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33 Cards in this Set

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Opioid analgesics

Tramadol (Ultram)
Moderate to severe pain
adverse effects: drowsy, dizzy, HA, N/V, constipation

Seizures have been reported
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)
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)
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)
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)
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
Other opioid analgesics:

Vicodin, Lortab, Percodan, Percocet, Oxycontin
Mild to moderate pain
Combo drugs - combine with APAP or NSAID
adverse effects like codeine
Watch hepatotoxicity in long-term use of APAP combination forms
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
Non-opioid analgesics

NSAIDs: COX2 inhibitors

celecoxib (Celebrex)
acute pain, esp. multiple types of arthritis
GI complaints, HA
May increase thrombotic events (MI, stroke)
May cause fluid retention
Watch hepatotoxicity for long-term use
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)
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
Cardiac medications

Cardiac glycosides

digoxin (Lanoxin, Digitek)
Heart failure and dysrhythmias
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
Cardiac medications

Phosphodiesterase inhibitors

milrinon (Primacor)
inamrinon (Inocor)
Short term management of heart failure
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
Cardiac medications

Direct vasodilators

nesiritide (Natrecor)
acute treatment of heart failure in pts with dyspnea at rest and/or minimal activity
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
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
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
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
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
Cardiac medications

ACE inhibitors

captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), moexpril (Univasc), ramipril (Altace)
HTN, MI, heart failure
Adverse: dizzy, fatigue, HA, hypotension, dry nonproductive cough. chest pain, tachycardia, hyperkalemia, hypermagnesemia
Serious: angioedema (rare)
Monitor K and Mg
Enhances thiazide diuretics
Cardiac medications

angiotensin II receptor blocker (ARBs)

losartan (Cozaar), olmesartan (Benicar), valsartan (Diovan)
anti-HTN, adjunctive therapy for heart failure
Adverse: mild, HA, upper resp infections, dizzy, GI problems, fatigue
Potent vasodilator
Often used in combo therapy for mgmt of HTN
Cardiac medications

Direct-acting vasodilators

hydralazine (Apresoline), nitroprusside (Nipride)
anti-HTN
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
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
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
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
Antibiotics

Penicillin
Gram +
Take on empty stomach with water Don't give w/aminoglycosides (inactivates)
Adverse: mild rash, n/v
Monitor renal patients
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
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)
Miscellaneous antibiotics

Daptomycin
Serious skin, wound, abscess
Adverse: GI, fever, HA, dizzy, insomnia, rash
Miscellaneous antibiotics

imipenem-cilastin
one of broadest spectrum any class
Adverse: low incidence of adverse effects, rash, GI (m/c)
clindamycin
broad spectrum
oral infections
assoc risk of pseudomembranous colitis
Adverse: rash, pruritus, difficult swallowing
linezolid (Zyvox)
For Vanco resistant MRSA
Caution: HTN, taking SSRI's, may precipitate HTN crisis
Adverse: thrombocytopenia, bleeding, GI, fever
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
Tetracyclines

doxycycline
tetracycline
tigecycline
broad spectrum
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