pharm - drug classes

growth hormone agonist (MOA?) adverse effects, indications & nursing considerations

growth hormone agonist (MOA?) adverse effects, indications & nursing considerations

promotes secretion of growth hormone

adverse effects: benign pituitary tumours, acromegaly;

indications: pituitary growth hormone deficiency

growth hormone antagonist (MOA?) adverse effects, indications & nursing considerations

inhibits the secretion of growth hormone

adverse effects: short stature, dyslipidemia, ⬇ muscle mass, ⬇ bone density, central adiposity, ⬆ CV mortality;

indications: acromegaly

growth hormone receptor antagonist (MOA?) adverse effects, indications & nursing considerations

blocks binding of growth hormone at growth hormone receptors in target tissues

adverse effects: short stature, dyslipidemia, ⬇ muscle mass, ⬇ bone density, central adiposity, ⬆ CV mortality;

indications: acromegaly

antidiuretic hormone agonist (MOA?) adverse effects, indications & nursing considerations

promotes secretion of ADH to increase water, sodium & potassium resorption

adverse effects: headache, nausea, upset stomach, flushed face;

indications: diabetes insipidus;

nursing considerations: monitor BP, body weight, input & output

thyroid hormone agonist (MOA?) adverse effects, indications & nursing considerations

synthetic T₄

adverse effects: sweating, insomnia, rapid pulse, dyspnea, irritability, fever and weight loss;

indications: hypothyroidism; nursing considerations: many drug-drug interactions

thioamides (MOA?) adverse effects, indications & nursing considerations

inhibit the synthesis of thyroid hormone (PTU disrupts conversion of T₄ to T₃)

indications: hyperthyroidism;

nursing considerations: methimazole effect can take 3-4 weeks but no hepatotoxicity & leukopenia (unlike PTU), monitor serum TSH levels

glucocorticoids (MOA?) adverse effects, indications & nursing considerations

provides cortisol

adverse effects: cushing's syndrome, dependency/adrenal atrophy;

indications: adrenal insufficiency; nursing considerations: crosses placenta, enters breast milk

radioactive iodine adverse effects, indications & nursing considerations

permanently destroys follicular cells in overactive thyroid gland

indications: hyperthyroidism;

nursing considerations: generally single exposure needed

oral combination contraceptives (MOA?) adverse effects, indications & nursing considerations

suppresses FSH levels​, LH surge​ causing ovarian follicle to not mature, inhibiting ovulation

adverse effects: breast milk reduction, increased blood glucose, hypertension,⬆ appetite, ⬆ weight, ⬆ fatigue, ⬆ depression, ⬆ acne, ⬆ hirsutism, menstrual irregularities, nausea, edema, breast tenderness;

indications: ⬇ risk of endometrial, ovarian and colon cancers​, ⬇ risk of fibroids and ovarian cysts, ⬇ acne, ⬇ body hair and facial growth​, regulate menstrual cycle, ⬇ premenstrual symptoms​, may ⬇ (or eliminate) menstrual flow and cramps​

progestin only oral contraceptives (MOA?) adverse effects, indications & nursing considerations

creates a thick, viscous mucus, preventing sperm movement across the cervix and induces endometrial changes that inhibit zygote implantation​

adverse effects: menstrual irregularities; amenorrhea, prolonged menstrual bleeding, breakthrough spotting​, ⬆ risk of ovarian cysts, ⬆appetite, weight gain, fatigue, depression, acne, hirsutism, headache​;

indications: migraine headache, smokers, hypertension, and breastfeeding

emergency contraception (MOA?) adverse effects, indications & nursing considerations

prevent pregnancy

adverse effects: nausea and vomiting;

indications: used to prevent pregnancy after unprotected sexual intercourse or contraceptive failure and inhibits ovulation​

medical abortion (MOA?) adverse effects, indications & nursing considerations

mifepristone blocks the effects of progesterone on the endometrium and myometrium, misoprostol induces contractions of the uterine myometrium and cervical dilation ​

adverse effects: vaginal bleeding and discharge, pain and cramping, nausea & vomiting, diarrhea, headache, fever/chills​;

indications: medical termination of fetus

menopausal hormonal therapy (MOA?) adverse effects, indications & nursing considerations

antagonizes the effects of estrogen on the uterus and breast, and demonstrates agonist activity on bone​

