Drug cards Flashcards
Morphine
class- opioid analgesic- agonist
indications- pain relief, (mod-severe) pre-op sedation, dec anxiety, pulm edema
mech action- mimick opioid peptide, produce endogenous analgesia/gen. cns depression
assessment- b/a bp, rr, o2, LOC, bowl fun, pain location;type; and intensity
adverse e- RESP. DISTRESS, n/v, pupil constric, euphoria, constip, slow motil, bowl spasm, urinary reten, orthostat hypoten, sedation
interactions- mao (monoamine oxidase inhib) w/in 14 days, alcoh/antipsychotics- sedation, resp dep, coma, death
warfarin- inc anticoag effects
patient ed-avoid o/ cns dep and alcoh, abuse pot, drowsy/dizzy (fall precaut), how/when ask for pain meds
HYDROcodone
class- opioid analgesic- agonist
indications- pain relif (mod-sev) or (constant/chronic)
mech action- bind opioid recep, alter percep/response pain, gen cns depress
assessment- b/a bp, rr, O2, LOC, bowl funct, brkthru pain- b/@peak, pain location, type, intensity, risk abuse
adverse e- confusion, dizzy, sedation, hypoten, n, constip, ingestion, urinary ret, RESP DEPRESS
interactions- mao inhib, benzodiazepines o/ cns dep- resp dep, sedation and coma
cyp3A4 inducers- dec fentanyl lvl anaelgesia
patient ed- avoid o/ cns dep and alc, abuse pot, drowsy/dizzy (fall precat), sugarl gum dec dry mouth
Codeine
class- opioid analgesic-agonist
indications- pain rel (mild-mod) cough reducer
mech action-bind opioid recep, alter percep/response pain, gen cns depress
assessment- b/a bp, rr, O2, LOC, bowl funct, brkthru pain- b/@peak, pain location, type, intensity, risk abuse
adverse e- RESP DEPRES, hypoten, constip, n/v, confusion, sedation
interactions- MAO inhib, alcoh/ benzodiazepines- inc cns depres, CYp3A4 inhib- inc lvl/ risk resp depre, mixed agonist/antagonist- risk withdrawl, dec effects
patient ed-avoid o/ cns dep and alcoh, abuse pot, drowsy/dizzy (fall precaut), s/s respir deprssion
fentaNYL
class- opioid analgesic- agonist
indications- pain supp for gen anesth, nerve block, pre/post op pain relief
mech action- bind opioid recep, alter percep/response pain, gen cns depress
assessment- b/a bp, rr, o2, LOC, bowl fun, pain location;type; and intensity, toxic overdose (hypoten, bradycardia, asystole)
adverse e- arrhyth, circ depress, hypoten, n/v, skel rigidty, confusion, APNEA, LARYNGOSPASM, RESP DEPRES
interactions- MAO inhib, alcoh/ benzodiazepines- inc cns depres, CYp3A4 inhib- inc lvl/ risk resp depre, mixed agonist/antagonist- risk withdrawl, dec effects
patient ed- sensations expect b4 surg, how/when ask pain m, dizzy/drowsy, avoid alc o/ cns depres at least 24hrs
HYDROmorphone
class- opioid analgesics- agonist
indications- pain rel (mod-severe), suppression cough
mech action- *no active metab, bind opioid recep, alter percep/response pain, gen cns depress
assessment- b/a bp, rr, O2, LOC, bowl funct, brkthru pain- b/@peak, pain location, type, intensity, risk abuse
adverse e- RESPIR DEPRSS, hypoten, confusion, sedation, unusual dreams
interactions- MAO inhib (dc 2wk prior), alcoh/ benzodiazepines- inc cns depres
mixed agonist/antagonist- risk withdrawl, dec effects
antidep, SSRI- inc risk serotonin toxicity
patient ed- pot abuse, how as pain meds, s/s respir depress, drowsy/dizzy (fall precaut), avoid alc/ o/ cns depres
Meperidine
class- opioid analgesics- agonist
*active metabolites
indications- pain relief
mech action- bind opioid recep, alter percep/response pain, gen cns depress
assessment- cns stimulation (risk toxicity), b/a bp, rr, o2, LOC, bowl fun, pain location;type; and intensity
adverse e- SEIZURES, RESPIR DEPRES, HYPRSEN RXNS, constip, n/v, hypoten, confusion, sedation
