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