exam three prototype drugs

aspirin

Class: NSAIDS

class: salicylate

MOA: inhibits COX-1 and inhibits COX-2 to decrease inflammation and fever

USE: pain inflammatory conditions, fever reduction, platelet inhibition

Aspirin #2

ADR: Gi irritation, renal/kidney dysfunction, reye’s syndrome: avoid in child with viral infections and under age of 3, salicylism: tinnitus, hyperventilation, dizziness, confusion

DONT: Gi bleeding, renal impairment, children with viral infections, pregnancy (3rd trimester)

Consid: stop 7-10 days before surgery, monitor for signs of bleeding, take with food to reduce GI discomfort

Ibuprofen

NSAID

Class: propionic acid derivative

MOA: inhibits COX1 and COX2, reducing prostaglandin synthesis to decrease inflammation

USE: pain, inflammatory conditions, fever reduction, menstrual pain

Ibuprofen #2

ADR: GI irritations, renal/ kidney dysfunction, increased BP, risk of heart attack and stroke with long term use

DONT: GI ulcers, renal impairment, pregnancy (3rd trimester ) asthma

Considerations: monior for GI bleeding and kidney function, take with food, use lowest effective dose

celecoxib (celebrex)

Class: selective COX-2 inhibitors

MOA: reduces prostaglandin

USE: inflammatory conditions, short-term acute pain: dysmenorrhea: pain associated with menstruation

celecoxib (celebrex) #2

ADR: increase risk of heart attack, stroke, GI irritation, Renal impairment especially in preexistingsteroidal anti kidney conditions

DONT: cardiovascular disease, GI disorders, renal dysfunction, pregnancy

CONsid: monitor if cardiovascular risk, assess renal function, GI side effects, educate: to take with food and resport signs of cardiovascular issues

prednisone

class: Corticosteroid, Anti-inflammatory

MOA: Inhibits phospholipase A2,
reducing prostaglandins and leukotrienes, decreasing inflammation,

USE: autoimmune, (rheumatoid arthritis, lupus) allergic (asthma, anaphylaxis), inflammatory, (IBD) acute (shock)

prednisone #2

ADR: immunosuppression, osteoporosis, hyperglycemia, GI issues, mood changes (anxiety and depression), cushing’s syndrome

DONT: active infectinos, peptic ulcers, live vaccines, prgnancy

Considertions: monitor for infectinons , blood glucose levela dn bone health, tampering, Gi protection

acetaminophen

Class: antipyretics, analgesic

MOA: inhibits COX activity in the CNS.

USE: fever, mild to moderate pain

acetaminophen #2

ADR: rare allergic reactions (rash, anaphylaxis), hepatotoxicity, acetaminophen toxicity: NV, anorexia, jaundice, confusion

DONT: liver diease, chronic alcohol use

Considerations: monitor liver functions, do not exceed the maximum daily dose, advise taking with food

antidote of acetaminophen toxicity

n-acetylcysteine (mucomyst)

morphine #1

opioid agonist

MOA: binds to opioid receptors (MU/KAPPA)

USE: severe acute pain, chronic pain, preanesthetic sedation

morphine #2

ADR: respiratory depression, sedation, NV, urinary retention, constipation

BLACK BOX: schedule 2, high risk for dependence, extended release for opioid-tolerant client only

Consideration:

• monitor for sedation and res, depression

• moniotr bowel movements

• use naloxone (narcan) for overdose

• routes: oral IV, subcutaneous

fentanyl #1

Class: agonist (IV)

MOA: binds to MU/KAPPA receptors - rapid analgesia

USE: short-duration analgesia, chronic pain management, severe pain in controlled settings

50-100 more potent than morphine

faster onset, short duration

fentanyl #2

ADR: respiratory depression, bradycardia, hypotension, muscle rigidity

BLACK BOX warning: SCH 2, high abuse potential, CNS depressant interaction

considerations:

• ensure airway support

• monitor for respiratory depression

• titrate carefully, especially in opioid-naive patients

• routes: IV, transdermal patches, lozenges

tramadol #1

class: synthetic opioid analgesic

MOA: binds to mu receptor, weak opioid agonist. inhibits pain transmission

USE: moderate pain, restless leg syndrome

tramadol #2

ADR: dizziness, NV, seizures, lethargy

DONT: history of seizures, use with an SSRI. ethanol = sudden death

consideration:

