E3 Medications Flashcards
Fluphenazine (Prolixin)
Blocks dopamine receptors in brain; typical antipsychotic (FGA)
Interactions: Alcohol (increased depression) Kava Kava (EPS)
Available in long acting IM for use when patient is stabilized on oral dose
Haloperidol (Haldol)
Blocks dopamine receptors in treatment of acute/chronic psychoses also used in dementia, schizophrenia, Tourette’s
SE: Similar to al FGA’s + EPS although less likely to cause sedation, hypotension, anticholinergics
Chlorpromazine (Thorazine)
Typical FGA used for schizophrenia, bipolar and other psychotic disorders
SE: orthostatic hypotension, anticholinergic effects, tardive dyskinesia, EKG changes (prolonged QT)
Thioridazine (Melleril)
High likelihood of EKG changes (prolong QT) so other FGAS should be tired first
SE: EPS, sedation, orthostatic hypotension, anticholinergic effects
Clozapine (Clozaril)
SGA used for severe schizophrenia that does not respond to other medications
Adverse: Agranulocytosis (fever, sore throat and mouth ulcers signs - reported immediately) + seizures
Interventions: Monitor WBC and neutrophil if ANC is below 1000 drug must be permanently discontinued
Olanzapine (Zyprexa)
SGA - Does not cause EPS
SE: weight gain, DM, duslipidemia, leukopenia/neutropenia
Nursing: WBC before starting and for multiple months after if ANC is less than 1000 stop medication and monitor for infection
Risperidone (Risperdal)
SGA - does not cause agranulocytosis
SE: low risk of EPS, weight gain, DM, dyslipidemia, agitation, fatigue, dizziness, orthostatic hypotension
Long acting IM available
Benzodiazepines
Immediate onset of action, can be used to treat anxiety - used on a schedule or PRN potential for dependence or abuse
SE: sedation, pt should avoid alcohol or other depressants
Ex: Chlordiazepoxide (Librium) Diazepam (Valium) Lorazepam (Ativan) Alprazolam (Xanax)
Buspirone (BuSpar)
Treats anxiety + depression
Effects in 2-4 weeks
SE: dizziness, headache, nausea, nervousness
Interacts with grapefruit juice (toxicity)
Phase 1 TB treatment
2 months, in regions without drug resistance
Isoniazid, rifampin, pyrazinamide, ethambutol
Phase 2 TB treatment
Minimum of 18 weeks
Isoniazid and rifampin are preferred
Generally 6-9 months of total treatment
Treatment for mutlidrug-resistant TB
Extended treatment time - 24 months, 2nd + 3rd line used. May need 5+ medications, extremely expensive 40-60% die
First line TB drugs
Isoniazid, rifampin, pyrazinamide, ethambutol, rifabutin, rifapentine
More effective than second line and less toxic
Second line drugs
cycloserione, ethionamide, caprdomycin, para-amino salicyclic acid, anminoglycosides (streptomycin, amikacin, kanamycin), quinolones (levofloxacin, moxifloxacin)
Less effective and more toxic
Bedaquiline
New treatment option for TB, does not interfere with metabolism of other medication, high mortality rate in trials
SE: prolonged QT + hepatotoxic
Isoniazid (INH)
Inhibits bacterial cell wall synthesis (prophylaxis and treatment of TB)
SE: gi distress, hepatotoxicity, blurred vision (photosensitivity) tinnitus, dizziness, peripheral neuropathy, psychotic behavior, seizures, blood dyscrasias, risk of hyperglycemia
Interaction: Increased risk of liver damage (alcohol, rifampin, rifabutin, rifapentine) increased phenytoin levels
Decreased absorption with antiacids
Teaching: complete regimen, sputum specimens early morning, pyridoxine (B6) to prevent neuropathy, frequent eye examinations, report (numbness, tingling, burning) teach about sun precautions and avoid antacids
Rifampin
Used with isoniazid to treat TB
Suppresses RNA synthesis
Tkae 1 hour before or 2 hours after meals
Red-orange discoloration of urine sweat and tears
Pt cannot wear soft contact lenses
