Meds Type 1
Antidiuretic Hormone
AKA: Vasopressin
Regulate blood osmolarity
Causes kidneys to reabsorb water into the blood, which decreases osmolarity
Also helps with regulation of the blood pressure
Increases blood volume, which in hence increases blood pressure
Can also cause vasoconstriction, which increase blood pressure
Amiodarone
Class 3 antiarrhythmic
Indications: treatment of life threatening ventricular arrhythmias.
Action: acts directly on heart muscle to prolong repolarization and the refractory period, increasing the threshold for ventricular fibrillation.
Adverse effects: fatigue, dizziness, heart failure, cardiac arrhythmias, cardiac arrest, constipation, N/V, hepatotoxicity, pulmonary toxicity, corneal microdeposits, vision changes.
Recommended for use during life support measures
Amiodarone has been associated with potentially fatal liver toxicity, ocular abnormalities, lung fibrosis, and the development of serious cardiac arrhythmias.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Indications: depression, anxiety, and PTSD
Common SSRIs: Sertraline, Citalopram, Escitalopram, Paroxetine, Fluoxetine
Side Effects: sexual dysfunction, weight gain, insomnia (usually improve after 3 months)
never mix with St. John’s Wart as it can cause serotonin syndrome
Calcium channel blockers
-dipine, -amil, -azem
prevent calcium from assisting in contraction of heart. Smooth muscles relax and arteries dilate —> increase blood flow to the heart
indications: angina, HTN, supraventricular tachycardia, coronary artery spasms, a fib/flutter short term, migraines, Raynaud’s disease
Contraindications: Acute MI, 2nd or 3rd degree AV block, hypotension
Adverse effects: hypotension, palpitations, tachy/bradycardia, constipation, nausea, dyspnea, rash, flushing, peripheral edema
INTERACTIONS:grapefruit juice, beta blockers, digoxin, azole antifungals, statins, clarithromycin, erythromycin, HIV drugs, cyclosporine, amiodarone
Considerations: monitor BP, pulse, wt, I/Os, edema and SOB
Pt must not stop med abruptly due to potential for rebound HTN
Pay close attention if patient has history of: hypotension,palpitations, tachy/bradycardia, constipation, dyspnea, edema
**if on NIFEDIPINE: follow admin orders carefully (esp. dosage) and closely monitor vitals
Benzothiazepines (diltiazem/cardizem), Phenylalkylamines (verapamil/ Calan), and Dihydropyridines (amlodipine, felodipine, isradipine, nifedipine) are used for treatment of chronic stable angina
Duragesic (Fentanyl)
Class: opioid analgesic
Dose: transdermal patch; replace every 72 hours
Indications: used for management of pain in opioid-tolerant patients, severe enough to require daily, around the clock, longterm opioid management treatment and for which alternative options are inadequate; also used to treat breakthrough cancer pain
Adverse Effects: application site reaction, diaphoresis, pruritus, abdominal pain, diarrhea, indigestion, nausea, insomnia, fatigue, dyspnea, urinary retention, paralytic ileus, coma, respiratory depression, drug dependence, neonatal abstinence syndrome, sedation
Contraindications: bronchial asthma, GI obstruction, Cepacol, mild or intermittent pain management, risk of life-threatening hypoventilation, opioid nontolerant patients
NI: Replace patch every 72 hours, alternate spots, monitor for addiction, monitor for sedation, only give for severe pain
ARB's
Angiotensin Receptor Blocker
Treat heart failure and high blood pressure
Common Meds: Tevetan, Avapro, Cozaar, Benicar, Micardis, Valsartan
SE: dizziness, fatigue, cough, headache, kidney failure, orthostatic hypotension, rash, angioedema, neutropenia, hyperkalemia, tachycardia or bradycardia
NI: Monitor blood pressure, use cautiously in patients with renal or hepatic disease, discontinue use in those who are pregnant, monitor heart rate, monitor potassium level, advise patient to avoid salt substitutes because of potassium content
Antacids
a group of inorganic chemicals that neutralize stomach acid. These are available in OTC form, and many patients use them to self-treat a variety of GI symptoms. They neutralize stomach acid by direct chemical reaction. They are recommended for the symptomatic relief of upset stomach associated with hyperacidity, as well as the hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, and hiatal hernia. Use in caution with electrolyte imbalances, GI obstruction, and pregnancy and lactation. Frequently causes acid rebound. Can result in alkalosis.
