Drugs 1. Marijuana (LSD) a. Schedule I b. Not legal in most U.S. 2. Morphine i. Schedule II (Valid medical indications) ii.

Prototype iii. inhibits release of Substance P; binds to CNS receptor sites to stop pain iv. Drug of choice for MI v. Depresses respiration, cough reflex, stimulates vomiting center, pruitis, hypotension vi. May see: Miosis, hypothermia, muscle contractions, euphoria vii. Adverse Effects: respiratory depression, constipation, hypotension, urinary rentention, cough suppression, biliary colic, emesis, sedation, miosis viii. Toxic: pin-point pupils ix. Peak times 1. IV 10-20 min 2. IM 30 min 3. Sub-Q 60-90 min 4. Oral 60 min b. MS Contin (Oxycontin) i. oral form of Morphine ii. Duration 5-7 hrs 3. Delaudid (hydromorphone) i. Schedule II ii. less nausea, euphoria, itching when given epidural iii. More potent than morphine when given orally 4. Demerol (meperdine) i. not used as much b/c other drugs with fewer side effects ii. not recommended unless true allergy to other opioids iii. IM very irritating to tissue iv. shorting acting (about 3 hrs) v. respiratory depression, hypotension, less euphoria, less spasm of biliary colic 5. Codeine i. Schedule II ii. Analgesic, Antitussive iii. C-section, post-op pain iv. nausea increases as dose increases, constipating v. Can cause respiratory depression, but less chance than morphine 6. Darvon (propoxyphene) i. Schedule IV

ii. 2/3 as potent as codeine iii. sedation and circulatory failure iv. No cough suppression, euphoria or respiratory depression unless large doses 7. Fentanyl i. transdermal patch ii. 72 hrs iii. takes longer to clear from system 8. Talwin i. Oldest Schedule IV drug on market ii. agonist-antagonist 9. Stadol i. agonist-antagonist ii. usually take antiemetic to counteract nausea 10. Nubain i. agonist-antagonist ii. usually take antiemetic to counteract nausea 11. Buprenex 12. 13. i. agonist-antagonist Amphedamines i. Schedule II Valium (diazepam) i. Schedule IV ii. Antianxiety and muscle relaxation (benefit) iii. CNS depressant (watch giving with other opioids) Robaxin (methocarbomoll) i. muscle relaxant Skelaxin (metaxalone) and Soma (carisoprodol) i. muscle relaxers esp. used for OA ii. for muscle spasms L-Dopa a. Used for Parkinsons Disease, Restless Leg Syndrome, and PLMD (periodic limb movement disorders) Phenobarbitol a. Schedule IV b. seizure medication Neurontin a. anti-seizure medication Tylenol III i. Schedule III ii. opiate (codeine) combined with non-narcotic (acetaminophen) Lomotil i. Schedule V

14. 15.

16.

17.

18. 19.

20.

ii. antidiarrheal 21. Flomax i. adrenergic ii. for urinary retention Narcan (naloxone) i. Antagonist (anecdote) ii. reverses effects (analgesic and adverse) of opioids in 1-2 min iii. IV rapid onset/shorter duration than RiVia can give more than once RiVia (naltrexone) i. antagonist (anecdote) ii. Oral - give ATC long acting iii. Give NSAID for the pain b/c RiVia reversing analgesic effect iv. OR may decrease opioid 25-50% along with RiVia and monitor closely Elavil (amitriptyline) i. tricyclic antidepressant ii. neuropathic pain (dull, aching, throbbing) iii. watch for tachycardia iv. Also used for Pruitic Pain v. Also used as antispasmotic for bladder spasms/stress incontinence Modafinil a. CNS stimulant promotes wakefulness b. Schedule IV c. Oral used to treat Narcolepsy Tegretol (carbarnazepine) i. Anticonvulsant ii. neuropathic pain (sharp, shooting, burning) iii. given to diabetics and chronic restless leg syndrome Phenergan i. potentiator (increases action/potency of opioids) ii. antiemetic iii. duration 4-6 hrs iv. Can increase respiratory depression; makes you sleepy Zophrin i. antiemetic Vistaril i. potentiator/adjuvant ii. analgesic, antiemetic, antihistamine, antianxiety (> doses dont > analgesia) iii. sedative/hypnotic iv. 50 mg = 5 mg morphine PO or IM (very irritating to tissue) Aspirin (ASA, acetylsalicylic acid) a. analgesic, antipyretic, anti-inflammatory, anticoagulant

22.

23.

24.

25.

26.

27.

28. 29.

