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65 Cards in this Set
- Front
- Back
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Types of Antiemetic drugs
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Phenothiazines (H1 blockers), Anticholinergics, Antihistamines (H1 blockers), Dopamine Antagonists, and 5HT3-receptor agonists
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Antiemetic Drugs EE, SE, and AE
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EE: Control n/v
SE: 4 can't and 1 OH, confusion, sedation, depression AE: Neuroleptic malignant syndrome, tardive dyskinesia, neutropenia, respiratory depression |
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Antiemetic Drugs Contraindications and Drug Interactions
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Contraindications: do not use in patients w/history of glaucoma, BPH, urinary retention, depression, or hypertension
Drug interactions: CNS depressants |
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Antiemetic Drugs Patient Education, Pregnancy Category, BF, and Geriatric
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Pt. Ed: do not drive/operate machinery, do frequent oral care to prevent dry mouth, monitor body temp for neuroleptic malignant syndrome, don't use CNS depressants
Pregnancy: Category C BF: passes into breast milk, do not use while BFing Geriatric: more likely to have SE and CNS effects, balance disturbance likely, Phenergan can cause acute confusion, sedation, and amnesia |
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Phenothiazines (H1 blocker) drug names, MOA, and indication for use
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Drug names: Phenergan, Compazine
MOA: Block H1 & dopamine receptors in brain, GI tract, and inner ear. Also cause sedation. Indication: motion sickness, AM sickness, post-op n/v, other drug-induced n/v |
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Anticholinergics drug names, MOA, and indications for use
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Drug name: Scopolamine patch (apply behind ear for 72 hrs)
MOA: block cholinergic receptors in brain and inner ear, stop intestinal cramping Indication: motion sickness, IBS |
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Antihistamine (H1 blockers) drug names, MOA, and indications for use
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Drug names: meclizine (Dramamine, Antivert)
MOA: block H1 receptors in brain and inner ear, cause sedation Indication: motion sickness, vertigo |
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Dopamine Antagonist drug names, MOA, and indications for use
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Drug name: Reglan
MOA: block dopamine receptor in brain and GI tract, increase GI motility (food moves through rapidly to reduce feelings of nausea) Indication: not as effective as other antiemetics, not used commonly |
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5HT3-Receptor Agonists drug names, MOA, and indications for use
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Drug name: Zofran
MOA: block serotonin receptors in intestinal tract and brain Indication: post-op n/v, other drug-induced n/v, post-chemo n/v, radiation-induced n/v, gastroenteritis |
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Drugs for Constipation
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Bulk-forming laxatives, stool softeners, lubricants, osmotic laxatives, and stimulants
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Constipation drugs Indications, EE, SE, & AE
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Indication: treat constipation, pre-surgical or pre-procedure bowel prep
EE: patient will have BM SE: diarrhea, nausea, abdominal cramps, rectal discomfort, bloating, flatulence AE: dehydration (hypotension/falls in elderly), electrolyte imbalance (cause life-threatening dysrhythmia) |
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Constipation drugs Contraindications and Monitoring Tests
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Contraindications: do not use if pt. has been diagnosed with abdominal pain or acute abdomen b/c of increased risk for bowel perforation
Monitoring tests: electrolytes (K+, Na+, Ca++) |
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Constipation drugs Pt. Ed, Pregnancy, and Geriatric
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Pt Ed.: encourage fluids, keep daily record of BMs, use only short term except for Metamucil
Pregnancy: safe, may induce labor Geriatric: reinforce fluid intake, monitor BP, prevent falls, monitor for life-threatening dysrhythmias, most abused and misused drugs by elderly women |
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Bulk-forming laxatives drug names and MOA
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Drug names: Citrucel, Metamucil (**only drug that can be used long term**)
MOA: add bulk (fiber) to stool to increase stool mass that stimulates peristalsis |
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Stool softeners drug names and MOA
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Drug names: Docusate, Colace
MOA: add fatty substances to stool to help it move easier |
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Lubricants drug names and MOA:
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Drug name: castor oil
MOA: coat surface of stool and help it retain water so it can be expelled easier by the body |
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Osmotic laxatives drug names and MOA
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Drug names: laculose, milk of magnesia
MOA: add water to stool to help it pass |
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Stimulants drug names and MOA
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Drug names: Dulcolax
MOA: increase GI peristalsis to eliminate stool |
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Antidiarrheal Drugs
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Antimotility, Adsorbent/Absorbent, and Antisecretory
