Pharm Flashcards
anticholinergic effects
dry mouth, urinary retention, blurry vision
Symptoms – dry mouth, dysphagia, urinary retention, impotence, nasal congestion
Nursing:
o Sugarless lozenges
o Good mouth care
o Void before taking medication
Adrenergics
Levophed (Norepinephrine), Intropin (Dopamine), Adrenalin (epinephrine)
Uses: cardiac arrest, COPD
Action: stimulate beta-2 receptors in lungs (so increase peripheral resistance and cause bronchodilation)
S/E: dysrhythmias, tremors, anticholinergic effects
Nursing: Monitor bp, peripheral pulses, and output
pt possibly drowsy
Anti-anxiety
(Benzodiazepines, Nonbenzodiazepines, Herbals)
Librium (chlordiazepoxide), xanax (alprazolam), ativan (lorazepam), vistaril (hydroxyzine), Equanil
Uses: anxiety disorders, panic attacks, manic episodes
Action: affect neuro transmitters
S/E: sedation, confusion, hepatic dysfunction (remember CNS depressant)
Nursing: potential for addiction/overdose
- avoid alcohol (CNS depressant)
- monitor liver functions ( AST, LST) (LDH)
- DC med very slowly
- smoking or drinking caffeine will decrease effectiveness of meds (complete in depth assessment)
Antacids
Amphojel (aluminum hydroxide), Milk of Magnesia (magnesium hydroxide), Maalox (both)
Uses – peptic ulcer, indigestion (prevent or treat), reflex esophagitis
Action – neutralize gastric acids
S/E: constipation, diarrhea, acid rebound
Nursing:
• Interferes with absorption of antibiotics, iron preps, INH, oral contraceptives
• Monitor bowel function – can cause bowel addiction
• Timing – given 1-2 hours after eating and other medications
• Fluid and electrolyte balance important bc affecting GI tract – so monitor labs!
Antidysrhythmics
Atropine sulfate, Lidocaine, Pronestyl (procainamide), Quinidine, Isuprel (Isoproterenol)
Uses – atrial fibrillation/flutter, tachycardia, PVCs (Decrease myocardial irritability)
Action – interfere with electrical excitability of the heart
S/E: light headedness, bradycardia, hypotension, urinary retention
Nursing
• monitor vitals signs (especially pulses and bp)
• monitor cardiac rhythm
• move positions slowly
with beta blockers worry about
broncospasms so affects airway
General S/E with antibiotics
Allergies – mild to anaphylaxis
Super-infection - Kill abnormal as well as normal flora in the body
Organ toxicity – liver and kidneys
General teaching with antibiotics
o take until gone
o do not culture and sensitivity first
o encourage fluids – hard on kidneys so need more fluids
o check expiration date
Aminoglycosides
(mycin) - Antibiotics
Gentamycin, Neomycin, Streptomycin, Tobramycin
Uses – Pseudomonas, E. coli
Action – inhibits protein synthesis in gram-negative bacteria
S/E: ototoxicity, anorexia, nausea, vomiting, diarrhea, nephrotoxic (kidneys)
Nursing: • Check 8th cranial nerve (hearing) • Check renal function (BUN, urinary output 1200 ml per day) • Take 7-10 days – until med complete • Encourage fluids – 3000 ml/day
Cephalosporins
antibiotics
Ceclor (Cefaclor), Ancef (cefazolin), Keflex (chephalexin), Rocephin (Ceftriaxone), Mefoxin (cefoxitin)
Uses – tonsillitis, otitis media, peri-operative prophylaxis, meningitis
Action – inhibits synthesis of bacterial cell wall
S/E: bone marrow depression, super-infections, rash
Nursing:
• Take with food – cause GI upset
• Cross allergy with PCN!!!
