FINAL EXAM PROTOTYPES (Simplified)

BETHANECHOL (TC, PC, MOA, USE, SE, CONTRA)

TC: treatment for urinary retention

PC: cholinergic, direct-acting parasympathomimetic

MOA: directly stimulates the muscarinic receptors on the bladder smooth muscle, giving a muscular contraction enough to initiate urination and voiding.

Use: post-operative urinary retention and neurogenic bladder

SE: incr. salivation and sweating, abdominal cramping, and hypotension

Contra: someone with bladder or GI obstruction, pts w/ asthma, bradycardia

ATROPINE (TC, PC, MOA, USE, AE/SE, NC, CONTRA)

TC: anti-arrhythmic, bronchodilator

PC: anticholinergic

MOA: inhibits the effects of the parasympathetic nervous system, which incr HR, bronchodilation, decr GI motility, and decr respiratory secretions

Use: preoperatively to reduce secretions, treatment of asthma/COPD, treatment of bradycardia

AE/SE: atropine poisoning (physostigmine), dry mouth, constipation, urinary retention, incr. HR.

NC: monitor for tachycardia and palpitations

Contra: glaucoma, GI obstruction, BPH, acute hemorrhage

PHENYLEPHRINE (TC, PC, MOA, USE, AE, ANTIDOTE)

TC: nasal decongestant, anti-hypotensive

PC: adrenergic drug, sympathomimetic

MOA: selective, alpha-adrenergic agonist

Use:

• Intranasal: constricts blood vessels (no more than 5 days)

• Topical: eyes for pupil dilation (no for narrow-angle glaucoma)

• Parenteral: reverse hypotension (caution with CAD, hypertension, and hyperthyroidism)

AE: rebound congestion and reflex bradycardia

Antidote: phentolamine

PRAZOSIN (TC, PC, MOA, AE, NC)

TC: antihypertensive

PC: adrenergic-blocking drug

MOA: alpha-1 adrenergic antagonist that competes with NE at its receptor on the smooth muscle in arterioles and veins, leading to rapid decrease in peripheral resistance.

AE: orthostatic hypotension (first dose at bedtime), reflex tachycardia

NC: caution w/ other antihypertensives and diuretics

MORPHINE (TC, PC, MOA, USE, NC)

TC: analgesic

PC: opioid agonist

MOA: inhibits pain sensation in the brain

Use: for moderate to severe pain, air hunger

NC: monitor for respiratory depression, urinary retention and constipation. assess vitals before admin and discontinue once non-opioids can manage pain

NALOXONE (TC, PC, MOA, USE, NC)

TC: antidote for opioid overdose

PC: CNS opioid receptor antagonist

MOA: competes with opioids at the receptor sites in the brain

Use: reversal of opioid overdose

NC: have accessible when admin of opioids, can cause sudden withdrawal

SUMATRIPTAN (TC, PC, MOA, USE, SE, NC)

TC: vascular headache suppressant

PC: serotonin (5-HT) agonist

MOA: vasoconstricting blood vessels in the brain to alleviate pressure

Use: migraine headache treatment

SE: triptan rush (sense of tingling, soreness, and tenderness of scalp/face/neck)

NC: non-preventative, don’t give to pts with MI, angina, on any other 5-HT agonist meds

ACETAMINOPHEN (TC, PC, MOA, USE, NC, CONTRA)

TC: analgesic, antipyretic

PC: analgesic

MOA: inhibits the synthesis of prostaglandins in the brain

Use: mild to mod pain

NC: don’t exceed 3,000 mg/day (hepatotoxic)

Contra: don’t give to pts with hepatic insufficiency or who drink more than 3 drinks/day

IBUPROFEN (TC, PC, MOA, USE, NC)

TC: analgesic, anti-inflammatory, antipyretic

PC: NSAID, non-selective COX inhibitor

MOA: inhibits the conversion of COX, which inhibits the production of prostaglandins

Use: mild to mod pain, treatment of inflammation, treatment of fever

NC: observe s/s of GI distress/bleeding, cross-sensitivity w/ aspirin, monitor renal and hepatic function (nephrotoxic)