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Antidiarrheal Drugs Indications for Use, EE, SE
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Indication: diarrhea
EE: stop diarrhea SE: constipation, bloating, flatulence, dependence if used long-term. Pepto can cause bleeding/bruising since it contains aspirin |
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Antimotility drug names and MOA
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Drug names: Immodium, Lomotil
MOA: decrease or slow GI motility |
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Antimotility AE
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AE: toxic megacolon inc. fever, abdominal pain, rapid heart rate, and dehydration, hypovolemic shock, death
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Antimotility drug interactions
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Drug interactions: do not administer with narcotics since both decrease GI motility
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Antidiarrheal Drugs Pt. Ed, Pregnancy, and Geriatric
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Pt. Ed: notify prescriber if diarrhea not relieved in 2 days, monitor for fever, abdominal pain, or distention (s/s of toxic megacolon or bowel obstruction)
Pregnancy: do not use, **do not give antisecretory drugs to children since they contain aspirin** Geriatric: potentiate constipation |
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Adsorbent/Absorbent drug names and MOA
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Drug names: FiberCon
MOA: remove substances that cause diarrhea from GI tract |
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Adsorbent/Absorbent AE
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AE: can cause intestinal obstruction
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Antisecretory drug names and MOA
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Drug names: Pepto-Bismol
MOA: decrease secretion of intestinal fluid, slows bacterial activity |
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Antisecretory AE, Contraindications, and Drug interactions
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AE: rare
Contraindications: bleeding ulcers, pre-surgical/pre-procedural patients due to the aspirin Drug interactions: anticoagulants, NSAIDs, Aminoglycosides (cause hearing loss), Diuretics (counteract each other) |
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Insulin MOA
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MOA: Regulate blood glucose by binding to insulin receptors on the cells to help move glucose from blood to cells for energy prod., help store glucose as glycogen in liver and muscles for energy, help store the extra flucose fat in adipose tissue
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Insulin Therapy: EE, SE, AE
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EE: maintain bld glucose in normal range, eliminate glucose/acetone from urine, keep blood lipid levels at/close to normal range
SE: site infections, lipohypertrophy, lipoatrophy AE: **hypoglycemia** (insulin shock) |
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Types of Insulin
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Rapid, Short, Intermediate, and Long Acting
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Rapid-acting insulin
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Name: Novolog, Humalog
Onset: 15 mins Duration: 4 hours |
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Short-acting insuling
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Name: Humulin R, Novolin R
Onset: 30 mins Duration: 12 hours |
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Intermediate-acting insulin
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Name: Novolin NPH, Humulin NPH
Onset: 2 hours Duration: 22 hours |
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Long-acting insulin
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Name: Levemir, Lantus
Onset: 4 hours Duration: 24 hours **Ideal Basal Insulin** |
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Classes of Oral Antidiabetic Drugs
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-Sulfonylureas
-Meglitinides -Bigaunides -Alpha-glucosidase inhibitors -Thiazolidinediones (TZD) or Glitazones -DPP 4 inhibitors -GLP-1 |
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Lifespan considerations for oral antidiabetic drugs
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Peds: sulfonylureas, AGIs, and TZDs not recommended
Preg/BF: insulin preferred Geriatric: may have more trouble monitoring bld glucose levels, higher risk of HYPOglycemia, esp. if using beta blockers/warfarin, difficult to control due to poor eating |
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Oral Secretagogoues
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-Two types: long-acting (sulfonylureas) and short-acting (meglitinides)
-Insulin booster: trigger beta cells in pancreas to boost insulin production |
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Sulfonylureas
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Drug names: "-zide", "-mide", or "-ride"
Indication: T2 diabetes, combo preferred, best for pts. over 40 who've had DM for <10 yrs Contraindications: T1 DM, **SULFA allergy** SE: HYPOglycemia, wt. gain Monitor: LFT, renal fxn Teaching: take in AM |
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Meglitinides
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Drug names: "-nide"
Indication: T2 diabetes, combo preferred, best for pts. over 40 who've had DM for <10 yrs, pts with sulfa allergy Contraindications: T1 DM SE: HYPOglycemia, wt. gain Monitor: LFT, renal fxn Teaching: take with or right before meals to boost insulin response, **NO MEAL, NO MED!** |
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Biguanides
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Drug names: Metformin
