ATI Pharmacology Proctored Exam

ATI Pharmacology Proctored Exam Medications for Infection: Aminoglycosides - ANS Gentamcin - fights infection - C: pregnancy, renal issues - AE: Ototoxicity, nephrotoxicity, hypersensitivity - NC: Peaks and troughs Medications for Infection: Carbapenems - ANS Meropenem, Imipenem - fights infection - C: Penicillin allergy, renal issues - AE: GI upset, superinfection, allergies - NC: Monitor for allergic reactions Medications for Infection: Penicillins - ANS Penicillin, Amoxicillin, Ampicillin - fights infection - C: Allergic to penicillin, renal issues - AE: Allergies, renal issues, hyperkalemia, hypernatremia, dysrhythmias - NC: Take with food, use additional contraceptive, complete entire course of therapy even it pt. is feeling better. Medications for Infection: Cephalosporins - ANS Cefazolin, Ceftriaxone =- fights infection - C: Penicillin or cephalosporin allergy, renal issues - AE: Renal issues, pain with IM injections, superinfection - NC: take with food, store oral's in refrigerator Medications for Infection: Cell wall inhibitor - ANS Vancomycin: fights infection - C: hearing loss, renal issues - AE: Red mans syndrome, otoxicity, renal toxicity - NC: Give slowly over 60 mins IV to help prevent red mans syndrome, complete entire course of therapy even it pt. is feeling better. Medications for Infection: Tetracyclines - ANS Doxycycline: fights infection, acne, lyme disease - C: pregnancy, liver/kidney disease - AE: If given to children 8 - causes tooth discoloration, photosensitivity, GI upset, superinfection - NC: use additional contraceptive, complete entire course of therapy even it pt. is feeling better. Medications for Infection: Macrolides - ANS Erythromycin, Azithromycin (z-pak) - fights infections, pneumonia, pertussis, chlamydia (is an alt. med. for those who are allergic to penicillin) - C: Liver disease, prolonged QT - AE: GI upset, ototoxicity, prolonged QT - NC: Use additional contraceptive, if treating an STD - treat partner as well. Medications for Infection: Sulfonamides & Trimethoprim - ANS Trimethoprim-silfamethoxazole - treats UTI's - C: Pregnancy/lactation, folate deficiency, renal issues - AE: Agranulocytosis, hyperkalemia, hypersensitivity - NC: Take on an empty stomach! Use additional contraceptive, complete entire course of therapy even it pt. is feeling better. Medications for Infection: Urinary tract antiseptic - ANS Nitrofurantoin: treats UTI's - C: pregnancy/lactation, renal issues - AE: GI upset, peripheral neuropathy - NC: turns urine rust-yellow to brown, can stain teeth, complete entire course of therapy even it pt. is feeling better. Medications for Infection: Fluoroquinolones - ANS Ciprofloxacin - fights infection - C: Can cause spontaneous tendon rupture in children 18, pregnancy/lactation - AE: GI upset, tendon rupture, superinfection, phototoxicity - NC: Low doses in pt's with renal impairment, complete entire course of therapy even it pt. is feeling better. Medications for Infection: UT analgesic - ANS Phenazopyridine: treats UTI's (is a dye that functions as a local anesthetic on the mucosa of the urinary tract) Medications for Infection: Antiprotozoals - ANS Metronidazole: treats protozoal infections - C: pregnancy, kidney/cardiac/fungal/candida infection, seizure disorder - AE: GI upset, darkening of urine, neurotoxicity, superinfection - NC: Use additional birth control Medications for Infection: Antimycobacterials - ANS Isoniazid: treats tuberculosis - C: older adults, people with diabetes, alcoholism - AE: hepatotoxicity, hyperglycemia, peripheral neuropathy - NC: Use additional birth control Rifampin: treats infection & TB - C: hepatic impairment - AE: Can turn excretory fluids orange, GI upset, superinfection, hepatotoxicity - NC: Full glass of water, non-hormonal contraception Medications for Infection: Antifungals - ANS Amphotericin B, Ketoconazole: treats fungal infections - C: Anemia, pregnancy/lactation, renal issues - AE: Gynecomastia, nephrotoxicity, hepatotoxicity, electrolyte imbalance, bone marrow suppression - NC: Amphotericin B is VERY toxic, used only for life-threatening situations, use additional birth control, complete entire course of therapy even it pt. is feeling better. Medications for Infection: Antivirals - ANS Acyclovir, Oseltamivir: Herpes Simplex & Herpes Zoster (Acyclovir), Influenza (Oseltamivir) - C: Renal impairment - AE: Acyclovir can cause phlebitis and nephrotoxicity - NC: Use additional contraception, complete entire course of therapy even it pt. is feeling better. Medications for Pain and Inflammation: Non-opioid Analgesics - ANS Aspirin, Ibuprofen, Naproxen, Celecoxib: treats fever, pain, inflammation, Antiplatelet (aspirin) - C: Children (aspirin), pregnancy/lactation, peptic ulcer disease - AE: Reye's syndrome, GI