PHARM FINAL EXAM

Epinephrine (Epi-pen)

Used for

• Hypotension

• Severe heart failure 

• Cardiac arrest 

Administration

• How to administer?

• Epipen cant be reused

• inject into outer thigh > hold firmly 5 seconds > remove > massage area

Macrolides

Used for:

• ?

Drugs

• ?

Side effects

• ?

Adverse SE

• ?

• resp infection, STI, alternative for people allergic to penicillin

• -thromycin

• GI distress

• QT prolonged, hepatotoxicity

Fluoroquinolone

Used for

• Resp infection

• Skin infection 

• Boint or joint infection

• UTI

• STI

Drugs

• ?

Adverse SE

• ?

Drug interactions

• ?

Nursing 

• ?

• -floxacin

• adverse SE

  • BLACK BOX WARNING = tendonitis/tendon rupture

  • Hepatotoxicity

  • GI distress

  • CNS (confusion, dizzy)

  • photosensitivity

  • CDIFF

• AVOID anti-acids + dairy + Mg, Ca, Fe, Al, Zn

• take 2 hrs before OR 2 hrs after the contraindicated drug + stay hydrated

When is a peak measured?

When is a trough measured?

• immediately after administration

• within 30 mins of the next dose

Aminoglycosides

Used for:

• ?

Drugs

• ?

Adverse SE

• ?

Nursing 

• ?

• pseudomonas infection

• gentramycin, neomycin, amikamycin, tobramycin, streptomycin

• ototoxicity, nephrotoxicity

• monitor peaks and troughs

Tetracyclines

Used for:

• Rocky mountain spotted fever 

• Lyme disease

• Chlamydia 

Drugs

• ?

Adverse SE

• ?

Contraindications

• ?

Drug interactions

Nursing

• ?

• (-cyclines)

• superinfection, photosensitivity, teeth mottling in kids under 8 y/o, disrupts oral contraceptives

• pregnancy, kids under age 8

• AVOID anti-acids + dairy + Mg, Fe, Ca, Al

• DONT take with food + stay hydrated

Sulfonamides 

Used for

• UTI

• Staph infection

Drugs

• ?

Adverse SE

• ?

Drug interactions

• ?

• (Sulf-)

• hepatotoxicity, steven johnson syndrome, agranulocytosis, anemia, disrupts oral contraceptives

• AVOID Celecoxib (2nd gen NSAID) bc cross sensitivity

Penicillin

Used for

• UTI

• STI

• Resp infection

Normal SE

• ?

Adverse SE

• ?

Drug interactions

• ?

Nursing

• ?

• GI distress

• anaphylaxis

• drug interactions

  • If person has penicillin allergy = AVOID Cephalosporin

  • AVOID caffeine

  • AVOID grapefruit

• Stay hydrated

Cephalosporin

Used for

• UTI

• tonsilitis/pharyngitis 

• Lower resp infection (ex: staph infxn)

• MRSA

Drugs:

• ?

Drug generations 

• which drug generation is best treatment for MRSA?

Adverse SE

• ?

Nursing

• ?

• (cef- or ceph-)

• 5th generaton; specifically Ceftaroline drug

• anaphylaxis + disrupts oral contraceptives

• AVOID anti-acids + Fe

Vancomycin

Used for: 

• Cdiff (oral route)

• MRSA (IV route)

Adverse SE

• ?

IV administration

• ?

• what do to if red man syndrome occurs?

Nursing

• ?

• ototoxicity, nephrotoxicity + if infused too fast = red man syndrome

• need to infused SLOW over 1 hour

• STOP infusion > let patient recover + give antihistamines if needed > restart infusion at SLOW rate

• monitor peaks and troughs

Azole drugs

Adverse SE

• ?

Drug interactions

• ?

Contraindications

• ?

• hepatotoxicity

• Azole drugs are a p450 inducer btw; AVOID grapfruit, anti-acids, -statins, warfarin, phenytoin

• liver disease, kidney disease, pregnancy

Nitrofurantoin

• brand name?

Used for 

• UTI

Normal SE

• ?

Adverse SE

• ?

Administration

• ?

• Macrobid

• GI distress + discolored urine (orange)

• pulmonary toxicity + hepatotoxicity

• eat w/food to reduce GI distress + hydration

Linezolid

• brand name?

Used for

• MRSA and VRE

Adverse SE

• ?

• Zyvox

• hypertension + if taken w/tyramine rich foods —> Serotonin Syndrome (SX: fever, altered mental status, clonus, sweating)

Metronidazole

Drugs:

• ?

Used for

• STI (trichomoniasis, BV)

• Cdiff

• Abdominal infections

Normal SE

• ?

Adverse SE

• ?

Nursing

• ?

• (-flagly)

• GI distress + metallic taste + dark urine

• if taken with alcohol —> disulfiram rxn (SX: vomit, flushing, cramps)

• AVOID alcohol + take w/food to reduce GI distress

Terbinafine

• brand name?

Used for

• Oral route used for?

• Topical route used for?

Adverse SE:

• ?

• Lamisil

• nail fungus

• jocks itch, athletes foot, ringworm

• hepatotoxicity, abdominal pain, anorexia

Influenza drugs 

Drugs

• ?

Nursing 

• ?

• (-amivir); Oseltamivir, Zanamivir, Peramivir

• NEED to take within 2 days of flu-SX appearance = or else its useless

• what drug is used to treat all 3 types of HPV?

Acyclovir

Hepatitis C treatment 

Drugs

• ?

Adverse SE

• ?

Contraindications

• ?

Nursing 

• ?

• ribavirin, interferon therapy

• hepatoxicity, anemia, suicide/depression, nerve demyelination, general sickness SX

• monitor for suicide/depression + hepatotoxicity

HIV treatment

• Uses anti-retroviral therapy

• what is the GOAL of therapy?

• REDUCE transmission from person-person via reduced viral load, but DOES NOT CURE anything

OPIOIDS

Drugs

• ?

• which drug combo forms Percocet?

• which drug combo forms Vicodin or Norco?

• Fentantyl patch info?

• Oxycontin extended release tablet info?

• Morphine adverse SE?

• Meperidine adverse SE?

Normal SE

• ?

Adverse SE

• ?

Contraindications:

• ?

Precautions:

• ?

• drugs

  • oxycodone

  • hydrocodone

  • morphine

  • fentanyl

  • meperidine

  • hypdromorphone

  • codeine

  • Percocet = combo of oxycodone + acetaminophen

  • Vicodin or Narco = combo of hydrocodone + acetaminophen

  • 72 hr duration. onset is 6-12 hrs. peak is 24-72 hrs

  • release is every 12 hrs

  • accumulation of toxic metabolites = hallucination, confusion, seizures

  • half life 2-4 hrs; accumulation of toxic metabolite risky for patient w/ kidney disease

• nausea, urinary retention/constipation

• orthostatic hypotension, sedation, confusion + overdose (resp depression, miosis, coma)

• resp depression + other CNS depressants

• asthma, seizure, children, elderly

Nursing process for opioid analgesics

• Assess vitals BEFORE and AFTER dose

• Before administering, perform medical history check for allergies + use of other CNS depressants (ex: alcohol)

• DONT ADMINISTER if respirations _____

• have ____ drug available for emergency 

• Infants + older adults more sensitive to resp.depression

• Long term use of opioids = results in ______

  • Teach pt to increase fluids and fiber + may need laxatives 

• Physical dependence (addiction) RARE for pt using med for short-term pain

• below 12 breaths per min

• Naloxone

• chronic constipation

Naloxone 

• Half life is ____

• Works best on PURE opioids

Nursing 

• which adverse SE can using Naloxone this risk?

