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33 Cards in this Set
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Opioid analgesics
Tramadol (Ultram) |
Moderate to severe pain
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adverse effects: drowsy, dizzy, HA, N/V, constipation
Seizures have been reported |
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Opioid analgesics
hydromorphone hydrochloride (Dilaudid) |
Moderate to severe pain
indicated for continuous analgesia for an extended period of time |
adverse effects: resp depression, bradycardia, constipation
Commonly abused antidote = naloxone (Narcan) |
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Opioid analgesics
morphine sulfate (Duramorph, MS Contin, DepoDur) |
symptomatic relief of mod to sev pain
DOC for MI (decreases workload) Preanesthetic Epidural single dose for extended pain relief |
Resp depression (OD=resp arrest)
Causes peripheral vasodilation -- orthostatic hypotension Constipation, contraindicated in pt's with GI obstruction, may mask gallbladder pain Commonly abused antidote = naloxone (Narcan) |
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Opioid analgesics
meperidine (Demerol) |
moderate to severe pain
pre-op sedation preferred OB analgesic - does not delay uterine contractions and less neonatal resp depression for patient's allergic to morphine |
drowsiness, dizziness, resp depression, constipation, N/V
Caution: elderly and debilitated avoid: with hepatic or renal disease antidote = naloxone (Narcan) |
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Opioid analgesics
fentanyl (Duragesic, Sublimaze) |
Short acting, moderate to severe
During operative and perioperative adjunct to regional and gen anesthesia Chronic pain - around the clock For cancer breakthrough pain |
Patch form for chronic severe pain
constipation, dizzy, euphoria, hypotension, bradycardia, resp depression, circulatory depression, cardiac arrest antidote = naloxone (Narcan) |
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Opioid analgesics
codeine |
mild to moderate pain
antitussive and cough suppressant |
Less analgesic/resp effects than other opioids
Only need low dose for coughs Dizzy, euphoria, drowsy, constipation, hypotension, bradycardia, pruritus |
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Other opioid analgesics:
Vicodin, Lortab, Percodan, Percocet, Oxycontin |
Mild to moderate pain
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Combo drugs - combine with APAP or NSAID
adverse effects like codeine Watch hepatotoxicity in long-term use of APAP combination forms |
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Non-opioid analgesics
NSAIDs ibuprofen (Advil, Motrin), naproxen sodium (Anaprox, Aleve), meloxicam (Mobic), ketorolac tromethamine (Toradol) |
DOC for mild to moderate pain, esp when there's inflammation
antipyretic certain types of arthritis |
GI complaints, GI bleeding - serious
take with food or milk contraindicated with peptic ulcer disease Monitor renal fx & UO with long-term use Caution: heart failure, HTN, MI |
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Non-opioid analgesics
NSAIDs: COX2 inhibitors celecoxib (Celebrex) |
acute pain, esp. multiple types of arthritis
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GI complaints, HA
May increase thrombotic events (MI, stroke) May cause fluid retention Watch hepatotoxicity for long-term use |
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Non-opioid analgesics
acetominophen (Tylenol) analgesic, antipyretic |
antifever DOC for kids (avoid Reye's)
Mild to moderate pain or fever No anti-inflammatory effect Primary alternative to NSAIDs |
Hepatotoxic
Contraindicated: liver disease, alcohol drinkers Inhibits warfarin metabolism causing warfarin toxicity Monitor ALT, AST, bilirubin antidote = N-actylcysteine (Acetadote) |
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Non-opioid analgesics
aspirin (acetylsalicylic acid, ASA) analgesic, NSAID, antipyretic |
Mild to moderate pain w/inflammation
antipyretic anticoagulant - reduces risk of MI, stroke and colorectal cancer |
GI bleeding
enteric coated, buffered available Stop 1 wk before surgery excreted in urine - may affect glucose or VMA testing contraindicated - kids (d/t Reye's), pts with Vitamin K deficiency, and peptic ulcer disease |
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Cardiac medications
Cardiac glycosides digoxin (Lanoxin, Digitek) |
