DRUGS!

Running List of Meds–Pharm

Cholinergic drugs

binds to receptor sites to mimic acetylcholine (ACh) to activate the PARASYMPATHETIC nervous system #restanddigest

Uses:

• reduce intraocular pressure (glaucoma)

• Increase bladder/GI tract tone + motility 

• Causes GI tract sphincters to relax/empty

• Treat dry mouth

• Alzheimer’s disease

• Decreased levels of ACh

AE: overstimulation of the PNS (parasympathetic NS)—syncope (fainting/passing out), hypotension/rflexive tachycardia, hypertension/bradycardia, headache, dizziness, abdominal cramps, increased secretions (bronchial, lacrimal, sweating)

Toxicity: cholinergic crisis—SLUDGE! “Everything loose and watery” (salivation, lacrimation, urination, defecation, GI distress, emesis) 

Drugs: Bathanechol; Donepszil

Bathanechol + Donepszil

Types of Cholinergic Drugs

Anticholinergic Drugs

BLOCKS the action of ACh (acetylcholine) at the receptors in the PNS (peripheral NS) #norestanddigest;

SE: Increase HR, dry out mucous membranes, bronchial dilation, decrease GI motility, decrease salivation, cause urinary retention, reduce sweating, dilate pupils, increase ocular pressure

Uses: 

• Parkinson’s Disease

• Decrease secretions (specifically respiratory)

• Treat IBS

• Increase HR in bradycardia

IMPORTANT: REDUCED SWEATING–ensure adequate hydration + avoid extreme heat → increased risk for HEAT STROKE

Toxicity: elderly = more susceptible to delirium, hallucinations, cardiac dysrhythmias 

Drugs: Atropine; Scopolamine

“hot as a hare, mad as a hatter, red as a beat, dry as a bone”

Atropine + Scopolamine

Types of Anticholinergic Drugs

Toxicity for Cholinergic Drugs

SLUDGE (salivation, lacrimation, urination, defecation, GI distress, Emesis)

Garlic, Ginger root, Ginkgo biloba, chamomile

Supplements that can cause bleeding

MAOIs (monoamine oxidase inhibitors)

an Antidepressant; now more often used for Parkinson’s Disease;

MOA: Increases the availability of norepinephrine + serotonin

AE:

• orthostatic hypotension (low BP when standing up from sitting/lying position), Dry mouth, Constipation, Confusion in elderly, Jaundice, Insomnia, HA, Hesitancy (difficulty starting/maintaining a urine stream)

Drug interactions: can cause hypertensive crisis when taken with a stimulant or tyramine-containing foods (charcuterie board—aged cheese, salami, wines, etc.); can cause adverse CV effects when taken with OTC cough/cold medications

CI: DO NOT use with SSRI (--> serotonin syndrome), meperidine (demerol—opioid pain reliever); clear all other meds with provider

Drugs: Phenelzine

Phenelzine

Type of MAOI drug

SSRIs

MOA: selectively inhibits reuptake of serotonin/serotonin and norepinephrine depending on the drug → increase of free serotonin to be used as the body doesn’t get rid of it

Indications: several mental health disorders;  1st line for anxiety + depression

CI: DO NOT use of monoamine oxidase inhibitors (MAOIs) in 14 days → serotonin syndrome; DO NOT use with St. John’s Wart (herbal antidepressant) → serotonin syndrome

AE: bleeding, insomnia (reduced REM sleep), weight gain, sexual dysfunction, serotonin syndrome

⅔ patients discontinue 2nd generations due to AEs!

Discontinuation/withdrawal syndrome—flu-like feeling, difficulty concentrating, faintness, GI symptoms

Interactions: highly bound to albumin like warfarin + phenytoin → results in more drug in system + compound risk of bleeding

Drugs: sertraline (Zoloft), citalopram (celexa), paroxetine (paxil), fluoxetine (prozac)

ENDS WITH: “ine” or “pram”

Setraline (zoloft), Citaloprom (celexa), Paroxetine (paxil), Fluoxetine (prozac); common ending in “ine” or “pram”

Types of SSRIs

Stimulants

used for ADHD and Narcolepsy

Contraindications: HTN, cardiac disease, concurrent MAOI use (compounding hypertensive crisis)

SE: insomnia, weight loss, growth suppression in children, HTN, physical dependence (oops)

Teaching: take in AM, drug holidays (planned temporary breaks to curb side effects), DO NOT mix with caffeine, monitor weight and growth

Drugs: modafinil + methylphenidate (ritalin)

Modafinil + Methylphenidate (ritalin)

Types of Stimulant Drugs

Chemotherapy

MOA: vary greatly, numbers drugs and drugs in trial phase (+ a lot of different subclasses)

Admin: requires special certifications, specific calculations, and special handling (no willy nilly)

SE: 

• Bone marrow suppression (--> low blood cell counts + platelets → infection risks, anemia, higher risk for bleeding, etc.)