• why monitor patient frequently?

Administration

• IV route preferred 

• Have resuscitation equipment ready 

• Multiple doses of Naloxone may be needed to outcompete long-acting opioids

• how to administer?

• 1-1.5

• withdrawal SX

• Opioid might outcompete Naloxone so we gotta keep an eye on patient

• Adminster dose 0.4-2mg →  if NO response then redose → repeat this every 2-3 mins —> if no response after accumulated 10mg = resusicatate + reassess diagnosis (bc the pt could be overdosed from a different non-opioid drug)

NON-OPIOIDS

1st gen NSAID (COX 1 and 2 inhibitors)

• high risk of ____

Used for

• ?

Drugs:

• ?

Adminstration

• for Ketorolac dosing rule?

Contraindications 

• ?

Nursing

• DONT take NSAIDs ____ before surgery 

• Will non-Aspirin NSAID protect against MI/stroke?

• GI ulcers/bleeding

• fever, inflammation, osteoarthritis

• Aspirin, Ibuprofen, Indomethacin, Naproxen, Diclofenac, Ketolorolac

• dont use more than 5 days, 40mg maximum per day

• GI ulcers/bleeding, CV issues, hypertension, kidney disease, bleeding disorders

• 1 week

• NO

Aspirin (acetylsalicylic acid)

MOA

• ?

Used for

• prophylactic for MI/stroke

• low-mod pain

• fever

• inflammation

Contraindicatons

Adverse SE

• ?

Nursing

• ____ patients usually have Aspirin sensitivity → monitor their breathing 

• antiplatlet, antiinflammatory, anti fever, anti pain

• contraindications

  • GI ulcers/bleeding

  • bleeding disorders

  • pregnancy

  • kids under 12 y/o with recent viral infection —> Reyes syndrome (SX: child looks constantly tired, sickness SX wont go away)

    • Aspirin is present in many OTC meds (Pepto bismol, Elka Seltzer, Exedrin)

    • Use Acetaminophen instead

• bleeding, GI distress, heartburn + Aspirin toxicity (aka salicylism; SX: tinnitus, kidney failure, confusion, hyperthermia, sweating)

• asthma

2nd gen NSAID (COX 2 inhibitors)

• Low risk of ____ but High risk of ____

Used for 

• low-mod pain

• inflammation

Drugs: 

• ?

Adverse SE

• ?

Contraindications 

• ?

Drug interactions

• ?

• GI ulcers/bleeding

• clotting/stroke/MI

• celecoxib, meloxicam

• adverse SE

  • Less risk for GI ulcer/bleeding

  • HIGHER clotting risk/stroke/MI

  • GI distress

  • Hypersensitivity (rash, asthma)

  • Kidney dysfunction

  • Photosentivity

  • Edema, weight gain

• kidney disease, history of thrombotic events, hypertension

• cross sensitivity with Sulfa drugs

Acetaminophen 

• Miscellaneous pain reliever (doesnt fall under NSAIDS classification)

MOA:

• ?

• NOT anti-inflammatory

• NOT anti-platelet

• SAFE for GI ulcers and Kidney issues

• Asprin alternative for kids under 12 y/o with recent viral infection

Toxicity

• ?

• antidote if overdose?

Drug interactions 

• SAFELY interacts with other anti-coagulants (ex: Aspirin) since its not a anti-platelet —> no bleeding risk

• affects hypothalamus to relieve fever + pain

• Acetaminophen toxicity (when dose > 4g or 4000 mg)

  • SX: hepatotoxicity

• Acetylsysteine (Mucomyst)

Gout

• Caused by excess uric acid buildup in joints 

• AVOID what food/drinks?

• Stay hydrated

Acute gout treatment

1. _____

2. _____

3. ____

• Adverse SE?

Chronic gout (hyper-uricemia) treatment 

1. ____

• MOA: inhibit uric acid production

• Adverse SE?

2. _____

• MOA: uric acid excretion via pee

• Adverse SE?

• alcohol and red meat

• indomethicen or any other NSAID

• corticosteroids

• Colcichine

• GI toxicity (**diarrhea)

• Alllopurinol

• steven johnson syndrome + agranulocytosis (SX: sore throat, sickness SX)

• Probenecid

• kidney stones

Neuropathy treatment 

• for both drugs, both cause CNS depressant SE, so need to AVOID CNS depressants

Pregabalin

• REPORT ____

Gabapentin

• REPORT ____

• mood changes/suicide/depression

• sudden rapid weight gain

Adalimumab, Ustekinumab, the other -mabs

Adverse SE

• ?

Nursing

• Before administration: ____

• If infection develops DURING treatment, pause drug > resume drug once no longer sick

• AVOID ____

• hepatotoxicity + increased infection risk

• patient cant be sick + might need to test for TB and Hepatitis to make sure there’s no latent infections

• sick people and crowds

Beta blockers

MOA

• ?

Used for:

• Hypertension

• Angina
  Migraines 

• Heart attack 

• Dysrythmia 

• Stage fright 

• Hyperthyroidism

3 drug categories:

1. Nonselective BB (blocks beta 1 and 2) 

• specific drugs?

2. Nonselective BB w/ additional vasodilating effect (blocks beta 1 and 2 + alpha 1) 

• specific drugs?

3. Cardioselective BB (only blocks beta 2) 

• specific drugs?

Common adverse SE amongst all BB:

• ?

Nursing 

• BEFORE administration: ___

• Monitor daily weight (bc BB can worsen heart failure)

• DONT withdraw abruptly → causes _____

• Masks SX of early diabetes (tachycardia) → watchout diabetics!

• blocks sympathetic nervous system

• Propanolol

• Carvedilol, Labetalol

• Atenolol, Metoprolol

• CNS affects (fatigue, suicide/depression + erectile dysfunction, nightmares) + bradycardia + AV heart block

• check apical pulse for a FULL MINUTE + blood pressure

• severe anxiety

Nonselective BB

Drugs

• ?

Adverse SE

• ?

Nursing 

• Propranolol

• CNS effects + bradycardia/AV heart block + bronchoconstriction

• DONT use if asthma/COPD

Nonselective BB w/vasodilating effect

Drugs

• ?

• Labetalol specific adverse SE?

Adverse SE

• ?

Nursing 

• ?

