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35 Cards in this Set
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Buspirone (BuSpar) - Antianxiety Preg: B 2-3 hr. HL with onset 7-10 days peak 3-4 wks. May act as a partial agonist at serotonin 5-hydroxytryptamine1A receptors in the brain, producing antianxiety effects. SE: Dizziness, nausea, headache, light-headedness, agitation; DI: diltiazem, erythromycin, itraconazole, nefazodone, nordiazepam, verapamil: hepatic enzyme CYP3A4 inhibitors, such as ketoconazole and ritonavir: Possibly inhibited buspirone metabolism Increased blood level and adverse effects of buspirone. Grapefruit juice: Increased blood buspirone level. NC: 1 to 2 weeks of therapy before noticeable decrease anxiety.
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Amitriptyline (Elavil)
Chemical class: Tertiary amine Therapeutic class: Tricyclic antidepressant Pregnancy category: D |
Onset 14 -21 days. Amitriptyline blocks serotonin and norepinephrine reuptake by adrenergic nerves. By doing so, it raises serotonin and norepinephrine levels at nerve synapses. This action may elevate mood and reduce depression. SE: Orthostatic hypotension, anticholinergic effects* sedation, decreased seizure threshold, excessive diaphoresis, use cautiously with HTN, DI: MAOIs & St. John’s wort = Serotonin Syndrome, Antihistamines & anticholinergic – additive, /|\ effect.TCAs decrease effect, avoid CNS depressants.CI: During acute recovery phase after MI. NC:•WARNING Don't give an MAO inhibitor within 14 days of amitriptyline therapy because of the risk of seizures and death. Monitor CV may cause sinus tach.
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Fluoxetine (Prozac) Chemical class: Phenylpropylamine derivative
Therapeutic class: Antibulimic, antidepressant, antiobsessive-compulsive Pregnancy category: C |
Onset 1-6 wks. Selectively inhibits reuptake of the neurotransmitter serotonin by CNS neurons and increases the amount of serotonin that’s available in nerve synapses. An elevated serotonin level may result in elevated mood and, consequently, reduced depression. DI: alprazolam, diazepam: Possibly prolonged half-life of these drugs aspirin, NSAIDs, warfarin: Increased anticoagulant activity and risk of bleeding astemizole: Increased risk of serious arrhythmias •WARNING Avoid giving fluoxetine within 14 days of an MAO inhibitor or starting MAO inhibitor therapy within 5 weeks of discontinuing fluoxetine. Risk of serotonin syndrome: s/sx agitation, confusion, diaphoresis, diarrhea, fever, hyperactive reflexes, poor coordination, restlessness, shaking, talking or acting with uncontrolled excitement, tremor, and twitching.
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Diazepam (Valium)
Chemical class: Benzodiazepine Therapeutic class: Anticonvulsant, anxi-olytic, sedative-hypnotic, skeletal muscle relaxant Pregnancy category: D Controlled substance schedule: IV |
May potentiate the effects of gamma-aminobutyric acid (GABA) and other inhibitory neurotransmitters by binding to specific benzodiazepine receptors in the limbic and cortical areas of the CNS. GABA inhibits excitatory stimulation, which helps control emotional behavior. The limbic system contains a highly dense area of benzodiazepine receptors, which may explain the drug’s antianxiety effects. Diazepam suppresses the spread of seizure activity caused by seizure-producing foci in the cortex, thalamus, and limbic structures.T: Seizure disorders, insomnia, muscle spasms; alcohol withdrawal, anesthesia.CNS depression, antegrade amnesia, acute toxicity = oral - lethargy, confusion; IV – resp depression, severe hypotension, paradoxical response – insomnia, excitation; withdrawal symptoms; DI: CNS depressants; Flumazenil (Romazicon) to counteract.CI:Acute angle-closure glaucoma and untreated open-angle glaucoma. NC:•Give I.M. injection into deltoid muscle for rapid and complete absorption.