adverse effects: hot flashes, muscle spasms, nausea, diarrhea, stomach upset, abdo pain, dizziness, neck pain, thromboembolism, risk of breast cancer, heart disease, and stroke;

indications: treat symptoms of menopause​

biguanide (MOA?) adverse effects, indications & nursing considerations

enhances insulin sensitivity in liver and peripheral tissues by activation of AMP-activated protein kinase

adverse effects: GI side effects, B12 deficiency;

indications: low cost, accessible, no weight changes;

nursing considerations: renal insufficiencies or hepatic failure

SGLT2i - sodium-glucose co-transporter 1 inhibitor (MOA?) adverse effects, indications & nursing considerations

reduces glucose reabsorption by the kidney

adverse effects: polyuria, genital mycotic infections, UTIs, hypotension;

indications: loss of 2-3 kg;

nursing considerations: hold prior to major surgery or during serious illnesses or infections, hold during acute illnesses associated with risk for dehydration or procedures associated with high risk of acute kidney injury, less glycemic efficacy at lower GFR

alpha-glucosidase inhibitor (MOA?) adverse effects, indications & nursing considerations

inhibits pancreatic alpha-amylase and intestinal alpha-glucosidase

adverse effects: GI side effects; indications: low cost, no weight changes;

nursing considerations: requires 3 times daily dosing

insulin (MOA?) adverse effects, indications & nursing considerations

activates insulin receptors to regulate metabolism of carbohydrates, fats, and proteins

adverse effects: weight gain, potentially greatest A1C reduction, risk for hypoglycemia;

indications: no maximum dose, allows for regimen flexibility;

nursing considerations: patient education on glucose monitoring, and preventing, detecting, and treating hypoglycemia

TZD - thiazolidinedione (MOA?) adverse effects, indications & nursing considerations

enhances peripheral and hepatic insulin sensitivity by activation of peroxisome proliferator-activated receptor-gamma receptors

adverse effects: weight gain of 2-2.5 kg, may induce edema and/or heart failure, macular edema, risk of MI, fractures;

indications: durable glycemic control

DPP-4 - dipeptidyl peptidase-4 inhibitor (MOA?) adverse effects, indications & nursing considerations

amplifies incretin pathway activation by inhibition of enzymatic breakdown of GLP-1 and GIP

adverse effects: pancreatitis, severe joint pain, risk of heart failure;indications: no weight changes;

nursing considerations: caution with history of pancreatitis,pancreatic cancer

GLP-1 - glucagon-like peptide-1 (MOA?) adverse effects, indications & nursing considerations

activates incretin pathway by utilizing DPP-4 resistant analogue to GLP-1

adverse effects: GI side effects, nausea + vomiting, pancreatitis, parafollicular cell hyperplasia;

indications: loss of 1.1-4.4 kg, less A1C reduction with short-acting agents;

nursing considerations: contraindicated in personal/family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2, caution with history of pancreatitis or pancreatic cancer, an injectible (NOT insulin)

sulfonylureas (MOA?) adverse effects, indications & nursing considerations

activates sulfonylurea receptor on pancreatic beta-cells to stimulate endogenous insulin secretion

adverse effects: weight gain, hypoglycemia; indications: low cost (*basically none → think twice before using);

nursing considerations: caution with renal/hepatic issues and elderly

meglitinides (MOA?) adverse effects, indications & nursing considerations

activates sulfonylurea receptor on pancreatic beta-cells to stimulate endogenous insulin secretion

adverse effects: weight gain;

indications: useful to reduce postprandial hyperglycemia, requires dosing with each meal, lower risk for hypoglycemia than sulfonylureas in renal impairment;

nursing considerations: drug-drug interactions, caution in elderly and renal/hepatic impairments

oxytocin agonist (MOA?) adverse effects, indications & nursing considerations

stimulates Gq receptors to ⬆ IP₃ and Ca²⁺ which stimulates contractions

adverse effects: uterine hypertonus, antidiuretic effects;

indications: induction of labour, postpartum hemorrhage;

nursing considerations: IV for induction & augmentation of labour, IM for control of postpartum hemorrhage

prostaglandin agonist (MOA?) adverse effects, indications & nursing considerations

bind to GqEP1 and GiEP3 prostaglandin receptors to stimulate contractions

adverse effects: nausea, vomiting, diarrhea, headache, HTN, bronchospasm;