• Carvedilol, Labetalol

• weight gain from edema + pulmonary edema

• CNS effects + bradycardia/AV heart block + broncoconstriction + orthostatic hypotension (bc vasodilating effect)

• Nursing

  • DONT use if asthma/COPD

  • monitor for orthostatic hypotension especially if elderly

  • if using Labetalol = monitor lung sounds + REPORT weight gain

Cardioselective BB

Drugs

• ?

Adverse SE

• ?

Nursing 

• SAFE for asthma/COPD → BUT high dose can cause ironically cause bronchonstriction

• Metaprolol, Atenolol

• bradycardia/AV heart block + CNS effects

ACE inhibitors

MOA: inhibits ACE = blocks vasocontriction + blocks aldosterone 

Drugs:

• ?

Used for

• Hypertension

• Heart failure

• Heart protection after a heart attack 

• Kidney protection for diabetics 

Normal SE

• ?

Adverse SE

• ?

Contraindications

• Kidney disease (esp Renal Artery Stenosis)

• Pregnancy 

Nursing

• Captopril administration?

• Measure BP after administration (bc orthostatic hypotension)

• AVOID what drugs?

• often combo with what drugs for balanced K levels?

• Reduce dose if pt has what health condition?

• -pril (ex: Lisinopril)

• headache, nonproductive dry cough

• FIRST DOSE orthostatic hypotension (what worsens 1-3 hrs after administration) + angioedema (if this occurs, NEVER take ACE inhibitor again) + decreased GFR + hyperkalemia + If Captopril = neutropenia (SX: sickness SX)

• 2-3x daily

• NSAIDs

• thiazide or loop diuretics

• renal artery stenosis

ARBs

• Good alternative from ____ bc DOESNT have non-productive cough

Drugs:

• ?

Used for

• Hypertension

• Heart failure 

Adverse SE

• ?

Contraindication

• Kidney disease (esp Renal Artery Stenosis)

• Pregnancy

Nursing 

• AVOID what drugs?

• often combo with what drugs for balanced K levels?

• Dose reduction if patient has what health condition?

• ACE inhibitors

• (-sartans)

• angioedema + hyperkalemia + decreased GFR + ARB toxicity —> hypotension

• NSAIDs

• thiazide or loop diuretics

• renal artery stenosis

Dihydropyridines

MOA

• ?

Used for:

• Hypertension

• Angina  ***think: person doing vogue dips takes dihydropyridines before vogue set to avoid chest pain ***

Adverse side effect:

• _____

Drugs

• ?

Nursing process

• Monitor BP, heart rate

• Monitor liver + kidney 

• REPORT what adverse SE?

• AVOID what food?

• is this safe or unsafe to take with Digoxin?

• blocks Ca at blood vessels —> vasodilation

• hypotension + gingival hyperplasia + edmema/weight gain + facial flushing and rash (bc vasodilation)

• weight gain

• AVOID grapefruit

• SAFE with digoxin bc doesnt direclty affect the heart

NON-Dihydropyridines

MOA

• ?

Used for:

• Hypertension

• Angina

• Dysrhythmia

Normal SE

Adverse side effect:

• ?

Drugs

• ?

Nursing process

• Monitor BP, heart rate

• Monitor liver + kidney 

• REPORT what adverse SE?

• AVOID what food?

• AVOID what drugs?

• is this safe or unsafe to take with Digoxin?

• blocks Ca at HEART —> vasodilation

• constipation

• hypotension, edema/weight gain, AV heart block

• weight gain

• AVOID grapefruit

• AVOID BB —> caridiosuppression

• UNSAFE with digoxon —> Digoxin toxicity

Loop diuretics

Drugs

• ?

Used for

• Hypertension 

• Edema 

• Heart failure

Adverse SE

• ?

Drug interactions

• AVOID what drugs?

Admninistraiton

• ?

• (-ide); Furosemide (Lasix), Torsemide, Bumetanide

• hypotension, hyponatremia, hypokalemia + loop diuretic toxicity (SX: otoxicity)

• BB —> worsens hypotension + Digoxin —> digoxin toxicity + hypokalemia other hyponatremia causing drugs (ex: ACE inhibitor, ARB inhibitor)

• morning

Thiazide diuretics

MOA: excretion of water, Na, K

Used for

• Mild hypertension

• Edema

• DONT use for heart failure (bc not as potent as loop diuretics)

Drugs

• ?

Adverse SE

• ?

Drug interactions

• AVOID what drug?

Administration

• ?

Nursing

• patient with what conditions to be careful with this drug?

• -thiazide

• hypotension, hyponatremia, hypokalemia + increased uric acid + increased glucose + increased triglyceride levels

• digoxin —> digoxin toxicity

• safest to take in morning

• gout patients + diabetes melliitus patients + high cholesterol patients

Potassium sparing diuretics 

MOA: water and Na excretion + retains K

Used for

• Hypertension

• Edema

• Heart failure 

Drugs

• ?

Adverse SE

• ?

***think: im gonna spare u potassium, but at the tradeoff cost of 3 things…**

Contraindications

• ?

Administration

• ?

Nursing

• AVOID what foods?

• AVOID what drugs?

• -thiazide

• hypotension, hyponatremia, hyperkalemia (SX: diarrhea, cramp, muscle weak, fatigue, confusion) + erectile dysfuncton, gyneconmastia, irregular periods

• safest to take in morning

• AVOID K-rich foods (ex: bananas, oranges, leafy greens, sweet potato)

• AVOID ACE inhibitor and ARB inhibitors

Osmotic diuretics  

MOA: water excretion via osmotic effect

Used for:

• Hypertension

• Severe head injury 

• Glaucoma

• Renal excretion of toxic substances

Drugs:

• ? (just one)

Adverse SE

• ?

Nursing

• MONITOR lung sounds, kidneys function, urine output

• Reflex tachycardia + Rapid fluid shifts → worsened heart failure and pulmonary edema

Alpha 2 agonist

MOA: decrease sympathetic response

Used for 

• Hypertension  

Drugs

• ?

Clondine 

• an alpha 2 agonist

Used for

• ?

Adverse SE

• ?

Administration

• ?

Nursing 

• DONT stop abruptly → or else ____

• Relieve dry mouth with ice chips, hard candy, hydration

• Monitor for ___ 

• pain relief

• dryness everywhere, drowsy, orthostatic hypotension

• transdermal patch; lasts 1 week + location sites include upper arms or torso

• drowsiness

• these drugs ARE NOT DIURETICS. they just relax bladder muscle to pee easier/completely empty bladder

Drugs

• ?

Used for 

• ?

Adminstration

• ?

Nursing 

• Monitor orthostatic hypotension

• Used combo with what drugs for most effective BPH treatment?

• Tamulosin + any drugs ending with (-zosin)

• BPH

• take at bedtime

• 5-alpha reductase inhibitors (Finasteride, Dudasteride)

MOA: decreases prostate size in people with BPH

Drugs

• ?

Normal SE

• ?

Contraindications 

• ?

Nursing

• Used combo with which drugs for most effective BPH treatment ?

• If woman is touching this drug, what should these girlies do so?