ASPIRIN (TC, PC, MOA, USE, AE, CONTRA)

TC: analgesic, anti-inflammatory, antipyretic

PC: NSAID, non-selective COX inhibitor, salicylate

MOA: inhibits the synthesis of prostaglandins by stopping the conversion of arachidonic acid into COX

Use: mild to mos pain, inflammation, fever, can be taken to prevent a heart attack or stroke because of its thinning ability

AE: Steven’s Johnson Syndrome

Contra: use in caution with other bleeding disorders and w/ alcohol, don’t use in children

PREDNISONE (TC, PC, MOA, USE, AE, CONTRA)

TC: potent anti-inflammatory

PC: corticosteroid

MOA: decr inflammation and suppresses the immune system

Use: treat allergies, skin conditions, lupus, ulcerative colitis, Crohn’s, psoriasis, asthma, and COPD

AE: Cushing’s syndrome

Contra: active infection

DESMOPRESSIN (TC, PC, MOA, NC, AE, CONTRA)

TC: drug for diabetes insipidus and nocturia

PC: anti-diuretic hormone

MOA: acts on the kidneys to reabsorb water

NC: take 1 hr before bed at night to drc nighttime urine production, check Na levels are normal before administering

AE: water toxicity

Contra: caution in pts with hyponatremia and heart failure, and don’t use it pts with DI caused by acute/chronic kidney disease

LEVOTHYROXINE (TC, PC, MOA, AE, NC, ADMIN)

TC: drug for hypothyroidism

PC: thyroid replacement hormone

MOA: synthetic form of T4 (thyroxine)

AE: osteoporosis in women with long-term use, hyperthyroidism (thyroid storm)

NC: check serum TSH to monitor if pt is receiving sufficient replacement (TSH levels decr as thyroxine levels incr/improve; high TSH occurs when pt has low thyroxine levels because the pituitary gland overcompensates by producing more TSH)

Admin: take 30 mins before a meal w/ water, no grapefruit juice, don’t double dose, LIFELONG drug

HYDROCORTISONE (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: adrenal hormone to treat Addison’s disease

PC: corticosteroid

MOA: structurally identical with cortisol hormone

Use: given at a physiological dose for people using it as hormone replacement to treat Addison’s, given at a high dose to treat inflammation

AE: develop Cushing’s syndrome when taken at high doses for prolonged periods

NC: may cause decr response to vaccines/toxoids due to immunosuppressive properties

Contra: active infections, pts with DM, drug hypersensitivity

DIPHENHYDRAMINE (TC, PC, MOA, USE, AE, CONTRA)

TC: drug to treat allergies

PC: antihistamine, H1 receptor antagonist

MOA: 1st gen H1 receptor antagonist

Use: treat minor symptoms of allergy and cold, prophylactic use before blood transfusions, certain meds, and chemo is hospitals

AE: drowsiness, paradoxical excitation in children, anticholinergic effects

Contra: pts w/ BPH, narrow-angle glaucoma, GI obstruction, caution in pts with asthma and COPD

LORATADINE (TC, PC, MOA, USE, SE, NC, CONTRA)

TC: drug to treat allergies

PC: antihistamine, H1 receptor antagonist

MOA: 2nd gen H1 receptor antagonist

use: treat minor allery s/s, long-acting (take once a day)

SE: headaches, dizziness, GI distress

NC: overdose leads to toxicity (renal, hepatic, and cardiac problems)

Contra: children 2 under

FLUTICASONE (TC, PC, MOA, AE, NC)

TC: drug for allergic rhinitis, asthma, and skin inflammation

PC: corticosteroid

MOA: decr local inflammation in the nasal passages, reducing stuffiness

AE: nasal irritations and epistaxis

NC: not for immediate relief because onset is several days adn takes 1-3 weeksfor full effect; 2 sprays per nostril 2x/day

DEXTROMETHROPHAN (TC, PC, MOA, NC, CONTRA)

TC: cough suppressant

PC: centrally acting antitussive

MOA: acts on the medulla without euphoric effects to reduce the cough reflex

NC: if no relief after several days, contact a healthcare provider, no grapefruit juice, caution with CNS depressants and MAOIs

