UWorld for Nclex Pharmacology

*Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs DRUG LIST NCLEX ANTIBIOTICS *All antibiotics have GI effects Aminoglycosides -micin i.e. gentamicin -mycin i.e. vancomycin, neomycin Side effects: -Ototoxicity -Nephrotoxicity -GI irritation Vancomycin: Red man syndrome; administer over 60 minutes Cephalosporins (broad spectrum) Floroquinolones Floroquinol(one) bone marrow depression Macrolides Cef- i.e. cefaclor, cefradoxil, cefdinir, cefotaxime, cephalexin -floxacin i.e. ciprofloxacin, gatifloxacin -thromycin i.e. azithromycin, erythromycin -GI disturbances -Nephrotoxicity -Superinfections i.e. C. difficile Similar to penicillins; contraindicated for clients with penicillin sensitivity Headache, dizziness, insomnia, depression -GI effects -bone marrow depression i.e. thrombocytopenia -photosensitivity, fever, rash -GI effects -pseudomembranous colitis (c. diff colitis) -superinfections -Hepatotoxic 1 -Assess for allergies esp. anaphylactic allergies -Monitor appropriate lab values prior to administration i.e. aminoglycosides with BUN and Cr -Monitor for adverse effects and report to HCP if they occur -Monitor ins and outs -Encourage fluid intake -Emphasize importance of completing full prescribed course *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Penicillins -cillin i.e. amoxicillin, carbenicillin, ampicillin Sulfonamides Sulfa- i.e. sulfadiazine, sulfasalazine Tetracyclines -cyclines i.e. doxycycline, tetracycline Antifungal medications Amphotericin B -nazole i.e Fluconazole Ketoconazole Antiviral medications -clovir i.e. acyclovir, ganciclovir, foscarnet -causes a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes -hypersensitivity reactions, including anaphylaxis -related to cephalosporins -GI effects -hepatotoxic and nephrotoxic -bone marrow depression i.e. thrombocytopenia -photosensitivity -ANY RASH WITH SULFONAMIDES MUST BE REPORTED TO HCP! -GI effects -hepatotoxicity -teeth staining and bone damage -photosensitivity, hypersensitivity **Can cause pill induced esophagitis. Clients taking this should sit upright for a period of time after ingestion to prevent tablet from lodging in esophagus -gastrointestinal effects -neuritis, dizziness, headache, malaise, drowsiness, hallucinations -hearing loss (ototoxicity) -peripheral neuritis 2 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs CARDIOVASCULAR MEDICATIONS Anticoagulants Thrombolytic medications Antiplatelet medications Positive inotropes/cardiotonic medications Oral: Warfarin, Dabigatran, Rivaroxaban Parenteral: Dalteparin, Heparin, Enoxaparin, Desirudin, Fondaparinux, Tinzaparin, Argatroban -teplase i.e. alteplase, reteplase, tenecteplase Prevent clot formation by inhibiting factors in clotting cascade and decreasing blood coagulability i.e. in MI, mechanical heart valves, DVT, atrial fibrillation, unstable angina Side effects: Hemorrhage Hematuria Thrombocytopenia Hypotension Activates plasminogen which digests plasmin and dissolves clots in cases of MI, DVT, occluded shunts and pulmonary emboli Bleeding Dysrhythmias Allergic reactions Aspirin, clopidogrel, Inhibit aggregation of cilostazol, dypiridamole, platelets in clotting process, ticlopidine thereby prolonging bleeding time Dobutamine Stimulate myocardial contractility and produce a Dopamine Imanrinone positive inotropic effect for Milrinone heart failure -increases CO, decreasing preload, improving blood flow to periphery and kidneys and increasing fluid excretion 3 GI bleeding Bruising Hematuria Tarry stools Dysrhythmias Hypotension Thrombocytopenia Adverse effects: Hepatotoxicity Hypersensitivity- wheezing, SOB, pruritus, urticaria (hives, clammy skin and flushing -contraindicated in clients taking NSAIDs, gingko and ginseng, corticosteroids, vit K containing foods (have this in moderation; no sudden increase or decrease) -contraindicated