Drug study guide

Adverse drug reactions

An unwanted negative response, predictable or unpredictable, to any med given for therapeutic, diagnostic or prophylactic reasons

Central venous access device (CVAD)

Devices that are inserted into the body through a vein to enable to admin of fluids, blood products, meds and other therapies to the bloodstream. These devices are inserted into the subclavian or jugular vein and can be accessed and deaccessed. An example = port-a-cath

Extravasation

Unintentional or inadvertent administration of a vesicant solution or medication into tissue surrounding the IV catheter

Infiltration

Inadvertent administration of a non-vesicant solution or medication into the tissue surrounding the IV catheter

Peak & Trough

Used to monitor drug levels to avoid toxicity and ensure correct dosing

Preload and afterload

Preload = amount of blood already in your ventricles when the heart is ready to pump it out

Afterload = pressure against which your heart has to pump the blood

Inotropes

ex. Dobutamine, Dopamine, Digoxin

Uses: Increases contractility, makes heart contractions stronger, increase CO and increase amount of blood heart can pump out to organs

Side effects: arrythmias, angina, acute MI, N/V, tachyarrhythmias, cardiac ischemia, extravasation, tissue necrosis, h/a, leg cramps, fever

Nursing implications: monitor BP, HR, ECG, pulmonary capillary wedge pressure, CO, CVP, UO continuously during admin. Report sig changes in VS or arrythmias

Anti-arrhythmics

ex. amiodarone, lidocaine, verapamil, propranolol, procainamide, adenosine (SVT)

Uses: prophylactic and therapeutic for atrial and ventricular arrythmias/irritability; works to correct and/or restore heart 2 a normal rhythm

Side effects: hypotension, dizziness, visual disturbances, h/a, confusion, GI symptoms, tiredness, further cardiac symptoms

Nursing implications: close monitoring of apical pulse, BP and EKG for life threatening adverse reactions. Be aware of interactions and s/s of toxicity

Vasodilators

ex. nitroglycerin, nitroprusside, nitro-bid, isordil

Uses: angina, acute decompensated HF, HTN

Side effects: h/a, hypotension, flushing

Nursing implications: monitor for nitroprusside toxcicity

Beta-blockers

ex. atenolol (tenormin), metoprolol (lopressor), propranolol (inderal), labetalol, esmolol

Uses: decrease workload of heart, decrease angina, to slow or convert SVT, emergency antihypertensive therapy

Side effects: bradycardia, depression, constipation, dyspnea, pruritus, bronchospasm

Nursing implications: use w/ caution or avoid w/ bronchospastic disease, CHF, or severe decreased cardiac function. Monitor cardiac and resp function, may cause myocardial depression. CI w/ HR < 60 or SBP < 100. Decrease protein oxidation leads to lower BMR and wt. gain. Should be considered in all pt. post AMI/ACS

ACE inhibitors

ex. enalapril, captopril, lisinopril

Uses: reduce morbidity and mortality post MI, delay progression of HF, antihypertensive

Side effects: cough, dizziness, edema, flushing, h/a

Nursing implications: reduce dose in renal dysfunction, avoid hypotension, watch for angioedema, hypotension or exacerbation of angina @ beginning of treatment. Should be considered w/in first 24hr post AMI/ACS

NSAIDs

ex. aspirin, ibuprofen (advil, motrin), naproxen (aleve), ketorolac fo rmoderate-severe pain is only given for a short term (5 days or less)

Uses: relief of mild to moderate pain, antipyretic, decrease inflammation and risk of thrombosis, treatment for arthritis and rheumatoid arthritis

Side effects: GI upset, n/v, bleeding, tinnitus or impaired hearing may indicate toxicity

Nursing implications: administer w/ food or milk, do not use for kids w/ chicken pox or flu (aspirin linked 2 Reyes’ syndrome). Teach side effects, avoid if pt. is bleeding, has blood-clotting disorder, ulcers or kidney disease. Don’t use ketorolac if taking ibuprofen, aspirin, naproxen, acetaminophen, other NSAIDs and after heart bypass or CABG. Avoid alcohol

Acetaminophen

Uses: relief of mild to moderate pain, antipyretic

Side effects: rash, itching, hypothermia, overdose can cause loss of appetite, dark urine, jaundice, liver damage or death.

Nursing implications: liver function tests and renal function should be monitored w/ long-term use. Max daily dose of 4,000 mg

Narcotic analgesic

ex. morphine,, dilaudid, percocet (oxycodone, oxycontin), tylenol #3 & #4, lortab, Norco, vicodin (acetaminophen and hydrocodone)

Uses: treat moderate to severe pain

Side effects: n/v, constipation (decreased gastric motility), dizzy and drowsy

SEVERE SIDE EFFECTS: respiratory depression, addiction, dependence, hallucinations, bradycardia, hypotension

Nursing implications: monitor for respiratory depression, orthostatic hypotension; pain is more efectively controlled when med is given around the clokc 2 limit intense pain. Alternate w/ non-narcotics. Follow-up pain assessment in 30 minute after IV dose, 1hr after PO, DOCUMENT.

