EXAM 2 PROTOTYPES

Diphenhydramine: therapeutic class

drug to treat allergies

Diphenhydramine: pharmacologic class

H1 receptor inverse agonist, antihistamine

Diphenhydramine: action

1st generation H1 antagonist (more side effects)

Diphenhydramine: uses

• minor symptoms of allergy and common cold

• found in combo with decongestant/analgesic/expectorant formulations sold OTC for cold and flu products

• used in hospital setting as a premedication for blood transfusions, certain meds, and chemotherapy

Diphenhydramine: adverse effects

• significant drowsiness, although usually diminishes with long term use

• can cause paradoxical CNS excitation in children

• anticholinergic effects (dry mouth, tachycardia, mild hypotension in some patients)

Diphenhydramine: contraindications

• don’t use in benign prostatic hyperplasia

• narrow-angle glaucoma

• GI obstruction

• use cautiously in asthma and other CNS depressants

Loratadine: therapeutic class

drug to treat allergies

Loratadine: pharmacologic class

H1 receptor inverse agonist, antihistamine

Loratadine: action

2nd generation H1 antagonist (less side effects)

Loratadine: uses

treat minor symptoms of allergy (pruritus, watery eyes, runny nose, and sneezing)

Loratadine: adverse effects

• usually does not cause drowsiness

• can cause headache, dizziness, and GI distress

Loratadine: nursing considerations

• teach how to take

• overdose can lead to toxicity, which includes cardiac, renal, and hepatic problems

Loratadine: contraindications

don’t use in children under 2

Fluticasone: therapeutic class

drug for allergy rhinitis, asthma, and skin inflammation

Fluticasone: pharmacologic class

corticosteroid

Fluticasone: uses

• reduces stuffiness

• some new formulations that combine an antihistamine with a corticosteroid in a nasal spray (Dymista)

Fluticasone: adverse effects

rare

Fluticasone: side effects

nasal irritation and epistaxis

Fluticasone: nursing considerations

• not for immediate relief (onset 12 hours, take 1-3 weeks for full effect)

• 2 sprays in each nostril 2 times a day, then decrease to 1 dose a day

• nasal spary, inhaler, or cream formulations

Fluticasone: contraindications

infection (can mask signs of infection)

Dextromethorphan: therapeutic class

cough suppressant

Dextromethorphan: pharmacologic class

centrally-action antitussive

Dextromethorphan: action

acts in medulla without euphoric effects

Dextromethorphan: use

cough suppressant with a quick onset of 15-30 mins

Dextromethorphan: adverse effects

uncommon at therapeutic dose

Dextromethorphan: nursing considerations

if no relief after several days, contact HP

Dextromethorphan: contraindications

• chronic cough due to asthma or COPD

• don’t use in children under 6

• caution with concurrent use with CNS depressants and MAOI’s

Dextromethorphan: interactions

grapefruit juice can cause toxicity

Oxymetazoline: therapeutic class

nasal decongestant

Oxymetazoline: pharmacologic class

sympathomimetic

Oxymetazoline: action

through alpha-adrenergic stimulation causes arterioles in the nasal mucosa to constrict, drying the mucous membranes within minutes and lasts 10 or more hours

Oxymetazoline: uses

for congestion in nose due to cold or allergy

Oxymetazoline: adverse effects

• rebound congestion when used longer than 3-5 days

• minor stinging and dryness in nasal mucosa

• few systemic effects

Oxymetazoline: nursing considerations

don’t use longer than 3-5 days

Oxymetazoline: contraindications

• thyroid disorder

• HTN

• diabetes mellitus

• heart disease

Albuterol: therapeutic class

short-acting bronchodilator

Albuterol: pharmacologic class

beta-2 adrenergic agonist

Albuterol: action

stimulates beta-2 receptors in smooth muscle of bronchi and bronchioles which produces bronchodilation

Albuterol: uses

• rescue inhaler for wheezing, difficulty breathing due to bronchoconstriction

• inhaled or nebulized meds

Albuterol: side effects

jitteriness, tachycardia, tremor/shakiness, agitation/anxiety

Albuterol: nursing considerations

• 2 puffs every 4-6 hours for acute exacerbation

• 4-8 puffs every 20 mins, then every 1-4 hours as needed for mild exacerbation

• use spacer to increase med delivery to lung tissues

• inhale 15-30 mins prior to exertion or physical activity

Albuterol: contraindications

concurrent use of beta-blockers will inhibit bronchodilation effect, caution with HTN, seizure disorders, and diabetes mellitus

Ipratropium: therapeutic class

bronchodilator

Ipratropium: pharmacologic class

anticholinergic

Ipratropium: action

blocks PNS receptors in the bronchi which results in bronchodilation and reduces bronchospasms

Ipratropium: use

• used to treat bronchospasm related to COPD

• often combined with albuterol

• also used for off-label treatment of asthma

Ipratropium: side effects

few systemic effects, may irritate upper respiratory tract (dry mouth, irritation of pharynx, and bitter taste)

Ipratropium: nursing considerations

• instruct patient on inhalation techniques and wait 2-3 mins between doses

• rinse mouth after use

Ipratropium: contraindications

hypersensitivity to soya lecithin (soy or peanut)

Beclomethasone: therapeutic class

anti-inflammatory drug for asthma and allergic rhinitis

Beclomethasone: action

decrease release of inflammatory mediators that block the production of cytokines

Beclomethasone: use

• inflammation due to asthma or allergic rhinitis

• for long-term management of persistent asthma, allergies, COPD, or COVID

Beclomethasone: side effects

produce very few systemic effects, can mask signs and symptoms of infection, hoarseness, dry mouth, and taste changes