• Nausea and vomiting (usually causes nausea for 2-3 days)

• Anorexia

• Alopecia

• Fatigue

Nursing implications: HIGH RISK medications, Encourage oral intake + hydration, prevent infection in patients, instruct pts on risk of bleeding, preventative anti-emetics (give on day 1 about 1 hour prior to chemotherapy + continue days 2-4)

Opioid Analgesics

MOA: bind to receptors to relieve pain + induce mild sedation

Major SE: ***RESPIRATORY DEPRESSION***, sedation, constipation, strong potential for addiction

Drug: Morphine

Morphine

Type of Opioid Analgesic

NSAIDs (non-steroidal anti-inflammatory drugs)

MOA: block the chemical activity of the enzyme COX which leads to decreased inflammation, temperature and pain; inhibition of leukotriene/prostaglandin/both pathways

Uses: mild to moderate general pain, pn associated with arthritic disorders (RA, juvenile arthritis, ankylosing spondylitis, + OA)

CI: GI PROBLEMS! (ulcers, bleeding, dyspepsia), allergy to ASA, RENAL (impaired function, fluid retention), CARDIOVASCULAR EFFECTS (inc risk of MI or CVA (stroke)), BLEEDING (hematologic events)

NI: take with food, watch for bleeding, assess why they are taking medication

Drugs: ibuprofen! (motrin, advil), naproxen, ketorolac, celecoxib, aspirin*

BLACKBOX WARNING: GI BLEEDING + ADVERSE CARDIAC EVENTS

Ibuprofen (advil, motrin), Naproxen, Ketorolac, Celecoxib, Aspirin

Types of NSAIDs

Antacids

neutralizes Ph in stomach to treat GERD + heartburn

Can lead to electrolyte and acid base imbalances when used excessively (alkalosis)

Types: aluminum based, calcium carbonate (tums), magnesium based, sodium bicarbonate (alka-seltzer)

SE: block absorption of other medications, can cause diarrhea or constipation

*teach patients to take 30 min-1 hr apart from other meds

aluminum based, calcium carbonate, magnesium based, sodium bicarbonate

Types of Antacids

Beta Blockers

MOA: reduction of the HR by forming a blockade → reduced secretion of renin; long-term use causes reduced peripheral vascular resistance (drop BP!)

Uses: HTN, slowing the HR

Nursing Actions: always assess HR!! Teach patients to not abruptly stop these meds (rebound HTN)

Drug: Metoprolol

Ends in “lol”

Metoprolol; commonly ending in “lol”

Types of Beta Blockers

ACE (angiotensin-converting enzyme) Inhibitors

used for HYPERTENSION! RENAL protection for diabetic patients, treat HF

MOA: causes vasodilation (decreases systemic vascular resistance) → reduces BP; prevents sodium + water reabsorption by blocking aldosterone

AE: dry, non-productive cough (very common), hyperkalemia, fatigue, HA

Drug: Lisinopril 

Commonly ending “pril”

Lisinopril; commonly ending in “pril”

Types of ACE inhibitors

Anticoagulants

 “antithrombotic”

MOA: prevents intravascular thrombosis by decreasing blood coagulability

Used to prevent thrombus formation + emboli (#noMIorCVA)

CI: allergy, acute bleeding process, other anticoagulants

Adverse reactions: BLEEDING!!!!!! Heparin-induced thrombocytopenia (HIT!)

Drugs: Heparin, warfarin

heparin + warfarin

Types of Anticoagulants

GI Effects: bleeding, ulceration, dyspepsia

Renal Effects: impaired function, fluid retention

Cadiovascular Effects: increased risk of MI or stroke (CVA)

Hematologic Effects: increased bleeding risks

Side Effects/Adverse Effects of NSAID use

Ibuprofen (Motrin + Advil)

one of the MOST USED nsaids for mild/moderate pain and inflammation

Admin: PO!

SE: GI discomfort, LOOK FOR GI BLEEDING!, impaired kidney function, increased risk of MI + CVA

Nursing implications: 

• check for bleeding in stool, 

• check KIDNEY function! (BUN, Creatinine—indication that kidneys are having a hard time filtering waste products from blood)

• Take with food!

Motrin + Advil

Brand names of Ibuprofen

Celecoxib

Celecoxib ~ only blocks COX-2 (2nd generation-spares COX-1 enzyme) → ***lower risk for GI bleeding

Uses: mild to moderate pain + inflammation + OA/RA

Admin PO

SE: risk of MI and CVA!!!

CI: allergy to sulfonamides

Nursing implications: Check CARDIAC/KIDNEY function (BUN/creatinine), take with food

Lower risk for GI bleeding

Why use Celecoxib?

Ketorolac (Toradol)

GIVEN IN HOSPITAL POST-OP! 

Uses: mild/moderate pain and inflammation

Admin PO, IV, IM

SE: GI discomfort, impaired kidney function

Contraindications: pts with SEVERE KIDNEY PROBLEMS!!