Heart failure and dysrhythmias
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Monitor level - s/b 0.5-2 ng/mL
Monitor K+ (low K increases toxicity) Teach pulse taking - hold <60 Administer over 5 minutes May be given loading dose to quickly achieve therapeutic level Adverse: fatigue, anorexia, bradycardia Toxicity: HA, vertigo, photophobia, yellow-green halos, tachycardia, AV heart block antidote = Digibind |
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Cardiac medications
Phosphodiesterase inhibitors milrinon (Primacor) inamrinon (Inocor) |
Short term management of heart failure
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ventricular arrhythmias, hypotension, chest pain, HA, hypokalemia, tremors, thrombocytopenia
High risk of toxicity - last resort for pts who don't respond to glycosides or ACE inhibitors |
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Cardiac medications
Direct vasodilators nesiritide (Natrecor) |
acute treatment of heart failure in pts with dyspnea at rest and/or minimal activity
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Adverse: arrhythmias, hypotension, HA, fainting, anxiety
If hypotension occurs - stop or reduce Check creatinine, need baseline and continuous checks - may be nephrotoxic with acute decompensated heart failure |
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Cardiac medications
Organic nitrate / vasodilator nitroglycerin (Nitro-Bid) isosorbide (Isordi) |
Treats stable and unstable angina
rapid acting for acute episodes long acting - prevents angina attacks |
Adverse: HA (m/c), hypotension, tachycardia, contact dermatitis
contraindicated: preexisting hypotension, head trauma, ICP, tamponade Adequate hydration req'd for admin Hold for systolic BP <100 Store in dark, light resistant container replace supply every 6 months may administer up to 3 tabs SL Topical: use gloves, place on non-hairy site, rotate sites, avoid lower extremities |
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Cardiac medications
beta-adrenergic antagonists (beta-blockers) atenlol (Tenormin), metoprolol (Lopressor), propanolol (Inderal) |
treats angina (particularly caused by exercise)
HTN, dysrhythmias, MI migraines, stage fright (slows heart) |
well tolerated at low dose
adverse: bradycardia, hypotension, 2nd and 3rd degree heart block, fatigue, lethargy, depression, wheezing, dyspnea, impotence, decreased libido, altered glucose and lipid metabolism hold for HR <60 withdraw gradually to avoid rebound HTN, angina and MI Monitor blood sugar, cholesterol and triglycerides Caution: asthma and diabetes |
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Cardiac medications
Calcium Channel Blockers amlodipine (Norvasc), diltiazem (Cardizem), ranolazine (Ranexa) |
Angina, HTN, dysrhythmias
Migraines and Raynaud's |
adverse: bradycardia or tachycardia, heart block, hypotension, dyspnea, wheezing, GI complaints, dermatitis
caution: liver disease (use reduced dose) Taper dose |
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Cardiac medications
Alpha adrenergic agonists clonidine (Catapres), methyldopa (Aldomet) |
Anti-HTN, manages opioid withdrawal
Aldomet - pregnancy induced HTN |
Adverse: orthostatic hypotension (m/c), bradycardia, reflex tachycardia, sedation, dizziness and HA
Don't discontinue abruptly |
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Cardiac medications
ACE inhibitors captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), moexpril (Univasc), ramipril (Altace) |
HTN, MI, heart failure
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Adverse: dizzy, fatigue, HA, hypotension, dry nonproductive cough. chest pain, tachycardia, hyperkalemia, hypermagnesemia
Serious: angioedema (rare) Monitor K and Mg Enhances thiazide diuretics |
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Cardiac medications
angiotensin II receptor blocker (ARBs) losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan) |
anti-HTN, adjunctive therapy for heart failure
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Adverse: mild, HA, upper resp infections, dizzy, GI problems, fatigue
Potent vasodilator Often used in combo therapy for mgmt of HTN |
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Cardiac medications
Direct-acting vasodilators hydralazine (Apresoline), nitroprusside (Nipride) |
anti-HTN
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Adverse: HA, dizzy, reflex tachycardia, hypotension, rebound HTN, hyperglycemia, Na+ and water retention
