Pharmacology Study Guide

1. Oxycodone (Extended-release) Class: Opioid analgesic • pain medication- severe pain- swallow whole, every 12 hours should be administered, can take with food or milk to decrease gastric irritation, can cause chronic constipation, a supplemental short acting opioid medication can be taken for breakthrough pain. Longacting opioid, chronic or severe pain. Oral oxycodone- relieves moderate to moderately severe pain 2. Cyclosporine Class: Immunosuppressant (Calcineurin inhibitor) • weakens the immune system- tells the body to not attack something it thinks is foreignincreased susceptibility to infection, can cause nephrotoxicity that can lead to oliguria, these can cause hirsutism, treatment for autoimmune disorders- do not increase risk. CAN DEVELOP HIGHER BP (MIGHT NEED TO START ON ANITHYPERTENSIVE). Used for a kidney transplant- must be used for life. 3. Warfarin Class: Anticoagulant (Vitamin K antagonist) • prevent blood clots (thins them out) increased risk of bleeding- carry a medical alert ID card, avoid aspirin and ibuprofen and herbal substances, check PT and INR for the first 5 days and then twice weekly for the next 1 to 2 weeks, avoid dark green vegetables due to vitamin K (can reduce the anticoagulant effects of warfarin) AVOID fondaparinux and bivalirudin due to being hyper coagulated. 4. Simvastatin Class: Statin (HMG-CoA reductase inhibitor) • lowers cholesterol- used for hyperlipidemia- avoid grapefruit juice, oatmeal is recommended for clients who have hyperlipidemia due to containing soluble fiber and lowers LDL cholesterol. Adverse effect that needs to be reported immediately is my legs feel weak and achy due to the serious side effect of muscle injury, which can progress to severe myositis. 5. Rifampin Class: Antitubercular (Rifamycin antibiotic) • taken for active pulmonary tuberculosis- Rifampin can turn body fluids orange, can cause hematuria (blood in urine). Red/orange tinged urine is adverse effect of rifampin BUT IS HARMLESS- should inform provider if becomes dark in color since this is indication of hepatoxicity. 6. Isoniazid Class: Antitubercular • does not cause bladder irritation, can be toxic to the liver- monitor AST (monitor jaundice, nausea, dark colored urine or other findings indicating hepatitis)- take this medication on an empty stomach. Last 6 months to 2 years- Monitor for liver function due to risk of hepatotoxicity. Avoid antiacids due to decrease absorption. 7. Morphine (IV bolus) Class: Opioid analgesic • pain relief medication- called opioid- respiratory depression can occur within 7 minutes of administration (naloxone ready), peaks in 20 minutes, withhold if respiratory rate is less then 12, administer slowly over 4-5 minutes to prevent hypotension and respiratory depression. 8. Propylthiouracil (PTU) Class: Antithyroid • treatment for hyperthyroidism- slows down production of thyroid hormone- check liver function (can cause severe liver injury, hepatotoxic- report dark urine and yellowing of the eyes), take multiple times each day, rash is an adverse reaction (does not need to be reported), can cause drowsiness. 9. Lithium Class: Mood stabilizer • treat mood disorders- balances mood- adverse effects is tinnitus, blurred vision and dry mouth. I can experience lithium toxicity if I experience vomiting or diarrhea (can cause electrolyte imbalance, if serum sodium decreases, lithium is retained by the kidneys and the risk of lithium toxicity increases. INCREASE SODIUM TO MAINTAIN LITHIUM LEVELS. Diuretics decrease kidney excretion of lithium, which can cause lithium levels to rise and increases potential for toxicity. 10. Diphenoxylate Atropine Class: Antidiarrheal (opioid + anticholinergic combo) • used to treat diarrhea, slows down intestines- not having a bowel movement shows it is effective, drowsiness, dry mouth is an adverse effect, bronchodilation should not happen, but this medication can stimulate asthma like manifestations. 11. Amphetamine / Dextroamphetamine Class: CNS stimulant • used for ADHD, increased focus and attention- should NOT have palpitations (requires immediate interventions), can cause restlessness, avoid caffeine, do not take before bedtime due to restlessness and can cause insomnia, can cause weight loss. 12. Levothyroxine Class: Thyroid hormone replacement • used for hypothyroidism-replaces thyroid hormone level- can be crushed- mixed with 5 to 20 ml of water- medications that are extended release, sublingual or enteric coated can’t be crushed. Heart rate that is high requires intervention, as this may indicate the opposite (hyperthyroidism). Dry skin and lethargy are common signs of hypothyroidism and should resolve after this medication. Tremors and anxiety are expected findings in acute levothyroxine overdose. This overdose can cause tachycardia, heat intolerance, hyperthermia. THYROTOXICOSIS (TOO MUCH) CAN HAPPEN AND THIS INCLUDES CHEST PAIN, TACHY, INSOMNIA, TREMORS, HYPERTHERMIA, HEAT INTOLERANCE, DIAPHORESIS. IF taking a calcium supplement (take 4 hours after taking levothyroxine due to absorption). Take in the morning on an empty stomach. Zinc, magnesium, iron prevent complete absorption of the medication. 13. Tobramycin Class: Aminoglycoside antibiotic • strong antibiotic used to treat serious bacterial infections- peak level of 5-10 is normal, do not alter medication, monitor WBC and client’s condition 14. Alosetron Class: 5-HT3 antagonist (IBS medication) • treat IBS- constipation should be reported (dose will be adjusted or stopped), medication may be increased depending on effectiveness or discontinued, decrease in abdominal pain and diarrhea are indications that this medication is working 15. Digoxin Class: Cardiac glycoside • heart beat stronger and more efficiently, can also slow HR- less then 60 HR (nausea, anorexia, visual effects, cardiac dysrhythmias) the medication should be held- eat fruits and vegetables that have high potassium content everyday due to hypokalemia being an adverse effect. Blurred vision or yellow vision can occur, report changes to the provider. 16. Phenytoin Class: Anticonvulsant (hydantoin) • Prevent and control seizures- serum phenytoin level of 10-20 is expected and medication can be received, do not administer half a dose, do not withhold dose if in range or clarify dose. Monitor for cardiac dysrhythmias. 17. Hepatitis A vaccine Class: Vaccine (inactivated virus) • protect against infection from hepatitis A, which can affect the liver- loss of appetite is normal and can last for 1-2 days, does not have an antidote. 