CNS Stimulants
ADHD Medications
Amphetamine (Adderall, Dexedrine)
Mechanism of Action: Stimulates excitatory neurons, increases dopamine & norepinephrine.
Indications: ADHD, narcolepsy.
Adverse Effects: Increased HR/BP, anxiety, tremor, insomnia, headache, decreased appetite, GI distress, dry mouth.
Contraindications: Cardiac abnormalities, hypertension, anxiety, agitation, glaucoma, MAOI use (within 14 days).
Nursing Implications:
Administer 4-6 hours before bedtime.
Take on an empty stomach.
Monitor BP, pulse, weight, growth patterns in children.
Avoid abrupt withdrawal.
Methylphenidate (Ritalin, Concerta)
Mechanism of Action: CNS stimulant affecting dopamine reuptake.
Indications: ADHD, narcolepsy.
Adverse Effects: Same as amphetamines.
Nursing Implications: Same as amphetamines.
Lisdexamfetamine (Vyvanse)
Mechanism of Action: Converted into dextroamphetamine.
Indications: ADHD, binge-eating disorder.
Nursing Implications: Similar to amphetamines.
Atomoxetine (Strattera)
Mechanism of Action: Selective norepinephrine reuptake inhibitor.
Indications: ADHD (children >6 and adults).
Adverse Effects: Lower abuse potential, less insomnia, but Black Box Warning for suicidal thoughts.
Nursing Implications:
Monitor mental health for suicidal ideation.
Narcolepsy Medications
Modafinil (Provigil)
Mechanism of Action: Low abuse potential stimulant.
Indications: Narcolepsy, shift work sleep disorder.
Nursing Implications:
Monitor BP & mental health.
Antimigraine Medications
Rizatriptan (Maxalt), Sumatriptan (Imitrex)
Mechanism of Action: Serotonin receptor agonist, causing vasoconstriction.
Indications: Acute migraine treatment.
Adverse Effects: Tingling, flushing, chest tightness, rebound headaches if overused.
Contraindications: Cardiovascular disease, hypertension, glaucoma.
Nursing Implications:
Administer at first sign of migraine.
Avoid triggers.
Monitor cardiac history.
Endocrine Medications
Pituitary Medications
Somatropin (Humotrope)
Mechanism of Action: Growth hormone replacement.
Indications: Growth failure (hypopituitarism, HIV wasting).
Adverse Effects: Hyperglycemia, hypothyroidism, injection site reactions.
Nursing Implications:
Monitor growth, motor skills, thyroid, and glucose levels.
Rotate injection sites.
Octreotide (Sandostatin)
Mechanism of Action: GH antagonist.
Indications: Acromegaly, GH-producing tumors.
Adverse Effects: GI distress, glucose changes, cardiac conduction issues.
Nursing Implications:
Monitor glucose, EKG, growth.
ADH Medications
Vasopressin (Pitressin) & Desmopressin (DDAVP)
Mechanism of Action: Mimics ADH.
Indications:
Vasopressin: Hypotension, hemorrhage.
Desmopressin: Diabetes insipidus, bedwetting.
Adverse Effects: Increased BP, headache, GI distress.
Nursing Implications:
Monitor VS, urine output, cardiac status.
Thyroid Medications
Levothyroxine (Synthroid)
Mechanism of Action: Synthetic T4.
Indications: Hypothyroidism.
Adverse Effects: Hyperthyroid symptoms.
Nursing Implications:
Administer before breakfast on an empty stomach.
Monitor thyroid labs (TSH, T3, T4).
Avoid iodine-rich foods, iron/calcium supplements.
Propylthiouracil (PTU)
Mechanism of Action: Inhibits thyroid hormone production.
Indications: Hyperthyroidism, thyroid storm.
Adverse Effects: GI distress, bone marrow suppression.
Nursing Implications:
Monitor thyroid levels & CBC.
Avoid iodine-rich foods.
Radioactive Iodine (I-131)
Mechanism of Action: Destroys thyroid tissue.
