Drug cards

SABA (short acting beta agonist)

Bronchodilator

• Attach to beta-receptors that relax the

muscles in your lungs

• "Rescue inhaler"-only used when needed

• Onset: minutes

• Duration: 4-6 hrs.

• Ex: albuterol (Airsupra), albuterol sulfate

(Pro Air)

• Side effects: Tachycardia, tremors,

restlessness (stimulant

LABA (long acting beta agonist)

Bronchodilator

• "Maintenance"-used daily

• Not for quick relief

• Onset: Minutes

• Duration: ~12 hrs.

• Combine with ICS for best

outcomes

• Ex: formoterol (Symbicort),

salmeterol (Advair)

ICS (inhaled corticosteroids)

• "Maintenance"-used daily

• Decreases airway inflammation

• Decreases frequency of exacerbations

• Onset: Days to weeks

• Often combined with LABAs for best

results

• Ex: fluticasone (Flovent), budesonide

(Pulmicort)

Leukotrine Modifiers

• "Maintenance"-used daily

• Decreases airway inflammation

• Decreases bronchoconstriction

• Decreases mucous production

• Not routinely used in COPD clients

• Monitor for neuropsychiatric changes:

mood changes, anxiety, insomnia,

depression, suicidal ideation

• Ex: montelukast (Singulair)

Mucolytics

• Thins mucous to make the cough more

productive

• Help prevent exacerbations

• Rinse mouth to prevent thrush

• Encourage fluid intake up to 3 Ls

• Take with food to prevent GI upset

• Ex: N-acetylcysteine (NAC)

ACEI (angiotensin-converting enzyme inhibitors)

-pril

MOA: Inhibits angiotensin I conversion to angiotensin II (

ARBs (Angiotensin Receptor Blockers)

-sartan

MOA: Blocks angiotensin II at receptor site

CCBs (calcium channel blockers)

-ine

MOA: Prevents calcium from entering channels of vascular smooth muscle,

causing vasodilation

• Common Agents: amlodipine, nifedipine, diltiazem

• Adverse Effects: Slower heart rate, Hypotension/Headache, Reflex

tachycardia, Edema, Dizziness

• Mnemonic: SHRED

• Nursing Considerations:

• Avoid grapefruit

• Don't abruptly stop - reflex tachycardia and angina

• Slow position changes

• Careful use with HF patients

• Angina/MI with initiation

Thiazide and Thiazide-Type Diuretics

OA: Decreases sodium & water reabsorption in distal tubules

• Common agents: hydrochlorothiazide and chlorthalidone

• Adverse effects: Orthostatic hypotension, Calcium increases, Uricemia,

Rash/Raises blood sugar, Elevated lipids, Sun sensitivity, Electrolyte losses

• Mnemonic: CURES Edema

• Nursing Considerations:

• Monitor Electrolytes!

• Educate on orthostatic hypertension

• Slow position changes

• Gout

Beta Blockers

-olol:

slow HR, decrease vasoconstriction, decrease O2 consumption. Used in: HF, HTN, HR control, angina, migraine. AE: HF, bronchospasm, dizzy, constipation, suppresses hypoglycemia indicators. Contra: asthma, bradycardia.

Nursing: check HR before giving. Teach: take med at bedtime, do not stop abruptly. Propranolol=essential tremors, Parkinsons

ANTICHOLINERGICS (MUSCARINIC ANTAGONISTS)

• Indication: Urge incontinence

• Examples: oxybutynin, tolterodine, solifenacin

• MOA: blocks bladder muscle receptors, preventing contractions and the urge to void

• Adverse Effects: Blurred vision, constipation, dry mouth and eyes, anhidrosis,

photophobia, tachycardia, hallucinations, confusion, flushed skin, urinary retention

• Can't See, Can't Pee, Can't Spit, Can't sweat, Can't poop

• Red as a beet, Dry as a bone, Blind as a bat, Mad as a hatter, Hot as a hare, Full as a flask

• Nursing Considerations: Contraindicated with urinary retention, gastrointestinal

problems, and uncontrolled narrow-angle glaucoma.

• Avoid use in older adults: Confusion!

• Increase dietary fiber and consume 2-3 L/day of fluid

CHOLINERGICS (MUSCARINIC AGONISTS)

Indication: Urinary retention

• Example: bethanechol

• MOA: Stimulates bladder contraction and sphincter muscle relaxation

• Adverse Effects: diarrhea and GI cramping, diaphoresis, headache, nausea &

vomiting, bradycardia, hypotension, bronchospasm, increased salivation

• Nursing Considerations: Do not give if patient has GI or urinary tract obstructions,

asthma, bradycardia, hypotension, or Parkinson's Disease.

