Unit 3 Gold Standard Drugs

Flashcards summarizing key drugs and their classifications from Unit 3.

Albuterol (Proventil)

Adrenergic B2 agonist- SABA, acute exasperations, bronchodilator, COPD, asthma attacks- RESCUE

• complication: tachycardia, tremors, headache, hypokalemia

• precautions: tach arrythmias

• int: beta-blockers, MAOIs, TCAs

• onset: 5 min, peak: 30min, duration: 4-6hrs

Salmeterol (Serevent)

Adrenergic B2 agonist- LABA, bronchodilator, long-acting, take daily

• comp: tachycardia, tremors, headache, hypokalemia,

• precautions: tach arrythmias

• int:

• onset: beta-blockers, MAOIs, TCAs
  onset: 30-40 min, peak: 3-5 hrs, duration: 12 hrs

Beclomethasone (Beclovent)

Glucocorticoid- anti-inflam, inhaler/nasal spray, long term maintenance, scheduled prophylaxis, MAY TAKE UP TO 24HRS TO FEEL ANY EFFECT, 2-4 WKS FOR FULL EFFECT, TAPER OFF-AVOID REBOUND INFLAM,

• ADEs: oropharyngeal candidiasis (thrush), dysphonia, cough, adrenal suppressant

• Nursing considerations: rinse mouth after

Fluticasone/Salmeterol (Advair)

Corticosteroid & B2 adrenergic agonist- corticosteroid/LABA combo, asthma & COPD, decrease inflam, bronchodilation

• comp: throat irritation, oral candiasis, increased risk of pneumonia, CV effects

• precautions: hypersensitvity, primary treatment of acute symptoms

• int: diuretics, diabetes meds-increase glucose from steroids

Montelukast (Singulair)

Leukotriene receptor antagonist- suppress effects of leukotrienes, decrease airway edema & mucus, bronchodilation, chronic treatment of asthma, allergic rhinitis

• comp: (BLACK BOX-depression, suicidal- in kids), liver injury

• precautions: preg/lact, hepatic disease

• int: Warfarin, phenytoin

Ipratropium (Atrovent)

Anticholinergic- bronchodilation, relieves bronchospasm,

• ind: COPD, asthma

• comp: dry mouth, blurred vision, urinary retention (NOT good for BPH), constipation

• precautions: narrow-angle glaucoma, BPH, paralytic ileus

Diphenhydramine (Benadryl)

Antihistamine, H1 receptor antagonist- for allergies,

• ind: allergic rhinitis, conjunctivitis, urticaria, pruritis, motion sickness

• comp: sedation, dry mouth, blurred vision, constipation, urine retention

• precautions: preg, older adults, children (use on planes)

• int: CNS depressants

Cimetidine (Tagamet)

H2 receptor blocker- decrease acid secretions and H+ ions,

• Ind: ulcers, GERD, heartburn

• Comp: CNS effects, constipation, nausea, diarrhea, hepatoxicity

• Precautions: older adults, upper resp inf, COPD, immunosuppressed

• Int: antacids, smoking

*take separate from other meds by at least an hour

Aluminum hydroxide

Antacid- neutralize stomach acid

• Ind: PUD, GERD, prevent stress ulcers

• Comp: constipation, fluid reten, alkalosis, elec imhalances, diarrhea, magnesium toxicity, rebound acidity

• Precautions: GI perforation, ab pain-get checked up bc only masks symptoms

• Int: Warfarin, digoxin, tetracyclines

  decreased absorption of meds/make insoluble

  *Wait 1-2 hrs before admitting other meds

Metoclopramide (Reglan)

Cholinergic dopamine receptor antagonist- increase GI motility, decrease nausea

• Ind: GERD, gastroparesis, constipation

• Comp: sedation, extrapyrimidal symp, diarrhea

• Precautions: GI bleeds, seizures, kids & older adults

• Int: CNS depressants: benzos, alc, opiods= increase constipation

  *Parkinson’s symptoms-since dop antagonist

Omeprazole (Prilosec)

