Unit 4 Drug Cards N140 Scc

Front 1

Oxycodone
(Roxicodone, Oxycontin)

Back 1

Oxycodone (Roxicodone, Oxycontin) Davis’s p.902
CLASSIFICATION: Th.: opiod analgesics; Ph.: opiod agonists
ACTION/USES: Decrease pain by binding to opiate receptors in the CNS, altering the perception of and response to painful stimuli, while producing generalized CNS depression.
ROUTES/DOSES: Vary depending on use. Oral: Adult 5 – 10mg q 3 - 4 hr initially, as needed.
Controlled-release tablets (Oxycontin, Roxicodone SR) may be given q12h after careful consideration as to dose, indication, and previous analgesic use/abuse history. Rectal: 10 – 40mg 3-4 times daily initially, as needed
SIDE EFFECTS: Confusion, sedation, constipation most common; respiratory depression most serious.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Hypersensitivity; pregnancy/lactation (avoid chronic use). Use with caution with MAO inhibitors, alcohol, antihistamines, sedative/hypnotics, partial-antagonist opioid analgesics, nalbuphine, buprenorphine, pentazocine, kava, valerian, chamomile.
NURSING IMPLICATIONS: Patients taking controlled-release tablets may require additional short-acting opioid doses for breakthrough pain. Doses should be equivalent to 10-20% of 24-hr total and given every 2 hr as needed.
Assess type, location and intensity of pain prior to and 1 hr (peak) after administration. Assess BP, pulse, RR before & periodically during administration. If RR<10/min, assess level of sedation. Antidote = narcan.
High alert: Accidental overdosages can be fatal. Check doses and don’t crush/break/chew SR tabs; do not confuse oxycodone with OxyContin.

Front 2

Oxycodone/Aspirin (Percodan); Oxycodone/Acetaminophen (Percocet, Tylox)

Back 2

Oxycodone/Aspirin (Percodan), Oxycodone/Acetaminophen (Percocet, Tylox) Davis’s p.902
CLASSIFICATION: Th.: opiod analgesics; Ph.: opiod agonists/nonopioid analgesic combinations
ACTION/USES: see above (oxycodone)
ROUTES/DOSES: see above (oxycodone), and consider cumulative effects of additional acetaminophen/aspirin; if toxic levels are exceeded, change to pure oxycodone product.
SIDE EFFECTS: As above (oxycodone), and see aspirin/acetaminophen as appropriate
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): see above (oxycodone), and see aspirin/acetaminophen as appropriate
NURSING IMPLICATIONS: As above (oxycodone), and see aspirin/acetaminophen as appropriate. Do not confuse Percocet with Percodan.

Front 3

Hydrocodone/Acetaminophen (Vicodin, Lortab); Hydrocodone/Ibuprofen (Vicoprofen)

Back 3

Hydrocodone/Acetaminophen (Vicodin, Lortab), Hydrocodone/Ibuprofen (Vicoprofen) Davis’s p.604
CLASSIFICATION: Th.: allergy, cold, and cough remedies (antussive), nonopioid analgesics, opiod analgesics;
Ph.: opiod agonists/nonopioid analgesic combinations
ACTION/USES: Manage moderate - severe pain by binding to opiate receptors in the CNS, altering the perception of and response to painful stimuli, while producing generalized CNS depression. Suppress cough reflex via a direct central action.
ROUTES/DOSES: PO (adult) : 2.5 – 10mg q 3 – 6 hr as needed ; if combination, acetaminophen or aspirin dosage should not exceed 4g/day.
SIDE EFFECTS: (hydrocodone): Confusion, sedation, hypotension, constipation. Also see acetaminophen/ibuprofen as pertinent.
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): Hypersensitivity; pregnancy/lactation (avoid chronic use). Use with caution with MAO inhibitors, alcohol, antihistamines, sedative/hypnotics, partial-antagonist opioid analgesics, nalbuphine, buprenorphine, pentazocine, butorphanol, kava, valerian, chamomile, skullcap, hops. Also see acetaminophen/ibuprofen/aspirin as pertinent.
NURSING IMPLICATIONS: Assess BP, pulse, RR before & periodically during administration. If RR<10/min, assess level of sedation. Antidote = Narcan.
Assess bowel function routinely. Assess type, location and intensity of pain prior to and 1 hr (peak) after administr’n.
High alert: Accidental overdosages can be fatal. Check doses and don’t crush/break/chew SR tabs; do not confuse hydrocodone with hydrocortisone; do not confuse Lortab with Lorabid.