30.

b. inhibits synthesis of cyclooxygenase (enzyme) which inhibits production of prostaglandins c. Not an NSAID: 80-160 mg/day prophylactic thromboembolic i. MI, Coronary Artery disease, High cholesterol, diabetics at risk for CV disease ii. 325-650 mg q4h for analgesic effect or antipyretic d. Considered an NSAID: 3-6 g/day i. large doses routinely for inflammation e. GI irritation i. causes < in gastric acid production ii. has anti-platelet effect iii. Risk: age, cigarettes, PUD, alcohol iv. enteric coated, take with milk or food, assess for melena (black tarry feces/blood in stool resulting from GI bleed), petichiae on abdomen/forearms f. Side Effects i. allergy or cross sensitivity to other NSAIDs ii. > clotting time: Labs pro time, hematocrit, platelets iii. Renal Impairment: Labs BUN, creatinin, urinary output iv. saliclism saturated metabolic pathways slowing drug elimination, prolonging life, and causing drug accumulation 1. Causes severe HA, N & V, tinnitus, confusion, > pulse and respirations v. hyperventilation and diaphoresis vi. pH in blood (altered acid base balance) vii. Do not administer to flu-like symptoms (esp children) may cause Reye syndrome g. Aspergum i. can irritate oral mucosa esp. in bleeding gums 31. Ibuprofen (motrin, midol, Excedrin, advil) a. musculoskeletal pain (arthritis, HA, minor trauma) b. Inhibits prostaglandin synthesis like aspirin (< pain, fever, inflammation) c. < 400 mg non-prescriptive strength d. 4-6-800 mg prescription strength 32. Acetaminophen (Tylenol, Datril, Panadol) a. NO ANTI-INFLAMMATORY effects b. analgesic, antipyretic c. prostaglandin blocker i. prevents sensitization of pain receptors ii. acts on hypothalamus to reduce fever/vasodilation to release heat from blood d. Symptom of toxicity tinnitus e. Onset 20 min f. Peak concentration 30-60 min 33. Mucomyst a. anecdote for acetaminophen b. smells/tastes like rotten eggs

34. Toradol a. Non-opioid b. NSAID only parenteral NSAID c. analgesic i. post-op ii. ER d. ATC schedule (no longer than 5 days; prolongs bleeding time) e. Mainly IM, but also PO and IV 35. Naproxin (Anaprox, Naprosyn) a. Non-opioid b. NSAID c. Antipyretic, anti-inflammatory d. Mainly for dysmenorrhea give few days b/f menses starts e. RA and OA (anti-inflammatory) f. OTC non-prescriptive 36. Indocin a. Non-opioid b. NSAID c. not administered as analgesic (high risk of toxicity) d. Anti-inflammatory/anti-arthritic (RA and OA, and Gout) e. Sustained Release not for Gout patients (flare-ups periodic) f. Side Effects Severe HA, vertigo, confusion g. Rare Life-Threatening Side effects i. bone marrow depression ii. thrombocytopenia (low platelets) iii. neutropenia (low neutropils/predisposes to infection) iv. gastric perforation w/hemorrhage (hole in stomach/intestine) v. Seizures ________________________________________________________________________ STEROIDS *naturally occurring hormones in body mineralocorticoid gonadocorticoid glucocorticoid *treat symptoms/ not a cure; RELIEVES INFLAMMATION *inhibit synthesis of prostaglandins and histamine *loss of potassium (irregular HR, leg cramps); retain sodium (edema) *produces euphoria/mood swings *decreases cerebral edema/ intracranial pressure in stroke patients *suppresses immune response/reduce resistance to infection *once/daily doses preferred (mimic bodys production) & D/C ASAP to < S/E and gastric irritation *Side Effects

37.

38.

39.

40.

increase gastric irritation/decrease gastric acid production (like aspirin) menstrual irregularities Infection (b/c masks s/s of infection) hyperglycemia (caution diabetics (sliding scale) Osteoporosis Heart Failure Theomboembolism (ck peripheral pulses, assess pain, feel temp lower extremities) Cushings Syndrome moon face excessive hair growth buffalo hump psychic phenomenon (mood changes, insomnia, euphoria/mania) Cortisone (hydrocortisone) a. Steroid b. short acting life 8-12 hrs c. Use with Caution: can bleach the skin d. In excess of 1% is prescriptive strength e. relieves itching Prednisone - CORTICOSTEROID a. Steroid b. intermediate 12-36 hrs Decadron a. Steroid b. long acting 36-54 hrs Solumedrol a. Steroid b. IV push (fast acting)

