Unit 1- Pharmacology Gold Standard Drugs

Epinephrine

Adrenergic Agonists

Indication: Allergic reactions, cardiac arrest

Side effects: Tachycardia, palpitations, hypertension

Norepinephrine

Adrenergic Agonists

Midodrine (Proamatine)

Adrenergic Agonists

Albuterol (Proventil)

Adrenergic Agonists

Indication: Asthma

Side effects: Tachycardia, palpitations, hypertension

Prazosin (Minipress)

Adrenergic Antagonists

Doxazosin (Cardura)

Adrenergic Antagonists

Alpha-Blocker

Indication: hypertension

Side effects: dizziness and headaches

Tamsulosin (Flomax)

Adrenergic Antagonists

Metoprolol

Adrenergic Antagonists

Beta-Blocker

Indication: hypertension

Side effects: Bradycardia and hypotension

Propranolol (Inderal)

Adrenergic Antagonists

Bethanechol (Urecholine)

Cholinergic Agonists

Indication: many uses

Side effects: hypertension, hyperhidrosis, bradycardia, hyper urination

Pilocarpine (Salagen)

Cholinergic Agonists

Indication: many uses

Side Effects: hypertension, hyperhidrosis, bradycardia, hyper urination

Donepezil (Aricept)

Cholinergic Agonists

Indication: many uses

Side effects: hypertension, hyperhidrosis, bradycardia, hyper urination

Pyridostigmine (Mestinon)

Cholinergic Agonists

Indication: many uses

Side effects: hypertension, hyperhidrosis, bradycardia, hyper urination

Atropine (Atropen)

Cholinergic Antagonists

Indication: many uses

Side effects: Dry mouth, blurred vision, tachycardia, and urinary retention

Scopolamine (Scopace)

Cholinergic Antagonists

Indication: many uses

Side effects: dry mouth, blurred vision, tachycardia, and urinary retention

Dicyclomine (Bentyl)

Cholinergic Antagonists

Indication: many uses

Side effects: dry mouth, blurred vision, tachycardia, and urinary retention

Ipratropium (Atrovent)

Cholinergic Antagonists

Indication: many uses

Side effects: dry mouth, blurred vision, tachycardia, and urinary retention

Ibuprofen (Advil)

Pain Medications: NSAID

Mild-moderate pain, inflammatory pain, fever reduction, chronic pain management

Side effects: bleeding risk, kidney problems, stomach upset/ulcer, hypertension/stroke

Considerations: GI effects: dyspepsia, heartburn, peptic ulcers, gastritis, GI bleeding; Cardiovascular risk: heart attacks, stroke; Impaired kidney function: fluid retention, HTN, AKI; Inhibition of platelet function: risk of bleeding

Naproxen (Aleve)

Pain Medications: NSAID

Aspirin

Pain Medication: NSAIDS

Acetaminophen (Tylenol)

Pain Medications: Analegsic (pain relieving), Antipyretic (Fever-reducing)

Minimal anti-inflammatory effects

Complications: hepatoxicity- Antidote: acetylcysteine

Considerations: impaired liver function, renal impairment (use cautiously)

Interactions: warfarin, alcohol, CYP 450

Morphine (MS Contin)

Pain Medications; Opioid

Side effects: sedation, nausea, respiratory depression, constipation, euphoria, reduced attention, itchiness

Considerations: Build tolerance, dependence on drug, withdrawal symptoms, increased pain sensitivity, low sex hormone levels, death

Oxycodone (OxyContin)

Pain Medication: opioid

Side effects: sedation, nausea, respiratory depression, constipation, euphoria, reduced attention, itchiness

Considerations: tolerance, dependence on drug, withdrawal symptoms, increased pain sensitivity, low sex hormone levels, death

Hydromorphone (Dilaudid)

Pain Medication: Opioid

Side effects: sedation, nausea, respiratory depression, constipation, euphoria, reduced attention, itchiness

Considerations: tolerance, dependence on drug, withdrawal symptoms, increased pain sensitivity, low sex hormone levels, death

Fentanyl (Duragesic)

Pain Medication: Opioid

Side effects: sedation, nausea, respiratory depression, constipation, euphoria, reduced attention, itchiness

Considerations: tolerance, dependence on drug, withdrawal symptoms, increased pain sensitivity, low sex hormone levels, death

Naloxone (Narcan)

Pain Medication: Opioid Antagonits

Reversal of effects of opioids

Administration: Nasal injection

Complications: tachycardia and tachypnea, abstinence syndrome

Naltrexone (Vivitrol)

Pain Medication: Opioid Antagonist

Treatment of opioid abuse by preventing euphoria

Complications: Tachycardia and tachypnea, abstinence syndrome

Lidocaine (Xylocaine)

Pain Medication: Local Anesthetic

Decrease pain by blocking conduction of pain impulses within a limited area

Local anesthetics:

Complications: seizures, respiratory depression, can lead to unconsciousness, hypotension, cardio suppression, allergic reactions, labor and birth issues

Gabapentin (Neurontin)

Pain Medication: Anticonvulsant

Used to relieve neuropathic pain and neuralgia

Complications: GI distress: N/V, diarrhea, constipation, drowsiness

Amitriptyline (Elavil)