Front 4

Aspirin
(Bayer Aspirin)

Back 4

Aspirin (Bayer Aspirin), Davis 1055
CLASSIFICATION: T: antipyretics, nonopioid analgesics; P: salicylates
ACTION/USES: Mild to moderate pain. Prophylaxis of TIAs and MI. Inhibits production of prostaglandins. Analgesia. Reduces inflammation and fever.
ROUTES/DOSES: PO for pain – 325-500mg q3hr; PO for inflammation – 2.4 g/day
SIDE EFFECTS: nausea, heartburn, dyspepsia, epigastric distress, anaphylaxis, laryngeal edema
CONTRAINDICATIONS: hypersensitivity, chronic alcohol use/abuse, severe renal and hepatic disease. May increase risk of bleeding with warfarin, heparin, clopidogrel, etc. May increase activity of penicillins, phenytoin, and sulfonamides. Increases anticoagulant effect/bleeding risk with chamomile, clove, garlic, ginger, etc.
NURSING IMPLICATIONS: increased risk for hypersensitivity to ASA, allergies, asthma

Front 5

Ibuprofen
(Advil, Motrin)

Back 5

Ibuprofen (Advil, Motrin), Davis 622
CLASSIFICATION: T: antipyretics, antirheumatics, nonopioid analgesics, NSAIDs; P: nonopioid analgesics
ACTION/USES: mild to moderate pain or dysmenorrheal. Inflammatory disorders (rheumatoid arthritis, osteoarthritis). Lowering of fever. Inhibits prostaglandin synthesis.
ROUTES/DOSES: PO anti-inflammatory 400-800mg Q6-8hrs; <3600mg/day. Analgesic 200-400mg Q4-6hr
SIDE EFFECTS: headache, constipation, dyspepsia, nausea, vomiting, anaphylaxis
CONTRAINDICATIONS: increased risk of bleeding. Aspirin, corticosteroids, NSAIDs, alcohol. May decrease effectiveness of diuretics and antiHTN drugs. Increase risk of hypoglycemia with insulin.
NURSING IMPLICATIONS: increased risk of hypersensitivity: allergies to ASA, asthma. Assess for tinitis, asthma, urticaria.

Front 6

Naproxen
(Aleve)

Back 6

Naproxen (Aleve) , Davis 837
CLASSIFICATION: T: nonopioid analgesics, NSAIDs, antipyretics
ACTION/USES: mild to moderate pain. Fever. Inflammatory disorders (rheumatoid arthritis, osteoarthritis)
ROUTES/DOSES: PO 250-500mg, up to 1.5g/day.
SIDE EFFECTS: dizziness, drowsiness, headache, constipation, nausea, anaphylaxis, Stevens-Johnson syndrome
CONTRAINDICATIONS: ↑ risk of bleeding with anticoagulants, clopidogrel. ASA, corticosteroids, other NSAIDs. May decrease response to Ace inhibitors. ↑ risk of hypoglycemia with insulin.
NURSING IMPLICATIONS: ↑risk for hypersensitivity with allergies to ASA, asthma. Assess for asthma, urticaria, rhinitis. Passes into breast milk, not for nursing moms, avoid during 3rd trimester.

Front 7

Morphine sulfate combinations:
MS Contin, Avinza, Kadian, MSIR, Astromorph

Back 7

Morphine sulfate sustained release tablet (MS Contin); morphine sulfate sustained release capsule (Avinza, Kadian); morphine sulfate tablets (MSIR); morphine w/o preservatives (Astramorph).
Note: These drugs are HIGH ALERT drugs. (all found in Davis 813-818)
CLASSIFICATION: T: opioid analgesic P: opioid agonist
ACTION/USES: Severe pain, pulmonary edema, MI-associated pain. Alters perception of and response to painful stimuli; produces general CNS depression.
ROUTES: PO, IM, IV, SQ, rectal, epidural
SIDE EFFECTS (COMMON): confusion, sedation, constipation, hypotension, RESPIRATORY DEPRESSION
NURSING IMPLICATIONS: Assess type, location, & intensity of pain before and after administration. Assess LOC, BP, RR, & pulse before and during administration. Clarify any dosages that greatly exceed normal range. XR, SR, CR tablets should be swallowed whole, not crushed or broken. IV administration should be diluted and slow; rapid may lead to increased respiratory depression, hypotension, and circulatory collapse

Front 8

Buprenorphine
(Buprenex)

Back 8

Buprenorphine (Buprenex) (Davis 215)
Classification: T- opioid analgesics P – opioid agonists/antagonists
Action/Uses: management of moderate to severe acute pain. Suppression of w/drawl symptoms during detox and maintenance from heroin or other opioids. Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Has partial antagonist properties that my result in opioid w/drawl in physically dependent pts when used as an analgesic.
Route: IM, IV
Side Effects: confusion, hallucinations, sedation, nausea, constipation, euphoria, dizziness.
Contraindications: Use w/ extreme caution w/ MAO inhibitors. May precipitate withdrawal in narcotic-dependent patients; avoid in labor; not readily reversed by naloxone.
Nursing implications: Monitor vitals (resp. less than 10, decrease dose), assess pain.