indications: induction of labour, postpartum hemorrhage;

nursing considerations: not for augmentation of labour, not for women with history of C-section, uterine surgery, uterine hypertonus, or with other oxytocics

ergot alkaloids (MOA?) adverse effects, indications & nursing considerations

bind to Gq prostaglandin E1 receptors and a1 adrenoceptors which stimulates contractions of uterus & blood vessels

indications: postpartum hemorrhage;

nursing considerations: risk of uterine hypertonus, monitor BP

glucocorticoids (MOA?) adverse effects, indications & nursing considerations

improve fetal lung development, ⬇ risk of respiratory distress syndrome, brain bleeds, necrotizing enterocolitis, sepsis

indications: preterm labour;

nursing considerations: only use between 24-34 weeks 7 days gestation, with regular contractions, when cervix is dilated & begins to efface

prostaglandin inhibitors (MOA?) adverse effects, indications & nursing considerations

inhibits prostaglandin synthesis via inhibition of COX1 and COX₂ enzymes

adverse effects: nausea, postpartum hemorrhage, premature closure of ductus arteriosus → pulmonary hypertension, tricuspid regurgitation, renal failure;

indications: preterm labour;

nursing considerations: caution with platelet disorders, renal dysfunction, NSAID-sensitive asthma, PUD

beta₂ adrenergic agonists (MOA?)* adverse effects, indications & nursing considerations

stimulates Gs B₂ adrenergic receptors which prevents contractions

adverse effects: tachycardia, tremor, palpitations, arrhythmias, hyperglycemia, myocardial ischemia;

indications: cephalic version;

nursing considerations: not recommended

oxytocin receptor antagonist (MOA?)* adverse effects, indications & nursing considerations

inhibits binding of oxytocin at receptor site on uterine & breast cells

adverse effects: nausea, vomiting, headache;

indications: uterine hypertonus;

nursing considerations: not recommended, only effective at later ages

calcium channel blocker (MOA?)* adverse effects, indications & nursing considerations

inhibits the entry of extracellular calcium into myometrial cells and slows uterine contractions

adverse effects: headache, dizziness, flushing, reflex tachycardia, hypotension;

indications: slow labour, gestational hypertension

magnesium sulphate (MOA?)* adverse effects, indications & nursing considerations

potentially a cerebral vasodilator to manage eclampsia & seizures

indications: seizures & fetal neuroprotection less than 32 weeks;

nursing considerations: not recommended, MOA not well understood

cholinergic drugs – muscarinic agonists/ parasympathomimetics​ (MOA?) adverse effects, indications & nursing considerations

stimulate smooth muscle (lungs, GI)​, ⬇ heart rate & force of contraction​, pupil​ constriction – bind to muscarinic cholinergic receptors​ (direct acting), inhibit acetylcholinesterase, ⬆ acetylcholine levels​

adverse effects: extreme parasympathetic effects (SLUDD);

indications: treat postoperative ileus and bladder atony​ (direct), myasthenia gravis, Alzheimer’s disease (indirect)

anticholinergic drugs – muscarinic antagonists/ parasympatholytics​ (MOA?) adverse effects, indications & nursing considerations

inhibit parasympathetic inputs to target organs​, effects similar to SNS

adverse effects: Opposite of parasympathetic effects,

indications: mydriatic, treatment for carbamate insecticide poisoning, reduces airway and gastric secretions​

adrenergic agonist drugs​ – sympathomimetics (MOA?) adverse effects, indications & nursing considerations

constrict smooth muscle and dilate pupils​ (A₁ receptors), increase heart rate, force of contraction and release of renin (B₁ receptors), inhibit smooth muscle (B₂ receptors)

adverse effects: over-stimulation of the sympathetic nervous system (tachycardia… etc);

indications: anaphylaxis, shock, heart failure​ (B₁), ​acute asthmatic bronchoconstriction​ (B₂), hypotension & nasal congestion​ (A₁)

adrenergic antagonist drugs​ – sympatholytics (MOA?) adverse effects, indications & nursing considerations

relax vascular smooth muscle (alpha-adrenergic antagonists), decrease the rate and force of contraction of the heart and reduce the production of renin (beta-adrenergic antagonists)

adverse effects: inhibition of sympathetic nervous system activity (bradycardia, hypotension…etc); indications: tachycardia, hypertension