_____________________________________________________________________________________ 41. Tagamet or Karafate H2 Inhibitor a. histamine blocker (antiulcer agent)/ stomach acid reducer (for gastric reflux) b. take with steroids to coat the stomach and reduce GI irritation c. Decrease the dosage of Sonata if you have to take it with Sonata (hypnotic drug) i. cimetidine in these drugs can interact with the serum levels of Sonata 42. Cimetidine a. stomach acid reducer found in a lot of OTC medications such as Tagamet b. Decrease the dosage of Sonata (hypnotic) if you have to take it with Sonata c. Can interact with the serum levels of Sonata 43. Zantac H2 Inhibitor a. stomach acid reducer b. Prevent Peptic Ulcers

44. Prilosec H2 Inhibitor a. stomach acid reducer b. Prevent Peptic Ulcers 45. Pepcid H2 Inhibitor a. stomach acid reducer b. Prevent Peptic Ulcers 46. Cholase or Ilopan or Metamucil a. mild laxative stool softener b. stimulate peristalsis (relieves gas/bloating after surgery) 47. Solganal (aurothioglucose) a. Gold Compound: IM injection b. Antiinflammatory/Arthritis c. Interferes with progression of disease d. Controversal 48. Myochrysine (gold sodium thiomalate) a. Gold Compound: parenteral b. Antiinflammatory/Arthritis c. Interferes with progression of disease d. Controversal 49. Ridaura (auranofin) a. Gold Compound: PO not as effective b. Antiinflammatory/Arthritis c. Interferes with progression of disease d. Controversal 50. Dimarcaprol (BAL in Oil) a. anecdote for Gold Compounds b. Heavy metal antagonist c. binds with metal, forms a water soluble substance and excreted through kidneys 51. Lidocaine Swabs or Xylocaine Swabs a. numb surface for insertion of IV 52. Lidocaine (Xylocaine) with Epinephrine a. administered together to prolong the effects of anesthesia and slow down absorption 53. Bupivacaine (Marcaine) a. anesthetic 54. Cholorprocaine (Nesacaine) a. Anesthetic 55. NIX, RID, KWELL a. Treatments for Lice 56. Benedryl (diphenhydramine HCL) a. Oral antihistamine for pruitis, allergies 57. Colchicine a. Analgesic for Gout

58.

59.

60.

61.

62.

63.

64.

65.

b. Interrupts/STOPS the active attack c. stops the deposit of uric acid during an active attack d. Usually given IV e. PO causes stomach upset, bad cardiac, liver, and kidney effects Allopurinol (Zyloprim) a. DRUG OF CHOICE: for Gout - PREVENTS the attack b. Decreases uric acid production c. Prevents attacks Probenecid (Benemid) a. For prevention of Gout attacks b. Helps you excrete more uric acid Uloric (febuxostat) a. For prevention of Gout attacks b. Combination (new drug) that balances out uric acid levels to normal Colbenemid a. Combination new drug for Gout (Colchicine and Benemid) b. Also works both ways less production and more excretion of uric acid Methotrexate (chemotherapy agent) a. antineoplastic (cancer drug) b. Treatment of Rheumatoid Arthritis c. Used to treat Bladder Cancer d. Lowers Immune response e. Can cause renal failure and severe damage to site where its going in f. Look for bloody urine/ melanin Enbrel a. Antirheumatic b. Decreases inflammation and slows progression of arthritis (RA) c. IV or injection Very Expensive per dose d. Irritating to tissues, cause psych and allergic reactions/immunosuppression flurazepam (Dalmane) benzodiazepine a. Provides relief of insomnia b. Schedule IV c. has THE LONGEST half-life in its category (50-100 hrs) d. dangerous to elderly and under 18 e. hangover effects (physician may order drug holidays) temazepam (Restoril) benzodiazepine a. Provides relief of insomnia b. Schedule IV c. More common benzodiazepine d. Intermediate half-life (10-20 hr); meant for short-term treatment i. one of the most commonly addictive drugs e. Not a lot of side-effects (doesnt affect REM sleep)

