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211 Cards in this Set

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Diazepam (Valium)
Benzodiazepine – Sedative hypnotic anxiolytic: enhance inhibitory effects of gamma-aminobutyric acid (GABA) in CNS, relief occurs rapidly; T: Seizure disorders, insomnia, muscle spasms; alcohol withdrawal, anesthesia
CNS depression, antegrade amnesia, acute toxicity = oral - lethargy, confusion; IV – resp depression, severe hypotension, paradoxical response – insomnia, excitation; withdrawal symptoms; DI: CNS depressants; Flumazenil (Romazicon) to counteract, P-D* S-IV*
Buspirone (BuSpar)
Nonbarbiturate – Atypical anxiolytic: Unknown – binds to serotonin and dopamine receptors; T: Panic disorder, OCD, social anxiety disorder, PTSD
Dizziness, nausea, headache, light-headedness, agitation; DI: no MAOIs, use 14 days after, Erythromycin, ketoconazole, grapefruit juice increases effects, P-B,
Paroxetine (Paxil)
SSRI – Antidepressant: selectively inhibits serotonin reuptake; T: Generalized Anxiety Disorder, panic disorder, OCD, social anxiety disorder, PTSD, depressive disorders, effects = 4 wks
Early – nausea, diaphoresis, tremor, fatigue, drowsiness; Late – sexual disfunction (5wks); wt gain, GI bleed, Serotonin syndrome* Bruxism* withdrawal DI: MAOIs or TCAs = serotonin syndrome
Amitriptyline (Elavil)
TCA - Tricyclic Antidepressant – block reuptake of norepinephrine and serotonin – intensifying these neurotransmitters; T: Depression, depressive episodes of bipolar disorder (BD), chronic pain, enuresis*
Orthostatic hypotension, anticholinergic effects* sedation, decreased seizure threshold, excessive diaphoresis, use cautiously with HTN, DI: MAOIs & St. John’s wort = Serotonin Syndrome, Antihistamines & anticholinergic – additive, /|\ effect of sympathomimetics, TCAs decrease effect, avoid CNS depressants, P-C
Fluoxetine (Prozac)
SSRI: - selectively block reuptake of monoamine neurotransmitter serotonin in synaptic space T: Major depression, OCD, bulimia nervosa, premenstrual dysphoric disorders, PTSD
Sexual dysfunction, CNS stimulation, wt loss, serotonin syndrome, withdrawal, hyponatremia, rash, sleepiness, GI bleeding, Bruxism DI: MAOIs, TCAs, St. John’s wort = Serotonin Syndrome, displaces warfarin, increase levels of lithium TCAs, suppresses platelet aggregation, P-C
Phenelzine (Nardil)
MAOI – Monoamine Oxidase Inhibitor: block MAO-A in brain = increases norepinephrine, dopamine, & serotonin T: atypical depression, bulimia nervosa, OCD
CNS stimulation, Orthostatic hypotension, hypertensive crisis (tyramine), local rash from admin; DI: indirect acting sympathomimetics & TCA & Tyramine= hypertensive, antihypertensive = hypotensive, Meperidine (Demerol) = hyperpyrexia* P-C
Bupropion HCL (Wellbutrin)
Atypical Antidepressant: inhibiting dopamine uptake; T: Depression, aid to quit smoking, SAD (seasonal affective disorder) prevention Alternative to SSRI for sexual function
Headache, dry mouth, GI distress, constipation, /|\ heart rate, nausea, restlessness, insomnia, wt loss, seizures; DI: MAOIs /|\ risk of toxicity, P-B; use autumn to spring
Lithium Carbonate (Lithane, Eskalith, Lithobid)
Mood Stabilizer: neurochemical changes, serotonin receptor blockade, decrease in neural atrophy and/or neural growth; T: Bipolar disorder, acute mania, prevention, suicidal, alcoholism, bulimia, schizophrenia
Gastrointestinal distress, fine hand tremors, polyuria, mild thirst, wt gain, renal toxicity, goiter and hypothyroidism (long-term) bradydysrhythmia, hypotension, electrolyte imbalances, toxicity***
DI: Reduced serum sodium = reduced lithium excretion, NSAIDs & celecoxib (Celebrex) /|\ reabsorption of Li, anticholinergics = urinary retention with polyuria of lithium; P-D, initial monitor 2-3days normal levels between .4-1.0; need 2-3 daily doses b/c ½ life,
Carbamazepine (Tegretol)
AED – Mood-Stabilizing Antiepileptic Drug: slows entrance of Na & Ca back into neuron (slows return to action state), potentiates inhibitory effects of GABA, inhibits glutamic acid (glutamate) à suppressing CNS excitation; T: manic & depressive episodes, prevention, esp – rapid cycling
CNS – minimal, nystagmus* double vision, vertigo, staggering gait, headache; Blood dyscrasia, teratogenesis, hypo-osmolarity, dermatitis, rash, Steven-Johnson Syndrome* DI: Carbamazepine \/ effect of warfarin, grapefruit juice inhibits metabolism, phenytoin and Phenobarbital decrease effects of carbamazepine, P-D
Valproic Acid (Depakote)
AED: slows entrance of Na & Ca back into neuron (slows return to action state), potentiates inhibitory effects of GABA, inhibits glutamic acid (glutamate) à suppressing CNS excitation; T: manic & depressive episodes, prevention, esp – rapid cycling
GI effects, hepatoxicity (anorexia, ab pain, jaundice), pancreatitis, thrombocytopenia, tetratogenesis, DI: Concurrent use – increases phenytoin and Phenobarbital, P-D
Lamotrigine (Lamictal)
AED: slows entrance of Na & Ca back into neuron (slows return to action state), potentiates inhibitory effects of GABA, inhibits glutamic acid (glutamate) à suppressing CNS excitation; T: manic & depressive episodes, prevention, esp – rapid cycling
Common – double or blurred vision, dizziness, headache, nausea, vomiting; skin rash, Stevens-Johnson syndrome, DI: Carbamazepine, Phenytoin, Phenobarbital \/ effect, Valproic acid inhibits metabolism of lamotrigine, P-D
Chlorpromazine (Thorazine)
Antipsychotic – Conventional: Block dopamine (D2), acetylcholine, histamine, and norepinephrine (NE) receptors in brain & periphery; T: acute & chronic psychosis, Schizophrenia, Bipolar disorder, Tourette’s, delusional & schizoaffetive disorders, dementia, prevention of nausea & vomiting in trigger zone – medulla; 2-4 wks for affect
Acute dystonia* Parkinsonism* Akathisia* Late extrapyramidal symptoms (EPS)*, tardive dyskinesia (TD)* Neuroleptic malignant syndrome* anticholinergic effects, orthostatic hypotension, sedation, neuroendocrine effects* Seizures, sexual dysfunction, photosensitivity, agranulocytosis* severe dysrhythmias; DI: concurrent anticholinergics, CNS depressants, counteracts antipsych meds
Risperidone (Risperdal)
Antipsychotic – Atypical: works by blocking serotonin & some dopamine receptors; also block receptors for NE, histamine, and ACh; T: Schizophrenia, psychosis by levodopa therapy, relief of psychotic behavior ie bipolar
Onset of DM, wt gain, hypercholesterolemia, orthostatic hypertension, anticholinergic effects, agitation, dizziness, sedation, sleep disruption, mild EPS; DI: Immunosuppressive agents, CNS depressants; Barbiturates & phenytoin decrease levels; P-C
Fluoxetine (Prozac)
SSRI: - selectively block reuptake of monoamine neurotransmitter serotonin in synaptic space T: Major Depression, bulimia nervosa, panic, school phobia, separation anxiety disorder, PSTD, OCD, ADHD
Sexual dysfunction, CNS stimulation, wt loss, serotonin syndrome, withdrawal, hyponatremia, rash, sleepiness, GI bleeding, Bruxism DI: MAOIs, TCAs, St. John’s wort = Serotonin Syndrome, displaces warfarin, increase levels of lithium TCAs, suppresses platelet aggregation, P-C
See depression
See Depression
Amitriptyline (Elavil)
TCA - Tricyclic Antidepressant – block reuptake of norepinephrine and serotonin – intensifying these neurotransmitters; T: Depression, depressive episodes of bipolar disorder (BD), Autistic disorder, ADHD, Panic school phobia, separation anxiety disorder, PTSD, OCD
Orthostatic hypotension, anticholinergic effects* wt gain sedation, decreased seizure threshold, excessive diaphoresis, use cautiously with HTN, DI: MAOIs & St. John’s wort = Serotonin Syndrome, Antihistamines & anticholinergic – additive, /|\ effect of sympathomimetics, TCAs decrease effect, avoid CNS depressants, P-C
See depression
Buspirone (BuSpar)
Nonbarbiturate – Atypical anxiolytic: Unknown – binds to serotonin and dopamine receptors No Sedation; T: Panic disorder, OCD, social anxiety disorder, PTSD
Dizziness, nausea, headache, light-headedness, agitation; DI: no MAOIs, use 14 days after, Erythromycin, ketoconazole, grapefruit juice increases effects, P-B,
See anxiety
Methylphenidate (Ritalin, Methylin)
Dexmethylphenidate (Focalin)
Dextroamphetamine (Dexedrine)
Amphetamine Mix (Adderall)
CNS Stimulants: Raise the levels of NE, serotonin, & dopamine in CNS T: ADHD, Conduct disorder
CNS Stimulations – insomnia, restlessness, wt loss; cardio – dysrythmias, chest pain, high BP, sudden death w/ heart abnormalities; hallucinations, paranoia, withdrawal (depression, severe fatigue); drug abuse, severe anxiety, psychosis, CV disorders; DI: MAOIs – hypertensive crisis, CNS stimulants, Methylphenidate inhibits metabolism of warfarin, phenobarbital – take in morning
Atomoxetine (Strattera)
Norepinephrine Selective Reuptake Inhibitor: block reuptake of NE, not stimulant! T: ADHD
Tolerated well, minimal side-effects – wt loss, growth suppression, nausea, vomiting, suicidal ideation in children & teens, hepatoxicity; DI: w/ MAOIs = hypertensive crisis; Paroxetine, fluoxetine, or quinidine gluconate /\ atomoxetine