  

• Finasteride, Dudasteride

• Decreased sex drive + decreased cum volume

• pregnancy

• Flomax or (-zosin) drugs

• women need to wear gloves when handling this drug

Adrenergic agonist 

MOA: increased sympathetic effect

Used for:

• Severe heart failure (via improving perfusion)

• Emergency cardiac arrest

• Shock

• Hypotension 

Drugs:

• Dopamine

• Doputamine 

• Epinephrine 

Adverse SE: occurs from excess Alpha 1 stimulation

• ?

• Hypertensive crisis, dysrhytmia, angina + Necrosis that occurs after extravstation (basicallt the necrosis of tissue due to IV drug leaking into tissue and injures it so badly the tissue dies) —> STOP infusion immediately

Anti-cholinergics for asthma/COPD

MOA: blocks AcH from attaching to airway → prevents bronchoconstriction 

Drugs

• ?

Normal SE

• Headache 

• Dryness

• Non-productive cough

• GI distress

Adverse SE

***usually stays local, but if absorbed systematically = these adverse SE occur***

• Hypotension

• Vision problems (increased intraocular pressure cant be drained from eye)

• Anxiety, restless

Contraindications 

• Glaucoma 

• Benign Prostatic Hyperplasia (BPH)

Intranasal corticosteroids 

MOA: decrease inflammation and edema 

Used for

• Most effective maintenance for Allergic rhinitis 

• Allergies

Normal SE:

• Headache

• Sore throat

• Dried nasal mucosa > burning/itching sensation

• Epistaxis (nosebleed)

Administration 

• ?

1st gen intranasal steroids

• ?

2nd gen intranasal steroids

• ?

• patient tilts head forward > dont let the nozzle touch septum during administration > dont blow nose for 1 min post-administration

• Beclomethasone, Tramcinolone, Flunisolide, Budesonide

• Mometasone, Ciclesonide, Fluticasone propionate, Fluticasone furoate

Decongestants

• Short term treatment

• Sympathomimetic 

MOA: activates receptors @ nose blood vessels > vasoconstriction > nasal drainage + decreased pressure 

Used for:

• Rhinitis

• Sinus 

• Common cold

Oral decongestants 

• drug example?

• Pros?

• Cons?

Nasal decongestants 

• Pros?

• Cons?

Drugs: 

• Ephedrine (Emerphed)

• Phenylephrine (Sudafed PE)

• Oxymetazoline (Afrin)

• Tetrahydrozoline (Tyzine Nasal)

Administration

• Use ____ MAXIMUM

• Take in the morning/daytime

• Sit down when administering

Nursing

• Limit caffeine/ stimulants

• Report: dizziness, palpitations, weakness, excessive irritability

• pseudoephedrine

• DOESNT risk rebound decongestion

• slow onset (but long duration)

• fast onset (but short duration)

• RISKS rebound decongestion

• 5

Leukotriene Receptor Antagonists (LTRAs)

MOA: non-bronchodilating; blocks leukotriene receptor @ trachea smooth muscle → anti-inflammation 

Used for:

• ?

Drugs

• ?

Adverse SE:

• ?

Administration

• ?

Nursing process:

• DONT use for _____

• CHRONIC asthma + allergic rhinitis

• has (-leuk or -leukast) in it

• GI distress (+diarrhea), insomnia, headache

• acute asthma or any type of COPD

Antihistamines

1st gen antihistamines (aka sedating)

• drugs?

2nd gen antihistamines (minimal sedating)

• drugs?

• long acting, so take ___ a day

Adverse SE

• ?

Contraindictions

• Glaucoma 

• Kidney issues

• Babies/infants + breastfeeding + 3rd trimester of pregnancy

Nursing process

• Report: excess sedation, confusion, hypotension

• Cautious if pt has ____sensitivity

• Be cautious using for kids/elderly 

• Caution with driving, etc…

• Avoid CNS depressants

• Chlorpheniramine, Diphenydramine, Meclizine, Prometazine

• Loratidine, Cetirazine, Fexofenadine, Deslotoradine

• once

• dryness, hypotension, sedation (from mild drowsy to deep sleep)

• asthma

Antitussive

Used for:

• ?

Drugs

• ?

Adverse SE

• ?

Administration

• ?

Nursing process

• Before administration =____

• REPORT_____

• nonproductive cough relief

• opioid antitussives (codeine, hydrocodone) + non-opioid antitussives (dextromorthphan, benzonatate)

• tilt head forward > dont let tip of nozzle touch septum/aim AWAY from septum > droplet > dont blow nose 1 min afterward

• persistent fever, cough lasting over 1 week, sickness SX = bc this indicates the nonproductive cough is caused by smth else

Beta 2 agonists

MOA

• ?

SABA drugs

• ?

LABA drugs

• use how many times daily?

• BLACK BOX WARNING: ______

LABA monotherapy

• ?

LABA with inhaled corticisteroids 

• formoterol and budesonide (Symbicort)

• formoterol and mometasone (Dulera)

• salmeterol and fluticasone( Advair)

Adverse SE of Beta 2 agonists

***beta 2 agonists are sympathomimetics**

• ?

Nursing for Beta 2 agonists

• Have inhaler with you 24/7

• Only use inhalers 2x daily

• If person is prescribed SABA and inhaled corticosteroids, use SABA first then corticosteroids after

• used for quick relief of ACUTE asthma/COPD exaserbation

• Albuterol, other (-uterol), Terbutaline

• 2x daily

• contraindicated if using LABA monotherapy alone for chronic ASTHMA

• CNS (restless, insomnia, anxiety, high HR, palpitations, urinary retention/constipation

Theophylline

Used for

• ?

Drugs

• ?

Toxicity

• Therapeutic range?

• Mild toxicity SX?

• Severe toxicity range?

• Severe toxicity SX?

Administration

• ?

Nursing process

• Monitor blood levels

• AVOID _____

• CHRONIC asthma/COPD

• Theodur

• 10-20

• restless, insomnia, GI distress

• 30+

• seizures, tachycardia, palpitations

• take in morning

• caffeine/stimulantd + smoking (=decreased TE)

Digoxin

MOA: cardiac glycoside that influx Ca into cardiac cells → ___ contractions, ___ HR, ___conduction

Used for

• 2nd line drug for Heart failure (bc narrow toxicity index)

• Afib

Toxicity 

• Therapeutic index?

• Antidote?

• Early toxicity SX: headache, bradycardia, GI distress, anorexia

• Late toxicity SX: confusion, bad vision, weak muscles 

Drug interactions 

• AVOID drugs?

Nursing process

• Before administration _____

• Check electrolytes + kidney function (bc rmb hypokalemia → increases digoxin toxicity)

• increased

• decreased

• decreased

• 0.5-2

• digifab

• BB, non-dihydrodipines (Veramapil, Diltiazem), hypo-kalemia causing drugs (thiazide, loop),

HMG reductase

MOA: reduce LDL + raise HDL

Drugs

• ?

Adverse SE

• ?

Before administration

• ?

Administration

• ?

Contraindications

• ?

Nursing

• Takes 1-2 months to see effect

• AVOID what drugs?