66. triazolam (Halcion) benzodiazepine a. Provides relief of insomnia b. Schedule IV c. Short half-life (2-4 hrs) d. Less daytime sedation e. No hangover effect BUT can cause anteriograde amnesia (failure to remember new things) 67. zaleplon (Sonata) hypnotic drug a. Short-term treatment for insomnia (7-10 day treatment) b. Schedule IV c. Peaks 1 hr Initial insomnia (helps you go to sleep) d. Dont take with meals (esp high fat) slows absorption/ reduces effectiveness e. Causes REM rebound 68. zolpidem (Ambian) hypnotic drug a. Short-term treatment for insomnia b. Schedule IV (VERY COMMON) c. Ordered a lot in hospital setting d. Fast acting e. SE: HA, drowsiness f. Dont take with meals slows absorption, reduces effectiveness g. Does NOT cause REM rebound 69. Melatonin Supplements hormone a. Induce sleep/ decrease jet-lag (3 days b/f and 3 days after flight) b. Severe HA, vivid nightmares, transient depression c. Elderly have markedly decrease in their body 70. Kava herb a. restlessness/ insomnia b. Dont take with other CNS depressants c. FDA warning Can cause severe liver toxicity d. Dont take with renal/herpatic complications e. Causes thrombocytopenia (low platelet count), and neutropenia (low lymphocyte count) 71. Metformin (Glucophage) a. anti-diabetic medication b. puts at risk for lactic acidosis 72. Lovenox (enoxaparin) a. anticoagulant antithrombotic b. low molecular weight heparins c. Prevents DVT and Pulmonary Embolism 73. Arixtra a. anticoagulant antithrombotic b. low molecular weight heparins c. blood thinner

74. Heparin a. anticoagulant antithrombotic b. blood thinner 75. Protamine Sulfate a. anecdote for Heparin 76. Coumadin a. anticoagulant antithrombotic b. blood thinner 77. Vitamin K a. anecdote for Coumadin 78. Plavix, Ticlid, Persantine, and Low dose Aspirin (Bufferin, Ecotrin, Ascriptin) a. anticoagulant thins blood 79. Amicar a. hemostatic agent - coagulant b. manages acute life-threatening hemorrhage (prevents bleeding) 80. Albumin a. adds volume to the blood 81. t-PA a. tissue plasmodium activator b. clot buster for ischemic strokes, TIA c. used within 3 hrs of stroke/ narrow window of opportunity d. cant take with any other anticoagulant including low-dose aspirin 24 hrs. after t-PA administration 82. Zocor (simvastatin) Statin a. cholesterol lowering drug 83. Lipitor Statin a. cholesterol lowering drug 84. Adriamycin a. antineoplastic (cancer drug) b. used to treat bladder cancer c. turn urine bright cherry red d. Can cause Hemorrhagic Cystitis i. bladder inflamed (severe pain) and blood in urine ii. complaints of frequency/ urgency iii. Causes Renal Damage iv. Stop the treatment immediately and notify physician 85. Aminoglycosides antibiotic a. Gentamicin, Geramycin, Kantamycin b. used to treat UTIs c. can cause ottotoxicity (ear) d. can cause renal failure 86. Sulfonamides antibiotic

used to treat UTIs can causes Renal Failure can crystallize in the urine i. force fluids 2-3 L/day ii. drink full glass water with each dose iii. adequate output 1500-2000 mL/day iv. ck allergy to Sulfa 87. Cephalosporines antibiotic a. Keflex, Suprax, Monurol, Duricef b. ck drug allergy to penicillin or cephalosporines c. used to treat UTIs d. used to treat ottitis media (fluid/infection in middle ear) e. report watery diarrhea f. can cause kidney damage g. Monurol dont take with any other drug increasing GI motility (laxitives) 88. Fluroquinolones antibiotic a. Cipro, Proquin, Levoquin, Maxaquin, Noroxin, Floxin, Zagam b. used to treat UTI c. Levoquin increased effectiveness in nursing homes/ group living quarters d. Noroxin DRUG ERROR WARNING: Neurontin (prevents seizures) e. dont crush or chew: swallow whole f. dont use within 2 hrs of antacid g. wear sunscreen/protective clothing in sun h. REPORT ABNORMAL PULSE IMMEDIATELY 89. Penicillin antibiotic a. Amoxicillin (Amoxil) b. Amoxicillin/clavulnate (Augmentin) c. Cartbenicillin d. Augmentin has sodium clavulnate in it (cant give 2 - 250 mg tabs for 500 mg order) e. Amoxil is resistant to E-coli f. check for allergy to penicillin g. may give cephalosporin or macrolid (if anaphylactic reaction to cephalosporine, give the macrolid) h. take with food report watery diarrhea use alternate form of birth control 90. Macrolids a. Erythromycin b. Azithromycin (Z-Pack) 91. Primarin a. estrogen b. increases tone of bladder muscles

a. b. c. d.