Contra: patients with a chronic cough (asthma or COPD)

OXYMETAZOLINE (TC, PC, MOA, AE, CONTRA)

TC: nasal decongestant

PC: sympathomimetic

MOA: acts on alpha-adrenergic receptors to cause vasoconstriction in arterioles of the nasal mucosa, which dries out mucus membranes and reduces congestion; can also be used in eye drop form to minimize redness and irritation

AE: rebound congestion, minor stinging or irritation

Contra: thyroid conditions, HNT, DM, and heart disease

ALBUTEROL (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: bronchodilator

PC: beta-2 adrenergic agonist

MOA: stimulates beta-2 receptors in smooth muscles of bronchi and bronchioles to stimulate bronchodilation

Use; rescue inhaler for wheezing, dyspnea, and bronchoconstriction

AE: SNS (jitteriness, tremors/shakiness, anxiety/agitation, tachycardia)

NC: 1-2 puffs with 5 mins between each puff

Contra: caution in pts with hypertension, seizure disorders, and DM

BECLOMETHASONE (TC, PC, MOA, USE, SE, NC, CONTRA)

TC: used to treat asthma and allergic rhinitis

PC: corticosteroid

MOA: decr inflammatory mediators and block cytokine production

Use: treat asthma, COPD, and COVID

SE: hoarseness, dry mouth, bad taste, thrush

NC: use over 3-4 weeks for optimal use (not used for acute asthma)

Contra: any known infection

MONTELUKAST (TC, PC, MOA, USE, AE, NC)

TC: drug for asthma prophylaxis

PC: leukotriene modifier

MOA: leukotriene receptor blocker reduces bronchoconstriction and inflammation cause by leukotrienes

Use: long-term treatment of asthma, decr the use of beta-2 agonists, improves nighttime asthma symptoms

AE: suicidal ideation in children, headache, nausea, diarrhea

NC: not a rescue inhaler, take at night or when symptoms get worse

IPATROPIUM (TC, PC, MOA, SE, NC, CONTRA)

TC: bronchodilator

PC: anticholinergic

MOA: inhibits PNS response in lungs, causing bronchodilation

SE: dry mouth, bitter taste, pharynx irritation

NC: wait 2-3 mins between doses and rinse mouth after use to avoid thrush

Contra: soy lecithin and peanut allergy

INSULIN (TC, OC, MOA, USE, AE, NC, CONTRA, LAB TESTS)

TC: parenteral medication for diabetes

PC: hyperglycemic medication

MOA: promotes cellular uptake of insulin to reduce blood glucose levels

Use: monotherapy for DM TI, combo with oral antidiabetic drugs for DM TII, given in emergency to treat DKA, gestational diabetes (cannot give oral diabetes meds to pregnant women)

AE: hypoglycemia and lipohypertrophy

NC: ensure pt has enough food and not hypoglycemic, and rotate injection sites to avoid lipohypertrophy

Contra: pts with hypokalemia

Lab tests: Normal BG (70-100 mg/dL) adn A1C (normal: <5.5 and >6.5 is diabetic)

TYPES OF INSULIN

• Insulin aspart RAPID (O: 10-20 min, P: 1-3 hrs, D: 3-5 hrs; give just before meal)

• Human “regular” insulin SHORT (O: 30-60 mins, P: 2-4 hrs, D: 5-8 hrs; give 30-60 mins before meal and is the only type that can be given IV)

• Isophane insulin INTERMEDIATE (O: 1-2 hrs, P: 4-12 hrs, D: 18-24 hrs; 30 mins before a meal and cannot be mixed with rapid and short, but clear before cloudy)

• Insulin glargine LONG (O: 1.5 hrs, P: NO PEAK, D: 24 hrs; cannot be mixed with other types of insulin)

GLUCAGON (TC, PC, MOA, NC, AE)

TC: drug to incr BG levels

PC: glycogenolytic hormone (made by alpha cells)

