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116 Cards in this Set
- Front
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ALPHA- 1 RECEPTORS
Effects? |
• Vasoconstriction
• Increased peripheral resistance w/ increased BP • Contracted piloerection muscles • Pupil dilation • Thickened salivary secretions • Closure/contraction of urinary bladder sphincter • Male sexual emission |
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ALPHA – 2 RECEPTORS
Effects? |
• Negative feedback control of NE release from presynaptic neuron (ability of receptor to turn off stimulation of NE when there is enough)
• Moderation of insulin release from pancreas Sympathethic System: Epinephrine/Norepinephrine |
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BETA – 1 RECEPTORS
Effects? |
• Increased heart rate
• Increased conduction – AV node • Increased myocardial contraction • Lipolysis in peripheral tissues |
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BETA – 2 RECEPTORS
Effects? |
• Vasodilation
• Bronchial dilation • Increased breakdown of muscle & liver glycogen • Release of glucagons from pancreas • Relaxation of uterine smooth muscle • Decreased gastrointestinal (GI) Muscle tone & activity • Decreased GI secretions • Relaxation of urinary bladder detrusor muscles |
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DOPAMINE
Effects? |
• Dilates renal blood vessels
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Classification:
ALPHA & BETA ADRENERGIC AGONISTS |
Produce an “adrenalin-like” response
Types: Alpha 1 – Constricts veins and arterioles to increase BP in a time of shock Beta 1 – Raises BP and pulse in response to Beta 2 – Facilitates breathing through bronchodilation Dilates pupils Meds: epinephrine, norepinephrine, dopamine, ephedrine |
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Classification:
ALPHA SPECIFIC ADRENERGIC AGONISTS (Part I) |
Potent vasoconstrictor w/ little or no effect on heart or bronchi.
Used in many combination cold & allergy products. Ophthalmic: Pupil dilation Meds: phenylephrine (Neo-Synephrine, Allerest) |
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Classification:
ALPHA SPECIFIC ADRENERGIC AGONISTS (Part II) |
Stimulates alpha-2 receptors. This leads to decreased sympathetic outflow from the CNS because the alpha-2 receptors moderate the release of norepinephrine from the nerve axon.
Used to treat: • hypertension as a step 2 drug • Chronic pain in cancer patients in combo w/ opiates • Ease withdrawal symptoms -Comes in a TTS transdermal patch as well as other routes to control pain & withdrawal symptoms -Centrally acting drug w/ severe CNS effects & hypotension Meds: clonidine (Catapress & Catapress TTS transdermal patch) |
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Classification:
BETA SPECIFIC ADRENERGIC AGONISTS (Part I) |
Beta-2 specific agonists
Treats obstructive pulmonary disease, i.e. asthma Meds: albuterol (inhaler/po), salmeterol (long acting albuterol), terbutaline |
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Classification:
BETA SPECIFIC ADRENERGIC AGONISTS (Part II) |
Used to treat shock, cardiac standstill & to prevent bronchospasm
Meds: isoproterenol (Isuprel) |
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ALPHA AND BETA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Contraindication w/ Herbal Alternatives? |
Caution w/ following alternative drugs:
Ginseng, sage, xuan shen, nightshade, celery, coriander, saw palmetto |
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ALPHA AND BETA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Action and Prototype drug? |
Drugs that block alpha & beta receptors are mainly used to treat cardiac related conditions
*Prototype Drug: Labetalol (Normodyne, Trandate) |
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ALPHA AND BETA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Antiarrythmics |
Meds: amiodarone (Cordarone); bretylium (Bretylate)
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ALPHA AND BETA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Combination tx for hypertension & CHF |
carvedilol (Coreg)
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ALPHA AND BETA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Hypertension related to renal disease |
guanethidine (Ismelin)
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ALPHA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Important Notes/Holds |
Hold for elevated liver enzymes
Excreted by kidneys; watch BUN, Cr |
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ALPHA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Action & Indication Name of Medication |
Blocks alpha 1 & 2 receptor sites
Treatment of pheochromocytoma Med: phentolamine (Regatine) |
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ALPHA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Alpha-1 Selective Adrenergic Blocking Agents |
Blocks alpha 1 receptor sites
BPH: Blocks or reduces contraction of smooth muscle in bladder & prostatic capsule; relieves symptoms of dysuria associated w/ BPH Meds: doxazosin (Cardura) tamsulosin (Flomax) terazosin (hytrin) |
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ALPHA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Alpha-1 Selective Adrenergic Blocking Agents (Other meds.) |
Blocks alpha 1 receptor sites
Treats hypertension SE: 1st dose syncope; take 1st dose at bedtime; Dizziness may last 24 hours Med: prazosin (Minipress) |
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BETA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Non Selective Beta Blocker |
Total blockade of SNS beta receptors
SE: • bradycardia, hypotension • dyspnea, coughing, cronchospasm, to pulmonary edema • GI upset, n/v; impotence/ejaculation problems • May affect body’s ability to raise BG in “fight/flight” or hypoglycemia. May alter s/s of tachycardia w/ hypoglycemia Meds: propranolol (Inderal) Given to reduce intraocular pressure through its relaxing effects on the eye muscles in treatment of Glaucoma --> Meds: timolol eye drops (Timoptic, Betimol) |
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BETA ADRENERGIC ANTAGONISTS (BLOCKING AGENTS)
Beta 1 Selective Blocking Agents |
SE: Bradycardia, hypotension; take BP & pulse
Do not stop abruptly; gradually decrease dose over 2 weeks Give w/ food Meds: atenolol (Tenormin) metoprolol (Lopressor, Toprol XL) |
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MUSCARINIC
RECEPTORS Effects? |
• Pupil constriction
• Accommodation of the lens • Decreased heart rate • Increased GI motility • Increased GI secretions • Increased urinary bladder contraction • Male erection • Sweating • (Increased bronchial constriction) • (Decreased, relaxed tone of arterioles- vasodilation) Parasympathetic System: acetylcholine |
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NICOTINIC
RECEPTORS Effects? |
• Muscle contractions
• Release of norepinephrine & epinephrine from the adrenal medulla • Autonomic ganglia stimulation Karch: p. 469 |
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CHOLINERGICS
Direct-Acting Cholinergic Agonists (Part I) |
Directly act on Ach receptor sites
Tend to cause stimulation of the muscarinic receptors Indications: Treat esophagitis, glaucoma Also used to increase bladder tone, urinary excretion, & increase GI secretions Contraindications: Any condition exacerbated by parasympathetic effects: bradycardia, hypotension; peptic ulcer disease (PUD); Intestinal obstruction or recent GI surgery; asthma; bladder obstruction; epilepsy & parkinsonism Caution: Pregnancy & lactation SE: __ bradycardia __ hypotension (vasodilation) __ bronchoconstriction __ pupil constriction __ Increased GI secretions & activity __ Increased bladder tone __ Relaxation of GI & genitourinary (GU) sphincters Elderly should be started on lower doses Drug interaction: Acetylcholinesterase |
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CHOLINERGICS
Direct-Acting Cholinergic Agonists (Part II) |
Treats neurogenic bladder in children older than 8 years; Treats nonobstructive post op & postpartum urinary retention & neurogenic bladder atony by directly increasing muscle tone & relaxing the sphincters thereby allowing voiding to take place
SE: Includes general SE above. SE manifested in n/v, cramps, diarrhea, increased salivation, involuntary defecation; urinary urgency; flushing & increased sweating Med: bethanechol (Duvoid, Urecholine) |
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CHOLINERGICS
Direct-Acting Cholinergic Agonists (Opthalmic drops) |
Used to induce meiosis (pupil constriction) to relieve the increased intraocular pressure of glaucoma; and to allow surgeons to perform certain surgical procedures
*Limited primarily to ophthalmic agents because of profound negative systemic effects Meds: pilocarpine (Pilocar) carbachol (Miostat) |
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CHOLINERGICS
Indirect-Acting Cholinergic Agonists or Acetylcholinesterase Inhibitors |
Blocks acetylcholinesterase at synaptic cleft, allowing accumulation of ACh released from the nerve endings & leading to increased & prolonged stimulation of ACh.
