TOP DRUGS

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1. ACETAMINOPHEN (Tylenol)
EFFECTS: Analgesic (mild to moderate pain) Antipyretic NO anti-inflammatory action NO platelet action THERAPEUTIC LEVEL: 10 30 mg/dL ANTIDOTE: Acetlycysteine (Mucomyst)

ADVERSE EFFECTS: hepatotoxic

2. AMINOGLYCOSIDES
STREPTOMYCIN/ GENTAMYCIN Obtain Peak and trough level o Peak level 30 minutes after taking the drug o Trough level 30 minutes before the next dose Adverse effects: Neurotoxic

Ototoxic therapeutic to Menieres disease to relieve from vertigo (but this is the last resort because it will lead to permanent deafness) Nephrotoxic Monitor BUN

3. ANESTHESIA Epidural anesthesia Hypotension Spinal anesthesia Spinal headache

4. ANTICOAGULANTS AND THROMBOLYTICS

Action Onset Use WARFARIN SODIUM (Coumadin) Blocks synthesis of vitamin K and clotting factors thus preventing prothrombin synthesis 2 to 5 days Thrombosis and embolism Atrial fibrillation with embolization Adjunct in treatment of coronary occlusion Oral Milligrams Vitamin K/ Phytonadione (AquaMEPHYTON) Prothrombin time (PT) Normal value:11 to 13 seconds Long term therapy Slow HEPARIN (Hepalean) Blocks conversion of prothrombin to thrombin 30 seconds to 1 minute Thrombosis and embolism Prevention of clotting in heparin lock sets, blood samples and during dialysis Treatment of disseminated intravascular coagulation SQ, IV (DO NOT give IM, may lead to hematoma and pain) Units Protamine sulfate Partial Thromboplastin Time (PTT) Normal value: 60 to 70 seconds; 2 to 2.5 times the control Activated Partial thromboplastin time (APTT) Normal value: 30 to 45 seconds; 1.5 to 2 times the control Short term therapy Quick

Route Expressed in Antidote Laboratory Test Usage Effect

Coumadin and Heparin CAN BE GIVEN together Heparin-induced side effect: thrombocytopenia 1 | TOP DRUGS

 WHAT ARE THE DRUGS THAT ENHANCE THE EFFECTS OF ANTICOAGULANTS? 4A Aspirin, Antihistamines, Alcohol, Antibiotics 5G Ginseng, Garlic, Ginger, Ginko biloba, Guiafenesin

ANTICOGULANT prevents clot formation THROMBOLYTICS dissolves clot USE: pulmonary embolism, coronary artery thrombosis, deep vein thrombosis, MI SIDE EFFECT: bleeding Start therapy as soon as possible after thrombus appears as thrombi older than 7 days react poorly to streptokinase Heparin is discontinued before streptokinase is started IM injections are contraindicated ANTIDIOTE: aminocaproic acid (Amicar) Examples: streptokinase (Streptase) PROTOTYPE; alteplase (Activase), urokinase (Abbokinase), reteplase (Retavase), tenecteplase (TNKase), anistreplase (Eminase)

5. ANTIDEPRESSANTS

2 weeks interval in shifting from one type of anti-depressant to another Antidepressant effect: 2 4 weeks

Tricyclic Antidepressants (TCA) increases norepinephrine and/or serotonin in CNS by blocking the reuptake of norepinephrine by presynaptic neurons 1. Imipramine (Tofranil) 2. Amitriptyline (Elavil) SIDE EFFECTS: hypotension, arrhythmias, blurred vision, constipation, urinary retention, dry mouth NURSING CONSIDERATIONS: Check BP and PR Give drug at BEDTIME Changing from TCA to MAOI, patient must discontinue TCA for 14 days 2 to 4 weeks needed before the full therapeutic effect happens TCA OVERDOSE (anticholinergic toxicity): o Coma, convulsion o Ataxia, agitation o Stupor, sedation