Beclomethasone: nursing considerations

• DON’T USE FOR AN ACUTE ASTHMA ATTACK

• taken daily to prevent/control symptoms of asthma or allergic rhinitis

• may take 3-4 weeks for therapy before optimal benefits occur

• rinse mouth after use to prevent oropharyngeal candidiasis (thrush)

Beclomethasone: contraindications

active infection, and pediatric growth should be monitored carefully due to inhibition of growth velocity in some children

Montelukast: therapeutic class

anti-inflammatory for asthma prophylaxis

Montelukast: pharmacologic class

leukotriene modifier

Montelukast: action

leukotriene receptor blocker which reduces bronchodilation and inflammation caused by leukotrienes (pro-inflammatory mediators)

Montelukast: uses

• for long-term treatment of asthma/allergies in children/adults

• decrease the use of beta-2 agonist medications

• improves nighttime symptoms

Montelukast: adverse effects

• BBB: serious neuropsychiatric events, such as depression and suicidal ideation, especially in children

• may produce headache, nausea, and diarrhea

Montelukast: nursing considerations

• DON’T USE FOR ACUTE ASTHMA ATTACK

• taken daily in the evening or at night when asthma symptoms worsen to prevent/control symptoms

Desmopressin: therapeutic class

drug for diabetes insipidus and nocturia

Desmopressin: pharmacologic class

anti-diuretic hormone (synthetic ADH)

Desmopressin: action

• acts on kidneys to reabsorb water

• causes contraction of smooth muscle in vascular system, GI tract, and uterus

• produces an increase in clotting factor for Factor VIII or Von Willebrands for bleeding disorders

Desmopressin: use

• control acute symptoms of DI

• taken within 1 hour at night to decrease nighttime urine production and reduces bed wetting

Desmopressin: adverse effects

water intoxication (headache, drowsiness, listlessness, progressing to convulsions and coma), hypertension, mild abdominal pain and cramping

Desmopressin: nursing considerations

• PO, intranasal, parenteral

• ensure serum sodium is not too low

• carefully monitor I/Os

• watch for water intoxication

• overdose: diuretics and water retention

Desmopressin: contraindications

• don’t use in patients with acute/chronic kidney disease

• use cautiously in patients with heart failure because it will worsen fluid retention and overload, HTN, and risk for hyponatremia and thrombi

Desmopressin: interactions

few

Levothyroxine: therapeutic class

thyroid hormone

Levothyroxine: pharmacologic class

thyroid hormone replacement

Levothyroxine: action

synthetic T4

Levothyroxine: use

when there are high TSH levels, which means low thyroxine levels

Levothyroxine: adverse effects

• rare at therapeutic level

• osteoporosis in women due to long-term use

• hyperthyroidism (palpitations, anxiety, insomnia, weight-loss, heat intolerance)

Levothyroxine: nursing considerations

• PO: 1-3 weeks for full effects

• Administer in morning on empty stomach

• Serum TSH is checked if patient receiving sufficient replacement

Levothyroxine: contraindications

• severe cardiovascular conditions or MI

• adrenal insufficiency (causes serious adrenal crisis)

• caution in older adults

Levothyroxine: interactions

cholestyramine (decreases absorption), increases effect of warfarin, and avoid grapefruit juice or coffee 1 hour after taking

Hydrocortisone: therapeutic class

adrenal hormone

Hydrocortisone: pharmacologic class

corticosteroid

Hydrocortisone: action

structurally identical with natural hormone cortisol

Hydrocortisone: use

replacement therapy is given at physiological doses, inflammation is given at much higher doses than physiologic

Hydrocortisone: adverse effects

rare at low doses, prolonged use/long-term can cause Cushings Syndrome

Hydrocortisone: contraindications

• drug hypersensitivity and known infections

• caution with diabetes

• may cause a decrease response to vaccines and toxoids

Hydrocortisone: interactions

NSAIDs increase the risk for peptic ulcer disease

Insulin: therapeutic class

parenteral drug for diabetes and is a replacement for pancreatic hormone

Insulin: pharmacologic class

hypoglycemic drug

Insulin: action

promotes cellular uptake of glucose, amino acids, and potassium

Insulin: use

• monotherapy to lower blood glucose in type I

• combo with oral antidiabetic drugs for type II

• emergency treatment of DKA (regular insulin in IV)

• gestational diabetes (don’t give oral antidiabetic)

Insulin: adverse effects

• Hypoglycemia

• Lipohypertrophy where injections occur

Insulin: nursing considerations

• clear before cloudy

• patient should have sufficient food, not be hypoglycemic before administration

• rotate injection sites

• always check blood before giving

• overdose of insulin can cause death

Insulin: contraindications

pts with hypokalemia

Insulin: interactions (drugs causing hypo and hyper)

• hypoglycemia (alcohol, ACE inhibitors (incr. insulin sensitivity), and non selective beta blockers)

• hyperglycemia (corticosteroids)

Insulin: antidote

glucose

RAPID

insulin aspart

Insulin aspart: onset, peak, duration, and when/how

• o: 10-20 min

• p: 1-3 hours

• d: 3-5 hours

• SQ, just before meal

SHORT

Human “Regular” Insulin

Human “Regular” Insulin: onset, peak, duration, and when/how

• o: 30-60 min

• p: 2-4 hours

• d: 5-8 hours

• SQ, 30-60 mins before meal and can be given through IV

INTERMEDIATE

Isophane insulin

Isophane insulin: onset, peak, duration, and when/how

• o: 1-2 hours

• p: 4-12 hours

• d: 18-24 hours

• SQ, 30 mins before first meal of day, can mix with rapid and short insulin

LONG

Insulin glargine