MOA: used for severe hypoglycemic rxns

NC: give IM to stimulate glyconeogenesis and incr BG

AE: nausea, vomiting, low blood pressure

METFORMIN (TC, PC, MOA, AE, CONTRA)

TC: antidiabetic drug

PC: biguinide

MOA: reduces fasting and post-meal glucose levels by decr gluconeogenesis and insulin resistance, does not cause hypoglycemia, promotes insulin uptake by skeletal muscle, and incr insulin sensitivity

AE: GI, metallic taste, anorexia, lactic acidosis (rare but potentially fatal seen in pts w/ comorbidities like CKD, liver disease, infection, excessive alcohol intake, shock, or hypoxemia)

Contra: do not take for 2 days before or 2 days after receiving IV radiographic contrast

ATORVASTATIN (TC, PC, MOA, AE, SE, NC, CONTRA)

TC: antihyperlipidemic

PC: HMG-CoA reductase inhibitor, statin, inhibiting HMG-CoA reductase stops the biosynthesis of cholesterol in liver

MOA: decr LDL cholesterol (less cholesterol produced = liver produces more LDL receptors = more removal of LDL from the blood), decr triglycerides, incr HDL

AE: rhabdomyolysis, incr levels of digoxin, no grapefruit juice

SE: headache, fatigue, heartburn, liver damage (monitor LFT)

NC: it takes 2 weeks to take therapeutic effect, often a lifelong drug, given with food for GI distress, taken at night, low progression of CAD and reduced risk of stroke and MI by 50%

Contra: pregnant women

CHOLESTYRAMINE (TC, PC, MOA, SE, NC, CONTRA)

TC: antihyperlipidemic

PC: bile acid sequestrant

MOA: bonds with bile acids in an insoluble complex and is then excreted in feces, the liver makes more LDL receptors, and the drug can produce 20% drop in LDL

SE: gas, bloating, constipation, nausea

NC: give the drug with at east 60-180 mLs of water and drink immediately, give other drugs 2 hrs before or 4 hours after

Contra: pts w/biliary obstruction (gallbladder issues), taking w/ food can impair the absorption of nutrients and minerals, drug/drug interactions w/ digoxin and warfarin

GEMFIBROZIL (TC, PC, MOA, SE, CONTRA)

TC: antihyperlipidemic

PC: fibric acid drug

MOA: incr lipoprotein lipase, which incr the breakdown of triglycerides in plasma, reduce VLDL by 50% and incr HDL

Use: first line for several hypertriglyceridemias and hypercholesterolemias

SE: nausea, vomiting, abdominal pain, dyspepsia (taking with food minimizes effects)

Contra: incr risk of gallstones, affects liver function, incr the effects of anticoagulants, incr risk of myopathy and rhabdomyolysis when taken with statins

FUROSEMIDE (TC, PC, MOA, SE, NC)

TC: drug for heart failure and hypertension

PC: loop diuretic, potent-potassium wasting diuretic

MOA: works in the loop of Henle to promote sodium and water excretion and potassium wasting, and IV is given to cause rapid diuresis

SE: hypokalemia, orthostatic hypotension, ototoxicity and nephrotoxicity

NC: monitor I/Os, monitor potassium levels, monitor blood glucose, watch s/s of hearing loss, use caution with other potassium-wasting diuretics

HYDROCHLOROTHIAZIDE (TC, PC, MOA, SE, NC, CONTRA)

TC: drug for hypertension and edema

PC: thiazide (potassium-wasting diuretic)

MOA: reduces blood volume through excretion or water and potassium, reducing volume and blood pressure (acts in the distal convoluted tubule)

SE: hypokalemia, hyponatremia, hypotension, dizziness, and dehydration

NC: observe for hypokalemia and incr potassium-containing foods, hypokalemia incr risk of digoxin toxicity

Contra: do not give to pts with anuria

SPIRONOLACTONE (TC, PC, MOA, SE, NC)

TC: antihypertensive and reduces edema

PC: potassium-sparing diuretic, aldosterone antagonist

MOA: inhibits aldosterone, causing water and sodium excretion, commonly used to treat hypertension w/ other antihypertensive drugs, and used to slow down the progression of heart failure