Selective Serotonin Reuptake Inhibitor (SSRI) inhibits CNS neuron uptake of serotonin, but not of norepinephrine 1. Fluoxetine (Prozac) 2. Sertraline (Zoloft) SIDE EFFECTS: hypotension, headaches, arrhythmias, insomnia, dry mouth, weight loss, sexual dysfunction NURSING CONSIDERATIONS: o Give drug in the MORNING o Takes 4 weeks for full effect o Changing from MAOI to SSRI, patient must discontinue MAOI for 2 weeks Changing from SSRI to MAOI, patient must discontinue SSRI for 5 weeks o Monitor for weight o Provide oral hygiene

Monoamine Oxidase Inhibitor (MAOI) acts as a psychomotor stimulator or psychic energizers; blocks oxidative deamination of naturally occurring monoamines (epinephrine, norepinephrine, serotonin) causing CNS stimulation 1. tranylcypromine (Parnate) 2. isocarboxazid (Marplan) 3. phenelzine (Nardil) SIDE EFFECTS: Hypertensive crisis happens if the drug is taken with tyraminecontaining foods 2 | TOP DRUGS

o o o o o

Sweating Headache, HPN Urinary retention Nausea, Neck stiffness Tachycardia

Constipation Orthostatic hypotension Photophobia, dilated pupils Agranulocytosis

AVOID tyramine or tryptophan containing foods: o Aged meat, avocado o Banana, beans o Chocolates, coffee, cheese (cheddar, aged, swiss), chicken and beef liver o Drinks that are fermented (wine, beer) o Smoked fish, soy sauce, sour cream, sausage o Pickled foods (herring) o Overripe foods o Raisins o Tea o Yogurt, yeast ALLOW: cottage and cream cheese Monitor BP Therapeutic effect are achieved within 10 days to 4 weeks

6. ANTI-GOUT COLCHICINE (Novocolchine) anti-inflammatory

o o

SIDE EFFECTS; diarrhea, abdominal cramps NURSING CONSIDERATIONS: DO NOT give IM or SQ, this may lead to irritation Administer drug after meals No more than 12 tablets should be given in a 24 hour period

ALLOPURINOL (Zyloprim) prevent production of uric acid by inhibiting the enzyme xanthine oxidose o USE: prophylactic for attacks of gout; clients with calcium oxalate calculi o SIDE EFFECTS: hepatotoxic PROBENECID (Benemid)/ SULFINPYRAZONE (Anturane) uricosuric agents: reduces uric acid in the blood by increasing its renal excretion

7. ANTI-PARKINSONS
Dopaminergic Drugs (increase dopamine) 1. Amantadine (Symmetrel) 2. Levodopa (L-dopa) 3. Levodopa-Carbidopa (Sinemet) Anticholinergic Drugs (decrease Acetylcholine) 1. Akineton 2. Cogentin 3. Artane 4. Benadryl

8. ANTI-PSYCHOTIC (MAJOR TRANQUILIZERS)

USE: Schizophrenia 1. Haloperidol (Haldol) 2. Chlorpromazine (Thorazine) SIDE EFFECTS: HYPOtension leukopenia (sore throat) 3 | TOP DRUGS

NEUROLEPTIC MALIGNANT SYNDROME (HYPERthermia/ diaphoresis, HYPERtension) pink-red urine (normal: thorazine)

9. ASPIRIN/ SALICYLATES/ ACETYLSALICYLIC ACID

EFFECTS: Antiplatelets reduce risk of myocardial infarction and transient ischemic attack

Anti-inflammatory rheumatic fever, Kawasaki disease, rheumatoid arthritis Antipyretic fever Analgesic mild to moderate pain

Aspirin toxicity Tinnitus early sign of salicylism Metabolic acidosis late sign of salicylism Epistaxis, nephrotoxic

10.