Aluminum salts: available as tablets, capsules, suspensions, and liquid form, do not cause acid rebound but are not very effective in neutralizing acid. They are bound in the feces for excretion. They have been related to severe constipation. Aluminum binds dietary phosphates and causes hypophosphatemia, which can then cause calcium imbalance throughout the system. Normal dose is 500-1500mg three to six times per day between meals and at bedtime for symptomatic relief of GI hyperacidity, treatment of hyperphosphatemia, and prevention of phosphate urinary stones.
Calcium salts
Magnesium salts
Sodium bicarbonate
Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
Dual purpose drug for both depression and pain
Indications: depression, anxiety, pain associated with fibromyalgia
Common SNRIs: Venlafaxine, Desvenlafaxine, Duloxetine
Side Effects: nausea, vomiting, dizziness, headaches, weight gain, dry mouth, constipation, sexual dysfunction (typically resolve after a few days)
Carbamazepine
Aka Tegretol
alter the electrical conductivity in membranes and reduce the firing rate of neurons in the brain
Indications: bipolar disorder (acute mania or maintenance and depression depending on the medication)
Contraindications: hepatic disease, pregnancy, bone marrow suppression, within 14 DAYS OF STOPPING MAOI
Adverse effects: tremors, wt gain, sedation, thrombocytopenia, pancreatitis, hepatic failure, birth defects, anticholinergic, orthostasis, ataxia, rash
**RASH MAY CAUSE STEVENS-JOHNSON SYNDROME
Interactions: anticoagulants, MAOIs, aspirin, alcohol, grapefruit juice
Considerations: must obtain baseline liver function tests and CBC, monitor labs and therapeutic levels periodically. Must obtain baseline EKG and electrolyte levels
Enoxaparin (Lovenox)
class:anticoagulant
indication: for PE and DVT, unstable angina, acute coronary syndrome, non q-wave MI
forms: given IV or Sub Q with prefilled syringes or multidose vials
action: Accelerates formation of antithrombin III–thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin.
adverse reactions: confusion, fever, N/D, thrombocytopenia, hemorrhage, hematuria, dyspnea
Interactions: other anticoagulants, SSRIs, alfalfa, anise, and bilberry
nursing considerations: monitor VS and site for hematoma and bleeding, get baseline coagulation studies, for abnormal coagulation parameters or bleeding monitor anti-Xa levels not PT and PTT, monitor pts closely that receive epidural or spinal anesthesia, never give IM, routine head to toe assessment for bleeding, bruising, petechiae, and other signs of bleeding
Aripiprazole (Abilify)
Trade Name: Abilify
Class: Atypical Antipsychotics
Dosage: Adult: 10-15 mg/d PO, Pediatric (13-17 y): 10-30 mg/d PO
Indications: Treatment of acute manic and mixed episodes of bipolar disorders
SE: Sedation +, Anticholinergic +, Hypotension ++, Extrapyramidal +
Dizziness, N/V, drowsiness, excessive saliva/drooling, weight gain, headache, insomnia, etc.
This has medium potency
Watch for extrapyramidal side effects and addiction as there is a potential with this medication
Antihypertensives
Purpose: use to treat/manage high blood pressure.
Agents:
ACE Inhibitors (-pril). (RAISE POTASSIUM)
Angiotensin II Receptor Blockers (-sartan).
Renin Inhibitors (Aliskiren).(RAISE POTASSIUM)
Calcium Channel Blockers (-pine, -mil, -zem).
Vasodilators (severe hypertension).
Diuretics (make you pee!).
Beta-blockers (-olol).
Beta Blockers cause issue in asthma
Contraindications: Pregnancy & Lactation, hypotension.
