IMPORTANT DRUGS

for da love of the game-dj jazzy jeff (insulin has its own set)

glipizide (oral hypoglycemic — sulfonylurea)

stimulates the release of insulin from the beta islet cells of the pancreas, treating T2DM. the first oral hypoglycemic. client must have a somewhat functioning pancreas, so this drug is ineffective w/ T1DM. ADRs include hypoglycemia, as this drug lowers BG regardless of whether it is already high or low. hypoglycemia is more common in those who have impaired liver or kidney function. other ADRs include nausea and diarrhea. monitor for s/s of hypoglycemia and give carbs if the client is conscious and in this state (IV form if unconscious). give 30 min AC, do not administer if client is skipping a meal. CNS effects such as confusion and behavior changes are late s/s of hypoglycemia. can produce hypoglycemia and a disulfiram-like reaction in those who drink alcohol.

metformin (oral hypoglycemic-biguanide)

lowers blood glucose by decreasing absorption of glucose from the intestines, decreasing glucose synthesis in the liver, and increasing sensitivity of insulin receptors in the tissues. treats T2DM. ADRs include nausea, diarrhea, vomiting, and an unpleasant metallic taste. this drug can also decrease the absorption of vitamin B12 and folic acid so deficiencies in both of these micronutrients is possible.can also cause lactic acidosis which is rare but potentially fatal. not recommended for those who have impaired renal function, alcoholism, COPD, or those with heart failure. monitor liver function, for s/s of lactic acidosis, Is and Os, and for vitamin deficiencies. do not use if patient has a procedure that requires IV contrast media. give w/ meals; do not give if GFR is lower than 30.

trimethoprim + sulfamethoxazole (TMP SMX)

combination antibacterial that works to treat UTIs, pneumocystis pneumonia, shigella, bronchitis, and acute otitis media. broad spectrum and bacteriostatic. ADRs include GI s/s, SJS, blood dyscrasias (agranulocytosis, aplastic anemia, thrombocytopenia), superinfections, nephrolithiasis, disulfiram like reactions, and kernicterus (bilirubin deposits in the brain). not recommended for infants or those pregnany/lactating. monitor GI s/s and give with food if necessary, CBC, for superinfections, Is and Os, and urinalysis. client should intake 1200-1500 mL of water a day. decreases efficacy of oral contraceptives.

nitrofurantoin (urinary tract antiseptic; folic acid)

broad-spectrum antibiotics that treat and prevent lower UTIs; exert no antibacterial action outside of the urinary tract, bacteriostatic or bactericidal. acidic pH of urine enhances the action of these medications. can be useful in those with DM who have frequent UTIs. ADRs include GI s/s, hypersensitivity reactions that manifest as pulmonary distress, peripheral neuropathy in those with decreased renal function, blood dyscrasias (hemolytic anemia, thrombocytopenia, and neutropenia), teeth staining, brown discoloration of urine, CNS effects, and photosensitivity. monitor CBC, Is and Os, and for all other ADRs.

fluconazole (azalea antifungal)

interrupts the cell wall integrity of fungi by interfering with the synthesis of ergosterol, increasing the permeability of the cell wall causing cell death. fungistatic and fungicidal depending on the dose. offers a less toxic alternative treatment for thrush, yeast infections, and tinea infections (athlete’s foot, ringworm, and jock itch). ADRs include burning, itching, redness, and localized hypersensitivity in the topical form, and hepatotoxicity and CNS effects in the systemic form. monitor liver enzymes and all other ADRs. best given w/ food, acidic beverages can help with absorption. give 2 hrs before all GI meds.

acetaminophen (Tylenol)

COX inhibitor that is limited to the CNS and does not have anti-inflammatory or anti-coagulant effects. does not affect gastric mucosa or platelets. works to reduce pain and fever. ADRs include liver toxicity (toxic hepatitis) and HTN in women. antidote is acetylsystine. ensure patient is not taking multiple OTC drugs alongside this one as it can be present in many different types of OTCs, causing toxicity. limit dose to no more than 4mg per day. BP should be monitored often. not recommended for those with alcohol dependence/abuse issues.

aspirin/ibuprofen (1st gen NSAIDs)

nonselective COX inhibitors that block platelet aggregation, inflammation, pain, and fever. can also help with period cramps. ADRs arise as a result of COX-1 being blocked. they include gastric upset, heartburn, ulceration, bleeding, renal dysfunction, salicliysm, and reye’s syndrome in children. monitor patients for bleeding in any form (occult, petechiae, etc.), Is and Os/decreased renal function (elevated BUN and creatinine), s/s of salicilysm, and all other ADRs. discontinue a week before surgery, adhere to 81 mg dose if using as antiplatelet, take with food, and avoid alcohol. do not give to children under 18 who have vital infections. teratogenic; not recommended for those with preexisting PUD or those peri-op.