ANTIDOTE: activated charcoal (can also give Ipecac syrup to induce vomiting of aspirin) Give the drug with full stomach after meals Aspirin is ulcerogenic Monitor CBC, Prothrombin time, renal and liver functions DO NOT give with any anticoagulant (Coumadin, Heparin). It may cause additive effect, high risk for bleeding AVOID Aspirin in patients with viral infection to prevent Reyes Syndrome AVOID Aspirin with OHA causes hypoglycemia

ATROPINE SULFATE (Atropair, AtroPen)

block neurotransmitter acetylcholine and inhibits parasympathetic actions USE: pre-op medication to reduce secretions and bradycardia; produces mydriasis CONTRAINDICATED in acute glaucoma, prostatic hypertrophy

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11. BETABLOCKERS
Example: propanolol (Inderal), timolol (Blocadren), pinolol (Visken), nadolol (Corgard), metoprolol (Lopressor), timolol maleate (Timoptic) MODE OF ACTION: inhibit sympathetic stimulation of beta receptors in the HEART decreasing myocardial oxygen consumption and demand by: decreases heart rate and *** decreases force of myocardial contraction EYES decreases intraocular pressure (IOP) by decreasing aqueous humor formation and increases aqueous humor outflow Change of position gradually Take pulse before taking drug***

12.BRONCHODILATOR
USE: bronchospasms, asthma EXAMPLES: BETA-ADRENERGIC: abuterol (Proventil, Ventolin), metaproterenol (Alupent) XANTHINES: theophylline (Theo-Dur) PROTOTYPE, aminophylline (Truphylline) THERAPEUTIC LEVEL OF THEOPHYLLINE: 10 20 mcg/ml (mg/dl) SIGN OF THEOPHYLLINE TOXICITY: Tachycardia 4 | TOP DRUGS

nausea and vomiting FOODS TO BE AVOID ICE TEA caffeine and caffeine containing foods because Theophylline is a xanthine derivative which has same effect with caffeine

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13.

DIAZEPAM (Valium)
USE: Drug of choice for status epilepticus EFFECTS: Anxiolytic Anti-convulsant Muscle relaxant DO NOT MIX with other drugs DO NOT withdraw abruptly AVOID alcohol, smoking, activities that requires alertness May cause physical dependence Oral form should be given BEFORE MEALS Examples: alprazolam (Xanax), clorazepate (Tranxene), flurazepam (Dalmane), midazolam (Versed), triazolam (Halcion), chlordiazepoxide (Librium), clonazepam (Klonopin), lorazepam (Ativan)

14.

DIGOXIN (Lanoxin)
Effects:

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(+) inotropic increases FORCE OF CONTRATION increase cardiac output (-) chronotropic decreases HEART RATE decrease oxygen demand of the heart muscles

Digoxin toxicity nausea, yellow color vision, arrhythmia, sign of hypokalemia (weakness, muscle cramps) Antidote: Digibind

15.

DIURETICS
SITE OF ACTION Proximal tubule Loop of Henle Glomerul us Distal tubule EXAMPLES Acetazolamide (Diamox) Furosemide (Lasix) Bumetanide (Bumex) Mannitol Osmitrol Glycerin Urea Spironolactone (Aldactone) Amiloride (Modiuretic, Midamor) Triamterene (Dyrenium) Hydrochlorothiazide Chlorothiazide (Diuril) Metolazone INDICATIONS Menieres disease, OPEN glaucoma Potent diuretic Increased ICP Warm solution to avoid crystallization Avoid potassium-rich foods (banana, potatoes, spinach, broccoli, nuts, prunes, tomatoes. Oranges, peaches) SPECIAL NURSING INTERVENTIONS

CLASSIFICATIONS Carbonic Anhydrase Inhibitors Loop Diuretics Osmotic Diuretics

Potassium Sparing

Mild diuretic, CHF, HPN

Thiazide and Thiazide-like

Proximal tubule

HPN (Not effective for immediate dieresis)

K-sparing: K-wasting:

Spironolactone, Amiloride, Triamterene CAI, Loop, Osmotic Thiazides 5 | TOP DRUGS

NURSING 1. 2. 3.

INTERVENTION Monitor blood pressure (first/ before) and weight (second/ after) Administer in the MORNING Administer with FOOD

EVALUATION: for effectiveness of therapy Weight loss Increased urine output Resolution of edema Decreased congestion Normal BP

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16.

HERBAL DRUGS that causs BLEEDING

GINKO BILOBA GINGER GARLIC GINSENG

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17.