Binds reversibly to acetylcholinesterase, so effects pass w/ time. Treatment of Myasthenia Gravis & Alzheimers’s Disease |
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CHOLINERGICS
Acetylcholinesterase Inhibitors Indications? |
Tx of Myasthenia Gravis: Chronic muscular disease caused by a defect in neuromuscular transmission; autoimmune disease; patients make antibodies to ACh receptors, gradually destroying them.
S/S :Progressive weakness & lack of muscle control w/ periodic acute episodes. |
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CHOLINERGICS
Acetylcholinesterase Inhibitors: Prototype meds? |
*edrophonium (Tensiloln, Enlon): Diagnostic agents for myasthenia gravis; used to distinguish betw/ myastheic crisis & a cholinergic crisis
*pyridostigmine ((Regonol, Mestinon): Longer duration of action than neostigmine neostigmine (Prostigmin): Strong influence at neuromuscular junction *ambenonlum (Mytelase): Available only in oral form; cannot be used if the patient is unable to swallow tablets. Caution w/ pregnancy because uterus may be stimulated & labor induced, resulting in preterm birth. |
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CHOLINERGICS
Indirect-Acting Cholinergic Agonists or Acetylcholinesterase Inhibitors |
Treatment of Alzheimer’s Disease in which there is progressive neural degeneration in the cortex, leading to loss of memory & inability to carry on activities of daily living; progressive loss of ACh-producing neurons & their target neurons.
SE: Same as Direct-Acting Cholinergic Agonists Drug Interactions: NSAIDS Prototype Meds: *donepezil (Aricept): Once-a-day dosing *galantamine (Reminyl): Used to stop progression of Alzheimer’s dementia rivastigmine (Exelon): Available in solution for swallowing ease tacrine (Cognex): First drug to treat Alzheimer’s dementia |
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CHOLINERGICS
Indirect-Acting Cholinergic Agonist |
Irreversible acetylcholinesterase inhibitor
Action: Leads to toxic accumulations of ACh at cholinergic receptor sites Indications: Can cause parasympathetic crisis & muscle paralysis Med: Nerve Gas |
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PARASYMPATHOLYTICS:
ANTICHOLINERGICS/ ANTIMUSCARINICS AE |
Adverse Effects: Blurred vision, dry mouth, constipation, urinary retention
Memorize: “Mad as a hatter” (CNS psychotic effect); “Dry as a bone“(<salvation); "Red as a beet" (peripheral vasodilation); "Blind as a bat" (midriasis) |
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PARASYMPATHOLYTICS:
ANTICHOLINERGICS/ ANTIMUSCARINICS Actions & Systemic Indications |
Blocks acetylcholine from stimulating muscarinic receptors, with little effect on nicotinic receptors, and therefore having little effect at neuro-muscular junction. Also blocks the acetylcholine receptors at the sympathetic receptor sites that control sweating.
Reduces gastric & respiratory secretions Prevents drop in heart rate caused by vagal nerve stimulation during anesthesia Mydriatic Effects (pupil dilation, cycloplegia): Eye drops used in clinics or preoperative meds for eye surgery; Much less effective in African Americans; Increased dosage may be needed; prolonged time to peak effect. Physiological Effects GI: Smooth muscle: blocks spasm, blocks peristalsis. Secretory glands: decreases acid & digestive enzyme production Urinary tract: Decreases tone & motility in the ureters & fundus of the bladder; increases tone in the bladder sphincter Biliary tract: Relaxes smooth muscle, antispasmodic Bronchial muscle: Weakly relaxes smooth muscle Cardiovascular: Increases HR (may decrease at very low doses); causes local vasodilation & flushing Secretions: Reduces sweating, salivation, respiratory tract secretions CNS: Decreases extrapyramidal motor activity; Atropine may cause excessive stimulation, psychosis, delirium, disorientation Scopalamine: depression, drowsiness |
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PARASYMPATHOLYTICS:
ANTICHOLINERGICS/ ANTIMUSCARINICS Contraindications/Cautions? |
Contraindications/Cautions: At risk of worsening s/s of following:
Glaucoma: Increased pressure w/ pupil dilation Peptic ulcer disease (PUD): Stenosing peptic ulcer; intestinal atony, paralytic ileus, GI obstruction Asthma: Bronchial constriction Prostatic obstruction & hypertrophy: Blocks bladder muscle activity & sphincter relaxation in bladder Cardiac arrhythmias, tachycardia, myocardial ischemia: When PNS is blocked potential for SNS influence = tachycardia & increased contractility Impaired liver & kidney function: Alters metabolism & excretion of drug Breastfeeding mother: Impaired lactation Myasthenia Gravis: Further block of cholinergic receptors |
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PARASYMPATHOLYTICS:
ANTICHOLINERGICS/ ANTIMUSCARINICS Prototype Drugs & Effects? |
Prototype Anticholinergic Drugs:
Atropine: Increases heart rate; Given to correct bradycardia in emergencies; Atropine may cause excessive stimulation, psychosis, delirium, disorientation Atropine toxicity: Dose related & may progress to coma Scopolamine (Transderm Scop): Motion Sickness transderm patch Induces obstetric amnesia & relaxes the mother BUT also supresses lactation in breastfeeding mother Given w/ morphine, causes drowsiness/amnesia. Robinul: Antispasmodic |
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PARASYMPATHOLYTICS
Anticholinergics/Antispasmodics Indications & Action Meds. |
Treatment of Urge incontinence (Overactive Bladder). Caused by hyperactivity of the detrusor muscle. Meds relax oversensitive bladder. Drug specifically targeted at bladder.
