E2 Medications Flashcards
Carbidopa-levodopa (Sinemet)
Dopaminergic - prevents dopamine enzymes from being destroyed
Decreased effect when taken with 1st gen antipsychotics, MOA inhibitors
Pramipexole dihydrochloride (Mirapex)
Dopamine agonist (activation of dopamine receptors in striatum - basal ganglia) Nonergot derivative (…) Can be combination with carb/levo
SE: postural hypotension, hallucinations, IMPULSIVE behaviors, fatigue (can make intolerable)
Bromocriptine (Parlodel)
Dopamine agonist (activation of dopamine receptors in stratum - basal ganglia) Ergot derivative (…)
SE: n/v, hallucinations, delusions, postural hypotension
Nursing: Monitor liver functions
Can be used with carb/levo or on its own
Entacapone (Comtan)
COMT inhibitor (stops COMT enzyme from inactivating dopamine)
Used in combo with carb/levo MAY increase the half life (needs a lower dose)
Does NOT affect the liver function (safer than tolcopone (comtan))
SE: turn urine orange (harmless)
Selegiline (Eldepryl) + Rasagiline (Azilect)
MOA-B inhibitor (stops the MOAB enzyme from destroying dopamine) used as an early onset medication, may be used in combination with carb/levo (monitor for increase SE of carb/levo)
Adverse: Tyramine metabolism and hypertensive crisis possible
Amantadine (Symmetrel)
Antiviral also used for Influenza A - stimulates dopamine receptors
Not first line r/t loss of effectiveness
Improves rigidity and bradykinesia, less effective for tremors
Benztropine (Cogentin) + Trihexphenidyl HCL (Artane)
Anticholinergics - parasympatholytic; inhibits the release of acetylcholine
Reduces rigidity and some tremors, minimal change in bradykinesia (slow movement)
Fits BEERS criteria - not ideal for elderly
Anticholinergics Nursing Interventions
Monitor vitals, urine output (for retention) increase fluid, fiber and exercise to avoid constipation, AVOID alcohol, cigarettes, caffeine, and aspirin r/t decrease in gastric acidity, wear sunglasses, relieve dry mouth with ice chips, hard candy or sugarless chewing gum
Donepezil (Aricept) + Rivastigmine (Exelon) + Galantamine (Razadyne)
AChE inhibitors - Donepezil can be used for more severe dementia
Memantine (Namenda)
NMDA receptor antagonist - moderate to severe dementia symptoms, may be taken without regard to food, no known severe side effects
Glatiramer acetate (Copaxone)
Remission-exacerbation treatment of MS. Relives spasticity
SE: chest pain (scary but benign), injection site reaction
Fingolimod (Gilenya)
SPECIAL handling precautions; MS treatment
SE: bradycardia, infection, macular edema, liver injury
Need to test for varicella-zoster (chicken pox) if no history of disease or vaccine
Natalizumab (Tysabril)
DMT MS
Decreases immunity over time, not to be given with other immunosuppressants/HIV AIDS
Risk for progressive multifocal leukoencephalopathy (PML)
Monitor: Liver toxicity and opportunistic infections
Mitoxantrone
MS treatment used for CHRONIC and when disease is unresponsive other treatment
TOXIC - used to treat cancer, lifetime dose limit
Monitor: signs of infection (CBC), hold if neutrophils below 1500, reduces left ejection fraction
Baclofen (Lioresal) + Diazapam (Valium) + Tizanidine (Zanaflex)
Central acting muscle relaxants
Cyclobenzaprine (Flexeril)
Central acting muscle relaxant - Does not cause drug dependence
Alleviates muscle spasms associated with acute pain
SE: drowsiness, dizziness, ANTIcholinergic (dry mouth, blurry vision, urinary retention) dysrhythmias
Muscle Relaxants Nursing Interventions
Take with food, monitor liver, check vital signs, do not drive, most central are for ACUTE and no longer than 3 weeks, avoid alcohol
Those in adjunct with anesthesia remember patient is conscious and HEARING could be intact
Amphetamines
Stimulate release of norepinephrine and dopamine, increase alertness, may cause euphoria
SE: tachycardia, palpitations, hypertension, sleplessness, irritability, anorexia, dry mouth, diarrhea, constipation, weight loss
Anorexiants
Appetite suppressions
Risk for hemorrhagic stroke, potential for abuse
Not for children under 12
SE: nervousness, restlessness, irritability, insomnia, heart palpitations, hypertension
Analeptics
Used to stimulate respiratory system
Ex: caffeine + theophylline
SE: restlessness, tremors, twitching’s, diuresis, tinnitus, dependence, arrhythmias
Doxapram (Dopram)
Respiratory stimulant
Onset 20-40 sec (IV), peak 2 minutes SHORT
SE: hypertension, tachycardia, trembling, convulsions
Echinacea
Herb used for colds, flu or UTI - probable antiviral/antibacterial, increases lymphocytes and granulocytes in circulation at site of infection
Toxic with long term use (more than 3 months) can cause disruption in GI flora (possible C-diff)
Ginger