MOA: reduce glucose released from liver (convert glycogen into glucose), increase cell sensitivity to insulin to INCREASE uptake of glucose by periph. tissue (muscles), reduce absorption of glucose from GI tract/suppress appetite, helps lower triglycerides and increase HDL Indication: first-line drug for T2 diabetes, most commonly used Contraindications: withhold before and 48 hrs after any testing using IV dye, dye increases chance of lactic acidosis SE: nausea, diarrhea, wt loss AE: lactic acidosis (muscle aches, drowsiness, low BP, and slow HR) Monitor: LFT, renal fxn, cardiac output |
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Thiazolidinediones (TZDs) or Glitazones
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Drug names: "-glitazone"
MOA: reduces insulin resistance by improving cell response to insulin, increases glucose uptake, suppresses hepatic glucose prod Indication: T2 diabetes w/o CHF Contraindications: pts with CHF SE: wt gain, anemia, edema AE: heart disease/heart failure Monitor: LFT, CBC, wt, cardiac output Teaching: takes 4-6 wks for full effect, v. long acting |
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Alpha Glucosidase Inhibitors
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Drug names: precose (acarbose)
MOA: blocks alpha-glucosidase enzymes in sm. intestine to inhibit carb b/down to glucose (delay and decrease glucose absorp from GI) Indication: combo drug for T2 diabetes Contraindications: pts with renal disfxn, IBS, colonic ulceration, or cirrhosis SE: gas, wt loss, bloating, diarrhea Teaching: use glucose tabs/gel for hypoglycemia |
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Incretins
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-Insulin secretagogues/booster, natural hormones to boost insulin prod and inhibit glucagon prod in pancreas
-One type: **glucagon-like peptide-1 (GLP-1), inactivated by the enzyme dipeptidyl peptidase-4 (DPP-4) -Produced in GI TRACT in response to carb and fat intake -Cause n/v/d and severe hypoglycemia -Take BEFORE two main daily meals, not after meals |
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Amylin
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-Hormone naturally prod by BETA cells in pancreas
-Partner hormone of insulin in response to post meal high blood sugar (postprandial hyperglycemia) -Cause nausea/full feeling -Only given by SQ injection -Reduces postprandial glucose by about 75% |
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Glucagon-like Peptide-1 (GLP-1)
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Drug names: exenatide (Byetta), liraglutide (Victoza)
MOA: incretin mimetics, boost insulin production in pancreas, inhibit glucagon prod in pancreas, decrease GI motility, induce nausea feeling Indication: adjunctive therapy for T2 diabetes SE: nausea, decreased appetite, wt loss Teaching: SQ injections in AM and dinner time |
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DPP-4 Inhibitors (Gliptins)
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Drug name: sitagliptin (Januvia)
MOA: increase incretins or GLP-1 by inhibiting DPP-4, increases insulin release from pancreas, decreases glucagon Indication: in combo with other meds for treating T2 diabetes SE: increased risk for infxn and headache, wt gain and/or hypoglycemia if used with sulfonylureas |
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Analgesic Drugs: 5 Types
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-Opioids (Narcotics)
-NSAIDs -Acetaminophen -Antidepressants -Anticonvulsants |
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Administering analgesic drugs
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Monitoring: assess pain before and 30 min after meds given, assess with VS
Teaching: take on regular schedule rather than prn, increase fluids and physical activity, use stool softeners to treat constipation |
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Opioids (Narcotics)
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MOA: bind to opioid receptor sites in brain, ALTERS perception of pain and reduces anxiety, does not treat tissue damage
Indications: moderate to severe pain SE: constipation, drowsiness, sedation, OH/dizziness, miosis (pinpoint pupils) AE: respiratory depression, addiction, dependence, tolerance, withdrawal **Narcan used to treat resp. depression in OD** Monitoring: RR, O2 sats, orthostatic BP, bowel patterns Teaching: no driving/operating machinery, change positions slowly, increase fluids, fiber, and activity Geriatric: avoid DEMEROL (meperidine), causes chest tightness |
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NSAIDs
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MOA: supress part of the inflammatory pathway
SE: reduces clotting (esp aspirin), bruising/bleeding, irritation of PUD and GERD, water and salt retention AE: asthma, salicylate poisoning (aspirin only) Monitoring: hx. of HTN, CHF, PUD, GERD Teaching: do not take on empty stomach, monitor for bleeding, do not take with Coumadin Peds: only use ibuprofen, avoid aspirin Pregnancy: pre-close ductus arteriosus, category C, avoid during last 3 mos Geriatric: cardiac probs due to water/salt retention |
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Acetaminophen
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MOA: unknown, change perception of pain, usually combined w/other drugs (esp opioids)
AE: permanent liver or kidney damage Antidote: Mucomyst, but MUST BE GIVEN <24 HRS after OD otherwise will not work Peds: toxic to liver/kidneys at high doses, must calculate doses accurately per wt |
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Antidepressants
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Drug names: "-line", amitriptyline, nortiptyline, sertraline)
Indication: reduce some types of chronic and cancer pain -Takes 1 to 2 weeks to work SE: constipation, dry mouth, urinary retention, intraocular pressure, OH -Flexeril is a muscle relaxant med to relieve skeletal muscle spasms, causes HEAVY sedation |
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Anticonvulsants
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MOA: change the way Na and Ca travel across surface of nerve cells in brain. Nerve cells send fewer pain signals to brain.