18. Ethambutol Class: Antitubercular • Used to treat tuberculosis- decreased visual acuity should be reported to the provider due to being an adverse reaction, anorexia can be an adverse effect, loss of red/green color discrimination is an adverse reaction. 19. Nitroglycerin Class: Nitrate (vasodilator) • treat chest pain- rotate location for patch, headache is common, can be worn for 12-14 hours each day and removed at night, placed each morning, transdermal have a delayed onset of action, should not be applied to treat an ongoing episode of chest pain. Oral route- cause hypotension (this is expected). 20. Sulfasalazine Class: Anti-inflammatory (DMARD/5-ASA derivative) • used to treat inflammatory conditions of the bowel and joints- can be used to treat rheumatoid arthritis- can cause bone marrow suppression, complete blood count should be monitored and should be review prior to administering, does not affect respirations, blood pressure and kidneys. MONITOR FOR JAUNDICE- YELLOW DISCOLORATION OF THE SKIN/ YELLOW-ORANGE DISCOLORATION OF THE URINE. Can also cause diarrhea, stomatitis, headache. 21. Glucocorticoid Class: Corticosteroid • steroid hormone that is produced naturally by the adrenal cortex- an adverse effect is osteoporosis- so increasing calcium supplements and vitamin d supplements should be encouraged, does not affect liver functions, NSAIDs should be avoided due to risk of gastric ulcerations, hyperglycemia is a side effect of oral glucocorticoid therapy. 22. Zidovudine Class: Antiretroviral (NRTI) • it’s a medicine used to fight HIV- decreased hemoglobin, this can cause severe anemia and neutropenia from bone marrow suppression and can result in hematologic toxicity, nausea and vomiting, decreased appetite, anxiety are adverse effects. 23. Colchicine Class: Antigout agent • used for acute gout attack 24. Allopurinol Class: Xanthine oxidase inhibitor (antigout) • is used for chronic gout- used for gout- lowers uric acid levels in the bodyFEVER/RASH NEEDS TO BE REPORTED, GI affects can happen- take with food, metallic taste in mouth is normal, drowsiness can happen. Increase fluids to at least 2 Liters per day. Starts at 100 mg- can be increased. Once a day and can cause hypoglycemia. 25. Probenecid Class: Uricosuric agent • this act by lowering plasma urate levels and increasing excretion of uric acid in the urine but can exacerbate an acute gout attack and is indicated once the acute gout attack is controlled. 26. Pegloticase Class: Uricase enzyme (antigout) • this is used to treat chronic gout that has not responded to the normal treatment. 27. Naproxen Class: NSAID • first choice treatment for relieving manifestations of an acute gout attack. Increases the risk of developing ototoxicity when taken with streptomycin. 28. Sumatriptan Class: Triptan (serotonin receptor agonist) • Used for migraine headaches- heart disease is a contraindication, causes vasoconstriction, do not take for a patient who have myocardial infarction or CAD, uncontrolled hypertension and other types of heart disease. 29. Theophylline Class: Methylxanthine bronchodilator • Helps with lungs- opens the airways- zafirlukast and zileuton is contraindicated with this medication. Toxicity to this medication is tremors (early manifestation), can also have diarrhea, tachycardia. Increased blood level of this is restlessness and irritability. 30. Zafirlukast Class: Leukotriene receptor antagonist • used to asthma maintenance. 31. Cromolyn Class: Mast cell stabilizer • decrease inflammation of the airways or nasal passageways (CAN TAKE SEVERAL WEEKS FOR THERAPEUTIC EFFECTS TO HAPPEN)- This is a nebulizer (inhaled mist) inhale and exhale normally (remember has a slow onset) 32. Albuterol Class: Short-acting beta2 agonist (SABA) • used to treat bronchospasm. 33. Methylprednisolone Class: Corticosteroid • used for long term treatment and management of asthma- decreases inflammation of the airways and can be prescribed with theophylline. 34. Metoprolol Class: Beta-blocker • slows heart rate and lowers blood pressure- beta blocker- can cause hypoglycemia, can cause weight gain due to fluid retention. 35. Prednisone Class: Corticosteroid • a steroid medication- used to reduce inflammation and calm the immune systemschedule the medication on alternate days to decrease adverse effects, decrease gradually, can cause GI distress and lead to ulcer formation, do not take on an empty stomach, no used for a rescue medication. Adverse effect- stress fractures (which can lead to osteoporosis), high risk of hypertension due to sodium and fluid retention, high risk of weight gains due to water retention. This medication can cause delayed wound healing. Have the client report immunosuppression, other adverse effects are osteoporosis and adrenal suppression. USED FOR CLIENTS WITH SEVERE RHEUMATOID ARTHRITIS. 36. Vincristine sulfate Class: Antineoplastic (chemotherapy, vinca alkaloid) • This is chemotherapy drug that helps stop cancer cells from growing- Risk for neurotoxicity (paresthesia- numbing), autonomic and central nervous dysfunction. 37. Memantine Class: NMDA receptor antagonist • Used for Alzheimer’s disease- used to help with memory and thinking problems- can cause renal impairment due to being excreted by the kidneys- monitor creatinine 38. Aspirin Class: NSAID (salicylate) • Used for pain, fever and inflammation- can interfere with Reyes syndrome in kidsshould not be given, chronic use of salicylates can lead to ototoxicity, which can have manifestations of tinnitus or hearing loss. SHOULD NOT BE CRUSHED. 39. Sucralfate Class: Mucosal protectant • forms a gel like substance that protects ulcers. Wait at least 30 minutes before taking this medication after I take an antacid due to raising gastric PH, AND CAN AFFECT THE MEDICATION. Take one hour before meals and bedtime, last for 4-8 weeks for treatment and take entire dose , can be broken in water before ingestion due to being large. 40. Raloxifene Class: Selective estrogen receptor modulator (SERM) • acts as an estrogen- prevents and helps treat osteoporosis- CAN INCREASE RISK OF DVT (DO not give to patients who have a history of this due to being an estrogen). 41. Isosorbide mononitrate Class: Nitrate • helps prevent chest pain- produces vasodilation- this can cause orthostatic hypotensiontake as soon as remembered if missed dose, side effect can be a headache. 