SE: hyperkalemia, gynecomastia (men), menstrual irregularities

NC: give with food to incr absorption, do not give with K+ supplements or with salt substitutes

LISINOPRIL (TC, PC, MOA, SE, CONTRA)

TC: drug for hypertension and heart failure

PC: ACE inhibitor

MOA: inhibits ACE (angiotensin II converting enzyme) and ultimately blocks the effects of aldosterone, used in combo w/ thiazide diuretics (potassium-wasting)

SE: dry cough, angioedema (stop med if this occurs), postural hypotension

Contra: hyperkalemia (use in caution if giving to pts with potassium-sparing diuretics)

LOSARTAN (TC, PC, MOA, SE, NC, CONTRA)

TC: drug for hypertension

PC: angiotensin II receptor blocker (ARB)

MOA: vasodilation and reduced blood volume due to aldosterone blocking

SE: hypoglycemia, dizziness, stuffy nose, fatigue, hypotension

NC: hyperkalemia when given with potassium-sparing diuretics

Contra: pregnancy

METOPROLOL (TC, PC, MOA, USE, SE, NC, CONTRA)

TC: drug used for hypertension and heart failure

PC: beta-adrenergic blocker, selective B1 blocker

MOA: reduces sympathetic stimulation in the heart, ultimately decr cardiac output; blocks sympathetic activity on B1 receptors to reduce heart rate B1 receptors in the juxtamedullary apparatus inhibit renin and stop angiotensin II

Use: preferred for pts with respiratory conditions due to B1-selectivity

SE: hypotension, bradycardia, hypoglycemia (may enhance hypoglycemic effects of parenteral/oral antidiabetic drugs)

NC: acute withdrawal from the drug can cause angina or MI, so it must be tapered off over a few weeks

Contra: heart block, cardiogenic shock, hypotension, cardiac failure

NIFEDIPINE (TC, PC, MOA, SE, NC)

TC: drug for hypertension, chest pain, and cardiac arrhythmia

PC: calcium channel blocker

MOA: block calcium channels in myocardial and vascular smooth muscle, causing vasodilation, making blood flow more accessible, and lowering blood pressure

SE: hypotension and dizziness, peripheral edema, fatigue and headache

NC: avoid alcohol, do not take with grapefruit juice, use caution with other antihypertensive drugs, incr digoxin serum levels, can lead to bradycardia or digoxin poisoning, can incr the effects of statin drugs and mess up liver enzymes

MILRINONE (TC, PC, MOA, AE, NC)

TC: drug for acute heart failure

PC: phosphodiesterase inhibitor

MOA: blocks the enzyme phosphodiesterase in cardiac smooth muscle, incr cardiac force of contraction and cardiac output (short half life, IV), incr calcium availability to the heart muscle, PDE inhibition prevents cGMP metabolism, causing vasodilation; typically saved for emergencies

AE: ventricular dysrhythmia (1 in 10 patients), hypokalemia

NC: need continuous ECG monitoring, overdose causes hypotension, so treat with vasopressor or normal saline

DIGOXIN (TC, PC, MOA, AE, NC, CONTRA)

TC: drug for heart failure

PC: cardiac glycoside

MOA: inhibits the Na+K+ ATPase responsible for pumping Na+ ions out of the myocardium in exchange for potassium; Na+ accumulates, and Ca 2+ ions are released from storage in the cell, which incr the contraction of heart muscle fibers; incr contractility of the heart (positive inotrope), incr cardiac output, incr urine production, and decr blood volume (relieves pulmonary congestion and edema); suppresses the SA node (decr heart rate to promote full forceful contractions)

AE: hypokalemia (when used with diuretics)

NC: take apical pulse for 1 min, and is HR is below the parameters (<60), withhold dose; check serum digoxin levels, use with caution in elderly and children due to renal and hepatic immaturity; interacts with many different drugs and used with ACE inhibitors, it can cause hyperkalemia; Digibind is the antidote

Contra: AV block or ventricular arrhythmias unrelated to HF

HEPARIN (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: anticoagulant

PC: indirect thrombin inhibitor

MOA: given IV to stop the existing clots from getting larger and new clots from forming

