Pharm Cards

Front 1

Celebrex

Back 1

One of 2nd Generation NSAIDS
Selective inhibitor of COX-2

May reduce GI effects more than first generation NSAIDS

FDA Issues: Does not inhibit platelet aggregation - prothrombic effect. ^ Risk of MI, sudden cardiac death and stroke.

Indications: anti-inflammatory (OA,RA), acute pain

SE: Dyspepsia/GI irritation, abdominal pain
Renal toxicity (edema, hypertension)
CV warning issued (blood clotting can occur)

Contraindications: Sulfonamide allergy, pregnancy, heart disease

Front 2

Ergot Alkaloids (Ergomar, Ergostat, Cafergot, DHE45, Migranal)

Back 2

Action: Unknown. Serotonin agonist/Vasoconstrictor
Indication: Ongoing moderate to severe migraine HA

SE: N,V, VASCULAR(INCLUDING CORONARY) OCCLUSION, angina, ^HR, muscle weakness, pain, numbness,

Long-term use complications -> Fibrotic cardiac valves

OD: Ischemia -> gangrene

Nursing implications
Administer anti-emetic
liver disease and fever can accelerate development of ^vasoconstriction
Never combine with triptans
CONTRAINDICATED WITH PREGNANCY, SEPSIS, CAD, PVD

Front 3

Triptans (Sumatriptan, Zolmitriptan)

Back 3

Actions:
Selective serotonin-receptor agonist with a short duration of action
VASOCONSTRICTION, DECREASED VASCULAR INFLAMMATION

Indication: terminating ongoing moderate to severe HA (DRUG OF CHOICE)

Routes: SC, Nasal spray, oral; administer as soon as symptoms begin

SE: CHEST PRESSURE/TIGHTNESS, ANGINA (***CORONARY VASOSPASM), MI, DYSRHYTHMIAS, STROKE
Tingling, Flushing
Dizziness, Drowsiness, Fatigue
Bad taste

Nursing Implications:
CONTRAINDICATED WITH PREGNANCY, MAOIs, PRIOR MI, HTN, CAD
monitor BP

Front 4

Benzodiazepines
(alprazolam, diazepam, orazepam, temazepam)

Back 4

Schedule IV Controlled Substances

Indications:
Anxiety (DRUG OF CHOICE)
Panic Disorder
Insomnia
Seizures
Other - preop sedation, muscle spasms, alcohol withdrawal

Obtain thorough sleep assessment before giving this medication to induce/maintain sleep. Careful considerations with Geriatric patients

SE: CNS depression, amnesia, sleep behaviors, PARADOXICAL REACTIONS (esp. in elderly), respiratory depression, abuse, tolerance, physical dependence with high doses

toxicity/OD: not serious
drowsiness, lethargy, confusion, gastric lavage, activated charcoal, saline cathartic, monitor RR and patient airway,
Administer Romazicon (competitive benzodiazepine receptor antagonist, reverses sedative effects but NOT RESPIRATORY DEPRESSION)

Contraindications: pregnancy, sleep apnea, suicidal tendencies, elderly

Implications:
Give w/ food if GI upset occurs
Educate about sleep fitness, coping with anxiety, inform patients about side effects and paradoxical reactions, AVOID ALCOHOL AND CNS DEPRESSANTS, indicated for SHORT-TERM USE ONLY, taper dosage

Front 5

Ambien, Sonata, Lunesta

(Benzodiazepine-like drugs)

Back 5

Bind with GABA-A receptors

Indication: short-term use for insomnia

Peaks in 2 hours

SE: daytime drowsiness, dizziness

Amnesic effects, sleep related behaviors with Ambien

No alcohol

Ambien - Induces and Maintains sleep
Sonata - Induces Sleep
Lunesta - Maintains sleep

Front 6

Rozerem

Back 6

Binds with melatonin receptors

Indication: Insomnia, delayed sleep onset

No dependence or potential for abuse

SE: HA, somnolence, fatigue, dizziness

Implications: administer 30 minutes before bedtime

Front 7

Caffeine

(Stimulant)

Back 7

Actions/Side Effects
CNS system - drowsiness, fatigue -> nervousness, insomnia, tremors
Heart - ^HR, ^CARDIAC OUTPUT
Blood vessels - VASOCONSTRICTION, ^BP
Bronchi - bronchodilation
kidney - diuretic
GI - ^GASTRIC ACID

Indications: stimulation/wakefulness, neonatal apnea

Implications: caution with patients with cardiac disease, encourage normal sleep fitness, OD/Toxicity can cause convulsions