baclofen (central acting)

muscle relaxant that enhances the inhibitory effects of GABA on receptors in the spinal cord, resulting in the suppression of hyperactive reflexes. treats muscle spasms related to SCIs, MS, cerebral palsy, or due to MSK injuries or other disorders. ADRs include CNS effects (drowsiness, dizziness, weakness, fatigue), n/v, constipation, and sometimes urinary retention. withdrawal s/s can occur with abrupt stoppage (anxiety, restlessness, visual hallucinations, and seizures). give at lowest effective dose and taper client off of drug for 1-2 weeks. PO form should be taken with food; can be given via intrathecal infusion into the spine (do not stop this route abruptly due to risk of rebound spasticity). concurrent use of MAOIs can lead to serotonin syndrome or hyperpyretic crisis.

sumatriptan

works to reverse the 5 HT/CGRP ratio by activating 5-HT receptors, promoting vasoconstriction and suppression of the release of CGRP, preventing the inflammatory response from occurring and treating existing migraines or cluster headaches. ADRs include chest pressure, anginal pain, tingling sensations, and vertigo. monitor VS during chest pains and notify provider when they occur due to the possibility of cardiac ischemia. do not exceed the max dose in 24 hours as this can cause excessive vasoconstriction and compromise blood flow to vital organs.

phenytoin (Dilantin)

decreases the neuronal activity of seizure generating cells in the brain by inhibiting the influx of sodium through sodium channels, treating tonic-clonic (full body) and partial seizures. ADRs include mild drowsiness, gingival hyperplasia, and a skin rash that can progress into SJS. stopping this med abruptly can lead to reoccurrence of seizures and status epilepticus. monitor rashes closely; excessive drowsiness may indicate toxicity. monitor gums, give with meal to reduce GI upset, and don’t push IV form too quickly as this could cause cardiac collapse. therapeutic range is between 10 and 20 mcg/mL. toxicity can be caused by concurrent use with valproic acid and is indicated by nystagmus, ataxia, sedation, and blurred or double vision.

donepezil

inhibits enzyme that inhibits Ach, increasing the amount of Ach available and improving cognitive function, treating alzheimer’s disease. ADRs include nausea, insomnia, dizziness, headache, GI bleeds, and bradycardia leading to syncope. give with food to minimize n/v. monitor clients for adequate nutritional intake, s/s of GI bleeds, and assist with ambulation as necessary. recommended to give at bedtime to avoid GI s/s. taking with food can also help with GI s/s. important to provide education to the patient’s caregiver as well. client should avoid NSAIDs due to GI bleed risk.

memantine

decreases influx of calcium into neurons in the brain, restoring normal nerve transmissions to slow the progression of alzheimer’s. can be taken in conjunction with drugs like donepezil. ADRs include CNS effects (headaches, dizziness, and increased confusion) and constipation. monitor clients for ADRs and provide fiber supplements, stool softeners, and laxatives as needed. important to provide education to the patient’s caregiver as well. not recommended for clients who have severe liver impairment. client should also avoid antacids that contain sodium bicarbonate as they can lead to toxicity.

levodopa/carbidopa

a dopamine replacement med that crosses the BBB to be taken up by remaining dopaminergic neurons. this med then converts to dopamine in these neurons and is available for use, relieving manifestations of parkinson’s. ADRs include n/v, orthostatic hypotension, darkened sweat and urine, and dyskinesias in initial phase of treatment. a decrease in dosage can help with dyskinesias. monitor clients for ortho hypo by assessing BP properly. client should be placed on fall precautions and alerted that this med may take 6 months to produce a therapeutic effect. on-off episodes (muscle rigidity and tremors recur) may happen, requiring regulation of the time of administration and the dose. client should avoid high protein diets as they decrease absorption and change positions slowly. be sure to include caregivers when giving instructions about this med.

interferon beta 1-a & 1-b

inhibits the movement of leukocytes across the BBB, protecting the myelin sheaths of neurons from damage, treating MS. ADRs include flu-like manifestations (headache, fever, chills, myalgia/muscle aches) that decreases with prolonged treatment, bone marrow suppression (bleeding, bruising, and fatigue), hepatotoxicity, and injection site reactions. given IM. monitor CBC for thrombocytopenia and neutropenia and premedicatewith tylenol for flu-like symptoms. liver fx tests are needed. start at low dose and gradually titrate to a higher one to prevent initial adverse reactions. patient should be educated on the s/s of liver failure/toxicity

fluoxetine (SSRI)

selectively blocks the reuptake of serotonin, strengthening the transmission of serotonin at synapses, treating nerve pain. ADRs include insomnia, nervousness, s3xual dysfunction, anxiety, headache, weight gain in long term use, hyponatremia, suicide, and serotonin syndrome in excess serotonin levels(can show hallucinations). monitor for ADRs and closely watch Na levels. clients taking diuretics and SSRIs are at high risk for hyponatremia. can take 4-6 weeks to achieve effectiveness. client should take in the morning w/ food; concurrent use with NSAIDs can cause GI bleeds.