SE: dry cough, GI issues, electrolyte imbalance, hypotension, dizziness.
NI: assess blood pressure, get baseline vitals (HR, BP, RR), monitor cardiac status, monitor I&O (Diuretics), assess kidney and liver function.
Tricyclic (TCAs)
Indications: depression and anxiety
Common TCAs: -ipramine, -iptyline, doxepin, amoxapine
Side Effects: dry mouth, constipation, photophobia, urinary retention, drowsiness, blurred vision
Cephalosporin
group of antibiotic the are effective against a wide range of bacteria
Inhibits the synthesis of bacterial cell walls, causing cell death in susceptible bacteria.
Contraindicated in those with known allergies to cephalosporins or penicillins
Use with caution in those with hepatic and renal impairment, pregnancy, or lactating
Reserve cephalosporins for appropriate situations because cephalosporin-resistant bacteria are appearing in increasing numbers
perform culture and sensitivity test before
Adverse effects: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, and pseudomembranous colitis (dangerous disorder with symptoms that include violent, bloody diarrhea, or abdominal pain (discontinue immediately)), headache, dizziness, lethargy, paresthesias, super infection, and nephrotoxicity.
Drug-drug interactions: aminoglycosides (increase risk for nephrotoxicity; frequently monitor BUN and creatinine levels), anticoagulants (may increase bleeding: teach patient to monitor blood loss), alcohol (avoid 72 hrs after to prevent disulfiram-like reaction (flushing, throbbing headache, nausea and vomiting, chest pain, palpitations, dyspnea, syncope, vertigo, blurred vision, and, in extreme reactions, cardiovascular collapse, convulsions, or even death)).
1st gen.
- Cefadroxil and Cephalexin (keflex)
- Treat Gram-positive bacteria affected by penicillin G and Gram-negative bacteria p.mirabilis, E. coli, K. pneumoniae
2nd gen.
-Cefaclor (ceclor), Cefoxitin, Cefprozil, and Cefuroxime (zinacef)
-Treat the same bacteria as 1st gen as well as H. influenza, Enterobacter aerogenes, and Neisseria spp.
3rd Gen.
-Cefdinir (Omnicef), Cefotaxime (Claforan), Cefpodoxime, Ceftazidime (tazicef, Ceptaz), Ceftriaxone (Rocephin)
- Treats the same bacteria as 1st and 2nd gen (most potent against gram-negative) as well as Serratia marcescens.
4th gen.
-Cefepime (maxipime)
-active against gram-positive and gram-negative bacteria including cephalosporin-resistant staphylococci and P. aeruginosa.
-Ceftolozane-tazobac-tam (zerbaxa)
5th gen.
-Ceftaroline (teflaro)
- effective some methicillin-resistant organisms and is indicated for treatment of community-acquired pneumonia and some skin and skin structure infections
Flu vaccine, Varicella vaccine
flu vaccine recommended annually, varicella first dose at 12-15 months and second dose at 18 months or after (before school entry)
given IM
action: stimulates active immunity in people who are at high risk of developing
contraindications: contraindicated for those with immune deficiency, depends on immune status during pregnancy, certain allergies
adverse effects: moderate fever, rash malaise, chills, fretfulness, drowsiness, anorexia, vomiting, and irritability, may have pain, redness, swelling at injection site
interactions: should not be given with immunosuppressive drugs including corticosteroids
nursing considerations: get H&P, determine ROM of extremity before admin, assess tissue perfusion, do not give to treat or if patient shows sign of infection, do not give if pt has received blood or blood products
Albuterol
Trade Name: Proventil HFA
Class: Sympathomimetics
Dosage: Adult: 2-4 mg PO tid to qid or two inhalations q4-6h or two inhalations 15 min before exercise or 2.5 mg oral inhalation nebulizer tid or qid
Pediatric (>12): Adult Dose
Pediatric (6-12 y): 2 mg tid to qid oral tablets
Pediatric (6-14 y): 2 mg tid to qid PO oral syrup
Pediatric (2-6 y): 0.1 mg/kg PO tid oral syrup
Pediatric (2-12 y Inhalation): 1.25-2.5 mg; for prevention of exercise-induced bronchospasm, 200-mcg capsule inhaled 15 min before exercise
Indications: Long- acting treatment and prophylaxis of bronchospasm and prevention of exercise-induced bronchospasm in patients 2 y and older
SE: tachycardia, hypertension, dizziness, tremors, headache, arrhythmias
NI: Monitor heart rate, monitor blood pressure, monitor for hypersensitivity, monitor lung sounds, monitor resp. rate, monitor oxygen saturation, teach proper administration
Bulk-forming laxatives
Purpose: cause the fecal matter to increase in bulk.