• Avoid alcohol – can cause flushing, dizziness, and muscle aches
• Obtain C&S before first dose
• May give false positive for protienuria or glucose in urine
Macrolide antibiotics
Erthromycin, Cleocin (clindamycin)
Uses – acute infections, acne, Upper respiratory infections, prophylaxis before dental procedures if allergic to PCN
Action – binds to cell membrane and changes protein function
S/E: diarrhea, confusion, hepatotoxicity, super-infections
Nursing:
• Take 1 H ac or 2-3 h pc – not with food, take with full glass of water not fruit juice
• Monitor liver function
• Increases effectiveness of Coumadin and theopaline (respiratory drug)
Penicillins
Amoxil (amoxicillin), Ampicillin , Augmentin (Amoxicillin/clavulanate)
Uses – moderate to severe infections, syphilis, gonococcus infections, Lyme disease
Action – inhibits synthesis of cell wall
S/E: stomatitis (breakdown in the mouth and along GI tract), diarrhea, allergic reactions, renal and hepatic changes
Nursing: • Check for hypersensitivity - multiple exposures cause reaction • Give 1-2 h ac or 2-3 h pc • Cross allergy with cephalosporins • Watch renal and hepatic labs
Sulfonamides
Gantrisin (acetyl sulfisonxazole), Bactrim (co-trimoxazole), Azulfidine (sulfasalazine)
Uses – ulcerative colitis, Crohn’s disease, otitis media, UTIs
Action – antagonize essential component of folic acid synthesis
S/E: peripheral neuropathy, crystalluria, photosensitivity, GI upset, stomatitis
Nursing:
• Take with meals or food
• Encourage fluids – bc of crystal formation 3000 ml/day
• Good mouth care
Tetracyclines
Vibramycin (doxycycline), Panmycin (tetracycline)
Uses – infections, acne, prophylaxis for ophthalmia neonatorum (given to every baby when born to prevent infection)
Action – inhibits protein syntheis
S/E: discoloration of primary teeth if taken my mom during pregnancy, glossitis, rash, phototoxic reactions
Nursing:
• Take 1 h ac or 2-3 h pc
• Do not take with antacid, milk, iron – decrease absorption
• Note expiration date – if taken beyond expiration is toxic
• Monitor renal function
• Avoid sunlight - Sunblock!
All antibiotics before and after meals except
cephalosporins and sulfonamides
Antimpotence
Viagra (sildenafil), levitra (vardenafil), Cialis (Tadalafil)
S/E: headache, hypotension, priapism
Contraindications: nitrates, alpha blockers - will cause hypotension
Nursing:
• Can not take with grapefruit juice
• Call PCP if erection lasting longer than 4 hrs
Meds that can’t be taken with grapefruit juice
lipitor, antimpotence drugs, anticonvulsants
Anticholinergics
– inhibit the action of acetcholine, block parasympathic nerve
Pro-Banthine (propanthekine), Atropine, Scopace (scopolamine)
Uses – ophthalmic exam, motion sickness, pre-operative (to reduce GI and bladder motility)
Action – dilates pupils, causes bronchodilation and decreased secretions, decreases mobility and GI secretions
S/E: blurred vision, dry mouth, urinary retention, change in heart rate
- Nursing • monitor output (1500 ml normal) • contraindicated with glaucoma • give 30 min ac, hs, or 2 h pc • not used with paralytic illeus – don’t want to slow down more, BPH – enlarged prostate and don’t want to slow down bladder
Anticonvulsants
Dilatin (phenytoin), Luminal (Phenobarbital), depakote (divalproex sodium), Tegretol (carbamazepine), Klonopin (clonazepam)
Uses – seizures
Action – decreases flow of calcium and sodium across neuronal membranes
S/E: respiratory depression, aplastic anemia, gingival hypertrophy, ataxia
Nursing • don’t discontinue abruptly • monitor I&O • caution with use medications that lower seizure threshold (MARI, antiphsychotics) • avoid alcohol – CNS depressant • pts become drowsy • may turn urine pink