Oxybutynin (Ditropan) Tolterodine (Detrol) |
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ORAL HYPOGLYCEMIC AGENTS:
Indications & Action |
Agents that lower blood glucose levels; Stimulates the pancreas to release its own insulin
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ORAL HYPOGLYCEMIC AGENTS:
Sulfonylureas – First Generation Sulfonylureas – Second Generation |
1st gen: Associated w/ risk of cardiovascular disease
2nd gen: Prototype: glyburide (DiaBeta, Micronase) glipizide (Glucotrol XL, Glynase Pres Tab) Ameryl (Glimepiride) |
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ORAL HYPOGLYCEMIC AGENTS:
NON-SULFONYLUREAS |
Often used in combination w/ sulfonylureas or Insulin ***Know therapeutic Actions/Indications
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ORAL HYPOGLYCEMIC AGENTS:
NON-SULFONYLUREAS - Biquanide |
*** Inhibits glycgenolysis in the liver thereby decreasing glucose use in the liver. May increase peripheral use of glucose, increase production of insulin, alters intestinal absorption of glucose. Does not cause hypoglycemia by itself. Used in Type II Diabetes
Prototype: glucophage (Metformin HCL) Hold w/ renal or hepatic disease, CHF, Sepsis, ETOH, adrenal, pituitary insufficiency ; Hold med for specific diagnostics ; Assess liver function; SE liver tox. |
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NON-SULFONYLUREAS
Alpha Glucosidase Inhibitor: |
Delay absorption of glucose; mile effect on glucose levels. Severe hepatic toxicity; Effects only additive to sulfonylureas
Meds: Acarbose (Precose), miglitol (Glyset) |
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NON-SULFONYLUREAS
Thiazolidnediones: |
Decrease insulin resistance; Used in combination w/ sulfonylureas or metformin to treat insulin resistance. First drug of this class, troglitazone withdrawn from market after reports of serious hepatotoxicity. Monitor liver function.
Meds: Pioglitazone (Actos); rosiglitazone (Avandia) |
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NON-SULFONYLUREAS
Meglitinides: |
Act like sulfonylureas to increase insulin release. Rapid-acting drugs w/ short half-life. Used just before meals to lower postprandial glucose levels. Can be used in combination w/ metformin. Long-term effects not known
Meds: repaglinide (Prandin) ; nateglinide (Starlix) |
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NON-SULFONYLUREAS
Newest drug: 2005 Synthetic form of human amylin |
a hormone produced by beta cells in pancreas; important in regulating postmeal glucose levels
Works to modulate gastric emptying after a meal; Causes feeling or fullness or satiety; Prevents postmeal rise in glucagons that usually elevate glucose levels. Prototype Drug: Pramlintide (Symlin) Rapid onset; Peaks in 21 minutes. Inject at least 2” away from any insulin injection site. Cannot be combined in insulin syringe. Administration: Injected SQ immediately before a major meal; Should be injected before each major meal of day. Can be used in combination w/ insulins & oral agents. |
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NON-SULFONYLUREAS
Newest drug: 2005 incretin |
mimics enhancement of glucose-dependent insulin secretion by the beta cells in the pancreas; Depresses elevated glucagon secretion & slows gastric emptying to help moderate & lower blood glucose levels.
Exanatide (Baraclude) Subcutaneous injection twice a day within 60 min. before the morning & evening meals. Rapid onselt of action & peaks in 2 hrs. Effects last 8-10 hrs. Given in combination w/ oral agents to improve glycemic control in Type 2 diabetes patients who cannot achieve glycemic control on oral agents alone. Should not be given if patient is unable to eat. |
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GLUCOSE ELEVATING AGENTS
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Antidote for hypoglycemia
Promotes hepatic hlycogenolysis & glucogenesis, causing a rise in blood glucose levels *Prototype: glucagons (GlucaGen) diazoxide (Proglycem, Hyperstat) Parenteral: Peak: 5-20 min May repeat in 20 min. ½ life 3-10 min. Dose: I.M., I.V., S.C.: 0.5-1 mg Family member may be taught parenteral administration for home in case of hypoglycemic emergency w/ coma |
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INSULIN
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Hormone produced in beta cells of Islets of Langerhans, that are required for glucose transport into cells; used as a replacement therapy for insulin dependent Diabetes Mellitus
Refer to Karch p. 606 for chart on Insulins |
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INSULIN
Rapid-acting : Give with meals |
Humalog (Lispro)
Onset 15 min.; Peak 1-3 h; Dur 3-5 h NovoLog (Aspart) Onset 5-10 min.; Peak 30-90 m; Dur. 2-5 h *Don’t give until food tray comes |
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INSULIN
Short-acting-Regular |
Onset 30-60 min
Regular Insulin (Humulin R., Novolin R.) Only insulin that can be given IV; used in surgery |
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INSULIN
Intermediate-Acting Insulin |
Onset: 1-1.5 h; Peak 5-10 h; Duration 12-16
Semilente NPH (Humulin N, Novolin N.) |
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INSULIN
Long-Acting Insulin |
Lantus (Glargine) - Onset: Unknown; No Peak – Duration 24 hrs
Detemir (Levemir) *Do not mix Lantus or Detemir w/ other insulins - Onset 1-2 h; Peak 6-8 h; Duration 24 h Lente - Onset: 1-2.5 h; Peak 7-15 h.; Duration 24 h Ultralente (Humulin U) - Onset – 4-8 h; Peak 10-30 hr – Duration 20-36 |
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INSULIN
Combination Insulins |
NPH & regular:
Humulin 70/30; Novolin 70/30; Humulin 50/50; Humalog 75/25 |
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INSULIN
Inhalational |
Exubera - Onset 10-20 min; Peak 2 h; Duration 6h
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ANTIDEPRESSANTS:
TRICYCLIC ANTIDEPRESSANTS (TCAs) Prototypes drugs? |
Should take all antidepressants 6-12 months
to realize full outcomes PROTOTYPE: imipramine (Tofranil); amitriptyline (Elavil) OTHER: nortriptyline (Aventyl, Pamelo) |
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ANTIDEPRESSANTS:
TRICYCLIC ANTIDEPRESSANTS (TCAs) |
Action: Reduces the reuptake of 5HT & NE at the presynaptic cleft, thereby making more 5HT & NE available at the presynaptic cleft to be used.
