Pharm Exam 3: GI, Neurological, Reproductive, GU, and Hematologic

histamine H2 antagonists: cimetidine, famotidine

treats GI ulcers, heartburn, erosive esophagitis, GERD, aspiration pneumonia, and hypersecretory disorders, decreases stomach acid, increases stomach pH

side effects: hepatotoxicity, reduced libido, impotence, susceptibility to pneumonia, agranulocytosis, aplastic anemia

-tidine ending, interacts w/ antacids, warfarin, phenytoin, lidocaine, and theophylline, inhibits liver metabolism, give w/ or w/o food, give IV slowly, monitor for GI bleed, don’t give w/ PKU patients bc of aspartame

proton pump inhibitors (PPI): omeprazole, pantoprazole

treats GI ulcers, heartburn, erosive esophagitis, GERD, and hypersecretory disorders, suppresses gastric acid production at baseline and after food

side effects: bone loss, abd pain, GI issues, hypomagnesemia, risk of C. diff, can cause pneumonia

-prazole ending, only for 8 wks, bone health, 1 h before food, drink fluids, careful w/ pregnancy, don’t give when taking rilpivirine, food decreases absorption

mucosal protectants: sucralfate

treats acute duodenal ulcers, creates gel coating over ulcers and stomach, not absorbed

side effects: constipation (rare)

decreases absorption of PO meds, don’t give with other PO meds, take on empty stomach and 1 h before meals or at bedtime, careful w/ diabetes and difficulty swallowing

antacids: aluminum hydroxide, calcium carbonate, magnesium hydroxide

treats peptic ulcer disease and GERD, neutralizes gastric acid

side effects: constipation w/ calcium and aluminum, diarrhea w/ magnesium

monitor sodium/electrolytes and fluid retention, watch for GI bleed, increase fluid/fiber/exercise, chew thoroughly w/ 8 oz of water, careful w/ hyper Ca or hypophosphatemia, don’t give w/ abd pain of unknown origin, take 2 h before/after other meds

serotonin 5-HT3 antagonists: ondansetron (Zofran)

treats n/v, often post-op and adjunct therapy for chemo or radiation, serotonin antagonists for brain and stomach

side effects: serotonin syndrome, Steven Johnson syndrome, diarrhea, constipation, dizziness

can give analgesics, fall risk, don’t drive, drink fluids, careful w/ pregnancy and kids < 13, don’t give w/ PKU and long QT syndrome/heart issues, w/ apomorphine makes Parkinson’s worse and hypotension

antihistamine/anticholinergic: dimenhydrinate (Dramamine)

treats vertigo, n/v, and motion sickness, blocks histamine release in the ear and related neurons

side effects: sedation, anticholinergic effects (drying out)

monitor bowel patterns and ambulation, increase fluid/fiber/activity, monitor urine output, careful w/ pregnancy, don’t give w/ glaucoma and pre-term/newborn infants, MAOI’s increase side effects

dopamine antagonists/prokinetic agents: metoclopramide

treats gastroparesis, GERD, n/v from chemo/radiation and opioids, blocks dopamine receptors, increases lower esophageal sphincter tone and peristalsis

side effects: extrapyramidal manifestations (esp tardive dyskinesia), sedation, restlessness, diarrhea

d/c if EPS symptoms start, monitor for muscle rigidity and changes, drink fluids, careful w/ CHF/HTN and porphyria, don’t give w/ pheochromocytoma and breast cancer, absorption of other meds can be affected

osmotic laxatives (laxative salts): polyethylene glycol (Miralax), lactulose, magnesium hydroxide (milk of magnesia), magnesium citrate

treats constipation, brings water into intestines, enlarges and softens stool, increases peristalsis, bowel evacuation in 2-12 hrs

side effects: diarrhea, cramping, flatulence, electrolyte imbalance, n/v

careful w/ hx of perforation and dysphagia (can’t be thickened), don’t give w/ bowel obstruction, interacts w/ laxatives (additive) and loop diuretics (electrolyte issues)

bulk-forming/fiber supplements: psyllium (Metamucil)

treats constipation, diverticulosis, IBS, stool regulator for fecal ostomies, non-digestible, absorbs water, forms glutinous mass, stretches intestines, increases peristalsis

side effects: esophageal or intestinal obstruction, diarrhea

take w/ at least 8 oz of water, monitor for retrosternal pain, report absence of BM’s and chest pain, increase fluid/fiber/activity, don’t give w/ dysphagia, appendicitis, narrow esophageal lumen, decreases absorption of PO meds