Instruct pt. 2 stop lortab right away if they experience skin redness, rash, blistering, peeling or if they’ve taken MAOIs in the last 2wks and avoid alcohol.

discarding an unused dose must be verified by a witness and charted.s

Skeletal muscle relaxant

ex. bacolfen, gabapentin, ropinirole, pramipexole

Uses: help relax certain muscles in body, relieves spasms, cramping and tightness, of muscles caused by medical problems. Including MS or certain injuries to the spine.

Side effects: sleepy, tired, dizzy, n/v, h/a, dry mouth, sleeping problems, rapid eye movements, blurred vision, difficulty focusing, excessive sweating or a mild rash

Nursing implications: can interact w/ other meds and substances that slow down brain activity. Includes alcohol, benzos, and opioids. Can interact w/ sleep meds and barbiturates

Heparin (unfractioned)

Action: inhibits thrombin generation

Use: adjuvant in AMI thrombus prevention, DVT stabilization

Nursing implications: immediate onset, protamine is used for reversal, watch for low platelets

LMWH

ex. Fragmin, Lovenox

Action: inhibit thrombin generation

Use: acute coronary syndrome, DVT stabilization, thrombus prevention, PE, TIA

Nursing implications: Onset @ 20-30min, CI in pork sensitivity, previous intracranial hemorrhage, and neuraxial anesthesia. Prolonged half-life in renal failure, increased bleeding risk when given w/ NSAIDs

Coumadin

Action: anticoagulant, interferes w/ vitamin K’s role in clotting process

Use: thrombus prevention, s/p MI, valve replacement, PCI and afib, DVT prophylaxis

Nursing implications: monitor INR >2 and < 3 for VTE and higher w/ heart valves. Dosing affected by illness, diet, meds, CI in pregnancy. Vitamin k for reversal

Rivaroxaban, Apixaban

Action: inhibits platelet activation and fibrin clot formation

Use: Afib (nonvalvular), stable CAD, stable PVD, and VTE

Nursing implications: CBC and renal function prior 2 starting meds, monitor hepative function and for s/s of bleeding. ANDEXXA used for reversal.

Ticlid

Action: inhibit platelet aggregation, antiplatelet action

Uses: prevent thrombus, s/p CABG, PCI, CVA

Nursing implications: monitor for neutropenia, TTP and aplastic anemia, monitor LFTs

Plavix

Action: blood modifier, inhibits platelet aggregation

Uses: thrombus prophylaxis w/ MI, PAD, CVA and PCI

Nursing implications: use w/ caution in hepatic and renal dysfunction. Not to be used w/ aspirin.

Persantine

Action: inhibit platelet aggregation

Uses: thrombus prophylaxis, s/p valve replacement, myocardial imaging

Nursing consideration: bronchospasm and hypotenion

ASA

Action: inhibits platelet aggregation by blocking thromboxane A2

Uses: thrombus prevention, adjuvant in AMI and ACS

Nursing implications: admin w/ food if cause discomfort, co-admin w/ a PPI

Streptokinase

Action: results in cascade that leads 2 lysis of fibrin clots. Causes thrombolytic state that usually resolves w/in 48hr of admin

Uses: acute ST-segment elevation MI, arterial thrombosis or embolism, DVT, PE and arteriovenous cannula occlusion

Nursing implication: more likely to cause an allergic reaction (fever, shivering or rash)

Fibrinolytics

ex. activase, tPA, eminase, retavase, TNKase

Action: thrombolytic enzyme, tissue plasminogen activator

Uses: AMI, acute ischemic stroke

Nursing implications: thorough assessment b4 admin, make sure no CI (recent surgery, hx of brain bleed, uncontrolled HTN, bleeding disorders), only activase is approved for CVA

Glygoprotein IIb/IIIb inhibitors

Action: inhibits integrin glycoprotein IIb/IIIb receptors in platelet membrane to inhibit platelet aggregation

Uses: non-Q-wave MI, unstable angina pectoris

Nursing considerations: used often w/ heparin, platelet functions recover after use

Corticosteroids

ex. hydrocortisone, prednisone, Decadron, Solumedrol

Uses: reduce inflammation, immunosuppression, adrenal insufficiency, rheumatoid arthritis, Covid-19 treatment, COPD

Side effects: hyperglycemia (long-term), increased appetite, GI irritation, mood swings, euphoria, insomnia, impair wound healing