Indications: Relief of s/s of depression; Sleep disorders; treatment of enuresis (bedwetting) for children over six; Chronic intractable pain relief; ADHD; Panic disorder Choice of drug for persons who want to induce sleep Takes 1-2 months for full effects Drug Interactions: MAOs, SSRIs, oral anticoagulants Ed: Karch, p. 334 Side Effects: (Most serious:) CV (orthostatic hypotension) Toxic: Cardiotoxic dysrhythmias, tachy, AV block; ventricular tachycardia/fibrillation. Anticholinergic effects (Blocks muscarinic receptors): dry mouth, drowsy, >HR; >BP Sedation Urinary retention Overdose: Life threatening; Give only 1 wk supply at a time Contraindications**: Do not take with alcohol |
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ANTIDEPRESSANTS:
SELECTIVE SERATONIN REUPTAKE INHIBITORS Prototype drug? |
PROTOTYPE: Prototype: fluoxetine (Prozac, Sarafem): Can miss a dose
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ANTIDEPRESSANTS:
SELECTIVE SERATONIN REUPTAKE INHIBITORS - Actions, Indications, other medications |
Action: Inhibits CNS neuronal reuptake of serotonin w/ little effect on NE & little affinity for cholinergic, histaminic, or alpha-adrenergic sites
Indications: Depression, OCD, panic attacks, bulimia, PMDD, post traumatic stress disorders (PTSD), social phobias, anxiety disorders 94% protein bound: Don’t use w/ other protein bound meds as it will be displaced or will displace the other med. Expect initial effects in 1-2 weeks. Meds: Clexa/Lexapro: Situational depression x 3 mo w/ counseling Sertaline (Zoloft): Elderly; no < libido; no appetite problems Paroxetine (Paxil): anxiety; 2 day min; Prefer 14d. Turns off message that says you are full = weight gain |
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ANTIDEPRESSANTS:
SELECTIVE SERATONIN REUPTAKE INHIBITORS - AE & Contraindications |
Not as many adverse effects as TCAs. No hypotension, no sedation, no anticholinergic;
OD = No cardiotoxicity Contraindications: Allergy, pregnancy, lactation, impaired renal or hepatic “Seratonin Syndrome”: 2-72 hrs after beginning drug or raising dose: altered mental, anxiety, uncoordination, hyperreflexia, tremor. Seratonin Syndrom often occurs with Overdose of SSRI occurs w/ taking St John’s Wart in addition to SSRI |
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ANTIDEPRESSANTS:
MONOAMINE OXIDASE INHIBITORS Indications (Used only for)? Prototype Drugs? |
Reserved for patients who have not responded to SSRIs or TCAs
Prototype Drug: pheneizine (Nardil): Non-Reversible x 2 wks. Isocarboxazid (Marplan) Tranylcypromine (Parnate): Reversible ; Used for adult outpatient with reactive depression |
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ANTIDEPRESSANTS:
MONOAMINE OXIDASE INHIBITORS Actions, Indications, Pharmakinetics, Contraindications |
Action: Inhibits the effects of Monoamine Oxidase, which breaks down norepinephrine (NE), dopamine, or serotonin (5HT), to be recycled or restored in the neuron or synaptic cleft. Irreversibly inhibits MAOs, allowing NE, serotonin, & dopamine to accumulate in the synaptic cleft & increase adrenergic response.
Indications: Tx of patients w/ depression who are unresponsive to or unable to take other antidepression agents Pharmakinetics: Absorbed from GI; Peaks in 2-3 hrs; Metabolized in liver & excreted in urine Crosses placenta & enters breast milk Contraindications: No MAOs w/ TCAs or SSRIs: Known allergy, pheochromocytoma, CV disease, Has, renal or hepatic impairment |
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ANTIDEPRESSANTS:
MONOAMINE OXIDASE INHIBITORS - “Hypertensive Crisis”: |
hypertension, coma, convulsions, if foods containing tyramine are included in diet.
Tyramine normally is broken down by MAO; With MAO inhibitors, Tyramine concentration increases in GI tract. Tyramine promotes release of NE, Seratonin, dopami & increases BP Karch p. 335-336 Special Diet: Avoid foods w/ Tyramine; Foods containing Tyramine: Aged cheeses: cheddar, blue, Swiss Aged or fermented meats, fish or poultry, beef liver, caviar Brewer’s yeast, fava beans, red wines, smoked or pickeled meats |
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ATYPICAL ANTIDEPRESSANTS:
bupropion (Welbutrin) |
Use for: smoking cessation
Similar to amphetamine w/ stimulant properties; suppresses appetitie Effect: 1-3 wks Side Effects: Well tolerated; Can cause seizures if > 450 mg. |
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ATYPICAL ANTIDEPRESSANTS:
nefazodone (Serzone) |
Associated w/ severe liver toxicity in some patients
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ATYPICAL ANTIDEPRESSANTS:
venlafaxine (Effexor) |
For major depression & generalized anxiety.
