Drugs to know for Pharm HESI

cef-

cephalosporines (antibiotics)

Ex: Cefadroxil, Cefaclor, Ceftibuten

Use: assorted bacterial infections (gram negative) like UTI

AE: Hypersensitivity, bleeding, thrombophlebitis (clot), anemia.

Interactions: Alcohol (sensitivity), drugs that promote bleeding, probenecid (stops secretion of antibiotic), oral contraceptives

Nursing: Take full course of abx to prevent antibiotic resistance and superinfection. Ask about allergy and have epinephrine and resuscitation equipment available. Take with water (no juice) 

antiretrovirals

Ex: -vir; Indinavir, Raltegavir, Tenofovir, Ziodovudine (Retrovir), Stavudine

Use; infection caused by HIV

SE: N/V, myalgia, fatigue

• Didanosine: Can cause pancreatitis

• Stavudine: Can cause peripheral neuropathy

Cyclosporine

immunosuppresant

Use: organ transplant rejection

AE: increase risk of infection, nephrotoxicity

Contra: active infection

Vasopressin, Desmopressin

natural or synthetic ADH that acts on V1 (vasoconstriction, peripheral vascular resistance, elevate BP) and V2 (enhance water reabsorption, reduce urine output, maintain fluid balance) receptors

Use: diabetes insipidus, hemodynamic support for vasodilator/septic shock, gastrointestinal bleeding to control variceal bleeding

SE: runny nose given intranasaly; headache vulval pain and flushed skin given IV

AE:  inc BP HTN, peripheral ischemia, MI, arrthymias, nausea, vomiting, abd cramp, trembling; water intox (lethargy, confusion, seizure, headache, drowsiness), hyponatremia (fatigue, nausea, confusion)

Nursing: Restrict oral fluids. Report water intoxication.

Mupirocin

Use: MRSA in nares

combined hormonal contraceptives

Use: contraception, dysmenorrha, endometriosis, PCOS, acne

AE: inc clot risk, HTN

Nursing: Two or more missed doses require backup contraception. Must take one pill at the same time each day for the duration of the pack. 

Isotretinoin (Accutane)

Use: nodulocystic acne

Adverse: birth defect, depression, elevate triglycerides

Interact: Vit A

Nursing: Teratogenic!

Sildenafil (Viagra)

Indicate: erectile dysfunction

Interact: nitroglycerin as dilates further 

herbals

St. John's Wort: CYP3A4 inducer → reduces warfarin, digoxin, cyclosporine, OCPs; serotonin syndrome with SSRIs/MAOIs

Ginkgo: antiplatelet → bleeding risk with anticoagulants; may lower seizure threshold

Ginger/Feverfew: antiplatelet → additive bleeding with NSAIDs, warfarin, heparin

Garlic: for hyperlipidemia and hypertension

Ginseng: improve memory, dec blood glucose

Valerian/Kava: CNS depression → additive with benzos, opioids, alcohol; Kava = hepatotoxicity

Echinacea: immunostimulant → opposes immunosuppressants (max 8 weeks use)

Bilberry: treat varicose veins, cataracts, retinopathy

Chamomile/Peppermint oil: antispasmodic

glycopeptide

Ex: Vancomycin

Use: MRSA, C. diff colitis (orally), Gram+ infection in penicillin allergy

Adverse: nephrotoxic, ototoxic, red man syndrome (flusing, erythemia)

Nursing: Vancomycin flushing syndrome (flushing, sweating, rash, urticaria) if given too rapidly so monitor BP. Infuse medication slowly after one hour. Monitor peak and trough (<50) levels 15-30 min before next dose. 

Sucralfate (Carafate)

mucosal protectants, protective barrier around ulcer

Nursing: May impair absorption of other drugs so take on empty stomach and take other foods 

Misoprostol (Cytotec)

prostaglandin analog that reduce gastric acid and enhance mucus production

Use: Prevent NSAID-induced ulcers

Nursing: Take before meals! Do not take w pregnant patients!

prokinetic antiemetic

Ex. -mide; Metoclopramide, Trimethobenzamide HCl

Block dopamine receptors in CTZ, desensitize CTZ to impulses it receives from GI tract, stimulate peristalsis

Use: IV for N/V; ORALLY for GERD, delayed gastric emptying (diabetic gastroparesis)

AE: extrapyramidal dystonic movement (twitching); long term use can cause tardive dyskinesia

adsorbents

Ex: Bismuth subsalicylate (Pepto-bismol), activated charcoal

Coat wall of GI tract, bind to bacterial toxins then eliminated through stool

Use: mild case of diarrhea

Contra: children/teens for Reye’s syndrome, older adults w/ increased bleeding time, clotting disorder, recent bowel surgery, confusion

Interact: digoxin, quinidine, hypoglycemic agents, warfarin, methotrexate

Nursing: Black stools is a normal side effect! Assess if taking salicylates and watch for salicylate toxicity (tinnitus, hearing loss, inc HR, dimness of vision, sweating, thirst) 

laxatives

Ex: Lactulose, Polyethylene glycol, Sorbitol, Glycerin - Osmotics ; Psyllium (Metamucil) - Bulk-forming ; Senna, Bisacodyl (Dulcolax) - Stimulant ; Docusate sodium (Colace) - Stool softener

Use: constipation

AE: fluid and electrolyte imbalance

Interact: warfarin, digoxin, fat-soluble vitamins

Nursing: Do not take laxatives if experiencing nausea, vomiting, abdominal pain or fecal impaction. High fiber diet and exercise is encouraged before starting. Long-term laxative use can result in decreased bowel tone and may lead to dependency. Drink plenty of fluid. 

