A=ACE inhibitor. ACE stands for angiotensin converting enzyme.

This enzyme is
responsible for the conversion of angiotensin I to angiotensin II. Angiotensin II (A2) is a
potent vasoconstrictor and it also stimulates the secretion of aldosterone which results in:
blood pressure (A2), sodium and water retention and potassium excretion (aldosterone).
An ACE inhibitor medication inhibits the enzyme that allows this conversion to occur, and
therefore, decreases blood pressure. Nursing responsibilities prior to administration:
Monitor BP and potassium level (for hyperkalemia). A persistent cough is a common side
effect of ACE inhibitors. Angioedema is a rare, but serious side effect. Generic names
often end in pril (i.e. lisinopril)

B=Beta adrenergic blockers. Can selectively block beta 1 receptors (found predominately
in the heart) or beta 2 receptors (found predominately in the lung) or can be nonselective,
and block both. Effects on the heart of cardioselective (beta 1) blockade: decrease HR,
slow (decrease) conduction through AV node, decrease myocardial oxygen demand,
decrease myocardial contractility. Blockade of beta 2 receptors causes
bronchoconstriction and should be avoided in patients with asthma, etc. Beta blockers
should NOT be stopped abruptly. Uses: Many, many uses including angina, hypertension,
dysrhythmias, MI, stage fright, etc. Commonly end in lol. For example: propranolol

C=Calcium Channel BlockersPrevent calcium from entering cells. Have greatest effects
on heart ( heart rate and contractility) and blood vessels (smooth muscle relaxation
which leads to blood pressure). Effects on the heart are similar to those caused by
beta blockers. Used to tx hypertension, angina, and cardiac dysrhythmias. There are 3
subcategories of CCBs: the
-dipines such as amlodipine (Norvasc) which are used to
treat hypertension and angina but NOT dysrhythmias, verapamil (Calan)used to treat all
the above, and diltiazem (Cardizem)used to treat all the above. Side effect of note:
constipationespecially with verapamil.

Dipines: amolopidine: drug company name: norvasc (normal vascular)

D=digoxin (Lanoxin). A cardiac glycoside. This drug increases the myocardial contractility.
It also slows the heart rate and improves stroke volume/cardiac output. Still used to treat
heart failure but no longer a first line drug for this purpose. It has a narrow therapeutic
window (approx 1-2 ng/ml). Early symptoms of digoxin toxicity: N/V and anorexia, visual
halos. Low serum K+ levels risk of toxicity. Nursing responsibilities: Monitor for
hypokalemia, monitor heart rate and hold if less than 60, monitor digoxin level. Do NOT
administer with meals high in fiber.

E=epinephrine (Adrenalin). A nonselective adrenergic agonist (Activating A1, B1, B2) which
is the same thing as saying it is a sympathomimetic. Often used to treat anaphylactic
reactions. Increases contractility of the heart, increases heart rate and BP, and causes
bronchodilation. Can increase blood glucose as well.

F=furosemide (Lasix). A loop diuretic meaning it exerts its action in the loop of Henle. Its
action is to inhibit the reabsorption of sodium and water and therefore, urine output is
increased. Used to treat hypertension, heart failure, edema, etc. Also causes excretion of
K+ so must monitor serum K+ levels for hypokalemia prior to administration.

G=Glucocorticoidsa corticosteroid or steroid. An immunosuppressant that also

influences the metabolism of: carbohydrates blood glucose; proteins suppress
protein synthesis reducing muscle mass and delaying wound healing; and fatsbreaks
down fat causing redistribution (moon face, hump back). Also possess potent antiinflammatory actions. MANY uses and MANY adverse reactions. Can also cause
hypokalemia. Must be tapered when discontinuing. increase blood glucose, steroids
using therapeutically, kidney transplant, primary reason: potent anti-inflammatory
effects,

H=Heparin. An anticoagulant administered IV or SC. Does NOT dissolve clots, but can
prevent clots from forming. Used to tx pulmonary embolism, CVA (stroke), deep vein
thrombosis, etc. Primary adverse reaction is hemorrhage. Protamine sulfate is the
antidote for heparin overdose. Effects of heparin monitored via a blood test, PTT,
usually obtained daily or even more often if heparin is administered IV. Generally not
necessary to monitor PTT with SC administration.

I=Insulin. Participates in the transport of glucose into the cell. Thats why diabetics
(who lack endogenous insulin) have high serum blood glucose levelsbecause the
glucose cant enter the cell due to the deficiency of insulin. Available in many
different types. Types differ in terms of onset of action, duration of action, etc.
Insulin aspart (Novolog) has a rapid onset and is commonly used for both meal
coverage and correction dosing. Glargine insulin (Lantus) provides basal coverage
meaning it lasts approximately 24 hours and does not peak.

J=Januvia (trade name). Generic name is sitagliptin. A dipeptidyl peptidase IV (DPPIV) inhibitor that is taken orally and used only for type II diabetes. Januvia delays the
breakdown of incretin hormones which ultimately increases insulin synthesis.
Generally well tolerated. FDA currently monitoring for increased incidence of
pancreatitis in patients taking Januvia. Taken one time/day. Class generally called
gliptins.

K=Potassium Sparing diuretics! Includes aldosterone antagonists and nonaldosterone

antagonists. Aldosterone antagonists (i.e spironolactone [Aldactone]) inhibit the
effects of aldosterone. (Aldosterone causes retention of sodium and water and
excretion of potassium). Nonaldosterone antagonists (i.e. triamterene [Dyrenium]) act
directly on the renal tubule to suppress reabsorption of sodium and water and
encourage reabsorption of potassium. Regardless, MUST MONITOR POTASSIUM LEVLS!