42. Adenosine Class: Antiarrhythmic • used for paroxysmal atrial tachycardia- will flatline the patient- dyspnea can occur. 43. Alendronate Class: Bisphosphonate • medication used to strengthen bones- when taking this medication sit upright or stand for at least 30 minutes after taking the medication to prevent esophagitis. Take with a full glass of water on a empty stomach (do not take with orange juice or coffee), to reduce the risk pf esophagitis. Do not suck or chew medication, take on an empty stomach and wait 30 minutes before consuming food or drink. Used for pagets disease- PRIORITY FOR THE NURSE IS TO AMBULATE THE CLIENT TO A CHAIR PRIOR TO ADMINSTERING THIS MEDICATION- make sure they are sitting up right to prevent esophagitis from occurring. 44. Selegiline Class: MAO-B inhibitor • helps increase brain chemicals, used for Parkinson’s disease- drowsiness should be reported due to being a adverse effect, diarrhea is an adverse effect. 45. Amlodipine Class: Calcium channel blocker • Used to treat high blood pressure and chest pain- relaxing and widening your blood vessels- adverse effects are dizziness, palpitations, peripheral edema, flushing and headaches. 46. Acarbose Class: Alpha-glucosidase inhibitor (antidiabetic) • used to treat type 2 diabetes- works in the intestines to slow down and breakdown of carbohydrates- so blood sugar rises for slowly after eating- take medication with food, taken with first bite of meal 3x a day. Adverse effect is diarrhea, abdominal distention, cramping and flatulence. Can cause sleepiness, headaches, anemia due to decrease absorption of iron. 47. Pioglitazone Class: Thiazolidinedione (antidiabetic) • used to treat type 2 diabetes- lowers blood sugar- should be taken when using insulinhelps with cellular response to insulin, monitor for hypoglycemia due to medication peak in 2-4 hours, only for type 2 diabetes due to needing insulin for medication to be effective. 48. Clopidogrel Class: Antiplatelet • prevent blood clots- bleeding is an adverse effect. Can also cause dizziness, headache, hypertension and diarrhea. Taken if a patient has had a myocardial infarction, stroke, peripheral vascular disease. 49. Depot medroxyprogesterone acetate (DMPA) Class: Progestin (hormonal contraceptive) • a hormonal contraceptive injection- should be received 6 weeks postpartum if the patient is exclusively breastfeeding and after ensuring the client is not pregnant. 50. Antacids Class: Acid neutralizers • relieve heartburn and indigestion- take 1 hour apart from other medications, can exacerbate certain condition like heart failure and hypertension, can cause diarrhea and constipation, can take up to 7x daily, given 2 and 3 hours after each meal. 51. Terbutaline Class: Beta2 agonist (bronchodilator/tocolytic) • relaxes smooth muscles- helps with asthma or bronchospasm or help slow/ prevent preterm labor- adverse effect of this medication is maternal heart rate more than 120/min, they can experience hypotension, hyperglycemia. 52. Omeprazole Class: Proton pump inhibitor (PPI) • blocks acid production, helps with healing and prevention of acid related problemsDIARRHEA IS an ADVERSE EFFECT- SHOULD BE REPORTED immediately- take in the morning BEFORE BREAKFAST EVERYDAY, pneumonia is a risk factor, can become deficient in magnesium. Should not be used for more than 1-2 months due to long term adverse effects of fractures and low magnesium. 53. Ceftriaxone Class: Cephalosporin antibiotic (3rd generation) • kills bacteria- used to treat bacterial infections- severe allergy to piperacillincontraindicated for patients who have an allergy to cephalosporine or penicillin. 54. Alosetron Class: 5-HT3 antagonist • used for IBS- slows down the movement of the intestines and reduces abdominal painmust sign an agreement before caring due fatal adverse effects, should stop if diarrhea is not controlled under one month, tachydysrhythmias is a adverse effect. 55. Epoetin alfa Class: Erythropoiesis-stimulating agent • stimulates the production of red blood cells- make more RBCs- therapeutic effect is promotes RBC production. Can cause hypertension, can cause clot formation. Can also cause headaches, seizures, heart failure and thromboembolic events related to increased hemoglobin levels. Can cause polycythemia. 56. Misoprostol Class: Prostaglandin analog • protects the stomach lining from damage caused by NSAIDS- can induce labor or cause abortion- AVOID BECOMING PREGNANT WHILE TAKING THIS MEDICATION (CATEGORY X DRUG), adverse effect of dysmenorrhea. Contraindication would be past cesarean delivery, due to the risk of uterine rupture. CAN ALSO PROMOTE RIPENING OF THE CERVIX AND INDUCE LABOR. 57. Dinoprostone Class: Prostaglandin • softens and dilates the cervix, stimulates uterine contractions- an inserted pouch to stimulate labor AND HELP WITH POSTPARTUM HEMORRHAGE- once inserted lie on your back for at least two hours without getting up. Removed after 12 hours, can require 2-3 dosing’s in the 12-hour time frame. 58. Brompheniramine Class: Antihistamine (1st generation) • relieve allergy symptoms- antihistamine- can cause dry mouth- relieve dry mouth by liquids or sucking on candy. Can have GI issues, dizziness, poor coordination, confusion, fatigue, urinary retention, constipation and palpations. 59. Enalapril Class: ACE inhibitor • lower blood pressure- ACE inhibitor- adverse effect is hypotension, can also cause decrease in hgb and hct, cause kidney failure and increase potassium levels. 60. Clozapine Class: Atypical antipsychotic • used for schizophrenia- blocks certain brain receptors- adverse effect is neutrophil count, should be between 2500-8,000, can cause agranulocytosis which is life threatening, dyslipidemia is an adverse effect, as well as hyperglycemia. Client is at risk for infection with this medication due to decreased agranulocytosis, monitor for fever. Can also cause urinary retention and orthostatic hypotension. 61. Etanercept Class: DMARD (TNF inhibitor) • reduce inflammation- DMARD- can be used for rheumatoid arthritis- risk for infection like tuberculosis, can cause injury to the liver. 62. Chlorothiazide Class: Thiazide diuretic • used to treat hypertension- adverse effect is MUSCLE WEAKNESS- DUE TO CAUSING HYPOKALEMIA- other side effects- hypercalcemia, hypoactive reflexes, hyperglycemia. 