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68 Cards in this Set

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"pril"s: benazepril, captopril, enalapril, lisinopril
ACE Inhibitors

Antihypertensive (non-diuretic), heart failure, decreased mortality and risk of MI, diabetic and non-diabetic neuropathy

Act as antagonists of renin-angiotensin system by not allowing angiotensin I to convert to angiotensin II via the inhibition of ACE, which allows this conversion; results in vasodilation and reduced B/P, excretion of sodium and water, and retention of potassium

Monitor for renal and hematologic changes, hyperkalemia, cough, rash, altered taste, angioedema, neutropenia
"zole"s: esomeprazole magnesium, lansoprazole, omeprazole, rabeprazole, pantoprazole
Proton Pump Inhibitors

Treat hyperacidity, GERD and the damage caused by these conditions

Suppress gastric acid secretion by blocking the final step in gastric acid production through the inhibition of H+, K+-ATPase in the gastric parietal cells
"pine"s, "zam"s, "pam"s: nifedipine, amlodipine, felodipine, nicardipine, verapamil, ditiazem
Calcium Channel Blockers

Antihypertensive (non-diuretic), vasodilation, decreased force of contraction in heart, decreased heart rate, slow rate of conduction through AV node, cardiac dysrhythmias, angina pectoris

Act by blocking calcium channels in blood vessels of peripheral arterioles and arteries or arterioles of heart

Watch for reflex tachycardia, acute toxicity, peripheral edema, orthostatic hypotension, constipation (verapamil), suppression of cardiac function, dysrhythmias (QT prolonged, QRS widened)
"sartan"s: losartan, valsartan, irbesartan, candesartan, olmesartan
Angiotensin II Receptor Antagonists

Antihypertensive (non-diuretic), management of heart failure and prevention of mortality post MI, stroke prevention, delays progression of diabetic neuropathy

Blocks the action of angiotensin II in the body resulting in vasodilation, excretion of sodium and water, and retention of potassium

Unlike ACE inhibitors, no cough or hyperkalemia as side effects; watch for angioedema
"cillin"s: amoxicillin, nafcillin, methicillin
Penicillins

Antibiotics, specifically for gram positive cocci (pneumonia, meninigitis, infectious endocarditis, pharyngitis), first choice for meninigiti and syphilis, and prophylactically for bacterial endocarditis

Destroy bacteria by weakening bacterial cell wall

Watch for allergies, anaphylaxis, renal impairment, hyperkalemia, dysrhythmias

Do not take with aminoglycosides or oral contraceptives
"cef"s, "ceph"s: cephalexin, cefaclor, ceftriaxone, cefepime
Cephalosporins

Antibiotics (broad-spectrum), usually for UTIs, postoperative infections, pelvic infections, meningitis

Destroy bacterial cell walls; different generations which are increasingly more effective against gram-negative organisms and anaerobes, less likely to be detroyed by beta-lactamase, and more able to reach CSF

Watch for allergies, anaphylaxis, hypersensitivity, bleeding tendencies, thrombophlebitis, pain with IM injection, cross allergy to penicillin

Do not take with alcohol or probenecid
imipemem
Carbapenems

Antibiotics (broad-spectrum), effective for serious infections (pneumonia, peritonitis, UTIs

Destroy bacterial cell walls causing destruction of micro-organisms

Watch for allergies, hypersensitivity, GI symptoms, suprainfection
vancomycin
Monobactams

Antibiotics, especially for serious infections caused by MRSA and antibiotic-associated pseudomembranous colitis caused by C. diff

Destroy bacterial cell walls causing destruction of micro-organisms

Watch for ototoxicity, infusion reaction, thrombophlebitis
tetracycline hydrochloride, doxycycline
Tetracyclines

Antibiotics (broad-spectrum), especially for acne vulgaris, Rocky Mountain spotted fever, typhus fever, infections of urethra/cervix, brucellosis, pneumonia, Lyme disease, anthrax, GI infections caused by H. pylori, periodontal disease

Inhibit micro-organism growth by preventing protein synthesis (bacteriostatic)

Watch for GI symptoms (cramping, N/V, diarrhea, esophageal ulceration), yellow/brown tooth discoloration, hypoplasia of teeth enamel, hepatotoxicity, photosensitivity, suprainfection of bowel

Do not take with milk, calcium, iron, magnesium-containing laxatives, antacids, oral contraceptives
erythromycin
Bacteriostatic Inhibitors

Antibiotics, especially for penicillin allergic clients with infections, Legionnaires' disease, pertussis, diphtheria, chlamydia, urethritis, cervicitis, respiratory tract infections caused by Strep pneumoniae; prevent recurrence of rheumatic fever, bacterial endocarditis

Slows the growth of micro-organisms by inhibiting protein synthesis (bacteriostatic)

Watch for GI discomfort, thrombophlebitis

Do not take with antihistamines, theophylline, carbamazepine, warfarin
gentamicin, neomycin, streptomycin, paromomycin, amikacin
Aminoglycosides

Antibiotics, especially for aerobic gram-negative bacilli (E. coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa); used for intestinal amebiasis and tapeworms

Bactericidal antibiotics that destroy micro-organisms by disrupting protein synthesis

Watch for ototoxicity, nephrotoxicity, respiratory depression, hypersensitivity, neurologic disorder