• AVOID what food?

• Encourage what diet?

• (-statin)

• heptatotoxicity + myglais —> myostitis —> rhabdomylosis

• obtain lipid panels + liver tests + CK levels (bc CK tells us abt muscle breakdown level)

• best to take at evening (which is when cholesterol is synthesized inside our body)

• liver disease, pregnancy

• Digoxin —> bc dixogin toxicity

• grapefruit

• low-fat high-veggie diet

Nitroglycerin 

MOA: reduced cardiac workload + vasodilation  

Normal SE

• ?

Adverse SE

• ?

Contraindicated 

• ?

General nursing 

• Have BP monitor at home  

Rapid acting nitroglycerin

• Used for?

• Drugs + thier routes?

Long acting nitroglycerin 

• Used for?

• Drugs + their routes?

• headache

• orthostatic hypotension, reflex tachycardia

• head injury + erectile dysfunction drugs (Slidenafil, Tadanafil) + hypotension-causing drugs

• treating acute chest pain episodes

• nitroglycerin (SL tablet, nasal spray, IV route)

• maintaince to prevent chest pain

• isosorbides (slow release enteric coated tablet) + nitrodur/nitrobbid (ointment) + transderm nitro (transdermal patch)

Rapid acting nitroglycerin

IV administration

• ?

Sublingual administration 

• how to use it?

• what feeling in ur mouth is NORMAL?

• Expiration?

• May take 1 sublingual tablet before ____ to prevent angina

• SAFE to use SL tablet concurrently w/ transdermal patch ONLY for____

Long acting nitroglycerin 

Slow release tablet administration 

• ?

Ointment administration

• ?

Transdermal administration

• SAFE to use SL tablet concurrently w/ transdermal patch ONLY for____

• Taking long acting nitrates should not stop you from using acute angina methods

• titrate based on blood pressure

• place 1 tablet tongue every > if chest pain isnt relieved after 1st tablet, take 2nd tablet and call 911 > can only take maximum 3 tablets

• burning/tingling

• 3 months

• exercise

• ACUTE angina

• DONT stop abruptly (bc rmb this is long term use) —> or else rebound angina

• place on paper > tape to skin > NO RUBBING it after

• ACUTE angina

Sildenafil, Tadalafil 

MOA

• ?

Used for:

• Pulmonary arterial hypertension

• Erectile dysfunction 

Normal SE

• ?

Contrainication

• ?

• vasodilation of pulmonary arteries

• headache, flushing, orthostatic hypotension, vision issues, penis erection

• chest pain drugs (nitroglycerin, isosorbides, nitrodur, transderm nitro)

ANTIPLATELETS, ANTICOAGULANTS, THROMBOLYTICS

General nursing for anticoagulants

• AVOID blood thinning meds (NSAIDS, aspirin, warfarin, ginkgo, feverfew, garlic)

• AVOID unnecessary venipunctures and IM injections

• AVOID straining when pooping

• AVOID giving if bleeding disorders (agranulocytosis, thrombocytopenia)

• Use soft toothbrush + electric razor 

• Fall precautions + dont walk around barefoot 

• Wear medical alert bracelet saying they’re on Heparin or Warfarin (so healthcare workers know which antidote to administer) 

yes

Antiplatelets 

Drugs

• ?

Used for

• Prevent clot formation 

Adverse SE

• ?

Contraindications

• bleeding disorders

Nursing 

• ?

• (-grel) and also Aspirin

• bleeding + thrombocytopenia (when platelets < 100,000)

• DONT administer 1 week before surgery

Anticoagulants 

Drugs

• ?

Heparin

• is this faster or slower than Warfarin?

Adverse SE

• ?

Therapeutic monitoring 

• Need to draw ____ blood lab levels

• Goal: _____

• Antidote: if APTT too long = IV promatine sulfate 

Nursing: 

• Monitor APTT, CBC, platelets, heart vitals

• If swelling/pain/bruising at IV site = DONT give med

• If given by ___ route = its used as prophylactic to prevent clot formation

• If give by ___route = its used for acute “now” treatment of a growing clot 

• Heparin REQUIRES another nurse to _____

  • Bc Heparin is the only drug in this category that uses IV route = high risk 

Warfarin

• Works slower than Heparin → often used combo w/Heparin for this reason

Adverse SE

• ?

Therapeutic monitoring 

• Need to draw _____ blood lab levels 

• GOAL: _____

• Antidote: if PT/INR too long = ____

Contraindicatons 

• ?

Administration

• Take strict schedule (same time everyday)

Drug interactions

• AVOID what drugs?

Nursing 

• Take a few days for full effect

• Maintain consistent (dont increase or decrease) diet of vitK foods (leafy green veggies, liver, liver, green tea)

• AVOID vitK supplements (bc basically negates warfarin effects)

• heparin, warfarin, enoxaparin

• faster

• bleeding, hypotension, bruising, decreased LOC + heparin induced thrombocytopenia (HIT)

• APTT

• 60-80 seconds

• IV protamine sulfate

• SQ route

• IV route

• double check the dose

• bleeding, hypotension, bruising, decreased LOC

• PT/INR

• 2-3

• vitamin K

• pregnancy ***think: preggo women dont want their husbnds going to war bc death*

• antifungals + antibiotics

Enoxaparin (Lovenox)

• a low molecular weight

• NOT same thing as Heparin, so units CANNOT be interchanged 

• DOESNT use APTT monitoring 

Drugs ( -parin)

• Enoxaparin (lovenox)

• Dalteparin 

• Tinzaparin 

Route

• ?

Adverse SE

• Bleeding 

  • Antidote: _____

Contraindications

• _____ ***think: equinox for 100 days challenge**

• _____ ***think: got rash from using equinox bikes*

Nursing 

• Monitor thrombocytopenia + platelet count CANNNOT be below ____)

• protamine sulfate

• thrombocytopenia within previous 100 days

• hypersensitivity (anaphylaxis rxn)

• 100,000

Newer anticoagulants 

Drugs

• Dabigatran

  • adverse SE?

  • contraindicated what health condition?

• Apixibab

• Rivaroxaban

Adverse SE:

• ?

• Black box warning: ?

Nursing 

• Monitor CBC 

• GI ulcers

• kidney issues

• risks bleeding

• spinal hematoma is used on patient with spinal epidural or any spinal puncture

Thrombolytics 

Drugs

• ?

Contraindications 

• ?

Before administration

• Review contraindications 

• Monitor baseline vitals

• Monitor EKG

• Monitor CBC + platelets 

• If pain/swelling/bruising at IV site = DONT give med

Adverse SE:

• ?

Nursing: 

• Monitor vitals

• Report signs of bleeding

  • IV site swell/burns

  • Urinary catheter site

  • Altered mental status

  • Abdominal pain

  • Heavy menstrual bleeding, gums, nosebleed

  • Blood in urine/black poop

• (- ase); alteplase, urikinase, reneplase, etc…

• preggo women + uncontrolled hypertension ( > 180/110), bleeding

• allergic rxn (chest pain, SOB, rash) + hemorhage + hypotension + dysrhythmia (due to sudden re-perfusion of oxygenated blood to myocardium)

Quinidine

• what class of dysrhythmia drug is this?