interactions- MAO inhib (dc 2wk prior), alcoh/ benzodiazepines- inc cns depres
mixed agonist/antagonist- risk withdrawl, dec effects
antidep, SSRI- inc risk serotonin toxicity, CYp3A4 inhib- inc lvl/ risk opioid toxicity
patient ed- pot abuse, how/when ask pain m, drowsy/dizzy, avoid alc and o/ cns dep, lying down dec n/v
Methadone
class- opioid analgesic- agonist
*long-duration action
indications- pain rel for opioid tol pt (daily), constant and sympt control during drug detox
mech action- bind opioid recep, alter percep/response pain, gen cns depress
assessment- hx heart dis, syncope, arrhyth, order ekg (causes v-tach and cardiac arrest), opioid withdrawl (sweating, loss apetit, runny nose), risk abuse, bowl fun, bp, pulse, rr, sedation lvl, pain type, location and intensity
adverse e- RESPIR DEPRES, constipation, hypotens, VENT TACHY
interactions- MAO inhib, antiarrhyth/ca channel blockers, diuretics (inc risk hypo mg/kalemia and inc risk arrhyth), CYP inhib (inc risk opioid toxicity) CYP inducers (dec effect analge), benzo’s and cns dep (sedation, coma, resp dep, death), agonist/antagonist (inc risk withdrawl)
patient ed- inform abt pot arrhyth, abuse pot, how/when ask pain m
oxyCODONE
class- opioid analgesic- agonist
*can be combo w/ acetamin. shrt/long acting
indications- pain rel (mod-sev)(daily, chronic)
mech action-bind opioid recep, alter percep/response pain, gen cns depress
assessment- b/a bp, rr, O2, LOC, bowl funct, brkthru pain- b/@peak, pain location, type, intensity, risk abuse
adverse e- RESPI DEPR, confusion, sedation, constip
interactions-MAO inhib, CYP inhib (inc risk opioid toxicity) CYP inducers (dec effect analge), benzo’s and cns dep (sedation, coma, resp dep, death), partial anagonist (inc risk withdrawl)
patient ed- oxycontin tab can appear stool, avoid o/ cns dep and alcoh, abuse pot, drowsy/dizzy (fall precaut), how/when ask for pain meds
Naloxone
class- opioid antagonist
indications-reversal cns dep/resp dep due to overdose
mech action- blocks effects opioids, cns/resp depression, no agonist effects!
assessment- rr, rhythm, depth, pulse, bp, LOC (after peak conc), pain lvl, withdrawl s/s
adverse e- VENTR ARRHY, htn, hypoten, n/v
interactions- withdrawl (if phys dependant)
patient ed- explain purpose
Metoclopramide
class- antiemetics (dopamine antagonist)
indications- prevent chemoinduced emesis, trt acute diabet gastroparesis, gastroesoph reflux, prevent postop n/v
mech action- block dopamine recep in chemorecep trigger zone of cns, stim motility upper GI, accel gastric emptying
assessment- b- n/v, abdom disten, during- extrapyram (tremors, shuffling, pill rolling, rigitidy, weakness) tardive dyskinesia (uncont mvmnt face, mouth, extrem) hyperthem, alt concious, tachycardia
adverse e- NEUROLEPTIC MALIGNANT SYDROME, anxiety, diarrh, gynecomastia, tremor
interactions- inc absorp , risk toxicity frm cyclosporine, affect gi absorp o/ drugs, exagg hypoten in anesthesia, opioids anatag effects, dec effectivess levodopa (parkinsons)
patient ed- drowsiness, no alco o/ cns depres, risk extrapyramidal/tardive dyskin/ neuro malig synd
not take when preg
dramamine
“dimenhyDRINATE”
class- antiemtics/antihistamines
indications- trt n/v, dizzin, vertigo, motion sickness
mech action- inhibi vestibular stim, cns dep properties
assessment- b/a n/v bowl sounds, abdom pain, chart I&O, dehydration s/s
adverse e- drowsiness, anorexia, hypoten, dysuria
interactions- inc cns depress effects, mask s/s ototoxicity, mao inhib inc anticholinergic effect antihistamine
patient ed- dry m, drowsy, no alco o/ cns depress, sunscreem
Scopolamine
class- antiemetic, muscarinic, acetylchol. antagonist
*most effective for motion sick.
