Simplified Pharm Drug Charts 2 PDF

KV Antibiotics For all: make sure to complete full course of treatment even if symptoms subside Will kill natural bacteria in your body as well Interfere with the bacteria cell wall synthesis in some way Best on empty stomach - 1 hr before meal or 2hr after Drugs What they Treat Distinguishing Characteristics Penicillin Strep throat Most common drug allergy penicillin G Otitis media Can cause GI upset - take w food amoxicillin Syphilis Prolonged bleeding time & Rash ampicillin Report diarrhea, mouth pain, and vaginal itching Cephalosporins Systemic Infections Administer IV or IM bc they dont absorbed as Bone/Ear/Skin well from GI tract cephalexin infection. Don't give to those with renal impairment cefazolin UTI or bleeding tendencies ceftriaxone Upper resp. Infection Can develop C-Diﬀ cefepime Avoid alcohol can cause n/v, dizziness, HA, ﬂushing Carbapenems Systemic infections: Reserved for client who cannot be treated w/ imipenem Pneumonias more narrow-spectrum antibiotics meropenem Peritonitis Only administered parenterally - injections/IV penem - UTI SE: thrombophlebitis at IV site thrombophlebitis Glycopeptides MRSA BLACK BOX: Teratogenic vancomycin C-Diﬀ Use cautiously w/ elderly, hearing & renal impairment BLACK BOX: Red Man’s Syndrome: Rapid Peak 1hr administration can cause ﬂushing, rash, 10-20 mcg tachycardia, and hypotension Monitor kidneys labs (BUN, creatinine) and hearing Tetracyclines Acne Can cause photosensitivity - educate to tetracycline Cholera wear protective clothing doxycycline Chlamydia Don't give to kids - will cause discoloration Syphilis of growing teeth When penicillin is Teratogenic contraindicated Oral contraceptives ineﬀective - condom Take on empty stomach X No dairy X No antacids Macrolides Legionnaires disease Best on empty stomach - but can be taken azithromycin Pertussis w/ food to minimize GI upset (n/v, pain) KV Acute diphtheria Hepatotoxicity Chlamydial infections Ototoxicity Pneumonias Angioedema Strep QT prolongation, dysrhythmias, death Cause superinfections: C-diﬀ, candidiasis Aminoglycosides SERIOUS INFECTIONS Powerful broad-spectrum abx that treat gentamicin UTI, septicemia, serious infection peritonitis, severe PID, Nephrotoxic gentleman have endocarditis Not ﬁrst line Tx - Back up seriously bad knees Take pregnancy test before giving Sulfonamide and UTIs Interfere with folic acid synthesis Trimethoprim Otitis media Teratogenic trimethoprim-sulfa Pertussis Kernicterus in infants < than 2 months methoxazole Pneumocystis jirovecii Increase water intake to decrease kidney pneumonia damage Decreased eﬀectiveness of birth control AE: rhabdomyolysis (muscle) , systemic lupus erythema, and photosensitivity Fluoroquinolones UTIs BLACK BOX WARNING: Tendon rupture ciproﬂoxacin Respiratory tract infect Photosensitivity levoﬂoxacin Prevention of anthrax Take with food (except for dairy products) if happy birthday xacin cake needs ﬂour & to be cooked (light bulb - GI discomfort occurs photosensitivity) Observe/ Report signs of yeast infection shouldn't have taken w other drugs Not compatible with other drugs Antituberculosis Drugs What they Treat Distinguishing Characteristics isoniazid Tx & Prevention of Hepatotoxicity tuberculosis Interacts with phenytoin - toxicity Leprosy Interacts w/ tyramine foods, alcohol, rifampin, & pyrazinamide usually given Educated to use condoms together Take on empty stomach unless GI upset Treatment will last months rifampin Tuberculosis Hepatotoxicity Discoloration of bodily ﬂuids Monitor for c-diﬀ: fever, diarrhea, ABD pain, and bloody stool Take on empty stomach unless GI upset Interacts w/ warfarin, contraceptives, protease inhibitors, NNRTIs - accelerated met KV Antivirals Inﬂuenza A, resp viruses, cytomegalovirus, HIV, AIDS, STDs, herpes Viruses are diﬃcult to kill bc they live inside our cells and any drug that kills a virus may also kill our cells Interfere w/ viral nucleic acid synthesis and/or regulation Drugs What they Treat Distinguishing Characteristics Acyclovir Herpes Don’t cure but helps reduce outbreaks Cytomegalovirus Use cautiously w/ preggos /lactation Varicella-Zoster (pox) Nephrotoxic - renal impairment bad kidneys and Cause n/v, HA, rash, GI upset, and hair loss hair loss Thrombophlebitis interferon alfa 2A Hepatitis B Only given parenterally - thrombophlebitis Interferon alfa 2B Some cancers Flu like symptoms, most patient will have these symptoms so they are given ibuprofen before starting the Tx tenofovir HIV patient Often requires combination of drug therapy zidovudine Pre exposure Patient can never miss a dose or risk efavirenz prophylaxis becoming resistant to the medication ritonavir never miss a dose of antiviral atazanavir Antifungals Drugs What they Treat Distinguishing Characteristics Polyene Fatal fungal infection BLACKBOX: Kidney failure - will eventually amphotericin B -sis : aspergillosis, kill your kidneys - Monitor BUN /Creatinine leishmaniasis, Thrombophlebitis cryptococcosis, blasto- Hematologic problems It takes 1hr for frogs to mycosis, moniliasis, Infusion reaction common - fever, chills, kill beans BEANS coccidioidomycosis, nausea, HA histoplasmosis, Test dose may be given 1hr to test mucormycosis reaction Azoles Systemic / Superﬁcial Less toxic/eﬀective than amph B ketoconazole fungal infections Nephrotoxicity ﬂuconazole Candidiasis, Hepatotoxicity - monitor liver function cryptococcal monthly azoles kill both liver meningitis Eﬀects on sex hormones for both males and and kidneys and the females (ketoconazole) squirrel scratches your skin (SJS) BLACK BOX: SJS/TEN - skin Interacts w/: digoxin, warfarin, antidiabetics KV Anti-other Stuﬀ Drugs What they Treat Distinguishing Characteristics Antihelminthic Worms ivermectin mebendazole Antimalarials Prevention of malaria SE: Cardiac, EPS, SJS/TEN chloroquine Photosensitivity hydroxychloroquine Protozoa Protozoa/ bacteria SJS/ TEN metronidazole Trichomoniasis Severe eﬀects if taken w/ alcohol - bad Amoebic dysentery Discoloration of bodily ﬂuids Lice and Scabies Lice Scabies: Entire body needs to be covered Permethrin (NIX) Scabies except mucous membranes and left covered pyrethrin (RID) 8-14 hours for Tx to be eﬀective Lice: Wash hair, leave in 10 min, comb hair ethrin has scabies with nit comb Pain Medication Drugs What they Treat Distinguishing