Side effects: Extended released w/ few side effects. Structured like TCAs but little anticholinergic or adrenergic effects. Lieele effect w/ alcohol or BZDs or interference w/ hepatic enzymes. Mild renal/hepatic effects. Decreased sexual effects. Used w/ elderly. |
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ATYPICAL ANTIDEPRESSANTS:
Trazodone (Desyrel) |
Given for sleep
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BENZODIAZEPINES (1 of 3)
prototype drug? |
PROTOTYPE: diazepam (Valium)
Drug of choice for muscle spasm & seizure disorders |
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BENZODIAZEPINES (2 of 3)
Action & other meds? |
Action: Act in limbic & RAS systems. Make GABA more effective. Stabilize post synaptic cell, thereby lowering anxiety
Decrease gradually Tolerance develops only in cases of seizure disorder, not to anxiety, insomnia, or sedation Antidote: Flumazenil In contrast to the barbiturates, the benzodiazepines have a built-in limit to the depth of CNS depression that they can produce. Rarely lethal when not taken in combination w/ another drug Meds: aprazolam (Xanax); chlordiazepoxide (Librium); clonazepam (Klonopin) clorazepate (Tranxene) lorazepam (Ativan): Drug of choice for elderly because it is least likely to accumulate w/ repeated dosing. Also used as antianxiety agent with Haldol & Benadryl for psychotic patients Used for Sleep: flurazepam (Dalmane) temazepam (Restoril) triazolam (Halcion) |
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BENZODIAZEPINES (3 of 3)
Indications, pharmakinetics, SE, contraindications |
Indications: 3 major uses: Anxiety, insomnia, seizure disorders
Relieve anxiety in smaller dosing. Cause sedation: Loss of awareness & reaction to environmental stimuli; moderate dosing Hypnosis: Extreme sedation resulting in further CNS depression & sleep; large dosing Pharmacokinetics Peaks in 30 min to 2hrs Highly lipophilic w/ increased distribution (Elderly = increased fat content) Crosses placenta & breast milk Metabolized in liver & excreted in urine High first pass effect: Alcohol blocks first pass effect. #1 killer for college age students when alcohol taken with benzodiazepines. Rarely lethal when not taken in combination w/ another drug Side Effects: 1) All BZDs suppress respirations by inhibiting CO2 response. All metabolized by Cytochrome P450. 2) CNS: Depressant action on CNS by depressing neuronal function at multiple sites. 3) Antianxiety at limbic system 4) Sleep at cortical area 5) Muscle relaxation at supraspinal motor area Side effects of confusion & anterograde amnesia by effects on hippocampus & cerebral cortex Anticholinergic: blurred vision, confusion, dry mouth, constipation, nv, hypotension, urinary retention Contraindications: PO – Cardiovascular IV – hypotension, cardiac arrest |
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OTHER ANXIOLYTIC-HYPNOTIC
AGENTS prototype drug? action? indications? |
PROTOTYPE DRUG: zaleplon (Sonata)
zolpidem (Ambien): Will not cause a hangover Action: Affect serotonin levels in sleep center near RAS. Caution w/ hepatic impairment. Elderly more sensitive so use lower doses. Indications: Used for those who want to fall asleep quickly; Will not necessarily maintain sleep. Will not relieve anxiety. |
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OTHER ANXIOLYTIC-HYPNOTIC
AGENTS buspirone (Buspar) - indications? |
Indications: Newer anti-anxiety agent w/ no sedative, anticonvulsant, or muscle-relaxant properties. Reduces s/s anxiety w/o CNS effects & adverse effects of other anxiolytics.
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OTHER ANXIOLYTIC-HYPNOTIC
AGENTS: Antihistamines |
Used to induce sleep & sedation
PROTOTYPE: diphenhydramine (Benadryl) |
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BARBITURATES (1of 2)
prototype drugs? |
PROTOTYPE: Phenobarbital (Luminal) – long acting
OTHER: Secobarbital (Seconal) – Short to intermediate acting Thiopental – Ultra short acting |
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BARBITURATES (2 of 2)
Actions? Indications? Drug to Drug Int? Contraindications? Allergies? |
Actions: Acts as general CNS depressant; Inhibits neuronal impulse conduction in the ascending RAS. Depress the cerebral cortex; Alters cerebellar function; Depresses motor output
Causes sedation, hypnosis, anesthesia, &coma Indications: Relief of s/s anxiety; sedation, insomnia, preanesthesia, seizures Drug-to-Drug Interactions: Increase CNS depression w/ alcohol, antihistamines, tranquilizers Alters response to phenytoin MAOs increase serum levels & effect Decrease effectivenss of following drugs: anticoagulants, digoxin, tricyclic antidepressants, corticosteroids, oral contraceptives Contraindications: Allergy; Previous hx of addiction to sedative-hypnotic drugs; tolerance & cross tolerance; hepatic imparment or nephritis; respiratory distress or dysfunction; pregnancy Side Effects: CNS depression, physical dependency, drowsiness, somnolence, lethargy, ataxia, vertigo, nausea, vomiting, constipation Toxicity: Resp depression, coma, pinpoint pupils |
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ANTIPSYCHOTICS
Neuroleptics: Prototype drug? |
Associated neurological adverse effects; Also once called “Major tranquilizers”
PROTOTYPE : Chlorpromazine (Thorazine)-low potency |
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TYPICAL ANTIPSYCHOTICS
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Also called “phenothiazines”
OTHER: fluphenazine (Prolixin)- high haloperidol (Haldol) – high prochlorperazine (Compazine) – low Hold w/ prolonged QTc interval: thioridazine (generic) - low thiothixene (Navane) - high thrifluoperazine - high |
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TYPICAL ANTIPSYCHOTICS (2 of 3)
Indications? Contraindications/cautions? Herbal? |
Indications: Schzophrenia & other psychotic disorders, including hyperactivity, combative behavior, agitation in the elderly, severe behavioral problems in children (short-term control)
Contraidications & Cautions: Medical conditions that can be exacerbated by dopamine-blocking effects: Circulatory collapse, Parkinsons, coronary disease, severe hypotension, bone marrow suppression, blood dyscrasias, prolonged QT interval. Medical conditions that can be exacerbated by anticholinergic effects: glaucoma, PUD, urinary or intestinal obstruction. Seizure disorders: Threshold for seizures could be lowered. Active alcoholism for CNS depression. Pregnancy & lactation: adverse effects on fetus or neonate African AmericAn: Respond more rapidly 7 have greater risk for adverse effects i.e. tardive dyskinesia. Start low. Also Asians & Arab Americans. Herbal: Patients w/ schizophrenia should avoid evening primrose; herb associated w/ increased s/s & CNS hyperexcitability. |
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TYPICAL ANTIPSYCHOTICS (3 of 3)
AE? Nursing Considerations? |
Adverse effects: Related to dopamine-blocking, anticholinergic, antihistamine, alpha-adrenergic activities. Most common are sedation, weakness, tremor, drowsiness. Bone marrow suppression leading to blood dyscrasias.