• ?

Used for: 

• ?

Normal SE:

• ?

Adverse SE:

• ?

Administration

• take every _____

Nursing

• AVOID what food?

• class 1a Na channel blocker

• Afib

• diarrhea

• adverse SE

  • AV heart block

  • hypotension

  • QT prolongation

  • thrombocytopenia

  • if overdose —> ototoxicity (tinnittus, vertigo, headache, nausea)

Class 3: potassium channel blockers

Drugs

• ?

Used for

**used for the SERIOUS stuff fr….*

• ?

Adverse SE

• list the advere SE + their corresponding intervention/nursing info

Nursing

• AVOID what food?

• (-darone); amiodarone, dronedarone

• ventricular dysrhytmia, ventricular tachycardia

• adverse SE ***think: PPBBHH-TVD**

  • Pulmonary toxicity —> need to do a chest xray before administration

  • Photosensitivity —> wear sunglasses/protective clothing

  • Balance issues —> careful ambulating

  • Bradycardia and Hypotension —> monitor pusle + BP

  • Hepatotoxicity —> monitor LFT

  • Thyroid issues —> can cause hypo or hyperthyroidism, so need thyroid panel beforehand

  • Vision issues —> need regular eye exams

  • Dysryhtmia —> monitor EKG, electrolytes, QT prolongation

• grapfruit
  

Rifampin

Used for

• ?

Drugs 

• ?

Normal SE

• ?

Adverse SE

• ?

Administration

• ?

Nursing

• ?

• tuberculosis

• (rifa-); rifabutin, rifapentine

• orange colored body fluids

• hepatotoxicity

• take on empty stomach (1 hr before meal OR 2 hr after meal)

• Rifampin is P450 inducer —> disrupts oral contraceptives —> use non-hormonal methods (ex: condoms)

Isoniazid

Used for

• ?

Adverse SE

• ?

• antidote if neuropathy occurs?

• active AND latent tuberculosis

• hepatoxicity + neuropathy

• B6

SSRI

MOA: decrease serotonin reuptake —> more serotonin available

Drugs

• ?

Adverse SE

• ?

Drug contraindication

• ?

• Fluoxetine (Prozac) ← drug of choice for major depression

• adverse SE

  • GI distress

  • CNS (insomnia, restless, anxiety, agitation)

  • Sexual dysfunction 

  • Thrombocytopenia → bleeding risk

  • If used in late pregnancy →  neonatal withdrawal syndrome (poor feeding, crying, insomnia) + persistent pulmonary hypertension of the newborn (SX: baby has resp distress)

• MAOI, (-triptans), TCA, SNRI —> results in serotonin syndrome

ANTI-ANXIETY

Benzodiazepines 

• High abuse potential  !!! 

Drugs: 

• ?

Used for

• ?

Adverse SE

• ?

• antidote if overdose?

Nursing

• what if the patient wants to get off this drug?

• anti-seizure tolerance can develop from long term use (but doesnt apply if used for anxiety or sedation)

• (-pam or -lam); Lorazepam, Diazepam (valium) Clonazepan, Alprazolam (xanax) etc…

• adverse SE (think: benzos will either put you to bed or hit the panic button and wake tf up)

  • Drug of choice for acute panic attack

  • Drug of choice for insomnia 

  • General ansethesia

  • Help patients withdrawal from alcohol use

• adverse SE

  • CNS depression

  • Amnesia

  • Paradoxical effects in children and elderly (anxiety, insomnia, euphoria)

  • if IV route —> risks resp depression, cardiac arrest, hypotension

• Flumanezil IV push for 30 sec —> may need repeat dose bc duration is 1 hr

• Taper off SLOWLY

Buspirone 

• is this safe for long term use + why or why not?

• onset?

Used for 

• ?

Adverse SE

• ?

Drug interactions 

• ?

Nursing 

• Take for how long for the full effect?

• Take consistently on schedule (not a PRN drug bc this is for generalized anxiety)

• safe for long term bc its a non-CNS depressant —> no risk for dependence

• slow onset (2-4 weeks)

• generalized anxiety disorder

• nausea, dizzy, nervous, excitement

• AVOID grapefruit and erythromycin

• 1 month

Tricyclic antidepressants
MOA: prevent reuptake of serotonin —> more serotonin available

Drugs

• ?

Adverse SE

• ?

Drug interactions

• ?

Administration

• ?

Nursing

• Monitor EKG + orthostatic hypotension

• (-tryptline or pramine); Amitriptyline, Nortriptyline, Desipramine, Imipramine

• adverse SE ****hint: I Tried to make this relationship work but it was too Toxic for my Heart (cardiac toxicity) so now im tired (sedation) and all shriveled inside (dryness)**

  • CNS depression

  • cardiac toxicity

  • sedation

  • orthostatic hypotension

  • dryness

• AVOID MAOI, anticholinergics, sympathomimetic decongestants (ex: ephedrine) bc of the excess norepinephrine, other CNS depressants

• give at bedtime (bc sedation SE)

MAOI drugs

MOA: blocks MAOI neurotransmitters → increased serotonin, dopamine, norepinephrine

Used for

• ?

Adverse SE

• ?

Drugs

• ?

• which of these drugs is the only transdermal route?

Drug interactions

• AVOID sympathomimetics (ex: decongestants like Ephedrine)

• AVOID other antidepressants (SSRI, SNRI, TCA) → risks ____

• AVOID tyramine-rich food → risks ____

• AVOID other CNS depressants 

Nursing 

• When changing to a different antidepressant, whats the washout period?

  • whats the washout period if specifically using Fluoxetine?

• Check use of OTC cold meds (ex: Ephedrine)

• atypical depression, bulimia, panic attacks, OCD

• CNS (anxiety, restless, insomnia) + orthostatic hypotension + if taken w/tyramine rich food —> hypertensive crisis

• Translycypromine, Isocarboxazid, Phenelzine, Selegiline

• serotonin syndrome (SX: “worst headache of my life”, hyper-reflexia, tremors, fever, sweating)

• hypertensive crisis

• 2 weeks

• 5 weeks

whats one major adverse SE that all anti-psychotic drugs (whether theyre typical or atypical anti-psychotics) have in common?

• neuroepileptic malignant syndrome (SX: super high fever, sweating, rigidity, seizure)

1st gen antipsychotics

• are these typical or atpical anti-psychotics + what does this indicate?

MOA: blocks dopamine 

• onset?

Drugs:

• ?

Adverse SE

• ?

Detailed deep dive into the EPS adverse SE:

• which one can occur within hours-days?

  • is it reversible?

  • antifdote?

• which one can occur within days-weeks?

  • is it reversible?

  • antifdote?

• which one can occur within weeks-months?

  • is it reversible?

  • antifdote?

• which one can occur within from long term use months later?

  • is it reversible?

  • antifdote?