63. Sodium Phosphate Class: Osmotic laxative • cleans out bowel before procedures- pulls water into the intestines- osmotic laxative- can have a imbalance in electrolytes due to cleansing the stool, can cause dehydration, take with clear liquids, rebound constipation is an adverse effect. 64. Fluticasone Class: Inhaled corticosteroid • DRY powder inhaler (DPI)- reduce inflammation in the airways or nasal passages- rinse mouth after administering medication due to cause thrush, LONG TERM THERAPY, do not shake. Are easier to use for people who have deformities of hands, directly to the lungs. Disadvantage of this medication is restricted dosage flexibility, easy to use device, long term use for clients who have asthma. 65. Chlordiazepoxide Class: Benzodiazepine • long acting benzo- used for alcohol withdrawal. FIRST LINE MEDICATION. 66. Cosyntropin Class: ACTH analog • can determine presence of adrenal insufficiency. If cortisol elevates they, have it. 67. Hydroxyzine Class: Antihistamine (H1 blocker) • blocks histamine and has sedative effects, helps with itching, anxiety and insomnia, N/Vadverse effect is dry mouth. 68. Epinephrine Class: Adrenergic agonist • opens airways, raises blood pressure, helps respond to severe allergies- adverse effect can be tachycardia, dysrhythmias due to cardiac stimulation. Hypertension and hyperglycemia can happen as well. 69. Carbamazepine Class: Anticonvulsant • seizures, nerve pain and helps with moods like bipolar disorders- This medication can decrease the effectiveness of oral contraceptives, remain on the medication if no seizure occurs, do not alter the dose, should reduce the frequency of seizures, if they keep occurring notify the provider. 70. Timolol Class: Beta-blocker (ophthalmic) • used for primary open angle glaucoma- lowering eye pressure, can lower blood pressure and heart rate. Can cause asthma (alternate medication will be betaxolol), can help with hypertension, but hypotension can be an adverse effect, peripheral vision loss is a manifestation of POAG, as well as intraocular pressure. 71. Gemfibrozil Class: Fibrate (antilipemic) • lowering high triglycerides, help decreasing the livers uptake of fatty acids, can cause liver toxicity. Monitor liver function, can also help lower blood fat to protect the heart. Decrease WBC’s, can cause hyperglycemia, can cause myopathy. 72. DTaP vaccine Class: Vaccine (toxoid + inactivated components) • vaccine- This is administered intramuscular (IM) in the deltoid and mediolateral thigh because these are larger muscles that can better diffuse inflammation. Adverse effects are fever, fretfulness and drowsiness and anorexia. Others can be acute encephalopathy, convulsions and shock like state. This is not a live vaccine (this is a toxoid combined with inactivated bacteria components. 73. Feverfew Class: Herbal supplement • preventing headaches, reduce fever and inflammation- Having fewer migraine headaches since I started taking this is a therapeutic effect. 74. Nifedipine Class: Calcium channel blocker • lowering blood pressure and treating chest pain- can be used for angina pectoris- it inhibits uterine contractions by blocking the entry of calcium into uterine cells- this works for clients who are pregnant. Can cause dermatitis and urticaria. THIS CAN HELP STOP PRETERM LABOR. 75. Doxycycline Class: Tetracycline antibiotic • treatment of helicobacter pylori infection- antibiotic that fights infections- wear protective clothing while in the sun, increases sensitivity of the skin to ultraviolet light and sunlight, take on an empty stomach, avoid during pregnancy and children younger than 8 years of age, can attack good and bad bacteria, can cause secondary infection such as C.diff. Diarrhea should be reported to the provider. 76. Mucolytic agent (acetylcysteine/hypertonic saline) Class: Mucolytic • breaks up thick mucus in the lungs- bronchospasms, can happen agents like hypertonic saline solution or acetylcysteine can irritate the airways, resulting bronchospasms. 77. Raloxifene Class: Selective estrogen receptor modulator (SERM) • taken for osteoporosis- preventing and treating osteoporosis- adverse effect of this medication is sudden onset of dyspnea, can increase risk of DVT, pe or stroke. Notify provider immediately. 78. Doxazosin Class: Alpha-1 blocker • used for benign prostatic hyperplasia- helps with blood pressure and enlarged prostate (BPH), helps improve blood flow and urination- hypotension is a adverse effect- CNS ADVERSE EFFECTS – dizziness, headaches, depression and drowsiness. 79. Tamoxifen Class: Selective estrogen receptor modulator (SERM) • anti-estrogen medication used to treat cancer of the breast in both premenopausal and postmenopausal. Used to prevent breast cancer in women who are at increased risk. 80. Albuterol sulfate Class: Short-acting beta2 agonist (SABA) • used for mild intermittent asthma. Opens the airways- SABA. Short acting and works quickly. 81. Ipratropium Class: Anticholinergic bronchodilator • prescribed to treat bronchospasms related to COPD. 82. Tiotropium Class: Long-acting anticholinergic bronchodilator • long-acting inhaled anticholinergic that is prescribed for long term maintenance therapy for patients with COPD. 83. Budesonide Class: Inhaled corticosteroid • Can be used to treat Crohn’s disease (decrease inflammation of the GI lining of the client’s large intestine is therapeutic (suppresses the immune system). Inhaled corticosteroids prescribed to decrease inflammation in clients who have asthma. This can increase blood glucose so adjust hypoglycemic medications as needed. This can cause sodium, water retention and potassium loss. HYPOKALEMIA IS A SERIOUS ADVERSE EFFECT DUE TO CAUSING LIFE THREATENING DYSRHYTHMIAS. Increase risk of peptic ulcer disease. 84. Hydrochlorothiazide Class: Thiazide diuretic • helps the body get rid of extra salt and water, a diuretic – gets rid of fluid to lower blood pressure- lowers hypertension- This medication can cause a loss of potassium- eat foods like bananas, raisins, baked potatoes, pumpkin and milk. For this medication this would be used for insipidus diabetes (which is over production of urine) Can also cause gouty arthritis due to the retention of uric acid. TAKE DURING THE DAY TO ALLOW FOR DIURESIS DURING THE DAY AND PREVENT NOCTURA. Check weight daily to monitor for edema. Take with food to reduce gastric distress. 85. Fludrocortisone Class: Mineralocorticoid • helps the body hold on to salt and water, helps raise blood pressure- adverse effect is hypokalemia, hypertension, weight gain, increased appetite and nausea. Can help with mineralocorticoid therapy and help maintain electrolyte and fluid balance. 