Dopamine blocking: CV effects include hykpotension, orthostatic hypotension, cardiac arrythmias, congestive heart failure (CHF), pulmonary edema; prolonged QTc intervals (thioridazine, mesoridazine, ziprasidone), which can be fatal. Respiratory: laryngospasm, dyspnea, bronchospasm. Extrapyramidal effects (p. 352-know): pseudoparkinsonism, dystonis, akathisia, tardive dyskinesia & potentially irreversible neuroleptic malignant syndrome. Anticholinergic effects: dry mouth, nasal congestion, flushing, constipation, urinary retention, sexual impotence, glaucoma, blurred vision, photophobia. Phenothiazines may turn urine pink to reddish-brown Nursing Considerations: Know information under heading, “Implementation w/ Rationale” and “Evaluation” in Karch, p. 354. |
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ATYPICAL ANTIPSYCHOTICS
prototype drugs: |
“First-line” to manage psychosis
PROTOTYPE: clozapine (Clozaril) OTHER: aripiprazole (Abilify) olanzapine (Zyprexa, Zydis) queliapine (Seroquel) risperidone (Risperdal) respirdo (Consta) = longterm injectible ziprasidone (Geodon) |
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ATYPICAL ANTIPSYCHOTICS
Action? Indications? AE? Nursing Considerations |
Action: Block both dopamine & serotonin receptors.
Indications: Schzophrenia & other psychotic disorders, including hyperactivity, combative behavior, agitation in the elderly, severe behavioral problems in children (short-term control) Main Adverse Effect: Weight gain Other: Bone marrow suppression leading to blood dyscrasias. Monitor CBC on a regular basis Adverse Effects: Same as “Typical Antipsychotics” but these newer antipsychotics block both dopamine receptors & serotonin receptors. This dual action may help alleviate some of the unpleasant neurological effects & depression associated w/ typical antipsychotics. Nursing Considerations: Know information under heading, “Implementation w/ Rationale” and “Evaluation” in Karch, p. 354. |
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MANAGEMENT OF
EXTRAPYRAMIDAL SYMPTOMS: benztropine (Cogentin) |
Classification: Anticholinergic Agent & Anti-histaminic effects
Indications: Treatment of drug-induced extrapyramidal effects except tardive dyskinesia |
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MANAGEMENT OF
EXTRAPYRAMIDAL SYMPTOMS trihexyphenidyl (Artane) |
Classification: Anticholinergic Agent
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MANAGEMENT OF
EXTRAPYRAMIDAL SYMPTOMS diphenhydramine (Benadryl) |
Classification: Antihistamine
Indications: Treatment of antipsychotic-induced extrapyramidal reactions. |
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SEDATIVE
Prototype drug? Used w/? Classification? Indications? |
PROTOTYPE: Lorazepam (Ativan)
Used with Antipsychotics Classification: Benzodiazepine, Anxiolytic Indications: Often used in conjunction w/ Haldol & Benadryl as a sedative. |
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SLEEP MEDICATION
Prototype drug? Classification? Action? |
PROTOTYPE: trazodone (Desyrel)
Classification: SSRI Antidepressant Action: Inhibits reuptake of serotonin; Significantly blocks histamine & adrenergic receptors. |
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ANTIMANIC DRUGS
BIPOLAR DISORDERS: DRUGS FOR MOOD DISORDERS (1of2) Prototype drug name? action? pharmacokinetics? indications? drug-drug int.? |
Period of depression followed by a
period of manic PROTOTYPE: lithium salts (Lithane, Lithotabs) Action: Exact mechanism of action in decreasing manifestations of mania are not understood Functions in several ways: 1) Alters sodium transport in nerve & muscle cells 2) Inhibits release of norepinephrine & dopamine but not serotonin, from stimulated neurons 3) Increases intraneuronal stores of NE & dopamine slightly 4) Decreases intraneuronal content of second messengers, which may allow it to selectively modulate responsiveness of hyperactive neurons that might contribute to the manic state. Pharmacokinetics: Readily absorbed from GI tract (peak in 30 m to 3 hrs). Follows same distribution patter in the body as water. Slowly crosses blood-brain barrier. Excreted from kidneky although 80% is reabsorbed. Indications: Taken orally for the management of manic episodes of manic-depressive or bipolar illness & for maintenance therapy for prevention or to diminish frequency & intensity of future manic episodes. Drug-Drug Interactions: Higher plasma levels w/ NSAIDS Thiazide diuretic increases risk of lithium toxicity Carbamazepine: Increased CNS effects Lithium-haloperidol: encephalopathic syndrome Nursing Considerations: Karch, p. 358 |
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ANTIMANIC DRUGS
BIPOLAR DISORDERS – DRUGS FOR MOOD DISORDERS (2of2) Therapeutic Li levels? AE? Preg? Contraind? |
Therapeutic Lithium Levels: 0.4-1.0 mEq/L
Adverse Effects: Monitor lithium blood levels 1) Serum levels of less than 1.5 mEq/L: CNS problems, including lethargy, slurred speech, muscle weakness, fine tremor; polyuria, which relates to renal toxicity; & beginning gastric toxicity, w/ n/v, diarrhea. 2) Serum levels of 1.5-2 mEq/L: Intensification of all the above reactions, w/ ECG changes. 3) Serum levels of 2-2.5 mEq/L: Possible progression of CNS effects to ataxia, clo nic movements, hyperreflexia, seizures; possible CV effects such as severe ECG changes & hypotension; large outputof dilute urine secondaryto renal toxicity; fatalities secondaryto pulmonary toxicity. 4) Servum levels greater than 2.5 mEq/L: Complex multiorgan toxicity, w/ significant risk of death. Physical signs of toxicity include: Caution: Hyponatremia leads to lithium toxicity During periods of sodium depletion or dehydration, the kidney reabsorbs more lithium into the serum, often leading to toxic levels. Therefore, patients must maintain hydration while taking lithium. Caution w/ dehydration or diuretic use because lithium depletes sodium reabsorption. Also watch w/ altered sodium levels w/ diarrhea or excessive sweating; infection or fever. Pregnancy & lactation: Crosses placenta ; associated w/ birth anomalies Enters breast milk & is toxic for baby Contraindications: Significant renal or cardiac disease, leukemia, metabolic disorders |
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ANTIMANIC DRUGS
BIPOLAR DISORDERS – DRUGS FOR MOOD DISORDERS Alternative PROTOTYPE DRUG: valproic Acid (Deapakote, Depakene) |
Used more often than Lithium for Manic, Bipolar Disorders
Classification: Anticonvulsant, Miscellaneous drug of choice over lithium because of greater therapeutic index (safer drug) Indications: Treats simple & complex seizures; Used in treatment of mania (Depakote) and Migraine . Unlabled use for behavior disorders for patients w/ Alzheimers. |
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CENTRAL NERVOUS SYSTEM
STIMULANTS - Controlled Substance Action? Admin? Ind? |
PROTOTYPE: methylphenidate (Ritalin,
Concerta) OTHER: dextroamphetamine (Dexedrine); Caffeine Action: The CNS stimulants act as cortical & RAS stimulants, possibly by increasing the release of catecholamines from presynaptic neurons, leading to an increase in stimulation of the postsynaptic neurons. The paradoxical effect of calming hyperexcitability through CNS stimulation seen in ADD is believed to be related to increased stimulation of an immature RAS, which leads to the ability to be more selective in response to incoming stimuli. Administration: Swallow tablet whole, once in A.M. If taken B.I.D., give second dose before 4 p.m. Indications: Attention-deficit disorders (ADD) and narcolepsy. Calm hyperkinetic children & help them focus on one activity for a longer period. They also redirect & excite the arousal stimuli from the RAS. Improve wakefulness in people w/ various sleep disorders. |
Adverse Effects: R/T CNS stimulation they cause. Nervousness, insomnia, dizziness, HA, blurred vision, w/ < accommodation.