• typical —> this means they have higher EPS risk

• 1 month for full effect

• Haloperidol, Chlorpromazine, Loxapine

• adverse SE

  • Extrapyramidal SX

  • Neuroepileptic malignant syndrome (SX: high fever, sweating, rigidity, seizures) —> STOP immediately —> antidote is Dantrolene and Bromocriptine

• Acute dystonia (SX: spasms of face and neck)

• reversible

• Akathasia (SX: cant sit still, pacing)

• reversible

• Parkinsonism (SX: bradykinesia)

• reversible

• Irreversible tardive dyskinesia

• irreversible

2nd gen antipsychotics

• are these typical or atypical anti-psychotics + what does this mean?

MOA: moderately blocks dopamine 

Drugs:

• ?

Adverse SE

• ?

• atypical —> they are newer drugs that have lower risk of EPS

• Clozapine, Olanzapine, Risperidone, etc….

• adverse SE

  • Neuroepileptic malignant syndrome (SX: high fever, sweating, rigidity, seizure)

  • Metabolic syndrome (SX: hyperlipidemia, weight gain, obesity)

Clozapine

• is this a 1st or 2nd generation anti-psychotic?

Used for

• 2nd line drug for Schizophrenia

Adverse SE

• ?

Nursing 

• Monitor ___

• 2nd gen

• EPS + neuroepileptic malignant syndrome + myocarditis + FATAL agranulocytosis + deadly if used @ dementia patient

• CBC

Metochlorpramide (Reglan)

MOA: blocks dopamine +  GI prokinetic drug

Used for

• ?

Normal SE

• ?

Adverse SE

• ?

• nausea/vomiting + diabetic gastroparesis

• diarrhea

• EPS + dryness + hypotension + irreversible tardive dyskinesia (if used long term)

Central anticholinergic

Used for

• ?

Drugs

• ?

Normal SE

• ?

Adverse SE

• ?

Nursing

• Patient education: notify the nurse if experiencing ____

• Provide hydration (ice chips, drinks, sugar-free hard candy) to relieve dry mouth

• Increased fluid/fiber (to prevent constipation)

• BE CAREFUL exercising or being in hot weather

• Drug of choice for parkinsons tremors + cogwheel rigidity + sialorrhea

• Benztropine, Tryhexylphenidil, Biperiden, Procyclidine

• Dryness + sedation

• Confusion @ elderly + orthostatic hypotension + Hyperthermia (since u cant sweat to cool urself down)

Phenytoin (Dilantin)

Used for

• seizures

Normal SE

• ?

Adverse SE

• ?

Toxicity

• Therapeudic range is ___

  • If 20-30 = ___

  • If 30-40 = ____

  • If 40+ = ____

Administration

• when to give?

• DONT stop abruptly → risks ____

• DONT use what route?

• rules for using IV route?

• what if patient is on enteral feedings?

• how does food affect Phenytoin absorption?

Nursing

• Phenytoin and Dilantin are the same drug, but different formulations are NOT interchangeable due to differences in absorption + dosing  

• nausea, gingival hyperplasia

• leukocytopenia + steven johnson syndrome + hepatotoxicity + purple glove syndrome if IV administered too fast

• 10-20

• diplopia, nystagmus

• ataxia, slurred speech

• coma

• take same time everyday (so strict schedule) without missing a dose

What to do if u missed a dose

• Warfarin?

• Phenytoin or other seizure drugs?

• Levadopa?

• Inhaled corticosteroids?

• DONT DOUBLE DOSE. take as soon as you rmb if within the SAME DAY. if its already the next day, just accept you missed the dose.

• DONT DUBLE DOSE. take as soon as you rmb (bc u dont want parkinsons SX to quickly return)

• take as soon as you rmb (bc u dont want that seizure to happen no maam)

• DONT DOUBLE DOSE. just accept you missed the dose

Carbmazepine

Used for

• ?

Therapeudic index

• Therapeudic blood level _____

Normal SE

• ?

Adverse SE

***think: stumbling thru a maze made of carbs ( baguette trees, candy fruit, etc… ) while intoxicated with alcohol (hepatotoxicity). Steven johnson syndrome from being allergic to nearby plants + bleeding from getting scraped ( bone marrow suppression/Aplastic anemia). Youre low on survival salt packets stolen from the wedding reception (hyponatremia). You become sus bc spidey senses start tingling (used for Trigeminal neurlogia)***

• Bone marrow suppression → Aplastic anemia + Agranulocytosis from scraping yourself 

• Hepatoxicity 

• Steven johnson syndrome 

• Hyponatremia (from SIDH - syndrome of inappropriate ADH)

1. SX: confusion, headache, weakness, slurred speech

• Drug of choice for partial seizures + trigeminal neuroglia + BPD

• 8-12

• nausea + photosensitivity + vision issues

• adverse SE

  • bone marrow suppression —> aplastic anemia + agranulocytosis

  • hepatotoxicity

  • SIADH —> hyponatremia, confusion, headache

  • steven johnson syndrome

Lithium

Used for:

• ?

Expected SE

• ?

Adverse SE

• ?

Contraindications

• ?

Therapeudic range

• Normal TI for maintenance treatment: ____

• Lithium toxicity mainly caused by ____

• If overdose need to do hemodialysis 

Drug interactions

• AVOID ______

• Lithium worsens SX of what health condition?

• Carbamazepine, Haloperidol → neurotoxicity 

• SSRI + SNRI —> worsens Mania 

Nursing

• Maintain sodium intake (dont increase/decrease) → discuss with HCP before adjusting 

  • Keep Na levels normal range (135-145)

• Hydration

• Monitor lithium levels:

  • 8-12 hrs first dose

  • 3x weekly during month 1

  • every week after month 1

• Monitor kidney function + electrolytes + thyroid function 

• Monitor patients with diabetes insipidus   

• drug of choice for mood stabilizer + preventing suicide

• polyuria + increased thirst + metallic taste + impaired memory

  • if impaired memory —> titrate the dose

• nephrotoxicity + hypothyroidism w/goiter + leukocytosis ( = infxn risk) + lithium toxicity (SX: GI distress, tremors, drowsy)

• hyponatremia

• dehydration, hot weather, diuretics, NSAIDS

Levodopa-carbidopa

Used for

• ?

Drugs

• ?

Normal SE

• ?

Adverse effects

• ?

Contraindicated 

• ?

Administration

• ?

Nursing

• good for how many years before effect is diminished?

• washout period before switching to another drug?

• drug of choice for parkinsons bradykinesia

• Sinemet, Parcopa

• discolored brown body fluid + orthostatic hypotension

• dyskinesia (involuntary movement) + on/off syndrome + altered mental (psychosis, hallucination)

  • if on/off syndrome occurs —> can ask HCP to adjust dose OR preventable by taking combo with either: Dopamine agonist (-triptan), MAO-B inhibitor, COMT inhibitor

• glaucoma + precancerous skin lesions

• admninstration:

  • take on empty stomach

  • AVOID high protein meals (or take 30 min before OR 1 hr after high protein meal)

  • AVOID B6 foods (beef liver)

• 3-5 years

• 8 hours

Dopamine agonists

• what 3 things makes this different from levadopa-carbidopa?