Use: prophylactic use and treatment indications

AE: abnormal bleeding, epidural or spinal hematoma (heparin given during epidural or spinal anesthesia incr risk), heparin-induced thrombocytopenia

NC: acts immediately (fast onset and fast offset, given IV), aPPT used to measure the effectiveness (should be 2-4x patient baseline, and dosage is based on aPTT labs; needs constant neurologic monitoring, paralysis/death; interacts with nicotine, aspirin, digoxin, tetracycline, anticoagulants

Contra: active bleeding, bleeding disorders, intracranial hemorrhage

ENOXAPARIN (TC, PC, MOA, NC)

TC: anticoagulant

PC: indirect thrombin inhibitor

MOA: similar to heparin

NC: duration is 2-4x longer, more stable medication, fewer lab follow-ups, okay for at home use, given SQ (onset action is 1 hr and duration is 12 hrs), watch for platelet counts (normal: 150,000-450,000), dosage is given based on weight; antidote is protamine sulfate

WARFARIN (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: anticoagulant

PC: vitamin K antagonist

MOA: inhibits vitamin K, which then stops the production of vitamin K clotting factors

Use: prevention of stroke, DVT, and pulmonary embolism, given to prevent clotting in high-risk patients following a MI or A-fib episode

AE: bleeding (can stay in the system for up to 10 days)

NC: take 3-5 days to achieve anticoagulation, affect is measured in PT and INR (INR in people not on warfarin is 1, INR therapeutic effects with warfarin is 2-3), bridge warfarin and heparin, INR goal is met, pt stops taking heparin and remains on warfarin; INR is measured daily, then weekly and monthly; life-threatening bleeding can occur so regular INR monitoring is required; interacts with alcohol, NSAIDs, diuretics, ginkgo/garlic, vitamin K foods

Contra: pts with recent trauma, internal bleeding, intracranial hemorrhage, severe hypertension, liver/kidney disease

CLOPIDOGREL (TC, PC, MOA, AE, NC, CONTRA)

TC: antiplatelet drug

PC: adenosine diphosphate (ADP) receptor blocker

MOA: blocking ADP stops platelet aggregation, reduce the rate of MI or stroke in pts with acute STEMI, unstable angina, or nSTEMI, prevent thrombi in coronary stents

AE: bruising, rash, flu-like symptoms

NC: do not crush pills, discontinue 5 days before surgery; interacts with NSAIDs, ginkgo/garlic/ginger, and anticoagulants

Contra: do not give to pts with active bleeding

ALTEPLASE (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: drug that dissolves clots, “clot buster”

PC: thrombolytic drug

MOA: identical to human TPA, converts plasminogen to plasmin, which dissolves fibrin clots

Use: strokes due to thrombus, off-label to restore patency to IV catheters

AE: bleeding, anaphylaxis

NC: given to pts within 12 hours of MI or 3-4 hrs of stroke; interacts with anticoagulants, ginkgo/garlic

Contra: internal bleeding, history of stroke past 3 months, recent surgery

FERROUS SULFATE (TC, PC, MOA, AE, NC)

TC: anti-anemic drug

PC: iron supplement

MOA: provides iron to make hemoglobin

AE: GI, constipation (stool may turn green or black)

NC: incr dietary fiber, IM, IV (monitor IV infiltration), tablets (do not crush, t hr before or 2 hrs after a meal or other meds), take only until anemia is corrected, monitor H&H levels and watch for toxicity, keep out of reach of children, take alone

CYANOCOBALAMIN (TC, PC, USE, AE, NC)

TC: drug for pernicious anemia (can’t absorb B12)

PC: vitamin supplement

Use: indicated for patients with B12 deficiency anemia

AE: anaphylaxis

NC: given IM, IV, nasally, onset is two day, and there is a possible link between B12 deficiency and depression, interacts with alcohol and neomycin

EPOETIN ALPHA (TC, PC, MOA, AE, NC)

TC: erythropoiesis-stimulating drug

PC: erythropoietin

MOA: stimulates the production of RBC

AE: hypertension, headache, fever, nausea

NC: SQ 2x/week until desired response, incr risk of cardiovascular and thrombotic events (MI, stroke, and DVT)

