exam 1 pharm drugs

acetaminophen (Tylenol)

MOA:
Therapeutic use:
Routes:
SE/AR:
Teaching:
Toxicity:
Antidote:

inhibits (weak) prostaglandins synthesis and inhibition of hypothalamic heat regulator center

used to decrease pain and fever

PO,PR, IV

anorexia, N/V, constipation, peripheral edema, hepatotoxicity, hearing loss, oliguria

keep out of reach of children, no self-medicating for >10 (>5 for kids), call poison control for OD, avoid alcohol

Toxic: s/s, N/V/D, abd pain, monitor LFTs

antidote: acetylcysteine

ketoralac (Toradol)

MOA:
ketoralac (Toradol)
therapeutic use:
Route:
SE/AR:
Contraindicated:
interactions:

inhibits synthesis of prostaglandins by different form so the COX enzyme, blocks COX-1 and COX-2 enzymes

decreases pain and fever, inflammation

PO,IM,IV (PO not approve for <17 years old

dizziness, tinnitus, GI upset, bleeding, renal failure

open heart surgery, pregnancy

anticoagulants, aspirin, lithium, ACE inhibitors, decreases laxis effect

Morphine

MOA:
therapeutic use:
Route:
SE/AR
Contraindications

depression of the CNS, depression of pain impulses by binding the opiate receptors in the CNS

relive moderate to severe pain

PO,IM,IV

dry mouth, nausea, drowsiness, anxiety, agitation, urinary retention, euphoria, insomnia diaphoresis, respiratory depression, GI obstruction


hypersensitivity, CNS or respiratory depression, status asthmaticus, increased intracranial pressure, shock, alcohol use disorder, ileus, hypovolemia, dysrhythmia

hydromorphone (Dilaudid)

MOA:
therapeutic use:
route:
SE/AR:
Contraindications :

opioid agonist that binds to several receptors

for moderate to sever pain

PO,IV,IM,PR (rare)

dizziness, drowsiness, headache, euphoria, constipation, respiratory depression, orthostatic hypotension, urinary retention

head injury, asthma, shock, hypotension

fentanyl (Sublimaze)

MOA:
therapeutic use:
Route:
SE/AR:
nursing considerations:

a synthetic opioid agonist, which acts primarily at the mu-opioid receptor

moderate to severe pain and anesthesia induction and maintenance

IV, IM, transdermal

drowsiness, euphoria, headache, fatigue, vomiting, confusion, respiratory depression, hypokalemia

check for old patches before applying a new one, cleanse old patch site, give slow IV push, check vital signs

hydrocodone /APAP (Vicodin, Lortab)

MOA:
Therapeutic use:
route:
SE/AR:
nursing considerations:

binds to receptor agonist and produces analgesic effects by activating mu-opioid receptors

to treat moderate to moderately severe pain

PO

headache, dyspepsia, N/V, dehydration, edema, flushing, abdominal pain, constipation, dyspnea

increases fluids and fiber intake, no additional Tylenol, taper off usage

Buprenorphine & Naloxone (suboxone)

MOA:
therapeutic use:
Route:
SE/AR:

Binds to receptors. to decrease cravings for drug, mixed narcotic agonist/antagonist

for opioid withdrawal/ dependence

sublingual

N/V, muscle aches, headaches, depression, diaphoresis, weakness

naloxone (Narcan) (reversal agent)

MOA:
therapeutic use:
route:
SE/AR:

blocks the receptor and displaces any opioids that would normally be at the receptor

opioid overdose

IV, IM, intranasal

tachycardia, N/V and sweating

Adjuvant Analgesics

*Gabapentin (Neurontin) - acts on peripheral nerves ad CNS by inhibiting spontaneous neuronal firing
-used for neuropathic pain and migraine prevention

*Tricyclic antidepressants (TCAs)- amitriptyline/ Cymbalta
-using a multi-class approach allows for a potential opioid dose

Cannabis

Dronabinol (Marinol)
-synthetic form of THC
-used to treat chemotherapy N/V anorexia related to AIDS, when other standards have failed
-FDA approved
_not great for pain control

Benzodiazepines

used for anxiety, sedation, etoh withdrawal, sleep induction, spasticity, N/V

Lorazepam (Ativan)

MOA:
therapeutic use:
route:
SE/AR:
Nursing considerations:
Antidote:

increases GABA to GABA receptors

treat insomnia, reduce anxiety, seizures, ETOH withdrawal, sedation induction

PO,IV, IM

drowsiness, dizziness, hypotension ,amnesia, memory impairment , and agitation

fall risk, monitor UOP, monitor for CNS depression and respiratory depression, asses vitals, no driving, no other sleep aids

Flumazenil (Romazicon)

Flumazenil (Romazicon) (reversal agent)

MOA:
indications:
SE/AR:

inhibits the activity of benzodiazepine and non-benzodiazepine substances that interact with benzodiazepine receptors site on the GABA/ benzodiazepine receptor complex

reversal of conscious sedation

agitation, confusion, tremors chest pain, dizziness

Lidocaine hydrochloride (Xylocaine)

-Used for:
Nerve Blocks, epidural & spinal anesthesia, can also be used topically to treat pain; and can be used for cardiac dysrhythmias
-Moderate Acting (1-3 hours)
-VARIOUS forms for use:
*1%/2% with injection (nerve blocks)
*Patches for pain (Lidoderm)
*Viscous lidocaine
*Gels
*Spray (airway anesthesia)