86. Methotrexate Class: DMARD (antimetabolite) • slows down cell growth, calms the immune system- helps with rheumatoid arthritisshould be prescribed within the 3 months of the initial diagnoses. This helps prevent or delay joint degeneration. NSAIDs, glucocorticoids and another DMARD can be prescribed during this time. Can cause hepatotoxicity. 87. Amoxicillin Class: Penicillin antibiotic • kills bacteria- adverse effect is- alterations in gastrointestinal flora- this is an adverse effect- can cause poor digestion and possible superinfection with other bacteria. This is converted by the liver- can cause liver failure and elevate liver enzymes (will see jaundice, sclerae in clients who have light pigmented skin and yellowing of hard palate and sclera near the iris in the clients who have dark pigmented skin. LIVER failure will see dark urine, light colored stools, N/V, malaise, abdominal discomfort and loss of appetite. 88. Doxycycline Class: Tetracycline antibiotic • this is an antibiotic- used to treat bacterial infections- adverse effect is photosensitivity (wear protective clothing outdoors and using sunscreen), can cause diarrhea, can affect color vision. 89. Atropine Class: Anticholinergic • blocks the parasympathetic nervous system- slows the HR and increases secretions. Cycloplegia can happen and this is blurred vision, or looking from far to near is temporarily impaired. Dilation of eyes can happen with this medication. 90. Glucocorticoids Class: Corticosteroids • steroid hormone- reduce inflammation and suppress immune system. This can slow linear growth in children. Oral candidiasis is an adverse effect of inhaled glucocorticoids (rinse mouth after inhaling), during times of stress the patient may need an oral one. Inhaled glucocorticoid steroids are not rescue medications, for acute bronchospasm a client should inhale a bronchodilator. 91. Disulfiram Class: Alcohol deterrent • a medication used to help people stop drinking alcohol. USED FOR MAINTAINING ABSTINENCE FROM ALCOHOL. Check labels of skin care products, medications and food for alcohol. This medication will continue for 2 weeks following the last dose. Avoid alcohol during this time. Adverse effects can be drowsiness and skin eruptions, respiratory depression and convulsions are manifestations of acetaldehyde syndrome, which is a dangerous event that can occur if alcohol is taken with this drug. Should not be administered if 12 hours ago alcohol was ingested. 92. Oxytocin Class: Uterotonic hormone • induce or strengthen labor and control bleeding after delivery and helps with milk ejection. If a patient is having ineffective labor- increase this dose to help with uterine contractions. Can be given IV for labor induction. IM to decrease postpartum bleeding. Monitor blood pressure and pulse. Goal for this medication is for contractions that last from 46-60 seconds, if prolonged, stop the medication. Contraindicated for clients experiencing preterm labor. 93. Thiamine (parenteral) Class: Vitamin B1 • ataxia, altered LOC, nystagmus is Wernicke Korsakoff syndrome, and this is thiamine deficiency- so give this medication. 94. Niacin Class: Vitamin B3 / lipid-lowering agent • used to reduce cholesterol levels. 95. Pyridoxine (parenteral) Class: Vitamin B6 • treat vitamin B6 deficiency (symptoms- peripheral neuritis and neuropathy) 96. Riboflavin Class: Vitamin B2 • used to treat vitamin B2 deficiency in early manifestations (sore throat, cracks in the skin in corner mouth) late signs- (painful cracks in the lips, inflammation in the tongue, itchy dermatitis of the scrotum or vulva). 97. Filgrastim Class: Colony-stimulating factor • helps the body make more white blood cell counts- Monitor neutrophils due to given to treat neutropenia. Can also cause anemia. 98. Opioid (general) Class: Opioid analgesic • This medicine can relieve pain by acting on the brain and nervous system- can cause constipation- increase dietary fiber because this helps prevent constipation. Also increase physical activity and fluid intake- a laxative may be needed to prevent opioid induced constipation. Fiber can increase nausea (should be treated with antiemetic). Fiber does not help with medication absorption. 99. Methadone Class: Opioid agonist • treats pain and helps people stop using other opioids by reducing withdrawal symptoms and cravings. 100. Methylnaltrexone Class: Opioid antagonist • opioid antagonist that is used to treat opioid induced constipation for patients who do not respond to other laxatives. 101. Naloxone Class: Opioid antagonist • treat opioid overdoses. 102. Hydromorphone Class: Opioid analgesic • strong opioid that is used to treat moderate to severe pain. Administer the medication over 4 to 5 minutes (IV medication). Place a client in a supine position during administration to prevent hypotension, assess pain before and 1 hour to 30 minutes after. Take vital signs. 103. Meperidine Class: Opioid analgesic • • • a strong opioid pain killer- only 50 mg every 3 to 4 hours, do not exceed 600 mg within 24 hours. IV IS THE FASTEST ROUTE FOR THIS MEDICATION. 104. Glucocorticoid medication Class: Corticosteroid • reduce inflammation and affect the immune system- used to treat long term Addison’s disease- Adverse effect is osteoporosis due to inhibiting bone growth. Can result in weight gain due to sodium and water retention, as well as hypertension. Also, can have restlessness, agitation and anxiety and irritability. 105. Saw Palmetto Class: Herbal supplement • can help with prostate health- a herbal supplement- can help with BPH. 106. Echinacea Class: Herbal supplement • used to treat cold and flu like illnesses, helps the immune system. 107. Ginkgo biloba Class: Herbal supplement • increases cognitive function in elderly people, can improve leg pain and other peripheral arterial disorders. Can also help with memory and mental focus. this CAN DECREASE PLATELET AGGREGATION- NOT TAKE WITH NSAIDS AND CLOPIDOGREL. CAN DECREASE RISK OF DVT. 108. Ginger root Class: Herbal supplement • prevent nausea or treat. 109. St. John’s Wort Class: Herbal antidepressant • used to help with mood and depression. 110. Black Cohosh Class: Herbal supplement • herb used for the treatment of menopausal symptoms, such as hot flashes, vaginal dryness, irritability and sleep disturbances. 