indications- prevent motion sick and post op n/v
mech action- inhib muscarinic act of acetylcholine, balances norepineph and acetylchol in CNS
assessment- s/s urinary renention
adverse e- dry m, urinary retention, blurred vision, drowsy, tachycard
interactions- inc anticholin effects w/ antidep/antihistam
inc cns dep w/ alc/opioid/ antidep, slow dwn gi tract (inhib absor Po drugs, inc gi mucosal lesions
patient ed- transderm precaut, no underwtr sports, drowsiness, heatstroke when exercising, no alco/cns dep, dry m, dont use if preg
NSAIDS
class- nonsteroidal anti-inflam
indications- reduction fever, pain relief (mid to mod)
mech action- analgesic (ihib prostaglan syn), vasodilation
assessment- asthma, allergies (inc risk hypersen rxn), pain, fever, GI blood loss?
adverse e- GI bleeding
interactions- prolong bleeding time, inc effects warfarin/ antiplatelet, dec response diuretics and antihtn drugs
patient ed- take w/ 8 oz h20, no alcoh (gastric irritation/bleeding), do not take before surg
Aspirin
class- antiplatelet, nonopioid analgesic
indications- trt RA, OA, mild-mod pain, fever, prophylaxis TIS/MI
mech action- pain/inflamm relief via inhib prostaglandin syn, dec platlet aggregation
assessment- asthma, allergies (inc risk hypersen rxn), pain, fever, s/s DRESS (fever, rash, facial swelling), monit serum uric acid, tsh, serum salicylate lvl, overdose
adverse e- drug rxn w/ EOSINOPHILIA, GI BLEEDING< HYPERSEN RXN (anaphylaxis)(laryngeal edema)
interactions-inc risk bleeding thrombolytic agents, ibuprofen (negate cardioprotect antiplat affects), inc act penicillins, serum salicylate lvl flucutate, blunt response diruects and ace inhib, inc risk gi irr w/ nsaids
inc bleeding w/ ginseng/ginkgo
patient ed- report tarry stool, tinnitus, fever longer 3 days no alco (inc gi bleeding) na restrictive diet, no vinegar-like tablets, hold wk b4 surg, not take in 3rd trimester or after 20 wks *not use in kids (reyes synd)
Acetaminophen
class- non-opioid analgesics
indications- mild-mod pain, fever, severe pain (IV)
mech action-inhib syn prostagland in cns
*no GI toxicity
assessment- alc usage, rash, stevens-johnson syndrome, blisters, oral lesions, fatigue, pain, fever, serum bilirubin, can lead false blood gluc lvls
adverse e- ACUTE GEN EXANTHEMATOUS PUSTULOSIS, STEVENS/JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, HEPATOTOXICITY, renal failure, hypokalemia
interactions- inc risk bleeding w/ warfarin, hepatotoxicity w/ alc, inc risk liver damage w/ barbiturates, inc risk renal dis w/ nsaids, dec propranolol metab
patient ed- no more 4g/ day, avoid alc (liver dam bc dec lvl glutathione), dc if rash, alters bg lvls
Chondrotinin/ Glucosamine
class- nonopioid analgesic
indications- delay brkdwn joint cart., syn new cartilage
trt OA, ischemic heart dis, osteoporosis, hyperlip.