Front 9

Carbamazepine
(Atretol)

Back 9

Carbamazepine (Atretol) (Davis, 239)
Classification: T - anticonvulsants
Action/Uses: prevention of seizures. Relief of pain in trigeminal neuralgia.
Route: PO
Side Effects: ataxia, drowsiness, fatigue, blurred vision, thrombocytopenia, urinary retention
Contraindications: do not use w/ MAO inhibitors
Nursing implications: For trigeminal neuralgia – assess for facial pain. Ask pt to identify stimuli that may precipitate facial pain.

Front 10

Gabapentin
(Gabarone)

Back 10

Gabapentin (Gabarone) (Davis, 561)
Classification: T - analgesic adjuncts, anticonvulsants
Action/Uses: Decreased postherpetic pain. Decreased incidence of seizures.
Route: PO
Side Effects: confusion, depression, drowsiness, ataxia
Contraindications: hypersensitivity.
Nursing implications: for pain – assess location, characteristics, and intensity of pain periodically during therapy

Front 11

Codeine

Back 11

Codeine / Davis 303
CLASSIFICATION: T: allergy, cold, and cough remedies, antitussives, opioid analgesics; P: opioid agonists
ACTION/USES: Binds to opiate receptors in the CNS. ↓ severity of pain, cough reflex suppression, diarrhea relief.
ROUTES: PO, IV, IM, SQ
SIDE EFFECTS: confusion, sedation, hypotension, constipation, N&V
NURSING IMPLICATIONS: Use with extreme caution in pts receiving MAO inhibitors. Overdose can result in fatalities, clarify ambiguous orders, have second practitioner independently check dose calculations and route of admin. Naloxone for overdose.

Front 12

Propoxyphene napsylate (Darvon N-100)

Back 12

Propoxyphene napsylate (Darvon N-100) / Davis 998
CLASSIFICATION: T: opioid analgesics P: opioid agonists
ACTION/USES: Binds to opiate receptors in the CNS. Decrease in mild to moderate pain.
ROUTES: PO (capsule, tablets)
SIDE EFFECTS: Dizziness, weakness, nausea
NURSING IMPLICATIONS: Use with extreme caution in pts receiving MAO inhibitors. Naloxone for overdose.

Front 13

Meperidine
(Demerol)

Back 13

Meperidine (Demerol) / Davis 755
CLASSIFICATION: T: opioid analgesics P: opioid agonists
ACTION/USES: Binds to opiate receptors in the CNS. Decrease in severity of pain.
ROUTES: PO, IM, SQ, IV
SIDE EFFECTS: Confusion, sedation, hypotension, constipation, N&V
NURSING IMPLICATIONS: Do not use with MAO inhibitors or procarbazine (may cause fatal reaction). Monitor pts on chronic or high dose therapy for CNS stimulation (restlessness, irritability, seizures) Narcan for overdose. ** In pts receiving meperidine chronically, naloxone may precipitate seizures by eliminating CNS depressant effects of meperidine. Monitor pt closely.

Front 14

Acetaminophen
(Tylenol)

Back 14

Acetaminophen (Tylenol), Davis pg. 85
CLASSIFICATION: Therapeutic-antipyretics, nonopioid analgesics
ACTION/USES: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. Used to ↓ mild pain & fever.
ROUTES/DOSES: PO or rectal suppository
SIDE EFFECTS: rash, urticaria, leukopenia, renal/hepatic failure (high doses/chronic use)
CONTRAINDICATIONS: Chronic ↑ doses may ↑ risk of bleeding in pt’s taking warfarin. Avoid ETOH since may ↑ hepatotoxicity.
NURSING IMPLICATIONS: Assess pain type, location, & intensity prior to and 30-60 min after administration. Assess fever, overall health status, and ETOH use before administering.