Monamine oxidase inhibitors (MAOI)
Antidepressant
Marplan (isocarboxazid), parnate (tranylcypromine), nardil (phenelzine)
Uses – depression, chronic pain
Action – causes increased concentration of neurotransmitters
S/E: hypertensive crisis when taken with tyramine-containing foods, photosensitivity
• Hypertensive crisis – severe headache, palpitations, diaphoretic, stiff neck – can progress to intracranial hemorrhage
Nursing:
• Avoid foods containing tyramine (aged cheese, bologna, pepperoni, salami, bananas, raisins, beer) – can cause hypertensive crisis
• Monitor output
• Takes 4 weeks to work
• Can’t take with CNS stimulates and cold medications
Selective serotonin reuptake inhibitors
antidepressants
Prozac (Fluoxetiner), Paxil (paroxetine hydrochloride), Zoloft (sertraline)
Uses – depression, OCD, bulimia
Action – inhibits CNS uptake of serotonin
S/E: anxiety, GI upset, change in appetite and bowel function, urinary retention
Nursing: • Suicide precautions (Do you have a plan! – only yes/no question) • Takes 4 weeks for full effect • Take in AM • Monitor nutrition • Turn urine pink
Tricycilics
Antidepressants
Elavil (amitriptyline), Toranil (imipramine), Norpramin (desipramine)
Uses – depression, sleep apnea
Action – inhibits reuptake of neurotransmitters
S/E: sedation, anticholinergic effects, confusion, postural hypotension, urinary retention
Nursing: • Monitor for suicide • Takes 2-6 weeks to work • Take at night – bc sedative effect • Monitor vital signs • Tell pt to slowly get up and down • Wean off over time – headache, vertigo, weight gain if come off too quickly • No alcohol • Avoid exposure to the sun
Heterocyclics
Antidepressant
Wellbutrin (bupropion), Desyrel (trazadone)
Uses – depression and smoking cessation
Action – alter affects serotonin in the CNS
S/E:
• Wellbutrin – agitation
• Desyrel - sedation
Nursing:
• Avoid alcohol and CNS depressants
• Wean off slowly
Non insulin antidiabetic
Diabinease, Orinase, Dymelor, Micronase
Uses – Type II diabetes
Action – stimulates insulin release from beta cells in pancreas - Push pancreas to produce more insulin – only used in type II
S/E: hypoglycemia, allergic skin reactions, GI upset
Nursing:
• Taken before breakfast – take to tell pancreas to produce insulin before eating, take awhile to work
• Instruct pt that they need to eat if taken the medication
• Monitor glucose levels (70-110 normal)
• Avoid alcohol, aspirin, sulfamides, oral birth contro, MAOIs – increase chance of hypoglycemia
Antidiarrheal
Kaopectate (bismuth subsalicylate), Lomotil (diphenoxylate/atropine), Imodium (loperamide), Paregoric (tincure of opium)
Uses – diarrhea
Action – slows peristalsis, increase tone of sphincters
S/E: constipation, anticholinergic effects (dry mouth, urinary retention, blurry vision) dizziness, drowsiness
Nursing
• do not use with abdominal pain
• monitor for urinary retention – pay attention to output
• give 2 h before or 3 h after other meds
• encourage fluids
Antiemetics
Tigan (Trimethobenzamide), Compazine (Prochlorperazine), Reglan (metoclopramdie), Antivert (Meclizine), Dramamine
Uses – vomiting
Action – increases GI motility, blocks effect of dopamine in chemoreceptor trigger zone
S/E: sedation, anticholinergic effects
Nursing
• used before chemotherapy
• when used with viral infections may cause Rye’s syndrome (toxic encephalopy)
Antifungals
Amphotericin B (fungizone), Nystatin (mycostatin)
Uses – candidiasis, oral thrush, histoplasmosis
Action – impairs cell membrane of the fungus
S/E: hepatotoxicity (hard on the liver to metabolize), thrombocytopenia (decrease platelets, so monitor for bleeding and hemorrage), leucopenia (decreased WBC, increase risk for infection), pruritius (itching)