surfactant laxatives/stool softeners: docusate sodium

treats constipation, prevents fecal impaction and straining/painful elimination, changes surface tension, increases water absorption into stool and softening, given after surgery

side effects: diarrhea, cramping, throat irritation (bitter taste), rashes

monitor for abd distention, take w/ glass of water and empty stomach, increase fluid/fiber/activity, careful w/ hx of dependency, don’t give w/ mineral oil, undiagnosed abd pain, or within 2 h of other laxatives

stimulant laxatives: bisacodyl

treats constipation from opioids or colon evacuation prior to procedures, increases colon peristalsis and water secretion of intestines, decreases absorption of fluid through intestines, usually suppositories

side effects: cramping, burning and proctitis w/ rectal route, dependence

don’t use long-term, monitor I&O’s, d/c if diarrhea starts, increase fluid/fiber/exercise, increase fiber slowly, careful w/ hx of eating disorders, don’t give w/ obstructions, anal fissures, ulcerated hemorrhoids, and undiagnosed abd pain, antacids/milk cause cramping

opioids: diphenoxylate w/ atropine and loperamide

treats diarrhea and too much ileostomy output, decreases GI motility

side effects: drowsiness, anticholinergic effects, arrhythmias, allergic reactions

not used for pain, recommend lowest dose and short course, monitor urine output, drink fluids, avoid caffeine, careful w/ hx of opioid abuse and existing GI conditions, don’t give to kids < 2 yrs and advanced glaucoma, cimetidine, erythromycin, and quinine increase arrhythmias

probiotics

nutritional supplement, used as treatment of diarrhea from multiple causes, can be used daily (preventative) or w/ diarrhea

restores normal flora of intestines that is disrupted by same types of bacteria/yeast, many strains exist

side effects: not common but n/v, bloating, abd pain, HA, appetite or stool changes

5-HT3 blocker: alosetron

treats irritable bowel syndrome (IBS) lasting 6 mths or longer, only for females, blocks serotonin receptors, decreases pain and peristalsis, increases Na and water absorption through intestines

side effects: constipation (must sign an agreement), obstruction, perforation, ischemic colitis

stop and report constipation, monitor LLQ pain and bloody stool, don’t give w/ constipation, diverticulitis, and ulcerative/Crohn’s, many drugs decrease effects

5-HT4 receptor agonist: lubiprostone

treats constipation from irritable bowel syndrome (IBS), for females over 18 yrs, increases peristalsis and secretion of water and Na/electrolytes from intestines

side effects: GI issues, flatulence

monitor for persistent HA, take w/ food or water, lie down if nauseous, d/c w/ severe side effects, don’t give w/ diarrhea, diverticulitis, ulcerative/Crohn’s, or volvulus, opioids decrease effects, lactulose is additive

5-aminosalicylates: sulfasalazine

treats mild-moderate inflammatory bowel disease (IBD), sulfonamide antibiotic, reduces inflammation

side effects: crystalluria, GI issues, infertility, expected orange urine, photosensitivity, dermatitis, Steven Johnson syndrome, agranulocytosis, peripheral neuropathy, angioedema

don’t give w/ sulfa/trimethoprim allergy or folate deficiency, drink clear fluids, give enteric coated, monitor joint pain and temp, take w/ food or water, careful w/ asthma, G6PD deficiency, and blood issues, iron and antibiotics affect absorption

immunosuppressants: azathioprine

treats inflammatory bowel disease (IBD) off label, approved for RA and organ rejection, inhibits B and T lymphocyte production, decreases body’s immune response

side effects: bone marrow suppression (pancytopenia, neutropenia), arthralgia, alopecia, rash, malignancy, retinopathy, GI issues

monitor CBC and liver, take w/ food, lie down if nauseous, report infection s/sx and excessive bleeding, careful w/ myasthenia gravis, don’t give w/ live vaccines, anuria, or pancreatitis, allopurinol increases blood issues

antibiotics for peptic ulcers w/ H. pylori: clarithromycin

treats whooping cough, diphtheria, chlamydia, PNA, eye prophylaxis, and bronchitis