with active bleeding -Heparin-Induced Thrombocytopenia can be ironic in that it can cause stroke and embolism -Contraindicated in active bleeding, history of hemorrhagic brain attack (stroke), intracranial or intraspinal surgery within the last 2 months, uncontrolled HTN -Apply direct pressure over a puncture site for 20 to 30 minutes -Used only for acute, life-threatening conditions Antidote: Aminocaproic acid -may be used with anticoagulants -used in prophylaxis of long-term complications following MI, CAD, stents, and strokes -used for IV administration; administer with IV infusion pump -monitor electrolyte (may lower K) and liver enzyme levels (may increase due to hepatotoxicity), platelet count, and renal function studies *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Cardiac glycosides Digoxin Stimulates myocardial contractility by inhibition of sodium-potassium pump -slows HR (negative chronotrope) and slows conduction velocity (negative dromotrope) -GI effects -headache -visual disturbances: diplopia, blurred vision, photophobia -drowsiness -bradycardia -fatigue, weakness -used for HF and cardiogenic shock, anything atrial (tach, fibrillation, flutter) -Early signs of digoxin toxicity present as GI symptoms (anorexia, nausea, vomiting, diarrhea); then heart rate abnormalities and visual disturbances appear -hypokalemia can cause digoxin toxicity; toxic levels above 0.5 to 2 are toxic (POTASSIUM COMPETES WITH DIGOXIN) Peripherally acting Alpha Adrenergic blockers -zosin i.e. doxazosin, prazosin, terazosin Decrease sympathetic vasoconstriction resulting in vasodilation and decreased BP Orthostatic hypotension Reflex tachycardia Drowsiness Nasal congestion Sodium and water retention -Monitor for fluid retention and edema -Avoid over the counter meds -change positions slowly to prevent orthostatic hypotension Centrally acting Adrenergic blockers Clonidine Guan- i.e. Guanabenz, Guanfacine Methyldopa -prils i.e. perindopril, enalapril Causes vasodilation, reducing peripheral resistance Na and water retention Drowsiness Bradycardia Hypotension Hyperkalemia Hypotension Persistent dry cough (ACEI) Angioedema (ACEI)** Hypoglycemia with DM -contraindicated in impaired liver function -Do not discontinue meds abruptly as it can lead to severe rebound HTN ACE inhibitors and ARBs Causes vasodilation; treats HTN and CHF -sartans i.e. losartan, eprosartan Nitrates Isosorbide Nitroglycerin Vasodilates and improves blood flow in MI Vasodilation/ Orthostatic hypotension Flushing or pallor Confusion Reflex tachycardia Dry mouth 4 -can cause hyperkalemia ! Avoid use with potassium supplements and potassiumsparing diuretics -Report side effect angioedema to the HCP right away -teratogenic drugs -administer up to three times in 15 mins; if after 5 mins symptoms have not been relieved at home, call 911 right away -always assess BP before administration and lower head of bed if hypotension occurs -administer sublingually *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Beta blockers -lol i.e. metroprolol, bisoprolol Block release of cathecholamines thus decreasing HR and BP Bradycardia Bronchospasm Hypotension Dizziness Calcium channel blockers -dipine i.e. amlodipine, felodipine Verapamil Diltiazem Promote vasodilation of coronary and peripheral vessels Miscellaneous vasodilator Nesiritide Vasodilates arteries and veins in CHF Bradycardia Reflex tachycardia as a result of hypotension Changes in liver and kidney function Hypotension Confusion Dysrhythmias Adrenergic Agonists Dopamine Epinephrine -statin i.e. atorvastatin, rosuvastatin Positive inotropes increases BP and cardiac output Lowers serum cholesterol HMG-CoA Reductase Inhibitors (statins) Antidysrhythmics Amiodarone Tachycardia Elevated liver enzyme levels Muscle cramps (myopathy) Nausea, abd pain or cramps Dizziness, headache Blurred