Nurs304: Module 5 Drugs/Prototypes

Chlorpromazine HCL

• Generic name: Thorazine

• Therapeutic class: Anti-psychotic (first generation/typical)

• Pharm class: Phenothiazine

• Primary use: for severe mental illness
  Mechanism of action: Blocks the excitement of the positive symptoms of schizophrenia; Act by preventing dopamine and serotonin from occupying critical and neurological receptor sites

• Adverse effects: Acute dystonia, akathisia, Parkinsonism, tardive dyskinesia, anticholinergic effects (drying of mouth, urinary retention, postural hypotension or orthostatic hypotension), sedation, hypotension, sexual dysfunction, menstrual disorders, and neuroleptic malignant syndrome

• Herbal/Food Alerts: We are told that Kava and St. John's wort may increase the risk and severity of dystonia (dystonic or painful muscle reactions)

  • inform patients to stay away from these herbals

Haloperidol

• Generic name: Haldol

• Therapeutic class: Anti-psychotic (first generation/typical)

• Pharm class: Non phenothiazine

• Primary use: Severe mental illness

• Mechanism of action: Blocking of the dopamine type 2 receptor

• Adverse effects: Identical to that of phenothiazines

• Administration Alerts: We should not abruptly discontinue this drug! Adverse reactions may occur and we should wean it off slowly

Chlorpromazine HCL

• Generic name: Thorazine

• Therapeutic class: Anti-psychotic (first generation/typical)

• Pharm class: Phenothiazine

• Primary use: for severe mental illness
  Mechanism of action: Blocks the excitement of the positive symptoms of schizophrenia; Act by preventing dopamine and serotonin from occupying critical and neurological receptor sites

• Adverse effects: Acute dystonia, akathisia, Parkinsonism, tardive dyskinesia, anticholinergic effects (drying of mouth, urinary retention, postural hypotension or orthostatic hypotension), sedation, hypotension, sexual dysfunction, menstrual disorders, and neuroleptic malignant syndrome

• Herbal/Food Alerts: We are told that Kava and St. John's wort may increase the risk and severity of dystonia (dystonic or painful muscle reactions)

  • inform patients to stay away from these herbals

Haloperidol

• Generic name: Haldol

• Therapeutic class: Anti-psychotic (first generation/typical)

• Pharm class: Non phenothiazine

• Primary use: Severe mental illness

• Mechanism of action: Blocking of the dopamine type 2 receptor

• Adverse effects: Identical to that of phenothiazines

• Administration Alerts: We should not abruptly discontinue this drug! Adverse reactions may occur and we should wean it off slowly

Risperidone

• Generic name: Risperdal

• Therapeutic class: Anti-psychotic

• Pharm class: Second generation/ Atypical antipsychotic

• Primary use: Severe mental illness; threats of both positive and negative symptoms; Beneficial for the treatment of schizophrenia

• Mechanism of action: Block dopamine type 2 receptors, serotonin (5-HT) and alpha-adrenergic receptors

• Adverse effects: Fewer than those of phenothiazines and nonphenothiazines, but obesity and its risk factors need to be monitored

• Drugs treat both positive and negative symptoms of schizophrenia and they have become the drugs of choice for treating psychoses.

Lorazepam and Alprazolam

• Generic name: Ativan and Xanax

• Therapeutic class: Anti-anxiety, sedative, hypnotic

• Pharm class: Benzodiazepines

• Primary use: For anxiety disorders and insomnia

• Mechanism of action: Binds to GABA receptor chloride channel molecule, which intensifies GABA effects

• Adverse effects: Drowsiness, dizziness, respiratory depression, sedation

Sertraline

• Generic name: Zoloft

• Therapeutic class: Antidepressant

• Pharm class: SSRI

• Primary use: Generalized anxiety and depression

• Mechanism of action: Increases availability of serotonin at specific postsynaptic receptor sites located within the CNS.

• Adverse effects: Dizziness, nausea, insomnia, somnolence, confusion, seizures, sexual dysfunction
  

Imipramine

• Generic name: Tofranil

• Therapeutic class: Antidepressant

• Pharm class: TCA

• Primary use: For major depression

• Mechanism of action: To inhibit reuptake of norepinephrine and serotonins

• Adverse effects: Orthostatic hypotension, sedation and anticholinergic effects (drying effects), rarely, cardiac dysrhythmias

  • Not for use for patients with heart attack, heart block, or arrhythmia

Bupropion

• Generic name: Wellbutrin

• Therapeutic class: Antidepressant

• Pharm class: SNRI

• Primary use: For depression

• MOA: To inhibit the reuptake of serotonin

• Adverse side effects: Headache, insomnia, hypertension

  • Cholinergic symptoms like constipation, dry mouth, loss of appetite, weight loss, tremors, abnormal vision, headaches, nausea, vomiting, dizziness, and loss of sexual
    

Phenelzine

• Generic name: Nardil

• Therapeutic class: Antidepressant

• Pharm class: MAOI

• Primary use: For depression

• Mechanism of action: To decrease the effectiveness of monoamine oxidase

• Adverse effects: Orthostatic hypotension, headache, insomnia, and diarrhea

  • Avoid foods containing tyramine including avocados, bananas, raisins, figs, java beans, beer, wine, papaya, beef, salami, sausages

Phenobarbital

• Generic name: Luminol

• Therapeutic class: Sedative/Hypnotic, Anticonvulsant

• Pharm class: Barbituates

• Primary use: As a sedative and hypnotic

• Adverse effects: Tolerance, respiratory depression, psychological and physical dependence, and can be linked very closely with addiction

Lithium Carbonate

• Generic name: Eskalith

• Therapeutic class: Mood stabilizer

• Primary use: Bipolar disorder

• Mechanism of action: Affects sodium transport across cell membranes

  • The exact mechanism of action is unknown

• Adverse effects: Excessive loss of sodium (so as the nurse and part of the medical team we need to make sure to monitor their serum sodium levels!)
  