Proton pump inhibitor (PPI)- decreases stomach acid,

• Comp:

  • good choice short-term: headache, diarrhea, nausea, vomit

  • bad choice long-term: C.diff, osteoporosis, rebound reflux activity

• Precautions: children, dysphagia, liver disease

• Int: decreased absorption of oral meds

Ondansetron (Zofran)

Antiemetic- serotonin antagonist

• Ind: prevent nausea, vomit from chemo, post-op, radiation

• Comp: QT prolongation/arrythmias, cardiac precautions, headache, diarrhea, dizzy

• Int: CNS depressants, antihypertensives= hypotension

Methotrexate

Disease-modifying antirheumatic drug (DMARD)-

slows joint degeneration and progression of rheumatoid arthritis and symptoms

• Comp: increased risk of inf, *also chemo agent! usually, increased hepatic fibrosis, & toxicity, UC, GI ulcers

• Precautions: HIGHLY Teratogenic-use contraception, liver failure, AUD, PUD, UC, malnutrition, inf

• Int: NSAIDs, alc, vaccines, other immunosuppressants

  *periodic lab tests required

  *drink lots of fluids to flush out med

  *thrombocytopenia

  *use saline/saltwater rinse-prevent bleeding gums

Hydroxychloroquine

DMARD-antimalarial

• Comp: retinal issues-blurred/double vision, eye pain=irreversible damage, GI issues, heart conditions

• Precautions: pre-existing liver/kidney disease

• Int: antidiabetics, QT prolongation

Sulfasalazine

DMARD- anti-inflammatory

• Comp: GI discomfort, bone marrow suppression, hepatic dysfxn, dermatologic (fever, Steven-Johnson syndrome-rare)

• Precautions: sulfa allergy

• Int: antibiotics, Warfarin, folic acid

Colchicine

Antigout/anti-inflammatory- only effective w/ inflam in gout

• Comp: GI distress, thrombocytopenia, rhabdomyolysis

• Precautions: preg-benefit vs. risk, severe renal/heart/ GI/hepatic dysfxn, odler adults

• Int: grapefruit juice, statins

Allopurinol

Antigout- decrease uric acid lvls in blood and osteoclast activity

• Comp: hypersensitivity, kidney injury-*encourage oral intake of fluids, BUN, creatinine, hepatitis, GI distress

• Precautions: preg- Cat C

• Int: Warfarin

Belimumab

Monoclonal antibody- inhibits abnorm B-cell activity-suppress immune response, AI conditions

• Comp: increased risk of inf, infusion reactions, psych-depress, anx, insomnia, GI, nausea, diarrhea, vomit

• Precautions: preg cat C

• Int: immune suppressants, live vaccines

*won’t illicit a robust immune response=immunosuppressed

Prednisone

Glucocorticoid- anti-inflammatory

suppress AI attack, but decrease inflam

• increased risk of inf

• osteoporosis

• increased BGL

• elec imbalance

• Int: Li & digoxin

Calcium citrate

Ca supplement- hypercalcemia: tingly, tachycardia, lethargy, constipation

• Ind: osteoporosis, hypoparathyroidism

• Comp: vomitting

• Precautions: hypercalcemia, renal calculi, hypophosphatasemia, digoxin toxicity, v-fib

• Int: glucocorticoids, tetracyclines, thyroid hormone, thiazide diuretic, foods: spinach, rhubarb, beets, whole grains

Alendronate

Bisphosphonate- prophylaxis, slows progression, and treats osteoporosis, long-term steroid use, inhibits bone breakdown (osteoclasts)

• Comp: esophagitis (burns), GI disturbances (can’t keep food down), musculoskeletal pain -jaw, visual disturbances-blurry, pain,

• Precautions: preg-Class D-NO, dysphagia-esophageal, kidney impair, hypocalcemia