IMCI DRUGS: IRON

1 dose daily x 14 days
TABLET Ferrous sulphate 200mg + 250 mcg Folate (60 mg elemental iron) THY SYRUP Ferrous sulphate 150 mg per 5 ml (6 mg elemental iron per ml) 2.5 ml (1/2 tsp) 4 ml (3/4 tsp) tablet 1 tab 5 ml (1 tsp) 7.5 ml (1.5tsp) DROPS Ferrous sulphate 25 (25 mg elemental iron per ml) 0.6 ml 1 ml 1.5 ml 2 ml

AGE or WEIGHT

2 to 4 months (4 to <6 kg) 4 to 12 months (6 to <10 kg) 1 to 3 years (10 to <14 kg) 3 to 5 years (14 to <19 kg)

18.

IMCI DRUG: VITAMIN A

AGE VITAMIN A CAPSULES 100,000 IU 200,000 IU 1 capsule 2 capsules 1 capsules

6 months to 12 months 12 months to 5 years

19.

IMCI DRUG: MEBENDAZOLE/ ALBENDAZOLE

Albendazole 400 mg tablet or 200 mg tablet 1 Mebendazole 500 mg tablet 1 1

AGE or WEIGHT 12 months to 24 months 24 months to 59 months

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20.

INSULIN
MODE OF ACTION: decreases blood sugar by Increasing glucose transport across cell membranes Enhancing conversion of glucose to glycogen
TYPE RAPID-ACTING: Regular, Humulin R INTERMEDIATE-ACTING: NPH/ Neutral Protamine Hagedorn (Insulin Isophane Suspension), Humulin N LONG-ACTING: Ultralente (extended insulin zinc suspension) Humulin U DESCRIPTION Color: Clear Route: IV, SQ Color: Cloudy Route: SQ Color: Cloudy Route: SQ ONSET 30 min 1 hr 1 2 hrs PEAK 2 4 hrs 6 8 hrs DURATION 6 8 hrs 18 24 hrs

3 4 hrs

16 20 hrs

30 to 36 hrs

(1) (2) (3) (4)

PEAK TIME time of hypoglycemic episodes 1ml of tuberculin = 100 units of insulin U100 insulin syringe is 100 units Administer insulin in room temperature ROUTE: SQ Administer insulin at either 45 degree (for skinny patient) or 90 degrees (for fat patients) Area: Abdomen fastest absorption Deltoid thigh buttocks AVOID: massage and apply compression (increase absorption) aspirate after injection shake. Gently roll vial in between palms Cold insulin lipodystrophy STORAGE: In room temperature last for 1 month Refrigerated once opened last for 3 months ADJUSMENT OF DOSE: increase insulin requirement Infection, Stress, Illness decrease insulin requirement Breast feeding (Antidiabetic effect) Mixing of insulin: (Aspirate 1st clear, Inject air 1st cloudy) Inject air to NPH Inject air to Regular Aspirate Regular Aspirate NPH Most common used: U100 (1) U40 (2)

21.

IRON SUPPLEMENTS
SIDE EFFECTS: dark stools (tarry stool), constipation, abdominal cramps Tablet: give with citrus juice (orange, tomato) Liquid: give with citrus juice (orange, tomato) and straw IM: Z-track method; DO NOT massage BEST given with empty stomach Citrus juice is AVOIDED with iron elixir preparation

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22.

LACTULOSE (DUPHALAC, CEPHULAC)

Laxative SIDE EFFECT: ammonia binder (therapeutic to patient with hepatic encephalopathy)

23.

LITHIUM
Anti-mania Therapeutic Level: 0.5 1.5 mEq/L Lithium toxicity (n/c, anorexia, abdominal cramps, diarrhea) PREPARATIONS: o Tablets: 300, and 450mg. o Capsules: 150, 300, and 600 mg. o Syrup: 300 mg/5 ml Maintain: o increase fluid (3L/day) o Increase Na (3 gm/day)

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24.