side effects: prolonged QT, GI upset, hepatotoxicity, ototoxicity

ends w/ -thromycin, avoid antacids, monitor LFT’s

antibiotics for peptic ulcers w/ H. pylori: amoxicillin

antibiotic, treats soft tissue infections and UTI’s

side effects: most common allergy, cross sensitivity w/ cephalosporins

-cillin ending

antibiotics for peptic ulcers w/ H. pylori: metronidazole

treats C. diff, trichomoniasis, amebiasis, and giardiasis

side effects: expected metallic taste, expected red/brown urine, seizures

no alcohol, increases lithium

antibiotics for peptic ulcers w/ H. pylori: tetracycline

antibiotic, treats bacterial infections, acne, lots of resistance

side effects: photosensitivity, tooth discoloration

end w/ -cycline, avoid sun, contraindication = kids < 8 yrs, avoid taking w/ Ca, or antacids, teratogenic

phenothiazine derivative: promethazine

treats n/v, motion sickness, and sedates, antidopaminergic, antihistamine, and anticholinergic properties, increases effects of pain meds

side effects: drowsiness, anticholinergic effects, NMS, hypotension, arrhythmias, cholestatic jaundice, bone marrow suppression, hypo/hyperthermia, seizures, IV is very harmful to veins (burns)

monitor pseudo-Parkinsonism, constipation, and “lead pipe rigidity”, don’t drive, don’t give w/ kids < 2, SQ or intra-arterial, comas, and lower respiratory infections, no anticholinergics, MAOI’s, pregnancy tests, or CNS depressants

centrally acting muscle relaxants: baclofen (Lioresal)

(other meds: carisoprodol, methocarbamol, cyclobenzaprine)

treats muscle spasms from spinal cord injury, cerebral palsy, MS, musculoskeletal injury, or acute musculoskeletal disorders, inhibits GABA in spinal cord, suppresses hyperactive reflexes

side effects: orthostatic hypotension, dizziness, drowsiness, weakness, n/v, urinary retention, constipation, withdrawal

start w/ low dose, give w/ food, taper off over 1-2 wks, fiber/fluids/fitness, don’t drive, don’t give w/ MAOI’s, avoid alcohol, other CNS depressants, SSRI’s, and SNRI’s

peripherally acting muscle relaxants: dantrolene (Dantrium)

eases muscle spasms from CVA, stroke, spinal cord injury, neuroleptic malignant syndrome, and CP, prevents malignant hyperthermia (antidote!), stops calcium release

side effects: hepatotoxicity (black box), expected sedation/drowsiness, diarrhea, muscle weakness

watch LFT’s, avoid alcohol and other CNS depressants, start low, assess muscle strength, don’t drive, careful w/ cardiac, pulmonary, or neuromuscular disease or over 35 yrs, no estrogen or calcium channel blockers

hydantoins: phenytoin (Dilantin)

treats seizures (epilepsy, partial, tonic-clonic, status epilepticus), stops influx of sodium and repetitive neuron firing

side effects: acute toxicity (ataxia, slurred speech, nystagmus), expected gingival hyperplasia, rash, withdrawal, IV: bradycardia and hypotension

narrow therapeutic index: 10-20 mcg/mL, taper dose, don’t drive, use other birth control, teratogenic, don’t give w/ heart block or seizures from hypoglycemia, several incompatibilities (inc. dextrose)

anticonvulsants: carbamazepine (Tegretol)

treats tonic-clonic and partial seizures, mood stabilizer for bipolar, and trigeminal neuralgia, inhibits influx of sodium

side effects: agranulocytosis (black box), Steven-Johnson syndrome (black box), rash, headache, ataxia, photosensitivity

d/c if infection s/sx start, start low, give at night, gene testing w/ Asians, don’t mix oral, don’t drive, don’t give w/ absent seizures, HF, or MAOI’s in 2 wks, avoid grapefruit juice, false negative pregnancy test, birth control interference

anticonvulsants: valproic acid (Depakene)

treats all seizures, control mania in bipolar, prevents migraines, inhibits influx of sodium, inhibits calcium and effects of GABA

side effects: fatal hepatotoxicity/pancreatitis, decreased platelets, GI issues, rash, neural tube defects, hyperammonemia

monitor LFT’s, teratogenic, give w/ food, extended release, add H2 agonist, don’t give w/ other anticonvulsants or thrombocytopenia, increase phenytoin and phenobarbital, topiramate increases hyperammonemia

other anticonvulsants: phenobarbital (Luminal)