Agents:
Methylcellulose (Citrucel)
Polycarbophil (FiberCon)
Psyllium (Metamucil)
Contraindications: fecal impaction or intestinal obstruction, acute abdominal issues.
Caution: Heart block, CAD, debilitation, pregnancy/lactation.
SE: diarrhea, abdominal cramping, nausea, weakness, fainting, sweating, palpitations.
NI: monitor neurological status, monitor electrolyte levels, promote fluid intake, monitor I&O, assess for fecal impaction, have bedside commode readily available if needed.
Monoamine Oxidase Inhibitors (MAOIs)
never mix with other antidepressants as it can cause serotonin syndrome
avoid foods rich in tyramine (aged cheeses, pickled/smoked meats, beer, wine, avocado, sauerkraut) as it can cause a headache, hypertension, heart attack, or CVA stroke
Indications: depression, panic disorder, and social phobia
Common MAOIs: Phenelzine, Selegiline, Isocarboxazid, Tranylcypromine
Side Effects: dry mouth, constipation, diarrhea, rise in BP causes headaches, dizziness, nausea, vomiting, vision or hearing loss
Monitor for a hypertensive crisis
Divalproex (depakote)
Valproic Acid
Treatment of partial seizures, absence seizures, and bipolar disorder.
act to increase gamma-aminobutyric acid (GABA) in brain
Adverse effects: Hepatotoxicity, birth defects, pancreatitis, GI effects, headache, tinnitus, blurred vision, ataxia, and infection.
Contraindications: known allegery, use with caution with hepatic or renal impairment, caution with pregancy or lactation (only use if benifit outweighs risk)
Drug-drug interactions: Valproic acid can increase serum levels and potential toxicity of phenobarbital, ethosuximide, diazepam, primidone, and zidovudine (pt should be monitored carefully and adjust dosage appropriately).
Glipizide (Glucotrol)
**Controls high blood sugar in people with type 2 diabetes
Therapeutic class: Antidiabetics, Sulfonylureas
Action: Stimulates insulin release from pancreatic beta cells, reduces glucose output by the liver, and increases peripheral sensitivity to insulin.
Forms:
Tablets (extended-release): 2.5 mg; 5 mg; 10 mg
Tablets (immediate-release): 5 mg; 10 mg
Administration:
Give immediate-release tablet about 30 minutes before meals.
Give extended-release tablet with breakfast.
Don’t split or crush extended-release tablets.
Patients on nothing-by-mouth status or those requiring decreased caloric intake may need doses withheld to avoid hypoglycemia.
Adverse Reactions:
CNS: dizziness, drowsiness, headache, nervousness, tremor.
GI: nausea, dyspepsia, flatulence, constipation, diarrhea, vomiting.
Hematologic: leukopenia, hemolytic anemia, agranulocytosis, thrombocytopenia.
Metabolic: hypoglycemia.
Skin: rash, pruritus, urticaria, photosensitivity reactions.
Nursing considerations:
Advise patient to always wear or carry medical identification.
Warn patient to avoid alcohol, which lowers glucose level.
Inform patient that something resembling a tablet may appear in the stool; assure patient that it’s the nonabsorbable shell of the extended-release tablet.
