Pharmacology Review

MECHANISM OF ACTION / WHAT DISORDER PRESCRIBED FOR

• Analgesic: Used for pain relief.

• Tramadol: Analgesic; mechanism involves opioid receptors and inhibiting reuptake of norepinephrine and serotonin.

• Anti-inflammatory: Reduces inflammation.

• Disease-Modifying Antirheumatic Drug (DMARD): Used to slow the progression of rheumatic diseases.

• Corticosteroids: Used for reducing inflammation and suppressing the immune system.

• Sucralfate: Used to treat and prevent ulcers by forming a protective layer over the ulcer.

• Pantoprazole: Proton pump inhibitor (PPI) used to reduce stomach acid production.

• Docusate (Colace): Stool softener used to relieve constipation.

• Lactulose: A synthetic sugar used to treat constipation and hepatic encephalopathy by reducing ammonia levels in the blood.

• Histamine (H₂) Receptor Antagonists: Reduce gastric acid secretion.

• Indirect Thrombin Inhibitors: Prevent blood clot formation by inhibiting thrombin indirectly (e.g., heparin).

• Fibrinolytic Drug: Used to dissolve blood clots in conditions like myocardial infarction or pulmonary embolism.

SIDE EFFECTS / ADVERSE REACTIONS

• Opioids: Side effects include respiratory depression, constipation, nausea, and dependence.

• Pentazocine (Talwin): Opioid; side effects similar to other opioids, but can also cause anxiety and hallucinations.

• Acetaminophen: Liver toxicity in high doses or with chronic use.

• Methocarbamol: Muscle relaxant; side effects include drowsiness, dizziness, and blurred vision.

• Aspirin: Gastrointestinal bleeding, tinnitus, and Reye's syndrome in children.

• Corticosteroids: Immunosuppression, hyperglycemia, osteoporosis, and weight gain.

• Anticoagulant Therapy: Increased risk of bleeding.

• Internal Bleeding: A serious adverse reaction to anticoagulants and antiplatelet drugs; signs include black, tarry stools, coffee-ground emesis, and unexplained bruising.

• Adalimumab (Humira): Immunosuppressant; increased risk of infection, injection site reactions.

• Magnesium-Based Antacids: Diarrhea.

• Metoclopramide: Tardive dyskinesia, restlessness, and drowsiness.

• Bulk-Forming Laxatives: Bloating and gas if not taken with enough water.

• Stool Softeners: Generally safe, but can cause abdominal cramping.

• Atropine: Anticholinergic effects such as dry mouth, blurred vision, urinary retention, and constipation.

• Dronabinol (Marinol): Psychoactive effects, dizziness, and nausea.

• Fibrinolytic Drugs: Bleeding.

• Apixaban (Eliquis): Bleeding.

• Heparin: Bleeding, heparin-induced thrombocytopenia (HIT).

• Erythropoietin Stimulating Agent: Hypertension, blood clots.

NURSING IMPLICATIONS

• Opioids: Monitor respiratory rate, pain level, and bowel function.

• Steps After Accidental OD of Hydromorphone (Dilaudid): Administer naloxone, support breathing, and monitor vital signs.

• Promethazine (Phenergan): Can cause significant sedation and extrapyramidal symptoms; use with caution.

• Cyclobenzaprine: Muscle relaxant; caution patients about drowsiness and avoid alcohol.

• Aspirin Daily: Monitor for signs of bleeding and educate patients about potential gastrointestinal upset.

• Corticosteroids: Monitor blood glucose levels, blood pressure, and signs of infection.

• Long-Term Corticosteroid Therapy: Monitor for osteoporosis, adrenal insufficiency, and Cushing's syndrome.

• Proton-Pump Inhibitors: Monitor for hypomagnesemia and increased risk of fractures with long-term use.

• Atropine: Monitor for anticholinergic effects.

• Metoclopramide: Monitor for tardive dyskinesia and other extrapyramidal symptoms.

• Epoetin Alfa: Monitor hemoglobin and blood pressure.

CONTRAINDICATIONS/DRUG INTERACTIONS

• Aspirin: Contraindicated in children with viral infections (Reye's syndrome), patients with bleeding disorders, and those with aspirin allergy.

• Topical Corticosteroids: Avoid prolonged use on thin skin or open wounds.

• Anti-Inflammatory Analgesics: Contraindicated in patients with renal impairment, peptic ulcer disease, and aspirin allergy.

• Etanercept: Contraindicated in patients with active infections.