Risperidone (Risperdal)
Antipsychotic – Atypical: works by blocking serotonin & some dopamine receptors; also block receptors for NE, histamine, and ACh; T: Schizophrenia, psychosis by levodopa therapy, relief of psychotic behavior ie bipolar
Onset of DM, wt gain, hypercholesterolemia, orthostatic hypertension, anticholinergic effects, agitation, dizziness, sedation, sleep disruption, mild EPS; DI: Immunosuppressive agents, CNS depressants; Barbiturates & phenytoin decrease levels; P-C
See psychosis
Chlordiazepoxide (Librium)
Diazepam (Valium)
Lorazepam (Ativan)
Detox: Alcohol Withdrawal; Benzodiazepines: maintenance of client’s vital signs within normal limits; decrease risk of seizures, Decrease in intensity of symptoms
See Benzodiazepines
Carbamazepine (Tegretol)
Detox: Alcohol Adjunct Withdrawal Meds:
Carbamazepine: AED
Clonidine (Catapres)
Carbamazepine: decrease in seizures
Clonidine: α2 adrenergic agonist
Propranolol (Inderal)
Clonidine & Propanolol: depression of autonomic response (BP, HR, diaphoresis
Propranolol: Nonselective B Blocker
Propanolol: decrease in cravings
Disulfiram (Antabuse)
Maintenance: Alcohol Abstinenc: daily oral med, aversion (behavioral) therapy
W/ alcohol causes acetaldehyde syndrome*; nausea, vomiting, weakness, sweating, palpitations, and hypotension
Naltrexone (Revia)
Pure Opioid Antagonist: suppresses craving and pleasurable effects of alcohol also used in opioid withdraw
Withdrawal symptoms; monthly injections for trouble adhering
Acamprostate (Campral)
Decreases unpleasant effects resulting from abstinence – anxiety, restlessness
Diarrhea, adequate fluid intake, avoid if pregnant
Methadone (Dolophine)
Substition – Oral Opioid Agonist: replaces opioid addiction, prevent abstinence syndrome, withdrawal and long-term maintenance, still has dependence
Taper slowly, 12-step program
Clonidine (Catapres)
Suppresses autonomic hyperactivity, does not reduce cravings
Drowsiness, anticholinergic affects
Buprenorphine (Subutex);
Agonist-Antagonist Opioids: decrease feelings of craving and adherence
Buproprion (Zyban)
Decreases nicotine craving and symptoms of withdrawal
Anticholinergic affects – dry mouth, etc; avoid CNS stimulants
Nicotine Gum (Nicorette)
Nicotine Patch (Nicotrol)
Nicotine replacements are substitutes for cigarettes or chewing tobacco
Avoid while pregnant, breastfeeding; gum not longer than 6 months; chew slowly over 30 min; avoid eat/drink 15 prior;
Neostigmine (Prostigmin)
Cholinesterase Inhibitor: prevents cholinesterase (ChE) from inactivating acetylcholine (ACh) /| ACh in brain; T: treatment and reversal of myasthenia gravis
Excessive muscarine stimulation = GI motility, GI secretions, bradycardia, urinary urgency; Cholinergic crisis – resp depression; DI: Atropine counters, reverses nerve blocks, succinylcholine /\ neuromuscular blockade; P-C
Levodopa (Dopar, Larodopa)
Dopaminergic: precursor crosses b-b barrier & taken up by dopaminergic nerve terminals à more DA; T: 1st line med for Parkinson’s Disease (PD)
N/V/D; Dyskinesias (head bobbing, tics, grimacing, tremors); Ortho hypotension; Cardio – tachycardia, palpitations, irregular heart beat, hallucinations, nightmares, discoloration of urine, activation of malignant melanoma; DI: High protein meals & conventional pysch drugs & Pyridoxine = \/ effect; MAOIs = hypertensive crisis; Carbidopa, dopamine agonists, anticholinergics, COMT inhibitors* = /\ effect, P-C
Levodopa w/ carbidopa (Sinemet)
Dopaminergic Augment – decreases amount of levodopa converted to DA in intestines and periphery; T: PD
Abnormal movements, psychiatric disorders
Pramipexole (Mirapex)
Dopamine Agonist: Act directly on DA receptors; T: PD for early onset w/ younger pts b/c hypotension & drowsy
Sudden inability to stay awake; daytime sleepiness, ortho hypotension; hallucinations, nightmares; dyskinesias, Can allow lower dosage of levodopa & w/ may = hypotension, dyskinesia, P-C
Benztropine (Cogentin)
Central Acting Cholinergic: block acetylcholine at muscarinic receptors, maintains DA & ACh balance; T: PD
N/V; atropine-like effects – dry mouth, blurred vision, mydriasis*, urinary retention, constipation, discoloration of skin (livido reticularis*) DI: None noted
Amantadine (Symmetrel)
Antiviral: stimulate DA release, prevent dopamine reuptake, may block cholinergic & glutamate receptors; T: PD
CNS – confusion, dizziness, restlessness; atropine like effects; antihistamine effects – sedation, drowsiness
Phenobarbital (Luminal)
Barbiturates: suppresses seizures by potentiating the effects of GABA, binds to GABA receptors causing receptor to respond more intensely to GABA = CNS depression; T: partial* & generalized* seizures EXCEPT absence* seizures
CNS – drowsiness, sedation, confusion, anxiety; toxicity – nystagmus, ataxia, respiratory depression, come, pinpoint puils, hypotension; DI: none listed
Phenytoin (Dilantin)
Antiepileptic Drugs (AED) - Hydantoins: slows entrance of Na & Ca back into neuron (slows return to action state), à suppressing CNS excitation; T: ALL seizures EXCEPT absence; IV route for status epilepticus
CNS – nystagmus, sedation, ataxia, double vision; Gingival hyperplasia*, skin rash, tetratogenic (cleft palate, heart defects), dysrhythmias, hypotension; coarsening of facial features, hirsutism DI: \/ warfarin, oral contraceptives, & glucocorticoids; ETOH, diazepam, cimetidine, valproic acid /\ levels; carbamazepine, Phenobarbital, \/ levels; Depressants = additive affect
Diazepam (Valium)
AED - Benzodiazepines: Sedative hypnotic anxiolytic: enhance inhibitory effects of gamma-aminobutyric acid (GABA) in CNS, relief occurs rapidly; T: status epilepticus
Respiratory depression, anterograde amnesia; DI: None Listed
Carbamazepine (Tegretol)
AED - Benzodiazepines: slows entrance of Na & Ca back into neuron (slows return to action state), à suppressing CNS excitation T: partial & tonic-clonic seizures
CNS – nystagmus, double vision, vertigo, staggering gait, headache; DI: \/ in effect of oral contraceptives & warfarin; grapefruit /\ levels, phenytoin & Phenobarbital \/ effects
Ethosuximide (Zarontin)
AED - Benzodiazepines: suppresses neurons in thalamus responsible for generating absence seizures (low-threshold calcium currents) T: absence seizures
N/V; sleepiness, lightheadedness, fatigue
Valproic Acid (Depakote)
AED – Suppression of high-frequency neuronal firing by blocking Na channels, suppresses Ca influx in T-type channels, augments inhibitory factors of GABA; T: partial, generalized & absence seizures – GOOD
N/V, indigestion, hepatotoxicity, pancreatitis, thrombocytopenia; concurrent use /|\ levels of phenytoin & phenobarbital
Gabapentin (Neurontin)
AED – Unknown, analog of GABA, but does not directly affect GABA receptors, may enhance release of GABA, increasing GABA-mediated inhibition of neural firing; T: single agent for partial seizures
Drowsiness, nystagus
Timolol (Timoptic, Betimol)
Beta Adrenergic Blockers – decrease intra-ocular pressure by decreasing amount of aqueous humor produced T: primarily for POAG
Stinging discomfort after drop administered; conjunctivitis, blurred vision, photophobia, dry eyes, - may have systemic effects of BB; DI: oral forms = more system affects, may interfere w/ insulin
Brimonidine (Alphagan)
Alpha2 Adrenergic Agonists – decrease production & outflow of aqueous humor; T: 1st line long term med for POAG
Local stinging, blurred vision, headache, red sclera, hypotension, drowsiness
Latanoprost (Xalatan)
Prostaglandin Analog: increases aqueous humor outflow through relaxation of ciliary muscle; T: for ocular hypertension & POAG
Stinging, red conjunctiva, blurred vision, migraine (rare)
Mannitol (Osmitrol)
Osmotic Agent: Decrease intraocular pressure rapidly drawing fluid from anterior chamber of eye; T: treat rapid progression of closed-angle glaucoma to prevent blind
None
Acetazolamide (Diamox)
Carbonic Anhydrase Inhibitor (systemic): Reduces production of aqueous humor by causing diuresis through renal effects; T: last resort, non-antimicrobial sulfonamide for emergency acute angle closure glaucoma – also, seizures, heart failure, acute mountain sickness
Anaphylaxis (allergy); N/V; Na & K depletion; flu-like symptoms, paresthesias, fatigue, sleepiness, rare seizures, glucose disturbances; DI: w/ aspirin – metabolic acidosis, /\ quinidine, kidney stones, osteomalacia, decrease lithium levels
Amoxicillin (Amoxil)
Antimicrobial: eradication of infection; T: otitis media & bacterial infections of body
Possible allergy, GI upset, suprainfection w/ other microbes, oral candidiasis – take w/ meals
Ciprofloxacin + Dexamethasone (Cipro HC) otic drops
Fluoroquinolone Antibiotic + Steriod: decrease pain, edema, and erythema in ear canal; T: treat otitis externa
CNS – dizziness, lightheadedness, tremors, restlessness, convulsions; rash – warm container w/ hands so no dizziness; use for 30-60 secs!