vision (Cataract formation) Pulmonary fibrosis Photosensitivity Peripheral neuropathy Tremor 5 -keep in a dark tightly closed bottle; cannot be mixed with other drugs - contraindicated in clients with asthma, bradycardia or stroke, DM -assess for resp distress and for signs of wheezing and dyspnea -can mask symptoms of hypoglycemia i.e. tachycardia and nervousness; monitor BG -better choice for clients with asthma -monitor kidney function tests -DO NOT ADMINISTER WITH GRAPEFRUIT JUICE as it can lead to severe hypotension Administer by continuous infusion via IV pump Monitor BP, cardiac rhythm, urine output and body weight -Epinephrine used for cardiac stimulation in cardiac arrest (asystole) -Lovastatin is highly protein-bound and should not be administered with anticoagulants and should be administered with caution in clients taking immunosuppressive medications -instruct client to receive annual eye exam because meds can cause cataract formation -Hepatotoxic -HCP should be notified when client experiences muscle aches (monitor CK and myoglobin levels) Used to treat anything ventricular (V tach or PVCs) *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Corneal deposits Bluish skin discoloration Poor coordination DIURETICS *All diuretics are contraindicated in clients taking lithium! Hyponatremia can induce lithium toxicity *ALL diuretics can induce Digoxin toxicity except potassium-sparing diuretics i.e. spironolactone! Thiazide diuretics -thiazide i.e. Chlorothiazide, cholorthalidone, hydrochlorothiazide, indapamide, metolazone Increase sodium and water excretion by inhibiting sodium reabsorption in kidneys Hypokalemia, hyponatremia Hypovolemia Hypotension Photosensitivity *Hyperglycemia Loop diuretics (Potassium-wasting diuretics) -ide i.e. Furosemide, Torsemide, ethacrynic acid, bumetanide Inhibit sodium and chloride reabsorption from the loop of Henle and the distal tubule Hypokalemia, hyponatremia Thrombocytopenia Hyperuricemia Dehydration Orthostatic hypotension Ototoxicity and deafness Potassium-sparing diuretics Spironolactone, triamterene, amiloride HCl, eplerenone Promotes sodium and water excretion AND potassium retention Hyperkalemia Nausea, vomiting, diarrhea Rash Dizziness, weakness 6 -not effective for IMMEDIATE diuresis -used with caution in the client taking lithium because lithium toxicity can occur (due to lack of sodium) -instruct client to take meds in morning to prevent nocturia and sleep interruption -change positions slowly to prevent orthostatic hypotension -instruct client with DM to check BG periodically -more rapid than thiazide diuretics -causes hypo of all electrolytes; monitor electrolytes, Mg, BUN, Cr, and uric acid levels -monitor digoxin (due to hypokalemia) or lithium (hyponatremia) toxicity -administer furosemide IV slowly to prevent ototoxicity -contraindicated in severe kidney or hepatic disease and severe hyperkalemia -monitor for HYPERKALEMIA!! -avoid salt substitutes because they contain potassium *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Osmotic diuretics Mannitol Increases osmotic pressure of the GFR, inhibiting reabsorption of water and electrolytes -used with chemo to induce diuresis Fluid and electrolyte imbalances Pulmonary edema Tachycardia from the rapid fluid loss Hyponatremia and dehydration -can be used to decrease ICP DIABETIC DRUGS **Watch for hypoglycemia during peaks! INSULIN NPH Basal long acting Onset: 6 h Peak: 8-10 h Duration: 12 h Glargine (lantus), Detemir Basal long acting Regular i.e. humulin R, novolin R Postprandial short acting Lispro (Humalog), Aspart, Glulisine Postprandial short acting No essential peak Duration: 12-24 h Onset: 1 h Peak: 2 h Duration: 4 h Onset: 15 mins Peak: 30 mins Duration: 3 h (LAG) 7 Cloudy suspension; precipitates and therefore cannot be given IV (can overdose client) “N for not so fast and not