Other Laxatives –Methylnaltrexone Gastrointestinal Stimulants increase in GI activity and secretions –Dexpanthenol –Metoclopramide (Reglan) ANTIDIARRHEAL 2 categories: Adsorbents – Bismuth subsalicylate (Pepto- Bismol) – Kaolin and Pectin (Kaopectate) Opiates – Loperamide (Imodium) – Diphenoxylate HCL with Atropine (Lomotil) – Opium Tincture (Paregoric  D rowsiness, dizziness, dry mouth, I nhibits gastric mobility A lcohol is out R eport if there is a narcotic drug Hx R esponse of a drug determined prior to driving H abit forming- only take prescribed dose E lectrolytes- monitor w/ severe diarrhea; encourage clear liquids A ssess frequency of BM; bowel sounds  Irritable Bowel Syndrome Drugs Alosetron Lubiprostone Hyoscyamine  ANTIEMETICS Phenothiazines –Chlorpromazine (Thorazine) –Perphenazine –Prochlorperazine –Promethazine (Phenergan) Nonphenothiazine – –Metoclopramide (Reglan) Anticholinergics/ Antihistamines Buclizine (Bucladin) Cyclizine Meclizine (Antivert)  5-HT3 receptor antagonists: Ondansetron (Zofran) – tx chemotherapy induced nausea and vomiting (CINV), postop NV (PONV) Dolasetron Granisetron Palonosetron  Substance P/Neurokinin 1 Receptor Antagonist – Aprepitant Miscellaneous Agents – Dronabinol – Hydroxyzine (Vistaril) – Nabilone – Trimethobenzamide (Tigan) - PONV  EMETICS –Ipecac Syrup –Apomorphine HCl DRUGS AFFECTING THE IMMUNE SYSTEM ANTI-INFLAMMATORY, ANTIARTHRITIS AND RELATED AGENTS  Salicylates ANTIPYRETIC ANALGESIC ANTI-INFLAMMATORY Inhibits PROSTAGLANDIN synthesis Aspirin Balsalazide Choline magnesium Trisalicylate Diflunisal Mesalamine Olsalazine Salsalate Sodium thiosalicylate NONSTEROIDAL ANTI- INFLAMMATORY AND RELATED AGENTS  Nonsteroidal Anti- Inflammatory Agents (NSAIDs) Propionic Acids Fenoprofen Furbiprofen Ibuprofen (Motrin, Advil) Ketoprofen Naproxen (Naprosyn) Oxaprozin Acetic Acids Diclofenac (Voltaren) Etodolac Indomethacin (Indocin) Ketorolac (Toradol) Nabumetone Sulindac Tolmetin Fenamates Meclofenamate Mefenamic acid (Ponstan) Oxicam Derivatives Meloxicam (Mobic) Piroxicam (Feldene) Cyclooxygenase-2 Inhibitor Celecoxib (Celebrex) Related Agent Acetaminophen (Tylenol)  N o alcohol S E: “BIRTH” (Bone marrow depression, Increased GI distress, Renal toxicity, Tinnitus & Hepatotoxicity) A spirin sensitivity- do not give I nhibits prostaglandins D o take w/ food S top 5-7 days before surgery  Antiarthritis Agents Gold Compounds *Chrysotherapy Auranofin (Ridaura) Gold sodium thiomalate (Aurolate) Other Antiarthritis Drugs - DMARDs Anakinra (Kineret) Etanercept (Enbrel) Hyaluronidase derivatives Leflunomide Penicillamine Sodium hyaluronate ANTI-GOUT ALLOPURINOL (ZYLOPRIM) G ulp 10-12 glasses (8oz) of fluid daily O utput & input- monitor closely U ric acid production decreased SE no alcohol T ake after meals – Avoid: beer, ale, wine, smoked meats and high CHON diets  IMMUNE MODULATORS Immune Stimulants Interferons INTERLEUKINS Colony-stimulating factors – filgrastim (Neupogen) – pegfilgrastim – sargramostim Immune