oldest, breaks a seizure, less common now from side effects, enhances GABA and slows nerve signaling, broad spectrum

side effects: somnolence, insomnia, vertigo, nightmares/hallucinations, GI or CV issues, tolerance

interferes w/ vit K clotting factors, no alcohol or CNS depressants, taper dose off, watch for abuse

other anticonvulsants: levetiracetam (Keppra)

treats partial, myoclonic, and tonic-clonic seizures, next gen, controls electrical activity in brain, decreases excitatory neurotransmitters, broad spectrum

side effects: sedation/fatigue, dizziness, neuropsychiatric symptoms, increases suicide risk, agitation

used w/ children and adults w/ epilepsy preventatively, therapeutic range (10-40 mcg/mL), taper off

other anticonvulsants: gabapentin (Neurontin), pregabalin

treats partial seizures, epilepsy, neuropathic pain, and restless leg syndrome, next gen, blocks calcium channels, increases GABA synthesis, decreases excitatory neurotransmitters, narrow spectrum

side effects: CNS and GI issues, respiratory depression, DRESS, sedation, dizziness, ataxia, weight gain

local anesthetics: lidocaine (Xylocaine)

local analgesic, for small areas of anesthetic, procedures, and wounds, treats ventricular arrhythmias, interrupts nerve impulses temporarily, stops sodium

side effects: related to IV/systemic, CNS stimulation, rebound CNS depression, hypotension w/ spinal, bradycardia, HA

-caine ending, monitor vitals, don’t use in eyes, lower HOB for hypotension, report paresthesia, don’t give to children < 3 yrs, interacts w/ beta-blockers and phenytoin

short-acting barbiturates: methohexital-sodium (Brevital)

rapid induction of anesthesia and hypnosis for brief procedures, CNS depression to treat seizures, enhances GABA

side effects: sedation, respiratory depression/apnea, bradycardia, hypotension, overdose/death, tolerance/dependence

-barbital ending, don’t give other CNS depressants, take at bedtime, benzos are safer, monitor vitals, constant supervision, resuscitation equipment close, monitor IV for leaking, multiple incompatibilities

benzodiazepines: midazolam (Versed)

for conscious sedation for short procedures (endoscopies, colonoscopies, sedation before general), enhances GABA, promotes faster sleep

side effects: cardiac/respiratory arrest, hypoxia, amnesia

-lam ending, controlled substance, no other CNS depressants or herbals, antidote = flumazenil, resuscitation equipment nearby, awake and answering questions but won’t remember, teratogenic, don’t give w/ glaucoma, cimetidine causes toxicity

opioids: fentanyl (Duragesic)

used as supplementation to general anesthesia, narcotic agonists, gives analgesic and sedative effects

side effects: highly addictive, dependence, respiratory depression, drowsiness, n/v, circulatory collapse

monitor RR frequently, no MAOI’s or other CNS depressants, antidote = naloxone (Narcan), antiemetics or food, resuscitation equipment nearby, don’t give w/ hx of substance abuse or pregnancy, careful w/ increased ICP

amphetamines: dextroamphetamine sulfate (Adderall)

treats ADD/ADHD and narcolepsy, increases norepinephrine and dopamine release, CNS stimulation, helps focus, lengthens attention span, lessens impulsivity

side effects: insomnia, nervousness, HTN, tachycardia, suppresses appetite and growth (weight loss), dependence - schedule 2, withdrawal, toxicity

take early in the day, avoid caffeine, taper off, don’t give w/ glaucoma, hyperthyroidism, structural CV issues, CVD, and HTN, no MAOI’s, other stimulants, or vitamin C

amphetamine-like: methylphenidate (Ritalin)

treats ADD/ADHD and narcolepsy, increases dopaminergic and noradrenergic activity in the brain by stopping reuptake

side effects: insomnia, HTN, tachycardia, weight loss, dependence, n/v, restlessness, tremors, irritability, dizziness, HA, dry mouth

lower abuse potential, preferred treatment, take last dose before 4 pm, taper dose, avoid caffeine, don’t give w/ glaucoma, hyperthyroidism, structural CV issues, arrhythmias, HTN, or kids < 6 yrs, no MAOI’s or other sitmulants

non-amphetamine stimulant: modafinil (Provigil)

promotes wakefulness w/ narcolepsy, shift work tiredness, obstructive sleep apnea, and jet-lag, works related to reuptake of norepinephrine

side effects: n/v/d, CNS stimulant effects (HA, tachycardia, HTN), Steven-Johnson syndrome

give w/ food, take 1 hr before work, monitor for psychological dependence, don’t give w/ valvular heart disease and pregnancy, decreases oral contraceptive effects, interacts w/ several meds

dopamine replacement: levodopa-carbidopa (Sinemet)