• psyllium: safe for long term use. Must mix w 8oz water followed by another glass of water

• bisacodyl: only give w water (no milk, antacids, or juice)

antacids

Ex: magnesium salts (Gaviscon, Mylanta), aluminum salts, calcium salts (TUMs), sodium bicarbonate

Use: acute relief of symptoms associated with PUD, gastritis, gastric hyperacididity, heartburn

AE:  metabolic alkalosis from overuse; constipation from aluminum and calcium; diarrhea from magnesium; kidney stones or rebound hyperacidity from calcium; production of gas

Interact: reduce ability of other drugs to be absorbed, chelation (antacid combines w drug to produce insoluble complex)

Nursing: Separate taking meds w antacids 1-2 hours! Should not be used long-term. 

MAOIs

Ex: -ine; Selegiline, Phenelzine, Rasagiline, Tranylcypromine

blocking the monoamine oxidase enzyme, which breaks down neurotransmitters like serotonin, dopamine, and norepinephrine

Use: depression, PD

SE: ortho hypotenson, insomnia, dry mouth, weakness, weight gain 

Nursing: Need to avoid tyramine containing foods as it can cause hypotensive crisis. Avoid cheese, wine, smoked or pickled foods, yeast extracts, figs.

SSRIs & SNRIs

Ex: -xetine; Fluoxetine, Sertraline, Escitlaopram, Duloxetine, Bupropion (smoking cessation)

inhibit serotonin and/or norepinephrine

Use: first-line treatment for depression, bipolar, ED, OCD, panic

AE: serotonin syndrome (delirium, agitation, tachy, sweating, hyperreflexia, shivering, fever), insomnia, weight gain, sexual dysfunciton, inc suicidality

Interact: warfarin, phenytoin, MAOIs

Nursing: Therapeutic effect takes 2-6 weeks so continue taking. Monitor for suicidal ideation and do not stop abruptly. 

• Bupropion: high dose can cause seizure

• Fluoxetine: many CNS and GI side effects

Lithium

Use: bipolar disorder for mania

AE: cardiac dysrhythmia, long-term hypothyroidism, slurred speech, chorea, ataxia, goiter, inc urination; Toxicity (>1.5mEq/L) with GI discomfort, tremor, confusion, somnolence, seizure, possibly death.

Nursing: Monitor sodium levels bc if abnormal they will not have therapeutic effects. Keep daily fluid and salt intake maintained and avoid caffeine. 

anorexiants

Ex: Phentermine, Benzphetamine, Methamphetamine, Diethylpropion

stimulate satiety center in brain causing appetite suppresion, stimulate limbic and hypothalamic regions of the brain

Use: obesity for higher risk pts

AE: elevate BP and heart palpitations, anxiety, agitation, dizziness, headache, orlistat (fecal incontinence with oily stools)

Contra: CVD, uncontrolled HTN, hyperthyroid, EDD, MAOI use

Nursing: Follow diet and exercise. Take in morning avoiding caffeine. May take fat-soluble vitamin supplements.

analeptics/caffeine

Ex: Doxapram, Methylxanthine, Caffeine, Theophylline

act on brainstem and medulla to stimulate respiration

Use: respiratory depression syndrome

AE: stimulate gastric sedcretions, diarrhea, reflex tachycardia, flushing, sweating, elevated resp rate, muscular tesnion and temors

Contra: seizure, CV disorders, HTN, pulmonary embolism, liver problems

Nursing: For children, assess height and weight and keep close eye on ABCs.

muscle relaxants

act to relieve pain associated with skeletal muscle spasms and resemble GABA to enhance sedation

Ex: Cyclobenzaprine, Baclofen, Dantrolene

Use: relieve musculoskeletal pain

AE: euphoria, lighthead, drowsy, dizzy, fatigue, muscle weakness, dry mouth, slurred speech

Interact: MAOIs

Nursing: Monitor airways, EKG, administer fluids. Effects should diminish with continued medication use.

• dantrolene: malignant hyperthermia

• baclofen: spastic conditions given in morning

general anesthetics

Ex: Ketamine (may cause hallucinations), Propofol (fast onset, careful monitoring for adverse), Nitrous oxide (for dental procedures) 

Use: surgical procedures for unconsciousness, skeletal muscle relaxation visceral smooth muscle relaxation

Contra: glaucoma, acute prophyria, malignant hyperthermia

AE: myocardial depression, affect heart, peripheral circulation, liver, kidney, respiratory tract, toxicity, cardiac and respiratory arrest

Interact: antihypertensives, beta blockers

Nursing: Dantrolene given for malignant hyperthermia.

antigout

Allopurinol: prevent uric acid production, prevent acute tumor lysis syndrome

• Nursing: Long-term use, don’t start during acute attack

Colchicine: reduce inflammatory response to deposits of urate crystlas in joint tissue

• Nursing: short term management or prevention of gout. Restrict to low-purine foods (avoid scallop, sardine, organ meats, other seafood)

nonopioid analgesics

Acetaminophen: inhibits prostaglandin synthesis, antipyretic effect

• AE: hepatotoxicity, GI bleed, renal failure; toxicity (anorexia, nausea, diaphoresis, fatigue, vomit, RUQ tenderness)

• Antidote: Acetylcysteine thins mucus and has strong sulfur (rotten egg) smell

• Nursing: Do not exceed 4g/day. Combination with alcohol can result in severe liver damage. 