Nursing considerations: unless CI give PO dose after meals 2 reduce GI irritation

Bronchodilators

ex. albuterol, metaproterenol, xopenex, maxair, theophylline

Use: open breathing passages in episodes of reversible airway obstruction (asthma attack or complications from COPD)

Side effects: chest pain, palpitations, n/v, feelings of nervousness, anxiety, tremor, h/a

Nursing implications: monitor VS, edu on side effects and inform nurse if they occur (notify MD)

Anti-infectives

ex. penicillin, cephalosporin, aminoglycoside, sulfonamide, tetracycline

Uses: treat infections of susceptible organisms

Side effects: skin rash, hives, anaphylaxis, diarrhea, toxicity, hypersensitivity, and cross-sensitivities

Nursing implications: watch for allergic reactions, ask about previous allergic reactions; determine if culture and sensitivity has been ordered; watch 4 superinfection, therapy should be carried out for prescribe amount of time

Tetracycline: admin 1hr ac or 2hr pc; do not admin dairy products or antacids bc neutralize the drug, may discolor teeth in kids, yeast super-infections common

Antimicrobials (aminoglycosides)

ex. gentamycin sulfate, garamycin, gentafair

Uses: serious infections caused by sensitive strains or Pseudomonas Aeruginosa Staphylococcus

Side effects: h/a, lethargy, ototoxicity (tinnitus, vertigo, hearing loss, acoustic nerve damage), increased BUN, non-protein nitrogen and serum creatinine

Nursing implications: use cautiously in neonates, infants, elderly pt. w/ impaired renal function, obtain specimen for culture and sensitivity before admin, watch for superinfection

MAOIs

ex. phenelzine, selegiline, tranylcypromine

Action: block monoamine oxidase

Use: treatment resistant depression

Nursing implications: dietary restriction of foods high in tyramine to prevent hypertensive crisis

NRIs

ex. atomoxetine

Action: selectively inhibits the presynaptic transporter of norepinephrine

Use: depression, ADHD

Nursing implications: monitor BP and pulse. Assess for signs of liver injury.

SSRIs

ex. citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

Action: inhibit neuronal uptake of serotonin in the CNS and thus increase serotonin activity

Use: major depressive disorders, panic disorders, OCD, PTSD

Nursing implications: assess for suicidal tendency, may increase risk of diabetes, abnormal bleeding and bone loss

SNRIs

ex. desvenlafaxine, duloxetine, levomilnacipran, milnacipran, venlafaxine

Action: block presynaptic serotonin and norepinephrine transporter proteins

Use: depression, anxiety, OCD, PTSD

Nursing implications: administer w/ food to reduce nausea, monitor BP, may increase risk of bleeding and hyponatremia

Bupropion (atypical antidepressant)

Action: decreases neuronal reuptake of dopamine in the CNS

Use: depression, smoking cessation

Nursing consideration: monitor mood changes, monitor hepatic and renal function

Mirtazapine (atypical antidepressant)

Action: potentiates the effects of norepinephrine and serotonin

Use: depression

Nursing consideration: monitor for changes in behavior, assess for serotonin syndrome

Lorazepam (anticonvulsant)

Action: depress the CNS

Use: seizures

Nursing considerations: assess characteristics of seizures

Phenobarbital (anticonvulsant)

Action: CNS depression

Use: seizures

Nursing considerations: monitor BP, pulse, respiration, assess for s/s of angioedema

Phenytoin (anticonvulsant)

Action: alter ion transport and may decrease synaptic transmission

Use: grand mal seizures, complex partial seizures

Nursing implications: monitor for behavioral changes, assess oral hygien and phenytoin hypersensitivity syndrome, monitor CBC, serum calcium, albumin and hepatic function

Tegretol (anticonvulsant)

Action: decreases synaptic transmission in the CNS by affecting the sodium channels in the neurons

Use: seizures

Nursing considerations: monitor CBC assess for changes in mood and skin condition

Lithium (antimanic)

Action: stimulates inhibitory neurotransmission and inhibits excitatory transmission

Use: bipolar disorder

Nursing implications: administer w/ meals, monitor lithium levels, assess for toxicity and change in mood.