MAGNESIUM SULFATE
tocolytic agent USE: premature labor, anticonvulsants in pregnancy induced hypertension (PIH) Check: o deep tendon reflex (DTR) FIRST reflex lost with CNS toxicity o Check RR (at least >12 breaths/ min o Check urine output (at least 30 mL/ hr) ANTIDOTE: calcium gluconate

25.

METRONIDAZOLE (FLAGYL)
Anti-amoeba AVOID alcohol (Metronidazole + Alcohol = Disulfiram-like effect)

26.MORPHINE SULFATE (Duramorph) EFFECT: induce sedation, analgesia and euphoria INDICATION: moderate to severe pain, pain relief in myocardial infarction
DECREASES preload and afterload DECREASES workload SIDE EFFECTS of Morphine SO4 Miosis Orthostatic hypotension Respiratory depression Produces tolerance and dependence Hyperglycemia Increase urinary retention/ constipation, Nausea and vomiting Euphoria Sedation/ dizziness

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Assess clients pain before giving medication Check before and after the respiration May lead to tolerance FIRST SIGN of tolerance is decrease duration of effect of the analgesic AVOID activities that require alertness, alcoholic beverages, smoking, CNS depressants, sedatives, muscle relaxants Change position gradually

27.

NITRATES AND NITROGLYCERINE (Nitro-bid, Nitrodur, Nitrostat IV)

MODE OF ACTION: vasodilator USE: angina pectoris and hypertension SIDE EFFECTS OF NITRATES: headache, flushing, orthostatic hypotension, dizziness Other Related drugs: isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur) SUBLINGUAL form: 0.15 0.6 mg No more than 3 tablets should be taken in a 15 minute period (one tablet every 5 minutes); if pain not relieved after 15 minutes and 3 tablets, notify physician immediately SIGN OF POTENCY: burning sensation under tongue Drink water first BEFORE taking drug OINTMENT applied to a hairless or clipped/ shaved area new site should be used with each new dose use ruled applicator paper that comes with ointment to measure dose wear gloves during application leave applicator on site and cover it with plastic wrap and secure it with tape TRANSDERMAL PATCH Apply a patch once a day only Rotate site Place patch in non-hairy area Determine a base region and remove the old patch Wear gloves during application IV form: 5 mcg/ min dilute IV nitroglycerine in 5% dextrose or 0.9% sodium chloride and titrate every 3 to 5 minutes STORAGE: store in original dark glass container in a cool, dry place. date bottle when opening discard after 6 months NURSING CONSIDERATIONS: Change position gradually to prevent dizziness HEADACHE is a sign that the drug is taking effect. It will discontinue with long term use. AVOID alcohol, hot baths Carry drug at all times DO NOT administer nitrates with sildenafil (Viagra), both drugs are vosadilator which may lead to HYPOTENSON

28.

NONI JUICE
Morinda citrifolia High in fibers

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29.OCTREOTIDE (SANDOSTATIN)
Inhibits GROWTH HORMONE, GLUCAGON, INSULIN 2 formulations Sandostatinis a short acting version Sandostatin LARis a long acting version. Sandostatin is given by subcutaneous injection It may be necessary to take the shot several times a day. The injection sites should be rotated regularly. This medication may also be given intravenously. Sandostatin LAR is given by intramuscular injection. This medication is generally given once every 4 weeks. The preferred site for injection is the hip, because it is painful given into the arm. Sandostatin LAR should NOT be given by S.C. or IV routes. COMMON SIDE EFFECT: constipation

30.

OXYTOCIN (Pitocin)
stimulate uterine contraction USE: postpartum bleeding, labor induction ADVERSE EFFECTS: uterine hyperstimulation, arrhythmias, tachycardia, hypertension Given IM or IV; IV via piggyback and delivered with an infusion pump Observe fetal hypoxia or distress

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31.

PANCREATIC ENZYMES
USE: aid in digestion; cystic fibrosis Give WITH MEALS*** Expected outcome of the drug is absence of steatorrhea EXAMPLES: pancreatin (Dizymes), pancrelipase (Cotazym)

32.PHENYTOIN (Dilantin)

USE: seizure SIDE EFFECT: gingival hyperplasia, may turn urine pink, red, or red-brown ADVERSE EFFECTS: hepatotoxic, Steven-Johnsons syndrome DO NOT administer IM Give drug with NSS BEFORE AND AFTER (flushing) drug administration Provide oral hygiene, Use soft, bristled toothbrush Takes 7 to 10 days to achieve therapeutic serum level Therapeutic level: 10 20 mg/ dl

33.