TMP, SMZ, Bactrim, Cotrim, Septra

92. Drugs that Increase urinary retention a. anticholinergics b. antihistamines c. decongestants d. tranqualizers e. antidepressants 93. 5 Alpha Reductase Inhibitors a. Proscar (finasteride) b. Avadart (dutasteride) i. shrinks prostate ii. stops conversion of testosterone to dihydrotestosterone iii. teratogenic effect causes birth defects iv. Side Effects: 1. gynecomastia 2. ED, impotence, ejaculation disorders, loss of libido 3. flushing 94. Alpha Adrenergic Blockers a. Flomax (tamsulosin) b. Uroxatral c. Rapaflo i. relax smooth muscle (dilates circumference of urethra) at bladder neck and in the prostate ii. IMPROVES URINE FLOW 95. Alpha Blockers a. Minipress (prozosin) b. Cardura (doxazosin) c. Hytrin (terazosin) i. Control Hypertension and treat BPH pull fluid off (diuretic effect)/< circulatory volume ii. Classic SE: Hypotension, Fatigue 96. Viagra a. vasodilator b. erectile dysfunction 97. Antimuscarinics/antispasmotics/anticholinergics a. B and O Suppository b. Ditropan c. Doxepin d. Pro-Bonthine e. Detrol f. Detrol LA g. Cystospaz h. VESIcare

Anaspaz Botox (clinical research trials) i. inhibits bladder contraction and controls feeling of urgency ii. Anticholenergenic Effects: dry mouth, confusion, blurred vision, dizziness, fainting, increased heart rate, fever, difficulty voiding, dilates pupils (photosensitive) 98. Medications that cause Kidney Stone formation a. Diamox used to treat glaucoma b. Crixivan HIV medication c. Dyrenium potassium sparing diuretic 99. Drugs that Treat Renal Calculi (get rid of them) a. Struvite Stones i. Garamycin (aminoglycoside) cause ottotoxicity and nephrotoxicity ii. Keflex (cephalosporine) iii. Hydrea acidifies the urine iv. Lithostat acidifies the urine; If Serum Creatinin > 2 HOLD LITHOSTAT b. Calcium Stones i. Duiril (thiazide diuretic) reabsorbs calcium in renal tubal ii. Calcibind reduces calcium absorption in the gut c. Phosphate Stones i. aluminum hydroxide binds with phosphate so excreted in the gut ii. lowers phosphate (which raises calcium) d. Uric Acid Stones i. Zyloprin (Allopurinol) e. Cystine Stones i. Penicillamine ii. AMPG iii. Capotin (catopril) 100. Emlacream a. topical anesthetic cream (lithotripsy) b. nurse must wear gloves to apply 101. Kayexalate a. removes potassium resins (lowers potassium) 102. Antihypertensives a. Vasodilator i. Apresoline OLD Gold Standard b. Calcium Channel Blocker i. Adalate c. Alpha Beta Antagonist i. Labetalol 103. Digoxin a. slows and strengthens the heart

i. j.

104.

105.

106.

107.

108.

b. comes from the foxglove plant Elmiron a. bladder protectant b. sticks to exposed (IC) bladder wall and replenishes GAG layer c. mild anticoagulant properties Antifungal Medications (Yeast Infections) a. Creams (also come in vaginal suppositories) i. Monistat ii. Femstat iii. Gynelotrimin iv. Gynezol b. Oral i. Diflucan ii. Nystatin Medications for UTI due to Coitus a. Proloprim b. Trimpex c. Half Strength: bactrim, cotrim, septra, macrodantin, nephronex, novofuran Urinary Antiseptics a. Macrodantin turns urine brown b. Macrobid c. Urotoin d. Furadantin Urinary Analgesics a. Axo-Dine b. Pyridium - (AZO standard OTC) turns urine red/orange c. Prodium, Pyridate d. Urised - (Uristat OTC) turns urine green e. may stain clothing (Pyridium red/orange; Urised green) f. does not treat infection g. take with meals or immediately after

_____________________________________________________________________________________

Diuretics:
Thiazide work on distal convoluted tubal Loops work on loop of henle Potassium Sparing - work on collecting duct Osmotic work on proximal convoluted tubal 109. Thiazide Diuretics a. Diuril b. Hygroton