111. Garlic Class: Herbal supplement • CAN LOWER CHOLESTEROL AND TRIGLYCERIDES LEVELS. – ALSO DECREASE PLATELET AGGREGATION. 112. Risedronate Class: Bisphosphonate • helps strengthen bones- prevent or treat osteoporosis- take with a full glass of water, remain upright for at least 30 minutes to help with GI effects, take on an empty stomach, food can reduce absorption of the medication, take 30 minutes before the first meal in the morning. 113. Scopolamine patches Class: Anticholinergic • used to treat motion sickness- place the patch behind the ear. Should be replaced every 72 hours, clean the area with soap and water, one patch at a time, if not effective notify provider. 114. Penicillin Class: Penicillin antibiotic • helps treat bacterial infections- monitor for allergic reaction like laryngeal edema, pain at injection site is expected, motor dysfunction can happen, a high temp will be before giving this. Can be given IM. 115. Sirolimus Class: Immunosuppressant (mTOR inhibitor) • this medication suppressed the immune system- helps prevent organ rejection. AVOID grapefruit juice with this, avoid high fat foods to help maintain consistency for absorption. 116. Cyclosporine Class: Immunosuppressant • can take with apple juice to improve palatability. Do not take with tacrolimus (due to nephrotoxicity) STOP THIS MEDICATION 24 HOURS BEFORE BEGINNING THE MEDICATION. 117. Donepezil Class: Cholinesterase inhibitor • a medication used to treat Alzheimer’s, helps improve memory, thinking and daily functioning. Take this MEDICATION LATE IN THE EVENING, JUST BEFORE BED, swallow whole, can be taken with or without food, GI affects can occur, if the dose is missed, just skip and take the next day. 118. Memantine Class: NMDA receptor antagonist • monitor creatinine clearance due to determining how the kidneys filter waste, needs to be in range or can indicate renal impairment and this medication is excreted by the kidneys and can be a contraindication. 119. Clomiphene Class: Ovulation stimulant • helps with fertility- if the medication has been effective will see follicular enlargement and conversion to corpus luteum after ovulation. Can increase LH and follicular stimulating hormone, promotes follicular maturation, increases HCG levels. 120. Antiretroviral medications (ARV) Class: Antiretroviral • used to help with AIDS/HIV- take on a routine schedule, there will be multiple of these prescribed at a time to improve effectiveness of medication, avoid raw fruits, vegetables, due to risk of immunosuppression. Does not kill the HIV virus but helps reduce viral replication of it. 121. Atorvastatin Class: Statin • lowers cholesterol 122. Propranolol Class: Beta-blocker • slows the HR and lowers BP. If taken with albuterol can decrease effect of albuterol. 123. Sucralfate Class: Mucosal protectant • helps protect the stomach lining- can be CRUSHED INTO A ENTERAL FEEDING TUBE. 124. Vasopressin Class: Antidiuretic hormone (ADH) • retain water and constrict blood vessels- monitor creatinine clearance (should be above 107 for female/male clients) lower than that- CAN CAUSE RENAL IMPAIRMENT WHICH CAN CAUSE WATER INTOXICATION. Sodium, potassium, AST can be elevated but no a contraindication of this medication. 125. Morphine Class: Opioid analgesic • Opioid pain medication- increase fluid intake due to constipation, can make it difficult to see in a dim lighting area, urinary retention is an adverse effect (try to void at least once every 4 hours), sedation and drowsiness are adverse effects of medications (stand up slowly). 126. Psyllium Class: Bulk-forming laxative • absorbs water into the intestines- makes stool softer and bulkier- mix with water and follow with additional glass of liquid, increase intake of fluids, can be taken on long term basis, dietary bulk and fiber should be used during this time to relieve constipation, do not use laxatives with this. 127. Salmeterol Class: Long-acting beta agonist (LABA) • relaxes smooth muscles in the airways- long-acting beta agonist (LABA) bronchodilatorcan cause asthma related death. 128. Fluticasone / Budesonide Class: Inhaled corticosteroids • decrease airway inflammation 129. Theophylline Class: Methylxanthine bronchodilator • bronchodilator used to alleviate bronchospasm by relaxing smooth muscle in the bronchi during asthma attack. 130. Alprazolam (Xanax) Class: Benzodiazepine • used to treat anxiety and panic attacks- plan to taper of the drug slowly over several weeks or months due to ease the physiological and psychological manifestation of withdrawal. Can cause drowsiness, during discontinuation of the medication the patient may experience periods of insomnia. IF muscle twitching occurs, call provider due to cause convulsions if it is discontinued too rapidly. CAN CAUSE confusion if acute toxicity occurs from oral overdose, periods of paranoia and delirium if the medication is discontinued too rapidly. 131. Insulin (glulisine, regular, NPH, glargine, lispro) Class: Antidiabetic (insulin) • glulisine- very short onset about 15 minutes, regular insulin- 30-60 minutes, NPH- rotate injection sites, thigh or abdomen, roll vial between palms, cloudy suspension, onset of 1 to 2 hours. Insulin glargine (long-acting insulin- releases slowly over 24-hour periodkeeps blood sugar steady all day) can’t be mixed with any other solution, can be given at any time of the day, clear solution, can only be administered once in a 24-hour period. Insulin lispro- acts in 15 minutes due to rapid acting- CAN LAST FOR 3-6 HOURS. 132. Chenodiol Class: Bile acid • used to dissolve gallstones- works by reducing cholesterol bile- monitor liver function while taking this medication due to being hepatotoxic, contraindicated for patients who have preexisting liver conditions. Take as prescribed usually two years, can cause diarrhea, can’t be taken by a pregnant person (category x). 133. Estradiol cream Class: Estrogen hormone • used for age related vaginal atrophy- used for vaginal symptoms like dryness, itching, burning- less side effects then the oral one, can be used 1-3 days per week, applied internally, can decrease risk of postmenopausal bone lose, which can cause osteoporosis. 134. Acetylcysteine Class: Mucolytic / Antidote • used for chronic bronchitis- hand held nebulizer- breaks up mucous in the lungs- cough it out easier- ALSO the antidote for acetaminophen- try to cough productively before you begin the treatment (this will allow for better absorption), open vial of medication can be stored in the refrigerator for up to 96 hours. Drink plenty of fluids, at least 2-3L a day to help thin secretions, might develop a light purple color (does not alter the potency of the medication, do not discard). 