Phenazopyridine: symptomatic relief of UTI symptoms

• Nursing: Causes reddish-orange discoloration of urine

Pregabalin: for peripheral neuropathy, fibromyalgia

• SE: suicidal thoughts, dizziness, drowsiness, edema, dry mouth, abdominal pain, constipation

opioid analgesics

Ex: Morphine (most common), Fentanyl patch (strong for cancer pts, good for renal impairment), Oxycodone (postop), Codeine (weak), Hyprodmorphone (stronger than morphine), Meperidine

Use: mod-severe pain

AE:  respiratory depression, euphoria, sedation, constipation, urinary retention, pruritus, tremors, hypotension; overdose (pinpoint pupils, slow breathing, unconsciousness)

Antidote: Naloxone (narcan) but be prepared for rebound respiratory depression

Contra: severe asthma, alcoholism, hypovolemia

Interact: alcohol, antihistamines, barbiturate, benzodiazpeines, Monoamine oxidase inhibitors

Nursing: Hold is RR<12 and obtain baseline VS. Take w/ food. Safety measures (side rails up). Drink water and take stool softeners.

• Overdose: inc temp, inc BP, abdominal cramping, vomiting, restless

Insulin

SE: hypoglycemia (cold, clammy, diaphoretic), weight gain

Nursing: Insert air into NPH. Aspirate into shorter acting first. Draw up clear (regular) first, then cloud (NPH). Long acting Insulin glargine (Lantus) cannot be mixed with any other insulin and has no peak so given once daily. Store at room temp after opening for 30 days. Gently roll vial to mix.

• rapid-acting (Humalog, Novolog, Lispro, Aspart): “15 minutes feels like an hour during 3 rapid responses”

• short-acting (Regular insulin): “Short staffed nurses went from 30 patients 2 (to) 8 patients”

• intermediate (NPH): “Nurses Play Hero 2(to) eight 16-year olds”

• long-acting (Glargine, Detemir, Levamir, Lantus): “The two long nursing shifts never peaked but lasted 24 hours”

oral antidiabetics

Use: Type 2 DM

biguanide (Metformin): inhibiting hepatic glucose production and increasing the sensitivity of peripheral tissue to insulin

• AE: GI disturbance (diarrhea), B12 deficiency, renal impairment

• Nursing: Stop taking metformin at least 48hrs before and after imaging scan with contrast to prevent lactic acidosis

sulfonylurea (Glyburide, Glipizide, Glimepiride): stimulate insulin release

• AE: hypoglycemia, weight gain

• Nursing: Take with food. Educate on signs of hypoglycemia (tremors, confusion, cool, clammy).

GLP-agonist (Liraglutide/Ozempic): delay gastric emptying

• AE: nausea, pancreatitis

• Nursing: Used for obesity.

SGLT-2 inhibitor (Dapaglifozin, Empaglifozin): block glucose reabsorption in kidney, secrete glucose in urine

• AE: UTI/genital yeast infection

• Nursing: Monitor renal function, genital hygiene

PPAR-y agonist (Pioglitazone):  reduce production of glucose by liver

• AE: hypoglycemia, upper repsiratory inf, headache, myalgias, weight gain; edema, bladder cancer, fractures, HF

meglifinide (Repaglinide): stimulate relase of insulin from pancreatic beta cell

• AE: hypoglycemia, GI upset, headache, upper respiratory infection

• Nursing: only taken with meals

DPP-IV inhibitor (Sitagliptin/Januvia): increasing concentrations of the naturally occurring incretins GLP-1 and gastric inhibitory peptide

• AE: upper resp infection, pancreatitis (rare) headache, hypersensitivity, angioedema, Stevens-Johnson syndrome

Levothyroxine

synthetic thyroid hormone (thyroxine T4)

Use: hypothyroidism, myxedema coma, shrink goiters

AE: tachycardia, palpitations, HTN, angina, tremors, nervousness, insomnia, GI upset, hyperthyroid (weight loss, heat intolerance, excessive sweating), thyroid storm, osteoporosis

Interact: calcium, iron, antacids

Nursing: Take in the morning on an empty stomach 30-60 min before food and at same time daily. It is a lifelong therapy. 

Propylthiouracil (PTU)

blocks conversion of thyroxine to triiodothyronine (T3) in peripheral tissue by interfering w enzyme thyroid peroxidase to reduce production of thyroid hormone

Use: hyperthyroidism, Grave’s disease

AE: liver damage, agranulocytosis, skin rash, joint/muscle pain, GI upset

Interact: iron, antacids, foods with iodine (seafood)

Theophylline

relax bronchial smooth muscle cells, dilates bronchi and bronchioles

Use: long term control of asthma and COPD

AE: toxicity (>20) N/V, tachycardia, seizure, restlessness

Interact: caffeine, chocholate

Nursing: Has a narrow therapeutic index (10-20)

Somatropin

synthetic form of human growth hormone (hGH) which is responsible for stim growth, cell reproduction, and regeneration in humans

Use: GH deficiency

AE: hyperglycemia, intracranial HTN, peripheral edema

antihistamine

Ex: Diphenhydramine, Loratidine, Cetirizine

Use: allergies

SE: drowsiness, dry mouth, nausea

antitussives

Ex: Codeine (opioid), Benzonatate (anticholinergic), Dextromethorphan

SE: sedation

Nursing: Do not use in productive cough

Guaifenesin

expectorant; increase the flow of fluid in the respiratory tract, usually by reducing the viscosity of secretions, and facilitate their removal by coughing 

SE: minimal, N/V, GI irritation

Nursing: Encourage hydration

Furosemide

act on loop of Henle to inhibit chloride transport of sodium

Use: pulmonary edema, HTN

AE: hypokalemia (muscle weakness), severe dehydration, hyponatremia, hypochloremia, hypotension, hyperglycemia, renal failure, thrombocytopenia, and circulatory collapse, tinnitus

Interact: aminoglycoside

Nursing: Take in the morning. Monitor weight, I&Os.