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Zolpidem (Ambien) Antianxiety, sedative-hypnotic Preg: B sched:IV May potentiate the effects of gamma-aminobutyric acid (GABA) and other inhibitory neurotransmitters. By binding to specific benzodiazepine receptors in the limbic and cortical areas of the CNS, zolpidem increases GABA’s inhibitory effects, blocks cortical and limbic arousal, and preserves deep sleep (stages 3 and 4). T: management of insomnia SE:Daytime sleepiness, lightheadedness – allow for 8 hours of sleep. CI: Hypersensitivity to zolpidem or its components, ritonavir therapy. ASE: Paradoxical CNS stimulation (including agitation, euphoria, hallucinations, hyperactivity, and nightmares), vertigo.
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PO: Fe Sulfate (Feosol)
IM/IVL Fe Dextran (INFed) |
Iron replacement.
Treats Iron deficiency anemia. Side Effects: Anaphylaxis (IM/IV), GI: nausea, indigestion, dark and tarry stools. Liquid stains the teeth. Interactions: Antacids decrease absorption and Ascorbic Acid (Vitamin C) promotes absorption of iron. Nursing Implications: Take with out food 1 hour before or 2 hours after meals. Dilute liquid in juice or water and administer through a straw to prevent teeth staining. For Z-track - test dose and wait 1 hour IV - test dose Increase dietary fiber/fluid via liver, broccoli, raisins. |
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Vitamin B12 (Cyanocobalamin)
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Required for cell growth by permitting utilization of folic acid. Used for Vitamin B12 deficiency, impaired absorption , pernicious anemia, demyelination nervous system.
Side effects: hypokalemia Nursing Implications: oral, intranasal, IM, or deep SQ. Dietary sources: leafy greens Monitor: Lifelong treatment when lacking intrinsic factor. Report to MD S&S. |
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Folic Acid (Folvite)
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Folic acid deficiency.
Insufficient intake (alcoholism) Prophylactic during pregnancy to prevent neural tube defects. Nontoxic. Dietary sources: asparagus, broccoli, spinach, liver. Can mask B12 def if taken in large doses at same time. |
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Alpha Adrenergic Blockers: Blocks alpha 1 (ZOSIN)
receptors to cause vasodilation prazosin (Minipress) doxazosin (Cardura) |
Blocks alpha 1 receptor to cause vasodilation.
Hypertension. Syncope c 1st dose; ORTHOSTATIC hypotension, nasal congestion, impotence in men. Monitor BP (Lying, sitting, standing) Administer 1st dose at HS. |
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Angiotensin Converting Enzyme inhibitors (PRIL):
captopril (Capoten) enalapril (Vasotec) lisinopril (Zestril) quinapril (Accupril) |
*Inhibits conversion of Angiotenin I to Angiotensin II (potent vasoconstrictor) & increases bradykinin. *Reduces peripheral resistance w/o changing CO
Reduce afterload & increase CO HF, HTN, reduce risk of cardio vascular mortality 1st dose hypotension, Cough (Hyperkalemia) K+ levels, Renal failure, angioedema Interactions: Increase effects- antihypertensive, diuretics Increases lithium levels Decrease effects- NSAIDS K+ supplements increase K+ levels Monitor VS Dry cough (D/C drug) Monitor renal studies & WBC Avoid- K+ supplements and salt substitutes. |
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Angiotensin II Receptor Blockers (SARTAN):
losartan (Cozaar) valsartan (Diovan) |
*Blocks action of angiotensin II in blood vessels & adrenals
Causes: blood vessel vasodilation, decrease relaease of aldosterone, increases renal excretion of NA & water, prevents pathologic changes in cardiac wall structure (hypertrophy). HTN HF, MI, migraines. Hypotension, Angioedema, Renal failure Fetal injury in 2nd & 3rd trimester Interactions: Increases effect antihypertensives Monitor VS Monitor renal studies Avoid K+supplements and salt substitutes. |
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Anticoagulants (RIN):
heparin Onset: rapid acting Duration: brief (hours) |
Antithrombotic; Disrupts coagulation cascade & inactivates thrombin & factor Xa interfering with fibrin production.