Do not mix with penicillin
trimethoprim-sulfamethoxazole
Sulfonamides/Trimethoprim

Antibiotics, especially for UTIs caused by E. coli

Inhibit bacterial growth by preventing the synthesis of folic acid (essential for synthesis of DNA, RNA, protein)

Watch for hypersensitivity (Stevens-Johnson syndrome), blood dyscrasias, crystalluria, kernicterus, photosensitivity

Do not take with warfarin, phenytoin, sulfonylurea oral hypoglycemics-tolbutamide
nirtofurantoin
Urinary Tract Antiseptics

Antibiotics, broad-spectrum for acute UTI, prophylaxis for recurrent lower UTI

Bacteriostatic qualities at low does and bacteriocidal at high doses by damaging cell DNA

Watch for GI discomfort, hypersensitivity reactions manifested with pulmonary symptoms (dyspnea, cough), blood dyscrasias, peripheral neuropathy

Urine will be brown, do not take with renal impairment
isoniazid
Antimycobacterials (Antituberculosis)

Antibiotics, highly specific for mycobacteria; used for active and latent TB

Inhibits growth of mycobacteria by preventing synthesis of mycolic acid in cell wall

Watch for peripheral neuropathy, hepatotoxicity

Do not take with liver disease, phenytoin, alcohol, rifampin, pyrazinamide; direct observation therapy needed for active TB, take on empty stomach
"vir"s: acyclovir, ganciclovir, interferon alpha, ribaviron, amantidine, lamivudine
Antivirals

Antibiotics, used for herpes simplex, varicella-zoster, cytomegalovirus, CMV retinitis (HIV clients), prophylactically for transplant patients

Prevents reproduction of viral DNA

Watch for phlebitis, inflammation at site of infusion, nephrotoxicity, mild discomfort associated with oral therapy (HA, nausea), granulocytopenia, thrombocytopenia, reproductive toxicity

Do not take if pregnant, and cautiously with renal impairment, dehydration, low white counts, and taking other nephrotoxic medications
ciprofloxacin
Fluoroquinolones

Antibiotics, broad-spectrum antimicrobials used for alternatives to parenteral antibiotics; respiratory, urinary, GI tract infections; infections of bone, joints, skin, soft tissues; prevention of anthrax

Bactericidal as a result of inhibition of enzyme necessary fro DNA replication

Watch for GI discomfort, Achilles tendon rupture, suprainfection

Do not administer to children <18YOA, with cationic compunds (antacids, iron salts, milk, dairy), theophylline, warfarin

Administer IV slowly over 60 minutes; for anthrax, q12h for 60 days
metronidazole
Antiprotozoals

Antibiotics, broad-spectrum used to treat protozoal infections (amebiasis, giardiasis, trichomoniasis); infections caused by anaerobic micro-organisms in CNS, bones, joints, abdominal organs, skin, soft tissues; prophylactically for surgeries involving high risk for anaerobic infection (abdominal, vaginal, colorectal); to treat H. pylori in patients with peptic ulcer disease

Antimocrobial with bactericidal activity against anaerobic micro-organisms

Watch for GI discomfort, darkening of urine, CNS symptoms (seizures, numbness, ataxia)

Use cautiously in patients with renal impairment, pregnant; do not take with alcohol, warfarin
amphotericin B deoxycholate, ketonconazole, nystatin
Antifungals

Antibiotics, used for systemic fungal infection, opportunistic mycoses (candidiasis, aspergillosis, cryptococcosis, mucomycosis) and nonopportunistic mycoses (blastomycosis, histoplasmosis); for superficial fungal infections; dermatophytic infections (ringworm of groin, foot)

Acts on fungal cell membranes to increase cell permeability, which results in leaking of intracellular cations and cell death; can be fungistatic (low doses) or fungicidal (high doses)

Watch for infusion reactions (1-3 hours after initiation), thrombophlebitis, nephrotoxicity, hypokalemia, bone marrow suppression, hepatotoxicity, gynecomastia (in males), irregular menstrual flow (in females)

Do not give to patients with renal impairment; do not take with aminoglycosides, flucytosine

Highly toxic and should only be used in severe fungal infections; amphotericin B IV over 2-4 hours; observe solution for precipitates and discard if present; renal damage decreased with administration of 1L NS on day of amphotericin B infusion
aspirin, celecoxib, ibuprofen, naproxen, ketorolac, valdecoxib
NSAIDs

Analgesics (mild to moderate), inflammation suppression, fever reduction, dysmenorrhea, low level suppression of platelet aggregation

Inhibition of cyclooxygenase; inhibition of COX-2 results in decreased inflammation, pain, fever and decreased COX-1 results in decreased platelet aggregation

Watch for GI discomfort, renal dysfunction, salicylism (tinnitus, sweating, HA, respiratory alkalosis), Reye syndrome

Do not give to patients with peptic ulcer disease, bledding disorders, hypersensitivity to aspirin and other NSAIDs, pregnancy, children with chicken pix or flu; use cautiously in older adults, smokers, H. pylori, hypovolemia, hay fever, chronic urticaria, alcoholism; do not give to patients taking warfarin, glucocorticoids, alcohol, ibuprofen

Stop taking one week before surgery or pregnancy due date; take with food
Acetaminophen
Analgesics, antipyretic

acetaminophen

Slows the production of prostaglandins in CNS

Watch for acute toxicity (N/V, diarrhea, sweating, abdominal discomfort)