Front 15

Tramadol
(Ultram)

Back 15

Tramadol (Ultram), Davis pg. 1166
CLASSIFICATION: Therapeutic-analgesics (centrally acting)
ACTION/USES: Binds to mu-opioid receptors and inhibits reuptake of serotonin and norepinephrine in the CNS. Used to reduce moderate to moderately-severe pain.
ROUTES/DOSES: PO
SIDE EFFECTS: dizziness, headache, somnolence, constipation, nausea, seizures
CONTRAINDICATIONS: ↑ risk of CNS depression when used concurrently w/ other CNS depressants (ie. Alcohol, antihistamines, opioid analgesics, etc.) or w/ some herbal meds (ie. Kava, valerian, or chamomile). ↑ risk of seizures w/ high doses of penicillin, cephalosporins, opioid analgesics, or antidepressants.
NURSING IMPLICATIONS: Assess pain type, location, & intensity prior to and 2-3hrs (peak) after administration. Assess BP, RR, bowel function, and previous analgesic hx. Monitor pt for seizures.

Front 16

Naloxone
(Narcan)

Back 16

Naloxone (Narcan), Davis pg. 834
CLASSIFICATION: Therapeutic-antidotes (for opioids), Pharm-opioid antagonists
ACTION/USES: Competitively blocks the effects of opioids, including CNS & respiratory depression, w/o producing any agonist (opioid-like) effects. Used to reverse opioid overdose.
ROUTES/DOSES: IV, IM, subcutaneous injection
SIDE EFFECTS: Hypertension, hypotension, ventricular fibrillation/tachycardia, nausea, vomiting
CONTRAINDICATIONS: Can precipitate withdrawal in pts who are physically dependent on opioid analgesics. Antagonizes postoperative opioid analgesics.
NURSING IMPLICATIONS: Monitor RR (rhythm & depth), pulse, ECG, BP, and LOC q3-4hrs after expected peak of blood concentration. Assess level of pain & signs/sx of opioid withdrawal. Resuscitation equipment, oxygen, vasopressors, & mechanical ventilation should be available to supplement therapy prn.

Front 17

Methodone
(Dolophine)

Back 17

Methodone (Dolophine) [D 767]
CLASSIFICATION: T-opioid analgesic, P-opioid agonist
ACTION/USES: binds to opioid receptors in CNS, changes perceptions/responses to pain while bringing generalized CNS depression. Use-↓pain; used for heroin withdrawal
ROUTES/DOSES: PO (5mg, 10mg); IM & SQ (10mg/ml)
SIDE EFFECTS: confusion, sedation, hypotension, constipation, prolong QT interval
CONTRAINDICATIONS: Hypersensitivity, PG, lactation, MAO inhibitors, use cautiously with cardiac dz, head trauma; renal,liv & resp disorders
Drug-drug: CNS depressants, agonist-antagonist opioids, anticholingeric meds, hypotensive drugs, opioid antagonists, CY3A4 inhibitors & MAOI inhibitors, class I&III antiarrythymics, neuroleptics, tricyclic antidrepressants, Ca channel blockers, laxatives, diuretics, mineralocoriticoids, ETOH, antihistamines, sedative/hypnotics, Nalbuphine pentazocine, interferons (A), nevirapine, efavirenz, ritonavir, ritonavir/lopinavir, phenobarbital, carbamazepine, phenytoin, rifampin, fluvoxamine, dovudine, desipramine, didanosine, stavudine
Drug natural: St. John’s Wort, Kava, Valerian, Chamomile
NURSING IMPLICATIONS: Assess for pain prior and 1-2hrs after administration; assess BP,RR, HR before and during administration- if RR<10min, assess for sedation; assess for bowel fxn regularly; accidental overdosage may result in fatality

Front 18

EMLA Cream
(lidocaine 2.5mg + prilocaine 2.5mg

Back 18

EMLA Cream (lidocaine 2.5mg + prilocaine 2.5mg) [D 718,1278]
CLASSIFICATION: T- anesthetic-topical/local
ACTION/USES: inhibits ion transport across neural membranes→stopping nerve impulse→ local anesthesia; applied to skin under occlusive dressing- allowing different levels of the skin to experience anesthesia
Uses- anesthesia in minor procedures: insertion of cannulae or needles; arterial/venous/lumbar puncture; IM& SQ injections, dermal procedures, laser txmts, circumcision
ROUTES/DOSES: topical
SIDE EFFECTS: local blanching, redness, ANAPHYLAXIS
CONTRAINDICATIONS: Drug-drug: interacts with tocainide, mexiletine, local anesthetics, sulfonamides
NURSING IMPLICATIONS: Apply only to intact skin (assess for open wounds); assess skin for sensitivity/anesthesia before/after use; cream must be applied 1hr before for minor dermal procedures & 2 hrs before for major dermal procedures

Front 19

Amitriptyline
(Elavil)