Hydrochlorothiazide

act on distal convoluted renal tubule to promote sodium, chloride and water excretion, vasodilation

AE: hyponatremia, hypochloremia, dehydration, hypokalemia, and hyperglycemia, fatigue

Spirinolactone

potassium-sparing, work in the collecting tubules of the kidneys by blocking epithelial sodium channels or inhibit action of aldosterone

Use: HF

AE: hyperkalemia

Mannitol

osmotic diuretic, pulls water into renal tubules

Use: cerebral edema, increased cranial pressure

antilipemics

Ex: Niacin, Ezetimibe, Alirocumab, Colesevalem, Gemfibrozil

Use: lower lipid levels, lower LDL, lower lipase

AE: pancreatitis, hepatititis, cholecystitis

Epoeitin alfa

Use: CKD, chemotherapy induced-anemia

AE: thromboembolic events, stroke, heart attack
Nursing: Hold if Hgb>12.

Ferrous sulfate

Use: iron deficiency anemia
SE: dark/black stools, constipation
Nursing: Take on empty stomach with vitamin C to enhance absorption. Give with straw to prevent staining of teeth. Eat fibrous diet to prevent constipation.

Heparin

binds with antithrombin III to inactivate thrombin, which then inhibits the conversion of fibrinogen to fibrin

Use: risk for venous blood clots
AE: heparin-induced thromobcytopenia (bleeding gums, excessive bruising, bloody stool, anxiety, drop in platelets, leg pain), osteoporosis

Antidote: Protamine sulfate
Interact: NSAIDs, anticoagulants
Nursing: Watch for signs of bleeding. Monitor aPTT labs (60-80).

Warfarin

Vitamin K antagonist is oral anticoagulents that decrease vitamin K dependent clotting factors
AE: intracranial, retroperitoneal, hypersensitivity, purple toes, lethargy 

Antidote: Vitamin K
Interact: NSAIDs, abx, grapefruit, alcohol
Nursing: Monitor INR levels (2-3). Maintain diet of dark leafy greens.

antiplatelet

Ex: Clopidogrel, Aspirin

Use: prevent MI or stroke, post-stent placement for arterial clots
SE: increased bleeding risk, TTP (blood disorder w clotting of small blood vessels w low platelet count)
Interact: OTC NSAIDs, omeprazole (for clopidogrel)
Nursing: Must hold 7 days before surgery cause inc risk of bleeding. Report any unusual bruising/bleeding.

cardiac glycoside

Ex: Digoxin
Use: HF
AE: toxicity (>2mg/mL) blurred yellow vision, visual halos, anorexia, fatigue, delirium, bradycardia, dysrhythmia
Caution: older adults
Nursing: Take apical pulse for 1 full minute. Hypokalemia increases digoxin toxicity risk.

vasodilator

Ex: Nitroglycerin, Hydralazine, sodium nitroprusside
Use: HF
SE: headache, N/V
AE: hypotension, reflex tachy, edema
Nursing:

• sodium nitroprousside can cause cyanide toxicity (confusion)

• nitroglycerin: 12-on and 12-off and remove old patches before applying new ones with gloves

antituberculars

Ex: rifampin, rifamate, rifapentine. Isoniazid

Use: TB Infections

AE: Hepatotoicity, Peripheral Neuropathy, Optic neuritis (red-green), GI Disturbances, neutropenia, flu-like symptoms

Interactions: P450 Inibitors will increase (risk of toxicity), Phenytoin, carbamezapine, diazepam, triazolam

Nursing: May turn body fluids red/orange/brown.

antiparkinson's

Ex. carbidopa-levodopa (Sinemet), Entracapone, Benztropine, Pramipexole

Use: inc catecholamines, dopamine or block Ach in PD

AE: dyskinesia, involuntary movements

Nursing: Watch for wearing-off phenomenon.

sulf-

Sulfonamides (antibiotics) Ex. SMT-TMP

Use: UTI's

AE: Hypersensitivity reactions, anemia, Kernicterus (infant neurotoxicity -- do not give to infants under 2 mos), renal damage.

Interactions: Inhibits hepatic metabolism of warfarin, phenytoin, & hypoglycemics (lower dose of other drugs to prevent toxicity).

Nuring: Drink 2-3L to prevent kidney crystals. May cause photosensitivity or sunburn. Hypernatremia risk. Avoid if sulfa allergy and potassium supplements. 

-ase

Thrombolytics (clot-busters)

Ex: Alteplase, TNKase, Reteplase

Use: Pulmonary embolism, acute MI, Ischemic Stroke (clots already formed)

AE: Bleeding (duh).

Interactions: Anticoagulants & antiplatelets (increase risk of hemorrhage). Warfarin/Heparin.