• Int: sitting upright inability

  *take 1st thing in the morn w/ glass of water on empty stomach

  *sit upright, no lying down!-esoph burns

Calcitonin-salmon

Calcium regulation- keeps Ca in bones maintain bone density, NASAL SPRAY or INJ

• Comp: nausea, nasal dryness & irritation,

• Precautions: preg Class C, fish protein allergy

• Int: Li

*prime pump first, 1 spray each nostril

*check for skin allergies

Whole blood

Blood product containing all components-

• Ind: acute blood loss, severe anemia, post-op, traumatic hemorrhage

• increase circulating blood volume, extensive burn injury, dehydration, shock

  *Need two nurse sign-off

Packed Red Blood Cells (PRBCs)

Concentrated RBCs- increase oxygen, carrying capacity

• Ind: used in anemia, kidney disease, acute/surgical blood loss, chemo

• restores mass without volume overload (CHF patients), bone marrow suppression

Platelet concentrate

Concentrated platelets- increase platelet count, stop bleeds

• Ind: thrombocytopenia, aplastic anemia, chemo, bone marrow suppression

Fresh frozen plasma (FFP)

Frozen plasma to preserve clotting factors- replace coag factors + albumin,

• Ind: dilution coagulopathy, liver disease-creates clot factors, excessive hemorrhage, extensive burns, shock

• INR too high- too much Warfarin

Apheresed granulocytes

Granulocytes- replace neutrophils/granulocytes

• Ind: extreme neutropenia, life threatening bacterial/fungal inf w/out antibiotic response, neonatal sepsis, neutrophil dysfxn, chemo

Albumin

Protein- increases BP by increasing oncotic pressure

• Ind: hypovolemia, extensive burns, hypoalbuminemia, third-spacing edema, resp distress, dehydration, shock

*consistency of egg whites, don’t shake=bubbles

*use albumin to pull H2O out of tissues, then diuretic to flush

*increase osmolality

Acyclovir (Zovirax)

Antiviral-

• Ind: HSV (cold sores, genital herpes), varicella (chicken pox), zoster (shingles), EBV (mono)

• Comp: Nephrotoxic, phlebitis, headache, nausea/diarrhea

• Precautions: preg, prevent spread (no kissing/use protection), caution in renal impairment

*receive sufficient fluid intake to combat diarrhea/nausea and for kidneys

*monitor flank pain, BUN, creatinine, urine color

Ganciclovir (Zirgan)

Antiviral-

• Ind: treat & prevent CMV, HIV, AIDS, immunosuppressed, organ transplants

• Comp: suppressed bone marrow, fever, headache, nausea/diarrhea- give w/ food

• Precautions: pregnant-NO=infertility, elderly/ kids

• Int: cytotoxic meds (chemo)

Emtricitabine/Tenofovir (Truvada)

Antiretroviral- combo drug to treat & prevent HIV

• Ind: HIV treat, PREP, PEP, decrease risk of transmission to others, prevent from progressing to AIDS

• Comp: GI symp, bone density loss (bone fractures), skin effects (rash, blister)

• Precautions: preg can take-need to be registered in system, safe sex practices

• Int: valproic acid, phenytoin (monitor for good seizure coverage)

raltegravir (Isentress)

Antiretroviral: 1st line treatment,

• Ind: treats HIV, resistant to other HIV meds; must take in combo w other HIV med

• Comp: GI upset, CNS-dizzy, headache, sleep difficulty, skin rash (Steven-Johnson), liver inj, renal failure, suicidal ideation

• Precautions: mild-mod hepatic disorders, not for <16y.o.