local anesthetics

block voltage-gated Na+ channels, inhibit motor & sensory neuronal signalling, bind to open Na+ channels, activate neurons most susceptible

ester anesthetics (MOA?) adverse effects, indications & nursing considerations

rapidly metabolised in the bloodstream by esterases; short half-life (1-2 min); pKa range: 8.6-8.9 adverse effects: vasoconstriction; indications: none; nursing considerations: short half-life, limit blood flow to area so drug is kept where it belongs

amide anesthetics (MOA?) adverse effects, indications & nursing considerations

metabolised in the liver (CYP 450); longer half-life (60-240 min); pKa range: 7.5-8.0

adverse effects: vasoconstriction;

indications: longer half-life, faster onset than ester anesthetics since it is closer to physiological pH;

nursing considerations: limit blood flow to area

nerve blocks (MOA?) adverse effects, indications & nursing considerations

block sensation in limb or large area of face

adverse effects: drug affects nerve bundles serving the surgical area

epidural injection (MOA?) adverse effects, indications & nursing considerations

used for labour pain; administered via injection into the epidural space (2nd lumbar vertebra; cauda equina)

adverse effects: backache, infection, inadequate anesthesia, arachnoiditis;

indications: directly targets fibres that control pain signal w/o affecting motor fibres;

nursing considerations: highly vascularised area = more drug required compared to intrathecal

intrathecal injection (MOA?) adverse effects, indications & nursing considerations

used for scheduled procedures (i.e., C-section); injected directly into CSF

adverse effects: backache, infection, inadequate anesthesia, arachnoiditis, spinal headache;

indications: easier to administer (clearer endpoint of CSF withdrawal), higher rate of efficacy compared to epidural anesthesia, requires less drug than epidural anesthesia;

nursing considerations: analgesics can be co-administered with local anesthetics

opioids (MOA?) adverse effects, indications & nursing considerations

used for visceral or labour pain; binds to presynaptic receptors in substantia gelatinosa, inhibit release of pain signalling neurotransmitters in spinal cord AND binds to postsynaptic receptors in the brain decreasing neuronal excitability

adverse effects: pruritus, nausea + vomiting, respiratory depression;

indications: no impact on motor neuron activity, very effective in controlling visceral pain, can be administered with local anesthetics, can be given epidural or intrathecal;

nursing considerations: opioids are NOT a form of anesthesia → co-administered with local anesthesia during surgery

intravenous anesthetics (MOA?) adverse effects, indications & nursing considerations

induce analgesia, sedation, muscle relaxation and loss of consciousness during surgical procedures

adverse effects: loss of sensation and movement, loss of consciousness;

indications: allows pt to move quickly through stages 1 & 2 of anesthesia, decreases need for inhaled anesthetics to maintain anesthesia;

nursing considerations: can be used alone if procedure is <15 min

inhaled general anesthetics (MOA?) adverse effects, indications & nursing considerations

used to maintain anesthesia, highly lipid soluble; prevent flow of Na+ ions into neurons in CNS, reducing neuronal activity

adverse effects: risk for respiratory/CV depression and complications

volatile liquids - sevoflurane adverse effects, indications & nursing considerations

used to maintain anesthesia

adverse effects: LOW minimum alveolar concentration = high potency, loss of consciousness;

indications: high safety profile (less side effects), does NOT induce same respiratory/CV depression as other drugs;

nursing considerations: poor analgesic properties

gaseous inhaled anesthetics - nitrous oxide (MOA?) adverse effects, indications & nursing considerations

for dental procedures, labour, or minor surgery

adverse effects: risk for respiratory/CV depression;

indications: strong analgesic properties;

nursing considerations: HIGH minimum alveolar concentration (no LOC)

acetaminophen (MOA?) adverse effects, indications & nursing considerations

not completely understood but activity at CB1 and TRPV1 receptors in brain

adverse effects: dose dependent;

indications: mild to moderate pain, fever

non-steroidal anti-inflammatory drugs NSAIDS (MOA?) adverse effects, indications & nursing considerations

inhibits cyclooxygenase activity which inhibits inflammatory and pain inducing prostaglandins, inhibit pain mediators at nociceptor level

adverse effects: dose dependent;

indications: mild to moderate pain, fever, inflammation;