Antidote: Amicar

Nursing: Monitor for signs of bleeding, BP, pulse, neurological, abd and black pain, blood in urine or stool.

-azole

Antiifungals/protozoals

Ex: Fluconozole, Itraconazole, Ketoconazole, Metrondiazole

Use: Systemic Fungal Infections (broad spectrum), Giardiasis, Trichomoniasis

AE: GI issues,cardiac suppression, Hepatotoxicity, visual disturbance, headache, rash

Interactions: Inhibits CYP3A4 - stops P450 drug metabolism, drugs that increase gastric pH, alcohol

Nursing: Monitor LFTs. Take with food and around the clock. No alcohol! Avoid sun exposure.

• amphotericin B: for severe systemic fungal infection. Severe side effects: fever, chills, nausea, headache, muscle and joint pain. Stop infusion in numbness or tingling occurs.

-azosin

Alpha Blockers (angrenergic antagonists)

Ex: Doxazosin, Terazosin, Prazosin (all selective alpha1 blockade), Tamsulosin

Use: HTN (dilates arterioles/veins) & BPH (relaxes bladder muscle)

AE: Orthostatic hypotension, reflex tachycardia, headache.

Interactions: CYP3A4 inhibitors (antibiotics), nitroglycerin (for BPH)

-barbital

Barbituates (sedative hypnotics)

Ex: Phenobarbitol, Pentobarbital, Secobarbitol.

Use: Sleep, suppress seizures, anesthesia.

AE: Respiratory depression, suicidal ideations, abuse, hangover symptoms, porphyria, hyperalgesia

Interactions: Other CNS depressants (alcohol, benzos, opiods, antihistamines), Warfarin (liver will metabolize too fast).

Antidote: Stop treatment & administer oxygen. Gastric Lavage, cathartic, &/or diuretic.

-caine

Sodium Channel Blockers

Use: Anesthetics (local)

AE: signs of overdose include tinnitus, diplopia, blurry vision, shaking, low HR and RR

calci-

Calcium and vitamin D supplements

Ex: calciferol, calcitriol, ergocalciferol

-ciclovir

Antivirals

Ex: Acyclovir, peciclovir, Valgancicolvir, Ganciclovir, Amantadine, Oseltamivir

Use: HSV-1, Cytomegalovirus, Herp-Simp, Influenza

AE: Nephrotoxicity, Granulocytopenia & Thrombocytopenia (CMV drugs). No Preggers!!!

Nursing: Increase fluid intake to prevent nephrotoxicty. Use barrier contraception and avoid contact with lesions. 

• Oseltamavir: start w/in 48hr of symptom onset for Influenza A+B to decrease symptoms

-curium

Neuromuscular Blockers

Ex: Atracurium, Cisatracurium, Succinylcholine (paralyze head-to-toe)

Use: Muscle Relaxation, Hypotenstion

AE: Respiratory arrest, Histamine release, paralysis (hypokalemia induced)

Interactions: General anesthetics, antibiotics, Cholinesterase Inhibitors

Antidote: Cholinesterase Inhibitors

-curonium

Neuromuscular Blockers

Ex: Pancuronium, Rocuronium

Use: Muscle Relaxation, Hypotenstion

AE: Respiratory arrest, Histamine release, paralysis (hypokalemia induced).

Interactions: General anesthetics, antibiotics, Cholinesterase Inhibitors

Antdiote: Cholinesterase Inhibitors

-cycline

Tetracyclines (antibiotics)

Ex: Tetracycline, Doxycycline, Minocycline

Use: Acne, Peptic Ulcers, multiple bacterial infections.

AE: GI issues, Superinfection (C-Diff), Hepatotoxicity, renal toxicity, tooth discoloration in children, photo- sensitivity, vestibular toxicity, DI

Contra: pregnancy, children under 8 (causes tooth discoloration)

Interactions: dairy, iron, antacids, antidiarrheal

-dipine

C+ Channel Blockers decrease rate of contraction

Ex: (includes VARAPIMIL & DILTIAZEM) Nifedipine, Amlodipine, Clevidipine.

Use: HTN, HF (reduce contractility, CO, vaso/arteriole dialation), Angina, Migraines,

AE: Constipation, Hypotension, AV Block, Bradycardia, flushing, dizziness, headache, fatigue, gingival hyperplasia, & eczema, peripheral edema

Interactions: Digoxin (CCB increases Dig levels- risk of toxicity), Beta Blockers (same effect as CCB), Grapefruit Juice.

Antidote: Nor-epinephrine (for the hypotension), gastric lavage, beta agonist

-dronate

Biphosphenates

Ex: Alendronate, Risedronate.

Use: Osteoperosis, bone cancers.

AE: Ocular inflammation, osteonecrosis of the jaw, femur fractures, a-fib.

-ergot

Ergotamines

Ex: Ergomar, Cafergot

Use: Migraines

AE: Heart problems- Bradycardia, peripheral vasoconstricion, myalgia, angina, tachycardia.

Interactions: No Preggers!!! Triptans, CYP3A4 Inhibitors

-floxacin

Fluoroquinolones (antibiotics)

Ex: Ciprofloxacin, Enoxacin, Trovafloxacin.