Instruct patients about disease and importance of following therapeutic regimen, adhering to diet, losing weight, getting exercise, and avoiding infection. Explain how and when to monitor glucose level, and teach recognition of episodes of low and high glucose levels.
Amantadine
Trade Name: Gocovri, Symadine, Symmetrel
Class: Antiparkinson Agents & Antivirals
MOA: Potentials the action of dopamine in the CNS & will also prevent penetration of influenza A vaccine into the host cell
Dose/Route: Adult: 200 mg/d PO; Pediatric (9-12 years): 100 mg PO bid; Pediatric (1-9 years): 4.4-8.8 ,g/kg/d PO daily
Indications: Treats parkinson disease and prevents respiratory virus infections, such as Influenza A
SE: dizziness, insomnia, anxiety, confusion, depression, drowsiness, psychosis, seizures, blurred vision, dry mouth, hypertension, edema, CHF, urinary retention, leukopenia, neutropenia, N/V, constipation, anorexia
Monitor for toxicity= issues with CNS will occur
CNS issues: seizures, suicidal ideation, ataxia, dizziness, insomnia, anxiety, confusion, depression, drowsiness, psychosis, urges (gambling, sexual)
The reversal for this is Physostigmine
Nursing Considerations: Inform patient to take around the clock, watch for dizziness and blurred vision, change position slowly to prevent dizziness, Dry mouth can be relieved with good oral hygiene, Notify health care provider if confusion, difficulty with urination, edema, shortness of breath, or worsening of parkinson's symptom; Do not give to those with end stage renal disease; Monitor for anticholinergic effects, such as dry mouth, blurred vision, and constipation; Inform patient to avoid alcohol & to not drive or operate heavy machinery until they know how the medication will affect them
Nursing Implications with Antidepressants
monitor for suicidal thoughts (especially in young adults), teach pt to change position slowly as antidepressants decrease blood pressure, inform client of risk of weight gain
Duloxetine (cymbalta)
Trade Name: Cymbalta
Class: SNRI
Dose: 20 mg/d PO bid up to 60 mg/d may be needed
Indications: Treatment of major depressive disorder, neuropathic pain, fibromyalgia
Adverse Effect: neuroleptic malignant-like syndrome reaction, seizures, thrombophlebitis, supraventricular dysrhythmia, hepatic failure, headache, abnormal vision, nausea, agitation, etc.
Contraindications: alcohol intoxification, alcohol usage, closed-angle glaucoma, hepatic disease, hepatitis, hypersensitivity, jaundice, heart issues, kidney disease, those taking other depression meds
NI: Inform patient to not take this with alcohol, Don’t give to patient with glaucoma as it can increase intraocular pressure, this medication interacts with other antidepressant medications, monitor for s/s of neuroleptic malignant-like syndrome, watch for serotonin syndrome
Glucocorticoids
Includes: beclomethasone (Beconase AQ, QVAR Redihaler), betamethasone (Celestone Soluspan), budesonide (Rhinocort, Entocort EC, Pulmicort Flexhaler), cortisone, dexamethasone, flunisolide, hydrocortisone (Cortef), methylprednisolone (Medrol), prednisolone (Omnipred, Pred Forte), prednisone (Rayos), triamcinolone (Kenalog, Triesence).
Indicated for short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation.
Contraindications include the presence of any known allergy to any steroid preparation, if there is an acute infection present, lactation, diabetes, acute peptic ulcers, other endocrine disorders, and pregnancy.
Adverse effects include growth retardation associated with suppression of hypothalamic-pituitary system, burning and stinging sensations at site of injection.
Side effects include weight gain, feeling hungry, water retention and swelling, mood swings, blurred vision, feeling nervous or restless, trouble sleeping, muscle weakness, acne and stomach irritation.
Therapeutic and toxic levels increase if given with erythromycin, ketoconazole, or troleandomycin. Serum levels and effectiveness may decrease if combined with salicylates, barbiturates, phenytoin, or rifampin.
Do not give live vaccines when the patient is immunocompromised. Assess weight, glucose tolerance, endocrine function, renal function, serum electrolytes, and perform an eye exam.