in the bag” -never given at bedtime (can cause hypoglycemia while asleep) -given twice daily -little to no risk for hypoglycemia; only safe insulin for bedtime -best for IV use (i.e. DKA) -“R for rapid and run insulin” -give as client begins to eat, with meals not before meals (not AC) -ensure client eats within 15 minutes of administration *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs ORAL HYPOGLYCEMIC AGENTS Biguanides Metformin Supresses hepatic production of glucose and increases insulin sensitivity Sulfonylureas Chlorpropamide Stimulate the beta cells to produce more insulin Gli(___)ide i.e. glimepiride, glipizide, glyburide Meglitinides Tol(___)ide i.e. tolazamide, tolbutamide -linide i.e. nateglinide, repaglinide Gliptins (DPP-4 inhibitors) -gliptins i.e. sitagliptin, saxagliptin Thiazolidinediones -glitazone i.e. ciglitazone, darglitazone, englitazone Stimulate beta cells to produce more insulin -short duration of action; less chance of blood glucose-lowering effects Block the action of DPP-4, which destroys the hormone incretin (incretin help body produce more insulin when needed; inhibition causes more insulin to be produced) Insulin-sensitizing agents that lower blood glucose by decreasing hepatic glucose production and improving target cell response to insulin 8 Diarrhea Lactic acidosis GI disturbances Metallic taste in mouth Hypoglycemia Hypersensitivity reaction Weight gain GI disturbances Hypoglycemia -DO NOT TAKE same day of iodine contrast procedures i.e. cardiac catheterization (can induce lactic acidosis) Discontinue 24-48 hours prior to test Hypoglycemia GI disturbances Very fast onset of action allows client to take medication with meals and skip medication when a meal is skipped -Cross reaction with sulfa antibiotics (sulfonamides); if client has allergic reaction to either one, DISCONTINUE Flulike symptoms (runny nose, headache, nausea, stomach pain) Rash GI problems Hepatotoxicity Increased bone fractures Increased LDLs -Monitor for elevated ALTs and ASTs *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs PSYCH DRUGS *All psych drugs have indications for WEIGHT GAIN and HYPOTENSION *Always taper medications down and never stop dosing abruptly Serotonin Reuptake Inhibitors (SSRIs) -lopram i.e. citalopram Antidepressants that work through inhibition of serotonin reuptake Sertraline Fluoxetine Fluvoxamine Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) Contraindications: St. John’s Wort, MAOIs Side effects: Anticholinergic- dry mouth Blurred vision Constipation Drowsiness *Insomnia Venlafaxine Duloxetine Toxic effects: Agranulocytosis Priapism Monoamine Oxidase Inhibitors (MAOIs) PITS Phenelzine Isocarboxacid Tranylcypramine Selegiline Inhibits metabolism of amines, NE, and serotonin thus improving mood and preventing depression RISK OF: With SSRIs: Serotonin Syndrome With TCAs: hypertensive crisis Antidote for hypertensive crisis: phentolamine IV 9 -Monitor client for increased risk of suicidality esp. during improved mood and increased energy levels, and changes in doses -Instruct to change positions slowly to avoid ortho hypotension -Be aware of potential for Serotonin Syndrome Signs and symptoms include: Mental status changes (Anxiety, agitation, restlessness) and autonomic/neuromuscular hyperactivity (fever, muscle rigidity, shivering, diaphoresis, tachycardia, HTN, tremors)  Risk greatly elevated with concurrent use of MAOIs -Can cause insomnia; do not administer at bedtime -given at the last resort when no other antidepressant therapies are effective -TYRAMINE- CONTAINING FOODS may cause hypertensive crisis; avoid BAR (bananas, avocadoes and raisins or dried fruit), organ meats and processed meats, and aged cheeses *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Tricyclic Antidepressants (TCAs) -triptyline i.e. amitriptyline, nortriptyline Antidepressants