Nursing
• give with food
• monitor liver function (AST, ALT)
• good oral hygiene
Antigout
Colchincine (colsalide) (acute phase of gout), Probenecid (benemid) (chronic phase of gout), Allopurinol (Zyloprim)
Uses – gout
Action – decreases production and resorption of uric acid
S/E: agranulocytosis, GI upset, renal calculi
Nursing
• monitor for renal calculi (give fluids 3000 ml/day)
• give with milk, food, antacids
Antihistamines
Chlor-Trimeton, Benadryl (diphenhydramine), Phenergan (promethazine), Laratadine
Uses – allergic rhinitis, allergic reactions to blood, reactions to other meds
Action – block effects of histamine
S/E: drowsiness, dry mouth, photosensitivity, bronchospasm
Nursing • give with food • use sunscreen • avoid alcohol • assess respirations, mouth care
Antihyperlipidemic Agents
Questran (Cholestyramine) – block absorption, Lipitor (atorvastin) – inhibit synthesis of absorption of cholesterol and triglycerides
Uses – elevated cholesterol, reduce incidence of cardiovascular disease
Action – inhibits cholesterol and triglyceride synthesis
S/E: constipation, fat-soluble vitamin deficiency
Nursing
• take at hs or 30 min before ac
• administer 1 h before 4-6 h after other meds
• assess diet
ACE inhibitors
(A = arteries, decrease bp by affecting the arteries in the body) – the prils
Capoten (captoril), vasotec (enalpril)
Uses – HTN, CHF
Action – blocks ACE in lungs (so block angiotension I to angiotension II – causes vasoconstriction – so will have vasodilation if blocked)
S/E: GI upset, orthostatic hypotension, dizziness
Nursing:
• Give 1 h ac or 3 h pc – bc food decreases absorption
• Change positions slowly
• Monitor vitals
Beta adrenergic blockers
(B is for beats, affects heart beats itself – slows them down)
Tenormin (atenolol), Corgard (nadolol), Inderal (propranolol)
Uses – HTN, angina, SVT
Action – blocks beta-adrenergic receptors – decreases excitability of the heart
S/E: changes in heart rate, hypotension, bronchospasms
Nursing:
• Masks signs of shock and hypoglycemia
• Take with meals
• Do not discontinue abruptly – taper over 2 weeks
Calcium channel blockers
(C in the heart)
Procardia (nifedipine), Calan (verapamil), Cardizem (diltiazem)
Uses – angina, HTN, interstitial cystitis
Action – inhibits movement of calcium across cell membrane
S/E: orthostatic hypotension, renal failure, angioedema
Nursing:
• Caution about position changes
• Monitor for edema, (facial swelling and shortness of breath)
• Vital signs are important (pulse and bp)
Angiotensin II receptor blockers
(sartans)
Candesartan (Atacand), Losartan (Cozaar)
Uses – HTN, heart failure, MI, diabetic neuropathy, stroke prevention
Action – blocks vasoconstriction and aldosterone effects of angiotensin II
S/E: hypotensin, dizziness, GI distress
Nursing:
• Monitor vitals
• Do not chew or divide sustained release tablets
Alpha 1 adrenergic blockers
Doxazosin (Cardura), Prazosin (Minipress)
Uses – hypertension, benign prostatic hypertrophy, reflex tachycardia
Action – selective blockade of alpha 1 reception in peripheral blood vessels (affects peripheral system not heart itself)
S/E: reflex tachycardia, orthostatic hypotension, nasal congestion
Nursing:
• Administer 1st dose at bedtime to avoid fainting
• Monitor BUN, weight, and edema
• Change position slowly
Centrally acting alpha-andrenergics
Aldomet, Catapres
Uses – HTN
Action – stimulates alpha receptors in medulla (affecting CNS to tell the heart to do something different)
S/E: sedation, orthostatic hypotension
Nursing: • Don’t discontinue abruptly • Monitor for fluid retention • Change position slowly • Check blood pressure and pulses