Characteristics Opioid Agonists Severe acute pain Produced analgesia, sedation, and well-being morphine Chronic pain Rising problem of addiction fentanyl Analgesia during Potential for physical dependence hydromorphone anesthesia Respiratory depression; hold is < 12/min codeine Constipation *When deciding which Urinary Retention to use, select drug that Cough suppression will be most eﬀective Decreased LOC, dizzy, sleepy w/ fewest AE* ANTIDOTE: naloxone Opioid Agonist - Moderate to severe Not as much resp depression Antagonist pain Not for those with resp dysfunction, cardiac butorphanol Opioid use disorder problems, renal or hepatic problems pentazocine Resp depression Cough repression Light-headedness, HA, dizziness, psychoses, anxiety, fear, hallucination, impair mental process Dependence is less likely Monitor resp/ LOC KV Opioid Antagonist Reverse eﬀects of Acute opioid abstinence syndrome - naloxone opioids withdrawal - tremors, shaking, vomiting, sweating, tachycardia (100+) CNS excitement and reversal of analgesia especially common after surgery - shaking, irritability, more pain CV eﬀects - tachycardia, ventricular arrhythmias Anti Inﬂammatory & Anti Arthritis Drugs What they Treat Distinguishing Characteristics Salicylates Inﬂammation Someone who doesn't respond to one Aspirin Fever salicylate may respond to another Mild to moderate pain Directly aﬀects clotting system Monitor for Salicylate toxicity - tinnitus, n/v, vertigo, altered LOC, vision, kidney failure, GI bleeding Reye’s Syndrome in kids NSAIDs Inﬂammation GI eﬀects: n/c/d, dyspepsia, GI pain, or ibuprofen Pain ﬂatulence, GI bleeding, peptic ulcers naproxen CNS eﬀects: dizziness, somnolence, fatigue ketorolac Platelet inhibition (increased bleeding), HTN, bone marrow depression, Renal dysfunction Monitor for GI bleeds - dark black stool, abd pain, hematemesis, nausea Enteric coated - don’t crush Acetaminophen Pain Hepatotoxicity - not for alcoholics acetaminophen Fever (ﬂu) HA, hemolytic anemia, renal dysfunction, Prophylaxis before skin rash, fever shots Less than 4g per day Musculoskeletal pain ANTIDOTE: Acetylcysteine Increased risk of bleeding w/ anticoagulants Hyperuricemia / Inﬂammation SJS/TEN Antigout Agents High blood uric acid Metallic taste in mouth - chew gum allopurinol Gout Increase ﬂuid intake 3L a day to prevent kidney damage sunscreen for skin (SJS) and water for hydration (kidneys) in the sun & crabs take like metal Glucocorticoids Inﬂammation Hyperglycemia - for energy prednisone disorders Adrenal insuﬃciency - suppressed immune KV Immunosuppressive system - more prone to infection Transplant rejection Behavioral and mood disturbances Cancers Muscle fatigue Chronic Asthma Long term - Osteoporosis Peptic ulcers Fluid electrolyte imbalance Herbal Therapies Drugs What it Does Distinguishing Characteristics Aloe vera Treats burns Interacts w/ several meds including digoxin, diuretics, and antidysrhythmic Black Cohosh Estrogen substitute Increased eﬀectiveness of blood pressure meds Ginkgo biloba Vasodilation Interferes w/ seizure threshold for clients at Decrease platelet risk for seizures aggregation Can interfere w/ coagulation of blood St. John’s wort Increases Serotonin Aﬀects serotonin Produces antidepressant eﬀects Kava Promotes Sleep Liver damage including severe liver failure w/ Decreases anxiety large doses Sedation when taken with other CNS depressants ------------------------------------------------------------------------------------------------------------------------------- Anxiolytic and Hypnotics Drug What it treats Distinguishing Characteristics Benzodiazepines Anxiety / Panic Antidote is Flumazenil diazepam Seizure Better than barbiturates alprazolam Alcohol withdrawal CNS depressor (Respiratory) lorazepam Restless leg syndrome Sleep driving - uh oh Insomnia Paradoxical excitatory reaction Addictive Barbiturates Anxiety Sedation phenobarbital Seizures Adverse eﬀects are more severe - can pentobarbital Insomnia cause comas from the sedation Hypoventilation CNS depressor KV CV eﬀects High abuse potential buspirone Anxiety Reduce s/s of anxiety without any of the CNS ramelteon rzz Insomnia - hypnotic eﬀects and adverse eﬀects zaleplon (short term) Insomnia - hypnotic Sedatives - no actions that need alertness zolpidem Insomnia - hypnotic Paradoxical reaction for buspirone Antidepressants General Rules: No St. Johns Warts, no ginkgo biloba. Takes some time for them to work Anxiety disorders: OCD, panic disorders, social anxiety, social phobias Drug What it treats Distinguishing Characteristics SSRIs Depression Block reuptake of 5HT ﬂuoxetine Anxiety disorders Takes 4 weeks to take eﬀect sertraline Bulimia CNS eﬀects citalopram PMDD Titer up, taper down escitalopram PTSD NOT FOR SUICIDAL PATIENTS gives them the energy to do it Sexual dysfunction - pt education 1st line Serotonin syndrome (BAD) - cooling blanket Monitor insomnia TCAs Depression May take 2 weeks to take eﬀect amitriptyline Anxiety disorders CNS eﬀects - sedation / CV eﬀects imipramine Chronic pain Cause anticholinergic eﬀects (TEACH) Nerve pain RISK FOR SUICIDE Withdrawal syndrome 2nd line Don't take w/ other antidepressants Overdose can be fatal !!!!!!!!!!!!!!!!!!!! Monitor cardiac dysrhythmias MAOIs Depression Higher levels of available amines (EPI) ? phenelzine Eﬀect CNS / CV selegiline Food interaction (tyramines) isocarboxazid Black Box Warning: SUICIDE Don't take with other antidepressants 3rd line Orthostatic hypotension Titer up, taper down Hypertensive Crisis - High BP Bupropion Depression Stops dopamine uptake Smoking (low doses) Lowers seizure threshold Anticholinergic eﬀects Increased CNS eﬀects KV Antipsychotics Drugs What they Treat Distinguishing Characteristics FGAs (Typical) Psychosis: Stops release of dopamine chlorpromazine Schizophrenia, Anticholinergic -dry, constipated haloperidol Dementia, Bipolar CNS/CV eﬀects disorder EPS - Extrapyramidal symptoms - tremors, spams, tics, restlessness ○ Acute dystonia - mouth spasms chlor - halo ○ Pseudoparkinson - tremors ○ Akathisia - restlessness ○ Tardive dyskinesia - body tics Movement disorders from neuroleptic medications Use a cooling blanket, antipyretics for hyperthermia. Maintain hydrated SGAs (Atypical) Psychosis Less likely to cause EPS^^ risperidone Weight gain (dyslipidemia, diabetes) ziprasidone CNS eﬀects Agranulocytosis