Esidrix, Microzide HCTZ HydroDIURIL Lozol Zaroxolyn Uses: decrease fluid volume (< edema) in CHF, Cirrhosis with acites, renal dysfunction diseases (AGN, Nephrosis), hypertension i. Caution use in: elderly, small children, diabetes, gout, lupus j. Check allergy to sulfonamides, thiazide diuretics k. Undesirable Effects: Hypokalemia, Hyponatremia, Hyperuricemia, Hypercalcemia, Hyperglycemia, orthostatic hypotension, syncope, anorexia, N & V, dehydration, photosensitivity l. Complications: Digoxin toxicity if < K+ levels, Lithium toxicity (Bipolar med), Additional k+ losses if taking steroids or PCN, and decreases effectiveness of antidiabetic medications m. Teach: discontinue b/f parathyroid function test thiazides alter (>) calcium levels 110. Loop Diuretics a. Bumex b. Edecrin c. Lasix (furosamide) IV push slowly over 1-2 minutes d. Demadex e. Loops are ottotoxic and nephrotoxic. Dont combine with other meds that are ottotoxic (aminoglycosides: gentamycin, kantamycin, geramycin), aspirin, or Cisplatin (Platinol) anticancer drugs or meds that are nephrotoxic (aminoglycosides) OR other meds that cause you to lose k+ such as Amphotericin B (also causes nephrotoxicity) f. Uses: WORK FASTER to pull off fluid in CHF, Cirrhosis, Renal dysfunction, Hypertension g. Caution use in: Hypokalemia, Renal/hepatic dysfunction, Gout, Diabetes h. Check allergy to sulfonamides, Loop diuretics i. Undesirable Effects: Hyponatremia, Hypokalemia, Hypocalcemia, Hypomagnesemia, Hypochloremic alkalosis, Hyperglycemia, Hyperuricemia, hypotension, blurred vision (> sugar & lens in eye swells), HA, anorexia, N, V, & D, dehydration, muscle cramps j. Complications: Digoxin toxicity if < k+ levels, Lithium toxicity, additional k+ losses if taking steroids or PCN, decreases effectiveness of antidiabetic medications k. Teach: Lasix and Edecrin can cause Leukopenia (< WBCs) and photosensitivity 111. Potassium Sparing Diuretics a. Aldactone the granddaddy b. Midamor c. Dyrenium d. Caution use in: Hypokalemia, Impaired Renal function, Pregnancy induced hypertension, Diabetes e. Undesirable Effects: nausea, diarrhea, dizzy, headache, dry mouth (hypovolemia), rash, photosensitivity, Abnormal EKG (peaked T-Wave) if elevated levels of k+

c. d. e. f. g. h.

Complications: Digoxin toxicity, Lithium toxicity, decreased anticoagulation, Increased k+ levels with Ace Inhibitors, NSAIDs, meds containing k+, k+ supplements (K-dur, K-lite), salt supplements and foods high in k+, during blood transfusion watch for increased potassium levels if taking k+ supplements g. Monitor: Digoxin , Lithium, and Potassium levels h. Teach: May take 2 weeks to get maximum hypotensive effects i. Avoid: citrus, cola, milk low in sodium, salt substitutes, k+ supplements 112. Osmotic Diuretics *given intravenously only a. Osmoglyn (glycerin) b. Ismotic (isosorbide) c. Osmitrol (mannitol) d. Ureaphil (urea) e. Uses: Oliguria, Edema, ICP, IOP, specific drug toxicities to pull off poisonous/toxid substances f. Caution use in: heart failure, renal failure, hypertension, pulmonary edema, intracranial hemorrhage, severe dehydration g. Contraindicated: Serum osmolarity greater than 310-320 mOsm/kg h. Undesirable Effects: dry mouth, thirst, N & V, blurred vision, HA, dizzy, cellular dehydration, F & E imbalance, pulmonary edema i. Teach: Isosorbide and glycerin given to reduce IOP, Mannitol has to be dissolved in IV solution watch for crystallization (have to have a filter) dont give if you see crystals in IV solution _____________________________________________________________________________________ Eating Disorders 113. Medications Anorexia Nervosa antidepressants (not effective in acute stage) a. Prozac b. Zoloft c. Anafranil d. Periactin e. Thorazine f. Lithium g. Zyprexa 114. Medications for Bulemia a. Prozac 3 X regular dose for antidepressants 60 mg/day; up to 6 wk to take effect b. Tofranil c. Norpramin d. Desyrel e. Nardil 115. Medications for Binge Eating a. Prozac

f.

b. Meridia _____________________________________________________________________________________ Substance Abuse Substitution therapy for withdrawal and Deterrants CNS Stimulants trigger Dopamine; CNS Depressants trigger GABA or Endorphines Substitution Therapy decreases intensity of withdrawal symptoms reduces life-threatening effects of intoxication removes substance from system 116. Substitution Therapy for Alcohol Withdrawal Benzodiazepines (anxiolytics) a. b. c. d. e. 117. 118. Atavan Librium avoid if client has liver damage Valium avoid if client has liver damage Oxypam Xanax

Deterrant Drug for Recovering Alcoholics

a. Antabuse take with alcohol = SICK

MultiVitamin Therapy associated with Wernikes/ Korsakoffs Syndrome

a. B1 (Thiamine)

119. Treatment for Heroin Addiction a. Methadone *NCLEX and HESI books says treatment for Opioid withdrawal b. Rivia (naltrexone) 120. Treatment for Opioid Intoxication a. Narcan b. RiVia c. Revex 121. Substitution Therapy for Methadone a. Catapress (Clonidine) 122. 123.