upset, renal issues, increased risk of stroke or heart attack - NC: Take with food, DO NOT CRUSH/CHEW enteric coated or extended release aspirin tablets Medications for Pain and Inflammation: Acetaminophen - ANS Acetaminophen: pain, fever - C: liver issues, chronic alcohol use disorder - AE: Toxicity - NC: Read medication labels, if pain/fever lasts 3 days, contact provider Medications for Pain and Inflammation: Opioid Agonists - ANS Morphine: pain, sedation, cough suppression (codeine) - C: premature infants, asthma, renal/hepatic disease, kidney failure - AE: Respiratory depression, sedation, ortho. hypo, constipation - NC: Assess pain level, check vitals especially RR, double check doses with another nurse. Medications for Pain and Inflammation: Agonist-Antagonist Opioids - ANS Butorphanol: pain, less potential for abuse - C: MI, kidney/liver disease, respiratory depression, opioid dependancy - AE: Abstinence syndrome, sedation, dizziness, headache - NC: baseline vitals, have naloxone ready Medications for Pain and Inflammation: Opioid Antagonist - ANS Naloxone: Treats opioid overose - C: Liver failure, opioid dependency, pragnancy - AE: Tachycardia, tachypenia, abstinence syndrome - NC: Rescue medication Medications Affecting the Nervous System: Benzodiazepines - ANS Alprazolam, diazepam, lorazepam: Anxiety disorder, panic disorder, Seizure disorder, alcohol withdrawal - C: Pregnancy/lactation, liver disease, substance abuse - AE: CNS depression, amnesia, toxicity - NC: Take at bedtime Medications Affecting the Nervous System: Atypical Anxiolytics - ANS Buspirone: Generalized anxiety disorder, panic disorder - C: Pregnancy, liver & kidney problems - AE: Dizziness, constipation, suicidal ideation - NC: Short term treatment, take with meals, won't see effects until 2-4 weeks of taking drug. Medications Affecting the Nervous System: SSRI's - ANS Paroxetine, Fluoxetine, Sertraline: OCD, anxiety, panic disorder, depression - C: Pregnancy, MAOIs or TCAs, Liver/kidney problems - AE: Sexual dysfunction, weight changes, Bruxism (grinding of teeth), Serotonin syndrome, Suicidal ideation - NC: Take with food and in the morning, takes 2-4 weeks to see effects Medications Affecting the Nervous System: SNRI's - ANS Venlafaxine, Duloxetine: Depression, panic/anxiety disorder - C: pregnancy, MAOIs or TCAs - AE: Sexual dysfunction, weight loss, anxiety, withdrawal (if stopped abruptly), Suicide (children & adolescents), Serotonin syndrome - NC: Take in the morning, avoid use with other antidepressants Medications Affecting the Nervous System: Atypical Antidepressants - ANS Buproprion: Depression, smoking cessation - C: Seizure disorder, MAOIs, eating disorder - AE: Has anticholinergic effects, weight loss, seizures - NC: Do not give within 2 weeks of MAOIs Medications Affecting the Nervous System: Tricyclic Antidepressants - ANS Amitriptyline: Depression, neuropathic pain - C: MI, Seizure disorder, CAS, diabetes, liver/kidney/respiratory disorders - AE: Anticholinergic effects, sedation, decreased seizure threshold Medications Affecting the Nervous System: MAOIs - ANS Phenelzine: Depression - C: pregnancy, tyramine-rich foods (hypertensive crisis) - AE: CNS stimulation, orthostatic hypotension, hypertensive crisis - NC: May take more than 2 weeks to feel effects, avoid hard cheeses, chocolate, red wine, processed meats, etc. Medications Affecting the Nervous System: Mood Stabilizers - ANS Lithium carbonate: Bipolar disorder - C: pregnancy, thyroid disease, renal issues - AE: GI upset, fine hand tremors, polyuria, weight gain, renal toxicity, gioter & hypothyroidism, lithium toxicity - NC: Maintenance level range between 0.6-1.2, stress adequate fluid intake to avoid dehydration Medications Affecting the Nervous System: Other Mood Stabilizers - ANS Carbamazepine, Valproic acid, Lamotrigine: Bipolar disorder - C: Pregnancy, liver issues, bone marrow suppression (carbamazepine) - AE: Carb - CAN effects, leukopenia, skin disorders, hepatotoxicity Lamo - stevens-johnson syndrome, skin rash Val. Acid - GI upset, hepatotoxicity - NC: Monitor plasma levels and therapeutic levels, avoid alcohol Medications Affecting the Nervous System: Antipsychotics (first gen) - ANS Chlorpromazine, Haloperidol - acute & chronic psychotic disorders - C: Older patients with dementia, glaucoma, heart disorders - AE: Dystonia, parkinsonism, akathisia - NC: AIMS, 2-4 weeks for therapeutic effects Medications Affecting the Nervous System: Antipsychotics (second gen) - ANS Risperidone, Clozapine: schizophrenia - C: Dementia, cardiovascular disease, seizure disorder, diabetes - AE: EPS, prolactin-elevation, galactorrhea, gynecomastia - NC: Avoid eating and drinking 10 mins after dose Medications Affecting the Nervous System: CNS stimulants - ANS Methylphenidate: ADHD, Conduct