Use: PNA, anthrax, osteomyelitis, GI infection, UTI

AE: Black box warning- Tendonitis, tendon rupture (joint welling, snapping, popping), peripheral neuropathy, QT prolongation

Contra: myasthenia gravis, under 18yrs

Interactions: Increases blood levels of meds (Warfarin), antacids, calcium, iron, zinc, theophylline

Nursing:  Stop immediately and report tendon pain or swelling. Wear sun protection. Adequate hydration and separate from interacts by 2 hours before or 6hrs after

amphetamines

Ex: Amphetamine, Methylpehnidate, Adderall, Modafinil

Use: ADD/ADHD, Narcolepsy.

AE: loss of appetite, palpitations, tachycardia, HTN, dysrhythmia, restless, growth suppression

Contra: cardiac structual abnormalities, MAOI use

Nursing: Monitor height and weight in children. Drug holidays may be taken. Give early in day as may cause insomnia. 

-lam

Benzodiazapines

Ex: Midozolam, Alprazolam

Use: Anxiety, seizures, insomnia, muscle spasms, anesthesia, alcohol withdrawal.

AE: CNS Depression, Amnesia, Narcoleptic episodes, Behavioral effects (rage, excitation), Respiratory Depression. Hypotension w/toxicity, Dependence.

Interactions: No Preggers!!! Other CNS depressants (alcohol, barbs, opiods, antihistamines).

Antidote: Flumazenil, gastric lavage, respiratory support

-lol

Beta Blockers

Ex: Propanolol, Metoprolol (DOC for Af. Am.)

Use: HTN, Angina, HF, Migraine Prophylactic Tx, Anxiety, MI, Glaucoma.

AE: Bradycardia, Hypotension, Rebound Tachycardia, Reduced Cardiac Output, Bronchoconstriction, Hypoglycemia.

Interactions: Insulin, CCB's, allergy.
Nursing: Hold if HR less sthan 60. May mask signs of hypoglycemia. Monitor for evidence of HF by assessing weight, BP, apical pulse, weakness, bradycardia.

-sone

Corticosteroids (anti-inflammatory)

Ex: Prednisone, Hydrocortisone, Methylprednisolone, Dexamethasone

Use: Allergies, Inflammatory disorders

AE: Adrenal crisis (severe hypotension, weakness, shock, high K+), Osteoperosis, Infection, Hyperglycemia, delayed wound healing, fluid/electrolyte disturbances, growth retardation, Psychological disturbances, Cataracts, Glaucoma, Peptic Ulcers (GI bleed), Cushing's Syndrome s/s, immunosupperession.

Interactions: Drugs that promote K+ loss, NSAID's, Hypoglycemics, Vaccines.

Nursing: Rinse mouth after use to prevent thrush. Treat adrenal crisis w IV hydrocortisone. Take with food in morning and never abruptly stop. Dosages may be temporarily increased for surgery.

-micin

Aminoglycosides (antibiotics)

Ex: Streptomicin, Arythromicin, Amicin

Use: Aerobic Gram-Negative Bacterial Infections (E.Coli, Pneumonia)

AE: Ototoxicity (report tinnitus ASAP), nephrotoxicity, neuromuscular blockade, hypersensitivity, neurologic dysfunctions.

Interactions: Other antibiotics (beneficial). Ototoxic drugs, nephrotoxic drugs (NSAIDs), muscle relaxer (NMBDs)

Nursing: Monitor peak and trough levels. Maintain adequate hydration to minimize renal toxicity. Report ringing in ears, hearing changes, dizziness.

-thromycin

Macrolides (antibiotics)

Use: when penicillin is contraindicated, STDs, H.pylori

Adverse: QT prolongation, hepatotoxic

Interact: statins

-avir

HIV/AIDS Antivirals

Ex: Atazanavir, Ritonavir, Tripanavir, Indinavir, Raltegavir, Tenofovir, Ziodovudine (Retrovir), Stavudine

Use: HIV

SE: N/V, myalgia, fatigue

AE: GI problems, fat maldistribution, diabetes, hyperlipidemia, bone loss, hepatotoxicity.

Interactions: P450 Inhibitors (increase avir's), P450 Inducers (accelerate avir metabolism), P450 Substrates, St. John's Wart, Garlic (reduced absorption)

• Didanosine: Can cause pancreatitis

• Stavudine: Can cause peripheral neuropathy

-pam

Benzodiazapines (anxiolytics)

Ex: Lorazapam (seizures), Alprazolam (Xanax), Diazepam/Valium (status epilepticus)

Use: Anxiety, seizures, insomnia, muscle spasms, anesthesia, alcohol withdrawal, sedation

SE: clumsiness, unsteady, drowsiness (esp early)

AE: CNS Depression, Amnesia, Narcoleptic episodes, Behavioral effects (rage, excitation), Respiratory Depression. Hypotension w/toxicity; Overdose (somnolence, confusion, coma, diminished reflex)

Antidote: Flumazenil

Interactions: No Preggers!!! Other CNS depressants (alcohol, barbs, opiods, antihistamines), Cava. Dependance can develop.

• Clorazepate: may cause physical or psych dependence w prolonged therapy at high doses

-prazole

PPI (Proton Pump Inhibitor)

Ex: Omeprazole, Esomeprazole, Lansoprazole.

Use: DOC for Peptic Ulcers, GERD, erosive esophagitis, Zollinger-Ellison

AE: Pneumonia (bc of decrease HCl) , Fractures (bc of decreased Ca absoprtion), Rebound acid hypersecretion, hypomagnesemia, C-Dif, risk of cancer.

Interactions: HIV drugs (decreased metabolism), diazepam, phenytoin, warfarin, clopidogrel, sucralfate

Nursing: Take before meals preferably in morning.