Diuretics

ex. lasix, chlorothiazide (diuril), hygroton, diamox

Use: BP reduction in HTN, decrease edema in CHF, decrease IOP in glaucoma

Side effects: weakness, dehydration, orthostatic hypotension, hypokalemia, fluid and electrolyte imbalances (side effects vary w/ drug)

Nursing implications: take early to prevent nocturia, monitor I&O, electrolytes, wt., and observe for dehydration

Rapid acting - Insulin Lispro (humalog)

• Starts working in 5-15minutes

• Peak in 1-3 hours

• Lowers blood glucose most in 45-90minutes

• Finishes working in 3-4(5) hours

Rapid acting - Insulin Aspart (Novolog)

• Starts working in 10-20 minutes (5-15min)

• Lowers glucose most in 1-3 hours

• Finishes working in 3-5 hours

Short-acting - Regular (R) insulin

• Starts working in 30 minutes

• Lowers blood glucose in 2-5 (4) hours

• Finishes working in 5-8 hours

Intermediate-acting - NPH (N) or Lente (L) insulin

• Starts working in 1-3 hours

• Peak 4-8 hours

• Lowers blood glucose most in 6-12 hours

• Finishes working in 16-24 hours

Long acting - Ultralente (U) insulin

• Starts working in 4-6 hours

• Lowers blood glucose most in 8-20 hours

• Finishes working in 24-28 hours

Very long-acting - Insulin glargine (Lantus)

• Starts working in 1 hour

• Lowers blood glucose evenly for 24 hours

• Finishes working in 24 hours and is taken once a day at bedtime

• Should not be mixed together in a syringe w/ any other form of insulin

Premixed insulin

• NPH and regular insulin mixture

• Two types of insulins mixed together in one bottle

• starts working in 30 minutes

• Lowers blood sugar most in 7-12 hours

• Finishes working in 16-24 hours

Insulin Sensitizers (Biguanides, TZDs)

ex. Glucophage, avandia, actos

Side effects: anemia, edema, h/a, URI, wt. gain

Nursing Implications: Use w/ caution impaired liver function, CI with advanced CHF, can be potentiated by beta adrenergic blockers, St. John’s wort, cimetidine, ranitidine

Beta-cell stimulators (sulfonyreas)

ex. prandin, starlix

Side effects: arthralgia, diarrhea, hypoglycemia, URI

Nursing implications: Use w/ caution w/ impaired renal or lever function, not for use in type I DM, CI during stress of infection or surgery (as is glucophage)

Alpha glucosidase inhibitors

ex. glyset, precose

Action: to slow down carbohydrate transport into the blood for use

Side effects: abdominal discomfort, flatulence, URI

Nursing implications: use w/ caution in pt. w/ renal and liver dysfunction, CI in GI dysfunction - malabsorption, excess gas, inflammation, treat hypoglycemia w/ glucose not sucrose. Interacts w/ beta adrenergic blocking agents and MAOIs

Ginkgo Biloba

Benefits: decrease pain of claudication, improve memory

Adverse reactions: bleeding, inhibits platelet aggregation

Drug interactions: potentiates ASA, coumadin, ticlid, plavix, persantine

Ginseng

Benefits: stimulant, improve sex drive

Adverse reactions: hypoglycemia

Drug interactions: antihyperglycemics, coumadin

Ephedra

Benefits: wt. loss, improve performance, CNS stimulant

Adverse reactions: cardiac problems, with increased doses - palpitations

Drug interactions: MAO inhibitors

Kava

Benefits: relaxation, sleep aid

Adverse reactions: liver damage, extrapyramidal effects

Drug interactions: benzodiazepines, antipsychotics, barbiturates, cemitidine, hytrin

Saw Palmetto

Benefits: treat BPH

Adverse reactions: GI symptoms, maybe HTN

Drug interactions: endocrine or alpha-adrenergic blocking effect

St. John’s wort

Benefits: treat mild depression

Adverse reactions: Gi distress, photosensitivity, dizziness, dry mouth

Drug interactions: antidepressants, MAOIs, decreases the effect of anticoagulants

Echinacea

Benefits: immunostimulant

Adverse reactions: liver damage w/ prolonged use, not for use during pregnancy

Drug interactions: suppresses the effect of immunosuppressants and corticosteroids

Comfrey

Benefits: topical-wound healing, tea - soothe stomach

Adverse reactions: liver damage, can be poisonous

Drug interactions: drugs that can be hepatotoxic

Dong Quai

Benefits: for menstrual cramps

Adverse reactions: relaxes the uterus, not used during pregnancy

Feverfew

Benefits: regulate menstrual flow, prevent migraines

Adverse reactions: may cause miscarriage, transferred to breast milk

Licorice

Benefits: coughs and colds

Adverse reactions: HA, lethargy, HTN, K excretion, Na and water retention

Drug interactions: infants and children should not consume licorice

Garlic

Benefits: prevention of atherosclerosis

Adverse reactions: bleeding

Drug interactions: potentiates ASA, coumadin, ticlid, plavix, persantine

Senna

Benefits: laxative

Adverse reactions: chronic use causes low K and dehydration

Sassafras

Benefits: stimulant, antispasmodic

Adverse reactions: carcinogenic in rats and mice