2 drugs given together to treat Parkinson’s, crosses blood-brain barrier, taken up by dopamine neurons, converts dopamine to be available to use

side effects: psychiatric disturbances, orthostatic hypotension, dyskinesia (paralysis), n/v, expected dark urine and sweat, tremors/twitches

taper off, give w/ food, avoid high protein, don’t give w/ angle closure glaucoma, hx of melanoma, suicidal ideation, or psychosis, interacts w/ traditional antipsychotics, B6, MAOI’s, and anticholinergics (increase effects)

dopamine receptor agonists: pramipexole (Mirapex)

treats Parkinson’s and restless leg syndrome, binds to dopamine receptors, mimics natural response to dopamine

side effects: GI issues, orthostatic hypotension, dyskinesia, drowsiness (sleep attacks), muscle weakness

taper dose, take w/ food, avoid alcohol and other CNS depressants, teratogenic, cimetidine increases levels

monoamine oxidase type B (MAOI’s): selegiline (Eldepryl)

treats Parkinson’s and depression, inhibits MAO-B’s, increases dopamine in the synapse, slows deterioration of dopamine nerve cells

side effects: insomnia, dizziness, HA, confusion, depression, acts like MAO-A’s, irritates oral mucous membranes

monitor BP closely, take last dose before noon, avoid caffeine, no new supplements, don’t eat/drink for 5 mins after taking, don’t give w/ meperidine, no MAOI’s, SSRI’s, or St. John’s wort

cholinesterase inhibitors: donepezil (Aricept)

treats mild-moderate Alzheimer’s, stops inactivation of acetylcholine, increases acetylcholine, improves cognitive function

side effects: GI issues, insomnia, dizziness, HA, bradycardia

give w/ food at bedtime, monitor weights and bleeding, fall risk, report LOC changes, don’t give w/ GI bleeds or kids, NSAID’s increase bleeding, anticholinergics reduce effects

NMDA receptor agonists: memantine (Ebixa)

treats moderate-severe Alzheimer’s, blocks glutamate from stimulating NMDA receptors, decreases calcium into neurons, restores brain function, slows damage

side effects: CNS effects, confusion

assess for diarrhea or constipation, monitor dizziness, don’t give w/ renal failure or seizure disorders, antacids/drugs that increase urine pH can cause toxicity

immunomodulators: interferon beta-1a (Avonex)

treats multiple sclerosis, inhibits leukocyte movement across blood-brain barrier, protects myelin sheath of neurons

side effects: flu-like symptoms, myelosuppression, liver toxicity, pain/redness at injection site

start low, pre-medicate w/ acetaminophen, monitor CBC and LFT’s, rotate injection sites, careful w/ suicidal ideation, alcohol, kids < 18, seizures, mental health issues, don’t give other immunosuppressors

serotonin agonists: sumatriptan (Imigran)

treats migraines and cluster headaches, binds to serotonin receptors, mimics natural serotonin, modulates other neurotransmitter release, influences neuronal activity

side effects: chest pressure/heaviness, CNS effects (vertigo, tingling)

monitor vitals, report jaw pain, don’t give w/ CAD, PVD, older adults, stroke, MAOI use within 2 wks, St. John’s wort causes toxicity, serotonin agonists can cause serotonin syndrome

benzodiazepines: diazepam (Valium)

treats anxiety, muscle spasms/spasticity, seizures, and alcohol withdrawal, CNS depressant, enhances GABA, acts on limbic system (perception/emotions)

side effects: sedation/lethargy, respiratory depression (IV), tolerance/dependence, amnesia, confusion/anxiety, hypotension, tachycardia

-pam ending, controlled substance, take in the evening, don’t drive, antidote = flumazenil, taper dose, fall risk!, careful w/ alcohol, teratogenic, don’t give w/ glaucoma, coma, shock, and L/D, no CNS depressants, cimetidine, smoking, Kava-Kava, or chamomile

non-benzodiazepines: buspirone (Buspar)

short-term treatment for anxiety, binds to serotonin and dopamine receptors and activates them, increases norepinephrine metabolism, non-sedating, no abuse risk

side effects: HA, dizziness, paradoxical insomnia, anxiety, GI upset

take 2 weeks to show effects, can be taken during the day, give w/ food and regularly (not PRN), fall precautions, OTC meds for HA, no grapefruit juice, erythromycin, or MAOI’s

tricyclic antidepressants (TCA’s): amitriptyline (Elavil)