which block NE and serotonin reuptake -pramine i.e. desipramine, imipramine Mood stabilizers Benzodiazepines Lithium Quetiapine Olanzapine Risperidone Carbamazepine -zepam i.e. clonazepam, diazepam, oxazepam Stabilizes mood Lithium is a competitive binder with sodium- hyponatremia can cause toxicity -therapeutic level is 0.6-1.2; toxic is >2 -Lithium is teratogenic Side effects: Peeing Pooping Paresthesis Weight gain Drowsiness Anticholinergic Side effects: Anticholinergic Blurred vision Constipation Drowsiness**- can lead to somnolence Antianxiety; minor tranquilizer -lam i.e. alprazolam, triazolam Chlordiazepoxide Barbiturates -barbital i.e. anobarbital sodium Choral hydrate Eszopiclone Side effects: Anticholinergic Blurred vision Constipation Drowsiness *Sedation Urinary retention Used for short-term treatment of insomnia for sedation to relieve anxiety, tension and apprehension 10 Side effects: Dizziness Confusion Agranulocytosis -Concurrent use with MAOIs can lead to hypertensive crisis -Cardiac toxicity can occur and all clients should receive an ECG before treatment and after -antidote for TCA overdose: physostigmine -Avoid anything that has any diuretic effects i.e. diuretics, coffee, tea, cola -dehydration can cause lithium toxicity -Instruct client to maintain a fluid intake of six to eight glasses of water -contraindicated in glaucoma and should be used cautiously in children and older adults -used for induction of anesthesia, muscle relaxant, alcohol withdrawal syndrome, tranquilizer -antidote for benzo overdose: flumazenil -can only be given for 2-4 weeks, not a long term drug -maintain safety by supervising ambulation and using side rails at night *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Zolpidem Zaleplon Antipsychotics Typical: (older-think EPS as main side effect) Haloperidol Loxapine Chlorpromazine Atypical: Olanzapine Quetiapine Risperidone **Aripriprazole (not a proton pump inhibitor) Reduces psychotic symptoms Typical antipsychotics are better indicated for positive symptoms (t like +) i.e. delusions, hallucinations, illusions Atypical better for negative symptoms i.e. anhedonia, catatonia Side effects: Anticholinergic Blurred Vision Constipation Drowsiness *EPS- Typical i.e. parkinsonism, dystonia, rigidity, tremors Haldol- Torsades de pointes (can be fatal as it can lead to V. fib or pulseless V. tach) -avoid driving or operating hazardous equipment if drowsiness, dizziness or unsteadiness occurs -Administer with food or milk to decrease gastric irritation -protect liquid concentration from light -inform that some meds may cause a harmless change in urine color to pinkish to red-brown **Neuroleptic Malignant Syndrome (Haldol is most commonly tested)- characterized by altered mental status (lethargy, decreased LOC), muscle rigidity, hyperthermia (>40 C), tachycardia, HTN, tachypnea Treated by: supportive measures i.e. control temp (dantrolene), control agitation by benzodiazepines, and add dopamine agonist (bromocriptine)  antipsychotic decrease dopamine levels 11 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs RESPIRATORY MEDICATIONS *For any respiratory medication, think sympathetic effects! Bronchodilators (beta 2 agonists) -ol i.e. albuterol, formoterol, salmeterol Terbutaline (also a tocolytic drug) Methylxanthines -phylline i.e. Theophylline Aminophylline Relax smooth muscle of bronchi and dilate airways; promotes sympathetic response Side effects: Palpitations and tachycardia Hypertension Dysrhythmias Restlessness, anxiety, tremors Hyperglycemia Stimulate CNS and respiration, Dysrhythmias dilate coronary and pulmonary Seizures* vessels, cause diuresis and Tachycardia relax smooth muscle Insomnia -muscle spasm relaxer Restlessness GI effects Signs of toxicity: Anorexia Nausea, vomiting Insomnia, restlessness Cardiac toxicity Anticholinergics -tropium