Prevents VENOUS clot formation or extension; no effect on existing clots Pulmonary embolism, evolving stroke, DVT, DIC Active bleeding, heparin induced thromboctyopenia (HIT), hypersensitivity Antidote: protamine sulfate. SQ, IV Injection only Monitor APTT q4-6 hrs. Normal 30-40 sec. Therapeutic RANGE: 1.5-2 x's normal. Notify MD if increase in bleeding, bruising, occult bleeding, dc B/P. |
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Anticoagulants (RIN):
dalteparin (Fragmin) enoxaprin (Lovenox) |
Antithrombotic; inactivation of factor Xa interfering with thrombin formation
Prophylaxis; Prevents DVT clot formation or extension; no effect on existing clots Prevention of DVT; unstable angina Active bleeding. Severe neurologic injury from pressure on spinal cord bleed SQ only. Does NOT require aPTT monitoring. |
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Anticoagulants (RIN):
warfarin (Coumadin) Onset: 8-12 hrs Peak: several days Duration: prolonged |
Inhibits synthesis Vit K by blocking factors VII, IX, X, & prothrombin needed for clotting.
Prevents clot formation. Prevent pulmonary embolism, thromboembolism from cardiac valves, atrial fib, TIAs. Active bleeding Antidote: Vitamin K. Interactions: INCREASES effects- ASA, acetaminophen, antifungals, tagamet, some cephlasporins DECREASES effects - ORAL contraceptives phenobarbital, phenytoin, rifampin, BCP Oral only. Monitor PT or INR Therapeutic range: 12 seconds; INR 2-3 Do NOT eat foods high in Vit K -leafy greens Teach: Observe for bleeding; SQ injection, not massage; wear medic alert bracelet; avoid ASA containing drugs; use electric shaver (Iggy, Chart 38-6, p. 819 & Chart 38-7, p. 821). Surgeon aware of anticoagulant therapy prior to OR. |
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Antiplatelets:
Aspirin |
Irreversible inhibition of cyclooxgenase
Prevents ARTERIAL clot formation Prevention of MI GI upset; trigger asthma is taken in large quantities; N/V, dizziness Increases risk GI bleeding, liver/kidney issues Effects up to 7-10 days DC 1 week before dental surgery or invasive procedures; take c food |
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Antiplatelets:
clopidolgel (Plavix) Onset: 2 hrs Peak: 3-7 days |
Irreversible prevention ADP from binding to platelets
Prevention of ischemic stroke & MI GI upset, indigestion, diarrhea, rash Effects up to 7-10 days Take c food; avoid invasive procedures while on drug |
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Antiplatelets:
abciximab (ReoPro) |
GP IIb/IIIa antagonist
Reversible monoclonal antibody that binds to receptor surface and decreases stickiness of surface Prevent thrombosis from acute coronary syndrome Reduce rapid re-occlusion after revascularization Bleeding Allergic reaction Observe for skin rashes or dyspnea |
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Antiplatelets:
dipyridamole (Persantine) dipyridamole plus ASA (Aggrenox) |
Inhibits ADP formation
Prevention of thromboembolism after heart valve surgery. Used with warfarin TIA & prevent recurrent ischemic stroke Hypotension, H/A, dizziness, GI disturbances Bleeding-PUD Rise slowly Interactions: NSAIDS, ASA, Vit C&E, ginger, cumin, garlic Nursing Interventions: Monitor BP & pulse; Assess for recent surgery or stroke; Monitor CBC & platelet count Teach: Report bleeding; follow-up with lab work; avoid gastric irritation |
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Beta Adrenergic Blockers (OLOL):
atenolol (Tenormin) metaprolol (Lopressor) propranolol (Inderal) |
Reduces HR, decrease force of ventricular contraction, suppress conduction through AV node
inhibits glucogenolysis in liver. HTN, angina, MI, migraines. Bradycardia, AV Heart block, hypotension, HF Depression, insomnia, Bronchodilator constriction/wheezing, SOB. Assess AP & BP before administering. Avoid abrupt stopping. |
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Calcium Channel Blockers:
verapamil (Calan) Onset: 30 min Peak: 5 hrs diltiazem (Cardizem) Onset: few min Peak: 30 min |
*Blocks movement of Ca++ in cells of smooth muscle; vasodilation BLOCK peripheral vascular resistance. *Increases coronary perfusion.