Bipolar Disorder Drugs What they Treat Distinguishing Characteristics Lithium Bipolar disorder Inhibit NE & dopamine / Alters Na transport Low sodium increases toxicity so eat adequate amounts Lithium toxicity - slowly crosses BBB 1.5 level is a Dehydration DRINK WATER - Na goes up problem! Polyuria - pee a lot Therapeutic range is 0.6-1.2 mEq/L Fine hand tremors Teratogenic Not w NSAIDs or thiazide diuretics ADHD & Sleep Disorders Drugs What they Treat Distinguishing Characteristics Amphetamines ADHD Stimulants Dextroamphetamine Narcolepsy Weight loss sulfate Suppressed growth in children KV CV eﬀects (everything is going up) Skin rashes Tolerance/ Withdrawal Don't take with OTC cold medications Methylphenidate ADHD Causes insomnia Narcolepsy Weight loss CV problems (tachy, HTN, palpitations) Abuse/Withdrawal Non-Amphetamine Narcolepsy Promotes wakefulness Modaﬁnil CNS eﬀects - HA CV eﬀects - tachy Rash (SJS) Lower eﬀectiveness of contraceptives Glaucoma Meds ~ betaxolol, timolol, pilocarpine, echothiophate Drugs What they Treat Distinguishing Characteristics betaxolol Glaucoma Decreases production of aqueous humor timolol Direct-Acting Glaucoma Relieves pressure Cholinergic Diﬃculty seeing at night; don't drive - fall risk Agonists Systemic absorption possible so cover pilocarpine nasolacrimal sac for 1 minute Beta-Adrenergic Glaucoma Conjunctivitis possible Blockers Photophobia Dry eyes Systemic eﬀects - cover nasolacrimal sac Cholinesterase Glaucoma Lowers IOP Inhibitors Lower visual acuity especially at night echothiophate Myopia Wait 5 minutes before administering another eye medication Systemic eﬀects - cover nasolacrimal sac Muscle Relaxants ~ baclofen, methocarbamol, cyclobenzaprine, dantrolene Drugs What they Treat Distinguishing Characteristics Central Muscle tightness CNS depression baclofen Orthostatic hypotension KV methocarbamol © Anticholinergic eﬀects Cyclobenzaprine © Dont stop taking abruptly Peripheral Muscle tightness CNS depressant - no CNS depressors dantrolene Malignant BLACK BOX: hepatotoxicity hyperthermia Don't take with other CNS depressants NMS Antiepileptic General Rule: Start slowly and come oﬀ slowly; All antiseizure medication should be tapered oﬀ when discontinued. Risk-reward decision must be made on risk of medication vs risk of seizures in pregnant patients Drugs What they Treat Distinguishing Characteristics Hydantoins Seizures Stabilizes impulses phenytoin CV eﬀects fosphenytoin BLACK BOX: Give slowly to avoid adverse eﬀects Gingival hyperplasia (expected) - perform oral care, go to the dentist Reduced vit K = more bleeding - eat vit K Lowers eﬀectiveness of contraceptives Eat with meal for GI upset (test) Teratogenic carbamazepine Seizure CNS eﬀects (HA, irritability, confusion) Bipolar BLACK BOX: SJS/TEN, Aplastic anemia, Trigeminal nerve pain Agranulocytosis Decreases eﬀectiveness of oral contraceptive valproic acid Seizure CNS depressor Migraine BLACK BOX: GI EFFECTS Bipolar ○ Pancreatitis - monitor amylase/lipase ○ GI eﬀects ○ Hepatotoxicity - no sclerosis, no hepatitis, no liver transplant, no alcoholic patients ; monitor ALT/AST ○ Highly teratogenic lamotrigine Seizure One of the best for pregnant woman Bipolar BLACK BOX: SJS/TEN Suicide risk levetiracetam Seizure One of the best options for pregnant KV women One of the best options for kids CNS eﬀects Decrease eﬀectiveness of oral contraceptives gabapentin Seizure Nerve pain Nerve pain Oﬀ label: Migraines, anxiety topiramate Seizure Oﬀ label: Bipolar disorder, eating Migraines disorder, and essential tremors Weight loss weight loss Increased suicide risk Decrease eﬀectiveness of oral contraceptives pregabalin Seizures Weight gain - monitor weight daily Nerve pain CNS eﬀects Fibromyalgia Eye problems: visual disturbances Peripheral edema Pregame - alcohol makes you fat (weight gain) and your vision dizzy (eye problems) Anesthesia Drugs What they Treat Distinguishing Characteristics Local anesthetic Anesthesia in small Hypotension lidocaine area CNS stimulants: dizzy, restless, tremors, confusion, convulsants, cardiac conduction disorders CNS depressants: Respiratory arrest fentanyl Anesthesia in whole sedation barbiturates body nausea benzos resp. / circulation depression kill me plz -celeste Parkinson Drugs What they Treat Distinguishing Characteristics Dopaminergic Parkinson’s Increase dopamine or lower Ach levodopa/carbidopa Levodopa can cross BBB. Carbidopa can’t cross (review) Makes them able to complete ADLs SE: Psychosis (hallucinations, delusion, confusion, agitation) KV Orthostatic hypotension Dyskinesia: involuntary muscle movements Has a “wearing oﬀ” eﬀect Most beneﬁts within 5 years. Don't take with MAOIs No Vit B6 or high protein meals Dopamine Parkinson's disease Drowsiness Agonists Restless leg syndrome Insomnia - take in the morning pramipexole CNS issues apomorphine Constipation N/V pram-apo Take with food to reduce nausea selegiline (MAOI) Parkinson's disease Herbal drugs such as St. John's Wort, ginseng, or ma huang cause HTN No food containing tyramine Insomnia - so take in the morning Don't take with antidepressants Alzheimers Drugs What they Treat Distinguishing Characteristics donepezil Alzhimers Doesn’t cure only improves cognitive function GI symptoms (GI bleeds) so no NSAIDs CNS eﬀects - insomnia, dizziness, HA, bradycardia Not for those with liver, renal, heart, pulmonary, thyroid, seizure problems. memantine Alzhimers Slows decrease in functioning CNS eﬀects: dizzy, HA, confusion (report these) No OTC Antacids → toxicity Paralytics (Neuromuscular blockers) General Rule: SEDATION → PARALYTIC → INTUBATION Drugs What they Treat Distinguishing Characteristics vecuronium Neuromuscular Antidote: Sugammadex rocuronium blocker for intubation Requires mechanical ventilation - they are paralyzed, they can't breathe KV Not an analgesia or sedative SOOO all patients receiving paralytics need analgesics or sedative medications succinylcholine Neuromuscular Malignant hyperthermia → muscle rigidity, blocker for intubation fever, hypercapnia Requires mechanical ventilation Can produce micro tremors Hyperkalemia (Potassium) Short acting Not an analgesia or sedative SOOO all patients receiving paralytics need analgesics or sedative medications Immuno- ? Flu-like symptoms - can be pretreated with modulators drugs avonex Suppresses