Indications: Hyperthyroidism, thyroid cancer.
Adverse Effects: Radiation sickness, Pregnancy Category X.
Nursing Implications:
Radiation precautions: Avoid close contact, use separate utensils, increase fluids.
Adrenal Medications
Glucocorticoids
Hydrocortisone (Solu-Cortef), Prednisone (Deltasone), Dexamethasone (Decadron), Methylprednisolone (Solu-Medrol)
Mechanism of Action: Anti-inflammatory, immunosuppressant.
Indications: Adrenal insufficiency, inflammatory/autoimmune diseases.
Adverse Effects:
Metabolic: Hyperglycemia, weight gain, Cushing’s syndrome.
Musculoskeletal: Osteoporosis, muscle wasting.
CV: Hypertension, edema.
Neuro: Mood swings, insomnia.
Nursing Implications:
Administer in the morning with food.
Taper off slowly to prevent adrenal crisis.
Monitor glucose levels with long-term use.
Avoid sick contacts due to immune suppression.
Mineralocorticoids
Fludrocortisone (Florinef)
Mechanism of Action: Mimics aldosterone (Na & water retention).
Indications: Addison’s disease, adrenal insufficiency.
Adverse Effects: Hypertension, hypokalemia, edema.
Nursing Implications:
Monitor BP, electrolytes (Na, K).
Immunosuppressants
Cyclosporine (Sandimmune), Tacrolimus (Prograf)
Mechanism of Action: Suppresses immune response.
Indications: Organ transplant, autoimmune diseases.
Adverse Effects: Increased risk for infections, nephrotoxicity, diabetes.
Nursing Implications:
Strict dosing schedule (same time every day).
Avoid grapefruit juice & styrofoam cups.
No live vaccines (MMR, Varicella, Smallpox).
Report any signs of infection immediately.
Lifespan Considerations
Pediatrics:
Monitor growth in children using ADHD meds & growth hormones.
Pregnancy:
Avoid radioactive iodine (I-131) & immunosuppressants.
Elderly:
Caution with stimulants & corticosteroids (risk of cardiac issues, osteoporosis).
Patient Teaching
CNS Stimulants:
Avoid abrupt withdrawal.
Monitor growth (children).
Thyroid Meds:
Take levothyroxine on an empty stomach.
Avoid iodine-rich foods if on PTU.
Corticosteroids:
Taper off gradually.
Monitor glucose, avoid infections.
Immunosuppressants:
No live vaccines.
Strict dosing schedule.
Insulins
Rapid-acting Insulins (Insulin lispro - Humalog, Insulin aspart - Novolog)
Mechanism of Action: Fast-acting insulin that mimics natural insulin secretion in response to meals.
Indications: Type 1 or Type 2 Diabetes.
Adverse Effects: Hypoglycemia, weight gain, lipodystrophy at injection sites.
Nursing Implications:
Must eat a meal after injection.
Administer subcutaneously (SQ) or via infusion pump.
Clear, colorless solution.
Short-acting Insulin (Regular insulin - Humulin R)
Mechanism of Action: Provides short-term glucose control.
Indications: Type 1 & Type 2 Diabetes.
Adverse Effects: Hypoglycemia, weight gain.
Nursing Implications:
Onset: 30-60 min, Peak: 2.5 hr, Duration: 6-10 hr.
Can be administered IV, IM, or SQ.
Clear, colorless solution.
Intermediate-acting Insulin (NPH - Isophane insulin suspension)
Mechanism of Action: Delayed onset but prolonged glucose control.
Indications: Often combined with regular insulin for Type 1 & Type 2 Diabetes.
Adverse Effects: Hypoglycemia, weight gain.
Nursing Implications:
Onset: 1-2 hr, Peak: 4-8 hr, Duration: 10-18 hr.
Cloudy suspension, administered SQ.
Usually given twice daily before meals.
Long-acting Insulins (Insulin glargine - Lantus, Insulin detemir - Levemir)
Mechanism of Action: Provides basal insulin coverage with no peak effect.