Root used for Gi upset in pregnacy, chemo, motion sickness and post op; should be used short term (up to 4 days)
Ginkgo Biloba
Antioxidant, peripheral vasodilator that increased blood flow to CNS
Some patients use for prevention/treatment of Alzheimers, CVA, dementia
Causes decreased platelet aggregation - discontinue 2 weeks before surgery do not use during pregnancy
St. Johns wort
Antidepressant (effects 4-6 wks.) and antiviral
Many drug interactions, can cause serotonin syndrome when taken with other antidepressants
Should not take while on Antabuse
Interferes is digoxin making it less bioavailable
Reduces effectiveness of birth control, warfarin and some HIV meds
Lantanoprost (Xalantan)
Antiglaucoma agent - prostaglandin analogue
Lowers IOP and improves outflow of aqueous humor
Brimonidine (Alphagan P)
Alpha-Adrenergic Agonists - decrease IOP by decreasing production of aqueous humor
SE: can cause pupil mydriasis, dry mouth, burning/stinging, blurred vision, crosses BBB (drowsiness, fatigue, hypotension)
TEACHING: contact lenses should be removed and not reinserted for 15 minutes after admin
Carbonic Anhydrase Inhibitors
Brinzolamide ophthalmic (Azopt) Topical + Acetazolamide (Diamox) Systemic decrease IOP by decreasing production of aqueous humor
SE: risk of cross-reactivity with sulfa allergy
Topical: bitter after taste, stinging, blurred vision, 15 minute before contact lens
Systemic: Lethargic, drowsiness, headache, seizures, mental status changes, diuretic effect, polyuria, increased thirst, fluid/electrolyte imbalances
As a whole group not as effective and contains many SE
Pilocarpine
Parasympathomimetic direct acting muscarinic agonist - decreases IOP via miosis and contraction of ciliary muscles (improves outflow of aqueous humor)
SE: vision changes (cannot dilate enough) irritation pain bradycardia, bronchospasm, hypotension
Echothiopate (Phospholine Iodide)
Cholinesterase Inhibitor - reduces IOP via miosis and constriction of ciliary muscles
SE: blurred vision, bradycardia, urinary urgency, sweating, increased risk of cataracts
Netarsudil (Rhopressa)
Rho Kinase Inhibitor - decreases IOP, action unclear
Topical drop with minimal SE
Topical eye anesthetics
Corneal anesthesia achieved in 1 min last 15
SHOULD NOT BE SELF PERFORMED
Ask pt about allergies
Drug Ex: Proparacaine HCL and Tetracaine HCL
Cyclosporine ophthalmic emulsion (Restasis)
Immunosuppressant
Decreases immune response leading to decreased inflammation, allows tear production to resume
Contraindicated in viral eye infection
Long term risk of cataracts, glaucoma
Anticholinergic Mydriatics and Cyclopegics
Mydriatics: Dilate pupils
Cycloplegics: paralyze muscles of accommodation
SE: dry eyes (xerophthalmia), blurred vision, increased hr, constipation
Contraindicated in pts with narrow angle glaucoma
Acute Otitis Media Antibotics
Amoxicillin - first line
Cephalosporins - caution with PCN allergy
Azithromycin + Clarithromycin if severe PCN allergy
Ceftriaxone (Rocephin) IM for resistant and reoccurring infections
Ceruminolytics
Topical otic agent that can break up cerumen (ear wax) so it can be removed
Keratolytics
Antiacne drugs: dissolves keratin, mild-moderate acne
SE: erythema, dryness, peeling
Benzoyl peroxide
First line antiacne often used in combination with antibiotics
CAUTION with asthma patients
Salicylic acid
Antiacne drugs - reduce frequency if redness or peeling occurs
Topical Antibotics
Antiacne: Erythromycin, Clindamycin often used with benzoyl peroxide
-Cycline antibotics also used
Retinoids - Topical Vitamin A Derivative
Antiacne: Alters keratinization process and dcreases inflammation
SE: bursing, peeling, erythema (SE exacerbated with benzoyl peroxide)
Meds: Tretinoin, adapalene, tazarotene
Isotretinoin (Amnesteem, Accutane)
Systemic antiacne drug, do not use with vitamin A derivatives and tetracycline
SE: skin irritation, thrombocytopenia, elevated triglycerides, teratogenic, suicidal ideation + increased risk for depression
Blood work: two negative pregnancy before, monthly pregnancy, monthly lipid and CBC
Education: two types of birth control
Methotrexate
Psoriasis treatment - harsh also used for cancer.
Monitor liver, CBC and GI symptoms
Opportunistic infections possible
Biologic Psoriasis Agents
Act by supressing immune system
SE: infection, TB reactivation, cancer
Monitor for signs of infections
Labs: CBC, TB (required before starting)
Podophyllum resin
Treatment for gential warts
Not for use in pregnancy
Can irritate healthy tissue, wash off 2-3 times after application
Minoxidil (Rogaine)
Off label use to treat baldness
Stimulates hair growth - results vary
hair loss resumes when medication is discontinued
Mafenide (Sulfamylon Cream)
Topical burn treatment
SE: burning, blistering, superinfection, acidosis, bone marrow suppression