• monitor for seizures, patient should avoid alcohol/CNS depressants

• assess for serotonin syndrome

• schedule IV controlled substance

general anesthetics

MOA: induce state of unconsciousness by inhibiting CNS activity through GABA and NMDA receptor

ADR: respiratory depression, hypotension, nausea, arrhythmias

considerations: monitor vital signs, airway management, assess recovery from anestheisa

isoflurane #1

class: inhaled general anesthetic - GABA and glutamte receptor agonsist

MOA: enhances GABA activity, inhibits excitatory neurotranmitters, leading to general anesthesia

USE: induction and maintenance of general anesthesia during surgery

isoflurane # 2

ADR: hypotension, res depression, malignant hyperthermia, QT prolongation, cardiac arrest

DONT: malignant hyperthermia, severe hepatic/renal disease, pregnancy

considerations:

• assess for contraindications, baseline vitals, monitor HR,BP,ECG,RR, moniot rof rrep depression after operation, educatin P.T on grogginess, and assist with movement

nitrousoxide #1

Class: gaseous, inhalation anesthetic

MOA: mild sedation, CNA depressant that enhances GABA and inhibits NMDA receptors

USEL pain relief in dental procedures, labor,minor surgeries

nitrousoxide #2

ADR: N, dizzy, headache, euphoria, SERIOUS: hypoxia, re depression

DONT: pneumothorax, bowel obstruction, or COPD

condsiderations:

• assess for contrain, baseline vitals, monitor oxygen saturation, RR, and consciousness level, monitor for ADR after operation, educate PT on potential side effects like dizziness

propofol #1

class: general ane - GABA agonist

MOA: enhances GABA acitvity, rapidly depressing CNS for sedation

USE: induction and maintenance of general anesthesia, ICU sedation for ventilated p.t, procedural sedation

propofol #2

ADR: hypotension, res depression, propofol infusion syndrome (PRIS), metabolic acidosis

DONT: soy/egg allergy, hemodynamic instability, risk of PRIS, with prolonged use

considerations: assess allergies, baseline vitals, monitor ECG, BP, RR, watch for ADR post-op, educate P.T to avoid driving/decisions for 24 hours

succinylcholine #1

Class: neuromuscular blockar - nicotinic agonist

MOA: binds to nicotinic receptors, causing temporary paralysis

USE: rapid sequence intubation, muscle relaxation, short-term paralysis

succinylcholine # 2

ADR: muscle fasciclations, hyperkalemia, malignant hyperthermia, prolonged paralysis

DONT: history of malignant hyperthermia, hyperkalemia, neuromuscular disease (myasthenia gravis)

CONSID: check for contrain, monitor ECG, O2, K+, monitor muscke function post-op, patient education: temporary paralysis expected

sedative for anesthesia

MOA: CNS depressant that induce relaxation and amnesia

ADR: res depression, hypotension, drowsiness

consideration: monitor res rate and BP and ensure patient safety during recovery

midazolam #1

Class: Benzodiazepine sedtive, GABA agonist

MOA: enhanced GABA, inducing sedation, muscle relaxation, and amnesia

USE: pre-op sedation, procedural sedation, status epilepticus, ICU sedation for ventilated patients

midazolam #2

ADR: res arrest, apnea, agitation, delirium, drowsiness

DONT: severe resp depression, acute narrow-angle glaucoma

Consid: assess RR stauts, bp, mental status, monitor ECG, BP, O2, monitor for prolonged sedation, education: causes drowsiness avoid alc and driving post-op

local anesthetics

MOA: blocks sodium channels in nerve fibers to prevent action potential propagation and pain transmission

USE: minor surgeries, dental work, regional nerve block

ADR: hypotension, bradycardia, allergic reactions, seiures

COnsiderations: ensure proper injection technique, monitor for allergic reactions, use cautiously in patient with heart block or liver disease.

procaine #1

Class: local, ester-type sodium channel blocker

MOA: blocks sodium channels preventing nerve impulse transmission - loss of sensation

USE: local and regional anesthesia, dental procedures

procaine #2

ADR: numbness, dizzy, allergic reactions, seizures, cardiac arrest

DONT: allergy to ester anesthetics, severe cardiac disease, cholinesterase deficiency

CONSIDER: assess for ester allergies, baseline vitals, monitor BP, CNS status, prolonged numbness, education: avoid chewing numb areas and report unusual reactions

lidocaine (xylocaine) #1

Class:local, amide-type sodium channel

MOA: clocks sodium channels, preventing nerve impulse conduction and reducing excitability in cardiac tissue