Front 8

Ritalin, Adderall

(CNS Stimulants)

Back 8

IMPROVES ATTENTION SPAN AND FOCUS -> DECREASES IMPULSIVNESS/HYPERACTIVITY

Side effects decrease after 2-3 years

SE: insomnia, GROWTH SUPPRESSION due to appetite suppression, HA, abdominal pain

Implications: take the afternoon dose by 4 PM, administer with or after meals, take DRUG HOLIDAYS

Front 9

Daytrana

Back 9

First patch treatment for ADHD

Applied to the hip area once daily for up to 9 hours - no effect felt for 2 hours

Implications: Rotate hip placement, worn when bathing, showering and swimming, skin hypersensitivity possible

Front 10

Strattera

(NON CNS STIMULANT)

Back 10

Action: Selective inhibitor of NE reuptake

Indication: ADHD patients who do not respond to or cannot tolerate stimulants, ONLY DRUG FOR ADHD IN ADULTS

Dosage is once/day

Maximal effect takes 1-3 weeks

SE: GI upset, growth suppression due to appetite suppression, somnolence, dizziness, mood swings

BLACK BOX WARNING (cardiac abnormalities -> can lead to sudden death; may increase suicide risk in children)

Nursing implications: Caution with patients who have HTN, ^HR

Front 11

Inuniv, Kapvay

Extended Release

NON CNS STIMULANT

Back 11

Alpha agonists

Indication: Children with ADHD 6-17 years old

Only Kapvay is approved for use with stimulants

SE: SOMNOLENCE, HA, abdominal pain, N, fatigue, nightmares
Kapvay: irritability, emotional flattening, depression, bradycardia

Implications: taper dosage to prevent ^BP, do not crush/cut/chew

Front 12

Levodopa

Back 12

Activates dopamine receptors across BBB, Effectiveness decreases over 2-5 years (Most effective drug for PD)

SE: DOSE DEPENDENT, elderly are more sensitive
Beginning of drug therapy: N,V, anorexia, orthostatic hypotension
Chronic therapy: psychosis, DYSKENESIAS, compulsive behaviors

Drug Holiday

Contraindications: antipsychotic drugs (decrease levodopa), MAOIs (hypertensive crisis), anticholinerginics

Implications: administer anti-emetics in early treatments, DO NOT GIVE WITH MEALS (delays absorption), AVOID BOLUSES OF PROTEIN (competes with protein for uptake from the intestines or transport across BBB) and Vitamin B6, Start with small initial doses, Monitor for "ON-OFF PHENOMENON)
Support BP by increasing fluid intake
Never discontinue drug or reduce dose abruptly

Front 13

Levodopa-Carbidopa

Back 13

MORE EFFECTIVE THAN LEVODOPA ALONE, MOST EFFECTIVE TREATMENT OF PD

Role of carbidopa: Enhances the effects of levodopa to allow lower dosages; more levodopa available to CNS, no therapeutic value on its own; decreases CV, N, V side effects by decreasing peripheral conversion of levodopa to dopamine, less concern about Vitamin B6

Administration: titration issues when switching to other formulations, short half-life, must be given 2-3x daily

SE: Same as levodopa except when noted
Higher doses counteract on-off effects
OD - EYELID SPASMS, MUSCLE TWITCHING, JERKING, HALLUCINATIONS
less effect with time

Implications: effects delayed for weeks to months, move slowly when rising to a sitting or standing posture

Front 14

Mirapex, Requip, Parlodel

Back 14

Indication: EARLY, MILD OR MODERATE SYMPTOMS OF PD, require addition of levodopa over course of disease

Less effective than levodopa agens for motor symptoms, lower incidence of response failure over time, less dyskinesias

SE: N, Dizziness, hallucinations, confusion, toxic psychosis in elderly, daytime sleepiness, insomnia, postural hypotension, IMPULSE CONTROL DISORDER

Implications: prescribed for YOUNGER PATIENTS WHO CAN TOLERATE SE, USE AS ADJUNCT WITH LEVODOPA IN ADVANCED DISEASE, *****MONITOR FOR SLEEP ATTACKS

Front 15

COMT INHIBITORS

Back 15

Adjunct to Levodopa-Carbidopa (Sinemet) therapy

Enhances effectiveness by blocking COMT which is one of the enzymes responsible for breaking down levodopa in the bloodstream before it reaches the brain -> allowing more levodopa to be converted to dopamine in the brain (which decreases the amount needed for levodopa dosage) Prolongs the half-life of levodopa, more sustained effect, decreases off phases of PD