-pril

ACE Inhibitor (Anti-HTN)

Ex: Benazapril, Captopril, Quinopril.

Use: HTN, MI, Nephropathy, Left Ventricular Dysfunction , stroke.

SE: “ACE” dry cough

AE: 1st dose hypotension, nagging cough (most common reason pts. stop taking), hyperkalemia, renal failure, fetal injury, angioedema (rapid swelling of lips or tongue), neutropenia.

Interactions: Diuretics, HTN Drugs, Drugs that raise K+, Lithium toxicity, NSAIDs.
Nursing: Monitor K+ levels. Preserves renal function.

NSAIDs

Ex: Aspirin, Ketorolac, Diclofenac, Ibuprofen, Celecoxib, Naproxen, Indomethacin

Use: mild-moderate headaches, myalgia, neuralgia, arthralgia, alleviate postop pain, gout and hyperuricemia

AE: GI bleedings, acute renal failure, CV events

Contra: GI lesions, PUD, bleeding disorders, pregnancy

Interact: alcohol, diuretics, AE inhibitors, protein-bound drugs, corticosteorids, anticoagulants

Nursing: Take with food, milk, or antacids. Watch for any unusual bleeding. Avoid salicylates in children and teens because risk of Reye’s syndrome. Stop taking before surgery. May be prescribed in combination with opioids to improve pain control. 

• aspirin: Watch for salicylate toxicity (tinnitus, hearing loss, inc HR, dimness of vision, sweating, thirst). Dose 4g for RA, 325mg, 81mg antiplatelet.

• ketorolac: short-term use up to 5 days

• celecoxib: COX-2 inhibitor with less GI effects, contraindicated in sulfa allergy

-quine

Antiparasitics

Ex: Chloroquine, hydroychloroquine, Quinine, Primaquine

Use: Malaria, Amebiasis

AE: Tinnitus, Hemolysis (anemia), hypotension & circulatory failure (IV), GI Disturbance, Headache, Dizziness, dysrhthmias, visual distrubances.

Interactions: CYP3A4 inhibitors (antibiotics) increase drug levels (risk of toxicity)

-sartan

Angiotensin II receptor blocker

Ex: Valsartan, Telmisartan, Losartan, Irbesartan.

Use: HTN, MI, Stroke, Nephropathy, HF (Valsartan)

AE: Angioedema, Fetal Harm, Hypotension, Renal Failure, risk of cancer (small to zero).

Interactions: No preggers!!! Other HTN Drugs,

-setron

Serotonin receptor antagonist (antiemetics)

Ex: Odansetron, Dolasetron, Paonsetron, Granisetron.

Use: Chemotherapy emesis, postoperative emisis, radiations emesis, anesthesia emesis.

AE: Headache, Diarrhea, Dizziness, Torsades De Pointes (dysrhythmia - rare but fatal)- no go for pts wth HF or QT prolongation

-stigmine

Cholinergics

Ex: Neostigmine, Physostigmine, Pyridostigmine, Bethanechol

Use: Myasthinia Gravis to increase muscle strength in neck and face, Glaucoma, Parkinson's, Dementia, Muscarinic Poisoning.

AE: Excessive salivation, increased gastric secretions, Bradycardia, Sweating, Miosis, Neuromuscular blockade (paralysis of respiratory muscles). Cholinergic crisis (blood diarrhea, cramps, flushing, dyspnea, inc secretions, miosis, GI disturbances, bradycardia)

Antidote: Atropine and respiratory support

Interactions: Muscarinic antagonists, Muscle relaxers.

Contra: GI/GU obstruction, asthma, PUD, CAD.

• bethanechol: urinary retention.

• donepezil and rivastigmine: Alzhiemer’s disease. Watch for sundowning

• Pyridostigmine and Neostigmine and Edrophonium (Tensilon) are for Myasthenia gravis to boost muscle strength. Given 30 min before eating so able to chew and swallow better.

anticholinergic

Ex. Atropine, Scopalamine, Oxybutynin, Ipratropium, Pilocarpine HCl

Use: COPD, asthma, prepare pts for surgery, IBS, GI hypersecretory states, urge incontinence

AE: Toxicity/overdose: fast HR, hallucation, hot dry skin, dry mouth, confusion, urinary retention, restless

Antidote: Physostigmine and treat supportively

Contra: BPH, narrow angle glaucoma

Nursing: Older adults ahve higher risk of heatstroke.

antineoplastics

Use: chemotherapy, cancer

SE: N/V, hair loss, fatigue, dec WBC, extravasation

Nursing: Narrow therapeutic index so combination of drugs are usually more effective than single drug. Avoid contact with patients w/o aseptic technique. Monitor for anemia, bleeding, infection, stomatitis w severe ulcerations, bowel irritability, renal liver cardiac toxicity.

• Methotrexate: antimetabolite. Monitor CBC for bone marrow suppression. Leucovorin may be used to preserve normal cells.

• Paclitaxel: mitotic inhibitor. Monitor for bleeding and infection. May cause allergic rxns bc of castor oil

• Cisplatin/Cyclophosphamide: alylating drug. Monitor for bone marrow suppression. Report any ringing in ears, tingling, numbness or pain in extremities. Hydration is important.

• Doxorubicin: cytotoxic abx. Can cause L ventricular failure, cardiomyopathy. Need MUGA scan to evalaute heart.