Succinylcholine (Anectine)
Depolarzing Neuromuscular Blocker: mimics ACh, binds to cholinergic receptors at neuromuscular junction, blocking ACh, causes sustained depolarization of muscle = muscle paralysis; do no cross b-b barrier, no loss of consciouness or pain; T: general anesthesia – muscle relaxation, spontaneous resp. movement w/ mechanical vent., seizure control w/ electroconvulsive therapy, endotrach intubation and endoscopy
Respiratory arrest, hypotension, low pseudocholinesterase activity = apnea; malignant hyperthermia = muscle rigitidy + fever as high as 109.4 F, 12-24 hrs post op – muscle pain in upper body and back, hyperkalemia; P-C; DI: Aminoglycosides & Tetracyclines /\ effects; contra – burn victims (b/c /\ K); Cholinesterase inhibitors (Neostigmine) /\ effects of depolarizing neuromuscular blockers (Succinylcholine)
R: Pseudocholinesterase enzyme
Pancuronium (Pavulon)
Nondepolarzing Neuromuscular Blocker: Block ACh from binding w/ cholinergic receptors at motor end plate. Muscle paralysis occurs b/c inhibited nerve depolarization & muscle contraction
Respiratory arrest, hypotension; P-C; DI: Aminoglycosides & Tetracyclines /\ effects; contra – burn victims (b/c /\ K); Cholinesterase inhibitors (Neostigmine) /\ effects of depolarizing neuromuscular blockers

R: Neostigmine (Prostigmin)
Diazepam (Valium)
Centrally Acting Muscle Relaxants: acts in CNS to enhance GABA & produce sedative effects & depress spasticity of muscles T: muscle spasm, anxiety, panic, insomnia, status epilepticus, EHOH withdrawal, anesthesia induction
CNS – sleepiness, lightheadedness, fatigue, long-term use = dependency; DI: CNS depressants; no quick withdrawal; P-D
Dantrolene (Dantrium)
Peripherally Acting Muscle Relaxant: acts directly on spastic muscles and inhibits muscle contraction by preventing release of calcium in skeletal muscles; T: relief of spasticity – cerebral palsy, spinal cord injury, multiple sclerosis, malignant hyperthermia
CNS – sleepiness, lightheadedness, fatigue; hepatotoxicity – anorexia, nausea, vomiting, abdominal pain, jaundice; muscle weakness; DI: CNS depressants
Bethanechol (Urecholine)
Muscarinic Agonist: stimulation of muscarinic receptors of GU tract = relaxation of trigone & sphincter muscles & contraction of detrusor muscle; T: Nonobstructive urinary retention – postop or postpartum
Extreme stimulation – sweating, tearing, urinary urgency, bradycardia & hypotension; contra – peptic ulcer disease, asthma, coronary insufficiency, hyperthyroidism
Oxybutynin (Ditropan)
Muscarinic Antagonist (M3 receptor selective): inhibiting muscarinic receptors of detrusor muscle of bladder – prevent contraction & urge to void; T: overactive bladder
Anticholinergic effects – constipation, dry mouth, blurred vision, photophobia, dry eyes; CNS – hallucinations, confusion, insomnia, nervousness; contra – glaucoma, myasthenia gravis, paralytic illeus, etc; DI: antihistamines, tricyclic antidepressants, phenothiazines = extreme muscarinic blockage
Diazepam (Valium)
Benzodiazepine: enhance action of gamma-amino butyric acid (GABA) in CNS T: anxiety, seizure, insomnia, muscle spasm, alcohol withdrawal, panic disorder, induction to anesthesia
CNS depression, antegrade amnesia, acute toxicity = oral - lethargy, confusion; IV – resp depression, severe hypotension, paradoxical response – insomnia, excitation; withdrawal symptoms; DI: CNS depressants; Flumazenil (Romazicon) to counteract, P-D* S-IV*
Zolpidem (Ambien)
Nonbenzodiazepine: enhance action of GABA in CNS – prolonged sleep duration, decreased awakenings; NOT antianxiety, muscle relaxant, antiepileptic T: management of insomnia
Daytime sleepiness, lightheadedness – allow for 8 hours of sleep,
P-B
Ramelteon (Rozerem)
Melatonin Agonist: activation of melatonin receptors; T: management of insomnia; 30 min before bedtime on empty stomach
Sleepiness, dizziness, fatigue; hormonal – amenorrhea, decreased libido, difficulty w/ fertility, galactorrhea; Contra – pregos, lactation; DI: high fat foods \/ absorp.; w/ fluvoxamine /\ levels; CNS depressants = additive
Thiopental (Pentothal)
Midazolam (Versed)
Diazepam (Valium)
Fentanyl (Sublimaze)
Intravenous Anesthetics: Barbituate, Benzodiazepine 2x, Opioid; loss of consciousness & elimination of response to painful stimuli; T: induction & maintenance of anesthesia
Hypotension, bacterial infection w/ propofol; ketamine = hallucinations, confusion; CNS depressants increase depression, CNS stimulants increase, Opioids = cough suppression
Albuterol (Preventil, Ventolin)
Salmeterol (Serevent)
Beta2-Adrenergic Agonist: selectively activates Beta2-receptors in the bronchial smooth muscle – bronchodialation = histimine release inhibited; ciliary motility increased; Salmeterol = long term
Tachycardia & angina b/c activation of alpha1 receptors in heart; tremors in skeletal muscle; P-C; DI: beta blockers; MAOIs & tricyclic antidepressants – angina & tachycardia; use before glucocorticoids;
Theophylline (Theolair, Theo-24)
Methylxanthine: causes relaxation of bronchial smooth muscle; T: Orally for long-term chronic asthma; IV or oral - emergency
Mild toxicity reaction – GI distress & restlessness; high tox – dysrhythmias & seizures; (5-15mcg/mL) – use charcoal, lidocaine (dysrhythmias); diazepam (seizures) – periodic blood draws P-C DI: Caffeine /\ cardiac & CNS effects & /\ theophylline levels; Cimetidine, ciprofloxacin, fluoroquinolone antibiotics /\ levels
Ipratropium (Atrovent)
Inhaled Anticholinergics: block muscarinic receptors of bronchi = bronchodialation T: bronchospasm w/ COPD; allergen induced / exercise induced asthma
Local anticholinergic effects (dry mouth, hoarseness); P-B; contra – peanut allergies (may contain soy lecithin)
Beclomethasone Dipropionate (QVAR)
Glucocorticoids: Inhalation, prevent inflammation, suppress airway mucus production, & promote B2 receptor response in bronchial trees; not immediate; \/ frequency & severity of exacerbations & acute attacks T: short term status asthmaticus, acute asthma attack; chronic asthma;
Difficulty speaking, hoarseness, and candidiasis; P-C; contra – systemic fungal infections, live virus vaccine,
Prednisone (Deltasone)
Glucocorticoids: Oral, prevent inflammation, suppress airway mucus production, & promote B2 receptor response in bronchial trees; not immediate; \/ frequency & severity of exacerbations & acute attacks T: short term status asthmaticus, acute asthma attack; chronic asthma;
Suppression of adrenal function (glucocorticoid production); bone loss; hyperglycemia and glucosuria; myopathy (weakness); peptic ulcer disease; infection; disturb fluid & electrolytes; DI: K-depleting diuretics (hypokalemia); w/ NSAIDs (ulcer) hypoglycemic agents (counter effects)
Cromolyn Sodium (Intal)
Mast Cell Stabilizer (Anti-Inflammatory): stabilize mast cells, à inhibits release of histamine & other inflam. Mediators; suppress inflam. Cells (eosinophils & macrophages); T: chronic asthma, allergen-induced attack; allergic rhinitis
P-B; Contra – coronary artery disease; dysrhythmias; status asthmaticus; 15 min before exercise or allergen exposure; not bronchodialator
Montelukast (Singulair)
Leukotriene Modifier: prevent effects of leukotrienes à suppressing inflammation, bronchoconstriction, airway edema, & mucus production; T: long-term asthma therapy; prevent exercise-induced bronchospams
Contra – liver dysfunction; DI: none listed – take once daily before bed
Albuterol (Preventil, Ventolin)
Beta2-Adrenergic Agonist: selectively activates Beta2-receptors in the bronchial smooth muscle – bronchodialation = histimine release inhibited; ciliary motility increased; Salmeterol = long term
Tachycardia & angina b/c activation of alpha1 receptors in heart; tremors in skeletal muscle; P-C; DI: beta blockers; MAOIs & tricyclic antidepressants – angina & tachycardia; use before glucocorticoids;
Salmeterol (Serevent)
Theophylline (Theolair, Theo-24)
Methylxanthine: causes relaxation of bronchial smooth muscle; T: Orally for long-term chronic asthma; IV or oral - emergency
Mild toxicity reaction – GI distress & restlessness; high tox – dysrhythmias & seizures; (5-15mcg/mL) – use charcoal, lidocaine (dysrhythmias); diazepam (seizures) – periodic blood draws P-C DI: Caffeine /\ cardiac & CNS effects & /\ theophylline levels; Cimetidine, ciprofloxacin, fluoroquinolone antibiotics /\ levels
Ipratropium (Atrovent)
Inhaled Anticholinergics: block muscarinic receptors of bronchi = bronchodialation T: bronchospasm w/ COPD; allergen induced / exercise induced asthma
Local anticholinergic effects (dry mouth, hoarseness); P-B; contra – peanut allergies (may contain soy lecithin)
Beclomethasone Dipropionate (QVAR)
Glucocorticoids: Inhalation, prevent inflammation, suppress airway mucus production, & promote B2 receptor response in bronchial trees; not immediate; \/ frequency & severity of exacerbations & acute attacks T: short term status asthmaticus, acute asthma attack; chronic asthma;
Difficulty speaking, hoarseness, and candidiasis; P-C; contra – systemic fungal infections, live virus vaccine,
Prednisone (Deltasone)
Glucocorticoids: Oral, prevent inflammation, suppress airway mucus production, & promote B2 receptor response in bronchial trees; not immediate; \/ frequency & severity of exacerbations & acute attacks T: short term status asthmaticus, acute asthma attack; chronic asthma;
Suppression of adrenal function (glucocorticoid production); bone loss; hyperglycemia and glucosuria; myopathy (weakness); peptic ulcer disease; infection; disturb fluid & electrolytes; DI: K-depleting diuretics (hypokalemia); w/ NSAIDs (ulcer) hypoglycemic agents (counter effects)
Cromolyn Sodium (Intal)
Mast Cell Stabilizer (Anti-Inflammatory): stabilize mast cells, à inhibits release of histamine & other inflam. Mediators; suppress inflam. Cells (eosinophils & macrophages); T: chronic asthma, allergen-induced attack; allergic rhinitis
P-B; Contra – coronary artery disease; dysrhythmias; status asthmaticus; 15 min before exercise or allergen exposure; not bronchodialator
Montelukast (Singulair)
Leukotriene Modifier: prevent effects of leukotrienes à suppressing inflammation, bronchoconstriction, airway edema, & mucus production; T: long-term asthma therapy; prevent exercise-induced bronchospams
Contra – liver dysfunction; DI: none listed – take once daily before bed
Furosemide (Lasix)
High Ceiling Loop Diuretic: block reabsorption of Na & Cl & prevents reabsorption of H2O in ascending limb of loop of Henle; cause extensive diuresis even w/ severe renal failure; T: emergent mobilization of fluid, pulmonary edema, hypertension, hypercalcemia w/ kidney stone
