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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.
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.
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.
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.
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.
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.
Vitamin B12 (Cyanocobalamin)
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.
Folic Acid (Folvite)
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.
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.
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.
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.
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.
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.
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.
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
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
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
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
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.
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.
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
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
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+.
Loop: furosemide (Lasix)
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
Osmotic Diuretics: mannitol (Osmitrol)
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.
Thiazides: hydrochlorothiazide (Hydrodiuril)
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.
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
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
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
Bile-Acid Sequestrants: cholestyramine (Questran) colesevelam (Welchol)
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
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
Nitrates:

isosorbide dinitrate (Isordil)
Reduce preload; dilate coronary arteries
Headache, orthostatic hypotension, reflex tachycardia
Monitor for hypotension, orthostatic changes may occur
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
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
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.