Pain Medication: Antidepressant

Used to treat depression, fibromyalgia syndrome, and neuropathic pain

Complications: orthostatic hypotension, sedation, anticholinergic effects

Dexamethasone (Decadron)

Pain Medication: Corticosteroid

Improve appetite and decrease pain from intracranial pressure, spinal cord compression, and rheumatoid arthritis

Complications: adrenal insufficiency, impaired immune system, osteoporosis, fluid and electrolyte disturbances, glucose intolerance, and peptic ulcer disease

Levodopa/carbidopa (Sinemet)

Parkinson’s Disease Drugs: Dopamine replacement

-Levodopa crosses the blood-brain barrier, converted to dopamine

-Complications: nausea, vomiting, drowsiness, dyskinesias, orthostatic hypotension, cardiovascular effects (tachycardia, palpitations, irregular heartbeat), psychosis, discoloration of sweat and urine

-Side effects: Loss of appetite, postural hypotension, insomnia, vivid dreams, confusion, visual hallucinations, delusions, illusions

-Nursing Considerations: use cautiously in clients who have cardiovascular disorders, pregnancy (no adequate or well-controlled studies), wear off effect, on-off effect

Pramipexole (Mirapex) and Ropinirole (Requip)

Parkinson’s Disease Drugs: Dopamine Agonist

-Administered as a monotherapy, used in conjunction with levodopa/carbidopa to allow lower dosage to reduce fluctuations in motor control

-Side effects/complications: inability to stary awake, sleepiness, orthostatic hypotension, psychosis, impulse control disorder, dyskinesias, nausea

-Nursing considerations: pregnancy (may cause fetal harm)

Entacapone (Comtan) and Tolcapone (Tasmar)

Parkinson’s Disease Drugs: COMT inhibitor

-Beneficial in combination with levodopa/carbidopa to inhibit the metabolism levodopa in the intestines and peripheral tissues

-Side effects/complications: GI: Vomiting, diarrhea, constipation; discoloration of urine, rhabdomyolysis, liver failure

-Nursing considerations: use with caution if hepatic function is impaired

Rasagiline (Azilect) and Selegiline (Eldepryl)

Parkinson’s Disease Drugs: MAO-B Inhibitor

-Prevent dopamine breakdown; used in combination with levodopa/carbidopa to decrease the “wearing off” effect

-Side effects/Complications: insomnia, hypertensive crisis, nausea, diarrhea

-Nursing Considerations: Hypertensive crisis and death can be triggered so; Avoid foods containing tyramine (avocados, soybeans, figs, smoked meats, dried/cured fish, cheese, year products, beer, red wine, chocolate, caffeinated beverages); Avoid medications (meperidine, fluoxetine, MAOIs, antidepressants, sympathomimetics)

Diazepam (Valium)

Anti-Epileptic Drugs: Benzodiazepine

Lorazepam (Ativan)

Anti-Epileptic Drugs: Benzodiazepine

Phenytoin (Dilantin)

Anti-Epileptic Drugs

Carbamazepine (Tegretol)

Anti-Epileptic Drugs

Valproic Acid (Depakote)

Anti-Epileptic Drugs

Lamotrigine (Lamictal)

Anti-epileptic drugs

Levetiracetam (Keppra)

Anti-Epileptic Drugs

Anti-Epileptic Drugs

-Also known as anticonvulsants

-Mechanisms of action: stabilizing neuronal membranes enhancing inhibitory neurotransmitters

-Commonly used AEDs: Phenytoin, Carbamazepine, Valproic acid, lamotrigine, levetiracetam

-Side Effects: Blurry vision, irritability, mood change, weight gain or loss, dizziness, drowsiness, and sleep disturbance, nausea, swollen gums, hair loss or unwanted hair growth

-Nursing Considerations:

Parkinson’s Disease Drugs

-Dopamine replacement therapy (Primary Approach)

-Nursing Considerations: Improvement of manifestations~ absence of tremors or reduction of irritability and stiffness; increase ability to perform ADLs

-Patient Education: N/V reduced by taking meds with food; monitor for sudden loss of effects of the medication; effects may not be noticeable for weeks to months; do not discontinue abruptly

Pain Medication- NSAID

Pain Medication- Opioids

Act on body’s opioid receptors to relieve pain

Clinical uses: moderate-severe pain, postoperative pain, cancer-related pain, sedation

Contraindications/Cautions: Pregnancy and lactation, asthma, emphysema, head injuries, infants and older adults, extreme obesity, inflammatory bowel disease, enlarged prostate

Interactions: CNS depressants, anticholinergics, antihistamines, tricyclic antidepressants, antihypertensives

Administration considerations: assess pain level, take baseline vitals, administer IV opioids slowly over 4 to 5 minutes

Cholinergic Agonists

Cholinergic Antagonists

Adrenergic Antagonists

Adrenergic Agonists

Alpha-Blocker

-osin

Beta-Blocker

-olol

Lisinopril

ACE inhibitor

indication: hypertension

Side effects: angioedema, cough, electrolyte imbalance

Losartan

ARB’s

Indication: hypertension

Side effects: headache, dizziness, drowsiness

Diltiazem Verapamil (Amlodipine)

Calcium-channel blockers

Indication: hypertension

Side effects: peripheral edema and palpitations