Disorder, Narcolepsy - C: pregnancy, substance abuse, hypertension, psychosis, anxiety - AE: Decreased appetite, withdrawal, toxicity, cardiovascular effects - NC: Swallow whole, high potential for abuse Medications Affecting the Nervous System: Cholinesterase inhibitors - ANS Neostigmine, Donepezil: Myasthenia gravis (Neostigmine), Alzheimers (Donepezil) - C: GI and renal obstruction, bradycardia, hypotension, succinylcholine - AE: Cholinergic crisis, excessive muscarinic stimulation - NC: Slows the progression and improves ADL's, is not a cure! Monitor for toxicity. Medications Affecting the Nervous System: Anti-parkinsons - ANS Carbidopa/levodopa: Parkinsons - AE: Orthostatic hypotension, nausea & vomiting, drowsiness - NC: Increases ADL's is not a cure Medications Affecting the Nervous System: Antiepileptics - ANS Phentynoin, Lamotrigine, Levitiracetam, Topiramate: Seizures - C: Pregnancy/lactation - AE: Skin rash (lamotrigine), CNS effects, toxicity, hepatotoxicity, drowsiness/sedation - NC: Monitor therapeutic levels, caution due to sedative effects, do not discontinue abruptly. Medications Affecting the Nervous System: Centrally Acting Muscle Relaxants - ANS Baclofen, Cyclobenzaprine: Treats muscle spasms - C: Pregnancy/lactation - AE: CNS depression, hepatotoxicity, anticholinergic effects, seizures - NC: Do not stop taking medication abruptly, avoid other CNS depressants, avoid driving, take with food to avoid GI upset. Medications Affecting the Nervous System: Muscarinic Agonists - ANS Bethanechol: Urinary Retention - C: urinary or GI obstruction, asthma, peptic ulcer disease, bladder weakness - AE: abdominal cramps, diarrhea, sweating, tearing, bradycardia, hypotension - NC: Monitor I & O's, administer orally 1 hour before or 2 hours after meals Medications Affecting the Nervous System: Muscarinic Antagonists - ANS Oxybutynin: Urinary incontinence, over active bladder, pre-anesthesia - C: glaucoma, myasthenia gravis, GI or GU obstruction - AE: Anticholinergic effects, blurred vision, confusion, prolonged QT interval - NC: Swallow ER tablets whole, transdermal patch administered 2x per week. Eye & Ear Disorders and Med's Affecting Urinary Output: Osmotic Agents - ANS Mannitol: glaucoma, prevent renal failure in shock - C: Pregnancy, renal failure, active intracranial bleeding - AE: Headache, nausea, vomiting, edema, fluid/electrolyte imbalance - NC: Monitor for orthostasis, weight client at the same time each day Eye and Ear Disorders: Beta-adrenergic Blockers - ANS Timolol: glaucoma - C: pregancy, myasthenia gravis, bradycardia - AE: Stinging discomfort, occasional conjunctivitis, blurred vision, dry eyes, systemic affects of beta blockers - NC: Avoid touching applicator to eyes, monitor pulse Eye and Ear Disorders: Alpha-2 Adrenergic Agonists - ANS Brimonidine: Glaucoma - AE: stinging discomfort, dilated pupils, blurred vision, headache, dry mouth - NC: Monitor BP, avoid touching applicator to eyes Eye and Ear Disorders: Prostaglandin Analogs - ANS Latanoprost: Glaucoma - AE: Bulging of ocular blood vessels, increased pigmentation, stinging conjunctiva, blurry vision, migraine - NC: Avoid touching applicator to eyes Eye and Ear Disorders: Carbonic Anydrase inhibitor - ANS Acetazolamide: Glaucoma - C: Pregnancy/lactation - AE: Severe allergic reaction, bone-marrow depression, nausea, diarrhea, malaise, glucose disturbances, nephrolithiasis - NC: Take oral or IV Airflow Disorders: Beta-2 Adrenergic Agonists - ANS Albuterol: Asthma, bronchospasm - C: Pregnancy, hypertension, hyperthyroidism, tachydysrhythmias - AE: Angina, tachycardia, tremors - NC: Use as a rescue inhaler or prior to physical exercise Airflow Disorders: Methylxanthines - ANS Theophylline: Asthma, COPD - C: Pregnancy, heart disease, hypertension, diabetes, liver/kidney issues - AE: GI upset, restlessness - NC: Do not chew or crush sustained-release tablets, not a rescue medication!, do not take with caffiene Airflow Disorders: Inhaled Anticholinergics - ANS Ipratropium: Asthma, COPD - C: Pregnancy, peanut allergy, glaucoma, BPH - AE: dry mouth, hoarseness - NC: Not a rescue inhaler! Rinse mouth after inhalation to decrease unpleasant taste Airflow Disorders: Inhaled Glucocorticoids - ANS Beclomethasone, Budesonide: Asthma - C: Pregnancy, live virus vaccine, diabetes, systemic fungal infection - AE: Candidiasis, hoarseness, difficulty speaking - NC: Rinse mouth after use, do not use as a rescue Airflow Disorders: Oral Glucocorticoids - ANS Prednisone: Asthma - C: Pregnancy, live virus vaccine, systemic fungal infection, diabetes, kidney issues - AE: Suppression of adrenal function, bone loss, hyperglycemia, peptic ulcer disease, infection, weight gain, insomnia - NC: Taper drug off if taken long term, not a rescue, may require additional doses during times of