Indications: Type 1 & Type 2 Diabetes.
Adverse Effects: Hypoglycemia (less risk), weight gain.
Nursing Implications:
Onset: 1-2 hr, No peak, Duration: 24 hr.
DO NOT mix with other insulins.
Clear, colorless solution.
Oral Antidiabetics
Biguanides (Metformin - Glucophage)
Mechanism of Action: Decreases hepatic glucose production & increases insulin sensitivity.
Indications: First-line treatment for Type 2 Diabetes.
Adverse Effects: GI discomfort, diarrhea, metallic taste, reduced B12 levels.
Black Box Warning: Risk of lactic acidosis (especially in renal failure).
Nursing Implications:
Administer 30 min before meals.
Hold if contrast dye is used (renal failure risk).
Sulfonylureas (Glipizide - Glucotrol)
Mechanism of Action: Stimulates pancreatic insulin release.
Indications: Type 2 Diabetes (early stages).
Adverse Effects: Hypoglycemia, weight gain, nausea.
Contraindications: Sulfa allergy.
Nursing Implications:
Give 30 min before meals.
Monitor for hypoglycemia.
Glinides (Repaglinide - Prandin)
Mechanism of Action: Increases insulin secretion from beta cells.
Indications: Type 2 Diabetes (postprandial glucose control).
Adverse Effects: Hypoglycemia, weight gain.
Black Box Warning: May exacerbate heart failure.
Nursing Implications:
Take with each meal, skip if meal is skipped.
Glitazones (Pioglitazone - Actos)
Mechanism of Action: Improves insulin sensitivity.
Indications: Type 2 Diabetes (often combined with metformin or sulfonylureas).
Adverse Effects: Fluid retention, weight gain, fractures.
Black Box Warning: May exacerbate heart failure.
Nursing Implications:
Weigh daily.
Monitor for heart failure signs.
Alpha-glucosidase Inhibitors (Acarbose - Precose)
Mechanism of Action: Delays carbohydrate absorption.
Indications: Type 2 Diabetes (postprandial glucose control).
Adverse Effects: GI issues (flatulence, diarrhea).
Contraindications: GI disorders (IBD, malabsorption).
Nursing Implications:
Take with first bite of meal.
DPP-4 Inhibitors (Gliptins) (Sitagliptin - Januvia)
Mechanism of Action: Enhances incretin hormone function.
Indications: Adjunct to diet/exercise in Type 2 Diabetes.
Adverse Effects: URI, headache, diarrhea.
Nursing Implications:
Take once daily, with or without food.
SGLT-2 Inhibitors (Canagliflozin - Invokana)
Mechanism of Action: Inhibits glucose reabsorption in kidneys.
Indications: Type 2 Diabetes (weight loss benefit).
Adverse Effects: UTIs, yeast infections, dehydration, ketoacidosis.
Nursing Implications:
Take once daily before breakfast.
Injectable Non-Insulin Medications
Amylin Agonists (Pramlintide - Symlin)
Mechanism of Action: Slows gastric emptying, suppresses glucagon.
Indications: Type 1 & Type 2 Diabetes.
Adverse Effects: Nausea, vomiting, anorexia.
Contraindications: Gastroparesis.
Nursing Implications:
Inject before meals.
Take at least 1 hr before oral meds.
Incretin Mimetics (Exenatide - Byetta)
Mechanism of Action: Enhances insulin secretion.
Indications: Type 2 Diabetes (used when oral meds fail).
Adverse Effects: GI symptoms, weight loss, thyroid tumors (Black Box Warning).
Nursing Implications:
Administer SQ 1 hr before meals.
Glucose-Elevating Agents
Glucagon
Indications: Severe hypoglycemia.
Adverse Effects: Vomiting (turn patient on side).
Nursing Implications:
Used when patient cannot take oral glucose.
Dextrose 50% in Water (D50W)
Indications: Emergency treatment of hypoglycemia.