L=levothyroxine (Synthroid). A synthetic thyroid hormone used in hypothyroidism. It

has a long half-life and can be dosed one time a day BEFORE BREAKFAST (absorption
is better on an empty stomach). However, it can take approximately a month to reach
steady state. Replacement therapy generally necessary for life. Side effects:
Generally well tolerated, but if too much is taken it can results in s/s of
hyperthyroidismtachycardia, palpitations, etc.

M=metformin (Glucophage). A biguanide oral antidiabetic agent. Lowers blood sugar

by decreasing production of glucose in the liver. Metformin is excreted by the kidneys
and can cause lactic acidosis if the kidneys arent functioning well. Thats why it is
held prior to and following any procedure involving dye until kidney function is
confirmed via creatnine level. Also lots of GI side effects.

N=NSAIDsNonsteroidal Anti-inflammatory Drugs. Decrease inflammation by inhibiting

COX (cyclooxygenase). COX has two forms1 and 2. NSAIDs may be nonselective (1st
generation) meaning they inhibit both COX 1 and COX 2 or COX2 selective (2nd
generation) meaning they only inhibit Cox 2. In theory, there are fewer harmful
effects with COX2 selective agents. Aspirin is a nonselective; celecoxib (Celebrex) is
COX2 selective.

O=Opioids. Most effective pain relievers available. When classified according to

receptor activity, may be a pure agonist, an agonist-antagonist, or a pure antagonist.
When agonist-antagonists are given alone, they produce analgesia. When they are
given in the presence of a pure agonist, they will antagonize analgesia and can
precipitate withdrawal syndrome. Major adverse reactions of pure opioid agonist:
respiratory depression and constipation. Antidote for a pure agonist overdose: A pure
antagonist Naloxone (Narcan)

P=Proton pump inhibitors. Most effective drugs for suppressing secretion of stomach
acid. Blocks the final step in gastric acid production. Used primarily for ulcers and
GERD. Generic names commonly end in prazole. Prototype is omeprazole
(Prilosec) which is now available OTC.

Q=quinidine. A Class 1A andidysrhythmic. Common side effects: diarrhea and

hypotension. Can also cause cinchonism which causes blurred vision, tinnitus, and
GI upset. Fairly strong anticholinergic effects as well. Usually given po. Only
quinidine gluconate can be given IV.

R=Reglan. Generic name is metoclopramide. The only prokinetic (meaning it

increases the tone and motility of the GI tract) agent currently available. Used for
GERD, N/V, diabetic gastroparesis, and postoperative emesis. A common side effect is
DIARRHEA and will likely need to hold the medication if diarrhea occurs. A more
troublesome side effect with long-term use is tardive dyskinesia, a movement disorder.

S=Statins. Most commonly used class of drugs to lower cholesterol. They decrease
the rate of cholesterol production and are generally administered at bedtime since
this is when cholesterol is produced in larger amounts. Generally well tolerated.
However, can cause myopathy which can lead to rhabdomyolysis. Unexplained muscle
pain should be reported. Can also cause an elevation of liver enzymes and these may
be monitored periodically. Generally will not see a statin and a fibrate given
concurrently due to the increased risk of hepatotoxicity.

T=tamoxifen (Nolvadex-D). A selective estrogen receptor modulator (SERM) commonly

prescribed for breast cancer. Can inhibit cell growth by blocking estrogen receptors.

Used both to treat active disease as well as to reduce occurrence of breast cancer in
high risk women. Most common adverse effect is hot flashes. Most serious is
development of endometrial cancer or thromboembolism/stroke.

U=Ultram. Generic name is tramadol. This is a nonopioid analgesic, but it does have
weak agonist activity at mu opioid receptors. However, it causes minimal respiratory
depression (although the patient should still be monitored for this) and is currently not
a controlled substance. Notable side effect: seizures. Avoid use in clients with or at
high risk for seizures.

V=vancomycin (Vancocin). Generally the intravenous antibiotic of choice for MRSA

infections. May be given orally to treat C. diff. infections. Effective only against Gm+
organisms. Be alert for Red Man Syndromerash, flushing, hypotension, etc.,
generally caused by rapid IV infusionneed to give over at least 60 minutes. Toxicities
include ototoxicity and nephrotoxicity most commonly. Trough levels are monitored.

W=warfarin (Coumadin). Oral anticoagulant that antagonizes the effects of

vitamin K. Peak effects take several days to develop. PT and INR are tests
used to monitor effectiveness. Highly protein bound and subject to MANY drug
interactions. Antidote for overdose is vitamin K.

X=Xanax. Generic name is alprazolam. A benzodiazepine. Used for anxiety,

panic disorders, and occasionally for PMS. Drowsiness is a common side effect.
May be habit forming. Do not discontinue abruptly after long-term use.

Z=Zithromax. Generic name is azithromycin. A macrolide antibiotic. Used commonly

for respiratory tract infections. Administration on an empty stomach is preferred for
better absorption. Side effects uncommon, but can cause GI upset. Oral therapy
usually consists of once a day dosing for 3-5 days. Commonly give 500 mg on day 1
followed by 250 mg on days 2-5. Commonly referred to as a Z-pack. New FDA
warning out March 2013 regarding the risk of potentially fatal heart dysrhythmias
with the use of Zithromax!