Interactions: reduced effect of hormonal birth control
Rifapentine
May be taken with food
SE: Red orange discoloration of urine, sweat and tears (no soft contact lenses)
Interactions: reduced effect of hormonal BC
Rifabutin
Tb treatment - take with food to reduce GI upset, red/orange color body fluids
Uveitis - DC if eye pain
Interactions: reduced effect of BC
Pyrazinamide
Hepatotoxicity - monitor liver enzymes
Nongouty polyarthralgias (joint pain, NSAID treatment, hyperuricemia)
Ethambutol
Visual disturbances (visual acuity, color discrimination) Assess before and monthly, encourage pts to report symptoms and stop medication
SE: dizziness, confusion, hallucinations, joint pain
Valacyclovir HCL (Valtrex)
HSV-1, HSV-2 – acute outbreaks and/or chronic treatment
Herpes zoster (shingles)
Vericella (chicken pox)
Famciclovir (Famvir)
HSV, herpes zoster
Can decrease duration of shingles
HSV used for onset, recurrence, and prophylactically
Ganciclovir (Cytovene)
Systemic CMV treatment
Side effect: thrombocytopenia, nephrotoxicity, increased bilirubin
Hazardous – requires special training for handling
Serious side effects! Only used with immunocompromised!
Cidofovir (Vistide)
CMV retinitis, esp in AIDs patients
May cause severe kidney damage – given with probenecid which delays elimination, reduces the required frequency of dosing
Foscarnet (Foscavir)
CMV retinitis, HSV-1 & 2, varicella
Monitor kidney function, electrolytes
Topical Herpes Treatment
Penciclovir (Denavir) – HSV-1 &2
Trifluridine (Viroptic) – herpes eye infections
Acyclovir
Primary drug used to treat HSV 1+2 and Herpes zoster (CMV mostly resistant)
Drug Interactions: risk of nephrotoxicity
Interventions: Monitor renal function, safe in pregnancy, IV admin (maintain adequate fluid intake, infuse slowly to reduce risk of kidney damage)
Interferon Alfa
Treatment of HCV (+ HBV) - protects cells from virus, SQ administration
Combined treatment with ribavirin
SE: flu-like symptoms, depression and suicidal ideation
Ribavirin
Combined treatment with interferon alfa for HCV, available in a aerosol for children
SE: anemia, flu-like symptoms, teratogenic
Simeprevir
Protease inhibitor - treatment of HCV
Hepatotoxic, photosensitivity, used in combo of other medications
Interactions: Amiodarone - increases levels causing severe bradycardia
-Statins - increases levels, in turn lower the statin dose
NS5A Inhibitors + NS5B Inhibitors
Treatment of HCV
Many drug interactions (amiodarone - severe bradycardia) + should not use alone bc of resistance
Daclatasvir (NS5A) + Sofosbuvir (NS5B)
Lamivudine
Nucleoside Analog - treatment of HBV
Also used in treatment of HIV and must be tested before administering bc of difference in dose
Amantadine (Symmetrel)
Prophylaxis against influenza A, must be started 48 within symptom onset
Never used for B
Rimantadine HCL (Flumadine)
Prophylaxis and treatment of influenza A, not often used d/t resistance
Never used for B
Oseltamivir phosphate (Tamiflu)
Treatment of influenza A & B
Must be given within 48 hours of symptom onset
Shorten length of illness and decrease symptoms, reduce incidence of complications (sinusitis, bronchitis)
Nursing Considerations: GI upset, take with food
Zanamivir (Relenza)
Treatment of influenza A & B
Must be given within 48 hours of symptom onset
Shorten length of illness and decrease symptoms, reduce incidence of complications (sinusitis, bronchitis)
Nursing considerations: Inhaled powder, cough and throat irritation may occur
Baloxavir Marboxil
For treatment of both influenza A & B
Use within 2 days of symptom onset
Not to be administered with salts
Calcium salts, iron salts, magnesium salts
Remdesivir
Nucleotide analog, FDA approved to treat corona, IV medication, lots of SE