Use cautiously in patients drinking 3+ alcoholic drinks/day, taking warfarin; do not exceed 4g/day; give diluted Mucomyst to reduce liver damage in overdose
morphine sulfate, fentanyl, meperidine, methadone, codeine, oxycodone
Opioid Analgesics

Analgesics, sedation, reduction of bowel motility, cough suppression

Activation of mu receptors to produce analgesia, respiratory depression, euphoria, sedation

Watch for respiratory depression, constipation, orthostatic hypotension, urinary retention, sedation affecting activities, biliary colic, emesis, opiod overdose triad (coma, respiratory depression, pinpoint pupils)

Do not give after biliary tract surgery, premature infants; use with caution in asthma, emphysema, head injuries, pregnant clients, clients in labor, extremely obese, inflammatory bowel disease, enlarged prostate; do not give more than 600mg/day meperidine (seizures, neurotoxicity); do not give with CNS depressants, anticholinergic agents, MAOIs, antihypertensives

Do not give if RR <12/min, double check order with another nurse, administer IV over 4-5 minutes (have Narcan on hand), do not D/C abruptly (taper slowly over 3 days), closely monitor PCA settings, fentanyl 100 times more potent than morphine, give short-acting opiods during first administration of fentanyl patch for breakthrough pain and prior to therapeutic effects
pentazocine, butorphanol
Agonists-Antagonists Opioids

Analgesics (mild to moderate)

Antagonists to mu receptors, agonists to kappa receptors causing analgesia, sedation, decreased GI motility

Watch for abstinence syndrome (cramping, hypertension, vomiting)

Use cautiously in patients with history of MI, physically dependent on opioids; do not give if RR <12/min
naloxone, naltrexone
Opioid Antagonists

TX of opioid overdose, reversal of opioid effects, reversal of respiratory depression in infants

Interfere with actions of opioids by competing for opioid receptors; no effect in absence of opioids

Watch for tachycardia, tachypnea, abstinence syndrome (cramping, hypertension, vomiting)

Do not give to patients with hypersensitivity, opioid dependency, pregnant

Do not administer orally, monitor for withdrawal symptoms, abrupt onset of pain
Tricyclic Antidepressants: amitriptyline
Anticonvulsants: carbamazepine, gabapentin, phenytoin
CNS Stimulants: methylphenidate, dextroamphetamine
Antihistamines: hydroxyzine
Glucocorticoids: dexamethasone, prednisone
Biphosphonates: etidronate, pamidronate
Adjuvants to Analgesics

Enhance effects of opioids, alleviate other symptoms that aggravate pain, used for neuropathic pain, cancer-related conditions

Watch for orthostatic hypotension, sedation, anticholinergic effects (dry mouth, urinary retention, constipation), bone marrow suppression, weight loss, insomnia, adrenal insufficiency, osteoporosis, hypokalemia, glucose intolerance, peptic ulcer disease, flu-like symptoms, venous irritation at injection site
epinephrine, catecholamine, dopamine, isoproterenol, terbutaline
Adrenergic Agonists

Used for patients with superficial bleeding, hypertension, congestion of nasal mucosa, AV block, cardiac arrest, asthma, shock, heart failure by vasoconstriction, increasing HR, increasing myocardial contractility, increasing rate of conduction through AV node, bronchodilation, renal blood vessel dilation

Watch for vasoconstriction, dysrhythmias, increased workload of heart (angina), necrosis, increased HR

Cannot be taken orally, do not cross blood-brain barrier, duration of action is short; do not give to patients who are pregnant, with tachydysrhythmias, v. fib; use cautiously in patients with hyperthyroidism, angina, HX of MI, hypertension, diabetes; do not take with MAOIs, tricyclic antidepressants, general anesthetics, alpha-adrenergic blocking agents, beta-adrenergic blocking agents, diuretics

Give IV continuously, titrate dosage based on B/P, monitor for chest pain, use ECG, stop infusion if infiltration occurs
"zosin"s: prazosin, doxazosin mesylate
Alpha Adrenergic Blockers (Sympathomimetics)

Sympatholytics, used for hypertension, decrease symptoms of BPH (urgency, frequency, dysuria)

Selective alpha 1 blockade results in venous/arterial dilation, smooth muscle relaxation of prostatic capsule and bladder neck

Watch for orthostatic hypotension in first dose

Do not give to pregnant patients, patients with hypersensitivity; do not take with antihypertensive medications, NSAIDs, clonidine

Take with food, take initial dose at bedtime, obtain baseline B/P, HR
clonidine, guanfacine HCl, methyldopa
Centrally Acting Alpha 2 Agonists

Used for treatment of hypertension, severe cancer pain

Act within CNS to decrease sympathetic outlow resulting in decreased norepinephrine released from sympathetic nerves and a decrease in the amount of norepinephrine available to stimulate adrenergic receptors of the heart and peripheral vascular system; decreased sympathetic outflow resulting in bradycardia and decreased cardiac outflow; decreased sympathetic outflow to peripheral vasculature resulting in vasodilation and decreased BP

Watch for drowsiness, sedation, dry mouth, rebound hypertension

Do not take while pregnant, taking other antihypertensives, prazosin, MAOIs, triccylic antidepressants, CNS depressants
"lol"s: metoprolol, propanolol, atenolol, nadolol
Beta Adrenergic Blockers (Sympatholytics)