Cocaine Withdrawal and Deterrant

a. Disipramine

Hallucinogens and Cannibis

a. NO SUBSTITUTION THERAPY NECESSARY

_____________________________________________________________________________________ Anxiety Disorders - Generalized Anxiety Disorder, Panic disorders, OCD, Phobias, PTSD, Dissociative Disorders (Amnesia, Fugue States, Dissociative Identity Disorder/multiple personality), Somatoform

Disorders (Conversion Reactions, Labelle indifference, Hypochondrias), Psychosomatic Disorders (anxiety causes physical symptoms/ulcer, migraine, HBP) 1. Anxiolytics (a.k.a. benzodiazepines, minor tranquilizers) addictive a. lower anxiety levels calms you down increase GABA CNS depressants b. Buspar Only atypical anxiolytic; can be used long-term (no addiction) i. Buspar ONLY stimulates serotonin/relieves anxiety (no addiction) c. Antihistimenes rarely used for anxiety d. Valium long half-life e. Librium and Atavan (short-term) used for alcohol withdrawal (HESI) f. Xanax g. Prozac Mood Disorders Major Depression, Bipolar, Suicide 2. Antidepressants enhance (increase or reduce) norepinephrine, acetylcholine, serotonin 3. MAOIs a. Nardil, Parnate, Marplan, Eldepryl (skin patch) b. block MAO, increases serotonin, but makes you unable to digest tyramine c. Used for Resistant Depression, Bulimia, OCD, patients unresponsive to TCAs d. DONT PLAY WELL WITH OTHER DRUGS e. Anticholinergic Effects, sexual dysfunction, weight gain, photosensitivity f. Foods containing tyramine will cause Hypertensive Crisis: i. HA, HTN, tachycardia, stiff neck, N & V, maybe death from circulatory collapse or intracranial bleed g. Tyramine Foods: liver, cured meat, dried/pickled fish, meat extracts/flavor cubes, soy sauce, sour kraut, broad bean pods, bananas, hard cheeses, vitamins with brewers yeast, chocolate, yogurt, alcohol (beer/wine) 4. Tricyclic Antidepressants block reuptake of serotonin & norepinephrine making more available a. Elavil, Tofranil, Doxepin, Nortriptyline b. Anticholinergic Effects..maybe cardiac dysrhythmias, MI, heart failure c. no anecdote/treat the symptoms i. gastric lavage with inactivated charcoal ii. Antilirium counteracts toxic effects iii. Valium seizures iv. Lidocain calms the heart The following block the reuptake of their target, less ACHE, less cardiac involvement/toxicity, faster onset, less sexual dysfunction BUT may cause Serotonin Syndrome (agitation, confusion, hypomania, twitching, tachycardia, > BP, diaphoresis, seizures, uncoordination, hyperthermia, cardiovascular collapse) treat the symptoms and stop the drugs

5. Selective Serotonin Reuptake Inhibitors (SSRIs) a. Celexa, Lexapro, Prozac, Zoloft, Paxil 6. Dopamine-Norepinephrine Reuptake Inhibitors (DNRIs) a. Wellbutrin 7. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) a. Effexor 8. St. Johns Wort - herb a. active ingredient hypercin b. mild depressant c. minor SE (dry mouth, constipation, confusion) d. avoid foods with tyramine 9. Mood Stabilizer a. Lithium naturally occurring salt in the body b. drug of choice for Bipolar c. lowers serotonin and norepinephrine d. Contraindications: elderly, heart or kidney disease, diuretic therapy, dehydration, sodium depletion e. maintain adequate salt intake; avoid excessive perspiration or diuretic therapy f. maintenance 0.6-1.2 mEq/L g. Elderly 0.2 mEq/L h. Mild toxicity 1.5 mEq/L i. slight apathy/lethargy/drowsiness ii. decreased concentration, mild ataxia iii. mild muscle weakness, slight twitching iv. coarse hand tremors i. Moderate toxicity 1.5-2.5 mEq/L i. N & V, SEVERE diarrhea ii. moderate apathy/letharthy/drowsiness iii. moderate ataxia, slurred speech, tinnitus, blurred vision iv. irregular tremor v. muscle weakness j. Severe toxicity 2.5 mEq/L i. nystagmus, dysarthria, oliguria or anuria ii. deep tendon hyperreflexia iii. visual or tactile hallucinations iv. confusion, seizures, coma or death Schizophrenia excessive amounts of Dopamine 10. Antipsychotics/Neuroleptics/Major Tranqualizers a. Older Drugs 1st Generation Antipsychotics i. Narvane, Haldol, Thorazine (prototype)