Nursing Implications:
Administer IV.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Salicylates (Aspirin - ASA)
Mechanism of Action: COX-1 & COX-2 inhibitor, antiplatelet.
Indications: Pain, fever, inflammation, CV prevention.
Adverse Effects: GI bleeding, Reye’s syndrome in children.
Nursing Implications:
Do not give to children with viral infections.
Acetic Acid Derivative (Ketorolac - Toradol)
Indications: Short-term pain management (up to 5 days).
Adverse Effects: Renal impairment, GI distress.
COX-2 Inhibitor (Celecoxib - Celebrex)
Indications: Osteoarthritis, rheumatoid arthritis.
Adverse Effects: CV risk (Black Box Warning).
Contraindications: Sulfa allergy.
Propionic Acid Derivatives (Ibuprofen, Naproxen)
Indications: Pain, inflammation, fever.
Adverse Effects: GI distress, bleeding risk.
Antigout Medications
Allopurinol (Zyloprim)
Mechanism of Action: Reduces uric acid production.
Indications: Chronic gout prevention.
Adverse Effects: Stevens-Johnson syndrome.
Nursing Implications:
Take with food.
Colchicine (Colcrys)
Mechanism of Action: Reduces inflammatory response.
Indications: Acute gout attack.
Adverse Effects: GI distress, bleeding risk.
Nursing Implications:
Hydration (3L/day).
Immunizations
Active Immunizing Drugs
Mechanism of Action: Stimulate the immune system to produce antibodies against specific pathogens, offering long-term immunity.
Indications: Prevention of infectious diseases.
Adverse Effects:
Common: Soreness, fever, mild rash.
Severe: Fever >103°F, encephalitis, convulsions, anaphylaxis.
Contraindications: Immunocompromised patients, pregnancy (some vaccines), active infections.
Nursing Implications:
Assess medical history, immune status, and pregnancy.
Administer vaccines at appropriate sites:
Infants: Mid-lateral thigh.
Older children/adults: Deltoid muscle.
Use warm compresses, Tylenol for mild reactions.
Report severe reactions to VAERS (Vaccine Adverse Event Reporting System).
Examples of Active Immunizations:
Diphtheria, tetanus toxoids, acellular pertussis (DTaP, Td): Prevents diphtheria, tetanus, and pertussis.
Haemophilus influenzae type B (Hib): Prevents bacterial infections, especially in children.
Hepatitis B vaccine: Prevents Hep B infection.
Influenza vaccine: Annual vaccine for flu prevention.
Measles, mumps, rubella (MMR): Prevents viral infections.
Pneumococcal vaccine: Protects against pneumococcal infections (pneumonia, meningitis).
Poliovirus vaccine (IPV): Prevents poliomyelitis.
Rabies vaccine: Given for rabies exposure or pre-exposure prophylaxis.
Human papillomavirus (HPV - Gardasil): Prevents HPV-related cancers.
Herpes zoster (Zostavax, Shingrix): Protects against shingles.
Varicella vaccine: Prevents chickenpox.
Passive Immunizing Drugs
Mechanism of Action: Provides preformed antibodies for immediate protection; temporary immunity.
Indications: Post-exposure prophylaxis in high-risk patients.
Examples:
Hepatitis B immunoglobulin: Post-exposure protection for Hepatitis B.
Immunoglobulin: General immune support.
Rabies immunoglobulin: Post-exposure prophylaxis after animal bites.
Tetanus immunoglobulin: Used in unvaccinated individuals exposed to tetanus.
Dermatologic Medications
Antibacterials
Bacitracin
Mechanism of Action: Inhibits bacterial cell wall synthesis.
Indications: Minor skin infections.
Adverse Effects: Burning, itching.
Neomycin & Polymyxin B (Neosporin)
Mechanism of Action: Broad-spectrum antibacterial.
Indications: Minor wounds.
Adverse Effects: Local irritation.
Mupirocin (Bactroban)
Indications:
Topical: Treats impetigo (Staphylococcus, Streptococcus infections).