nursing considerations: can reduce opioid requirement by ~30%

opioid analgesics (MOA?) adverse effects, indications & nursing considerations

stimulate mu and kappa opioid receptors in brain & spinal cord

adverse effects: constipation, nausea, vomiting, pruritus, sedation, respiratory depression, delirium;

indications: analgesia, sever diarrhea, antitussive therapy, sedation;

nursing considerations: try after non-opioids & non pharmacological methods, stablize psychiatric disorders, do not use in clients with substance abuse

opiate antagonists (MOA?) adverse effects, indications & nursing considerations

prevents binding of opiates at receptors

adverse effects: respiratory depression;

indications: overdose;

nursing considerations: tolerance develops quickly, in cases of abrupt discontinuation unpleasant affects will last ~7 days

local anesthetics (MOA?) adverse effects, indications & nursing considerations

block afferent nerve transmission of pain

indications: analgesia

GABA receptor agents (MOA?) adverse effects, indications & nursing considerations

⬆ effect of GABA at receptor which suppresses pain

indications: analgesia

serotonin agonists (MOA?) adverse effects, indications & nursing considerations

pain suppression pathways release serotonin (5-HT)

adverse effects: intracranial vasoconstriction;

indications: analgesia, neuropathic pain, migraine; nursing considerations: inhibit release of substance P

corticosteroids (MOA?) adverse effects, indications & nursing considerations

inhibit phospholipase, which inhibits formation of arachidonic acid which inhibits formation of prostaglandins (that cause pain & inflammation)

indications: bone pain, nerve compression

anticonvulsants & antiepileptics (MOA?) adverse effects, indications & nursing considerations

⬇ pain transmission signals sent from damaged nerves

indications: neuropathic pain

cannabinoids (MOA?)

many analgesic pathways

adverse effects: sedation, euphoria, vasodilation, confusion, dysphoria;

indications: chronic cancer pain

non-steroidal anti-inflammatory drugs – non-selective/selective (MOA?) adverse effects, indications & nursing considerations

non-selective NSAIDs inhibit both COX-1 and COX-2 enzymatic activity, inhibit formation of gastric mucosa, ⬆ gastric acid secretion​, inhibit platelet aggregation. selective NSAIDs inhibit only COX-2 enzymatic activity

adverse effects: peptic ulcers (non-selective), risk of MI, stroke, and asymptomatic hypertension (selective);

indications: inflammation and fever

glucocorticoids (MOA?) adverse effects, indications & nursing considerations

block the activity of phospholipase A2 and COX-2 enzymes, inhibit histamine release, inhibit immune response

adverse effects: adrenal insufficiency, hyperglycemia, mood changes, osteoporosis, immunosuppression;

indications: severe inflammation

antipyretics (MOA?) adverse effects, indications & nursing considerations

two antipyretic drug classes: NSAIDS and acetaminophen – direct action on hypothalamus & dilation of peripheral blood vessels

adverse effects: sweating and dissipation of the heart (acetaminophen), peptic ulcers (NSAIDS);

indications: fever

antihistamines (MOA?) adverse effects, indications & nursing considerations

block the action of histamine at the H1 receptor

adverse effects: sedation;

indications: allergic rhinitis, motion sickness, vertigo

epinephrine adrenergic agonist adverse effects, indications & nursing considerations

agonize A1 (⬆ BP), B1 (bronchodilation​), and B2 (⬆ cardiac output) receptors

adverse effects: over-stimulation of SNS;

indication: anaphylaxis

selective serotonin reuptake inhibitors - SSRIs (MOA?) adverse effects, indications & nursing considerations

inhibit 5-HT reuptake into the presynaptic neuron; presynaptic 5-HT receptors become less sensitive, postsynaptic receptors become more sensitive; used for major depressive disorder (MDD)

adverse effects: sexual dysfunction, nausea, headache, weight gain, anxiety/nervousness, akathisias, sleep disturbances;

indications: improved side effect profile compared to other antidepressant drugs, no affinity for histamine, alpha adrenergic receptors or muscarinic receptors;

nursing considerations: pediatric cases, discontinuation of drug should be gradual (minimize withdrawal effects: nausea, dizziness, lethargy, anxiety, tremor, palpitations, irritability)

serotonin and norepinephrine reuptake inhibitors - SNRIs (MOA?) adverse effects, indications & nursing considerations