Suppressants Fingolimod Lenalidomide Thalidomide  T- and B-Cell Suppressors Abatacept Alefacept Azathioprine (Imuran) Cyclosporine (Sandimmune, Neoral) Glatiramer acetate Mycophenolate (CellCept) Pimecrolimus Sirolimus (Rapamune) Tacrolimus (Prograf) Interleukin Receptor Antagonist Anakinra Monoclonal Antibodies Adalimumab alemtuzumab basiliximab (Simulect) belimumab infliximab (Remicade) ipilimumab muromonab-CD3 (OKT3) DRUGS AFFECTING THE RESPIRATORY SYSTEM DRUGS ACTING ON THE UPPER RESPIRATORY TRACT  ANTITUSSIVES Benzonatate (Tessalon) Codeine Dextromethorphan Hydrocodone (Codan)  DECONGESTANTS Topical Nasal Decongestants Ephedrine Oxymetazoline Phenylephrine Tetrahydrozoline Xylometazoline Oral Decongestants- Pseudoephedrine (Sudafed) Topical Nasal Steroid Decongestants Beclomethasone (Beclovent) Budesonide (Pulmicort) Dexamethasone (Decadron) flunisolide (Aerobid) fluticasone triamcinolone (Azmacort)  ANTIHISTAMINES 1st generation – Diphenhydramine HCl (Benadryl) – Promethazine HCl (Phenergan) – Dimenhydrinate – Chlorpheneramine maleate (Chlor- Trimeton) 2nd generation – Loratadine (Claritin) – Cetirizine (Zyrtec) – Desloratadine  EXPECTORANT Guaifenesin liquefy lower respiratory tract secretion and facilitating the removal of viscous mucus  MUCOLYTICS Acetylcysteine (Mucomyst) Dornase alfa (Pulmozyme) DRUGS ACTING ON THE LOWER RESPIRATORY TRACT  Bronchodilators/ Antiasthmatics Breathing & coughing techniques Relaxation techniques Evaluate HR & BP Arm identification Tremors Have 8 or more glasses of fluids Emphasize no smoking  XANTHINES Aminophylline caffeine Dyphylline theophylline  SYMPATHOMIMETICS BETA-ADRENERGIC: Albuterol (Proventil, Ventolin) Metaprotenerol (Alupent) Anticholinergics Ipratropium tiotropium  Drugs Affecting Inflammation Inhaled Steroids Beclomethasone budesonide Ciclesonide fluticasone Triamcinolone CORTICOSTEROID INHALERS ACTION= decreased respiratory tract edema Zero improvement- contact provider Must taper off gradually Asthma control LEUKOTRIENE RECEPTOR ANTAGONIST Montelucast (singulair) Zafirlukast Zileuton  Lung Surfactants Beractant calfactant poractant DRUGS AFFECTING CENTRAL AND PERIPHERAL NERVOUS SYSTEM ANTI-ANXIETY BENZODIAZEPINES  Diazepam  Lorazepam  Alprazolam  Clonazepam Antidote: Flumazenil  A void abrupt discontinuation after prolonged use N ot give if increase BP renal/hepatic dysfunction or history of drug abuse X anax, Ativan, Serax-a few examples I ncrease in 3D’s-drowsiness, dizziness, decreased BP E nhances action of GABA (inhibitory transmitter) T each to rise slowly from supine Y es,alcohol should be avoided SEDATIVE HYPNOTICS Barbiturates –Phenobarbital Sodium (Luminal) –Pentobarbital sodium (Nembutal) –Thiopental sodium (Penthotal) Benzodiazepines ANTIDEPRESSAN TS  D riving is out until response to drug has been achieved E ffect has a delayed onset of 7-21 days P lanning Px- consult w/ provider of care R elieves Sx , not a CURE E valuate V/S S topping drug abruptly is OUT! S afety