Dehydration, hyponatremia, hypochloremia, hypotension, ototoxicity (transient), hypokalemia, hyperglycemia, hyperuricemia, \/ calcium & magnesium levels; P-C; avoid pregos unless absolutely necessary; DI: Digoxin (b/c hypoK); w/ antihypertensives = hypotensive; hyponatremia may \/ lithium excretion = toxicity; NSAIDs reduce diuretic effect; 20mg infusion or slower
Hyrdochlorothiazide (Hydrodiuril)
Thiazide Diuretic: in early distal convoluted tubule, blocks reabsorption of Na & Cl & prevents reabsorption of H2O, promote diuresis w/ no renal failure; T: 1st line med for hypertension; edema of mild-moderate heart failure/ liver & kidney disease
Dehydration, hypokalemia, hyperglycemia; DI: Digoxin (b/c hypoK); antihypertensives = hypotensive; NSAIDs reduce diuretic effect
Spironolactone (Aldactone)
Potassium-Sparing Diuretic: block action of aldosterone (sodium & water retention) = secretion of Na & H2O; T: heart failure, hyperaldosteronism
Hyperkalemia, endocrine – impotence, irregularities of menstrual cycle; DI: ACEIs /\ risk of hyperK, w/ K supplements, /\ risk of hyperK
Mannitol (Osmitrol)
Osmotic Diuretics: reduce intracranial pressure & intraocular pressure by raising serum osmolarity & drawing fluid back into vascular & extravascular space; T: renal failure w/ hypovolemic shock, severe hypotension, intracranial pressure, intraocular pressure; promote sodium retention & water excretion w/ hyponatremia & fluid volume excess
Heart failure, pulmonary edema, renal failure, fluid & electrolyte imbalances; furosemide adds effect; use filter needle when drawing from vile & filter in tube
Captopril (Capoten)
ACEI: block the production of angiotensin II = vasodialation (mostly arteriole); excretion of Na & H2O, retention of K in kidneys; reduces pathology of blood vessels from angiotensin II & aldosterone; T: hypertension, heart failure, myocardial infaction, diabetic & nondiabetic nephropathy
First-dose orthostatic hypotension, cough inhibition of kinase II = /\ in bradykinin, hyperkalemia, rash & dysgeusia (taste distortion), angioedema (tongue, pharynx), neutropenia (rare); DI – diuretics = 1st dose additive hypotension; K supplements add hyperkalemia; ACEis /\ lithium levels; NSAIDs \/ antihypertensive effects
Losartan (Cozaar)
ARB: block angiotensin II in body = vasodialation, excretion of Na & H2O, retention of K; T: hypertension, heart failure, stroke prevention, delay progress of diabetic nephropathy
NO cough, NO hyperkalemia; angioedema, fetal injury P-D; no 2nd & 3rd tri pregos; DI: antihypertensive meds /\ effect
Nifedipine (Adalat, Procardia)
Calcium Channel Blocker: Blocking of calcium channels in blood vessels = vasodialation (primarily arterioles) of peripheral arterioles & arteries/arterioles of heart; T: agina pectoris, hypertension
Reflex tachycardia, peripheral edema, acute toxicity; DI: Beta blockers \/ reflex tachycardia, grapefruit juice = toxicity
Verapamil (Calan)
Diltiazem (Cardizem)
Calcium Channel Blocker: Blocking of calcium channels in blood vessels = vasodialation (primarily arterioles) of peripheral arterioles & arteries/arterioles of heart & in myocardium, SA node, AV node = decreased force of contraction, heart rate, & slowing of rate of conduction through AV node; T: angina, hypertension, & cardiac dysrhytmias – atrial fib, flutter, svt
Orthostatic & peripheral edema, constipation, suppression of cardiac function (bradycardia, heart failure); dysrhythmias (QRS complex widened, QT interval prolonged); acute toxicity – hypotension, bradycardia, AV block, ventricular tachydysrhythmias; P-C; DI: can /\ digoxin = intensify AV conduction suppression, w/ beta blockers = heart failure, AV block, bradycardia, grapefruit juice = toxicity
Prazosin (Minipress)
Alpha Adrenergic Blockers (Sympatholytics): selective alpha-1 blockade = venous & arterial dilation, smooth muscle relaxation of prostatic capsule & bladder neck; T: primary hypertension, decrease symptoms of benign prostatic hypertrophy (urgency, frequency, dysuria)
First-dose hypertension, P-C; DI: antihypertensive meds add effect, NSAIDs & clonidine \/ effects
Clonidine (Catapres)
Centrally Acting Alpha2 Agonist: within CNS, \/ sympathetic outflow = \/ stimulation of adrenergic receptors of heart & peripheral vascular system = bradycardia & \/ cardiac output; vasodialation = \/ blood pressure; T: primary hypertension, severe cancer pain
Drowsiness, sedation, dry mouth, rebound hypertension, P-C; DI: antihypertensive meds, w/ prazosin, MAOIs, trycyclic antidepressants counter effect, CNS depressants
Metoprolol (Lopressor)
Beta Adrenergic Blockers (Sympatholytics): selective B1-adrenergic block in myocardium & electrical conduction of heart = \/ heart rate, contractility, rate of conduction through AV node; T: primary hypertension, angina, tachydysrhythmias, heart failure, myocardial infarction
Bradycardia, \/ cardiac output, AV block, orthostatic hypertension, rebound myocardium excitation; DI: CCBs intensify BBs, w/ antihypertensive meds intensify hypotension
Propanolol (Inderal)
Beta Adrenergic Blockers (Sympatholytics): B1 & B2-adrenergic block in myocardium & electrical conduction of heart = \/ heart rate, contractility, rate of conduction through AV node; T: primary hypertension, angina, tachydysrhythmias, heart failure, myocardial infarction
Bradycardia, \/ cardiac output, AV block, orthostatic hypertension, rebound myocardium excitation & bronchoconstriction, glycogenolysis inhibited; DI: CCBs intensify BBs, w/ antihypertensive meds intensify hypotension & mask hypoglycemic effect of insulin & prevent fat breakdown
Nitroprusside Sodium (Nitropress)
Hypertensive Crisis Med: direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure (decreased preload & afterload); T: hypertensive emergencies
Excessive hypotension, cyanide poisoning – headache, drowsiness, eventual cardiac arrest; thiocynate poisoning; P-C; Med color = light brown
Digoxin (Lanoxin, Lanoxicaps, Digitek)
Cardiac Glycoside: increased force of myocardial contraction (inotropic); decreased heart rate (chronotropic); T: heart failure, dysrhythmias
Dysrhythmias, cardiotoxicity (monitor drug & K levels; 0.5-2.ng/mL); GI – N/V, anorexia, ab pain; CNS – diplopia, blurred vision, yellow-green or white halos, fatigue, P-C; DI: Diuretics = low K, ACE & ARBs = hyperkalemia, sympathomimetics \/ effects, Quinidine /\ risk of toxicity, Verapamil /\ plasma levels; hold if heart rate less than 60/min
Epinephrine (Adrenaline)
Catecholamine: Alpha 1 receptor – vasocontriction (slows abs. Of local anesthetics), Beta 1 receptor - /\ heart rate, myocardial contractility, rate of conduction through AV node (AV block & Cardiac arrest), Beta 2 receptor – bronchodialation (Asthma)
Hypertensive crisis, dysrhythmias, /\ oxygen demand = angina; P-C; DI: MAOIs prolong effects, Tricyclic antidepressants prolong & intensify; general anesthetics = hypersensitivity, phentolamine blocks action on Alpha receptors, Beta-adrenergic blocking agents block effect
Dopamine (Intropin)
Catecholamine: Low Dose – Dopamine receptors – renal blood vessel dilation; Moderate - & Beta 1 - /\ heart rate, myocardial contractility, rate of conduction through AV node; High - & Alpha 1 – vasocontriction; T: shock, heart failure
Dysrhythmias, angina, necrosis from extravasation of high doses of dopamine; P-C; DI: , phentolamine blocks action on Alpha receptors, Beta-adrenergic blocking agents block effect; Diuretics /\ beneficial effects of dopamine
Dobutamine (Dobutrex)
Catecholamine: Beta 1 - /\ heart rate, myocardial contractility, rate of conduction through AV node
/\ heart rate; P-B; DI: , phentolamine blocks action on Alpha receptors, Beta-adrenergic blocking agents block effect
Nitroglycerin
Organic Nitrates: dilates veins & decreases venous return (preload), à \/ oxygen demand, also prevents or reduces coronary artery spasm à /\ O2 supply; T: acute angina, preventing chronic & variant angina
Headache, orthostatic hypotension, reflex tachycardia, tolerance (8hr free time), P-C, DI: Alcohol /\ hypotensive effect, antihypertensive meds /\ hypotensive effects, sildenafil (Viagra) + nitroglycerin = life-threatening hypotension; IV – start at 5 mcg/min & increase gradually
Ranolazine (Ranexa)
Antianginal Agent: lowers cardiac oxygen demand à improves exercise tolerance & \/ pain; T: chronic stable angina in combo w/ amlodipine (Norvasc) – beta adrenergic blocker or an organic nitrate
QT prolongation, elevated blood pressure; DI: inhibitors of CYP3A4 /\ levels of ranolazine à torsades de pointes* i.e. – grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole antifungals, & verapamil; Quinidine & sotalol /\ QT interval; w/ digoxin and simvastatin (Zocor) /\ serum levels
Procainamide (Pronestyl, Procanbid)
Class IA Sodium Channel Blocker: \/ electrical conduction, rate of polarization & /\ automaticity; T: supraventricular & ventricular tachycardia, atrial flutter & fibrillation
Systemic lupus syndrome (inflamed joints), blood dyscrasias, cardiotoxicity, hypotension; P-C; DI: antidysrhythmics /\ effect & toxicity, antihypertensives /\ hypotension; contra – heart block, atypical v. tachycardia, myasthenia gravis, lupus, heart failure
Lidocaine (Xylocaine)
Class IB Sodium Channel Blocker: \/ electrical conduction & automaticity; /\ rate of repolarization; T: short-term use only for ventricular dysrhythmias
CNS – drowsiness, altered mental status, paresthesias, seizures; respiratory arrest; P-B; contra – Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, severe heart block; DI: cimetidine, beta blockers, & phentytoin /\ levels (toxicity); IV – start loading dose, then maintenance = 1- 4 mg/min; NOT with epinephrine = severe hypotension or dysrhythmias
Propafenone (Rythmol)
Class IC Sodium Channel Blocker: \/ electrical conduction & excitability & /\ rate of depolarization; T: Severe ventricular dysrythmias
Bradycardia, heart failure, dizziness, weakness; P-C; contra – heart failure, bradycardia; DI: antidysrhythmics induce heart failure, propafenone slow metabolism = /\ levels of digoxin, oral anticoagulants, & propanolol
Propranolol Hydrochloride (Inderal)
Class II Beta-Adrenergic Blocker: \/ heart rate, slow conduction rate through SA node; \/ atrial ectopic stimulation; T: atrial fib. & flutter, paroxysmal SVT, hypertension, angina
Hypotension, bradycardia, heart failure, fatigue; P-C; contra – heart failure, bradycardia; DI: Verapamil & diltiazem /\ effects; may mask insulin effect – hypoglycemia fat break down; w/ food to increase absorption
Amiodarone (Cardarone, Pacerone)
Class III Potassium Channel Blocker: \/ rate of repolarization, electrical conduction, contractility, automaticity; T: conversion of atrial fibrillation – oral; recurrent ventricular fib or ventricular tachycardia