i.e. tiotropium, ipratroprium Results in bronchodilation due to blocking of muscarinic receptors in the bronchioles (anti-acetylcholine) antiparasympathetic therefore sympathetic effects drying of secretions* Dry mouth Blurred vision Urinary retention Hypertension Constipation Glucocorticoids -sone i.e. beclomethasone, Long term treatment of inflammation associated with asthma Immunosuppression 12 -assess vitals and lung sounds -given as rescue drug along with ipratropium (only drugs used for acute asthma exacerbations) -if administered with beta 2 agonist, cardiac dysrhythmias may result -administer with or after meals to decrease GI irritation -therapeutic level is 10-20; toxic level is >20 -IV infusions should be administered slowly and via an infusion pump -Usually given to relax airways during bronchospasm before bronchodilators can be effective -cimetidine and ciprofloxacin can dramatically increase serum theophylline levels and should not be used in these clients -clients with peanut allergies should not take ipratropium because it contains soya lecithin, which is in the same plant family as peanuts -contraindicated in clients with glaucoma -Monitor for signs of infection and report to HCP i.e. fever, high WBCs *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs prednisone, fluticasone Leukotriene modifiers Antihistamines Nasal decongestants Opioid antagonists -ide i.e. ciclesonide, flunisolide -lukast i.e. Used in prophylaxis and montelukast, treatment of chronic asthma zafirlukast (not used for acute exacerbations) -inhibit bronchoconstriction caused by specific antigens and reduce edema and smooth muscle constriction Dimenhydrinate Prevents a histamine response; Dipenhydramine used for common cold, rhinitis, nausea and vomiting -tadine i.e. loratadine, olapatadine Cetirizine Pseudoephedrine (ephedrine looks similar to epinephrine) -zoline i.e. naphazoline, tetrahydrozoline, xylometazoline Naloxone Naltrexone Alvimopan -Not used for acute exacerbations -Rinse mouth after use to prevent oral candidiasis or thrush infection Immunosuppression Nausea, vomiting Dyspepsia Generalized pain, myalgia -Coadministration of inhaled glucocorticoids increase the risk of upper respiratory infections -monitor liver function lab values i.e. ALT, AST drying effect* Drowsiness, fatigue Dizziness Urinary retention Constipation Dry mouth -Can cause CNS depression if taken with alcohol, opioids, tranquilizers or barbiturates -suck on hard candy or ice chips for dry mouth -contraindicated for glaucoma Reduce fluid secretion Major sympathetic effects* Hypertension (due to vasoconstriction) Hyperglycemia Restlessness, insomnia, nervousness -contraindicated in HTN, cardiac disease, hyperthyroidism, or DM -should NOT be used for longer than 48 hours due to tolerance and rebound nasal congestion (vasodilation) Reverse respiratory depression in opioid overdose Nausea, vomiting Tremors, Sweating Hypertension Tachycardia -Avoid use for non-opioid respiratory depression -Re-occurrence of respiratory depression can occur if duration of opiate effects exceed duration 13 *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Tuberculosis Agents Isoniazid Rifampin Ethambutol Pyrazinamide Rifabutin Rifapentine Treats active tb; treatment goes for 6-9 months for otherwise healthy clients (immunosuppressed clients can go for as long as 9-12 months) Hepatotoxicity Ototoxicity Neurotoxicity (numbness and tingling) Dry mouth Dizziness Red secretions (rifampin) Isoniazid treatment can be used for latent tb of antagonist- re-administer if needed -after 2-3 weeks of treatment, risk of transmission is greatly reduced -when one med is discontinued abruptly, resistance can occur (MDR-TB) -decrease efficacy of oral contraceptives; other means of birth control must be used -Take pyridoxine (vit B6) to prevent neuropathy Other commonly tested