mech action- building block articular cart
assessment- pain, gastric discom, bleeding
adverse e- n, heartburn, edema, bleeding
interactions- inc risk bleeding w/ nsaids/ anticoag
patient ed- take w/ glucosamine, reinforce consistent use, not take during preg
Capsicum
class- analgesic
indications- dec pain sensation, trt arthritis, dyspepsia (ingestion)
mech action- bind nociorec in skin= heightened sen/ cutaneous vasodil (densensitization by substance P depletion)
assessment- pain, liver/ kid function (can stim circ)
adverse e- buring, sweating, gi irrit, diarr, bleeding
interactions- inc risk bleeding w/ anticoag, inc absorp theophylline (bronchodilator)
patient ed- not during preg gloves worn, rub in so no cream shows, burning expected (inc by heat ei clothes, exercise diluted vinegar solution to remove not apply if shingles lesions dc pain contin > 1 month
Cimetidine
class- antiulcer agent (Tagamet)
indications- shrt trt active duodenal ulcers, management GERD, trt acid indigestion/heartburn
mech action- inhib action histamine at H2 recep site in gastric parietal cells= inhib gastric acid secretion
assessment- abdominal pain, blood in stool/emesis, confusion, CBC blood levels, inc serum creatinine
adverse e- ARRHY, AHRANULOCYTOSIS, APLASTIC ANEMIA, confusion, diarr
interactions- inc risk toxicity as inhib drug-metab enzymes in liver
inc effect succinylcholine (musc relaxant)
inc absorb ketoconazole (skin infections)
dec antacid absorb
patient ed- cessation smoking, drowsy, avoid alc, nsaids and irritating foods, consipation common, report tarry stools, fever, diarr, rash, confusion
Famotidine
class- antiulcer agent, h2 blocker
indications-shrt trt active duodenal ulcers, management GERD, trt acid indigestion/heartburn
mech action-inhib action histamine at H2 recep site in gastric parietal cells= inhib gastric acid secretion
assessment-abdominal pain, blood in stool/emesis, confusion, CBC blood levels, inc serum creatinine
adverse e-ARRHY, AHRANULOCYTOSIS, APLASTIC ANEMIA, confusion, diarr
interactions- dec absorb ketoconazole (skin infections)
patient ed-cessation smoking, drowsy, avoid alc, nsaids and irritating foods, consipation common, report tarry stools, fever, diarr, rash, confusion
Ranitidine
class- antiulcer agent
r2 blocker
indications- healing/prevem ulcers, dec gerd sympt, dec secretion gastric acid
mech action-inhib action histamine at H2 recep site in gastric parietal cells= inhib gastric acid secretion
assessment-abdominal pain, blood in stool/emesis, confusion, CBC blood levels, inc serum creatinine
adverse e-ARRHY, AHRANULOCYTOSIS, APLASTIC ANEMIA, confusion, diarr
interactions- dec absorb ketonconazole, inc absor triazolam, inc effects warfarin
patient ed-cessation smoking, drowsy, avoid alc, nsaids and irritating foods, consipation common, report tarry stools, fever, diarr, rash, confusion
Omeprazole
class- antiulcer agent
PPI
indications- healing duodenal ulcer, gerd maintan, dec accum acid in gastric lumen
mech action-binds enzyme on gastric parietal cells in presence of acid pH, prevent transport H ion into lumen
assessment-bowl fun, abdom pain, Mg lvls
adverse e- CDAD, abdom pain, dizziness, pneumonia, hypomag, inc risk cdiff, rebound acid hypersec
interactions- HIV/AIDS drugs (atazanavir)
antifungal drugs- ketoconazole
enzyme metab- clopidogrel
patient ed- tarry black stools, avoid alc/nsaids, drowsy
Clopidogrel
class-antiplatelet
indications- reduc risk mI/ stroke
mech action- inhib plate aggre via inhib ATP bind to platelet recep
assessment- stroke, periph vasc dis/ MI
thromboitc thrombocytopenic purpura
platelet count