stress Airflow Disorders: Leukotriene Modifiers - ANS Montelukast: Asthma - C: pregnancy/lactation, liver issues - AE: Depression, suicidal thoughts - NC: Not a rescue, take once daily at bedtime unless for excersize - take 2 hours before. Upper Respiratory Disorders: Antitussives (opioid) - ANS Codiene: non-productive cough - C: pregnancy/lactation, respiratory depression, asthma, alcohol use disorder - AE: CNS effects, GI upset - NC: Use for short duration, potential for abuse Upper Respiratory Disorders: Antitussives (non-opioid) - ANS Dextromethorphan: non-productive cough - C: pregnancy/lactation - AE: Nausea, dizziness, sedation, dystonia - NC: Use for short duration, potential for abuse in high doses Upper Respiratory Disorders: Expectorants - ANS Guafenesin: Productive cough (congestion), thins secretions - C: Pregnancy/lactation - AE: Rash, drowsiness, dizziness - NC: Do not crush ER tablets, drink lots of water! Report cough lasting longer than 2 weeks to provider Upper Respiratory Disorders: Mucolytics - ANS Acetylcysteine: COPD, cystic fibrosis, antitode for acetominophen poisoning - C: pregnancy, hypothyroidism, CNS depression, renal/liver disease - AE: Drowsiness, dizziness, hypotension, tachycardia, aspiration - NC: Administer by inhalation for bronchial secretion, monitor liver and renal function Upper Respiratory Disorders: Decongestants - ANS Phenylephrine: Allergic and non-allergic rhinities, stuffy nose - C: Glaucoma, hypertension, dysrhythmias - AE: Rebound congestion, agitation, nervousness, vasoconstriction - NC: Avoid prolonged use (3-5 days), do not exceed recommended doses Upper Respiratory Disorders: Abtihistamines - ANS Diphenhydramine (First gen), Loratadine (Second gen): Mild allergic reactions, motion sickness, insomnia, nasal congestion - C: Third trimester of pregancy/lactation, urinary retention, glaucoma, prostatic hypertrophy - AE: Sedation, anticholinergic effects, nausea, vomiting - NC: Avoid prolonged use (3-5 days), Second gen has less side effects (sedation, rebound congestion etc.) Upper Respiratory Disorders: Nasal Glucocorticoids - ANS Mometasone, Fluticasone: Allergic rhinities, sneezing, nasal itching, runny nose - C: Pregnancy/lactation - AE: Sore throat, nose bleeds, headaches, burning in nose - NC: Administer daily, can take up to 21 days for maximum relief, clear blocked nasal passages prior to administration. Medications Affecting Urinary Output: High-Ceiling Loop Diuretics - ANS Furosemide: pulmonary edema, edema - C: Pregnancy, anuria, diabetes - AE: Dehydration, hyponatremia, hypotension, hypokalemia - NC: Monitor for orthostasis, weigh clients at the same time each day. Medications Affecting Urinary Output: Thiazide Diuretics - ANS Hydrochlorothiazide: Hypertension, edema, - C: Pregnancy/lactation, renal issues - AE: Dehydration, hyponatremia, hypotension, hypokalemia - NC: Monitor for orthostasis, frequently combined with ACE inhibitors, weigh clients at the same time each day Medications Affecting Urinary Output: Potassium-Sparing Diuretics - ANS Spironolactone: Hypertension, edema, PCOS - C: Pregnancy, hyperkalemia, renal failure, anuria - AE: Dehydration, hyperkalemia, drowsiness, gynecomastia, menstrual irregularities - NC: Monitor for orthostasis, NO GRAPEFRUIT JUICE, weigh clients at the same time each day Medications Affecting Blood Pressure: ACE Inhibitors - ANS Captopril, Lisinopril: Hypertension, heart failure, MI, nephropathy - C: Pregnancy/lactation, allergy, angioedema, renal issues - AE: Hypotension, cough, angioedema, hyperkalemia, rash, neutropenia - NC: Monitor for orthostasis, avoid activites that require allertness, Captopril - take 1 hour before meals. Medications Affecting Blood Pressure: Angiogestin II Receptor Blockers (ARBs) - ANS Losartan: Hypertension, heart failure, MI, nephropathy - C: Pregnancy, renal stenosis, angioedema - AE: Hypotension, angioedema, hyperkalemia, dizziness - NC: Monitor for orthostasis, can be taken with or without food Medications Affecting Blood Pressure: Direct Renin Inhibitor - ANS Aliskiren: Hypertension - C: Pregnancy, hyperkalemia, asthma, history of angioedema - AE: Hypotension, angioedema, hyperkalemia, diarrhea - NC: Monitor for orthostasis, take at the same time each day, avoid high fat foods at the time of administration Medications Affecting Blood Pressure: Calcium Channel Blockers - ANS Nifedipine: Hypertension, Angina - C: Pregnancy/lactation, cardiogenic shock, acute MI, unstable angina, aortic stenosis - AE: Orthostatic hypotension, reflex tachycardia, peripheral edema - NC: Monitor for orthostasis, don't crush/chew ER tablets Verapamil, Diltiazem: Hypertension, Angina, Cardiac dysrhythmias - C: Pregnancy/lactation, hypotension, heart block, heart failure - AE: Orthostatic hypotension, dysrhythmias, peripheral