HTN, angina, cardio dysrhythmias. HF, hypotension, dyspnea, weight gain, edema of lower extremities, bradycardia, dizziness, H/A, constipation, gingival Monitor BP & AP. Hold if <110/100 - systolic. Pulse <60. Monitor baseline frequency and severity of angina. AVOID grapefruit juice. Pt teaching with journal of angina time, intensity, activities when occurred. Increase dietary fluids/fiber. Notify MD if edema of lower extremities, decreases AP, SOB, wt gain. |
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Calcium Channel Blockers:
nifedipine (Procardia) Onset fast acting: few min Peak: 30 min Onset SR: 20 min Peak: 6 hrs amilodopine (Norvasc) |
*Blocks movement of Ca++ in cells of vascular smooth muscle; vasodilation BLOCK peripheral vascular resistance
*INCREASES coronary perfusion Hypotension, dizziness, flushing, rash, weight gain, edema of lower extremities, H/A, reflex tachycardia, gingival hyperplasia, dyspnea Swallow SR whole-do NOT crush. Smoking decreases levels; grapefruit increases levels so tape off slowly |
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Cardiac Glycosides:
digoxin (Lanoxin) |
IMPROVED force of ventricular contraction & INCREASED CO
Result- REDUCE in heart rate, DECREASED urine production, decreases renin release *Potassium competes c Dig for binding to NaK ATPase. Low K+, allows more Dig to bind & INCREASED risk of toxicity *Enhances vagal effect on heart...decreases automaticity of SA node & SLOW conduction through AV node Improve contractility, increase SV & CO Cardiac dysrhythmias- AV block most common. Digitalis toxicity: HYPOkalemia predispose to toxicity Interactions: Diuretics- increases dig toxicity Beta blockers- decreases contractility & HR ACE & ARBs- increase K+ & decrease therapeutic response Antidote: (Digibind) Take AP x 1 min & withhold if heart rate < 60/min or > 120/min; instruct how to take pulse; Monitor therapeutic & potassium levels Therapeutic levels- 0.5-1.0 ng/ml Teach to report S&S of toxicity & hypokalemia: loss of appetite, N/V, diarrhea, palpitations, confusion, halos or rings around objects, blurred vision, and decreased urine |
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Diuretics:
Aldosterone Antagonist: spironolactone (Aldactone) |
Block sodium-potassium exchange mechanism in distal tubule; prevent sodium reabsorption & retain potassium
Liver disease, edema CHF, HTN HYPERkalemia Gynecomastia, hirsutism Take c food; Give in AM to avoid messing with sleep; monitor weight (report weight gain) Avoid foods high in K+. |
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Loop: furosemide (Lasix)
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Blocks Na, water reabsorption in Loop of Henle
Decrease preload & pulmonary congestion; edema, hypertension. Excessive urination & dehydration; HA, N/V, Diarrhea. HYPOkalemia, HYPOnatremia; ototoxicity (transient deafness) c rapid IV administration; orthostatic hypotension Monitor K; Give IV 10 mg/min |
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Osmotic Diuretics: mannitol (Osmitrol)
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Increases osmotic pressure in vascular system; draws fluid from tissues into vascular system; inhibits renal tubular reabsorption of water; lastly excreted
Edema, hypertension Circulatory overload (plasma expander); rebound increase intracranial pressure; slough tissue c IV infiltration; H/A from cerebral dehydration; hypokalemia, hyponatremia; excessive diuresis, dehydration Avoid giving c CHF, CRF; assess IV site frequently; check bottle for crystallation; give c filter; NOT compatible c any other IV med; monitor I&O qh Monitor K+ levels. |
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Thiazides: hydrochlorothiazide (Hydrodiuril)
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Blocks Na, Cl, water reabsorption in distal convoluted tubule
Edema, hypertension Orthostatic hypotension, HYPOkalemia, HYPOnatremia, general dehydration, N/V Assess allergy to sulfonamides; monitor for development of gout; adm c food Prevent orthostatic hypotension by avoiding sudden changes in position; monitor I&O, weight, BP, P, Na, K, glucose; encourage foods high K; administer early in day or evening (before 5 pm); S&S to report- edema, wt gain (>3-5 #), high BP; avoid ETOH Monitor K+ levels. |