Sympatholytics, used for angina pectoris, hypertension, cardiac dysrhythmias, MI, heart failure

Create a beta 1 adrenergic blockade in the myocardium and in the electrical conduction system of the heart resulting in decreased HR, decreased myocardial contractility, decreased rate of conduction through AV node

Watch for bradycardia, decreased cardiac output, AV block, orthostatic hypotension, rebound myocardium excitation, bronchoconstriction, inhibition of glycogenolysis

Do not use in patients with AV block, sinus bradycardia, asthma, bronchospasm, heart failure; use cautiously in patients with diabetes, history of severe allergies, depression

Do not take with calcium channel blockers, diltiazem, other antihypertensive medications, and cautiously with insulin; do not D/C abruptly, avoid sudden position changes, monitor HR and BP daily
sodium nitroprusside, labetalol, diazoxide, fenoldopam, trimethaphan
Hypertensive Crisis

Used for hypertensive emergencies and to decrease bleeding during surgery by producing controlled hypotension

Cause vasodilation of arteries and veins resulting in rapid reduction of BP by decreasing preload and afterload

Watch for excessive hypotension, cyanide poisoning, thiocyanate poisoning

Use cautiously in clients with liver and kidney disease, fluid and electrolyte imbalances, older adults

Continuously monitor BP, ECG during administration; do not mix drugs with nitroprusside, protect from light, should be slightly brown (discard if blue, red, green)
nitroglycerine, isosorbide dinitrate
Organic Nitrates

Used for treatment of angina (acute attack, prophylactically, variant angina); IV administration used to control angina not improved by other meds, perioperatively to control BP/produce hypotension, heart failure from acute MI

In stable angina, decreases cardiac oxygen demand by dilating veins and decreasing venous return (preload); in variant angina, relaxes/prevents spasm in coronary arteries increasing oxygen supply

Watch for HA, orthostatic hypotension, reflex tachycardia, tolerance

Do not use in patients with hypersensitivity, traumatic head injury; use cautiously in patients taking antihypertensives, have renal/liver dysfunction; do not take with alcohol, Viagra

Do not stop taking long-acting nitro abruptly

In treatment of anginal attack, stop activity, take a rapid-acting tablet SL (can only take 3 doses in 5 minute); if pain still present after 3 doses, call 911
digoxin
Cardiac Glycosides

Used for treatment of heart failure, dysrhythmias (a fib)

Causes positive inotropic effect (increased force of myocardial contraction) which improves heart's effectiveness as a pump improving SV and CO; decreased chronotropic effect (decreased HR) which slows the rate of SA node depolarization and rate of impulses through the conduction system of the heart giving the ventricles more time to fill with blood coming from the atria leading to increased SV and CO

Watch for dysrhythmias, cardiotoxicity, bradycardia, anorexia, N/V, abdominal pain, fatigue, weakness, vision changes

Do not use in patients with disturbances in ventricular fibrillation, ventricular tachycardia, second and third degree heart block; use cautiously in clients with hypokalemia, partial AV block, advanced heart failure, renal insufficiency

Do take with thiazide diuretics, ACE inhibitors, ARBs, sympathomimetics, quinidine, verapamil

Do not double dose, take as prescribed; check pulse and rhythm, do not take if HR <60 BPM in adults, <70 BPM in children, <90 BPM in infants; administer at same time daily; monitor levels and maintain therapeutic levels during treatment; avoid taking OTC meds to prevent adverse effects; observe for symptoms of hypokalemia (muscle weakness); observe for symptoms of toxicity (anorexia, fatigue, weakness) and to prevent and treat toxicity monitor K levels, treat dysrhythmias with phenytoin/lidocaine, treat bradycardia with atropine
procainamide, lidocaine, verapamil, diltiazem, amiodarone, adenoside, bretylium, sotalol, dofetilide, ibutilide
Antidysrhythmic

Used for treatment of supraventricular tachycardia, ventricular tachycardia, a flutter, a fib, SVT, v fib, v tach, Wolff-Parkinson-White Syndrome, ventricular dysrhythmias

Causes decrease in electrical conduction, increase/decrease automaticity, increase/decrease rate of repolarization, decrease force of contraction, decrease HR

Watch for systemic lupus syndrome, blood dyscrasias, cardiotoxicity, CNS (dizziness, altered mental status, paresthesias, seizures), respiratory arrest, pulmonary toxicity, hypotension, visual disturbances (photophobia, blurred vision), phlebitis, bradycardia, AV block, dyspnea, flushing of face, sinus bradycardia

Do not take with other antidysrhythmics, anticholinergics, antihypertensives, cimetidine, beta-blockers, phenytoin, diuretics, antibiotics, grapefruit juice, verapamil, diltiazem, methylxanthines, dipyridamole, quinidine, procainamide, digoxin, warfarin, cholecystyramine; do not take if pregnant, in clients with respiratory problems (asthma), heart blocks, heart failure
"statin"s: atorvastatin, simvastatin, lovastatin, pravastatin sodium, rosuvastatin
HMG CoA Reductase Inhibitors

Antilipidemic

Used for primary hypercholesterolemia, prevention of coronary events, protection against MI, raise levels of HDLs