Back 19

Amitriptyline (Elavil) [D p125]
CLASSIFICATION: T- antidepressants, P-tricyclic antidepressant
ACTION/USES: block uptake of 2 monoamine transmitters, norepinephrine, & serotonin→ effects intensified; has significant anticholinergic properties like dry mouth, blurred vision, photophobia, constipation, urinary hesitancy & ↑HR
Uses-depression, bipolar disorder; off label- neuropathic pain, chronic insomnia, ADHD, panic disorder, OCD
ROUTES/DOSES: PO, IM (occasional)
SIDE EFFECTS: orthostatic hypotension, anticholinergic effects (listed above), diaphoresis, sedation, cardiac toxicity, seizures, hypomania, ARRYTHYMIAS
CONTRAINDICATIONS: specifically in pts w/ MAOIs,
Drug-drug interactions: MAO inhibitors, direct acting sympathomimetic drugs, indirect acting sympathomimetic drugs, anticholinergic drugs, CNS depressants
NURSING IMPLICATIONS: Assess psychological status, arrange for an ECG especially with client >40yrs or heart dz; instruct clients to take as daily med and not as PRN- and immediately stopping meds may lead to relapse; drugs take 2-6 weeks before benefits are achieved; assess for improvement in symptoms (mood, sleep, energy, appetite, chronic pain) during evaluation of effects; don’t confuse Elavil (amitriptyline) with Oruvail (ketoprofen)

Front 20

Nortriptyline
(Aventyl)

Back 20

Nortriptyline (Aventyl) [D p. 873]
CLASSIFICATION: T- antidepressants, P-tricyclic antidepressant
ACTION/USES: block uptake of 2 monoamine transmitters, norepinephrine, & serotonin→ effects intensified; has significant anticholinergic properties like dry mouth, blurred vision, photophobia, constipation, urinary hesitancy & ↑HR
Uses: depression, bipolar disorder; off label- neuropathic pain, chronic insomnia, ADHD, panic disorder, OCD
ROUTES/DOSES: PO
SIDE EFFECTS: orthostatic hypotension, anticholinergic effects (listed above), diaphoresis, sedation, cardiac toxicity, seizures, hypomania, ARRYTHYMIAS
CONTRAINDICATIONS: specifically in pts w/ MAOIs,
Drug-drug interactions: MAO inhibitors, direct acting sympathomimetic drugs, indirect acting sympathomimetic drugs, anticholinergic drugs, CNS depressants
NURSING IMPLICATIONS: Assess psychological status, arrange for an ECG especially with client >40yrs or heart dz; instruct clients to take as daily med and not as PRN- and immediately stopping meds may lead to relapse; drugs take 2-6 weeks before benefits are achieved; assess for improvement in symptoms (mood, sleep, energy, appetite, chronic pain) during evaluation of effects; don’t confuse nortriptyline with desipramine

Front 21

Lidocaine patch
(Lidoderm)

Back 21

Lidocaine patch (Lidoderm)
CLASSIFICATION: T: anesthetic-topical
ACTION: local anesthesia by inhibiting transport of ions across neuronal membranes, preventing conduction of normal nerve impulses.
USES: Local anesthetic
ROUTE/DOSES: topical: <35g/day as cream. Patch: up to 3 patches applied for up to 12hr in any 24hr period.
SIDE-EFFECTS: -mainly applies to systemic uses-SEIZURES, CARDIAC ARREST, confusion, drowsiness, stinging, burning, contact dermatitis, erythema.
DRUG/DRUG: -applies mainly to systemic use- ↑ cardiac depression and toxicity w/ phenytoin, amiodarone, quinidine, procainamide, propranolol.
NURSING IMPLICATIONS: assess degree of numbness to affected part.

Front 22

Pregabalin
(Lyrica)

Back 22

Pregabalin (Lyrica)
CLASSIFICATION: T: analgesics, anticonvulsants. P: gamma aminobutyric acid (GABA) analogues, nonopioid analgesics.
ACTION: binds to calcium channels in CNS tissues which regulate neurotransmitter release. Does not bind to opioids receptors.
USES: ↓ neuropathic or post-herpetic pain. ↓ partial-onset seizures.
ROUTE/DOSES: PO: 50-100mg x 3/day (neuropathic pain).
SIDE-EFFECTS: dizziness, drowsiness, edema, dry mouth,
DRUG/DRUG: ↑ fluid retention w/ thiazolidinediones. ↑ CNS depression w/ other CNS depressants.
NURSING IMPLICATIONS: Assess location, characteristic, and intensity of pain periodically.