inhibit reuptake of 5-HT and NE to elevate mood

adverse effects: increased risk of postpartum hemorrhage;

indications: used for MDD + neuropathic pain;

nursing considerations: contraindicated with MAOIs, caution with elderly, renal/hepatic impairments, and other serotonin medications, symptoms may improve earlier than other drugs

norepinephrine and dopamine reuptake inhibitors - NDRIs (MOA?) adverse effects, indications & nursing considerations

inhibit NE and DA reuptake; used for MDD + smoking cessation

indications: less risk of sexual dysfunction, weight gain or insomnia compared to SSRIs, good side effect profile;

nursing considerations: contraindicated in those with seizure disorders

tricyclic antidepressants - TCAs (MOA?) adverse effects, indications & nursing considerations

inhibit NE, 5-HT, and DA reuptake into presynaptic neuron; used for MDD, neuropathic pain, and childhood enuresis

adverse effects: affinity for histaminergic, muscarinic, and alpha-1 adrenergic receptors = sedation, blurred vision, dry mouth, urinary retention, constipation, tachycardia, orthostatic hypotension; weight gain, sexual dysfunction

indications: used to treat depression in refractory cases;

nursing considerations: 90% of TCAs bind to serum albumin, side effects minimized if dose is slowly increased over 2-3 weeks

monoamine oxidase inhibitors - MAOIs (MOA?) adverse effects, indications & nursing considerations

deaminates DA, NE, and 5-HT; increases monoamine levels; used for MDD + parkinson’s disease

adverse effects: orthostatic hypotension, headache, insomnia, diarrhea, hypertensive crisis (SES, ⬆tyramine);

indications: used to treat depression when TCAs, SSRIs, or SNRIs are not effective (refractory cases);

nursing considerations: potentiate the hypoglycemic effects of insulin + antidiabetic drugs

lithium (MOA?) adverse effects, indications & nursing considerations

inhibits DA + glutamate (excitatory neurotransmitters) and promotes GABA-mediated neurotransmission (GABA is inhibitory); used for bipolar disorder (BPD)

adverse effects: lithium toxicity, muscle weakness, lack of coordination, vomiting, diarrhea, tremor, twitching, lethargy, mental confusion, polyuria;

indications: used for treatment of mania and reducing the frequency = magnitude of mood changes;

nursing considerations: drug-drug interactions (narrow therapeutic range), interaction with indomethacin → ⬇ renal clearance + ⬆ lithium levels (take at bedtime!), requires strict monitoring

anticonvulsant drugs (MOA?) adverse effects, indications & nursing considerations

used to manage manic episodes in BPD

adverse effects: dizziness, drowsiness, headache, nausea, blurred vision, sedation

atypical antipsychotic drugs (MOA?) adverse effects, indications & nursing considerations

used for management of BPD, MDD, schizophrenia

adverse effects: vary with each drug

typical antipsychotics (MOA?) adverse effects, indications & nursing considerations

antagonist action on D2 receptors in the mesolimbic and mesocortical tracts

adverse effects: acute dystonia, akathisia, pseudo-parkinsonism, tardive dyskinesia, anticholinergic effects, sedation, hypotension, sexual dysfunction;

indications: +ve symptoms of schizophrenia;

nursing considerations: can cause EPS

atypical antipsychotics (MOA?) adverse effects, indications & nursing considerations

antagonist activity at D2-like receptors, 5HT2A and α2 adrenergic receptors & agonist activity at 5HT1A receptors

adverse effects: blurred vision, dry mouth, constipation, urinary retention, orthostatic hypotension, light-headedness, sedation fewer EPS symptoms, obesity;

indications: -ve symptoms of schizophrenia

3rd generation antipsychotic drugs - dopamine system stabilizers (MOA?) adverse effects, indications & nursing considerations

partial agonist at dopamine D2, D3 receptors and serotonin 5HT1A receptors, partial antagonist at serotonin 5HT2A receptors

adverse effects: drowsiness, insomnia, agitation, changes in BP, anxiety, headache;

indications: +ve and -ve symptoms of schizophrenia;

nursing considerations: minimal EPS, little to no weight gain, lack of anticholinergic effects

levodopa (MOA?) adverse effects, indications & nursing considerations

converted to dopamine by dopamine decarboxylase

adverse effects: nausea, vomiting, cardiac arrhythmias, orthostatic hypotension;