(other meds: imipramine, desipramine, doxepin, clomipramine, nortriptyline)

treats depression, bed-wetting, insomnia, neuropathic pain, and OCD, blocks reuptake of norepinephrine and serotonin, improves mood, increases activity, reduces morbid feelings, restores appetite and sleep

side effects: sedation, arrhythmias, increased suicide risk in kids, lethal in overdose, orthostatic hypotension, anticholinergic effects, withdrawal potential

takes 2 weeks to show effects, take at bedtime, taper off, monitor BP, gastric lavage for OD, increase fiber/fluids/fitness, don’t give w/ kids < 12, recent MI, seizures, no CNS depressants, MAOI’s, cimetidine, St. John’s wort, or levodopa

selective serotonin reuptake inhibitors (SSRI’s): fluoxetine (Prozac)

(other meds: fluvoxamine, escitalopram (Lexapro), paroxetine, citalopram, sertraline)

treats depression/anxiety, PTSD, panic disorder, PMDD, bipolar, GAD, bulimia, and OCD, blocks reuptake of serotonin, causes better mood, CNS excitation (opposite of TCA’s)

side effects: dizziness, n/v, sexual dysfunction, insomnia, dry mouth, HA, serotonin syndrome, increases suicide risk in kids, weight gain, hyponatremia

takes 4-8 weeks to show effects, take in the morning, taper off, OTC meds for HA, don’t give w/ kids < 7 yrs, no MAOI’s, TCA’s, lithium, St. John’s wort, alcohol, or NSAID’s

selective norepinephrine reuptake inhibitors (SNRI’s): venlafaxine (Effexor)

(other meds: duloxetine, desvenlafaxine)

treats major depressive disorder, social anxiety disorder, panic disorder, neuropathic pain, and GAD, blocks reuptake of serotonin and norepinephrine w/o impact on other neurotransmitters, increases them, reduces depressive symptoms

side effects: sexual dysfunction, n/v, HTN, insomnia, serotonin syndrome, anorexia, hyponatremia, withdrawal potential, increased suicide risk for kids

taper off for 2-4 wks, take w/ food, don’t give w/ suicidal ideation, no MAOIs, St. John’s wort, alcohol, herbals, cimetidine, or grapefruit juice

monoamine oxidase inhibitors (MAOIs): phenelzine (Nardil)

(other meds: tranylcypromine, isocarboxazid, selegiline)

treats major depression (last resort), non-selective, blocks MAOI-A and B increases serotonin, norepinephrine, tyramine, and dopamine, reduces depression symptoms

side effects: insomnia, agitation, HTN crisis, HA, anticholinergic effects, orthostatic hypotension, dizziness, serotonin syndrome, n/v, peripheral edema, constipation, weight gain, increased suicidal ideation in kids

take in the morning, don’t give w/ suicidal ideation, renal/heptaic failure, > 60 or < 6 yrs, and glaucoma, takes 2 wks to get out of system, no tyramine (chocolate, red wine, aged cheese), SSRI’s, TCA’s, OTC meds, antihypertensives, or meperidine

atypical antidepressants: bupropion HCl (Wellbutrin)

treats depression, seasonal affective disorder, and helps w/ smoking cessation, weakly inhibits dopamine and norepinephrine

side effects: increased seizure risk, insomnia, HA, weight loss, n/v, tremors, agitation, psychosis, hallucinations, increased suicidal ideation in kids

take w/ food and as prescribed, no MAOI’s or alcohol, don’t give w/ anorexia/bulimia, head trauma, CNS tumor, or seizures

mood stabilizers: lithium carbonate (Lithobid)

controls acute mania and manic episodes associated w/ bipolar (first line), changes sodium transport and metabolism of catecholamines, decreases mania

side effects: weight gain, polyuria, n/v, arrhythmias, hypothyroid, polydipsia, fine motor tremors, transient fatigue, HA, confusion, kidney damage

takes 2 wks to show effects, narrow therapeutic range = 0.6-1.2 mEq/L, take w/ food or milk, maintain sodium, avoid caffeine, don’t give w/ CV disorders, dehydration, and hx of angioedema, draw lithium levels in the morning, drink 2-3 L of fluid/day, teratogenic, several toxicity risks, cross-reference!