Int: Rifampin

Isoniazid (INH)

Antitubercular-

• Ind: prevent & treat TBl

  • latent- 1x daily for 9mo

  • active-w/ Rifampin 1x weekly for 3 mo

• Comp: hepatotoxic, peripheral neuropathy

• Precautions: preg/lact, liver disease, elderly, DM, AUD

• Int: phynytoin, tyramines, alc-NO, Rifampin

  *supplement w Vit B6-pyroxidine for periph neurop

Rifampin (Rifadin)

Antitubercular-

• Ind: prevent & treat TB- 1x weekly for 3 mo

• Comp: hepatotoxic, orange discoloration of body fluids, GI distress, C.diff

• Precautions: preg/lact, liver dysfxn

• Int: Warfarin, oral contraceptives, HIV meds, alc-NO

*monitor PT & INR

Ciprofloxacin (Cipro)

Fluoroquinolone/broad spectrum-

• Ind: resp inf, UTI, GI inf, bone & joint inf

• Comp: GI distress, tendon rupture, CNS effects(seizures), phototoxic, superinfections (yeast inf, C.diff), QT prolongation

• Precautions: preg/lact, children, older adults

• Int: milk products, Ca supplement, Warfarin, ondansetron(QT),

  *yellow teeth in children & fetus

Trimethoprim-Sulfa (Bactrim)

Sulfonamide antibiotic- Broad spectrum

• Ind: UTI, otitis media (ear inf), pneumonia

• Comp: hypersensitivity, hematologic effects, renal effects, kernicterus (high bilirubin), hyperkalemia

• Precautions: preg/lact-NO, kidney impair, allergies to sulfonamides, thiazides, hypoglycemia, furosemide

• Int: Warfarin, phenytoin, oral sulfonylureas, hypoglycemics, ACE inhibitors, ARBs

Amoxicillin (Amoxil)

Aminopenicillin antibiotic-

• Ind: strep, staph, pneumonia, meningitis, endocarditis, ENT inf, UTI, STI, H.pylori

• Comp: allergic reactions, GI distress, Renal impairment, elec imbalances-arrythmias

• Precautions: preg/lact, hx of allergy, kidney dysfxn

• Int: birth control, aminoglycosides

  *monitro Is & Os, BUN, creatinine

  *antibiotic will inactivate aminoglycosides- use a different IV line

  *likely to be cross sensitive w/ cephalosporins!-monitor allergies!! Blake

Vancomycin

Glycopeptide antibiotic- SEVERE/RESISTANT INF, VESICANT

• Ind: MRSA, C.diff, strep, surgical prophylaxis

• Comp: nephrotoxicity, narrow therapeutic range, ototoxicity(rapid IV infusion), “Red man syndrome” (histamine/infusion reaction), thrombophlebitis @ IV site

• Precautions: elderly, renal impaired, hearing loss

• Int: loop diuretics, aminoglycosides

Ceftriaxone (Rocephin)

cephalosporin antibiotic-

• Ind: gonorrhea, meningitis, pneumonia, bronchitis, cellulitis, UTI

• Comp: allergic reaction, bleeding tendencies, renal impairment, C.diff

• Precautions: preg/lact, hx of allergy to penicillins, renal impairment, bleeding disorder

• Int: alcohol, disulf reaction, anticoagulants

  *likely to be cross sensitive w/ beta lactams (penicillins)! -monitor allergies!!

  *prevent secondary inf, like C.diff, by probiotics to increase natural gut flora

Doxycycline (doxycin)

A tetracycline antibiotic- Broad spectrum

• Ind: resp inf, acne, rosacea, STI, lyme disease, Rickett’s, UTI, H. pylori

• Comp: GI distress, photosensitivity, dental discoloration, hepatotoxicity

• Precautions: preg/lact-NO, kids <8, liver & kidney disease

• Int: milk/Ca, digoxin-diarrhea, blurred vision

Nystatin (mycostatin)

Antifungal- SUPERFICIAL SKIN INFECTION

• Ind: treatment & prophylaxis

• Comp: GI issues, local irritation (itch, rash)

• Precautions: proper admin *clean, dry, x times /day, oral, topical, intravag, swish & spot

  *monitor for superinfection

Amphotericin-B (Fungazone)

Antifungal- SEVERE, SYSTEMIC

• Ind: invasive candidiasis, invasive aspergillosis, cryptococcal meningitis, fungal inf in neutropenic patients

• Comp: hypokalemia, infusion related reaction, bone marrow suppression

• Precautions: preg/lact, kidney fxn, anemia, elec imbalance, blood dyscrasias

• Int: aminoglycosides

gentamicin (Garamycin)