b. Only treat positive symptoms of schizophrenia c. Side Effects: Extrapyramidal SE, ACHE SE, Lowered seizure threshold, Sexual dysfunction, weight gain, photosensitivity, skin reactions i. ACHE SE dry mouth, blurred vision, orthostatic hypotension, urinary retention, constipation, sedation ii. Extrapyramidal is portion of brain that controls body movement needs dopamine to function correctly neuroleptics reduce dopamine levels causing symptoms iii. EP System controls posture, gait, balance, support, motor function iv. EPSE - Acute Dystonic Reactions, Psudoparkinsonism, Akathesia, Tardive Dyskinesia, Neuroleptic Malignant Syndrome v. Acute Dystonic Reactions facial grimacing, torticollis, oculogyric crisis, abnormal posturing, spasms of neck/pharyngeal 1. early in treatment young adults 2. difficult muscle tone 3. treatment ABCs of EPSE (these are ACHE drugs) a. Artane b. Benedryl c. Cogentin d. Symmetrel vi. Pseudoparkinsonism bradykinesia, shuffling gait, pill-rolling, mask-like expression, drooling 1. older adults 2. movement based SE 3. treatment decrease dose of neuroleptic or ABCs of EPSE vii. Akathesia restless movements (hands, feet, body) 1. MOST COMMON REACTION 2. middle-aged 3. movement based SE 4. early onset symptoms appear/disappear spontaneously 5. Dont confuse symptoms with anxiety-based or psychomotor agitation 6. treatment decrease dose of neuroleptic; ABCs dont work well for this but will help with some of the underlying symptoms viii. Tardive Dyskinesia - disfiguring 1. females elderly 2. receptors sensitive to dopamine reducing neuroleptics in elderly for kidney/liver function allow more dopamine to be available 3. bizarre facial/tongue movements (appear during sleep) 4. chewing and lip smacking, stiff neck, difficulty swallowing 5. quick, darting movements of extremities 6. serpentine movements (snake-like), hip thrusts 7. if allowed to progess, will become permanent

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8. treatment none permanent damage AND ACHE drugs not only increase dopamine, but also block acetylcholine which opposes dopamine 9. prevention keep dose to minimum or use newer antipsychotic drug ix. Neuroleptic Malignant Syndrome Life threatening MEDICAL EMERGENCY 1. hyperthermia, confusion, HTN, tachycardia, incontinence, drooling, Cogwheeling (rigid arms/legs affects airway) 2. treatment DC all neuroleptic drugs immediately, supportive treatment (antipyretics, antihypertensives) a. Parlodel relieves muscle rigidity AND reduces fever b. Dantrium Strong muscle relaxant Haldol and Proxilin decanoate neuroleptics a. deep IM Z-track b. given approx every 3 wk c. helps them stay on their meds Clozaril 2nd Generation Antipsychotic a. treat positive and negative symptoms of schizophrenia b. binds to dopamine receptors like 1st generation drugs c. SE agranulocytosis (monitor WBC, S/S of infection, keep WBCs > 3500) i. rare but can be fatal (40%) not dose related ii. reversible with early detection Newer Antipsychotics a. Risperdal, Zyprexal, Seroquel, Giodone, Abilify b. SE weight gain, priapism (painful erection), QT prolongation/dysrhythmias, V-fib (Giodone), Metabolic Syndrome i. Metabolic Syndrome - hyperglycemia, dyslipidemia, abdominal obesity, HTN, Type 2 Diabetes c. avoid sunlight/ETOH, give with food/milk/antacids, liquids with fruit juice (corrosive), deep IM injections and decanoate forms, keep supine 30-60 min, DC 48 hr b/f surgery ECT Electrical Current Therapy a. Atropine 30 min b/f treatment dries up secretions and controls bradycardia b. Anectine (barbiturate) relaxes muscles and prevents muscle rigidity