traditional/typical antipsychotics: chlorpromazine (Thorazine)

(other meds: haloperidol, fluphenazine)

treats psychosis and schizophrenia (hallucinations, delusions, and disorganization), blocks norepinephrine, acetylcholine, dopamine, and histamine receptors, targets positive symptoms only

side effects: EPS, NMS, sedation, anticholinergic effects, sexual issues, dysrhythmias, dermatitis, photosensitivity, QT prolongation

monitor bowels and vitals, wear gloves, mouth checks, benzos for anxiety, fluids/fiber/fitness, report fever, teratogenic, don’t give w/ alcohol withdrawal or bone marrow suppression, no CNS depressants, antacids, antidiarrheals, or antiseizure meds

non-traditional/atypical antipsychotics (2nd gen): risperidone (Risperdal)

(other meds: clozapine, olanzapine, aripirazole, quetiapine, ziprasidone)

treats psychosis, schizophrenia (hallucinations, delusions, and disorganization) and bipolar, more strongly blocks dopamine and serotonin, fewer EPS symptoms and adverse effects, targets negative and positive symptoms

side effects: EPS, weight gain, hyperglycemia, hyperlipidemia, sedation, anticholinergic effects, agranulocytosis, NMS, QT prolongation, dizziness, constipation, heat stroke

monitor for sore throat or fever, fall precautions, mix w/ milk/juice/water, don’t drive, fiber/fluids/fitness, low carb and fat diet, don’t give w/ kids < 13, Parkinson’s, or demenia (black box), no antihypertensives, several med interactions

combination therapy oral contraceptives (E+P): ethinyl estradiol and drospirenone (Yasmin)

used for oral contraception, menstrual regulation, hormone HA’s, reduces uterine/ovarian cancer, PID, benign breast disease, and ovarian cysts, stops thickening of uterine wall to prevent implantation

side effects: thromboembolism, hyperkalemia, hypotension (rare)

report calf tenderness (DVT), SOB (PE), chest pain (MI), and stroke s/sx, don’t give w/ hx of blood clots, breast cancer, altered liver fx, or over 35 and a smoker, don’t smoke, careful w/ HTN, get mammograms, take at same time, no St. John’s wort, miss 1 = take 2, miss 2 = take 2 for 2 days, miss 3 = start over in 7 days

estrogen hormone replacement therapy (HRT): conjugated equine estrogen (Premarin)

used to supplement/substitute estrogen in pre/perimenopausal women, smaller amounts relieve menopausal symptoms and prevent postmenopausal osteoporosis, binds to estrogen receptors and maintains/promotes feminization

side effects: n/v, thromboembolic events, HTN, endometria hyperplasia, ovarian cancer

effects diminish over time, no more than 3-4 yrs, yearly pelvic exam, monitor uterine bleeding, take w/ food, don’t smoke, stop 4 wks before surgery, topical at night, don’t give w/ hx of blood clots, feminine cancer, liver disease, or undiagnosed vaginal bleeding, no warfarin, careful w/ gallbladder disease

estrogen + progesterone hormone replacement therapy (HRT): conjugated equine estrogen + medroxyprogesterone (Prempro)

used to supplement/substitute estrogen in pre/perimenopausal women, smaller amounts relieve menopausal symptoms and prevent postmenopausal osteoporosis, binds to estrogen receptors and maintains/promotes feminization, suppresses tissue growth in uterus, better for women w/ their uterus still

side effects: thromboembolic events, HTN, breast cancer, n/v, edema, breakthrough bleeding

effects diminish over time, no more than 3-4 yrs, yearly pelvic exam, monitor uterine bleeding, take w/ food, don’t smoke, stop 4 wks before surgery, topical at night, don’t give w/ hx of blood clots, feminine cancer, liver disease, or undiagnosed vaginal bleeding, no warfarin, careful w/ gallbladder disease