Pulmonary toxicity, sinus bradycardia & AV block – may heart failure, photophobia, blurred vision, may blind; phlebitius w/ IV, hypotension, GI disturbances, thyroid dysfunction; P-D; contra – newborns, infants, bradycardia, DI: /\ levels of quinidine, procainamide, digoxin, diltiazem, & warfarin; cholestramine \/ levels; grapefruit juice = may toxicity
Verapamil (Calan)
Class IV Calcium Channel Blocker: \/ force of contraction, heart rate, slow rate of conduction through AV node; T: paroxysmal SVT, Wolf-Parkinson-White syndrome
Bradycardia & hypotension & heart failure; P-C; contra- a fib/flutter, severe hypotension; DI: w/ beta blockers /\ effects; /\ effects of carbamazepine & digoxin; BB = congestive heart failure; notify Dr if peripheral edema or shortness of breath
Adenosine
Class IV: \/ electrical conduction through AV node
Sinus bradycardia (decreased conduction through AV node, hypotension, dyspnea, flushing of face; P-C; contra - atrial flutter & fib; DI: methylxanthines (theophylline & caffeine) block receptors = \/ effect, /\ effects of dipyridamole (Persantine); effects last for one minute
Digoxin
Class IV:\/ electrical conduction through AV node, /\ myocardial contraction
Bradycardia, hypotension, toxicity, N/V, dysrhythmias; 0.5 – 2 ng/mL; hold dose if HR < 60; P-C; DI: Amiodarone, diltiazem, nifedipine, quinidine, & verapamil /\ levels; Corticosteriods, diuretics, thiazides, & amphotericin B \/ potassium; antacids & metoclopramide \/ digoxin absorption; eat lots of K
Gemfibrozil (Lopid)
Fibrates: \/ triglyceride levels (/\ in VLDL secretion), /\ HDL levels by promoting production of precursors; T: \/ of plasma triglycerides (VLDL); /\ levels of HDL
GI distress; gallbladder stones, myopathy – muscle tenderness, pain), hepatoxicity, P-C; DI: w/ warfarin = /\ risk of bleeding, w/ statins = risk of myopathy, bile acid sequestrants interfere absorption, - take 30 min prior to breakfast & dinner
Atorvastatin (Lipitor)
HMG COA Reductase Inhibitors: \/ manufacture of LDL cholesterol, very low-density lipoproteins, /\ manufacture of High-density lipoproteins; promotion of vasodilation, \/ plaque site formation & risk of thromboembolism; T: primary hypercholesterolemia, prevents coronary events, MI & stroke w/ diabetes,
Hepatotoxicity (increase in serum transaminase), myopathy – muscles aches, pain, tenderness à may lead to myositis*, or rhabdomyolysis*, peripheral neuropathy – weakness, numbness, tingling, & pain in hands & feet; P-X; Asian decent = Rosuvastatin; DI: Fibrates & ezetimibe /\ risk of myopathy; Meds that \/ CYP3A4 (erythromycin, ketoconazole, grapefruit) /\ levels, take in the evening before bed
Ezetimibe (Zetia)
Cholesterol Absorption Inhibitor: inhibits absorp. Of cholesterol secreted in bile & from food; T: adjunct to lower LDL cholesterol, alone or combo as statin med
Hepatitis, avoid alcohol, myopathy; P-X; DI: Bile acid sequestrants (cholestyramine) interfere w/ absorp.; Statins /\ risk of liver dysfunction and/or myopathy; w/ fibrates /\ gallstone risk & myopathy; levels /\ w/ cyclosporine
Colesevelam (WelChol)
Bile-Acid Sequestrants: \/ LDL cholesterol; T: adjunct w/ HMG CoA reductase inhibitor & dietary measures
Cholestyramine & colestipol (others) may cause GI distress & \/ absorption of fat-soluble vitamins, constipation; Cholesteryamine & colestipol from complexes w/ digoxin, warfarin, thiazides, and tetracyclines \/ absorption; 30 min before meal
Nicotinic Acid, Niacin (Niacor, Niaspan)
Decrease LDL cholesterol & triglyceride levels; T: For pts w/ risk for pancreatitis & elevated triglyceride levels; \/ LDL & triglyceride levels & /\ HDL leels
GI distress, facial flushing, hyperglycemia, hepatotoxicity, hyperuricemia, 3x/ day w/ or after meals
Heparin Sodium
Anticoagulants/Parental: prevent bleeding by interaction of thrombin formation and factor Xa, resulting in inhibition of the formation of fibrin; T: prompt anticoagulant activity (stroke, dvt, etc); open heart surgery, renal dialysis; prophylaxis against post op veinous thrombosis
SubQ every 12 hr for 2-8 days; hemorrage from overdose; thrombocytopenia; hypersensitivity reactions (chills, fever, urticaria – {hives}); toxicity; Contra – eye, brain, spinal cord surgery, lumbar puncture, regional anesthesia; DI: antiplatelet agents; Monitor rate every 30-60 min; in ab 2 inches from umbilicus; aPTT – 60-80 secs
Enoxaparin (Lovenox)
Low Molecular Weight Heparin Anticoagulants/ Parental: prevent bleeding by interaction of thrombin formation and factor Xa, resulting in inhibition of the formation of fibrin; T: esp treating acute myocardial infarction
SubQ every 12 hr for 2-8 days; hemorrhage; neurological damage; thrombocytopenia, toxicity; DI: antiplatelet agents; no monitoring required, shot = two mins of pressure & rotate sites
Fondaparinux Sodium (Arixtra)
Activated factor X (Xa) inhibitory - Anticoagulants/ Parental: prevent bleeding by interaction of thrombin formation and factor Xa, resulting in inhibition of the formation of fibrin; T: esp treating disseminated intravascular coagulation
SubQ every 12 hr for 5-9 days: hemorrhage, thrombocytopenia, toxicity; DI: antiplatelet agents; no monitoring required, shot = two mins of pressure & rotate sites
Warfarin (Coumadin)
Anticogulant/Oral: antagonizes vitamin K, thereby preventing synthesis of four coagulation factors: factor VII, IX, X and prothrombin; T: venous thrombosis, thrombus formation w/ atrial fib, or prosthetic heart valves; recurrent myocardial infarction, transient ischemic attacks
Hemorrhage; Hepatitis; Toxicity/overdose; P-X; Anti – vitamin K (Mephyton); DI: w/ heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins /\ effects (bleeding); w/ Phenobarbital, carbamazepine, phenytoin, oral contras, & vitamin K \/ effects – foods (dark leafy vegetables, cabbage, broccoli, brussel sprouts, mayo, canola, soybean oil may \/ effects; PT – 18-24 secs, INR (levels 2-3) 2-3 & 3-4.5 levels
Aspirin (Ecotrin)
Antiplatelets / Salicylic: prevent platelets from clumping together by inhibiting enzymes & factors that normally lead to clotting; inhibit aggregation at onset of clotting process; T: Acute myocardial infarction & prevention; stroke prevention
Oral; GI – N/V, dyspepsia (ab pain/indigestion); hemorrhagic stroke; prolonged bleeding time, thrombocytopenia, tinnitus, hearing loss; P-D; DI: w/ NSAIDs, heparin, warfarin, thrombolytics, antiplatelets /\ bleeding; urine acidifiers may /\ levels; may \/ hypertensive actions of Beta blockers; corticosteriods /\ aspirin excretions & \/ effects; caffeine may /\ absorption; 325 mg during initial acute MI episode
Abciximab (ReoPro)
Antiplatelets / Glycoprotein inhibitor: prevent platelets from clumping together by inhibiting enzymes & factors that normally lead to clotting; inhibit aggregation at onset of clotting process; T: esp – acute coronary syndromes
IV; hypotension, bradycardia, prolonged bleeding, gastric bleed, thrombocytopenia; P-C; DI: w/ NSAIDs, heparin, warfarin, thrombolytics, antiplatelets /\ bleeding
Clopidogrel (Plavix)
Antiplatelet / Adp inhibitor: prevent platelets from clumping together by inhibiting enzymes & factors that normally lead to clotting; inhibit aggregation at onset of clotting process; T: Acute myocardial infarction & prevention; stroke prevention
Oral; prolonged bleeding time, gastric bleed, thrombocytopenia; P-B; DI: w/ NSAIDs, heparin, warfarin, thrombolytics, antiplatelets /\ bleeding
Pentoxifylline (Trental)
Antiplatelet / Aterial vasodilator: prevent platelets from clumping together by inhibiting enzymes & factors that normally lead to clotting; inhibit aggregation at onset of clotting process; T: esp – intermittent claudication (muscle pain)
Oral: dyspepsia, N/V; P-C; DI: w/ NSAIDs, heparin, warfarin, thrombolytics, antiplatelets /\ bleeding; Pentoifylline may /\ levels of theophylline;
Streptokinase (Streptase)
Thrombolytic: dissolve clots already formed, converts plasminogen to plasmin, which destroys fibrinogen & other clotting factors; T: acute MI, DVTs, massive pulmonary emboli, ischemic stroke (alteplase especially)
IV or intracoronary; serious risk of bleeding from different sites (brain, needle puncture sites, wounds); hypotension, allergic reaction (urticaria, itching, flushing) à severe anaphylactic reaction; DI: w/ NSAIDs, heparin, warfarin, thrombolytics, antiplatelets /\ bleeding; must be used w/in 4-6 hrs of onset; Use H2 antagonist – no GI bleeding
Epoetin alfa (Epogen, Procit)
Erythropoietic Growth Factor: acts on bone marrow to /\ production of red blood cells; T: anemia related chronic renal failure, use of zidovudine (Retrovir) – HIV-infection, chemotherapy, & elective surgery
SubQ or bolus 3x/week; hypertension secondary to hematocrit levels, /\ risk of cardiovascular event w/ /\ in Hgb above 12g/dL or more than 1 g in 2 weeks; Contra – uncontrolled hypertension, cancer w/ tumor growth; do not mix w/ other meds; do not agitate vial; use only for one dose;
Filgrastim (Neupogen)
Leukeopoietic Growth Factor: stimulates bone marrow to increase production of neutrophils; T: \/ risk of infection in pts w/ neutropenia (cancer)
Bone pain, leukocytosis, decrease or stop if > 100,000/mm3; Contra – pts sensitive to Escherichia; Do not agititate, use vial once, monitor CBC 2x/week; Goal - /\ 10,000/mm3
Sargramostim (Leukine)
Granulocyte Macrophage Colony Stimulating Factor: acts on bone marrow to /\ production of wbcs (neutrophils, monocytes, macrophages, eosinophils); T: hastens bone marrow function post bone marrow transplant; treats failed bone marrow transplant
IV; Diarrhea, weakness, rash, malaise, bone pain, leukocytosis, thrombocytosis; contra – clients allergic to yeast; do not combine w/ other meds or agitate
Oprelvekin (Interleukin-11, Neumega)
Thrombopoietic Growth Factors: /\ production of platelets; T: \/ thrombocytopenia & need for platelet transfusions in pts receiving chemotherapy
Fluid retention (peripheral edema, dyspnea on excertion); dysrhythmias – tachycardia, atrial fib, atrial flutter; conjunctival injection, transient blurring vision, papilledema; allergic reactions
Whole Blood
Increases circulating volume; T: replacement therapy for acute blood loss; volume extesion in pts w/ extensive burn injury, dehydration, shock
Reactions: Acute hemolytic*, febrile nonhemolytic*, anaphylactic*, mild allergic*, circulatory overload*, sepsis*;
Packed Red Blood Cells
Increases number of RBCs; T: severe symptomatic anemia, hemoglobinopathies, medication-induced hemolytic anemia, erythroblastosis fetalis
Reactions: Acute hemolytic, febrile nonhemolytic, anaphylactic, mild allergic, sepsis
Platelet Concentrate
Increases platelet counts; T: thrombocytopenia, aplastic anemia, chemotherapy-induced bone marrow suppression; active bleeding