• Can alter liver enzymes

• Take on empty stomach

• Can interact with antihistamines, tricyclic antidepressants, and phenothiazines

Diuretics

Act on the kidneys to increase urine production

• Several classes

• Thiazide

• Loop

• Potassium sparing

• More to come in Nursing II!

STOOL SOFTENERS/SURFACTANT LAXATIVES

• Example: docusate

• MOA: Lowers surface tension of stool so water can penetrate & soften

• Good to use for patients who need to avoid straining

• Adverse Effects: Electrolyte imbalance with prolonged use

• Nursing Considerations: BM should occur within 12 -72 hours

• CAUTION: Don't use with bowel obstruction keeps building up

Use with postpartum surgery Anastasia post op

STIMULANT LAXATIVES (CATHARTICS)

• Examples: bisacodyl, senna (sennosides)

• MOA: Stimulates intestinal peristalsis

• Adverse Effects: Stomach discomfort, nausea, diarrhea, cramps, and fluid

& electrolyte loss

• Nursing Considerations: BM should occur within ___ hours

• Don't take within 1 hour of milk or antacid

• CAUTION: Avoid with bowel obstruction

• Can create dependence

OSMOTIC LAXATIVES

• Examples: polyethylene glycol, magnesium hydroxide, lactulose,

glycerol, saline enema

• MOA: Draws water into the intestine to ↑ moisture in stool and stretch

intestinal muscle (causing peristalsis)

• Adverse Effects: Abdominal cramping, diarrhea, fluid & electrolyte

imbalance, dehydration

• Nursing Considerations: Bowel movement should occur in 24-48 hours.

• May interact with some antibiotics

• CAUTION: Don't use with bowel obstruction

• Don't use if pregnant or breastfeeding

BULK-FORMING LAXATIVES

• Examples: psyllium, calcium polycarbophil, methylcellulose

• MOA: Supplemental fiber to increase bulk of stool

• Adverse Effects: Increased bloating, abdominal pain, obstruction

• Nursing Considerations:

• Try to take 2 hours before or after other meds WHY?

• Sufficient water (8 oz at least)! WHY?

LUBRICANT LAXATIVES

Examples: mineral oil (oral or enema)

• MOA: lubricates the stool to allow easier passage of a hard stool

• Adverse Effects: GI discomfort, anal seepage, ____-soluble vitamin

malabsorption, dehydration electrolyte imbalance

• Nursing Considerations:

• Do not take orally with other meds

• CAUTION: Possible oil aspiration

Opioid Antagonists

• Indication: Opioid-induced constipation

• Examples: naloxegol, methylnaltrexone, naldemedine

• MOA: Blocks the opioid mu receptors in GI tract

• Adverse Effects: abdominal pain, nausea, vomiting, diarrhea, and

flatulence

• Nursing Considerations: Slight chance of opioid withdrawal symptoms or

poorer pain control

ANTI-INFECTIVE ANTIDIARRHEALS

• Example: bismuth salts

• MOA: Inhibits intestinal secretions antimicrobial action

• Adverse Effects: Dark tounge and/or grayish-black stools

• Nursing considerations:

• Do not use with aspirin allergy (breaks down into salicylate)

ANTICHOLINERGIC

• Examples: loperamide

• MOA: blocks action of acetylcholine, slowing mobility of the

intestines

• Adverse Effects: Fluid or electrolyte imbalance with prolonged use

• Nursing Considerations: Avoid using in patients with severe dehydration,

electrolyte imbalance, liver/renal disorders, or glaucoma

• Seek care if

• No diarrhea improvement within 2 days

• Fever develops

• Dehydration occurs

OPIOID ANTIDIARRHEAL

• Examples: paregoric (opium tincture)

• MOA: decreases intestinal motility and secretions

• Adverse Effects: lethargy, respiratory depression, confusion

• Nursing Considerations: Schedule III drug

Can cause dependence

Last resort

ANTIFLATULENCE AGENT

Examples: simethicone

• MOA: coalescence of gas bubbles facilitates passage of intestinal gas

• Adverse Effects: bloating constipation, diarrhea

ANTIHISTAMINES

ANTIHISTAMINES

– Block histamine receptors on lymphocytes in the GI and respiratory

tracts and blood vessels. Do not reduce amount of histamine

• Dry secretions with anticholinergic effect

• Cause drowsiness

• Can be given through oral, IV, intranasal, and ophthalmic routes

• 1st generation: diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton)

• 2nd generation (little to no drowsiness): cetirizine (Zyrtec), fexofenadine

(Allegra), levocetirizine (Xyzal), loratadine (Claritin)