measures (i.e., change position slowly) I nstruct client to report UE O bserve for suicidal tendencies N o alcohol or CNS depressants  TRICYCLIC ANTIDEPRESSANTS (TCAs) T rimipramine H ypotension I mipramine Anticholinergic N ortriptyline T achycardia A mitriptyline Sedation Amoxapine Clomipramine SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) Fluoxetine Paroxetine Sertraline Fluvoxamine Duloxatine MONOAMINE OXIDASE INHIBITOR (MAOI) Phenelzine Isocarboxacid Tranylcypromine Foods high in TYRAMINE Aged cheeses: cheddar, blue, Swiss Aged or fermented meats, fish, poultry Red wines: burgandy, cherry Smoked or Pickled meats ,fish or poultry, sausage, corned beef, salami, pepperoni Psychotherapeutic agents Psych Meds Commonly Abused Substances SUBSTANCES PHYSICAL SIGN WITHDRAWAL Stimulants Hyperactive Depression 1. Amphetamine Euphoria Irritability 2. Ecstasy Increase VS Psychosis 3. Cocaine Loss Appetite Narcotics/ Opiates Pinpoint pupils Runny Nose 1. Heroin Drowsiness Impotence 2. Codeine Incoordination Piloerection 3. Morphine Decrease VS Hallucinogen Dilated Pupils Visual 1. LSD (Lysergic Acid Diethylamide) Hallucination Disturbances 2. PCP (Phenycyclidine) Increase VS Flashback 3. Mescaline (Peyote) Hallucination 4. Psylocibin Cannabinoid Blood shot eyes Lack of appetite 1.Marijuanna Wt gain Depressed mood ADHD Drug of Choice: Methylphenidate (Ritalin) S/E: Decrease Appetite and Sleep Headache Growth Retardation Hyperactivity -Take in Morning before breakfast -IF BID: Before BF and lunch -If skip dose: 6 hours before bedtime (2-4pm) -DO NOT TAKE THIS IN THE EVENING DRUGS FOR SCHIZOPHRENIA TYPICAL ATYPICAL 1. Haloperidol (Haldol) 1. Clozapine (Clozaril) S/E: Extrapyramidal Effect WOF: Agranulocytosis 2. Chlorpromazine (Thorazine) (Fever ,Sore Throat) S/E: Hypotension Weekly WBC check up 3. Thioridizine (Mellaril) 2. Olanzapine (Zyprexa) S/E: Orthostatic Hypotension 3. Risperidone 4. Fluphenazine Therapeutic level: 4-8 mg/ day Autism Insomia/Irritability Suppreses Tardive Syskinesia 4.Seroquel Extrapyramidal Symptoms Irreversible  Extrapyramidal Effect Neuroleptic Malignant Syndrome PRIORITY!!!! M uscle Rigidity A ltered LOC T emperature increase -Withhold the medication -Monitor VS -Initiate supportive messures to lower temperature -ANTIDOTE: DANTROLENE (Muscle Relaxant)  DRUGS FOR DEPRESSION Depression = ↓NE, ↓S, ↑ MAO TCA SSRI MAOI Tricyclic Antidepressant Selective serotonin Mono-amine ↑ NE, S reuptake inhibitors Oxalate/Oxidase ↑ Seretonin Inhibitor ↓ MAO 1. PAMELOR 1. PROZAC 1. PARNATE 2. ELAVIL 2. Zoloft 2. NARDIL 3. ANAFRANIL 3. Paxil 3. MARPLAN 4. TOFRANIL WOF: Cardiac WOF: Sexula Dysfunction WOF: Hypertensive Dysrythmias Crisis Long period: 2-4 Weeks 1st-3rd weeks: Suicide Precaution DRUGS FOR MANIA CAUSE: ↑NE, SEROTONIN, INTRACELLULAR NA Drug of Choice: LITHIUM Therapeutic Goal: ↓NE and S General S/E: PNS Maintenance Dose: Carbamazepine (Tegretol) Antidote: None (activated charcoal and hemodialysis) Therapeutic Level: 0.6-1.2 mEq/L Increase Urine Output ↑ Na = ↓Li Toxic: Coarse hand Tremors, nystagmus, ↓Na = ↑Li hyperreflexia and ataxia -Overdose/Lithium Increase OFI: 2-3L / Day Toxicity Maintain Regular: Sodium intake 3 g/ day Antianxiety/ Anxiolytics 1. Major use to reduce anxiety, also induce sedation, inhibits convulsion. 