Intranasal: Used for MRSA colonization.
Adverse Effects: Burning, itching.
Silver Sulfadiazine (Silvadene)
Mechanism of Action: Acts on bacterial cell wall.
Indications: Burn treatment (prevention of infection).
Adverse Effects: Pain, burning, contraindicated in sulfa allergy.
Antiacne Medications
Benzoyl Peroxide
Mechanism of Action: Releases oxygen, killing acne bacteria.
Indications: Mild to moderate acne.
Adverse Effects: Red, peeling skin, warmth.
Tretinoin (Retin-A)
Mechanism of Action: Vitamin A derivative, stimulates cell turnover.
Indications: Acne, UV damage.
Adverse Effects: Skin peeling, severe sunburn risk (use sunscreen).
Isotretinoin (Accutane)
Mechanism of Action: Sebaceous gland suppression.
Indications: Severe cystic acne.
Adverse Effects: Teratogenic (Pregnancy Category X), liver toxicity, mood changes.
Black Box Warning: IPLEDGE Program (2 contraceptive methods required).
Antifungals
Clotrimazole (Lotrimin)
Mechanism of Action: Inhibits fungal growth.
Indications: Athlete’s foot, ringworm, yeast infections.
Adverse Effects: Local irritation.
Miconazole (Monistat)
Mechanism of Action: Antifungal, some Gram-positive action.
Indications: Yeast infections, jock itch, athlete’s foot.
Adverse Effects: Burning, itching, pelvic cramps.
Antivirals
Acyclovir (Zovirax)
Mechanism of Action: Inhibits viral DNA replication.
Indications: Herpes simplex (HSV-1 & HSV-2), shingles.
Adverse Effects: Stinging, rash.
Miscellaneous Dermatologics
Permethrin (Elimite)
Mechanism of Action: Neurotoxic to lice/scabies.
Indications: Head lice, scabies.
Adverse Effects: Itching, burning.
Ophthalmic Medications
Cholinergic Drugs (Miotics)
Acetylcholine (Miochol-E)
Indications: Induces miosis (pupil constriction) during surgery.
Adverse Effects: Eye discomfort, blurred vision.
Pilocarpine (Pilocar)
Mechanism of Action: Stimulates cholinergic receptors, reduces intraocular pressure.
Indications: Glaucoma, ocular surgery.
Adverse Effects: Blurred vision, tearing, reduced night vision.
Beta-Adrenergic Blockers
Timolol (Timoptic)
Mechanism of Action: Reduces aqueous humor production & increases outflow.
Indications: Glaucoma, ocular hypertension.
Adverse Effects: Eye irritation, systemic effects possible (bradycardia, hypotension).
Otic Medications
Ofloxacin (Floxin Otic)
Mechanism of Action: Fluoroquinolone antibiotic (bacterial DNA disruption).
Indications: Otitis externa & media.
Adverse Effects: Mild itching/pain.
Carbamide Peroxide (Debrox)
Mechanism of Action: Softens & breaks down earwax.
Indications: Earwax removal.
Adverse Effects: Ear irritation.
Nursing Considerations
Lifespan Considerations
Pediatrics:
Infants: Thigh for vaccines, avoid aspirin (Reye’s syndrome risk).
Monitor growth with long-term corticosteroids.
Pregnancy:
Avoid live vaccines (MMR, varicella, HPV, Zoster).
Avoid isotretinoin (teratogenic).
Elderly:
Caution with ophthalmic beta-blockers (can cause systemic effects).
Monitor renal function with fluoroquinolones (ototoxicity risk).
Patient Teaching
Vaccines:
Keep records, report reactions.
Use Tylenol, not aspirin for fever.
Dermatologics:
Apply with gloves, wash hands before & after.
Sunscreen required with tretinoin & isotretinoin.
Ophthalmic/Otic:
Apply pressure to inner canthus after eye drops (reduce systemic absorption).
Hold ear up & back (adults), down & back (children) for otic drops
Updated 38d ago
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