edema, toxicity, bradycardia - NC: Monitor for orthostasis, don't crush/chew ER tablets Medications Affecting Blood Pressure: Alpha Adrenergic Blockers - ANS Prazosin, Doxazosin, Terazosin: Hypertension, BPH - C: Pregnancy/lactation, hypotension, renal insufficiecy - AE: Ortho. hypo, dysrhythmias, peripheral edema, toxicity, bradycardia - NC: Monitor for orthostasis, additive hypotensive effects with other antihypertensives Medications Affecting Blood Pressure: Centrally Acting Alpha-2 Agonists - ANS Clonidine: Hypertension, ADHD, Severe cancer pain - C: Pregnancy/lactation, bleeding disorders, asthma - AE: Dry mouth, rebound hypertension, drowsiness/sedation - NC: Do not discontinue abruptly, transdermal patches applied every 7 days Medications Affecting Blood Pressure: Vasodilators - ANS Nitroprusside: Hypertensive crisis - C: Pregnancy/lactation, heart failure, liver/renal disease - AE: Hypotension, cyanide poinsoning, bradycardia, tachycardia - NC: Administered IV, continuous monitoring of vital signs and ECG Medications Affecting Blood Pressure: Beta-adrenergic Blockers - ANS Metoprolol, Atenelol, Propranalol, Carvedilol: Hypertension, Angina, tachydysrhythmias, heart failure, MI - C: Pregnancy/lactation, AV block, bradycardia, hypotension, asthma - AE: Bradycardia, decreased CO, AV block, ortho. hypo, bronchoconstriction - NC: Monitor pulse and hold if 60, may mask hypoglycemia symptoms, monitor for orthostasis Cardiac Glycosides and Heart Failure: Cardiac Glycosides - ANS Digoxin: Heart failure - C: Pregancy/lactation, V-fib, V-tach, heart block - AE: Cardiotoxicity, nausea, vomiting, abdominal pain, fatigue, weakness, blurred vision - NC: Monitor for signs of toxicity (0.6-1.2), monitor for bradycardia, avoid taking OTC medications to prevent adverse effects Cardiac Glycosides and Heart Failure: Adrenergic Agonists - ANS Epinephrine: Anaphylactic shock, bronchodilation, management of superficial bleeding, slows absorption of local anesthetics - C: Hyperthyroidism, angina, hypertension - AE: Hypertension, dysrhythmias, tachycardia - NC: Monitor ECG and BP, monitor for hyerglycemia in diabetics Dobutamine: Heart failure - C: Hyperthyroidism, angina, hypertension - AE: Hypertension, dysrhythmias, tachycardia - NC: Administered IV, monitor ECG and BP, older adults are more likely to experience adverse effects Dopamine: Heart failure, shock, acute kidney injury - C: Hyperthyroidism, angina, hypertension - AE: Hypertension, dysrhythmias, tachycardia - NC: Administered IV, monitor ECG and BP, monitor urine output Medications Affecting Cardiac Rhythm: Organic Nitrates - ANS Nitroglycerin, Isosorbide, Dinitrate: Acute angina, prophylaxis for chronic stable angina - C: Hypersensitivity, glaucoma, don't take with erectile dysfunction meds. - AE: Headache, ortho. hypo, reflex tachycardia - NC: Can be given sublingually, Take 1 tablet at the first sign of chest pain - may take a max of 3 pills every 5 minutes, go to the ER if the pain doesn't stop. Medications Affecting Cardiac Rhythm: Antianginal Agents - ANS Ranolazine: Chronic Stable Angina - C: Pregnancy, QT interval prolongation, hepatic impairment, ventricular dysrhythmias - AE: QT prolongation, elevated BP - NC: Administer as extended release tablet, obtain ECG Medications Affecting Cardiac Rhythm: Antidysrhythmic Agents (1A) - ANS Procainamide: A-fib, A-flutter, V-tach - C: Complete heart block, systemic lupus, liver/kidney disease - AE: Systmic lupus, neutropenia, hypotension, thromboctopenia - NC: Don't crush or chew ER tablets Medications Affecting Cardiac Rhythm: Antidysrhythmic Agents (1B) - ANS Lidocaine: Ventricular dysrhythmias - C: Severe heart block, Wolff-Parkinson-White syndrome, Kidney/liver disease - AE: Drowsiness, altered mental status, respiratory arrest, seizures - NC: Monitor for CNS depression, monitor lidocaine levels Medications Affecting Cardiac Rhythm: Class III - ANS Amiodarone: A-fib, A-flutter, V-tach - C: Pregnancy/lactation, bradycardia, liver/respiratory dysfunction - AE: Pulmonary toxicity, hypotension, bradycardia, visual disturbances - NC: Monitor for adverse effects - highly toxic, obtain baseline ECG, eye exam, and chest x-ray Antilipemic Agents: HMG-CoA Reductase Inhibitors (statins) - ANS Atorvastatin, Simvastatin: Lower's cholesterol, protection against MI and stroke - C: Pregnancy/lactation, liver disease - AE: Hepatotoxicity, myopathy/myalgia - NC: Monitor liver function every 6 months, avoid alcohol, report muscle aches, take in the evening. Antilipemic Agents: Cholesterol Absorption Inhibitors - ANS Ezetimibe: treats high cholesterol - C: Pregnancy/lactation, liver disease - AE: Hepatitis, myopathy - NC: May be combined with statins, monitor liver/kidney function, follow low fat and low cholesterol diet Antilipemic Agents: Bile Acid Sequestrants - ANS Colesevelam, Colestipol: treats high choelsterol - C: Pregnancy, bowel obstruction, dysphagia - AE: Constipation - NC: Take with food and water, may be combined with statins, don't crush or chew ER tablets, increase dietary fiber. Antilipemic Agents: Fibrates - ANS Gemfibrozil: Treats high triglycerides - C: Pregnancy, liver disease - AE: GI upset, gallstones, myopathy, hepatotoxicity - NC: Take 30 minutes prior to breakfast and dinner, monitor liver function Medications Affecting Coagulation: Anticoagulants - ANS Heparin: stroke, DVT, pulmonary embolism, prophylaxis - C: Pregnancy, thrombocytopenia, bleeding disorders, peptic ulcer disease - AE: Hemorrhage, topxicity, epidural or spinal hematoma, thrombocytopenia - NC: Monitor PTT levels and platelet levels, antidote is protamine sulfate, use electric razor for shaving, avoid OTC NSAIDS, administer sub q. injection 2 in from umbilicus, double check dose. Antilipemic Agents: Anticoagulants - ANS Enoxaparin (low-molecular weight heparin): prophylaxis for DVT, reduction in stroke risk - C: Pregnancy, thrombocytopenia, bleeding disorders, peptic ulcer disease - AE: Hemorrhage, toxicity, epidural or spinal hematoma, thrombocytopenia -NC: Monitor lab levels, same as heparin. Antilipemic Agents: Vitamin K Inhibitors - ANS Warfarin: Prophylaxis for DVT, reduction in stroke risk - C: Pregnancy/lactation, vitamin K deficiency, bleeding disorders, peptic ulcer disease - AE: Hemorrhage, hepatitis, toxicity - NC: Monitor PTT/INR (2-3 therapeutic), teach about dietary food interactions (foods with vitamin K), avoid OTC NSAIDs Antilipemic Agents: Direct Thrombin Inhibitors - ANS Dabigatran: Prophylaxis for DVT, reduces stroke risk - C: Pregnancy, bleeding disorders, peptic ulcer disease - AE: Nausea, vomiting, bleeding - NC: Observe for bleeding, avoid OTC NSAIDs, use electric razor for shaving Antilipemic Agents: Direct Inhibitor of Factor Xa - ANS Rivaoxaban: Prophylaxis for DVT, reduces stroke risk - C: Pregnancy, bleeding disorders, peptic ulcer disease, renal/liver impairment - AE: Elevated liver enzymes, bleeding - NC: Monitor hemoglobin, hematocrit, liver, and kidney function Antilipemic Agents: Antiplatelet - ANS Aspirin, clopidogrel, Dipyridamole: Primary prevention of MI, prevents stroke (prevents platelets from clumping - blood thinner) - C: Pregnancy, bleeding disorders, peptic ulcer disease, renal/liver impairment - AE: Bleeding, diarrhea, dyspepsia - NC: Discontinue 5-7 days before surgery, avoid OTC NSAIDs, observe for bleeding Antilipemic Agents: Thrombolytic Medications - ANS Alteplase (TPA): Acute MI, massive PE, ischemic stroke (disolves clots) - C: Pregnancy, bleeding disorders, prior intracranial hemorrhage, severe hypertention - AE: Bleeding - NC: Administer within 3 hours of manifestations Medications Affecting the Hematologic System: Erythropoietic Growth Factors - ANS Eptoetin Alfa, Erythropoietin: anemia from CKD - C: Pregnancy, uncontrolled hypertension - AE: Hypertension, DVT, headache, risk for thrombotic event - NC: Monitor hemoglobin and hematocrit, DO NOT GIVE if hemoglobin is 11 Vitamins and Minerals: Iron Preparations - ANS Ferrous sulfate, Iron dextran: Iron deficiency anemia - C: Peptic ulcer disease, enteritis, colitis, severe liver disease - AE: Nausea, constipation, heartburn, teeth staining (liquid form), anaphylaxis (dextran), iron toxicity (in children). - NC: Take on an empty stomach, can take with food if GI upset occurs, Vitamin C mayimprove absorption. Vitamins and Minerals: Vitamin B12 (cobalamin) - ANS Vitamin B12, Cyanocobalamin: Treats B12 deficiency, macrocytic anemia - C: Pregnancy, lactation - AE: Hypokalemia - NC: Monitor for signs of B12 deficiency Vitamins and Minerals: Folic Acid - ANS Folic Acid: Folate dificiency, Macrocytic anemia, prevention of neural tube defects during pregnancy - NC: Obtain baseline folic acid, Hgb, and Hct levels Vitamins and Minerals: Potassium Supplements - ANS Potassium chloride: Treats hypokalemia - C: Severe renal disease - AE: Nausea, vomiting, diarrhea, hyperkalemia - NC: Take with meals, never administer IV bolus - rapid infusion - can cause fatal hyperkalemia!! Vitamins and Minerals: Magnesium Supplements - ANS Magnesium Sulfate: Treats hypomagnesia, constipation - C: AV Block, rectal bleeding, nausea, vomiting, abdominal pain - AE: Muscle weakness, painful muscle contractions, respiratory depression, diarrhea - NC: Assess for depressed or absent deep tendon reflexes, monitor BP, HR, and RR. Peptic Ulcer Disease: Histamine-2 Receptor Antagonist - ANS Ranitidine, Famotidine: Prevents or treats gastric & duodenal ulcers, GERD - C: renal failure - AE: Constipation, diarrhea, nausea, pneumonia - NC: Increased risk to pneumonia due to neutralization of gastric acidity. Peptic Ulcer Disease: Proton Pump