Reactions: Febrile nonhemolytic, mild allergic, sepsis
Fresh Frozen Plasma
Replaces coagulation factors; T: active bleeding, massive hemorrage, extensive burns, shock, disseminated intravascular coagulatin, Antithrombin deficiency, Thrombotic thrombocytopenic purpura, reversal of anticoagulation effects of warfarin, replacement therapy for coagulation factors II, V, VII, IX, X, and XI
Reactions: Acute Hemolytic, febrile nonhemolytic, anaphylactic, mild allergic, circulatory overload, sepsis
Pheresed Granulocytes
Replaces neutrophils/ granulocytes; T: Severe neutropenia, life-threatening bacterial/fungal infection not responding to antibiotics, neonatal sepsis, neutrophil dysfunction
Reactions: Acute Hemolytic, febrile nonhemolytic, anaphylactic, mild allergic, circulatory overload, sepsis
Albumin
Expands circulating blood volume by exerting oncotic pressure; T: hypovolemia, hypoalbuminemia, burns, adult respiratory distress, severe nephrosis, cardiopulmonary bypass surgery, hemolytic disease of the newborn
Risk for fluid volume excess (ie - pulmonary edema)
See Below for definitions & procedures for blood products
Amoxicillin (Amoxil)
Bismuth (Pepto-Bismul)
Clarithromycin (Biaxin)
Metronidazole (Flagyl)
Tetracycline (Achromycin V)
Antibiotics: Eradication of H. pylori; T: Combination of 2 or 3 antibiotics for 14 days
See Antibiotics
Ranitidine Hydrochloride (Zantac)
Histamine2-Receptor Antagonist: Suppress secretion of gastric acid by selectively blocking H2 receptors in parietal cells lining the stomach; T: gastric & peptic ulcers, GERD, hypersecretory conditions – Zollinger-Ellison syndrome; w/ antibiotics to treat H. Pylori ulcers
None noted; older adults – impotence, CNS effects; P-B; DI: w/ antacids \/ absorption; eat six small meals/ day; oral dose 2x/day
Omeprazole (Prilosec)
Proton Pump Inhibitor: reduce gastric acid secretion by irreversibly inhibiting enzyme that produces gastric acid; reduce basal & stimulated acid production; T: gastric & peptic ulcers, GERD, & hypersecretory conditions – Zollinger-Ellison syndrome
None noted; N/V/D (low); P-C; contra – hypersensitive to meds; long term use – risk of gastric cancer & osteoporosis; DI: may /\ digoxin levels, extreme \/ of absorption of ketoconazole, itraconazole, & atazanavir; may sprinkle tablet over food; active ulcer = 4-6 wks treatment;
Sucralfate (Carafate)
Mucosal Protectant: Acid changes sucralfate into thick substance that sticks to ulcer, protects ulcer from further injury from acid & pepsin; sticks to ulcer for upto 6 hrs; T: duodenal ulcers & maintanence, gastric ulcers, GERD
P-B; drink 1500mL/day; DI: May interfere w/ absorption of phenytoin, digoxin, warfarin, & ciprofloxacin; Antacids interfere w/ absorption of sucralfate; 2hr interval for meds; 30 min for antacids
Aluminum Hydroxide (Amphojel)
Antacid: Neutralize gastric acid & inactive pepsin; protection may occur by antacid’s ability to stimulate production of prostaglandins; T: peptic ulcer disease (PUD), symptomatic relief of GERD
Constipation; diarrhea (Mg); fluid retention, hypophosphatemia, Mg – toxicity w/ renal impairment; P-C; DI: Aluminum binds to warfarin & tetracycline & interfere’s w/ absorption; water or milk w/ admin; 7x’s/ day 1 & 3 hrs after meals & before bed; take ALL meds 1 hr before or after antacids
Misoprostol (Cytotec)
Prostaglandin E Analog: acts as an endogenous prostaglandin in GI tract to \/ acid secretion, /\ secretion of bicarbonate & protective mucus, & promote vasodilation to maintain submucosal blood flow; T: prevention for long-term NSAID use, Induces labor
Diarrhea & abdominal pain; dysmenorrhea & spotting; P-X drug; take w/ meals & at bedtime;
Dexamethasone (Decadron)
Glucocorticoid: Unknown; T: combo w/ other antiemetics for chemotherapy-induced nausea & vomiting (CINV)
PO, IV; None noted; DI: CNS depressants may intensify antiemetic CNS depression; w/ antihypertensives = /\ hypotensive effects; w/ anticholinergics = /\ anticholinergic effects
Apreptitant (Emend)
Substance P/Neurokinin1 Antagonist: inhibits Substance P/Neurokinin1 in brain; T: combo w/ glucocorticoid or serotonin antagonist, extended duration – can be used for immediate & delayed response
Fatigue, diarrhea, dizziness, possible liver damage;
Ondansetron (Zofran)
Serotonin Antagonist: prevents emesis by blocking serotonin receptors in chemoreceptor trigger zone (CTZ) & antagonizing serotonin receptors on afferent vagal neurons that travel from upper GI tract to CTZ; T: prevents emesis w/ chemotherapy, radiation therapy, & postop recovery
PO, IV; headache, diarrhea, dizziness
Prochlorperazine (Compazine)
Metoclopramide (Reglan)
Dopamine Antagonist (subset of phenothiazine): blockade of dopamine receptors in the CTZ; T: prevents emesis w/ chemotherapy, opioids, & postop recovery
PO, IV; Extrapyramidal symptoms – restlessness, anxiety, spasms of face & neck; hypotension, sedation, anticholinergic – dry mouth, urinary retention, constipation;
Dronabinol (Marinol)
Cannabinoid: Unknown; T: controls CINV & /\ appetite in clients who have AIDS
PO; potential for dissociation & dysphoria; hypotension, tachycardia,
Scopolamine (Transderm Scop)
Anticholinergic: Interferes w/ transmission of nerve impulses traveling from vestibular apparatus of inner ear to vomiting center (VC) in brain; T: motion sickness
Topical, PO, SubQ; sedation & anticholinergic – dry mouth, urinary retention, constipation; DI: w/ anticholinergics = /\ anticholinergic effects
Dimenhydrinate (Dramamine)
Antihistamine: blocks muscarinic & histaminergic receptors in nerve pathways that connect inner ear & VC; T: treats motion sickness
PO, IM, IV; DI: w/ anticholinergics = /\ anticholinergic effects
Psyllium (Metamucil)
Bulk-forming Laxative: Softens fecal mass & increases bulk (just like dietary fiber); T: \/ diarrhea in pts w/ diverticulosis & IBS; control stool w/ ileostomy or colostomy; promote defecation
GI irritation, rectal burning sensation à proctitis; dehydration
Docusate Sodium (Colace)
Surfactant Laxative: lower surface tension of stool to allow water penetration; T: constipation, painful elimination, prevent straining, \/ risk of fecal impaction in immobile pts & promote defecation
GI irritation, rectal burning sensation à proctitis; dehydration, hypernatremia;
Bisacodyl (Dulcolax)
Stimulant Laxative: stimulation of intestinal peristalsis; T: treat short-term constipation by high-dose opioid; presurgery prep (colonoscopy)
GI irritation, rectal burning sensation à proctitis; dehydration
Magnesium Hydroxide (Milk of Magnesia)
Osmotic Laxative: draw water into intestine to /\ mass of stool – stretching musculature = peristalsis
Toxic levels of magnesium; DI: may destroy enteric coating of bisacodyl
Diphenoxylate plus Atropine (Lomotil)
Antidiarrheal: activate opioid receptors in GI tact to \/ intestinal motility & /\ absorption of fluid & sodium in intestines; T: provides symptomatic treatment of diarrhea
Recommended doses do not affect CNS; high doses – CNS depression, euphoria, typical opioid effect; atropine – blurred vision, dry mouth, urinary retention, constipation, tachycardia; contra – Inflammatory bowel disorders, no CNS depressants; Initial 4mg, w/ added w/ loose stool – 2mg, no more than 16mg/day drink lots of liquids; no caffeine, .45 NaCl IV may need
Metoclopramide (Reglan)
Prokinetic Agent: controls N/V by blocking dopamine & serotonin receptors in CTZ, augments action of acetylcholine à /\ in upper GI motility; T: control postop & chemo-induced N/V (CINV), GERD, gastroparesis
PO, IV; Extrapyramidal symptoms (antihistamine to stop); sedation, diarrhea; contra – GI perforation, GI bleed, bowel obstruction, & hemorrhage, seizures; DI: w/ CNS depressants /\ seizure & sedation, opioids & anticholinergics \/ effects
Alosetron (Lotronex)
Med for Irritable Bowel Syndrome w/ Diarrhea (IBS-D): Selective blockade of 5-HT3 receptors, which innervate viscera & result in /\ firmness in stool & \/ in urgency & frequency of defecation; T: female clients w/ IBS w/ diarrhea that has last > 6 months resistant to conventional therapy
Constipation à may result w/ GI toxicity – ischemic colitis, bowel obstruction, impaction or perforation; contra – constipation, hx of bowel obstruction, Crohn’s disease, ulcerative colitis, impaired intestinal circulation; DI: meds that induce cytochrome P450 enzymes (Phenobarbital), may \/ levels of absorption; 1-4 wk before resolves, symptoms return once off drug
Lubiprostone (Amitiza)
Med for Irritable Bowel Syndrome w/ Constipation (IBS-C): /\ fluid secretion in intestine to promote intestinal motility; T: IBS w/ constipation, chronic constipation
Diarrhea, nausea; P-C; DI: none; oral dosage 2x’s/day
Sulfasalazine (Azulfidine)
5-Aminosalicylates: decrease inflammation by inhibiting prostaglandin synthesis; T: IBS: Crohn’s disease, ulcerative colitis
Blood disorders including agranulocytosis, hemolytic, & macrocytic anemia; P-B; contra – med sensitive; DI: none; 4 oral doses/ day
Ferrous Sulfate (Feosol)
Iron Preparations: provide iron needed for RBC development & O2 transport to cells (normally poorly absorped = high doses); T: iron deficiency anemia (Iron sucrose & SFGC – solely for dialysis)
Ferrous – Oral; Dextran – Parenteral; GI distress, teeth staining (liquid form), staining of skin, etc; anaphylaxis risk; hypotension may à circulatory collapse, iron toxicity; DI: w/ antacids or tetracyclines \/ absorp; vitamin C /\ absorp & GI complications; Goal = 2g/dL per month
Vitamin B12
Vitamin B12-Cyanocobalamin: necessary to convert folic acid from inactive to active – DNA production; T: Vitamin B deficiency, megaloblastic (macrocytic) anemia
Hypokalemia b/c increased RBC production effects; DI: masking of signs – beefy red tongue, pallor, neuropathy
Folic Acid
Essential in production of DNA & erythropoiesis (RBC, WBC, & platelets); T: megaloblastic anemia, prevention of neural tube defects during pregnancy, malabsorption syndrome (sprue)
DI: \/ levels w/ sulfonamides, sulfasalazine, or methotrexate; Goal = folate level 6-15 mcg/mL;
Potassium chloride (K-Dur)
Potassium Supplements: essential for conducting nerve impulses, maintaining electrical excitability of muscle & regulation of acid/base balance; T: hypokalemia (Lasix), vomiting, diarrhea, GI fistulas
GI distress & ulceration, hyperkalemia; contra – severe renal disease, hypoaldosteronism; DI: w/ spironolactone & ACE inhibitors (lisinopril) /\ risk of hyperkalemia – NEVER bolus, no faster than 10mEq/hr; monitor urine output
Magnesium Sulfate; Oral - Magnesium Gluconate, Magnesium Hydroxide
Activates many intracellular enzymes & helps regulating skeletal muscle contractility & blood coagulation; T: hypomagnesemia, stop preterm labor