135. Chlorpromazine Class: Typical antipsychotic • antipsychotic medication- used to treat severe anxiety, schizophrenia, psychosis- calms the brain- can cause dermatitis and eczema. Adverse effect is orthostatic hypotension, palpitations, tachycardia, constipation, sedation, urinary retention, and photosensitivity. If A PATIENT STARTS HAVE INVOLUNTARY MOVEMENTS AND TREMORS GIVE AMANTADINE (due to symptoms of Parkinson’s). Involuntary tongue movement should be reported to the provider due to tardive dyskinesia (this is a rare neurological syndrome that has no cure). 136. Furosemide Class: Loop diuretic • loop diuretic- water pill- makes the body get rid of extra fluid- used for heart failure- eat foods high in potassium when taking this medication- due to depleting potassium, sodium, chloride, magnesium and water. DO NOT TAKE WITH NSAIDS due to decreasing efficacy, should reduce swelling and edema, avoid taking at bedtime due to needing to pee and disrupting sleep. Can have oliguria (urine specific gravity 1.035high). NOTIFY THE PROVIDER IF TINNITUS OCCURS. Diuresis is a therapeutic effect. Hypotension is an adverse effect; increased blood glucose can happen if a patient has diabetes mellitus. WEIGHT LOSS IS THERAPEUTIC RESPONSE FOR A CLIENT WHO HAS ACUTE GLOMERULONEPHRITIS (PREVENTS THE REABSORPTION OF WATER AND BLOCKS THE ABSORPTION OF SODIUM AND CHLORIDE WHICH DECREASES FLUID RETENTION. Can have ototoxicity when taken with streptomycin. 137. Erythromycin Class: Macrolide antibiotic • antibiotic- used to treat bacterial infections- report persistent diarrhea to the provider- can cause superinfection of the bowel because it destroys some sensitive flora in the GI system. Take on an empty stomach with a glass of water. Can cause hearing loss. 138. Cimetidine Class: H2 receptor blocker • used for duodenal ulcers, gerd, heartburn, acid reflux- blocks histamine in the stomachless acid made protecting the stomach- REPORT emesis that look like coffee grounds (this indicates GI bleed) and can mean medication is ineffective. Can cause erectile dysfunction, enlarged breast in male clients (will reverse when discontinued), myalgia or muscle pain can occur (does not need to be reported. 139. Infliximab Class: DMARD (TNF inhibitor) • used to treat autoimmune disease- like rheumatoid arthritis- reduces swelling and tissue damage- contraindication to receiving this medication is hepatitis b virus. Can reduce manifestations of psoriatic arthritis. Can treat inflammatory bowel disease, as well as ankylosing spondylitis. 140. Captopril Class: ACE inhibitor • used to treat hypertension, heart failure- a patient might feel dizzy while taking this medication- this is normal (monitor BP and change positions slowly), take 1 hour before meals or 2 hours after meals, avoid NSAIDS (ibuprofen), can cause severe neutropenia (let provider know about manifestations of infection). 141. Omalizumab Class: Monoclonal antibody (anti-IgE) • used for severe allergy related asthma- and chronic hives- MOA- it reduces the number of immunoglobulin (Ige) molecules on mast cells- this limits the ability of allergens to trigger immune mediators that cause bronchospasm. 142. Gentamicin Class: Aminoglycoside antibiotic • an antibiotic- serious bacterial infections- stops bacteria from making proteins so they can’t grow or survive. Can cause ototoxicity. PEAK LEVELS- IM INJECTION- 1 HOUR DRAW PEAK, IV- 30 MINUTES DRAW PEAK AFTER COMPLETING IV INFUSION. Trough will be drawn before administering the dose. Proteinuria is a manifestation of nephrotoxicity, an adverse effect of this medication (monitor for oliguria and hematuria. 143. Metformin Class: Biguanide (antidiabetic) • helps lower blood sugar- report myalgia, malaise, somnolence and hyperventilation due to lactic acidosis. You can also have weight loss, nausea, vomiting and diarrhea. Other two diabetes medications are glipizide and tolbutamide- they can cause weight gain. When taking sulfonylureas and glitazones with metformin they can cause severe hypoglycemia. 144. Hydroxychloroquine Class: DMARD • used for rheumatoid arthritis- calm down the immune system and reduce inflammation. EYE VISION IS A BIG ISSUE (RETINOPATHY- CAN BE IRREVERSIBLE AND CAUSE BLINDNESS). Can also cause gastrointestinal tract ulceration. 145. Linezolid Class: Oxazolidinone antibiotic • used to treat staphylococcus- kills tough bacteria- ones that are hard to treat. NURSE SHOULD REPORT PARESTHESIAS due to irreversible peripheral neuropathy and reversible optic neuropathy- this need to be reported to switch medications. Do not need to be reported are nausea, headaches (unless severe), insomnia. 146. Heparin Class: Anticoagulant • anticoagulant- blood thinner- aPTT should be between 60-80 seconds- if MORE THEN 80 slow it down and contact provider- ANTIDOTE- VIT. K. AVOID ASPIRIN. PROTAMINE SULFATE IS ANTIDOTE FOR SEVERE HEPARIN OVERDOSES. 147. Varenicline Class: Smoking cessation agent • smoking cessation aid- reduces craving for nicotine- monitor mood changes due to neuropsychiatric effects that can progress to depression and suicide. 148. Ergotamine Class: Ergot alkaloid (migraine) • helps with migraine headaches- only take the correct dose- do not take more due to physical dependence on it. DO NOT TAKE IF PREGNANT- notify provider if experiencing tingling in the fingers or toes due to ergotism or toxicity. Can also have signs of withdrawal if dependent on it headaches, nausea, vomiting and restlessness and provider should be notified. 149. Fexofenadine Class: Antihistamine (2nd generation) • used for seasonal allergies- standard tablets should not be used for 11 years and youngerthey should have oral disintegrating tablets or a suspension. Do not take with orange juice, twice daily, PO or orally. 150. Iron dextran Class: Iron supplement • iron supplements- iron deficiency anemia- BIG RISK IS ANAPHYLAXIS- small dose should be administered 5 minutes before the full dose- ANTIDOTE- DEFEROXAMINE. 