Inhibitors - ANS Omeprazole, pantoprazole: Treats GERD and ulcers - C: renal failure - AE: Headache, diarrhea, vomiting, pneumonia, rebound acid hypersecretion, osteoporsis - CN: Don't crush, chew, or break ER tablets, notify provider of GI bleeding, take once daily before breakfast. Peptic Ulcer Disease: Antacids - ANS Aluminum Hydroxide: Treats peptic ulcer disease - C: Abdominal pain - AE: Constipation, diarrhea, fluid retention, electrolyte imbalances - CN: Chew tablets and then drink atleast 8 oz of water Peptic Ulcer Disease: Mucosal Protectant - ANS Sucralfate: Treats acute GI ulcers, neutralizes/reduces stomach acid - C: hypersensitivity - AE: Constipation - NC: Take 1 hour before meals and at bedtime, don't crush or chew tablets Peptic Ulcer Disease: Prostaglandin E Analog - ANS Misoprostol: Prevents ulcers in patients with long-term NSAID use - C: Pregnancy/lactation - AE: Diarrhea, dysmenorrhea - NC: Take with meals and at bedtime Gastrointestinal Disorders: Antiemetics - ANS Ondansetron, metoclopramide, promethazine: Prevention of emesis (vomit) related chemotherapy, radiation, nausea and vomiting - C: Prolonged QT interval (ondansetron) Urinary retention (metoclopramide, promethazine) - AE: Diarrhea, headache, dizziness (ondansetron) EPS, anticholinergic, hypotension (metoclopramide, promethazine) - NC: Avoid activites that require alertness, monitor stool pattern. Gastrointestinal Disorders: Bulk-forming Laxatives - ANS Psyllium: Temporary treatment of constipation, decreases diarrhea in pt's with diverticulitis - C: Bowel obstruction, acute surgical abdomen - AE: Obstruction - NC: Administer with full glass of water, drink lots of fluids! Gastrointestinal Disorders: Surfactant Laxative (stool-softener) - ANS Docusate Sodium: Temporary treatment of constipation, softens stool - C: Bowel obstruction, acute surgical abdomen - AE: GI upset - NC: Administer with full glass of water (lots of fluids), don't crush or chew enteric coated preparation Gastrointestinal Disorders: Stimulant Laxatives - ANS Bisacodyl, senna: Temporarily treats constipation, prepares bowel for surgery or testing - C: Bowel obstruction, acute surgical abdomen - AE: GI upset, rectal burning - NC: Don't use on a regular basis, give with water, don't chew tablets Gastrointestinal Disorders: Osmotic Laxatives - ANS Magnesium hydroxide, lactulose: Preps bowel for colonoscopy, rapid evacuation of bowel, reduces serum ammonium in pt;s with liver disease (lactulose) - C: Bowel obstruction, acute surgical abdomen - AE: GI upset, dehydration, toxic magnesium levels - NC: Chronic laxative use can lead to fluid and electrolyte imbalance Gastrointestinal Disorders: Antidiarrheals - ANS Diphenoxylate, plus atropine, loperamide: Treats diarrhea - C: IBD, severe electrolyte imbalances, dehydration - AE: Blurred vision, dry mouth, constipation, urinary retention - NC: Avoid caffiene, avoid drinking plain water to replace GI losses Gastrointestinal Disorders: Prokenetic Agents - ANS Metoclopramide: Treats nausea and vomiting, diabetic gastroparesis - C: GI perforation, GI bleeding, bowel obstruction, hemorrhage - AE: Tardive dyskinesia,EPS, sedation, diarrhea - NC: Monitor for CNS depression, may be given orally or IV Gastrointestinal Disorders: Medication for IBS - ANS Alosetron: severe IBS - C: chronic constipation, bowel obstruction - AE: constipation - NC: Only available through providers enrolled in special program Lubiprostone: severe IBS, chronic constipation - C: Bowel Obstruction - AE: Diarrhea, nausea - NC: Take with food Sulfasalazine: Crohn's disease, mild-moderate ulcerative colitis - C: pregnancy/lactation, liver/kidney disease - AE: agranulocytosis, anemia, nausea, fever, rash, arthralgia - NC: Take with food, don't crush tablets Medications Affecting the Reproductive Tract: Estrogens - ANS Conjugated estrogens, estradiol: Contraception, relief of postmenopausal symptoms - C: pregnancy/lactation, breast cancer, heart disease, thromboembolic disorders - AE: Endometrial & ovarian cancers, breast cancer, altered coagulation - NC: Take at the same time each day, notify provider of swelling in legs, SOB, ensure regular breast exams Medications Affecting the Reproductive Tract: Progesterone - ANS Medroxyprogesterone: Contraception, endometriosis, amenorrhea, dysfunctional uterine bleedings - C: Pregnancy/lactation, heart disease, breast cancer, thromboembolic disorders - AE: Breast tenderness, breast cancer, altered coagulation, amenorrhea, birth defects, migraines, jaundice, edema - NC: Anticipate withdrawl bleeding, notify provider if swelling in legs, redness, SOB; notify provider if pregancy is planned or suspected. Medications Affecting the Reproductive Tract: Androgens - ANS Testosterone: Hypogonadism in males, delayed puberty in males, postmenopausal