the immune system → causes rebif myelosuppression (decreased production of betaseron all blood cell types) Liver toxicity sumatriptan Migraines Angina caused by coronary vasospasm Cluster Headaches CNS eﬀects: tingling / vertigo NO MAOIs - can cause toxicity Serotonin agonists so monitor for serotonin syndrome Monitor vital signs ramelteon Insomnia - does not CNS depression so monitor vital signs keep you asleep tho Hormonal eﬀects - amenorrhea, decreased libido, infertility Not for those with COPD / Apnea IV Non-Opioids CNS depression but we want this propofol For induction and maintenance of anesthesia ketamine and intubation and mechanical ventilation IV Opioids < morphine sulfate CNS depression but we want this fentanyl For induction and maintenance of anesthesia alfentanil/sufentanil and intubation and mechanical ventilation Blood Coagulation Drugs What they Treat Distinguishing Characteristics Antiplatelets CV disease - occluded Inhibits platelet adhesion and aggregation abciximab vessels © Risk for TTP (thrombotic and KV aspirin Maintains bv grafts thrombocytopenic purpura) very bad - clopidogrel © Prevents MI limites blood ﬂow to your organs, causes purple/red dots, burst capillaries, non blanchable Patient needs to beware of bleeding: black tar stool, red stool, blood in vomit Teach safety: soft bristled toothbrush, electric razors © Irreversible (7-10 days) Anticoagulants Prevents clots Interfere with the clotting cascade enoxaparin (SQ) Post op DTV All change neural status fondaparinux MI SE: bleeding - look for GI bleeds monitor vital heparin PTT- 1.5-2 Dysrhythmia signs (HR/RR) warfarin INR- 2-3 Atrial ﬁbrillation Changes in neuro status - brain bleeds DIC (heparin) Heparin (IV) - Antidote: Protamine sulfate Dabigatran - chances of hemorrhage , thrombocytopenia - monitor PTT keep between 1.5 -2 Enoxaparin (SQ) - only administer in the abdomen - based on weight no PTT needed monitor vital signs and platelet count keep platelet count over 100,000 Warfarin (PO) - Antidote is Vitamin K - Report INR above 2-3 = too much bleeding Patient needs to beware of bleeding: black tar stool, red stool, blood in vomit Teach safety: soft bristled toothbrush, electric razors. Warfarin pts get blood drawn ever 2-4 weeks Don’t take with garlic, ginger, glucosamine, ginkgo biloba, or OTC NSAIDs makes them bleed more Thrombolytic Clot buster: Give within 2 hours of symptom onset Alteplase DVT, MI, PE, ischemic Bleeding Reteplase stroke Cardiac arrhythmias Hypotension teplase GI bleeding Changes in menstrual status Anemia Iron deﬁciency anemia - negative iron balance occurs - microcytic Megaloblastic anemia - folic acid or vitamin B12 deﬁciency - macrocytic ○ Pernicious anemia Hemolytic anemia - sickle cell diseases or thalassemia KV Drugs What they Treat Distinguishing Characteristics ferrous fumarate Iron deﬁciency Elevates serum iron concentration ferrous gluconate anemia Oral iron: eﬀects related to GI irritation - ferrous sulfate Loss of RBCs rinse mouth out because of metallic taste iron dextran Don’t eat enough iron and can stain teeth. Parental iron: severe anaphylactic reactions, local irritation, staining of the tissue, phlebitis - Iron needs Z track Can have black stool (expected) Don't eat with eggs, milk (Calcium), coﬀee, tea, Vit C ***** Can cause GI upset - so it's okay to eat with food but NOT THOSE FOODS ^^^^^ folic acid Malabsorption of B9 Aﬀect, orientation, and reﬂexes; pulse, blood Leucovorin (folic acid) - sprue and pressure, and perfusion; respirations and celiac disease adventitious sounds; and CBC, hematocrit, and iron levels We need to get a baseline of these and then redraw in 2 weeks Hydroxocobalamin: Itching, rash, signs of excessive vit B levels Mild diarrhea unsure what Pain and discomfort at injection site info goes with Nasal irritation with intranasal spray - don’t give if nasal erosion seen what Hypokalemia cyanocobalamin Malabsorption of B12 Aﬀect, orientation, and reﬂexes; pulse, blood Strict vegetarian diet pressure, and perfusion; respirations and Inability to absorb adventitious sounds; and CBC, hematocrit, and iron levels We need to get a baseline of these and then redraw in 2 weeks Hydroxocobalamin: Itching, rash, signs of excessive vit B levels Mild diarrhea Pain and discomfort at injection site Nasal irritation with intranasal spray - dont give is nasal erosion seen Hypokalemia Epoetin alfa Anemia associated CNS eﬀects - depressant with chronic renal CV symptoms - serious eﬀects and increased 11g/dL + (bad) failure or kidney risk for DVT when hemoglobin is higher than diseases 11g/dL KV Stimulates production of erythropoietin to Epoitesis stimulating stimulate RBCs agents Don't give to functioning kidneys N/V, diarrhea Don't give to those with hypotension, cancer, or preggos Never mix in solution with other drugs***** hydroxyurea (PO) Sickle cell anemia Increases amount of fetal hemoglobin produced Don't give if they have leukopenia SE: bone marrow suppression Headache, dizzy, confused, fever, chills, malaise, GI eﬀects, dermatological eﬀects, cancer Antihemophilic Agents Drugs What they Treat Distinguishing Characteristics Factor IX Hemophilia B (9) Replace clotting factor 9 Prevent blood loss from injury or during surgery HA, ﬂushing, fever, chills, lethargy. N/V, stinging, itching, burning (IV site) Don't take NSAIDs, take acetaminophen Don't give to those with liver disease w/ signs of intravascular coagulation or lactation/ preggo Desmopressin Hemophilia A (8) Aﬀects posterior pituitary (bleeding or pre-op) Stimulates the release of stores factor VIII Causes ﬂuid retention and hyponatremia - less ﬂuid equals more concentrated Na Seizures, drowsiness, HA, Gi distress VACCINES Action Stimulate active immunity in people who are sick Facts Vaccines needed depends on the exposure Provides lifelong immunity Contraindication Live vaccine during pregnancy Cautions Known allergies KV Immune deﬁciency that prohibits persons capability to make antibodies Delayed vaccine for patients receiving globulin or what received blood or blood products History of febrile convulsions, or cerebral injury Condition were high fever is dangerous Acute infection Adverse eﬀects Fever Rash Malaise Chills Fretfulness Drowsiness Anorexia Vomiting Irritability Injection site reactions: pain, redness, swelling, nodule formation Rare: severe