adverse e- STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, DRUG RASH, ACUTE GEN EXANTHEMATOUS PUSTULOSIS, GI BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC PURPURA
interactions- aspirin inc risk bleeding, dec metab nsaids, opioids dec absorb/ effect of drug
patient ed- report s/s bleeding, fever, rash, weakness, jaundice
not mix w/ omeprazole
not use neuraxial blockade during preg
Sucralfate
class- antiulcer agent
gi protectant
indications- management duodenal ulcers
mech action- Al sal reacts w/ acid form protective paste
assessment- abdomin pain/ bloody stool
adverse e- constip, anaphylaxis
interactions- dec absob fat sol vitamins/ phenytoin
h2/ppi dec effectiveness via low pH
patient ed- constip precautions
Diphenoxylate/Atropine
class- antidiarrheal
indications- antidiarrheal
mech action- activ opioid recep in Gi tract - dec intest motility, reduces fluid in feces
assessment- freq/consis stools, dehydration, fluid bal, liver lvls
adverse e- drowsy, constipation, dry m, blurred vision, urinary retention
interactions- avoid alc, opioids o/ cns depress
patient ed- drowsy, dry m, no alc/ cns dep
Bismuth subsalicylate
class-antidiarrheal
indications- relief diarrh
mech action- inc intestinal absorp fluid/electrol, dec syn intestinal prostaglandins
assessment- consis/freq stools, n, indigestion, dehydr, fluid bal, ulcers (epigastric pain)
adverse e- constip, black stools
interactions- aspirin- inc risk salicylate toxicity
dec absor tetracycline
patient ed- black color common, dc aspirin if tinnitus occurs, call if diarr contin 2+ days and fever
Ondansetron
class- antiemetics (Zofran)
indications- prevent/ trt chemo induced n/v
mech action- block serotonin recep in ctz *no extrapydram effects ei dry m
assessment- n/v, abdom disn, bowel sounds, extrapyramidal effects, termor, seizures, rash, fatigue, joint aches, fever
adverse e- headaches, diarrh, dizziness, STEVENS JOHNSON SYN, TORSADE DE POINTES, SEROTONIN SYNDROME
interactions- apomorphine inc risk hypotension and loc
phenytoin dec lvls
maoi’s inc risk serotonin syndrome
patient ed- call if irreg heart beat, seroton syndrome, invol mvmnt eyes, face or limbs
Aprepitant
class- antiemetic (Emend)
indications- dec n/v w/ chemotherapy
mech action- block neurokinin 1 type recep for sub P in ctz
assessment- n/v, bowel sounds, pain, rash, hydration, I/Os, allergic rxns, infusion site rxn
adverse e- fatigue, hiccups, dizziness, diarrh
interactions- inhib/induce metab liver enzymes
patient ed- call if n/v persist
Prochlorperazine
dopamine antagonist
class- antiemetic
indications- post op n/v
mech action- block dopamine 2 recep in ctz
assessment-n/v, bowel sounds, pain, rash, hydration, I/Os, allergic rxns, infusion site rxn
adverse e- eps, anticholinergic e, hypotension, sedation, irrit to tissue and veins
interactions- avoid w/ pt with parkinsons
dec effects warfarin
inc lvl cyp3a4 substrates
inc lvl pimozide= inc risk torsade de pointes
patient ed- call if n/v persists
Albuterol
therap class- bronchodil
beta 2 recep SABA
(Proair)
indications- trt/ prevent bronchospasm asthma/COPD
mech action- bind beta 2 recep in sm musc airway to prevent bronchoconstriction
ae- chest pain, palpations, nervousness, tremor, restlessness, PARADOXICAL BRONCHOSPASM
assessment- lung sounds, bp, pulse, sputum, pulmonary function, wheezing, K+ lvs
interactions- mao- hypertensive crisis, dec digoxin lvl
pt ed- may cause bad taste, inform health care profess if SOB, chest pain etc, prime unit w/ 4 sprays before use- discard after 200 sprays
Flovent
class- corticosteroid
indications- long term trtmnt asthma