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Lipid lowering agent:
HMG-CoA reductase inhibitors: simvastatin (Zocor) |
Increases the number of LDL receptors on hepatocytes to allow for more removal of LDL- decreases LDL, triglycerides
Increases levels of HDL cholesterol Myopathy Hepatotoxic GI upset: constipation/diarrhea, N, cramps H/A Skin rash Interaction: Enhances bile acid-binding resins Report muscle weakness, monitor LIVER enzymes & renal status Most effective when taken c evening meal, avoid grapefruit juice Dietary limit cholesterol |
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Lipid lowering agents:
Nicotinic acid (Niacin) |
Decrease production of VLDL
*Intense flushing *Hepatotoxic *Hyperglycemia *Gout Take c meal; take ASA 325 mg 30 min before dose to prevent flushing & pruritus |
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Lipid lowering agents:
Fibric acid derivatives: fenofibrate (Tricor) |
Decreases production of triglycerides in liver
GI upset: N/V, diarrhea, abd pain, altered taste Skin- Rashes Cholelithiasis (gallstones)- increases cholesterol saturation in biliary tract Hepatotoxic; Impotence Take 30 min ac or c meals Interactions: increases effect of anticoagulants |
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Bile-Acid Sequestrants: cholestyramine (Questran) colesevelam (Welchol)
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Increases the number of LDL receptors on hepatocytes to allow for more removal of LDL.
Reduce LDL cholesterol Constipation Bloating Decrease uptake of FAT soluble vitamins Mix powder in water, fruit juice, applesauce to decrease esophageal irritation |
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Nitrates:
Nitroglycerin (Nitrostat) |
Relaxation of vascular smooth muscle causes vasodilation of veins & decreases oxygen demand & increases oxygen supply
Stable angina Variant angina relaxes arteriole spasms Headache, orthostatic hypotension, reflex tachycardia Interactions: INCREASED effect of anthypertensive meds CONTRAINDICATED with meds used for erectile dysfunction SL tablets SR capsules- swallow intact Transdermal- apply to clean, dry, hairless area Translingual Spray- metered dose, do NOT inhale Transmucosal tablets- b/t cheek & gum Topical ointment- Dispense from tube, cover with plastic wrap, rotate, "free" time IV- glass bottle with tubing from manufacturer Monitor for HYPOTENSION; drop in BP and HA Discontinue slowly |
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Nitrates:
isosorbide dinitrate (Isordil) |
Reduce preload; dilate coronary arteries
Headache, orthostatic hypotension, reflex tachycardia Monitor for hypotension, orthostatic changes may occur |
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Potassium Supplements:
Potassium Chloride (K-Dur) Potassium phosphate Potassium Bicarboante |
Replacement of electrolyte
HYPOkalemia GI- abd discomfort, N/V, diarrhea Interactions: insulin increases K+ uptake by cells. Monitor K+, AP, renal function Immediate release- Take with food, full glass water IV rate NOT to exceed 10mEq/hr; NO IVP |
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Renin inhibitor:
Aliskiren (Tekturna) |
Inhibits conversion of angiotensinogen into angiotensin I
HTN Angioedema, Cough, Diarrhea, hyperkalemia, fetal injury Interactions: Increases effects with antihypertensives Decreases effects with high fat meal Avoid K+ supplements Take at same time qd |
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Smoking Cessation:
Nicotine Push (Nicoderm) Nicotine Gum (Nicorette) |
Chewing releases nicotine & absorbed across oral mucosa
Relieve nicotine withdrawal Skin irritations, angina, dysrhythmias Sore throat, hiccups Apply patch qd to clean, non-hairy upper body for 24 hrs. Chew slowly for about 30 min. Do NOT smoke-higher than usual nicotine levels will occur; no more than 20-30 pieces of gum/day dependent on dose. |