STEROIDS
EFFECTS: Anti-inflammatory Hormonal replacement

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USE: USE: bronchial asthma, Addisons disease, allergies Examples: hydrocortisone (Cortisol), prednisone (Strap red), dexamethasone (Decadron), methylprednisone (Solu- medrol), betamethasone (Celestone) SIDE EFFECTS: Cushings syndrome Immunosuppression therapeutic to AUTOIMMUNE DISEASES 9 like nephrotic syndrome, SLE, multiple sclerosis, Rheumatoid arthritis, for organ transplant, hyperthyroidism, allergies) causes GI irritation and ulceration Long term: Adrenal insufficiency***, osteoporosis Short term: Immunosuppresant, hypokalemia, hypocalcemia, edema Give with food Watch out for infection Taper the dose (abrupt withdrawal may lead to acute adrenal crisis) Parenteral form: Give IM avoid SQ Oral form: Give it WITH food or milk, may cause gastric irritation Topical creams: DO NOT apply in broken skin and near eyes Administer in the morning (before 9 am); Take medication with breakfast (corresponds to biorhythms and reduces gastric irritation) Wear medic alert bracelet Isolation precaution AVOID sunlight, people with infections or crowded place AVOID immobility to prevent osteoporosis AVOID crowd DIET: Restrict sodium, alcohol and caffeine; high potassium foods Carry extra medication during travel. Adjust medications during periods of acute or chronic stress such as pregnancy or infections; contact health care provider.

34.

SYMPATHETIC AND PARSYMPATHETIC

SYMPATHETIC SNS (Adrenergic) Dumping Syndrome, MG Atropine Cholinesterase fight or flight response (BIOAMINE THEORY) Epinephrine (Adrenaline) faster release but short acting Norepinephrine Dopamine Serotonin (Increase) HR, RR, BP (Decrease) peristalsis, UO, secretions Pupil dilation (mydriasis) Bronchodilation Hyperglycemia PARASYMPATHETIC PNS (Cholinergic) Glaucoma, GERD Prostigmine Anticholinesterase Sleep and digest response Acetylcholine slowly release but long acting

(Decrease) HR, RR, BP (Increase) peristalsis, UO, secretions Pupil constriction (miosis) Bronchoconstriction Diarrhea Urinary frequency Miosis (constriction) Bradycardia Bronchoconstriction Erection/ emesis L Salivation

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35. THYROID AND ANTI-THYROID DRUGS
THYROID AGONISTS used to increase blood thyroid hormones LEVOTHYROXINE (Synthroid) USE: hypothyroidism (myxedema), cretinism (congenital hypothyroidism) SIDE EFFECTS: insomnia, tachycardia, diarrhea Taper the dose Monitor vital signs (temperature, BP, PR) Give the drug in the morning (due to insomnia side effect) CONTRAINDICATIONS: Cabbage, Cauliflower Peaches, Peas, Pears Raddish, turnips Spinach

THYROID ANTAGONISTS used to decrease blood thyroid hormones A. ANTITHYROID DRUGS inhibit synthesis of thyroid hormones B. IODIDES inhibit secretion/ release of thyroid hormone; decrease vascularity of the thyroid
gland (for thyroidectomy preparation) Examples: Potassium Iodide Saturated Solution (Lugols solution) Give at least 10 day before surgery SIDE EFFECTS: o agranulocytosis (sore throat) o paresthesias o bleeding (inhibits vitamin K) Taper the dose Monitor vital signs (temperature, BP, PR) AVOID iodine, iodine containing foods and sea foods ORAL form: dilute with water or juice (to improve taste) and use straw (to prevent discoloration) Examples: propylthiouracil (PTU, Propacil, Propyl-Thyracil), methimazole (Tapazole)

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