Nueromuscular blockade & respiratory depression, diarrhea; P-B; DI: \/ absorption of tetracyclines
Herbs Supplements
See Addendum Below
Lispro Insulin (Humalog)
Rapid-acting: promotes cellular uptake of glucose, converts glucose à glycogen, moves K into cell (w/ glucose); T: glycemic control of diabetes mellitus;
O: <15 min; P: 0.5-1hrs; D: 3-4hrs
Hypoglycemia, lipohypertrophy; DI: Sulfonylureas, meglitinides, beta blockers, & ETOH have additive hypoglycemic effects, w/ thiazide diuretics & glucocorticoids may /\ blood glucose levels & counteract insulin; Beta blockers may mask SNS response to hyperglycemia
Regular insulin (Humulin R)
Short-acting: promotes cellular uptake of glucose, converts glucose à glycogen, moves K into cell (w/ glucose); T: glycemic control of diabetes mellitus
O: 0.5-1hr; P: 2-3hrs; D: 5-7hrs
Hypoglycemia, lipohypertrophy; DI: Sulfonylureas, meglitinides, beta blockers, & ETOH have additive hypoglycemic effects, w/ thiazide diuretics & glucocorticoids may /\ blood glucose levels & counteract insulin; Beta blockers may mask SNS response to hyperglycemia
NPH insulin (Humulin N)
Intermediate-acting: promotes cellular uptake of glucose, converts glucose à glycogen, moves K into cell (w/ glucose); T: glycemic control of diabetes mellitus
O: 1-2hr; P: 4-12hrs; D: 18-24hrs
Hypoglycemia, lipohypertrophy; DI: Sulfonylureas, meglitinides, beta blockers, & ETOH have additive hypoglycemic effects, w/ thiazide diuretics & glucocorticoids may /\ blood glucose levels & counteract insulin; Beta blockers may mask SNS response to hyperglycemia;
Insulin Glargine (Lantus)
Long-acting: promotes cellular uptake of glucose, converts glucose à glycogen, moves K into cell (w/ glucose); T: glycemic control of diabetes mellitus
O: 1hr; P: none; D: 10.4-24hrs
Hypoglycemia, lipohypertrophy; DI: Sulfonylureas, meglitinides, beta blockers, & ETOH have additive hypoglycemic effects, w/ thiazide diuretics & glucocorticoids may /\ blood glucose levels & counteract insulin; Beta blockers may mask SNS response to hyperglycemia; DO NOT MIX, CLEAR in COLOR
Glipizide (Glucotrol)
Oral Hypoglycemic, Sulfonylurea: insulin release from pancrease; T: control blood glucose levels w/ type 2 DM
Hypoglycemia – SNS symptoms (tachycardia, palpitations, diaphoresis, shakiness) gradual = PNS symptoms – headache, tremors, weakness; P-C; DI: ETOH = disulfiram-like reaction (N/V, flushing, palpitations); ETOH, NSAIDs, sulfonamide antibiotics, Ranitidine, & cimetidine = additive effects; Beta blockers may mask SNS hypoglycemic response
Glyburide (Diabeta)
Oral Hypoglycemic, Sulfonylurea: Insulin release from the pancreas; T: control blood glucose levels w/ type 2 DM
Hypoglycemia – SNS symptoms (tachycardia, palpitations, diaphoresis, shakiness) gradual = PNS symptoms – headache, tremors, weakness; DI: ETOH = disulfiram-like reaction (N/V, flushing, palpitations); ETOH, NSAIDs, sulfonamide antibiotics, Ranitidine, & cimetidine = additive effects; Beta blockers may mask SNS hypoglycemic response
Repaglinide (Prandin)
Oral Hypoglycemic, Meglitinide: Insulin release from the pancreas; T: control blood glucose levels w/ type 2 DM
Hypoglycemia – SNS symptoms (tachycardia, palpitations, diaphoresis, shakiness) gradual = PNS symptoms – headache, tremors, weakness; P-C; DI: w/ gemfibrozil = inhibition of metabolism à /\ risk of hypoglycemia
Metformin HCl (Glucophage)
Oral Hypoglycemic, Biguanide: Reduces production of glucose w/in liver through suppression of gluconeogenesis, /\ muscle’s glucose uptake & use; T: control blood glucose levels w/ type 2 DM, & treats polycystic ovary syndrome (PCOS)
GI – anorexia, N/V à wt loss (6-8 lbs); Vitamin B12 & folic acid deficiency from altered absorption; lactic acidosis (hyperventilation, myalgia, sluggishness, somnolence) – 50% mortality; P-B; Contra – severe infection, shock, & hypoxic conditions; DI: w/ ETOH /\ risk of lactic acidosis; w/ iodine-containing contrast à acute renal failure
Rosiglitazone (Avandia)
Oral Hypoglycemic, Thiazolidinedione: /\ cellular response to insulin by \/ insulin resistance, /\ in glucose uptake & \/ glucose production; T: control blood glucose levels w/ type 2 DM
Fluid retention, /\ LDL cholesterol; P-C; DI: w/ gemfibrozil = inhibition of metabolism à /\ risk of hypoglycemia
Acarbose (Precose)
Oral Hypoglycemic, Alpha Glucosidase Inhibitor: slows carbohydrate absorption & digestion; T: control blood glucose levels w/ type 2 DM
Intestinal – abdominal distention & cramping, hyperactive bowl sounds, diarrhea, excessive gas; risk for anemia (\/ iron absorption); hepatoxicity w/ long-term use; P-B; contra – GI disorders DI: w/ sulfonylureas or insulin /\ risk of hypoglycemia; w/ Metformin = additive effects & risk for hypoglycemia
Sitagliptin (Januvia)
Oral Hypoglycemic, Gliptin: Augments naturally occurring incretin hormones à promote release of insulin & \/ secretion of glucagon; lowers fasting & postprandial blood glucose levels; T: control blood glucose levels w/ type 2 DM
None; P-B; DI: none
Pramlintide (Symlin)
Amylin Mimetic: reduction of postprandial glucose levels from \/ gastric emptying time & inhibition of section of glucagon, /\ in sensation of satiety à \/ calorie intake; T: Supplemental glucose control w/ insulin or oral agent – i.e. metformin or slufonylurea
Nausea, reaction at injection site; P-C; contra – renal failure or dialysis; DI: insulin /\ risk for hypoglycemia; w/ pramlintide & meds that slow gastric emptying (opioids) or delay food absorption (acarbose) may further slow gastric emptying; Oral med absorption delayed; take pramlintide subQ
Exenatide (Byetta)
Incretin Mimetic: mimics glucagon-like peptide-1, promotes release of insulin, \/ secretion of glucagon, slows gastric emptying, lowers fasting & postprandial blood glucose leves; T: Supplemental glucose control w/ insulin or oral agent – i.e. metformin or slufonylurea
GI – N/V/D; pancreatitis – severe & intolerable ab pain; P-C; contra – renal failure, ulcerative colitis, Crohn’s disease; DI: oral meds absorption delayed (esp. oral contras & antibiotics); admin before meal
Glucagon
Hyperglycemic Agent: /\ blood glucose levels by increasing breakdown of glycogen into glucose, \/ glycogen synthesis enhances synthesis of glucose; T: emergency of hypoglycemic reactions; \/ in gastrointestinal motility in pts w/ radiological procedures of stomach & intestines
GI distress (N/V); P-B
Methotrexate (Rheumatrex, Trexall)
Antimetabolites, Folic Acid Analog: S-phase specific, stops cell reproduction by inhibiting folic acid conversion; T: choriocarcinoma, solid tumors (breast & lung, head & neck sarcomas, acute lymphocytic leukemia, non-Hodgkin’s lymphoma
Oral, IV, IM, intrathecal; bone marrow suppression, N/V, mucositis (GI), gastric ulcers, perforation, reproductive toxicity, hyperuricemia or /\ levels of uric acid = may cause renal damage; P-X, contra – w/ psoriasis, rheumatoid arthritis, liver failure, immunodeficiencies, blood dyscriasis; DI: may \/ digoxin levels; NSAIDs, salicylates, & sulfonamides = toxicity, may \/ phenytoin level; Procarbazine may /\ nephrotoxicity, food may \/ absorp., may \/ vaccine strength;
Cytarabine (Cytosar-U)
Antimetabolites, Pyrimidine Analog: S-phase specific, inhibits RNA & DNA synthesis of cancer cells; T: acute myelogenous leukemia, solid tumors (breast & colon)
Subcut, IV, IM, intrathcal; bone marrow suppression, N/V, liver disease, pulmonary edema, arachnoiditis* (nausea, headache, fever); P-D; DI: \/ digoxin level & gentamicin response to Klebsiella pneumoniae; watch for neurotoxicity (nystagmus)
Mercaptopurine (Purinethol)
Antimetabolites, Purine Analog: S-phase specific, interrupts RNA & DNA synthesis of cancer cells; T: acute lymphocytic leukemia, acute non-lymphocytic leukemias
Oral, IV; bone marrow suppression, N/V, liver toxicity, mucositis (GI), gastric ulcers, perforation; P-D; DI: may \/ breakdown of mercaptopurine & musclar relaxant effect of nondepolarizing neuromuscular meds (pancuronium) & effects of warfarin
Doxorubicin (Adriamycin)
Antitumor Antibiotics, Anthracycline: Nonspecific cell cycle phase, binds to DNA, altering its structure; T: solid tumors – lung, bone, stomach, & breast, Hodgkin’s & non-Hodgkin’s lymphomas
IV; Bone marrow suppression, N/V, extravasations of vesicants cause severe tissue damage; alopecia, acute cardiac toxicity, dysrhythmias, cardiomyopathy, heart failure (may have delayed onset); P-D; contra – severe myelosuppression, cumulative dose 550 mg/ m2; DI: Calcium channel blockers may /\ cardiotoxicity; may \/ digoxin levels; Phenobarbital may /\ metabolism of doxorubicin; Paclitaxel may \/ metabolism of doxorubicin, may \/ phenytoin levels
Dactinomycin (Actinomycin D)
Antitumor Antibiotics, Nonanthracycline: Nonspecific cell cycle phase, binds to DNA, altering its structure; T: Wilm’s tumor, rhabdomyosarcoma, choriocarcinoma, Ewing’s sarcoma & Kaposi’s sacroma
IV; Bone marrow suppression, N/V, extravasations of vesicants cause severe tissue damage; alopecia; P-D; contra – active chicken pox or herpes zoster; DI: none
Vincristine (Oncovin, Vincasar)
Antimitotics, Vinca Alkaloid: M-Phase specific; useful in combo treatment, stops cell division during mitosis, not bone marrow toxic; T: acute lymphocytic leukemia, Wilms tumor, rhabdomycosarcoma, solid tumors (bladder & breast cancers, Hodgkin’s and non-Hodgkin’s lymphomas
IV; peripheral neuropathy – weakness & paresthesia, extravasations of vesicants cause severe tissue damage, alopecia; P-D; contra – Charcot-Marie-Tooth syndrome; P-D; DI: Asparaginase may \/ clearance of vincristine; Calcium channel blockers may /\ accumulation; may \/ effects of digoxin; may /\ risk of bronchospasm; may \/ level of phenytoin
Paclitaxel (Taxol, Onxol)
Antimitotics, Taxanes: Stop cell division during mitosis; T: ovarian, non-small cell lung tumors, & Kaposi’s sarcoma
IV; anaphylaxis (hypotension, dyspnea, rash), bone marrow suppression, bradycardia, heartblock, MI, alopecia, contra- hypersensitive to castor oil; DI: cisplatin may /\ myelosuppression; cyclosporine, dexamethasone, diazepam, verapamil, quinidine, & vincristine may slow clearance; Phenobarbital & carbamazepine may /\ metabolism
Cyclophosphamide (Cytoxan, Neosar)
Alkylating Agent, Nitrogen Mustard: Nonspecific cell cycle phase, kills rapid growing cells by interrupting DNA & RNA synthesis; T: acute lymphomas, solid tumors (head, neck, & breast; Hodgkin’s & non-Hodgkin’s lymphomas)
Oral, IV; bone marrow suppression, N/V, acute hemorrhagic cystisis, alopecia; P-D; contra – myelosuppression; DI: Barbiturates may /\ effect; may /\ cardiac toxicity or cardiotoxic agents; may /\ digoxin levels; w/ succinylcholine may /\ neuromuscular blockage