drugs Folate antimetabolite, antineoplastic, immunosuppressant drugs Methotrexate -treats malignancies, Rheumatoid Arthritis and psoriasis -CONTRAINDICATED in pregnancy unless abortion is warranted i.e. ectopic pregnancy Bone marrow suppression Immunosuppression Hepatotoxicity Photosensitivity Anticonvulsants Phenytoin Used to treat tonic-clonic seizures Therapeutic range is 10-20 mcg/mL Anything >20 is toxic Main side effect: Gingival hyperplasia Toxic effects: Gait unsteadiness/Ataxia Horizontal nystagmus CNS effects 14 -Clients should be instructed to get vaccinated with inactivated vaccines, avoid crowds and persons with known infections (as though they are being treated with chemo- antineoplastic drug) -Avoid alcohol as it is HEPATOTOXIC -Good oral hygiene can limit symptoms of gingival hyperplasia *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs NSAIDs Ibuprofen Naproxen Indomethacin Indicated for pain i.e. joint and inflammation Tarry stools (due to GI bleeding) Nephrotoxicity Hypertension (sodium retention) Fluid overload Proton pump inhibitors -prazole i.e. Omeprazole Pantoprazole Decreases acid production in stomach Associated with increased risk of pneumonia C. diff diarrhea Calcium malabsorption (osteoporosis) Tinnitus Hyperthermia Reye’s syndrome in peds Aspirin Corticosteroids -sone i.e. prednisone, bethametasone Anticholinergics Benztropine Antipyretic, antiinflammatory, antiplatelet and prophylactic treatment in recurrent MI Used for lack of corticosteroids in body (i.e. Addison’s), immune diseases Used to treat tremors in Parkinson’s disease 15 Hyperglycemia Immunosuppression Bone and muscle catabolism GI irritation Blurred vision Dry secretions Constipation Contraindicated in CHF due to sodium retention and associated HTN -Contraindicated in clients taking Lithium (again due to associated sodium retention) -Take with food to prevent GI upset -Bleeding risk associated when taken with aspirin, anticoagulants and other NSAIDs -may increase risk of C. diff infection due to lack of acid production in stomach leading to loss of gastric protection Contraindicated in administration to children due to risk of Reye’s syndrome (except in Kawasaki disease) -Do not discontinue abruptly -Increase dose of corticosteroid therapy in Addison’s disease during times of stress as a stress response can cause a sudden decrease in cortisol levels and can trigger an Addisonian crisis -Recommend diets high in calcium, protein and low in fat and simple carbs while on treatment -Cataracts are a side effect of corticosteroids -contraindicated in glaucoma as it can precipitate an acute glaucoma episode *Contains main drugs questioned in UWorld and mentioned in MK; Antibiotics, CV drugs, Diuretics, Diabetic drugs, Mental health drugs, and Respiratory drugs (in that order) plus other main drugs. i.e. proton pump inhibitors, dilantin, NSAIDs Urinary retention (contraindicated in BPH) EXTRA TIPS: Do not administer anything sedative i.e. opioids, benzodiazepines, barbiturates to clients with increased ICP as it can mask somnolence and decreasing LOC Always monitor blood pressure in vasodilating medications prior to administration i.e. ACE inhibitors, nitrates Neuroleptic Malignant Syndrome and Malignant Hyperthermia are similar in terms of symptoms! i.e. muscle rigidity, hyperthermia, mental status changes, tachycardia, tachypnea—difference lies in causes      Neuroleptic Malignant Syndrome Causes: Antipsychotics and low dose phenothiazines used as antiemetics i.e. Haldol, chlorpromazine Treated by: dantrolene for hyperthermia, benzodiazepines for anxiety and agitation, and dopamine agonist bromocriptine   16 Malignant Hyperthermia Causes: inhaled anesthetics ie. Halothane, muscle relaxant i.e. succinylcholine Treated by: dantrolene for hyperthermia, benzodiazepines for anxiety and agitation, NO bromocriptine