LDL levels decreased by suppressing cholesterol synthesis by decreasing amount of LDL receptors in liver cells; promote vasodilation, decrease in plaque site inflammation, and decrease risk of thromboembolism; production of VLDLs decreased, HDLs increased

Watch for hepatotoxicity, myopathy, peripheral neuropathy

Do not take if pregnant, in clients with hepatitis; do not take with fibrates, meds that suppress CYP3A4 (erythromycin), grapefruit juice

Administer with evening meal; monitor cholesterol levels before and during therapy
gemfibrozil, fenofibrate
Fibrates

Antilipidemic

Reduces VLDLs, increase levels of HDLs

Decreases levels of VLDLs by increasing rate of excretion; increases levels of HDLs by promoting production of precursors to HDLs

Watch for gall bladder stones, myopathy, hepatotoxicity

Do not take if pregnant, in clients with liver disorders, severe renal dysfunction, gall bladder disease; use cautiously with statins; do not take with warfarin, statins, bile acid sequestrants (cholestyramine)

Take 30 minutes prior to breakfast and dinner; monitor cholesterol levels before and during therapy
"parin"s: heparin, enoxaparin, tinzaparin
Anticoagulants- Parenteral

Used in prompt treatment of anticoagulant activity, during pregnancy, adjunct for open heart surgery or renal dialysis, prophylaxis against post-op venous thrombosis, disseminated intravascular coagulation, conjunction with thrombolytic therapy when treating an acute MI

Prevent bleeding by inactivation of thrombin formation and factor Xa, resulting in inhibition of fibrin formation

Watch for hemorrhage, thrombocytopenia (low platelets), hypersensitivity (chills, fever, urticaria)

Do not take in clients with low platelet counts, uncontrollable bleeding, during/following surgery of the eyes, brain, spinal cord, lumbar puncture, regional anesthesia; use cautiously in hemophilia, increased capillary permeability, dissecting aneurysm, PUD, severe HTN, threatened abortion; do not take with other antiplatelet agents (ASA)

Dosages should be checked with another nurse before administration, SQ should be administered deep in abdomen at least 2 inches away from umbiliucus with a 25-26 gauge (1/2-5/8 inch needle), do not aspirate, and apply firm pressure for 1-2 minutes after injection on rotated injection sites
protamine sulfate
TX for Heparin Overdose

Binds with heparin and forms a heparin-protamine complex that has no anticoagulant properties

Should be administered slowly IV, no faster than 20 mg/min or 50 mg/10 min
warfarin
Anticoagulants- Oral

Used in prevention of venous thrombosis, thrombus formation in clients with a fib, thrombus formation in clients with prosthetic heart valves

Antagonize vitamin K, preventing synthesis of 4 coagulation factors: 7, 9, 10, and prothrombin

Watch for hemorrhage

Do not take if pregnant, with low platelet counts, uncontrollable bleeding, surgery of brain, eyes, spinal cord, lumbar puncture, regional anesthesia, vitamin K deficiency, liver disorders, alcoholism; use cautiously with hemophilia, dissecting aneurysm, PUD, severe HTN, threatened abortion; do not take with heparin, aspirin, glucocorticoids, acetaminophen, sulfonamides, parenteral cephalosporins, phenobarbital, carbamazepine, phenytoin, oral contraceptives, vitamin K

Use soft bristled toothbrush to prevent gum bleeding, wear MedicAlert bracelet during therapy, anticoagulant effects can last up to 5 days after D/C due to long half-life; avoid alcohol, OTC drugs
vitamin K
TX of Warfarin Overdose

Promotes synthesis of coagulation factors 7, 9, 10, and prothrombin

Watch for anaphylactoid-type reaction (flushing, hypotension, urticaria, cardiovascular collapse)

Administer by mouth or IV in small doses to prevent development of resistance to warfarin; administer whole blood or fresh frozen plasma if vitamin K does not control bleeding
aspirin, ticlopidine, clopidogrel, dipyridamole, abciximab, tirofiban
Antiplatelets

Used for primary prevention of acute MI, prevention of reinfarction in clients following an acute MI, prevention of stroke, acute coronary sydromes

Prevent platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting

Watch for GI effects (bleeding), hemorrhagic stroke

Do not take if pregnant, in clients with bleeding disorders, thrombocytopenia; use cautiously in clients with PUD, severe renal and/or hepatic disorders

Do not take with other medications that enhance bleeding
"ase"s: streptokinase, alteplase, tenecteplase, reteplase
Thrombolytics

Used to treat acute MI, DVT, masive pulmonary emboli, ischemic stroke

Act by dissolving clots that have already formed by converting plasminogen to plasmin, which destroys fibrinogen and other clotting factors

Watch for serious risk of bleeding from different sites, hypotension, allergic reaction

Do not use in patients with prior intracranial hemorrhgae, known structural cerebral vascular lesion, suspected aortic dissection, active internal bleeding, HX of significant closed head or facial trauma in past 3 months, acute pericarditis, brain tumors; use cautiously with severe HTN, recent ischemic stroke, or major surgery within 2-4 weeks before start of treatment

Do not take with other medications that enhance bleeding

Begin usage within 4-6 hours of onset of symptoms, do not mix IV with any other medications
"terol"s: albuterol, formoterol, salmeterol, terbutaline
Beta 2 Adrenergic