Carmustine (BiCNU)
Alkylating Agent, Nitrosoureas: Nonspecific cell cycle phase, kills rapid growing cells by interrupting DNA & RNA synthesis; crosses blood brain barrier; T: brain tumors, Hodgkin’s & non-Hodgkin’s lymphomas, & multiple myeloma
IV, Topical; bone marrow suppression, N/V, pulmonary fibrosis, liver & kidney toxicity, reproductive toxicity, P-D; DI: anticoagulants may /\ bleeding time; w/ carmustine & cimetidine may /\ bone marrow suppression; w/ carmustine & mitomycin may /\ corneal dysfunction
Cisplatin (Platinol-AQ)
Alkylating Agent, Platinum Compounds: Nonspecific cell cycle phase, kills rapid growing cells by interrupting DNA & RNA synthesis; T: bladder, testicular, & ovarian cancers
IV; bone marrow suppression, N/V, renal toxicity, hearing loss; P-D; DI: w/ aminoglycosides may /\ risk for renal toxicity; w/ cisplatin & furosemide may /\ hearing loss; may \/ levels of phenytoin
Topotecan (Hycamtin)
Topoisomerase Inhibitors, : S-specific cell cycle phase, kills cancer cells by interrupting DNA synthesis; T: ovary & small cell lung tumors
IV; Bone marrow suppression (may occur 4-6 wks after infusion), alopecia; P-D, may /\ myelosuppression
Asparaginase (Elspar)
Other Antineoplastic Agents: G1-specific cell cycle phase, kills cancer cells by interrupting DNA synthesis in leukemia cells; T: acute lymphocytic leukemia
IV, IM; N/V, hypersensitivity reaction, alopecia, liver & pancreas toxicity, renal toxicity; P-C; contra – pancreatitis; DI: may \/ effects of methotrexate; predinsone & vincristine may /\ toxicity; give test dose w/ resuscitation equipment, use w/ birth control
Hydroxyurea (Hydrea, Mylocel)
Other Antineoplastic Agents: S-specific cell cycle phase; kills cancer cells by interrupting DNA synthesis, may cross blood-brain barrier; T: Chronic myelogenous, leukemia, ovarian & squamous cell cancers
Oral; N/V, bone marrow suppression (may occur 4-6 wks after infusion); P-D; contra – myelosuppression or anemia; DI: cytotoxic meds may /\ hydroxyurea (med); use w/ birth control
Procarbazine (Matulane)
Other Antineoplastic Agents: Non-specific cell cycle phase, kills cancer cells by interrupting DNA and RNA synthesis, may cross blood-brain barrier; T: brain tumors, Hodgkin’s & non-Hodgkin’s lymphomas
Oral; N/V, peripheral neuropathy – weakness & paresthesia; P-D; contra – severe myelosuppression; DI: may /\ depressant effects of CNS depressants, may \/ digoxin levels, opioids may cause hypotension; watch for neuro effects
Leuprolide (Eligard, Lupron)
Non-cytotoxic, Hormonal Agent, Gonadotropin-Releasing Hormone Agonist: Testes stop producing testosterone; T: prostate cancer
SubQ, IM; Hot flushes, \/ libido, \/ bone density, arrhythmias, pulmonary edema; P-X; DI: none noted; need to /\ Ca & vitamin D to /\ bone mass, prostate symptoms may worsen at first
Flutamide (Eulexin)
Non-cytotoxic, Hormonal Agent, Androgen Receptor Blocker: blocks testosterone at receptor site, used w/ gonadotropin-releasing hormone agonist, to block androgen receptors & suppress growth of prostate cancer
Oral; thrombocytopenia, leukopenia (rare), gynecomastia, N/V/D, hepatitis; P-D; DI: w/ flutamide & warfarin may /\ anticoagulation;
Admin w/ gonadotropin-releasing hormone
Tamoxifen (Nolvadex)
Non-cytotoxic, Hormonal Agent, Estrogen Receptor Blocker: stops growth of breast cancer cells, which are estrogen-dependent cancers; T: to treat & prevent breast cancer
Oral; endometrial cancer, hypercalcemia, N/V, pulmonary embolus, hot flushes, vaginal discharge or bleeding; P-D; contra – pts on warfain & w/ hx of blood clots or pulmonary embolism; DI: may /\ action of warfarin; antacids may alter absorption
Anastrozole (Arimidex)
Non-cytotoxic, Hormonal Agent, Aromatase Inhibitor: stops growth of cancer cells by blocking estrogen; T: to treat breast cancer in postmenopausal women
Oral; muscle & joint pain, headache, nausea, vaginal bleeding, /\ risk for osteoporosis, hot flushes; P-D; DI: tamoxifen & estrogen-like meds may \/ effects; w/ anastrozole & anthracyclines may /\ risk for cardiac effects
Trastuzumab (Herceptin)
Non-cytotoxic, Hormonal Agent, Monoclonal Antibody: targets breast cancer cells, prevents cell growth & causes cell death; T: used to treat metastatic breast cancer, may be used alone or in conjunction w/ paclitaxel
IV; cardiac toxicity, tachycardia, heart failure; hypersensitivity reaction, N/V; P-B; DI: none listed
Interferon Alfa-2a, Interferon Al-fa-2b
Biological Response Modifier: /\ immune response & \/ production of cancer cells T: to treat or prevent hairy cell leukemia, chronic myelogenous leukemia, malignant melanoma, & AIDS-related Kaposi’s sarcoma
IV, IM, SubQ; Flu-like symptoms (fever, fatigue, headache, chills, myalgia); bone marrow suppression, alopecia, cardiotoxicity, & neurotoxicity (prolonged therapy); hypotension; P-C; contra – liver, kidney failur, seizure, cardiac hx, or compromised immune system; DI: w/ = may lead to theophylline toxicity; Zidovudine may /\ risk of neutropenia; w/ antihypertensives = additive hypotensive effect; w/ vaccines w/ live virus may \/ antibody response; refrigerate med, do not freeze, do not shake vial
Cetuximab (Erbitux)
Targeted, EGRF-tyrosine Kinase Inhibitor: Antibody that stops cancer cell growth & /\ cell death; T: cancers that are EGFR positive (colorectal & solid tumors of head & neck)
IV; Infusion reaction, rash, hypotension, wheezing, pulmonary emboli, skin toxicity, rash; P-C; DI: sun may /\ skin toxicity
Imatinib (Gleevec)
Targeted BCR-ABL Tyrosine Kinase Inhibitor: stops cancer growth by inhibiting intracellular enzymes; T: chronic myeloid leukemia
Oral; N/V, flu-like symptoms (fever, fatigue, headache, chills, myalgia), edema, hypokalemia, neutropenia, anemia; P-D; DI: acetaminophen may /\ liver failure, may /\ warfarin effect; clarithromycin, erythromycin, & ketoconazole may slow metabolism & cause toxicity, carbamezapine & phenytoin may /\ metabolism
Rituximab (Rituxan)
Targeted CD20-Directed Antibodies: Antibody that stops cancer cell growth & /\ cell death; T: non-Hodgkin’s lymphoma
IV; infusion reaction, rash, hypotension, wheezing, flu-like symptoms (fever, fatigue, headache, chills, myalgia), tumor lysis syndrome due to rapid cell death may à kidney failure, hypocalcemia & hyperuricemia; P-C; DI: calcium channel blockers may alter effects
Bevacizumab (Avastin)
Targeted Angiogenesis Inhibitor: Antibody that stops cancer cell growth & /\ cell death; colorectal & lung cancers
IV; N/V, alopecia, mucositis (GI tract), hypertension, gastric perforation; P-C; DI: may /\ Irinotecan level
Aloe, Aloe Vera (Aloe Gel and Aloe Latex)
Antimicrobial, anti-inflammatory, analgesic – topically; cathartic properties – ingested; T: soothes pain & inflammation of burn, softens skin, laxative
Possible hypersensitivity, fluid & electrolyte imbalances
Black Cohosh
Acts as estrogen substitute, mechanism unknown; T: symptoms of menopause
GI distress, lightheadedness, headache, rash, wt gain, not in 1st two trimesters, no longer than 6 month use; DI: /\ antihypertensive med effects, estrogen med effects, hypoglycemia
Echinacea
Stimulates immune system, \/ inflammation, /\ phagocytosis; /\ T-lymphocyte, tumor necrosis factor, & interferon production; T: Oral – common cold (no research); topical – skin disorders, wounds, burns
Mild GI symptoms & fever, allergic reactions; DI: chronic use may \/ effects of meds for tuberculosis, HIV, or cancer
Feverfew
Possibly blocks factor necessary to cause migraine, stops release of arachidonic acid in thrombcytes à block platelet aggregation; T: \/ number & severity of migraines, not existing migraines
Mild GI symptoms, Post-feverfew syndrome – agitation, tiredness, inability to sleep, headache, joint discomfort; allergic reactions; DI: may /\ risk of bleeding
Garlic
Crushed garlic cells = enzyme allicin = blocks cholesterol synthesis in liver, suppresses platelet aggregation & coagulation; acts a vasodilator; T: lower cholesteral, LDL & triglycerides, slightly /\ HDL; may \/ BP
GI symptoms; DI: risk of bleeding w/ anticoagulants; /\ hypoglycemic effects of diabetic meds; /\ levels of saquinavir
Ginger Root
Unknown mechanism, acts on areas of brain that cause Nausea, /\ intestinal motility & gastric production; \/ GI spasms, inhibits prostaglandins & leukotrienes to produce anti-inflammatory effects, suppresses platelet aggregation; T: \/ nausea, morning & motion sickness, \/ pain & stiffness of rheumatoid arthritis
High doses – uterine spasms; DI: interfere w/ coagulation meds
Ginkgo Biloba
Promotes vasodialation, suppresses platelet aggregation & bronchospasm; T: mental ability, erectile dysfunction, pain, \/ risk of thrombosis & bronchospams
Mild GI upset, headache, lightheadedness, risk for seizure; DI: may interact w/ meds that lower seizure threshold (Antihistamines, antidepressants, & antipsychotics); interfere w/ coagulation meds
Goldenseal
Antiseptic, suppresses inflammation, may stimulate immune system, /\ bile secretion; T: treat infections, \/ gall bladder inflammation
High doses – CNS = respiratory failure & death; stimulates uterus (pregos); DI: none
Kava (Kava Kava)
Unknown; possibly acts on GABA receptors in CNS; T: insomnia, anxiety, & muscle relaxation w/ decreased concentration
Chronic use – dry, flaky skin & jaundice; chronic use & large doses = liver damage/ failure; DI: sedation w/ CNS depressants
Ma Huang (Ephedra Sinica)
May activate alpha & beta adrenergic receptors to constrict arterioles, /\ HR, bronchodialation, & suppress appetite; stimulates CNS; T: colds, influenza, & allergies, wt loss, /\ athletic abilities
Contains Ephedrine, stimulate cardio system & may cause extreme hypertension dysrhythmias, & death; euphoria & psychosis (high dose); DI: potentiates CNS stimulants; severe hypertension w/ MAOIs, \/ antihypertensive med effects
St. John’s Wort
Affects serotonin, NE, dopamine, & GABA uptake to produce antidepressant effects; T: mild depression
Dry mouth, lightheadedness, constipation, GI symptoms, skin rash w/ sunlight; DI: Serotonin Syndrome w/ antidepressants, amphetamine, & cocaine; \/ effect of oral contraceptives, cyclosporine, warfarin, digoxin, CCBs, steroids, HIV protease inhibitors, & some cancer chemotherapy meds
Saw Palmetto
Unknown, may \/ conversion of testosterone into dihydrotestosterone (DHT) in prostate; T: \/ symptoms of BPH
Mild GI effects; Can decrease PSA – marker to detect prostate cancer; DI: possible additive effects w/ finasteride (Proscar)
Valerian
/\ GABA to prevent insomnia; may be similar to benzodiazepines; T: promotes sleep; w/ increased effect of time
Drowsiness, lightheadedness, depression; risk of physical dependence; avoid with mental health disorders & pregos / lactating pts