indications: parkinson’s disease

carbidopa (MOA?) adverse effects, indications & nursing considerations

prevents peripheral conversion of levodopa into dopamine does not penetrate BBB

MAOIs (MOA?) adverse effects, indications & nursing considerations

inhibits monoamine oxidase, which prevents removal of norepinephrine, serotonin and dopamine from the brain

adverse effects: refer to emotional & mood disorders;

indications: parkinson’s disease

COMT inhibitors (MOA?) adverse effects, indications & nursing considerations

inhibiting COMT, which prevents peripheral degradation of levodopa

adverse effects: drowsiness, sweating, orthostatic hypotension, abdo pain, dry mouth, nausea, vomiting, urine discolouration;

indications: parkinson’s disease

anticholinergic - muscarinic cholinergic blockers (MOA?) adverse effects, indications & nursing considerations

binds to muscarinic cholinergic receptors in the CNS, which ⬆ amount of ACh

adverse effects: dry mouth, blurred vision, tachycardia, urinary retention and constipation;

indications: parkinson’s disease

acetylcholinesterase inhibitors (MOA?) adverse effects, indications & nursing considerations

inhibits acetylcholinesterase which prevents breakdown of ACh

adverse effects: parasympathomimetic effects;

indications: alzheimer's disease;

nursing considerations: used in early stages

thiazide and thiazide-like diuretics (MOA?) adverse effects, indications & nursing considerations

block sodium/chloride transporter in the distal tubule, facilitate urinary excretion of electrolytes (Na+, K+, Cl-, Ca2+) and water, reducing blood volume

adverse effects: GI upset, orthostatic hypotension, hyperglycemia, fluid and electrolyte imbalance (hypokalemia);

indications: hypertension; nursing considerations: administer during the day to prevent nocturia​

angiotensin converting enzyme (ACE) Inhibitors ​(MOA?) adverse effects, indications & nursing considerations

block conversion of Angiotensin I to Angiotensin II, decrease peripheral resistance & decrease blood volume​

adverse effects: dry cough, hyperkalemia, GI irritation and constipation​, allergic reaction of lips, mouth and throat;

indications: hypertension contraindicated in pregnancy

angiotensin II receptor blockers – ARBs (MOA?) adverse effects, indications & nursing considerations

block angiotensin II (AT1) receptors in arteriolar smooth muscle and in adrenal cortex​, decrease peripheral resistance & decrease blood volume, inhibit aldosterone release

adverse effects: similar to ACE inhibitor;

indication: hypertension

contraindicated in pregnancy

calcium channel blockers adverse effects, indications & nursing considerations

block calcium ion channels​

adverse effects: dizziness, light-headedness, fatigue, (hypotension & reflex tachycardia), flushing, nausea​;

indication: hypertension;

avoid grapefruit juice

Beta-blockers adverse effects, indications & nursing considerations

block effect of norepinephrine on arterioles​, block action of norepi and epi on cardiac muscle reducing speed & force of contraction (HR)​

adverse effects: fatigue, activity intolerance, sleep disturbance;

indication: hypertension

statins (MOA?) adverse effects, indications & nursing considerations

inhibits HMG CoA reductase, blocking cholesterol synthesis; ⬆ # of LDL receptors in liver + stimulates removal of LDLs from circulation; first-line treatment of lipid disorders

adverse effects: headache, heartburn, GI upset, risk for rhabdomyolysis in elderly, risk for acute renal failure from waste products, significant muscle pain, increased risk with higher doses/polypharmacy with inhibition of CYP 450 or ⬆ bioavailability of drug;

indications: high efficacy, significant reduction in LDL, ⬇ VLDL, ⬆ HDL, slows progression of CAD & reduces CVD associated mortality, can be co-administered with other cholesterol lowering meds or antihypertensive meds;

nursing considerations: effects are reversible, avoid alcohol + grapefruit juice, contraindicated in pregnancy or individuals who may become pregnant, potentiates warfarin, longer use = risk of T2DM

selective cholesterol absorption inhibitors (MOA?) adverse effects, indications & nursing considerations

inhibits intestinal cholesterol absorption (blocks by 50%); first-line add-on therapy

adverse effects: GI distress;

indications: monotherapy for pts with complete statin intolerance for LDL lowering, can be co-administered with statin therapy to increase effectiveness;