• Daunorubicin: cyctotoxic abx. Can cause HF. May turn urine reddish color

• Bleomycin: cytotoxic abx. Can cause pulmonary toxicity so monitor for pulmonary fibrosis

• Etoposide (VePepsid): Can cause orthostatic hypotension so monitor BP.

• Busulfan: for leukemia, increase uric acid level

• Asparaginase: Contraindicated in pancreatitis.

• Tamoxifen: compete w estradiol

-terol

Bronchodialators

Ex: Albuterol, Levalbuterol, Salmeterol

Use: Asthma, COPD.

AE: Tachycardia, Angina, Tremor, Palpitations, Nervousness

Interactions: Glucocorticoids (in conjunction).

Nursing: Take bronchodilator FIRST to open airway before using steroid inhaler.

• albuterol: SABA used in exacerbations as rescue inhaler!

• salmeterol: LABA used in maintenance

-tidine

H+ receptor antagonists (anti-ulcer)

Ex: Cimetidine, Famotidine, Ranitidine.

Use: Peptic Ulcers, GERD, erosive esophagitis, Zollinger-Ellison

AE: Anti-adrenergic effects (gynecomastia, impotence), CNS Effects (confusion), Pneumonia.

Interactions: Lowers liver metabolism - raises levels of other drugs (Warfarin, Phenytoin, Theophylline, Lidocaine). Antacids (may drop pH too much)

Nursing: Take at bedtime to prolong effect.

-triptan

SRA's - antimigraine

Ex: Sumatriptan, Rizatriptan, Almotriptan

Use: Migraines

AE: Coronary vasospasm, Teratogenesis, Vertigo, Malaise, Fatigue, Tingling.

Interactions: No Preggers!!! Ergot Alkaloids & other vasoconstrictors. MAOI's, SSRI's (can lead to serotonin syndrome)

-tyline

Trycyclics (antidepressants)

Ex: Amitriptyline, Nortriptyline, Protriptyline, Clomipramine

Use: Depression/Mood Disorders, Fibromyalgia, childhood enuresis (bed wetting), OCD

AE: Orthostatic Hypotension, Anticholinergic Effects, Diaphoresis, Sedation, Cardiac Toxicity, Seizures, Hypomania, Suicide idealization; Overdose: CNS and CV side effects

Antidote: Sodium bicarbonate

Interactions: MAOI's, Epinephrine and Dopamine, Anticholinergics, CNS Depressants.

• Clomipramine: used for OCD

-statin

Statins (anti-cholesterol)

Ex: Atorvastatin, Pravastatin, Simvastatin.

Use: High Cholesterol, Hyperlipidemia, Dyslipidemia, Osteoperosis.

AE: Myopathy, Hepatotoxicity, kidney damage, rhabdomyolysis (muscle pain/weakness), liver impairment, pancreatitis, cramps

Interactions: No Preggers!!! Other lipid lowering drugs, CYP3A4 Inhibitors (Macrolides, azole antifungals, HIV antivirals), grapefruit juice

Nursing: Monitor liver enzymes. Take at bedtime.

-zine

Phenothiazides (antipsychotics, antiemetics)

Ex: Chlorpromazine, Fluphenazine, Perphenazine, Clozapine, Olanzepine, Haloperidol

block dopamine receptors

Use: schizophrenia, autism, BPD, other conditions

SE: dry mouth, weight gain, constipation, orthostatic hypotension

AE: Acute dystonia, Parkinsonism, Tardive Dyskenisia (involuntary facial muscle monvements), Neuroleptic malignant syndrome (NMS) orthostatic hypotension, dysrhythmias, seizures, sedation, Agranulocytosis. Extrapyramidal symptoms (drowsy, excessive salivation, fixed stare)

Inetractions: Anti-cholinergic drugs, CNS Depressants, Dopamine receptor agonists

Nursing: Avoid alcohol. Assess for extrapyramidal symptoms of for NMS. May cause photosensitivty so wear sunscreen. May cause weight gain. 

-zoline

Nasal Decongestants

Ex: Nephazoline, Tetrahydrozoline, Oymetazoline

Use: Nasal Decongestant

AE: Rebound congestion, CNS Stimulation, CV Effects (vasoconstriction), stroke.

antiepileptics

Ex. Phenytoin, carbamazepine, valproic acid, pregabalin

Either suppress sodium influx, block sodium channels, inc GABA to prevent neuron firing

Use: seizures

AE: sore throat, fever, suicidal thoughts, myelosuppression, agranulocytosis, visual disorders, mental status change

Contra: renal disease

Nursing: Must comply to regimen, should not be driving. Do not stop abruptly as risk for status epilepticus. If dose missed, take dose as soon as remember as long as it is not too close in time to the next dose.

• phenytoin: Watch for gingival hyperplasia so floss. and monitor BP and HR for loading dose. Urine may turn pink/red brown but do not stop abruptly. Toxicity >20 seen with ataxia, hand tremor, slurred speech

• valproic acid: also used for bipolar disorder and migraines. Monitor for signs of bleeding.

antipsychotics

Ex. prochloperazine, haloperidol, clozapine

Use: treat serious mental illness like schizophrenia, autism, can also treat BPD, depression, certain medical conditions

AE: neurleptic malignant syndrome (NMS, hyperthermia rigidity altered MS autonomic instability), extrapyramial symptoms (EPS), tardive dyskinesia, insulin resistance, weight gain

Nursing. Dantrolene used as supportive care for NMS. May cause photosensitivity and weight gain.