Aminoglycoside antibiotic- Gram -

• Ind: E.coli, K. pneumonia, pseudomonas aeruginosa, tularemia, plague, brucellosis, TB, sepsis

• Comp: Nephrotoxicity, ototoxicity, neuromuscular blockade-rare(resp paralysis-M. gravis, muscle relaxants)

• Precautions: preg/lact, kidney impairment, hearing loss, myasthenia gravis

• Int: penicillin (DO NOT ADMIN IN SAME LINE), loop diuretics (ototoxic), skeletal muscle relaxants

metronidazole (Flagyl)

Nitrometronidazole, anti-infective-

• Ind: anaerobic inf, protozoal inf, abdominal inf=H. pylori, C.diff

• Comp: GI distress, CNS effects, dark urine

• Precautions: preg/lact, renal/hepatic impairment, seizures/neuro

• Int: alc, Warfarin, phenytoin, Li

methotrexate (Rasuvo)

Antimetabolite/ chemo- oral, IV, IM, intrathecal

• Ind: (increased dose for chemo use than RA), leukemia, lymphoma, breast, colorectal

• Comp: bone marrow, GI discomfort, reproductive toxicity, renal damage

• Precautions: renal/hepatic failure, blood dyscrasias, GI ulcers, elderly

• Int: NSAIDS, sulfonamides, penicillin, PPI

*methotrexate toxicity-renal/hepatic failure

doxorubicin

Antitumor cytotoxic chemo agent- “Red Devil”

• Ind: breast, ovarian, bladder, lung, leukemia, lymphoma

• Comp: bone marrow suppression, cardiac, severe tissue damage, alopecia, red urine & sweat, GI

• Precautions: preg/lact, sever myelosuppression

• Int: CCBs, phenytoin, live virus

Vincristine

Antimitotic chemo agent-

• Ind: lymphoma, neuroblastoma, sarcoma, leukemia

• Comp: nerve inj/periph neurop, sever tissue damage, alopecia

• Precautions: preg/lact, radiation, liver/neuromuscular disease

• Int: digoxin, phenytoin, live virus

  *monitor peripheral injuries-might not be able to feel them

Cyclophosphamide

Alkylating chemo-

• Ind: ovaries, breast, blood and lymph system, nerves & retinoblastoma (mainly in children), myeloma

• Comp: bone marrow suppression, GI, alopecia, acute hemorrhagic cystitis, sterility

• Precautions: preg/lact, myelosuppression, severe inf

• Int: succinychide-neuromuscular blockage

Topotecan

Topoisomerase inhibitor- IV

• Ind: metastatic ovarian, cervical, colorectal, small cell lung

• Comp: bone marrow suppression, GI distress, alopecia

• Precautions: preg/lact, severe myelosuppression, impaired renal fxn

• Int: live virus

Tamoxifen

Hormonal agent-

• *MOA: estrogen receptor modulator, specifically for breast cancer- blocks stimulation of estrogen on cancer cell growth

• Ind: HR+ breast cancer

• Comp: hypercalcemia, DVT, PE, strokes, endometrial cancer, hot flashes, vag discharge/bleeding, nausea, vomiting

• Precautions: preg, hx of blood clots/PE

• Int: Warfarin, SSRIs-antidepressants

Cetuximab

Antineoplastic-

• Ind: ONLY EGFR+ cancers, colorectal, solid tumors of neck & head

• Comp: infusion reaction(rash, hypotension, wheezing), PE, skin toxicity (rash)

• Precautions: preg/lact, hypersensitivity

• Int: sun exposure

Echinacea

Complementary/alternative medicine used to boost the immune system.

Ginger root

Herbal remedy thought to alleviate nausea.

Ginkgo biloba

Herbal supplement claimed to improve cognitive function.

St. John’s wort

Herbal treatment commonly used for depression.

Valeria

Herbal supplement used for anxiety and sleep disorders.

Cannabis

Plant used for therapeutic and recreational purposes.