FILGRASTIM (TC, PC, MOA, USE, AE, NC)

TC: drug for incr neutrophil production

PC: colony-stimulating factor

MOA: stimulates the bone marrow to make and release neutrophils

Use: reduces the duration of neutropenia and is often given to chemo pts or stem cell transplant recipients

AE: fever, bone pain, epistaxis, nausea, fatigue

NC: SQ, do not give 24 hrs before or after chemo, monitor CBC with differential

PENICILLIN (TC, PC, MOA, USE, AE NC, CONTRA)

TC: antibacterial

PC: cell-wall inhibitor

MOA: bactericidal used for gram-positive organisms, uses beta-lactam ring to kill bacteria; bacteria that have beta-lactamase are resistant

Use: ear, nose, throat, and upper respiratory infections (strep and syphilis infections)

AE: allergy, rash, pruritis, N/V/D, and fever

NC: IV, IM, some PO (amoxicillin), given in combo with other drugs to help fight resistance, pregnancy safe, but can decr the effectiveness of birth control pills, electrolyte imbalances with spironolactone, ACE, ARBs (most penicillins are sodium or potassium salts)

Contra: pt with hypersensitivity to the penicillin class

CEFAZOLIN (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: antibacterial

PC: cell-wall inhibitor, first gen cephalosporin

MOA: inhibit cell wall synthesis, bactericidal, beta-lactam ring

Use: respiratory infections, UTI, genital infections, endocarditis, prophylaxis before surgery

AE: allergy (like penicillin), proliferation of C. diff and other superinfections

NC: given IV, food delays absorption, nephrotoxicity (check labs)

Contra: pts with penicillin allergy

TETRACYCLINE (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: antibacterial

PC: tetracycline; protein synthesis inhibitor

MOA: bacteriostatic, inhibits protein synthesis and growth of organisms, requires good host defenses to eradicate organisms

Use: acne, Rocky Mountain spotted fever, STIs, H. pylori infection

AE: N/V/D and discoloration of teeth and photosensitivity

NC: give in empty stomach with water, avoid milk and iron supplements (decr absorption), take 2 hrs before or 6 hrs after antacids, calcium (milk), or ferrous sulfate; interacts with oral contraceptives, anti-lipids, and penicillin

Contra: 2nd half of pregnancy, children <8, pts w/ renal or hepatic problems

CIPROFLOXACIN (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: antibacterial

PC: fluoroquinolone, bacterial DNA synthesis inhibitor

MOA: inhibits DNA gyrase, affects replication and repair

Use: gram negative UTI, sinusitis, pneumonia, infectious diarrhea

AE: N/V/D

NC: take 2 hrs before or 4 hrs after antacids and ferrous sulfate, take with food to decr GI upset, can cause tendonitis and tendon rupture, extreme weakness with Myasthenia Gravis

Contra: discontinue if pain is felt in joints or tendons, pregnancy, children

VANCOMYCIN (CLASS, MOA, USE, AE, NC)

Class: miscellaneous antibacterial

MOA: effective against gram-positive bacteria

Use: for severe infections, effective against MRSA, used as last resort for drug-resistant bacteria

AE: very narrow therapeutic range, ototoxicity/nephrotoxicity, red man’s syndrome(hypotension, flushing, rash), superinfections, anaphylaxis, N/V

NC: use through central line (vessel irritant), given over 90 min period, monitor BP during infusion and watch for red man’s, check neph labs (GFR/BUN/creatinine)

FLUCONAZOLE (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: antifungal

PC: triazole

MOA: binds to sterols in fungal cell membrane, causing leakage and weakening of cell membrane (inhibits fungal cell membrane synthesis)

Use: infections in CNS, bone, eye, urinary tract, candida albicans

AE: N/V/D, anaphylaxis, rash

NC: narrow spectrum of action, used prophylactically for pts with AIDS and bone marrow transplant, can cause hypoglycemia with concurrent use of glucose meds and interacts with warfarin