nursing considerations: combination tablets available for synergistic inhibition of cholesterol absorption cholesterol synthesis

bile acid resins (MOA?) adverse effects, indications & nursing considerations

non-absorbed, bind to bile acids + impede enterohepatic circulation, ⬆ excretion of cholesterol (via feces)

adverse effects: addictive effect when co-administered w statins, GI upset (abdo pain, bloating, nausea, diarrhea, constipation, steatorrhea), may induce vitamin deficiency and causes ⬆ bleeding time;

indications: effective at reducing blood cholesterol levels and reduce risk of major CV events, no systemic side effects;

nursing considerations: non-selective → interferes w absorption of other drugs (take 1hr before or 4hrs after other meds)

PCSK9 inhibitors (MOA?) adverse effects, indications & nursing considerations

inhibit PCSK9 proteins that target liver LDL receptors for degradation, monoclonal antibodies bind to PCSK9, stopping it from binding to LDL receptors

adverse effects: significant reduction in clinical outcomes associated with atherosclerotic CVD;

indications: lower LDL levels by 50-70% in addition to statin, for clients whose LDL levels are above target despite maximally-tolerated statin dosing;

nursing considerations: injected subcut q2weeks or once a month

anticholinergics (MOA?) adverse effects, indications & nursing considerations

inhibit binding of ACh on muscarinic receptors in the NTS and CTZ

adverse effects: dry mouth, constipation, urinary retention;

indications: nausea, vomiting

antihistamines (MOA?) adverse effects, indications & nursing considerations

inhibit binding of histamine on H1 receptors in the NTS and CTZ

adverse effects: sedation;

indications: nausea, vomiting

cannabinoids (MOA?) adverse effects, indications & nursing considerations

bind at CB1 receptor in the cortex and VC

adverse effects: sedation, euphoria, vasodialtion, confusion, dysphoria;

indications: nausea, vomiting

dopamine antagonists (MOA?) adverse effects, indications & nursing considerations

inhibit binding of dopamine at D2 receptors in the CTZ and NTS

adverse effects: sedation, blurred vision, dry mouth, constipation, urinary retention, diarrhea, galactorrhea, extrapyramidal signs, hypotension;

indications: nausea, vomiting

serotonin antagonists (MOA?) adverse effects, indications & nursing considerations

inhibit binding of serotonin at 5HT3 receptors in the CTZ and NTS

adverse effects: QT prolongation, cardiac arrhythmias, headache, malaise, constipation;

indications: nausea, vomiting;

nursing considerations: generally, well tolerated

glucocorticoids (MOA?) adverse effects, indications & nursing considerations

anti-inflammatory & analgesic effects, reversal of chemotherapy-induced HPA hypofunction, inhibition of serotonergic tone

indications: nausea, vomiting;

nursing considerations: commonly combined with 5HT antagonists and NK1 antagonists

neurokinin receptor antagonists (MOA?) adverse effects, indications & nursing considerations

block the binding of Substance P at NK1 receptors in the CTZ and NTS

indications: nausea, vomiting;

nursing considerations: inhibit CYP enzymes, commonly prescribed with 5HT receptor antagonists & glucocorticoids, generally well tolerated

beta-adrenergic agonists (MOA?) adverse effects, indications & nursing considerations

stimulate smooth muscle receptors activating Gs protein receptors, bronchodilation

adverse effects: tremor, tachycardia

muscarinic antagonists​ (MOA?) adverse effects, indications & nursing considerations

blocks muscarinic receptors in the smooth muscle of the bronchi​

adverse effects: dry mouth, sedation

glucocorticoids (MOA?) adverse effects, indications & nursing considerations

stimulate GRE leading to increased production of proteins that inhibit phospholipase A2​, also inhibit the synthesis of COX-2

adverse effects: Low dose – throat irritation, oral candidiasis​, High dose – adrenal insufficiency, osteoporosis

leukotriene antagonists adverse effects, indications & nursing considerations

competitively bind to leukotriene receptors in bronchiolar smooth muscle

adverse effects: nausea and headache

mast cell stabilizers (MOA?) adverse effects, indications & nursing considerations

prevent allergen induced increase in calcium, prevents bronchoconstriction

lipoxygenase inhibitors​ (MOA?) adverse effects, indications & nursing considerations

inhibit the formation of all leukotrienes​

nursing considerations: contraindicated in clients with liver disease