hypersensitivity and CNS reaction Drug-Drug Immunosuppressant drugs - vaccines are not eﬀective if the drug Interaction suppressed the body's ability to make antibodies. With live vaccine, could cause severe illness Immune Sera Antitoxin and Antivenin Action Provide passive immunity to a speciﬁc antigen Maybe be used as prophylaxis against speciﬁc diseases after exposure in immunosuppressed patients May lessen the severity of a diseased after known or suspected exposure Facts Passive artiﬁcial immunity Antitoxin - antibodies against speciﬁc toxins Antivenom - antibodies to venom from spiders/snake bites Contraindication History of severe reaction to any immune sera or similar products Cautions Pregnancy Coagulation defects or thrombocytopenia Previous exposure to the immune sera Adverse eﬀects Immune sys: rash, vomiting, nausea, fever, chills Local reactions: swelling, tenderness, pain, muscle stiﬀness (IV site) Allergic reaction: chest tightness, decreased BP, diﬃculty breathing KV ------------------------------------------------------------------------------------------------------------------------------- Asthma Bronchodilators Drug What it treats Distinguishing Characteristics Sympathomimetics Acute asthma Causes bronchodilation - opens airway albuterol EIB - Exercise AMPS up the body - 3 Ts of albuTerol levalbuterol induced ○ Tachycardia (Increased HR) bronchospasm ○ Tremors ○ Tossing & Turning (Restlessness/ Jittery) RESCUE MED - Monitor/report SEVERE dizziness, heart 2-4 puﬀs 3x every palpitations, chest pain, SOB, tremors 20 minutes Use PRN - 30 minutes before exercise via MDI (metered dose inhaler) Clean 1-2 times a week with warm water Beta 2 Adrenergic Long term Cause bronchodilation Agonists management of Takes days to work - works slowlyyyy - so used salmeterol asthma and COPD in long term management BLACK BOX WARNING: should not be used as Salm the turtle is not a monotherapy (using a single med to manage alone. a medical condition - asthma attack) Anticholinergics COPD Causes bronchodilation ipratropium Relieves Anticholinergic eﬀects - can’t see, pee, spit, bronchoconstriction or shit ~ give candy and water & secretions Pharynx irritation - bc its dried out produced w/ COPD Increases intraocular pressure - pt should get tested for glaucoma Methylxanthines Long term Long-acting bronchodilator theophylline management of Has to stay within a therapeutic level (< 20 asthma mcg/mL) or else they become TOXIC When outside of therapeutic level: ○ Seizures ~ prepare to start anticonvulsants Theo has asthma. He is therapy if reaches toxic lvl having a seizure, ○ Tachycardia, dysrhythmias ~ monitor HR heart problems, and can't sleep. and rhythms ○ Restlessness, insomnia ~ take in AM because its a stimulant / avoid other stimulants ○ N/V KV Asthma Anti-Inﬂammatories Drug What it treats Distinguishing Characteristics GlucocorticoidS COPD, allergic Used for anti inﬂammatory quality prednisone reaction, arthritis, Peptic ulcers methylprednisolone psoriasis, lupus, Headache PO: suppression of adrenal function Long-term 7S: swollen (ﬂuid electrolyte imbalance - Systemic: IV, PO, IM management of body holds onto liquid ), sepsis (Infection), chronic asthma sugar (hyperglycemia ), skinny bones (bone The president ate meth Inﬂammation demineralization, muscle wasting - and it got into his system. osteoporosis ), sight (cataracts), slowly taper, stress surgery (increase dose). Inhaled Prevention/Tx of Taken daily for prevention Glucocorticoids inﬂammation Oral candidiasis for inhaled admin. beclomethasone Dry mucous membranes, epistaxis, & sore budesonide Long/short - term throat for nasal admin. ﬂuticasone management of Fewer side eﬀects when inhaled chronic asthma Sore throat, hoarseness coughing, dry mouth inhaled/nasal Pharyngeal and laryngeal infection Beck and Bud got the Flu Headache and had a runny nose. Long term same as above ^^^ 7s (inhaled/nasal) Mast Cell Stabilizer Allergic rhinitis Prevents release of inﬂammatory substance cromolyn EIB Used for long-term management because it is Long-term slow acting (takes 4 weeks to take full management of eﬀect) asthma NO LONGER A PART OF Tx STANDARDS bc it needs to be administered 4x daily on a ﬁxed Nobody uses chrome schedule - nobody wants to do that. anymore. Chrome has 4 colors for 4 weeks to Use 15 mins before exercise work and 4x a day Can cause rebound bronchospasm schedule. (taper/titer) Give epi/antihistamine to reverse anaphylaxis from allergic reaction Leukotriene Asthma - prophylactic Used for antiinﬂammatory quality Receptor Tx Available as tabs, chewables, or oral Antagonists Allergic rhinitis granules (give w/ applesauce/ food or place montelukast (PO) EIB on tongue) Upper resp infections, pharyngitis, cough, HA, Monte is on suicide dizziness, N/V, diarrhea, abdominal pain watch so we give him his Elevated liver enzymes (monitor liver labs) meds in his apple sauce, so his tummy wont hurt. Serious neuro psychiatric eﬀect (suicide risk) KV Treat Upper Respiratory Infections - Clear secretions Antitussives - block cough reﬂex Decongestants - decrease the blood ﬂow to the upper respiratory tract and decrease the production of secretions Antihistamines - block the release or action of histamine, a chemical that increases secretions and narrows airways Expectorants - increase productive cough to clear airways Mucolytics - increase or liquefy respiratory secretions to aid clearing of airways Drug What it treats Distinguishing Characteristics Antitussives Chronic non- Blocks cough reﬂex codeine productive coughs CNS depression dizzy & lightheaded - fall dextromethorphan risk Respiratory depression GI upset - constipation Don’t give to pts who need to cough to maintain an airways (COPD) or pts w/ head injuries Opioids - potential for abuse Topical Nasal / Oral Nasal congestion Shrinks the nasal mucosa Decongestants Allergic rhinitis CNS stimulation with PO med phenylephrine Sinusitis ○ Monitor agitation, anxiety, insomnia pseudoephedrine Common cold ○ Give mild hypnotic so they can sleep Seasonal allergies Tachycardia/palpitations Otitis media (pain / Overdose or systemic absorption congestion) symptoms: HTN, tachycardia, & palpitations ○ Monitor HR and BP Teach pts to read label so they don't accidentally overdose Stimulates sympathomimetic eﬀect (Fight or ﬂight) Rebound congestion w/ prolonged use of topical agents ~ only use for 3-5 days Recommend nasal glucocorticoids to minimize symptoms of CONGESTION while discontinuing after prolonged use. Steroid Nasal Allergic rhinitis Anti-inﬂammatory Decongestant Nasal Polyp removal Needs 1 week to work budesonide Nasal Congestions Shouldn't be absorbed systemically bc AE. ﬂuticasone (1st line med) Don't give to pt with active infection Can cause burning/stinging of mucosa / HA Can suppress healing in those who just had KV inhaled surgery Shouldn't be taken with any other nasal med Flu-bud needs a week to at the same time without contacting HCP work Antihistamine Mild allergic reaction Block eﬀects of histamines 1. diphenhydramine Anaphylaxis (edema) Don't give to pt with renal or hepatic 2. Cetirizine Motion sickness impairment Insomnia Adverse eﬀects less likely with 2nd gen Allergic conjunctivitis Antipruritic eﬀects ~ itchy skin Angioedema Anticholinergic eﬀects (can't see, can’t pee, Allergic rhinitis can’t spit, can't shit) Idiopathic Urticaria ○ Encourage liquid intake 1.5-2K mL daily You put a baby to sleep (hives) ○ Give hard candy to suck on dry. Pruritus - itchy skin Drowsiness and fatigue ○ Monitor clients when ambulating Expectorants Unproductive cough Makes a more productive cough guaifenesin related to viral upper Notify if cough worsens or fever develops respiratory tract infection Don't take w other meds that have guaifenesin Respiratory CNS eﬀects - Dizzy, drowsy, HA - enact safety conditions symptoms interventions - monitor pt when ambulating Not indicated for prolong use GI eﬀects - give with food or water Encourage ﬂuid intake of 1.5 - 2K mL daily~ it prob helps their throat Mucolytics Atelectasis (caused by Liquiﬁes and cleans out secretions ~ have acetylcysteine thick mucous suction available or give pt. a bag/tissues secretions) - CF SE: bronchospasm (don't give to asthma pts) ○ Monitor resp status & administer Acetaminophen bronchodilators if needed overdose Smells like eggs GI upset - makes sense bc it smells like eggs ○ Give antiemetic if needed (stop them from vomiting) Stomatitis - inﬂammation of mouth Rhinorrhea - runny nose Rash KV Blood Pressure Medications Drug What it treats Distinguishing Characteristics ACE Inhibitors Hypertension Decreases BP by stopping aldosterone benazepril Heart failure production captopril Left ventricular Place on renal watch bc works in RAAS enalapril dysfunction BLACK BOX WARNING: Preggos lisinopril DM neuropathy Not for acute HF / salt/volume depletion Orthostatic hypotension (careful when changing position) Severe hypotension with 1st dose (normal) -pril General 1st line ******* Dry, non productive cough ******* except w African Allergic reaction results in angioedema Americans (CCB) Hyperkalemia / Hyponatremia No NSAIDs, other hypertensives, potassium supplements, drugs that aﬀect RAAS, other ACE inhibitors, ARBS, renin inhibitors Angiotensin HTN (alone or in Brings with angiotensin receptors to block Receptor Blockers combo) vasoconstriction ~ block BP raising eﬀects (ARBs) Heart failure Less chance of cough/angioedema than ACE losartan After MI HA, dizziness, syncope (fainting) valsartan Slow progression of Hyperkalemia renal disease GI complaints, dry mouth, tooth pain causes Rash, dry skin, alopecia Not for preggos, hep/renal failure, ppl w. Hypovolemia (low BP already) - sartans Monitor BUN and creatinine (kidneys) No NSAIDs, other hypertensives, potassium supplements, lithium - same as ACE Aldosterone HTN (in combo bc its Gets rid of ﬂuids but keeps potassium Antagonists a weaker drug) Blocks aldosterone receptors = excretion of eplerenone HF after MI Na and water and retention of K spironolactone Hyperkalemia - potassium sparing eﬀect ~ - one make sure they stay below 5.0. Monitor palpitations, muscle twitching, weakness, parentheses, slow HR Take daily weights to monitor ﬂuid loss (edema) Increased urine output - Monitor I&O / kidney labs Direct Renin HTN Kills renin (eventually makes angiotensin) Inhibitors Never a ﬁrst line Tx aliskiren Kills slowly - absorbed slowly in GI - GI upset KV BLACK BOX: Teratogenic Dry cough Risk of hyperkalemia Angioedema with respiratory involvement Renal impairment (renin released from there) No furosemide, antihypertensives, ACE inhibitors, ARBs, K sparing diuretics Calcium Channel Hypertension Decreases BP, cardiac workload, and Blockers Angina myocardial oxygen consumption amlodipine 1st Tx for African Americans diltiazem Extended release - don't chew nicardipine Not for Heart block, sick sinus syndrome, HF, nifedipine and acute MI or preggos Verapamil Reﬂex tachycardia - dizzy, lightheaded ~ can give a Beta blocker to prevent this bc they lower HR My tia named veranica CNS eﬀects - Headache - caution w/ driving ate dipine-dots. CV eﬀects -peripheral edema (check legs and feet), , dysrhythmias GI eﬀects note: calcium makes Skin ﬂushing and rash vessels constrict so the blockers make them No grapefruit juice (increases med dilate eﬀectiveness) Nonselective HTN Decreases myocardial oxygen demand and Beta Blockers Heart Failure contractility. labetalol SVT Lowers heart rate and pulse propranolol HCM GI eﬀects when given PO Angina CV & Respiratory eﬀects (B1-heart B2-lungs) MI Decreased exercise tolerance IV or PO Hypoglycemia or hyperglycemia -lol Not for those w/ bradycardia (bc it lowers it more), or heart block, shock, no preggos, no diabetics, no asthmatic or COPD (bronchospasm) Take HR and pulse at the same time each day Don't discontinue abruptly Don't give with anesthetics, diabetic agents, CCBs, and antiarrhythmics that aﬀect QT Alpha 1 Blockers - HTN A1 receptors (located in smooth muscle) Selective Benign prostatic cause vasoconstriction, so the blockers Adrenergic hyperplasia prevent this, so vasodilation = lower BP Blocking Agent CNS eﬀects: syncope (fainting) - fainting at 1st use because of the low BP - start at low KV doxazosin nitroglycerin doses & careful when driving Allows urine to ﬂow easily -osin GI eﬀects (given PO) CV eﬀects - hypotension Eﬀects related to vasodilation Not for preggos, HF, or those in renal failure. No vasodilators and antihypertensives Beta 1 Blockers HTN Preferred for pts with pulmonary Selective Cardiac arrhythmias diseases/ problems Adrenergic Chronic angina CNS eﬀects - dizzy Blocking Agents After MI CV eﬀects - HR less than 60 atenolol