Used for

• ?

Drugs

• ?

Adverse SE

• ?

• doesnt need to be converted into dopamine + safe for high protein meals + decreased risk of dyskinesia

• drug of choice for early parkinsons

• ropinrole, pramipexole

• adverse SE

  • Orthostatic hypotension

  • Involuntary movements (dyskinesia)

  • Compulsive behaviors (gambling, alcoholism) 

  • Insomnia + Daytime somnolence (“sleep attacks”)

MAO-B inhibitors

MOA: irreversible inhibition of MAO-B brain (which naturally breakdown Dopamine) → increased Dopamine 

Used for

• ?

Drugs

• ?

Adverse SE

• ?

Food and drug interactions

• AVOID tyramine rich foods) → risks ____

• AVOID OTC cold medications (sympathomimetics) and SSRI (antidepressants) → risks ____

Administration

• when to give?
  

• drug of choice for on/off syndrome in parkinsons disease

• (-gilline) **think: gilline keeps it going*

• adverse SE

  • CNS (light-headed, confusion, dizzy, headache)

  • Dryness

  • Insomnia 

  • Orthostatic hypotension

• give in morning (bc insomnia SE)

COMT inhibitors

MOA: inhibits COMT (which naturally breaksdown Levadopa) → more Levadopa can cross BBB 

Used for

• used in combo w/levadopa to increase levadopa bioavailability

Drugs

• ?

Expected SE

• ?

Adverse SE

• ?

• (-capone); Tolcapone, Entacapone

• urine discoloration (brown/orange)

• hepatotoxicity + GI distress + worsened dyskinesia

Dopamine facilitator

• Works fast (a few days) but lasts only 6-12 months 

Used for

• ?

Drugs

• Amantadine 

Normal SE

• ?

Adverse SE

• ?

• levadopa-induced dyskinesia (uncontrolled movements)

• dryness + orthostatic hypotension + CNS effects (confusion, dizzy)

• livedo reticularis (aka skin mottling) + kidney toxicity (bc drug is excreted from kidneys)

Drugs for local muscle spasms 

• ?

Drugs for spasticity 

• ?

• diazepam, tizadine **think: just a tinge = small local spasm = tizadine*

• diazepam, baclofen, dantrolene

  • dantrolene is the only one here that ONLY acts on skeletal muscles + doesnt affect CNS

Baclofen

Used for

• ?

Adverse SE

• ?

Nursing

• Is this used short or long term?

• DONT STOP ABRUPTLY → or else _____

  • Antidote?
    

• drug of choice for muscle spasticity

• CNS depression (sedation, drowsy, dizzy) + resp depression

• LONG term (so pls continue using even after mucle spasticity SX go away)

• Baclofen withdrawal (SX: rebound spasticity, fever, sweating, fluctuating BP, tachycardia, hyperventilation, hallucination, seizures)

• Diazepam

Dantrolene (Dantrium)

MOA: acts on skeletal muscle 

Used for:

• ?

Normal SE

• ?

Adverse SE

• ?

• Muscle spasticity + Antidote for malignant hyperthermia

• diarrhea

• hepatotoxicity + sedation + acne-like rash

Neuromuscular blocking agents: Non-Depolarizing 

• what differentiates this from Succinylcholine?

Drugs

• ?

Used for

• Endotracheal intubation (for when Succinylcholine cant be used)

Nursing 

• can muscle paralysis be resolved?

• only affects muscles so conciousness and pain STILL INTACT

• (-coronium); Rocuronium, Vecuronium

• yes reversible with Neostigmine

Neuromuscular blocking agent: Depolarizing 

Used for

• Endotracheal intubation 

Drugs

• ?

Adverse SE

• ?

• Antidote for malignant hyperthermia?

Nursing

• can muscle paralysis be resolved?

• succynocholine, ethosuximide

• hyperkalemia + malignant hyperthermia (SX: high fever, sweating, flushed skin, severe hypotension, ridigity, dysrhythmia, hyperventilation, brown urine)

• Dantrolene

• Nope just gotta wait for the paralysis effect to naturally go away

Neostigmine, Pyridostigmine

MOA:

• ?

Used for:

• ?

 Adverse SE

• ?

• antidote?

Administration

• when to give?

Nursing 

• Monitor breathing, HR, muscle strength 

• prevents Ach breakdown via blocking acetylcholinesterase → increased Ach available at muscles—> improved muscle contraction  

• Mysathenia gravis + reversal of Rocuronium and Vecuronium muscle relaxants

• cholinergic crisis (SX: resp depression, paralysis, parasympathetic SX)

• neostigmine

• at least 30 min before meals (to prevent aspiration)

Serotonin agonist 

MOA:

• ?

Used for

• ?

Drugs

• ?

Adverse SE

• ?

Drug interactions

• ?

Contraindications

• ?
  

• vasoconstriction —> decreased inflammation and pain

• drug of choice for migraines

• (-triptans)

• adverse SE

  • If overused → headache

  • Hypertension

  • Chest pain

  • Thrombolytic event (MI, stroke)

• SSRI, TCA, SNRI, MAOI → Serotonin syndrome

• CV issues (HT, hyperlipidemia_, thrombolytic history) + smoking + liver disease

Amphetamines

• high abuse potential !!!

Used for

• ADHD

Drugs

• ?

Adverse SE

• ?

Contraindicated 

• Hypertension 

• CV disease

• MAOI drugs (antidepressant) → risk hypertensive crisis

Administration

• when to administer?

• adverse SE ***corticosteroid vibes***

  • CV (hypertension, palpitations, tachycardia, angina)

  • CNS (dizzy, insomnia, restless, anxiety)

  • Hyperglycemia 

  • Thrombocytopenia → bleeding risk 

  • Growth suppression @ children 

  • Anorexia

• Methylphenidate, Dextroamphetamine 

• in morning (bc this drug is a stimulant)

Cholinesterase inhibtors 

MOA: prevent AcH breakdown in brain → improves cognition in Alzheimers 

Used for

• Alzheimers

Drugs

• ?

Adverse SE

• ?
  

• Donezepil, Rivastigmine, Galantime **think: Riva is so Done with Galantime*

• bradycardia (if dose too high) + GI distress + dizzy

NMDA antagonist  

• Newer drug for alzheimers thats WELL TOLERATED

Drugs

• ?

Used for

• Moderate to severe alzheimers 

• Memantine

Atropine 

MOA: dopamine boost —> sympathetic response

Used for

• ?

Adverse SE

• ?

Contraindiactions 

• ?

• Symptomatic bradycardia + Antidote for cholinergic crisis + Dilate eyes for eye exam + reduce pre-op secretions

• adverse SE ***basically sympathetic response **

  • Confusion @ elderly 

  • Dryness

  • Tachycardia 

  • Atropine toxicity (SX: delirium, hyperthermia, severe tachycardia) 

• BPH + Glaucoma