Monitor I&O, blood glucose Nipride for emergency HTN, monitor VS's frequently |
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Antibiotics
Aminoglycosides gentamicin, tobramycin, neomycin, amikacin, streptomycin |
Gram - (serious infections)
streptomycin - just for TB |
Systemic use - not absorbed thru GI
Ototoxic and nephrotoxic Need baseline hearing test Monitor BUN and creatinine levels Fluids - 1500-2000 a day Adverse: GI, rash, fever, pain, swelling at injection site, dizzy, tinnitus, suprainfection and anaphylaxis Neomycin - topical |
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Antibiotics
Cephalosporins cefazolin, cephalexin, cefaclor, cefepime |
Gram -, for those who can't take penicillins
4 generations - 4 is highest coverage |
Contra: pts who had anaphylactic reaction to penicillin
1st and 2nd generation - doesn't cross BBB so can't use for neuro infections Adverse: skin rash, GI, superinfection, pseudomembranous enterocolitis, anaphylaxis If bleeding precautions - ck PT IM injection pain - use Xylocaine thrombophlebitis - admin over 60 mins Monitor renal patients |
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Antibiotics
Macrolides azithromycin, clarithromycin, erythromycin |
Broad spectrum
good alternative to penicillin |
Take on empty stomach
destroyed by gastric acid and fruit juice Contra: liver disease Adverse: GI, superinfecgtions, hepatotoxicity, dysrhythmias, ototoxicity, pseudomembranous colitis, anaphylaxis |
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Antibiotics
Penicillin |
Gram +
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Take on empty stomach with water Don't give w/aminoglycosides (inactivates)
Adverse: mild rash, n/v Monitor renal patients |
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Antibiotics
Fluoroquinolones Ciprofloxacin |
Gram - and some Gram +
Not generally first line antibiotics DOC for anthrax |
Don't give with antacids or vitamins/supplements - won't absorb
Monitor BUN, creatinine, I&O Adverse: GI, dizzy, HA, sleep disturbance, superinfections, phototoxicity, cardiotoxicity, tendon/joint toxicity Contra: pregnancy, pts <18 |
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Miscellaneous antibiotics
Vancomycin |
Gram + (severe infections)
DOC for MRSA |
Ototoxic, nephrotoxic
Get baseline hearing test Peak and trough Monitor BUN, creatinine Infuse over 60 mins on pump, monitor BP and HR during admin d/t risk of hypotension Adverse: GI, skin rash, fever/chills, confusion, seizures, Red Man syndrome (flushing, hypotension, tachycardia) |
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Miscellaneous antibiotics
Daptomycin |
Serious skin, wound, abscess
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Adverse: GI, fever, HA, dizzy, insomnia, rash
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Miscellaneous antibiotics
imipenem-cilastin |
one of broadest spectrum any class
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Adverse: low incidence of adverse effects, rash, GI (m/c)
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clindamycin
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broad spectrum
oral infections |
assoc risk of pseudomembranous colitis
Adverse: rash, pruritus, difficult swallowing |
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linezolid (Zyvox)
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For Vanco resistant MRSA
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Caution: HTN, taking SSRI's, may precipitate HTN crisis
Adverse: thrombocytopenia, bleeding, GI, fever |
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Sulfonamides
trimethoprim/sulfamethoxazole silver sulfadiazine (topical) sulfisoxasole |
Broad spectrum
UTI's |
Increase fluids to 2000-3000
Adverse: GI, skin rash, superinfections, crystalluria, renal damage, phototoxicity, hyperkalemia, blood dyscrasias, Stevens-Johnson syndrome, anaphylaxis |
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Tetracyclines
doxycycline tetracycline tigecycline |
broad spectrum
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Take on empty stomach unless they can only tolerate it with food
Strong affinity to calcium so don't administer with antacids or dairy Contra: pregnancy, kids <8 (teeth staining) Photosensitivity and GI (m/c) Adverse: GI, skin rashes, superinfections, hep[atoxicity, anaphylaxis |