Indications: migraines, trigeminal neuralgia, fibromyalgia, diabetic neuropathy, cancer pain Most common: Neurontin (gabapentin) and Lyrica (pregabalin) SE: drowsiness, confusion, blurred vision, clumsiness, muscle aches, weakness Peds: can cause aggressive behavior Preg/BF: category C, benefit must outweigh risks, avoid BF |
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Insomnia Drugs (4 types)
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-Benzodiazepine receptor agonists (1st line drugs, non-benzo)
-Benzodiazepines -Antihistamines -Sedating antidepressants |
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Non-Benzodiazepines
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Drug names: zolpidem (Ambien), eszopiclone (Lunesta)
MOA: act on GABA-A receptor sites in brain to induce sleep, short-acting for short-term use SE: drowsiness, dizziness, fatigue, headache, GI upset, sleep-related behavior (eating, driving, phone calling, etc) Teaching: take immediately before going to sleep, take only when able to get a full 7 or 8 hrs of sleep, do not drink alcohol the same evening |
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Benzodiazepines
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Drug names: "-pam" or "-lam", clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril)
SE: resp. depression, daytime sleepiness, memory loss, sleep-related behaviors, falls, urinary incontinence -Stopping suddenly will cause dependence, withdrawal, reboound insomnia Teaching: elderly should not use long-acting forms |
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Antihistamines
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Drug names: "-mine" or "-zine", diphenhydramine (Benadryl) or hydroxyzine (Vistaril)
SE: next day drowsiness, unrestful sleep, daytime sleepiness, cognitive impairment, dry mouth, blurred vision **Do not use in pts with CHF, arrhythmias, glaucoma, or urinary retention** |
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Antidepressants
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-Used for secondary insomnia caused by depression
-Not recommended for use in elderly due to SE |
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Types of Lipid-Lowering Drugs
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-Statins (HMG-CoA reducatase inhibitors)
-Bile acid sequestrants (Resins) -Nicotinic acid agents (Niacin, Vit B) -Fibric acid (Fibrates) -Cholesterol absorption inhibitors |
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Statins (HMG-CoA Reductase Inhibitors)
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Drug names: "-statin"
MOA: block HMG-CoA reductase (an enzyme that helps cholesterol production), removes cholesterol from blood EE: decreased LDL, less effective vs. fibrates or niacin in reducing triglycerides and raising HDL SE: (rare) upset stomach, gas, constipation, abdominal pain and cramps, muscle aches AE: myopathy/RHABDO, leading to acute renal failure, decreased liver function so check LFT every 3-6 mos Teaching: take at bedtime, takes 4-6 weeks for drug to work |
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Resins (Bile acid sequestrants)
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Drug names: "chole-", "cole-"
MOA: bind with cholesterol in intestine to prevent reabsorption of cholesterol, increases cholesterol elimination via bile EE: decrease LDL, increase HDL, may decrease triglycerides SE: GI discomfort, n/v, constipation, gas AE: inhibit absorption of fat-soluble drugs and vitamins (A,D,E,K), increase action of warfarin -Check INR if taking warfarin and renins, take them an hour apart Teaching: increase fluid intake, take with meals to absorb intestinal cholesterol -Avoid use in children |
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Niacin (Nicotinic Acid Agents)
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MOA: inhibits cholesterol release from fat cells, decreases triglyceride prod in liver and increases trig metabolism, remove cholesterol from blood, decreases HDL metabolism
EE: decrease trigs, total cholesterol, LDL, increase HDL SE: GI discomfort, itching, dilated blood vessesl (FACE/NECK FLUSHING) AE: bleeding. liver toxicity, gout, hyperglycemia Contraindications: do not use in pts with HTN, PUD, or active bleeding Monitoring: blood sugar, LFTs **Stop before surgery or dental work** Preg/BF: do not use in BFing, excreted in breast milk |
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Fibric Acids (Fibrates)
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Drug names: "fibr-"
MOA: decrease liver prod of trigs and increase trig metabolism, increase cholesterol elimination via bile, increase risk of cholesterol-based gallstones EE: decrease trigs, increase HDL, decrease LDL SE: GI discomfort, gallstones, myopathy AE: increased creatinine in pts with kidney disease/liver damage Drug interactions: EE/SE/AE increased with warfarin and statins Monitor: kidney functions, LFTs, INR if pt taking warfarin Teaching: take 30 mins before AM and PM meals Preg/BF: safety not established |
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Cholesterol Absor,ption Inhibitors
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Drug names: ezetimibe (Zetia)
MOA: inhibit absorption of cholesterol in small intestine, **only drug that blocks EXOGENOUS cholesterol**, increases cholesterol elimination in bile, combine with statins for increased effects SE: stomach pain, diarrhea AE: angioedema Drug interactions: risk of liver toxicity with statins, risk of gallstones with fibrates, decreased effects with resins Monitor: LFTs Teaching: report muscle pain, tenderness, weakness, take once daily at same time |