Used for prevention of asthma attack, ongoing asthma attack, long-term control of asthma

Act by selectively activating the beta 2 receptors in the bronchial smooth muscle resulting in bronchodilation, ultimately resulting in relief of bronchospasm, inhibition of histamine release, increased ciliary motility

Watch for tachycardia, angina, tremors

Do not take if client has tachydysrhythmias; use cautiously in clients who are pregnant, diabetic, hyperthyroidism, heart disease, HTN, angina; do not take with beta blockers, MAOIs and tricyclic antidepressants

Can be administered via MDI, DPI, nebulizer; inhale beta 2 agonist before glucocorticoids
theophylline
Methylxanthines

Used for long-term control of chronic asthma

Causes relaxation of bronchial smooth muscle resulting in bronchodilation

Watch for GI distress, restlessness, dysrhythmias, seizures

Use cautiously in client who are pregnant, have heart disease, HTN, liver/renal dysfunction, diabetes, children, older adults; do not take with caffeine (increases levels), phenobarbital, phenytoin (decreases levels), cimetidine, ciprofloxacin (fluoroquinolones= increased levels)

Do not double dose if dose is missed
"tropium"s: ipatropium, tiotropium
INH Anticholinergics

Used to relieve bronchospasm associated with COPD and allergen-induced and exercise-induced asthma

Block muscarinic receptors on bronchi resulting in bronchodilation

Watch for systemic effects, anticholinergic effects (dry mouth, hoarseness)

Use cautiously in client who are pregnant, narrow-angle glaucoma, BPH; contraindicated in patients with allergies to peanuts

Rinse mouth after inhalation (decrease unpleasant taste), wait at least 1 minute between puffs and 5 minutes between medications
"sone"s, "lone"s: beclomethasone diproprionate, budesonide, fluticasone proprionate, triamcinolone acetonide, prednisone
Glucocorticoids

Used for long-term prophylaxis of asthma, short-term oral therapy for symptoms following acute asthma attack, long-term oral therapy for chronic asthma, replacement therapy for primary adrenocortical insufficiency, promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth

Prevent inflammation, suppression of airway production, and promote responsiveness of beta 2 receptors in bronchial tree; no immediate effects but promotes decreased frequency and severity of exacerbation and acute attacks

Watch for difficulty speaking, hoarseness, candidiasis, bone loss, hyperglycemia, glucosuria, myopathy (muscle weakness), PUD, infection, disturbances in fluids and electrolytes

Do not use in patients who have received live virus vaccine, clients with systemic fungal infections; use cautiously in children, patients with diabetes, HTN, PUD, renal dysfunction; do not take with potassium depleting diuretics, NSAIDs, insulin, oral hypoglycemics

Used orally for short-term for 3-10 days after acute attack; should use spacer; administer with MDI, DPI, nebulizer; used long-term only, no immediate effects
cromolyn sodium, nedocromil sodium
Mast Cell Stabilizers

Used or management of chronic asthma, prophylaxis of exercise-induced asthma, prevention of allergen-induced attack, allergic rhinitis by intranasal route

Anti-inflammatory, stabilize mast cells, inhibiting the release of histamine and other inflammatory mediators; suppress inflammatory cells

Use cautiously during pregnancy, liver/kidney impairment; do not use in patients with coronary artery disease, dysrhythmias, status asthmaticus

Take 15 minutes prior to exposure to allergen/exercise; may take several weeks for full therapeutic effects to be seen; no intended for aborting attack of asthma
"lu"s, "leu"s: montelukast, zileuton, zafirlukast
Leukotriene Modifiers

Used for long-term therapy of asthma in adults and children over 12 YOA

Prevent the effects of leukotrienes, suppressing inflammation, bronchoconstriction, airway edema, mucus production

Watch for liver injury

Use cautiously in patients with liver dysfunction; do not take with warfarin, theophylline

Take zafirlukast without food, 1-2 hrs after meals; take montelukast once daily at bedtime
"cod"s: codeine, hydrocodone
Antitussive-Opioids

Used for chronic, non-productive cough

Suppresses cough

Watch for dizziness, lightheadedness, drowsiness, respiratory depression, GI distress (N/V, constipation), potential for abuse

Use cautiously during pregnancy, with children, older adults, clients with drug abuse history; do not use in patients with acute asthma, had trauma, liver/renal dysfunction, acute alcoholism

Avoid hazardous activities, change positions slowly, avoid alcohol or other CNS depressants
acetylcysteine, hypertonic saline
Mucolytics

Used in clients with acute and chronic pulmonary disorders exacerbated by large amounts of secretions, clients with cystic fibrosis, and antidote for acetaminophen overdose

Enhance the flow of secretions in respiratory passages

Watch for aspiration and bronchospasm

Use cautiously in pregnancy, in clients with PUD, esophageal varices, severe liver disease; do not use in clients at risk for GI hemorrhage

Dilute in fruit juice or other beverage, will make drainage watery and facilitate coughing; be prepared to suction
phenylephrine, ephedrine, naphazoline, phenylpropanolamine
Decongestants

Used to treat allergic rhinitis by relieving nasal stuffiness, acts as decongestant in sinusitis and common cold

Stimulate alpha 1 adrenergic receptors causing reduction in the inflammation of the nasal membranes