Midazolam (Versed)

MOA:
therapeutic uses:
Route:
SE/AR:
Nursing considerations:
Antidote:

potentiates the GABA receptors

used for seizures, sedation/anestheisa induction, given to children prior to surgery

IV,IM,PO

can cause respiratory depression with use of opioids, dizziness, and drowsiness, similar to other benzos

same for other benzos

Flumazenil (Romazicon)

Cyclobenazaprine (flexeril)

MOA:
therapeutic use:
route:
SE/AR:

relaxes skeletal muscles, acts at brainstem level:
structurality resembles tricyclic antidepressant

alleviate muscle spams associated with acute painful musculoskeletal conditions, unlabeled use for the management of fibromyalgia

PO

anticholinergic effects, drowsiness, dizziness, headache fever, abdominal pain, ED, liver dysfunction

Isoproternal (Isuprel)

MOA:
route:
Use:
SE/AR:

works on beta-adrenergic (1and 2) to casue vasoconstriction and increase heart rate

IV

shock, hypotension states

tachycardia, hypertension, excessive vasoconstriction, and poor organ perfusion

Epinephrine (adrenaline)
MOA:
route:
use:
SE/AR:
nursing considerations:
Antidote:

alpha 1 (increases blood pressure through vasoconstriction) Beta 1 (increases heart rate by inotropic action) beta 2 (promotes bronchodilation)

IV,Im, ETT, SQ

Anaphylaxis, anaphylactic shock, bronchospasm, status asthmaticus, cardiogenic shock, cardiac arrest

cardiac dysrhythmias, palpitations, tachycardia, hypertension, headache, restlessness, tremors, hyperglycemia

monitor vital and urinary output, monitor IV sites for infiltration, teach the use of EpiPen (blue to sky orange to thigh)

for IV infiltration- phentolamine (regitine)

Albuterol Sulfate (ventolin)

MOA:
route:
use:
SE/AR

selective beta 2 agonist
acts on beta 2 receptors of smooth muscle on lungs, uterus, vasculature

inhaled, PO

bronchodilation and decreases spasms

headache, tremor, dizziness, muscle cramps, palpitation, tachycardia, hypertension

phenylephrine (neosynephrine)

MOA:
route:
use:
SE/AR:
Nursing considerations:

stimulates alpha 1 receptors to cause vasoconstriction

intranasal, IV, PO

sinus/nasal congestion, hypotension, and shock (IV)

poor organ and tissue perfusion with excessive vasoconstriction, headache

educate pts with HTN to avoid cold medication OTC, IV sites monitoring, monitor VS

Atenolol (Tenormin)

MOA:
route:
use:
SE/AR:
nursing considerations:

selectively blocks beta 1 adrenergic receptor sites, decreases sympathetic outflow to the periphery, suppresses renin-angiotensin-aldosterone system

PO

treat hypertension, angina prophylaxis, and treatment of acute MI

orthostatic hypotension, rebound hypertension if stopped abruptly,
emotional changes, bradycardia, dizziness, shortness of breath, weakness

consult with HCP before taking OTC cold meds educate rising slowly from reclining position, educate how to check HR

Metoclopramine (Reglan)

MOA:
route:
use:
SE/AR:

direct-acting cholinergic agonist that blacks dopamine in the CTZ in the CNS

PO IV

GERD, nausea, gastroparesis

sedation, fatigue, tardive dyskinesia

Bethanechol (Urecholine)

MOA:
Route:
use:
SE/AR:
nursing consideration:
antidote:

stimulates cholingeric recepptors, promotes contraction of the bladdar, increases GI secretions and peristalsis

PO SQ

urinary retention, neurogenic bladder

abdominal cramps, hypersalivation, diaphoresis , headache, weakness, flushing, tachycardia hypertension

monitor urinary output, vitals, education regarding orthostatic hypotension, and parkinsonism, do not give pt with bowel obstruction or urinary obstruction

atropine

Varenicline (Chantix)

MOA:
route:
use:
SE/AR

partial nicotine agonist and prevents binding of nicotine to receptors

PO

a decreased desire to smoke

mental status changes, mood changes

donepezil (Aricept)

MOA:
Use:
Route:
SE/AR:

Blocks the breakdown of acetylcholine and allows
acetylcholine to accumulate at the neuromuscular junction

Alzheimers disease

PO (usually taken at bedtime)

GI (mild to severe, diarrhea, nausea, vomiting), headache

Doxazosin (Cardura)

Not as commonly used More likely to cause:
Orthostatic hypotension Reflex tachycardia

It also treats sx of benign prostatic hyperplasia
Relaxes muscles of the bladder and prostate to allow urine flow

Atropine

MOA
uses:
SE/AR
nursing considerations

inhibits acetylcholine by occupying the receptors, increases heart rate by blacking vagus stimulation, promotes pupil dilation by blocking iris sphincter muscle

preoperatively to reduce salivation, bradycardia, cholinergic crisis, dilate pupils for diagnostic exams

dizziness, dry mouth, headache, insomnia, flushing mydriasis, palpitations, urinary retention

monitor VS, urinary output, and constipation (increase fiber, fluids, and movement)
bed alarms for confusion, oral care, and eye drops for dry eyes.