GI: anorexia, nausea, weight loss. CV: htn, arrhythmias, angina. Skin rashes. Physical L& psychological dependence. Contraindications: Allergy. Marked anxiety, agitation, or tension, severe fatigue or glaucoma, cardiac disease, pregnancy & lactation. Hx of seizures which could be potentiated by CNS stimulation Drug dependence, including alcohol Refer to Nursing Considerations in Karch, p. 360-361. |
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AMPHETAMINE
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PROTOTYPE: dextroamphetamine
(Dexedrine) Drug used for amphetamine toxicity: Alpha-adrenergic blocker Symptoms of toxicity: Tachycardia, insomnia, restlessness |
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STIMULANT
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PROTOTYPE: Caffeine
Action: CNS Stimulant with adrenergic effects Large amounts of caffeine may cause convulsions |
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ANALGESIC: OPIOIDS
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A drug or drugs used to produce analgesia, or the absence of sensibility to pain. Drug choice(s) will vary depending on type of pain, severity of pain, length of pain experience, and client’s interpretation of pain.
PROTOTYPE: Morphine Sulfate |
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ANALGESIC: OPIOIDS (Others)
Admin? |
Habit forming, Regulated by the US Controlled Substance Act. Addictive or habit forming.
OTHER: PARENTERAL OR PO: Demerol (Only give in small increments of 1-2 doses; metabolites collect & danger of resp depr Dilaudid ORAL: Percodan, Percocet, Vicodin, ES Vicodin, codeine, Darvocet N 100, Darvon, Tylenol w/ Codeine #2, #3, #4 TRANSDERMAL PATCH: Fentanyl Patch (TTSI, TTSII) (change q 72 hours) |
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ANALGESIC: NON-OPIOIDS (Non-Narcotic)
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PROTOTYPE: Acetaminophen (Tylenol)
Acetaminophen (Tylenol 325 mg/tab) ES Tylenol 500 mg/tab) |
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ANALGESIC: NON-OPIOIDS (Non-Narcotic) - NSAIDS:
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Non-Steroidal, Anti-Inflammatory Drugs: inhibit prostaglandin synthesis; aspirin-like drugs w/ analgesic, antipyretic, and anti-inflammatory activity
PROTOTYPE: Aspirin : A Salicylate ; Ibuprofen (Motrin) - PO naproxen (Alieve) ketorolac tromethamine (Toradol) – IV Other: Prostaglandin Analog (Cox 2 Inhibitors) = celecoxib (Celebrex) |
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Classification:
ANTI-INFECTIVE ANTIBIOTICS (ANTIMICROBIALS): What they do? types? |
Agents used to treat infections caused by pathogenic microbes
Med types: Bacteriocidal &/or Bacteriostatic |
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ANTI-INFECTIVE
ANTIBIOTICS (ANTIMICROBIALS): PENICILLINS |
Action: Inhibits cell wall synthesis
Meds: Anaphylaxis Prophylactic amoxicillin for rheumatic fever & bacterial endocarditis Topical ointments may sensitize patients Beta-Lactam Antibiotic – Bacterial enzyme that inactivates the Beta-Lactam ring on penicillins & cephalosporins Drug: Amoxicillin Beta Lactam Inhibitors Clavulanate Sulbactam Taxobactam Drug: Augmentin = amoxicillin + clavulanate acid |
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ANTI-INFECTIVE
ANTIBIOTICS - CEPHALOSPORINS: Action |
Action: Ea. generation has increased bactericidal activity to breakdown gm(-) bacteria & anaerobes, as well as reach the CSF; interfere w/ bacterial cell wall synthesis & are considered broad-spectrum. The cell weakens, swells, bursts & dies as a result of increased osmotic pressure inside cell.