GnRH agonists: leuprolide (Lupron)

treats endometriosis, uterine fibroids, and advanced prostate cancer, increases estrogen and progesterone from pituitary gland, body fooled into believing its in menopause, overgrown tissue shrinks and relieves symptoms

side effects: vasomotor symptoms (hot flashes), bone loss, vaginal dryness, HA, typical menopause s/sx

only take for 6 mths, lubricants, weight-bearing exercise, OTC analgesics, teratogenic, careful w/ osteoporosis or older age, no SSRI’s or bupropion

progesterone: medroxyprogesterone acetate (Provera)

used as contraceptive, protective from uterine cancer on HRT, endometriosis, and palliative care, antagonizes estrogen-influenced tissue growth in uterine

side effects: thromboembolic events, breast cancer, breakthrough bleeding, n/v, edema

monitor weight, breast self exams, give w/ food, teratogenic, don’t give w/ hx or high risk of TE’s, undiagnosed vaginal bleeding, or feminine cancers, no rifampin, St. John’s wort, dilantin

testosterone hormone replacement therapy: androderm (Delatestryl)

treats male hypogonadism, delayed puberty, and testicular function, illegally used to increase muscle mass, used for hypoactive sexual desire disorder and gender affirming, binds to receptor, produces androgenic/anabolic effects

side effects: virilization, growth of existing prostate cancer, edema, weight gain, gynecomastia, fetal demise risk, hepatotoxicity

stop therapy to reverse virilization, I&O’s and weight, x-rays for bone growth, report sexual fxn changes and breast enlargement, don’t give w/ BPH, breast cancer in males, HTN, and CV/hepatic/renal issues, using for athletic performance is illegal, reduces insulin needed, no anticoags or cyclosporin

5-alpha reductase inhibitor: finasteride (Propecia/Proscar)

treats urinary outflow disorders (esp. BPH) and male pattern hair loss, changes testosterone into 5-alpha DHT in prostate, regression of prostate tissue, reduces prostate cancer risk

side effects: reduced libido, seminal volume, and PSA levels, gynecomastia

monitor for breast enlargement, take w/ or w/o food, lifelong therapy, effects take 6-12 wks, can crush, regular prostate screenings, teratogenic, don’t give to female kids

alpha-adrenergic receptor agonists: tamsulosin (Flomax)

treats urinary outflow disorders esp. BPH, makes smooth muscle of prostate and outlet of bladder relax, increases urine flow, works only on the prostate gland

side effects: reduced seminal volume, HA, retrograde ejaculation, hypotension, dizziness, fainting

monitor BP, take same time each day, swallow whole (ER form), change positions slowly, lifelong therapy, don’t give w/ Viagra and to females or kids, hypotensives are additive, tagamet increases ortho hypo

PDE-5 inhibitor: sildenafil (Viagra)

treats erectile dysfunction, blocks PDE-5 (enzyme that ends erections), no effects if there’s no arousal, doesn’t effect libido

side effects: priapism, HA, hypotension, vision/hearing loss, fainting, dizziness

take 1 hr before sex, once daily, NEVER take w/ nitroglycerin (death risk), high fat foods delay effects, address priapism immediately, effects last 4 hrs, don’t give to kids, no grapefruit juice, BPH drugs, or rifampin, careful w/ CV issues

anticholinergics: oxybutynin (Ditropan)

treats overactive bladders and urinary incontinence, blocks muscarinic receptors in muscle that lines the bladder, relaxes bladder, contracts internal sphincter, makes urine stay in

side effects: dry mouth, constipation, dry eyes, blurry vision, dilated pupils, HA, dizziness, drowsiness, fever, heat exhaustion, urinary retention

monitor for UTI, give twice a day in ER tablet, OTC eye remedies, fluid/fiber/fitness, don’t give w/ angle-closure glaucoma, myasthenia gravis, GI/GU obstruction, or CV issues, no grapefruit juice, ketoconazole, itraconazole, dilantin, rifampin, or carbamazepine, careful w/ hiatal hernia and reflux

cholinergics: bethanechol (Urecholine)

treats urinary retention from delayed/absent bladder emptying (post-op or delivery) and bladders w/ lack of neurologic innervation (don’t sense fullness), can be PRN

activates muscarinic receptors in muscle that lines the bladder, contracts bladder, relaxes internal sphincter, makes urine come out

side effects: hypotension, bradycardia, increased gastric acid production, fecal incontinence, bronchoconstriction, dizziness, syncope

encourage fluids, fall risk, don’t drive, don’t give w/ hyperthyroidism, asthma, COPD, GI ulcers, GI/GU obstruction, or recent GI surgery, no cholinesterase inhibitors