Mast Cell Stabilizers

– decrease release of histamine

• Inhaled and intranasal for allergic rhinitis; ophthalmic solutions for allergic conjunctivitis

• Leukotriene Modifiers

block the action of inflammatory leukotrienes

• Montelukast, zafirlukast & zileuton

• Reduce inflammation and nasal congestion and prevent asthma-induced airway constriction

Corticosteroids

– anti-inflammatory and suppression of immune system

• Topical, oral, IV, IM, ophthalmic, intranasal, or inhaled routes

• CAUTION: Long-term use can cause hyperglycemia, extremity muscle wasting, and deposition of

fat in face and neck

Nitrofurantoin

(Macrobid)

Nitrofuran antibiotic (class)

Treats uncomplicated UTI Concentrates in urine

• GI upset

• Renal function

considerations

• Safe for Pregnancy

Take with food

• Urine may turn brown

TMP-SMX (Bactrim)

Sulfonamide antibiotic (Class)

Treats susceptible UTIsInhibits bacterial growth

• SJS risk

• Photosensitivity

• Avoid during pregnancy

• Increase fluids

• Wear sunscreen

• Report rash

Cephalexin (Keflex)

Cephalosporin Antibiotic (Class)

Treats susceptible UTIs

• Inhibits cell wall synthesis

• Nephrotoxic

• Watch for C-diff

• Hypersensitivity risk

Phenazopyridine (Pyridium)

Analgesic (Class)

Relieves dysuria

• Orange/red urine

• GI upset

• Does not treat infection

Urine discoloration

• May stain clothing

NSAID

Ketorolac (Toradol) (med)

Pain relief

• GI irritation

• GI bleeding

• Renal effects

• Report S/S GI bleeding

Opioid analgesic

Morphine (med)

Severe pain

• Used if NSAIDs ineffective

• Respiratory depression

• Sedation

• Hypotension

• Avoid alcohol

• Avoid driving

Cns depression or depression

Thiazide diuretic

Hydrochlorothiazide (HCTZ) (med)

Prevents calcium stones•

Hypotension

• Electrolyte changes k

• Rise slowly

• Maintain prescribed fluids

Alpha blocker

Tamsulosin (Flomax) (med)

Relaxes ureter

• Helps stone passage

• Dizziness

• Orthostatic hypotension

• Rise slowly

• Use caution with dizziness

Urinary alkalinizer

Potassium citrate (med)

• Increases urine pH

• Prevents stones in acidic urine

• GI upset

• Potassium changes

• Take as prescribed

• Maintain fluid intake

Xanthine oxidase inhibitor

Allopurinol (med)

Decreases uric acid

Grout

• Prevents uric acid stones

• GI upset

• Rash• Maintain fluids

• Report rash

Rapid acting insulin

Rapid acting

Sub q

lispro (Humalog)

lispro biosimilar (Ademolog)

lispro aabc (Lyumjev)

aspart (Novolog) (Fiasp)

glulisine (Apidra)

insulin human (Afrezza) inhaler

Onset 5-15

Short acting

Short Acting

Sub q

regular (Humulin R) (Novolin R) (ReliOn R)

regular (Humulin R) (Concentrated U-500)

Onset 30 min

Intermediate insulin

Cloudy

Sub q

Intermediate

NPH (Humulin N) (Novolin N)(ReliOn N)

This / ?

Onset 2 hr

Long Acting

Sub q

Long Acting

glargine (Lantus) (Basaglar) (Toujeo)

detemir (Levemir)

degludec (Tresiba)

Onset 2hr

Tall thin bottle

Antiseizure Agents

xamples: gabapentin, pregabalin

• MOA: poorly understood, likely blocking pain receptors in CNS

• Adverse Effects: dizziness, __drowsiness__, peripheral edema, weight gain,

xerostomia, fatigue, headache, blurred vision

• Multiple other significant reactions as well:

• CNS/respiratory depressant_, suicidal ideation

• Nursing Considerations:

• No grapefruit or grapefruit juice

• Avoid antacids

• Avoid use in pregnant or breastfeeding women

Antidepressants (SNRIs)

• Examples: duloxetine, venlafaxine

• MOA: inhibits reuptake of certain neurotransmitters, which helps modulate

pain

• Side Effects: dizziness, drowsieness_, nausea, decreased appetite, sexual dysfunction

• Adverse Effects: May activate mania in bipolar disorder, bleeding risk,

fragility fractures, hepatotoxicity, ocular effects, serotonin syndrome,

suicidal thinking/behavior, withdrawal syndrome

• Nursing Considerations:

• Take with food

• Therapeutic levels likely reached in 4-6 weeks