Watch for CNS stimulation (agitation, nervousness, uneasiness), rebound congestant, vasoconstriction

Do not take in chronic rhinitis; use cautiously in coronary artery disease, HTN

Use topically for 3-5 days to avoid rebound congestion, be in lateral head low position to prevent swallowing
furosemide, ethacrynic acid, bumetanide, torsemide
High Ceiling Loop Diuretics

Diuretics

Used to treat pulmonary edema caused by heart failure, reserved for conditions not responsive to other diuretics, renal impairment, treat hypercalcemia related to kidney stone formation
hydrochlorothiazide, chlorothiazide
Thiazides

Diuretics, used for essential hypertension, edema of mild to moderate heart failure, liver/kidney disease

Work in early distal convoluted tubule to block reabsorption of sodium and chloride, prevent reabsorption of water at site, promote diuresis when renal function is not impaired

Watch for dehydration, hypokalemia, hyperglycemia

Avoid use during pregnancy, do not breastfeed while on medication; use cautiously in patients with decreased renal function (decreased effectiveness); do not take with digoxin, antihypertensives, lithium, NSAIDs

Obtain baseline data (orthostatic BP, weight, electrolytes, edema); monitor K levels; take first dose in the morning and second dose at 1400 (prevent nocturia); consume foods high in K and maintain adequate fluid intake (1500 mL/day); take with or after meals with GI upset
spironolactone, triamterene, amiloride
Potassium-Sparing Diuretics

Diuretics, used for K-sparing effects, heart failure, primary hyperaldosteronism by blocking actions of aldosterone

Block action of aldosterone (sodium and water retention) resulting in K retention and secretion of sodium and water

Watch for hyperkalemia, endocrine effects (impotence in males, irregularities of menstrual cycles in females)

Do not take with ACE inhibitors, K supplements

Obtain baseline data, monitor K levels, only give orally, avoid salt substitutes, monitor BP, triamterene may turn urine blue
mannitol, urea, glycerin, isosorbide
Osmotic Diuretics

Diuretics, used to prevent renal failure in specific situations, decrease ICP, decrease IOP, promote sodium retention and water excretion in clients with hyponatremia and fluid volume excess
"dine"s: ranitidine hydrochloride, cimetidine, nizatidine, famotidine
Histamine 2 Receptor Antagonists

Used for gastric and peptic ulcers, GERD, hypersecretory conditions, used with antibiotics to treat H. pylori

Suppress the secretion of gastric aid by selectively blocking H2 receptors in parietal cells lining the stomach

Watch for decreased libido, impotence, CNS effects

Use cautiously in pregnancy , older adults, high risk for pneumonia, COPD, taking warfarin, phenytoin, antacids

Eat six small meals instead of three large meals, reduce stress, increase rest, avoid smoking, avoid aspirin, NSAIDs, avoid alcohol
Sucralfate
sucralfate

Used for acute duodenal ulcers and those requiring maintenance therapy

The acidic environment of stomach, intestines changes sucralfate into viscous substance that adheres to ulcer and thus protects ulcer from further injury for up to 6 hours with no systemic effects

Use cautiously during pregnancy; do not give to clients who are hypersensitive to the medication, taking phenytoin, digoxin, warfarin, ciprofloxacin, antacids

To prevent constipation, drink at least 1500 mL of fluid a day and increase fiber intake; should be taken on empty stomach; take 4 times a day, 1 hour before meals and at bedtime; can dissolve in water but do not crush/chew medication
aluminum hydroxide gel, aluminum carbonate, magnesium hydroxide, sodium bicarbonate
Antacids

Used to treat PUD, provide symptomatic relief to patient with GERD

Neutralize gastric acid and inactive pepsin, mucosal protection may occur

Watch for constipation, diarrhea, fluid retention, hypophosphatemia, magnesium toxicity

Use cautiously in patients who are pregnant, lactating, abdominal pain; do not use in patients with GI perforation, obstruction, taking warfarin, tetracycline

Chew tablets thoroughly and take with water/milk, take all medications 1 hour before or after taking antacids
misoprostol
Prostaglandin E Analog

Used in clients taking NSAIDs chronically to prevent gastric ulcers; used in pregnant women to induce cervical ripening

Acts as an endogenous prostaglandin in the GI tract to decrease acid secretion, increase secretion of bicarbonate and protective mucus, promotes vasodilation to maintain submucosal blood flow preventing formation of gastric ulcers

Watch for diarrhea, abdominal pain, dysmenorrhea, spotting in women

Do not take during pregnancy unless prescribed

Take with meals and at bedtime
Serotonin Antagonists: ondansetron
Dopamine Antagonists: prochlorperazine
Glucocorticoids: dexamethasone
Cannabinoids: dronabinol
Anticholinergics: scopolamine
Antihistamine: dimenhydrinate
granisetron, promethazine, metoclopramide, hydroxyzine, aprepitant
Antiemetics

Watch for HA, diarrhea, dizziness, EPS, hypotension, sedation, anticholinergic effects, dissociation, dysphoria, tachycardia

Use dopamine antagonists cautiously in children/older adults, urinary retention or obstruction, asthma, narrow angle glaucoma, taking CNS depressants, opioids, antihypertensives, anticholinergics
psyllium, docusate sodium, biscodyl, magnesium hydroxide, senna, lactulose
Laxatives