Nursing implications: 

• Check for bleeding in stool

• Check KIDNEY function (BUN, creatinine—ndication that kidneys are having a hard time filtering waste products from blood)

• Take with food 

• DO NOT TAKE FOR MORE THAN 5 DAYS! (→kidney damage!!)

Aspirin

Uses: mild to moderate pain, inflammation, low-dose therapy for heart attack prevention/heart disease risk

Admin: PO

SE: BLEEDING! Salicylism, Reye’s syndrome in children

CI: DO NOT GIVE TO CHILDREN! → Reye’s Syndrome

Nursing implications: 

• DON’T GIVE TO CHILDREN!

• Monitor for BLEEDING! (stop 1 week before surgery)

Salicylism

Tinnitus, Sweating, Headache, Dizziness, and Alkalosis; a complication of aspirin!

Ketorolac (Toradol)

What drug is typically administered post-op in hospitals for pain??

Reye’s Syndrome

rare + strongly associated with aspirin/salicylate use in children + can follow a viral illness

Symptoms: INC temp, hyperventilation —> respiratory alkalosis, tinnitus, nausea/vomitting, dehydration/excitability, severe toxicity = metabolic acidosis + seizures

MONITOR for confusion, lethargy, vomiting, and even seizures; CEREBRAL SWELLING —> intracranial pressure; CAN BE FATAL!!!

Acetaminophen (Tylenol)

Uses: mild to moderate pain and fever

Admin: PO + IV

SE: LIVER PROBLEMS!!!

Nursing implications: no more than THREE grams per day

Antidote for Overdose: N-Acetylcysteine

one of the most common drugs in intentional overdoses

N-Acetylcysteine

What is the antidote for acetaminophen overdose?

Sumatriptan (Serotonin Agonist)

Uses: migraines + cluster headaches

MOA: causes vasoconstriction + decreases inflammation

Admin: PO-take at first sign of migraine

SE: vague feeling of chest pressure, rebound HA if taken too frequently, TERATOGENIC

Nursing implications: 

• check for PREGNANCY

• educate on timing (family planning)

• check for cardiac history (HTN risk bc vasoconstriction)

• Monitor for serotonin syndrome if on other serotonin meds!

OTC Drugs

Non-prescription drugs

Used for SHORT-TERM treatment of common minor illnesses (no more than 2 weeks @ a time)

More than 300,000 available

Risk profile = generally low

Potential Hazards: may postpone effective treatment of more chronic disease states/delay treatment of serious/life-threatening disorders, may relieve symptoms of a disorder (not the cause), toxicity, interactions with current prescription meds, abuse

• may postpone effective treatment of more chronic disease states

• may delay treatement of serious or life-threatening disorders

• may relieve symptoms of a disorder but not the cause

• toxicity

• interactions with current prescription meds

• abuse

Potential Hazards for OTC meds

Feverfew

herbal supplement that can block platelet aggregation (prevents clot formation) + decreases migraines

Interactions: can cause risk of bleeding with NSAIDS, heparin, or warfarin (anticoagulants)

Education: discontinue 2 weeks pre-op!

Garlic

herbal supplement that can block platelet aggregation, decreases LDLs (#cholesterolwin), can cause vasodilation (*in high quantities)

Interactions: increased risk of bleeding with NSAIDs, heparin, or warfarin

Education: speak with HCP is they take NSAIDs + Anticoagulants; (may need to be) stop 2 weeks before surgery

Ginger Root

herbal supplement that increases intestinal motility, decreases GI spasms, can be useful in morning sickness/nausea

Interactions: can increase hypoglycemic effects of antidiabetic medications; can slow blood clotting and increase the risk of bleeding!

Education: pt taking meds for diabetes should monitor glucose closely!

Ginkgo Biloba

herbal supplements that promote vasodilation → increase blood flow to extremities; increase in BF to brain assists with increased memory

Interactions: can increase risk of seizures/interfere with antidepressants; can increase risk of bleeding due to slowing blood clotting!

Education: do not take if pt has a history of seizures

Kava

herbal supplement that increases relaxation + decreases anxiety

Interactions: can cause oversedation (or respiratory depression) when taken with other meds that promote sedation; SEVERE LIVER FAILURE

Education: can cause SEVERE LIVER ISSUES, DO NOT TAKE if pt has liver problems; should not be taken if pt has an increase of alcohol intake

St. John’s Wart

herbal supplement that increases SEROTONIN and induces liver enzymes

Uses: mild depression, pain management, or topical (for infection)

Interactions:

• can cause serotonin syndrome when mixed with antidepressants “___…are you SSRI (ous)  right MAOI (now)?”

• Decreases efficacy of birth control and anticoagulants 

Education: encourage pts to report uses to HCP to assess for interactions, decrease sun exposure/wear sunscreen

Feverfew, Garlic, Ginger Root, and Ginkgo Biloba

What herbal supplements should we be hesitant to take with NSAIDs and Anticoagulants (heparin/warfarin) because of increased bleeding risks?