USE: local and regional anesthesia, ventricular arrhythmias, nerve block, epidural, topical anesthesia

lidocaine (xylocaine) #2

ADR: numbness, tingling, sexuires, res depression

DONT: severe heart block, woldd-parkingson-white syndrome

consid: assess for allergies, monitor ECG, Bp, Res status, numbness, education: avoid biting numb area, report unusual symptoms

dantrolnene #1

Class: skeletal muscle relaxant, ryanodine receptor antagonist

MOAL inhibiits calcium release from sarcoplasmic reticulum prevents contraction and hyperthermia

USE: malignant hyperthermia treatment and prevention, neuroleptic malignant syndrome, chronic spasticity (cerebral palsy)

dantrolnene #2

DAN has liver diease

ADR: drowsiness, hepatotoxicity (BLAC BOX WARNING), res depression

DONT: severe hepatic disease, active liver dysfunction

Consid: assess liver function, watch for sedation, monitor liver enzymes, RR,BP, muscle strength

allopurinol #1

Class: antigout agent, xanthine oxidase inhibitor

MOA: inhibits xanthain oxidase, reducing uric acid production in blood and urine

USE: chronic gout, hyperuricemia

allopurinol #2

ADR: hepa and renal toxicity, rash, diarrhea, SJS

DONT: acute gout flare, severe renal or hepatic impairment

interactions: warfarin, diuretcs

CONSID: monitor BUN, creatinine, liver function, encourage adequate fluid intake, admin with food to reduce GI upset. educate to avoid alc and high-purine foods (red meat and shellfish)

ketorolac #1

Class: NSAID, acetic acid derivative

MOA: inhibits COX 1 and 2 - reducing pain and inflammation

USE:short-term pain management, inflammatory conditions

ketorolac #2

ADR: N, headache, GI bleeding, anaphylacis, liver toxicity

DONT: active Gi bleeding, severe renal impairment, pegnancy (3rd tri)

interactions: monitor with anticoagulants, NSAIDS, diruetics

CONsid: monitor renal/ liver function, admin with food, ensure hydration, education, take with food, avoid alc and smoking

sodium polystyrene sulfonate (KAYEXALATE) #1

Class: electrolye modifer, cation exchange resin

MOA: binds with potassium ions in the GI tract

USE: treatment of hyperkalemia

sodium polystyrene sulfonate (KAYEXALATE) #2

ADR: Gastrointestinal upset (NVConstip), hypokalemia, sodium retention

DONT: bowel obstruction, severe constipation:

Consid: monitor electrolytes, assess gastrointestinal symptoms, administer with sorbitol to enhance efficacy and reduce risk of constipation

furosemide

class: loop diuretic

MOA: inhibits sodium in loop of henle & distal tubule, enhancing water excretion

USE: Edema, hypertension

furosemide #2

ADR: hypokalemia, ototoxicity

consideration: admin slowly to prevent ototoxicity, educate to increase potassium to prevent hypokalemia - take in morning

HCTZ

class: thiazide diuretic

MOA: inhibits sodium and chloride reabsorption in distal renal tubule

USE: hypertension, kidney stone preventio

HCTZ #2

ADR: hyponatremia, hyperglycemia, hyperuricemia

consideration: monitor blood pressure, educate on sun protection, take in morning

spironolactone

class: potassium- sparing diuretic

MOA: antagonizes aldosterone in distal renal tubules - conserving K+

USE: heart failure ,hypertension, edema

spironolactone #2

ADR: hyperkalemia, gynecomastia and menstrual irregularities

consideration: monitor potassium levels, avoid potassium supplements, take with food

mannitol

class: osmotic diuretic

MOA: increases osmotic pressure in renal tubules

USE: cerebral edema, increased intraocular pressure (glaucoma)

mannitol #2

ADR: hyponatremia, hypokalemia

consideration: admin through a filter to prevent crystallization, monitor vital signs, fluid balance, assess for pulmonary edema (SOB crackles)

acetazolamide

class:carbonic anhydrase inhibitor

MOA: inhibits carbonic anhydrase, reducing sodium bicarb reabsorption, leading to diuresis

USE: glaucoma, altitude sickness, metabolic alkalosis, epilepsy

acetazolamide #2

ADR: tingling, kidney stone, hypo kalemia and natremia

consideration: monitor electrolytes, renal function, encourage hydration, monitor neurological effects