Either bulk-forming, surfactant, stimulant, or osmotic

Watch for GI irritation, rectal burning, magnesium levels, sodium levels, dehydration

Do not use in patients with fecal impaction, bowel obstruction, acute surgical abdomen, nausea, cramping, abdominal pain, ulcerative colitis, diverticulitis, milk; use cautiously in patients who are pregnant, lactating

Encourage exercise, high fiber diet, take with water
diphenoylate, loperamide, difenoxin
Antdiarrheals

Used to treat underlying causes, provide symptomatic treatment

Activate opioid receptors in the GI tract to decrease intestinal motility and increase the absorption of fluid and sodium in the intestine

Watch for euphoria, CNS depression

Use cautiously in patients with inflammatory bowel disorders, taking alcohol, other CNS depressants

Avoid caffeine, manage dehydration, avoid regular water, drink small amounts of clear liquids
metoclopramide
Prokinetic Agents

Used to control postoperative and chemotherapy induced N/V, to treat GERD, to treat diabetic gastroparesis

Block dopamine and serotonin receptors in the CTZ, thus suppressing emesis; augment action of acetylcholine which causes an increase in upper GI motility

Watch for extrapyramidal symptoms, sedation, diarrhea

Do not use in patients with GI perforation, GI bleeding, bowel obstruction, hemorrhage, seizure disorder; use cautiously in children and older adults; do not take with alcohol, CNS depressants, opioids, anticholinergics

IV<10mg, give undiluted over 2 minutes; IV>10mg, give diluted in 50 mL D5W, LR over 15 minutes
Regular insulin
Insulin

Used for glycemic control of Type II DM

Promotes cellular uptake of glucose, converts glucose into glycogen, moves potassium into cells

Watch for hypoglycemia, lipohypertrophy, taking sulfonylureas, meglitinides, beta-blockers, alcohol, thiazides, glucocorticoids

Adjust dosage to meet client needs; when giving both short and long-acting, draw short-acting first then long-acting
"mide"s, "ride"s, "zide"s: tolbutamide, glipizide, chlorpropamide, glyburide, glimepiride
Oral Hypoglycemics

Sulfonylureas

Control blood glucose levels in client with type 2 DM, used in conjunction with diet and exercise lifestyle changes

Promote insulin release from pancreas

Watch for hypoglycemia

Use cautiously during pregnancy, avoid use during pregnancy/lactation, client with renal/hepatic dysfunction; ineffective on type 1 DM; do not use to treat DKA, alcohol, NSAIDs, sulfonamide antibiotics, ranitidine, cimetidine, beta-blockers
"linide"s: repaglinide, nateglinide
Oral Hypoglycemics

Meglitinides

Used to control blood levels in clients with type 2 DM, used in conjunction with diet and exercise lifestyle changes, used in conjunction with metformin

Promote insulin release from the pancreas

Watch for hypoglycemia

Use cautiously in pregnancy, hepatic dysfunction; do not use in clients with type 1 DM, treatment of DKA, with gemfibrozil

Eat within 30 minutes of taking medication
metformin HCl
Oral Hypoglycemics

Biguanides

Used for control of blood glucose levels in clients with type 2 DM, in conjunction with diet and exercise lifestyle changes, to treat polycystic ovary syndrome

Reduce production of glucose within the liver through suppression of gluconeogenesis and increase muscles' glucose uptake and use

Watch for GI effects (N/V, anorexia), vitamin B12 and folic acid deficiency, lactic acidosis

Use cautiously during pregnancy; do not use in treatment of DKA, patients with hepatic/renal/cardiac failure, sever infection, shock, any hypoxic condition; do not take with alcohol

Take immediate release twice a day with breakfast and dinner and sustained release once a day at dinner
"glitazone"s: rosiglitazone, pioglitazone
Oral Hypoglycemics, controls blood glucose levels in clients with type 2 DM, used in conjunction with diet and exercise

Thiazolidinediones

Increase cellular response to insulin by decreasing insulin resistance

Watch for fluid retention, elevations in LDLs, hepatotoxicty; do not give if patient is pregnant; ineffective in patients with type 1 DM; contraindicated in TX of DKA, clients with severe heart failure; use cautiously in mild heart failure (fluid retention); do not give with gemfibrozil, insulin

Monitor glucose levels in log and note patterns, encourage exercise, diet
acarbose, miglitol
Oral hypoglycemic, controls postprandial blood glucose levels in type 2 DM clients, used in conjunction with diet and exercise

Alpha Glucosidase Inhibitors

Slow carbohydrate absorption and digestion

Watch for intestinal effects, risk for anemia, hepatotoxicity

Do not take of pregnant, in TX of DKA, GI disorders; do not take with sulfonylureas, insulin, metformin

Take with first bite of each meal, maintain glucose level log
Glucagon
Used for hypoglycemia secondary to insulin overdose in unconscious, unable to swallow patients; decrease in GI motility in clients undergoing radiological procedures of stomach/intestines

Insulin Overdose

Increases glucose levels by increasing breakdown of glycogen into glucose, decreasing glycogen synthesis, stimulating synthesis of glucose

Watch for GI distress

Ineffective for hypoglycemia secondary to starvation; do not use in patients with pheochromocytoma

Administer SC, IM, IV immediately; give food as sson as patient regains consciousness, ability to swallow