Enalapril

• Generic name: Vasotec

• Therapeutic class: Anti-hypertensive

• Pharm class: ACE inhibitor

• Primary use: For hypertension

• Mechanism of action: Inhibits effects of angiotensin II, lowering peripheral vascular resistance and decreasing blood volume so we have a reduction in preload

• Adverse effects: Nagging and persistent cough (in some people it is related to the stimulation of bradykinin in the lungs) and hypotension

  • These are known to cause angioedema (associated with African-American people). It can lead to airway and intestinal issues and is an emergency!

Losartan

• Generic name: Cozaar

• Therapeutic class: Anti-hypertensive

• Pharm class: Angiotensin-receptor blockers (ARB)

• Primary use: For hypertension

• Mechanism of action: To block angiotensin receptors in arterial smooth muscle and adrenal glands so we will have a blockade in the RAAS system

• Adverse effects: Hypotension

Metoprolol and Atenolol

• Generic name: Lopressor and Tenormin

• Therapeutic class: Anti-hypertensive

• Pharm class: Beta blockers

• Primary use: For hypertension, to reduce blood pressure

• Mechanism of action: Decrease heart rate and contractility; blockade beta 1 receptors in juxtaglomerular apparatus which inhibits the secretion of renin and the formation of angiotensin II

• Do not give these drugs to asthmatic or patients with pulmonary disease (pulmonary constriction); These should also not be given to diabetics because they mask the signs of hypoglycemia

Nifedipine

• Generic name: Procardia

• Therapeutic class: Anti-hypertensive

• Pharm class: Calcium channel blocker

• Primary use: For hypertension and angina

• Mechanism of action: Block calcium ion channels which cause vasodilation, decreasing blood pressure

• Adverse effects: Include dizziness, headache, and flushing

• Interactions: Grapefruit juice may enhance absorption for calcium channel blockers so we must educate patient to watch consuming grapefruit in their diet

• Overdose: Calcium infusion

• DOC of antihypertensive for African Americans

Doxazosin

• Generic name: Cadura

• Therapeutic class: Anti-hypertensive

• Pharm class: Alpha 1-Adrenergic antagonist

• Primary use: Hypertension

• Mechanism of action: To block sympathetic receptors in arterioles leading to vasodilation; decreased peripheral vascular resistance, which decreases blood pressure

• Adverse effects: Orthostatic hypotension, dizziness, nausea, nervousness, fatigue

Hydralazine

• Generic name: Apresoline

• Therapeutic class: Anti-hypertensive

• Pharm class: Direct-acting vasodilators

• Primary use: For severe hypertension and hypertension crisis

• Mechanism of action: To cause vasodilation by direction relaxation of arterial smooth muscle

• Adverse effects: Reflex tachycardia (response to a sudden drop in blood pressure; your heart will speed up to compensate for such a radical change in pressure within the vessel), sodium and fluid retention

  • There are too many adverse effects for these to be first-line agents (dangerous/must be used with caution)
    

Atorvastatin

• Generic name: Lipitor

• Therapeutic class: Antilipidemic

• Pharm class: HMG-CoA reductase Inhibitor/statin

• Primary use: Reduces serum-lipid levels

• Mechanism of action: Inhibits HMG-CoA reductase

  • Statins can drop LDL, lower triglycerides, and lower VLDL, and raise HDL

  • HMG-CoA reductase inhibitors are responsible for cholesterol biosynthesis or the formation of cholesterol.

• Adverse effects: Headache, fatigue, muscle or joint pain, and heartburn, rarely rhabdomyolysi, severe myopathy
  

Cholestyramine

• Generic name: Questran

• Therapeutic class: Antipidemic

• Pharm class: Bile-Acid Resins

• Primary use: To lower serum-lipid levels

• Mechanism of action: Bind with bile acids (which contain a lot of cholesterol) increasing cholesterol excretion in stool

• Adverse effects: GI tract, such as bloating and constipation

Niacin

• Generic name: Niacor

• Therapeutic class: Antilipidemic

• Pharm clme: ass: Nicotinic Acid

• Primary use: To reduce triglycerides; because LDL is synthesized from VLDL you will also get a reduction in LDL

• Mechanism of action: To decrease VLDL levels

• Adverse effects: Flushing, hot flashes, nausea, excess gas, diarrhea; more serious effects like hepatotoxicity and gout possible

  • The adverse effects make the drug undesirable for a lot of patients

  • Niacin also can raise fasting glucose so it might not be the correct lipidemic for diabetics
    

Gemfibrozil

• Generic name: Lopid

• Therapeutic class: Antilipidemic

• Pharm class: Fibrin-Acid agent

• Primary use: Treating severe hypertriglyceridemia

• Mechanism of action: Unknown

• Adverse effects: GI distress, watch for bleeding with patients on anticoagulants

  • When we combine them with statins we greatly reduce our triglycerides
    Preferred drugs for treating hypertriglyceridemia
    

Ezetimibe

• Generic name: Zetia

• Therapeutic class: Antilipidemic

• Pharm class: Cholesterol Absorption Inhibitor

• Primary use: Modest reception in LDL

• Mechanism of action: Inhibits absorption of cholesterol in intestinal walls

• Adverse effects: No serious side effects