• Laxatives: Contraindicated in patients with bowel obstruction or undiagnosed abdominal pain.

• Promethazine (Phenergan): Contraindicated in children under 2 years old due to risk of respiratory depression.

• Antiplatelet Drug: Increased risk of bleeding when used with anticoagulants or other antiplatelet drugs.

• Anticoagulant: Increased risk of bleeding when used with antiplatelet drugs or NSAIDs.

• Warfarin (Coumadin): Interacts with many drugs and foods; requires careful monitoring of INR.

LABS

• Gout: Monitor uric acid levels.

• Clopidogrel: Monitor platelet count and signs of bleeding.

• Coumadin: Monitor PT/INR.

• Heparin: Monitor APTT.

• Therapeutic INR Range: Typically 2.0-3.0 for most indications; may be higher for mechanical heart valves.

PATIENT EDUCATION

• Opioids: Educate patients about the risk of respiratory depression, constipation, and addiction.

• Hydromorphone (Dilaudid): Instruct patients on proper use and disposal of medication.

• Aspirin Daily: Educate patients about the risk of bleeding and gastrointestinal upset; advise taking with food.

• Heparin: Teach patients how to administer subcutaneous injections and monitor for signs of bleeding.

• NSAID Ibuprofen: Educate patients about the risk of gastrointestinal upset and renal impairment; advise taking with food.

• Prednisone and Diabetic Patient: Monitor blood glucose levels closely, as prednisone can increase blood sugar.

• Clopidogrel: Educate patients about the risk of bleeding and the importance of not discontinuing medication without consulting a healthcare provider.

• Corticosteroids: Educate patients about potential side effects, including weight gain, mood changes, and increased risk of infection.

• Adalimumab (Humira): Teach patients how to administer subcutaneous injections and monitor for signs of infection.

• Allopurinol: Educate patients about the importance of taking medication daily to prevent gout attacks; increase fluid intake.

• Anti-Inflammatory Drugs: Educate patients about the risk of gastrointestinal upset and renal impairment; advise taking with food.

• Corticosteroid Therapy: Educate patients about the importance of not stopping medication abruptly and potential side effects.

• Antacid: Educate patients to take antacids 1-2 hours apart from other medications.

• Proton-Pump Inhibitors: Educate patients to take PPIs 30-60 minutes before meals.

• Famotidine: Educate patients to take famotidine as directed, usually once or twice daily.

MISCELLANEOUS

• Assessing Pain: Use a standardized pain scale (e.g., numeric rating scale) and consider the patient's individual experience.

• Pain and Paralyzed Patient: Observe nonverbal cues, such as facial expressions, body language, and vital sign changes, to assess pain.

• High Alert Medications: Medications that have a high risk of causing significant patient harm when used in error.

• Morphine Admin Schedule: Administer morphine on a regular schedule for chronic pain; breakthrough pain can be treated with additional doses as needed.

• Methocarbamol: Urinary retention =>HTN Can cause urinary retention leading to hypertension.

• Strong Opioid Agonists Medications: Morphine, fentanyl, oxycodone, and hydromorphone.

• Drugs That Are Considered to Have a “Role” in Pain Management: Opioids, NSAIDs, acetaminophen, and adjuvant analgesics (e.g., antidepressants, anticonvulsants).

• Aspirin Not for Infants: Risk of Reye's syndrome.

• Gout Diet: Avoid high-purine foods, such as red meat, organ meats, and seafood; limit alcohol consumption.

• Inflammation S&S: Redness, swelling, heat, pain, and loss of function.

• Anticoagulant Therapy Purpose: To prevent blood clot formation in conditions such as atrial fibrillation, deep vein thrombosis, and pulmonary embolism.

• Benign Prostatic Hypertrophy and Anticholinergic Meds: Anticholinergics can worsen urinary retention in patients with BPH.

• Aspirin Risk Factors: History of peptic ulcer disease, bleeding disorders, and concurrent use of anticoagulants or antiplatelet drugs.

• Protamine Sulfate…What Is It Used For: Reverses the effects of heparin.

• Heparin & Breast Feeding: Heparin is safe to use during breastfeeding as it is not absorbed orally by the infant.

• Phytonadione What Is It Used For: Vitamin K; used to reverse the effects of warfarin.

• Fibrinolytic Drugs IV: Administered intravenously to dissolve blood clots.

• Direct Thrombin Inhibitor…Know Medications in This Classification: Examples include dabigatran, argatroban, and bivalirudin.