Glaucoma (decrease IOP) Pulmonary eﬀects (less than nonselective) metoprolol GI/GU eﬀects Decreased exercise tolerance Absorbed from GI after Hyperglycemia / Hypoglycemia given (PO) but works Okay for preggos better when administered via IV - dont give Not for those w/ bradycardia, heart block, ophthalmically (eye) cardiogenic, shock, HF, hypotension, diabetics, thyroid disease, COPD Alpha 2 Agonists HTN Titrate / taper meds to reduce CNS eﬀects clonidine Severe pain (Cancer) Rotate patches if given transdermal ADHD Take at bedtime because it can cause drowsiness & dizziness 3Ds of cloniDine: dizziness, drowsiness, PO Not mentioned: and dry mouth Transdermal Opioid withdrawal Can give feelings of euphoria, so monitor for misuse Don't give to those on anticoagulant therapy Vasodilators HTN EMERGENCIES Acts directly on smooth muscles (vein) to hydralazine relax to drop BP nitroglycerine Rapidly absorbed Reﬂex tachycardia Cyanide toxicity Headache Not to those with CAD, HF (crackles in lungs, edema), tachycardia, PVD Cardiac Glycosides HF Increased force of myocardial contractions, (Inotropic Agents) Atrial problems slowed HR = increased cardiac output. Heart digoxin Sudden attacks beats slower but each contraction has Paroxysmal more purpose/ it's more eﬀective Take apical pulse for 1 min prior to admin SE: HA, weakness, drowsiness, hypokalemia and vision changes, bradycardia, arrhythmias KV Monitor serum levels Toxicity is a concern. 1st sign is GI upset. Keep levels < 2.0 ng/ mL Signs of Toxicity: n/v, fatigue, visual changes : yellow tinge, halos around dark objects Antidote: Digoxin Immune Fab Don't take with ginseng (more chance of toxicity) or St. John's Worts (lowers digoxin) Inotropic Inhibitors Emergency HF Stronger contraction and prolonging eﬀects milrinone (only!!!) - hasn't of sympathetic stimulation responded to digoxin SE: arrhythmias, hypotension, chest pain /diuretics Thrombocytopenia: harder time clotting Burning at IV site IV only Monitor vitals continuously Not for ppls w/ SL valve disease, acute MI, ventricular arrhythmias, hypovolemia, or preggos Assess if they have any of those ^^^ & their cardiac status and heart sounds Diuretics Drug What it treats Distinguishing Characteristics Thiazide and HTN (1st line) Gets rid of ﬂuid and sodium Thiazide-Like Edema Monitor BUN and Creatinine Diuretic Monitor I & Os , report less than 30mL/hr hydrochlorothiazide Take daily weight to see if its working on edema Causes GI upset, All: Take them in the Electrolyte imbalance: hypokalemia (take K morning bc they make supplement), decreased calcium excretion you pee and you don't want to be up all night - Prolonged use: Hyperglycemia no later than 3 PM Hypotension Can cause gout- check their feet Not with digoxin, antidiabetics, lithium, antihypertensive Loop Diuretics HTN Decreases reabsorption of Na and Cl Furosemide Edema Makes you pee to get rid of ﬂuid. Monitor I&O Acute HF Hypokalemia. Monitor signs: irregular Pulmonary edema pulse, , anxiety, confusion, hypoactive Edema bowels, skeletal muscle weakness and Ascites polyuria Hyperglycemia KV Hypocalcemia Alkalosis Problems related to electrolyte depletions: CNS eﬀects: N/V, irregular HR Ototoxicity Educate on what foods have potassium Potassium Sparing Hypokalemia Gets rid of ﬂuids/sodium but keeps Diuretics Edema potassium spironolactone HF Blocks aldosterone receptors = excretion of Hyperaldosteronism Na and water and retention of K Hyperkalemia - potassium sparing eﬀect ~ make sure they stay below 5.0. Monitor palpitations, muscle twitching, weakness, parentheses, slow HR Take daily weights to monitor ﬂuid loss (edema) Increased urine output - Monitor I&O / kidney labs Type of steroid which has hormonal eﬀects - hair growth and gynecomastia No salicylates, antihypertensives, and RAAS Weaker drug so used in combo w/ other drugs KV Angina Meds Drug What it treats Distinguishing Characteristics Nitrates Prevention of angina Blows veins up, veins dilate, BP lowers, less nitroglycerin Stable angina pressure means increased oxygen to heart isosorbide - mononitrate Unstable angina tissues - workload less so heart is pumping Vasospastic angina better- so less pain Don't give to those with hypotension, -Rapid-acting form (SL) hypovolemia, have limited cardiac output, -Long-acting from (sustained-release oral severe head injury, erectile dysfunction meds capsules/ transdermal) Causes HA that diminish with time Reﬂex tachycardia Postural hypotension - take laying down Tolerance may develop - take oﬀ patch at night Store: airtight, dark, with metal cap If it hurts when you’re taking it the med its working Check BP before giving in hospital Long term - transdermal - take oﬀ for at least 8 hours - drug vacay If angina occurs: 1. Stop activity or lie down, and take SL tablet 2. If there's no relief in 5 mins, call 911 & take another tab 3. If there’s no relief in 5 mins, take a third SL tab, & pray paramedics get there probably. Beta adrenergic Angina prevention Decreases workload to heart to help antagonists (BB) HTN for preggos angina propranolol Caution on ppl w/ pulmonary and cardiac metoprolol problems labetalol Fatigue and bradycardia BLACK BOX: don't stop abruptly, can cause cardiac eﬀects (taper/titer) Misc Angina chronic Prolong QT interval ranolazine When other meds don't work Don't give if hepatic problems You ran a race, but came in 6th place. You came 6th not ﬁrst, so it's not a ﬁrst line only when other things don't work. 6 months is chronic so it's for chronic angina. It was a long race so it caused QT proLONGation. KV Antiarrhythmic Meds Administered via IV Not for block, shock or sick All can cause asystole Dizziness, HA, blurred vision, prolong QT interval Measure baseline BP, pulse, I & O, cardiac rhythms Take serum levels before administering Instruct patient to report adverse eﬀects to physicians Not for those with QT prolongations Monitor: toxic eﬀects, cardiac rhythms, HR, BP, well-being, skin color, temp, heart and lung sounds, QT prolongation Report: worsening SOB, edema, dizziness, syncope, chest pain, GI distress, blurred vision Drug What it treats Distinguishing Characteristics Class I - Na CB Block sodium channels A. procainamide Arrhythmias All treat V-tach B. lidocaine Ventricular Lidocaine with Epi cannot be given via IV & dysrhythmias only as a local anesthetics