2. Do not modify psychotic behaviour 3. Can cause: drowsiness and mental confusion BENZODIAZEPINE 1. Alprazolam (Xanax) 5.Chlordiazepoxide (Librium) 2. Diazepam (Valium) 6.Flurazepam (Dalmate) 3. Lorazepam (Ativan) 7. Midazolam (Verzed) 4. Temazepam (Restoril) NONBENZODIAZEPINE 1. Buspirone (Buspar) 2. Zolpedem (Ambien) W Warfarin A ACE Inhibitor / Aspirin L Lithium T Tetracycline S Statins V Valproic Acid I Isotretinoin R Retinoid (Vit A) T Thalidomide I Iodine O OHA ANTIPSYCHOTIC S  Chlorpromazine (Thorazine) Clozapine (Clozaril) Thioridazine (Mellaril) Haloperidol (Haldol) Thiothixine (Navane) Fluphenazine (Prolixin)  S edation; Sunlight sensitivity T ardive dyskinesia; Tachycardia; Tremors A nticholinergic; Agranulocytosis N euroleptic malignant syndrome C ardiac arrhythmias (orthostatic hypotension) E xtrapyramidal (akathesia); Endocrine (change in libido)  Dystonia-spasm of the tongue,neck, back and neck. May cause abnormal eye movements and excessive salivation Akathisia- continous restlessness, inability to sit still with constant hand moving and foot tapping  Tardive dyskinesia - abnormal muscle movements such as lip smacking, tongue darting Pseudoparkinsonism- muscle tremors, drooling, shuffling gait, slow movements ANTIMANIC MEDICATION  L evel – therapeutic (0.5-1.5 mEq/L) I ncreased urination T hirst increased H eadache; Hand tremors I ncrease fluids U nsteady M orton’s Salt-adequate intake CNS STIMULANTS Methylphenidate (Ritalin) Amphetamine, dextroamphetamine (Dexedrine) Treatment for ADHD  ANTICONVULSANT Barbiturates - Phenobarbital Benzodiazepines - Diazepam Succinimides – absence seizures Valproic Acid (Depakene) Acetazolamide (Diamox) Hydantoins Phenytoin (DILANTIN)  G ingival hyperplasia U se alternate birth control M outh care- dental check-up S oft toothbrush, don’t stop abruptly  ANTIEPILEPTIC AGENT Gabapentin (Neurontin) Carbamazepin (Tegretol)  C NS: dizziness, insomnia- UE Antacids decrease Eat food with drug (nausea, vomiting,anorexia) Support group for epileptics Alert tag indicating specific drug Report U E (hepatotoxic, teratogenic) ANTIPARKINSONISM 2 major categories: –ANTICHOLINERGIC –DOPAMINERGICS  ANTICHOLINERGIC Trihexyphenidyl HCl (Artane) Benztropine mesylate (Cogentin) –blocks the action of acetylcholine in the CNS to help normalize the acetylcholine-dopamine imbalance  DOPAMINERGICS Levodopa Amantadine Bromocriptine Avoid –Vitamin B6 (grains & Brans)- Speeds up conversion of levodopa to dopamine Carbidopa—Levodopa combination = SENEMET Works by increasing the level of dopamine  “When a person really desires something, all the universe conspires to help that person to realize his dream.” – Paulo Coehlo