151. Phenelzine Class: MAOI antidepressant • used for major depressive disorder- MAOI- MEAT/BEEF STEAK IS SAFE TO CONSUME AND DOES NOT INTERACT WITH MEDICATION. DO NOT EAT CHEESE, PEPPERONI, SALAMI, CURED MEATS, FISH. 152. Amitriptyline Class: Tricyclic antidepressant (TCA) • used to treat depression- MONITOR EKG DUE TO RISK OF CARDIOVASCULAR EFFECTS- get a pre ekg to see baseline before taking. They can have blurred vision, dry mouth, severe constipation and urinary retention as well. Can cause orthostatic hypotension- instruct the client to take precautions. Prescribed 3x a day until therapeutic dose has been reached. 153. Ciprofloxacin Class: Fluoroquinolone antibiotic • kills bacteria 154. Phenazopyridine Class: Urinary analgesic • pain reliever for urinary tract infection (numbs the bladder and urethra)- CAN BE TAKEN TOGETHER- ONE TREATS PAIN, THE OTHER TREATS INFECTION. Urine can turn an orange color. Take with medication to relieve GI upset. Drink 2-3L of fluid while taking to dilute the urine and flush the urinary tract. 155. Lamotrigine Class: Anticonvulsant • used for seizure disorder- calms overactive nerve signals- NOTIFY THE PROVIDER OF A RASH DUE TO STEVENS JOHNSON SYNDROM OR TOXIC EPIDERMAL NECROLYSIS, WHICH ARE LIFE THREATENING AND START AS A RASH. 156. Ibuprofen Class: NSAID • can slow progression of pulmonary damage for a patient. Can be used to treat Cystic fibrosis. 157. Fluoxetine Class: SSRI antidepressant • used for premenstrual disorder- SSRI- increases serotonin in the brain- you should expect decreased manifestations within a few days. Begins working in less than 2 months. Estrogen/ Progestin- used for menopause for hormonal therapy- progestin can protect against estrogen induced cancer of the uterus- however estrogen increases the risk of estrogen induced breast cancer. Can prevent chronic disorders like osteoporosis. (Class: Hormonal therapy / Combination sex hormones) Zolpidem- a sleeping pill- helps you fall asleep faster- can cause dizziness and daytime drowsiness, can cause confusion in older adult clients. (Class: Sedative-hypnotic / Nonbenzodiazepine hypnotic) QT interval medication is bradycardia- be used caution for patients who have hypotension or heart failure or low potassium or magnesium levels. (Class: Antiarrhythmic / QT-prolonging agents) Rotavirus vaccine- contraindicated for patients who have a history of intussusception. Moderate to severe diarrhea should not receive until they recover. Begin around the age of 8 weeks for this vaccine. (Class: Live attenuated vaccine) Celecoxib- NSAID- new diagnoses of rheumatoid arthrisits. (Class: COX-2 selective NSAID) Adalimumab- used for clients with moderate to severe rheumatoid arthritis who have no responded well to other forms of treatment. (Class: TNF inhibitor biologic DMARD) Abatacept- used for rheumatoid arthritis who have not responsed well to other forms of treatment. (Class: T-cell activation inhibitor biologic DMARD) Zileuton- monitor ALT due to liver function test. (Class: Leukotriene inhibitor) Levodopa- used for Parkinson’s disease- will take several months, vivid dreams can occur, management of more severe symptoms. (Class: Dopamine precursor / Antiparkinson agent) Selegiline is used to treat mild symptoms. (Class: MAO-B inhibitor) Lactulose- used for cirrhosis- a laxative that should decrease ammonia levels. Increase AST can indicate condition worsening, as well as increased PT. (Class: Osmotic laxative / Ammonia reducer) Vancomycin- used for C.diff- it is nephrotoxic and can result in renal failure. Monitor serum creatinine (range is 0.5-1.3)- HIGH creatinine can mean renal failure. (Class: Glycopeptide antibiotic) Varicella- CONTRAINDICATED IF ALLERGIES TO GELATIN. (Class: Live attenuated vaccine) Gabapentin- used for lumbar vertebrae- therapeutic effect is reduced cramping, achin and burning neuropathic pain- used to treat pain that is sharp and darting- decreases cramping, aching and burning pain and suppress spontaneous neuronal firing that causes pain. (Class: Anticonvulsant / Neuropathic pain agent) Etidronate- can help reduce cancer related bone pain in some clients. (Class: Bisphosphonate) Dexamethasone- is a glucocorticoid that can reduce spinal edema from an inflammatory response to cancer tumors that are compressing the spinal cord. Decreases inflammation by affecting the client’s immune system- the client us susceptible to infection and should avoud large crowds, as well as people who are ill. (Class: Corticosteroid / Glucocorticoid) Amphotericin B- Antifungal medication used to treat severe fungal infections- can cause nephrotoxicity (monitor creatinine every 3-4 days to increase fluid intake) if greater then 3.5 for creatinine then medication should be reduced. Can cause hypokalemia, hypotension and diarrhea. (Class: Polyene antifungal) Clonidine- used for hypertension- avoid driving until the client’s reaction to the medication is known. Can cause drowsiness, weakness and sedation and other CNS effects. Report rash to the provider. Dry mouth is normal, as well as constipation (increase fiber). (Class: Alpha-2 adrenergic agonist antihypertensive) Antitussive- helps suppress the cough relax. (Class: Antitussive) Spironolactone- used for heart failure, watch for increased breast tissue growth while taking this medication due endocrine adverse effects- just let patient know this can occur. Limit intake of potassium due to risk of hyperkalemia, do not drink a lot of water due to excreting sodium and can cause electrolyte imbalance (Class: Potassium-sparing diuretic / Aldosterone antagonist) Metoclopramide- this reduces nausea and vomiting by increasing gastric motility and promoting gastric emptying. Contraindicated is intestinal obstruction. Used for caution for people who have hypertension. (Class: Antiemetic / Prokinetic agent) Famotidine- treat gastric ulcers, reduces stomach acid, avoid smoking with this medication. Dizziness can happen. (Class: H2 receptor antagonist) Desmopressin- used for diabetes insipidus- adverse effect is headache, which can mean water intoxication. This medication causes fluid retention and places the client at risk of water intoxication. (Class: Antidiuretic hormone (ADH) analog) Diphenhydramine- used for allergies- try antihistamines with non-sedative effects if the patient feels sleepy during the day- take with food to avoid gastrointestinal irritation. Sedation can happen but should go away after a few days. (Class: First-generation antihistamine) Lisinopril- lowers blood pressure- can cause angioedema- monitor for it. (Class: ACE inhibitor) Imipenem- used for bacterial infections- seizures can occur and should be reported immediately (Class: Carbapenem antibiotic)