breast cancer - C: Pregnancy/lactation, prostate or breast cancer, heart failure - AE: Androgenic effects, hypercalcemia, hypoglycemia, edema, hypercholesteremia - NC: Wash hands after applying gel form, use barrier contraception, reduce cholesterol in diet Medications Affecting the Reproductive Tract: 5-alpha Reductase Inhibitors - ANS Finasteride: BPH, male-pattern baldness - C: Pregnancy/lactation, liver disease - AE: Decreased libido and ejaculate volume, gynecomastia - NC: Takes 6 months or longer for therapeutic effects, do not donate blood unless discontinued 1 month prior Medications Affecting the Reproductive Tract: Phophodiesterase Type-5 Inhibitors - ANS Sildenafil: Erectile dysfunction - C: Patients taking nitrates, cardiac disease - AE: Priapism, MI sudden death, sudden hearing loss - NC: If treating hypertension take 3 times daily, if taking for ED, do not take more than 1 dose in 24 hours, take 1 hour prior to sexual activity. Medications for Bone Disorders: Calcium Supplements - ANS Calcium Citrate: Treats hypocalcemia, vitamin D deficiency, deficiency of PTH - C: Hypercalcemia, renal caliculi, digoxin toxicity, hypophosphatemia - AE: Hypercalcemia - NC: Monitor lab calcium levels, chewabletablets provide more consistent bioavailability, prior to IV admin. warm IV infusions to body temp. Medications for Bone Disorders: Selective Estrogen Receptor Modulator - ANS Raloxifene: Preventation and treatment of postmenopausal osteoporosis, protects against breast cancer - C: pregnancy, history of venous thrombosis - AE: Increased risk of DVT, hot flashes - NC: Monitor bone density & liver function, consume lots of calcium Medications for Bone Disorders: Biphosphates - ANS Alendronate: Treats & prevents osteoporosis - C: Pregnancy, dysphagia, kidney impairment, GI disorders - AE: Esophagitis, diarrhea, nausea, abdominal pain, blurry vision, musculoskeletal pain - NC: Monitor bone density, take first thing in the morning on empty stomach with 8 oz of water, sit up right for 30 mins after admin. avoid calcium products within 2 hours of admin. Medications for Bone Disorders: Calcitonin - ANS Calcitonin-salmon: Hypercalcemia, treats but does not prevent postmenopausal osteoporosis - C: hypersensitivity to medication or fish protein - AE: Nausea, nasal dryness with intranasal route - NC: Monitor bone density & calcium levels, rotate sub q. injection sites, for intranasal - admin. in a differentnostril each day. Complementary and Alternative Therapies: Aloe Vera - ANS Anti-inflammatory properties - Drug to drug interactions: Digoxin,diuretics, corticosteroids, antidysrhythmic Complementary and Alternative Therapies: Black cohosh - ANS Estrogen substitute, treats mnifestations of menopause - C: pregnancy - Drug to drug interactions: insulin & diabetes meds. (increased hypoglycemia) Complementary and Alternative Therapies: Echinacea - ANS Stimulates immune system, anti-inflammatory - Drug to drug interactions: Meds for TB, HIV, cancer (decreased positive effects) Complementary and Alternative Therapies: Feverfew - ANS Blocks platelet aggregation, decreases severity of migraine - Drug to drug interactions: NSAIDs & anticoagulants Complementary and Alternative Therapies: Garlic - ANS Blocks LDL cholesterol, raises HDL, suppresses platelet aggregation - Drug to drug interactions: NSAIDs & anticoagulants Complementary and Alternative Therapies: Ginger root - ANS Relieves vertigo and nausea, increased gastric mucous production, increased GI motility - C: Caution in pregnancy - Drug to drug interactions: NSAIDs, anticoagulants, antidiabetic meds (increases hypoglycemic effects) Complementary and Alternative Therapies: Gingko Biloba - ANS Promotes vasodilation, decreased platelet aggregation, decreased bronchospasm, increased GI motility - Drug to drug interactions: Seizure-threshold lowering meds, coagulation Complementary and Alternative Therapies: Glucosamine - ANS Stimulates cells to make cartilageand synovial fluid, suppresses inflammation in joints & cartilage - Drug to drug interactions: Antiplatelet or anticoagulant Complementary and Alternative Therapies: Kava - ANS Promotes sleep, decreased anxiety - C: liver disease/dysfunction - Drug to drug interactions: CNS depressants Complementary and Alternative Therapies: St. Johns Wort - ANS Mild depression relief, analgesic, anti-inflammatory - Drug to drug interactions: antidepressants, amphetamine, cocaine, oral contraceptives Complementary and Alternative Therapies: Saw palmetto - ANS Decreased manifestations of prostatic hyperplasia - Drug to drug interactions: Finasteride (additive effects), antiplatelet and anticoagulants Complementary and Alternative Therapies: Valerian - ANS Increases GABA to prevent insomnia, reduces anxiety - C: Mental health disorders, pregnancy and lactation.