Contra: pregnancy, CKD

NYSTATIN (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: superfical antifungal

PC: polyene

MOA: binds to sterols in the fungal cell membrane, causing leakage and weakened membrane

Use: candidiasis (thrush)

AE: skin irritation, N/V/D

NC: comes in cream, ointment, powder, tablet lozenges, and liquid, swish for 2 mins and swallow

Contra: should not be given orally to pregnant women (swish and spit)

METRONIDAZOLE (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: anti-infective, antiprotozoal

PC: drug that disrupts nucleic acid synthesis

MOA: kills amoebas

Use: preferred drug for giardiasis and trichomoniasis, has antibacterial properties against anaerobic bacteria (respiratory, bone, skin, and CNS infections), anti-inflammatory properties (rosacea and crohn’s)

AE: N/D, anorexia, metallic taste, dry mouth

NC: extended-release tablet, swallowed whole on an empty stomach, carcinogenic in lab animals, used for approved indications only

Contra: first trimester of pregnancy, blood disorders (bone marrow suppression)

OMEPRAZOLE (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: antiulcer drug

PC: proton pump inhibitor

MOA: reduces acid secretion by binding to the H+K+ ATPase (the pump that releases acid into the GI mucosa)

Use: works better than H2 blockers and has a longer duration of action, short-term therapy for peptic ulcers (4-8 wks), longer can incr osteoporosis, often used for pts with GERD and erosive esophagitis

AE: B12 deficiency, osteoporosis risk in women

NC: give 30 mins before a meal, it can take up to 2 hrs to reach therapeutic effect, DOA is up to 72 hrs; interacts with many different drugs/herbs

Contra: not for children under 18

ALUMINUM HYDROXIDE (TC, PC, MOA, AE, NC, CONTRA)

TC: anti heartburn drug

PC: antacid

MOA: neutralize stomach acid by raising the pH of the stomach contents, used alone or in combo with other antacids like magnesium to incr the effectiveness and decr constipation, less systemic effects than calcium-based antacids

AE: consipation

NC: at least 2 hrs before or 1 hr after other drugs because absorption can be affected

Contra: pts w/ suspected bowel obstruction

SULFASALAZINE (TC, PC, MOA, USE, AE, NC, CONTRA)

TC: drugs for inflammatory bowel disease

PC: 5-ASA (cousin if aspirin), sulfonamide

MOA: inhibits mediators of inflammation in the colon, such as prostaglandins and leukotrienes

Use: anti-inflammatory that treats mild to mod symptoms of ulcerative colitis, off-label use to treat crohn’s and rheumatoid arthritis

AE: N/V, anorexia, and headache, steven’s johnson syndrome, photosensitivity

NC: decr absorption of digoxin, incr anticoagulation effects w/ warfarin

Contra: pts with sulfa allergy, hepatic impairment, anemia or other blood disorders

DIPHENOXYLATE W/ ATROPINE (TC, PC, MOA, AE, NC)

TC: antidiarrheal

PC: opioid

MOA: diphenoxylate is an opioid that slows down peristalsis, allowing water absorption to occur in the colon

AE: anticholinergic effects (dry mouth, drowsiness, tachycardia)

NC: acts within 45-60 mins, atropine is not added for therapeutic effect but to prevent pts from taking too much of the drug; higher doses will produce the anticholinergic effects of atropine, has low abuse potential and NO analgesic properties (if there is overdose, use naloxone); interacts with other CNS depressants (respiratory depression and altered LOC) and MAOIs (lead to hypertensive crisis)

PSYLLIUM (TC, PC, MOA, AE, NC, CONTRA)

TC: bulk-type laxative

PC: herbal agent

MOA: made from seeds of the plantain plant, and when taken with enough water, the psyllium swells and incr the size of the fecal mass, promoting passage

AE: if taken with insufficient water, it can swell and get stuck in the esophagus and cause obstruction

NC: several doses may be needed over 1-3 days to produce therapeutic effects, taken with at least 8 oz of water, juice, or milk, and administer immediately after mixing with liquid

Contra: pts w/ undiagnosed abdominal pain, intestinal obstruction or fecal impaction