C. ﬂecainide Propafenone Severe ventricular cain prop dysrhythmias Class II - BB Angina Slows impulse conduction - SLOWS HR so labetalol HTN, HF take HR before giving med - hold if under 60 PSVT Makes each beat a little better Ventricular dysrhythmias Class III - K CB Diﬃcult dysrhythmias Increase APD amiodarone V-tach, v-ﬁb, a-ﬁb, Pulmonary toxicity - hypoxia a-ﬂutter Class IV- CCB PSVT Reduce AV node conduction verapamil A-ﬁb, A-ﬂutter Inhibits channel pathways diltiazem Adenosine PSVT Slows conduction and resets the heart Sinus rhythms Only administered fast IV push WILL cause asystole Short half life 10 seconds Have them on ECG, have crash cart ready Don’t give in places where there no proper equipment to restart the heart Be ready to start the heart; before it stops KV SE: chest pain, dyspnea, ﬂushing of skin Hyperlipidemia Meds Drug What it treats Distinguishing Characteristics HMG-CoA Hyperlipidemia Decreases LDLs, slightly increases HDLs reductase ASCVD Take in evening because this is when inhibitors MI, stroke, cholesterol synthesis happens atorvastatin revascularization Can cause liver problems so don't give to pts rosuvastatin prevention with liver problems simvastatin SE: Hepatotoxicity, Rhabdomyolysis (mel) N/V, diarrhea, HA -statin No grapefruit PCSK9 Inhibitors Hyperlipidemia Prevents LDL receptor breakdown; allows alirocumab Homozygous familial liver to process more LDL evolocumab hypercholesterolemia Used when they can't take statins Given via SQ injections. Every 2-3 weeks Risk for infection Injection site reaction Bile acid Hyperlipidemia LDL + bile = poop out the fat sequestrants hypercholesterolemia CNS eﬀects (HA, drowsiness, fatigue, anxiety) cholestyramine Pruritus - biliary GI irritation - constipation, hemorrhoids colesevelam obstruction More likely to bleed Vitamine A and E deﬁciencies Muscle aches and pain Take hours before other medications No thiazides, warfarin, thyroid hormone, birth control, corticosteroids Cholesterol Hyperlipidemia Stops cholesterol absorption - lowers LDL absorption hypercholesterolemia Add on to statin therapy or on its own inhibitors Homozygous CNS eﬀects HA, dizziness, fatigue, ezetimibe sitosterolemia Back pain, muscle aches GI upset: diarrhea If combined w/ statins: liver problems Fibrates Hypertriglyceridemia Lowers LVDL (triglycerides) fenoﬁbrate Increases risk of gallstones Thiazide - long term, HF, peripheral edema - make you pee; hypokalemia Loop - make you pee - more intense- quickly need to get rid of ﬂuid; hypokalemia Spirol - not as harsh - potassium sparing KV ------------------------------------------------------------------------------------------------------------------------------- Gerd and Ulcer Drugs Drug What it treats Distinguishing Characteristics Histamine-2 Prophylaxis of stress Interfere w/ gastric acid production Antagonists ulcers/ NSAID use Caution w/ hepatic or renal dysfunction cimetidine (PO) Erosive GERD GI eﬀects - diarrhea famotidine (IV) H. pylori ulcers CNS eﬀects - dizziness, confusion, HA Heartburn/ Can cause hypotension Indigestions Cardiac arrhythmias Take w/ or before meals or at bedtime Cimetidine can cause gynecomastia or (Short-Term) impotence / slows metabolism of various drugs **** Antacids Upset stomach bc of Neutralize stomach acid hyperacidity Take 1hr before or 2hr after other meds calcium carbonate Peptic ulcers / Not for those w electrolyte imbalance, magnesium salts Gastritis acid-base imbalance, bc it can cause Ulcers present hypercalcemia/ hypophosphatemia Osteoporosis Not for those w/ GI obstruction bc causes Constipation or Diarrhea If you take too much you can get metabolic alkalosis (HA, nausea, weakness, confusion) Rebound acidity with frequent use Proton Pump Short Term: Suppress section of hydrochloric acids Inhibitors Duodenal ulcers, Maintenance therapy: erosive esophagitis GERD, Erosive and ulcers omeprazole esophagitis, & Benign CNS eﬀects - HA, dizziness, vertigo, insomnia esomeprazole active gastric disease GI eﬀects - diarrhea, abd pain, n/v pantoprazole Long Term: Upper respiratory tract symptoms - cough Hypersecretory Long term - increase in bone loss & -prazole conditions hypotension - bone fractures GI Protectant Prevent further injury Coat any injured are in the stomach - when sucralfate from acid the acid isn't touching, the ulcer can heal Promote healing of GI eﬀects - CONSTIPATION, diarrhea ulcers by covering it DIzzy, sleepy, vertigo, skin rash, & back pain Take before meal on an empty stomach Interacts with risky drugs - phenytoin, digoxin, warfarin, ﬂuoroquinolone, & abx Prostaglandin NSAID induced ulcers Protects the stomach lining by increasing misoprostol mucus production NOT FOR PREGGOS - will cause abortion AE: n/v & abd pain & hypermenorrhea, KV dysmenorrhea, miscarriage Laxatives - Constipation Drug What it treats Distinguishing Characteristics Chemical Short-term Tx of Chemically irritates the lining of the GI tract Stimulant Laxative constipation causing increase motility senna Not for those with acute abdominal disorders / pain, heart block, CAD, or debilitation GI: diarrhea, abd cramping, nausea CNS: dizzy, HA, weakness - stimulant Cathartic dependence - hard to have BM w/o Bulk Forming Tx of constipation Increase motility of GI tract by increasing size Laxative of fecal matter Diarrhea in pt w/ IBS Good for people who should not be methylcellulose or diverticulosis straining: Heart problems. psyllium Not for those w/ intestinal obstructions, perforation, rectal bleeding, or is healing for acute abd surgery GI eﬀects: diarrhea, abd cramping, nausea Advise pt to take w/ plenty of water Osmotic Laxative Constipation Draw more water into GI tract and stimulate Pre-colonoscopy to increased GI motility polyethylene glycol clean them out GI eﬀects: diarrhea, abd cramping//bloating, nausea polyethylene glycol Not for those w/ activate surgical abdomen, electrolyte solution fecal impaction, intestinal obstruction, hx of seizure (polyethylene glycol) Dehydration: dry mouth, dizziness, light-headeddness - take w/ lots of water Sweating, palpitations, ﬂushing, fainting Lubricants Short- term for Make pooping easier w/o stimulating docusate constipation movement of GI tract For patients who could be harmed by straining - hemorrhoids, rectal surgery, etc. GI

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