moa- anti-inflamm
ae- headache, CHURG STRAUSS SYNDROME, dry mouth, oral fungal infection
assessment- lung sounds, withdrawal, bone density, thrush
interactions- cyp34 INHIB
pt ed- 5min btw each breath, not used for acute exacerbations, rinse/gargle after use
Montelukast
(singulair)
class- Leukotriene antagonist
indications- prophylaxis asthma
moa- block inflamm, vasc perm, dec inflamm cell migration/activation, dec bronchoconstriction, prevent leukotrienes attaching to recep on cells in lungs
ae- churg strauss syndrome
assessment- limit alcoh, liver function
interactions- phenytoin- alters metab drungs in liver
pt ed- not used rescue inhaler, important follow routine admin
Salmeterol
class- bronchodil
beta 2 recep LABA
indications- long term control bronchospasms
moa- bind beta 2 recep in sm musc airway to prevent bronchoconstriction
ae- severe asthma exacerbations (become tolerant) never use alone
assessment- lung sounds, pulse bp, wheezing, K lvls
interactions- beta blockers dec effect, mao/ cyp3a4- cardiovasc effects
pt ed- don’t exhale into disc, use as directed, use w/ ICS
theophylline
class- methylxanthines (bronchodil)
indications- adjunct maintenance therapy COPD
moa- relaxes sm usc in bronchi
ae- diarrhea, vf, seizures, death, n/v, insomnia
assessment- bp, pulse, rr, monitor for diuresis, pulmonary function
interactions- caffine (inc effects), phenytoin dec effects, h2 recep inc risk toxicity
pt ed- drink 2000mL/day, no smoking, routine serum lvl testing
Ipratropium
class- anticholinergic (bronchodil)
(atrovent)
indications- therapy for reversible airway obstruction due to COPD
moa- bind acetylcholine recep to prevent ach frm binding, prevents bronchconstriction
ae- inc intraocular p, dry mouth
assessment- rr, pulse, wheezing, rhinorrhea (nasal spray)
interactions- o/ ach drugs inc lvls
pt ed-avoid Combivent if allergic peanuts, rinse mouth after use, do not inhale while spraying
Pseudoephedrine
Sudafed
class- adrenergic- decongestant
indications- management nasal congestion
moa- stimulates alpha/beta-adrenergic recep, vasoconstriction respir tract mucosa
ae- nervousness, anxiety, SEIZURES, palpations, CARDIOVASC COLLAPSE
assessment- congestion, pulse, bp, lung sounds, maintain fluid intake 1500-2000mL/day
interactions- mao- htn crisis, acidic foods dec effectiveness
pt ed- caution w/ kids < 4 or breastfeeding
Phenylephrine
Sinex
class- decongestant
(nasal)
indications- shrt term management nasal congestion
moa- stim alpha-adrenergic recep in nasal mucosa producing vasoconstriction
ae- rebound congestion, burning, drying nasal mucosa
assessment- nasal congestion
interactions- inc risk htn w/ antidepress
pt ed- not take w/ lrg amnts caffeine
Diphenhydramine
Benadryl
class- antihistamine
indications- treat common cold, motion sickness, sleep aid, anaphylaxis, allergic rhinitis
moa- anticholinergic effects-
ae- dry mouth, drowsiness, constipation, changes vision, pupil dilation
assessment- depends on intended use, cold- sneeing, rhinorrhea, nasal stuffiness
interactions-inc risk cns depress w/ opioids/alcoh, mao inhib inc anticholinergic effects
pt ed- not use w/ alcoh and opioids, can cause drowsiness and dry mouth
Loratadine
Claritin
class- 2nd gen antihistamine
indications- relief seasonal allergies
moa- block effect histamine- dec vasodil, dec respir secretions, dec cap perm
ae- confusion, drowsiness, blurred vision, dry mouth
assessment- allergy symptoms (hives, conjunctivitis (pink eye))
interactions- mao inc effects, inc cns dep w/ opioids/ alcoh
pt ed- sunscreen, avoid alcoh, good oral hygiene avoid dry m, caution while driving