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ANTI-INFECTIVE
ANTIBIOTICS - CEPHALOSPORINS: Lab checks? SE? Contraind.? Interactions? |
*Check hepatic (AST/ALT), renal (BUN, Cr.), GI; Cross-sensitive to penicillin
20% cross sensitivity w/ penicillins Cefoperazone, cefometazole, cefotetan: potential for bleeding. Monitor PT/INR. Avoid in patients w/ bleeding tendencies or that take NSAIDS, anticoagulants SE: Nephrotoxicity; thrombophlebitis, irritation @ IV or IM site; GI: pseudomembranous colitis; C difficile Interactions: Alcohol = disulfiram-like rxn Aminoglycosides - deactivates |
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ANTI-INFECTIVE
ANTIBIOTICS - CEPHALOSPORINS: 1st Generation |
Effective against Gm + plus limited Gm – (proteus mirabilis, E. coli, Klebsiella pneumonia (PEcK)
Med: cephazolin (Ancef), cefalexin (Keflex) |
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ANTI-INFECTIVE
ANTIBIOTIC - CEPHALOSPORINS: 2nd Gen. |
Less effective Gm+ but more Gm-
Meds: cofactor (Ceclor), cefuroxime (Zinacef) |
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ANTI-INFECTIVE
ANTIBIOTIC - CEPHALOSPORINS: 3rd Gen. |
Weak against Gm+ but increased Gm-
Meds: Ceftriaxone (Rocephin) Cefotaxime (Claforan): Most effective against meningitis |
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ANTI-INFECTIVE
ANTIBIOTIC - CEPHALOSPORINS: 4th Gen. |
in development
Active against Gm- and Gm+ PLUS cephalosporin resistant staphylococci & P. aeruginosa cefepime (Maxipime): Effective against meningitis; theoretically more than cefotaxime Prototype cephalosporin drugs highlighted |
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ANTI-INFECTIVE
ANTIBIOTIC - AMINOGLYCOSIDES: |
Action: Bactericidal against a wide variety of Gm(-) bacteria (narrow-spectrum) & certain Gm(+) organisms. Disrupts bacterial protein synthesis
Nephrotoxic, Ototoxic Peak & Trough levels May alter dose for high creatinine instead of not using the antibiotic **Refrain from giving to elderly or pediatric patients Meds: gentamacin (Garamycin), neomycin, streptomycin, tobramycin (Nebcin) |
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ANTI-INFECTIVE
ANTIBIOTIC - MACROLYDES: |
Action: Bind to bacterial ribosomes, preventing bacterial protein synthesis. Metabolized in liver, excreted in urine
Cyt P450 affect: Lots of drug interactions (i.e., Digoxin, anticoagulants, theophyllines, corticosteroids & others) Highly protein bound Highly lipid soluble, so crosses CNS w/ SE Take 1 hr before or 1 hr after meals Adverse effects: GI, pseudomembranous colitis Meds: erythromycin Azithromycin (Zithromax) + Z-PAC Take 2 tabs 1st day; then 1 tab qd x 2 days |
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ANTI-INFECTIVE
ANTIBIOTIC - LINCOSAMIDES |
Action: Similar to Macrolydes
Effective against same bacteria but stronger; Used for severe infections Med: clindamycin (Cleocin) |
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ANTI-INFECTIVE
ANTIBIOTIC - SULFONAMIDES |
Action: Metabolic inhibitors that block synthesis of folic acid. Administer oral drug on an empty stomach 1 hr before or 2 hrs after meals w/ a full glass of water to promote adequate absorption of drug
- Check renal function - Check for allergies, especially rash - Dizziness & CNS affects Meds: Sulfasalazine (Azulfidine) Trimethoprim/sulfamethoxazole (Bactrim DS) ---DS stands for double strength |
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ANTI-INFECTIVE
ANTIBIOTIC - TETRACYCLINES |
Action: Prevent protein synthesis by binding messenger RNA
Avoid direct sunlight & UV rays GI distress eliminated w/ drinking a full glass of water w/ oral medication Hepatotoxicity Discoloration of teeth: Binds to calcium found in teeth & may result in discoloration of children’s teeth (under 8 yrs) Med: Tetracycline |
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ANTI-INFECTIVE -
ANTIMYCOBACTERIALS |
Mycobacteria have an outer coat of mycolic acid that protects them from many disinfectants; They survive for long periods in the environment; show growing; Need to be treated for several yrs (Mycobacterium tuberculosis, Mycobacterium leper) Isoniazid (INH) used in prophylaxis for family members living w/ a person who has tuberculosis
Action: Affects the mycolic acid coating of the bacterium Meds: Isoniazid (INH) (Nydrazid) ; rifampin (Rifadin) |
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ANTI-INFECTIVE - ANTIFUNGALS
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Agents used to treat infections caused by pathologic fungi. Fungi do not contain a peptidoglycan cell wall that renders them resistant to all antibiotics for this reason.
Examples: histoplasmosis & yeast Meds: **clotrimazole (Lotrimen) **ketoconazole (Nizoral) fluconazole (Diflucan) miconazole (Monistat IV) Topical: Nystatin, Mycostatin Amphotericin B (“amphoterible”) check out side effects |
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ANTI-INFECTIVE - ANTIVIRALS
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Viruses called “intracellular parasites.” They are non-living agents & contain none of the organelles necessary for self-survival that are present in a living organism. They infect their host by entering a target organ and then using the machinery inside that cell to replicate. Responsible for common cold as well as HIV-AIDS & Hepatitis. Viruses are the smallest agents capable of causing disease. Antivirals remain the least effective of all the antiinfective drug classes.
Meds: Zidovudine (Retrovir, AZT) *anemia, neutropenia, bone marrow suppression, anorexia, nausea, diarrhea Acyclovir (Zovirax) |
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ANTI-INFECTIVE - ANTIPROTOZOAL AGENTS
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Action: Prevention & tx of amebabiasis, trichomoniasis, & giardiasis metronidazole (Flagyl)
SE: Used as prophylaxis for patients undergoing colorectal surgery |
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ANTI-INFECTIVE - ANTIHEIMINTIC AGENTS
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Treatment of whipworm, pinworm, roundworm, hookworm
Med: Mebendazole |
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DIURETICS
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Agents that increase urine output
Loop: Action in Henle’s loop; Na retained in the tubule & excreted w/ urine, carrying water w/ it. K+ and hydrogen excreted w. it. Ca ions also excreted in higher than normal amt. Meds: ***Furosemide (Lasix) Ethacrynic acid (edecrin) *Assess K+ level *Is patient taking K+ supplements? *Precautions for elderly: falls r/t orthostatic hypotension *May cause elevated sugars in DM patients |
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DIURETICS:
Hydrochlorothiazide (HCTZ) |
Thiazide: Inhibits Na and Cl ions in distal tubule. K & Cl ions exreted
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DIURETICS:
Spironolactone (aldactone) |
Potassium Sparing Diuretics
***Assess for hyperkalemia |
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DIURETICS:
acetazolamide (Diamox) |
Routes: Oral, sustained release oral, IV
Carbonic Anhydrase Inhibitors Adjunctive tx of open-angle glaucoma, 2ndary glaucoma, preoperative use in acute angle-closure glaucoma when delay of surgery is indicated; also used for edema caused by CHF |
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