Paxlovid (combination of nirmatrelvir and ritonavir)
Inhibits the SARS-CoV-2 protein from replicating
oral antiviral pill started within 5 days of sx
can be taken at home
helps keep high-risk patients from needing to be hospitalized
- Must be 12+ years old AND at high risk of complications from COVID 19 illness, MUST be positive
SE: altered or impaired sense of taste, diarrhea, increased BP, muscle aches
Amphotericin B
Polyene for treatment of severe fungal infections - DRUG OF CHOICE - for systemic
Monitor for toxicity (nephrotoxicity - kidney function + hydration, hypokalemia, bone marrow suppression, hypotension/hypertension, seizures
Interventions: Give IV slowly, monitor vitals, increase fluids, monitor UO and weight, monitor electrolytes, renal and liver function
Nystatin (mycostatin)
Oral or topical administration
Teaching: needs to make contact with infected area, oral (swish siwsh swallow, gargle if throat involved)
Ketaconazole (Nizoral)
Azole class antifungal
Topical scalp infection (seborrheic dermatitis) or PO for systemic infections
Teaching: ETOH increases risk of hepatotoxicity
Fluconazole (Diflucan)
Azole - IV or PO used for systemic + topical infections
Vaginal yeast infections (one time PO dose)
Itraconazole (Sporanox)
Taken PO for fungal nail infections - requires consistent treatment
Monitor for hepatotoxicity
Caspofungin (Cancidas)
Echinocandins class - treatment of antifungals, only available for IV administration
High risk of phlebitis, treats systemic infections
Flucytosine (Ancobon)
Pyrimidine Analog - used to treat serious systemic fungal infections
SE: hepatotoxicity + bone marrow suppression
Chloroquine
Treatment of malaria mild/moderate attack or for prophylaxis
SE: visual changes, GI effects, H/A, pruitis
Assessment/Intervention: Monitor kidney + liver function, take drug with meals, report vision (CNII) and hearing (CN VIII) changes, avoid large quanities of alcohol, lemon juice decreases effect
Primaquine
Drug of choice for prevention of relapse of P. vivax, SHOULD NOT be administered until further infection risk has ceased (not returning to endemic areas
Not effective for treatment during erythocytic phase
Monitor urine for hemoglobin - discontinue if hemolysis develops
Quinine
Antimalarial - Lots of side effects (potential cardiovascular effects) only treatment for the last 100 years
Polymyxin B
Peptide Antibiotic - Treats gram negative bacteria, slow IV infusion (not well absorbed in GI tract)
Adverse: nephrotoxicity + neurotoxicity
Bacitacin
Peptide Antibiotics - Meningitis, skin and ocular infections
Route: topical opthalmic oitments or IM (not well absorbed in GI)
Adverse: GI distress/renal damage
Anthelminitics (3)
- Ivermectin (Stromectol)
Works on multiple parasites
Also works for lice
Single dose - Praziquantel (Biltricide)
Tapeworms, flukes
Safe to use during pregnancy - Pyrantel pamoate (Pin-X, Reese’s Pinworm Medicine)
Hookworms, pinworms
Single dose
Given for 1-3 days
SE: Gi upset, dizziness/drowsiness (warn against driving) HA, weakness
Interventions: Give after meals to prevent Gi upset, encourage good hygiene (showers over baths) wash bedding, towels and undergarments daily, proper food preparation, wash hands well, at risk for re-infections
Nitrofurantoin (Macrodantin)
Antibotic treatment for UTI, effective against many gram-positive + gram-negative organisms (especially E. Coli)
Phenazopyridine (Pyridium)
Urinary analgesic - relieves pain/bladder spasms, burning sensation, frequency + urgency
SE: GI upset, red-orange urine, blood dyscrasia, nephrotoxicity/hepatotoxicity
Methenamine Hippurate (Hiprex)
Treatment of chronic UTI strains of E.coli + P. aeruginosa: Bactericidal when urine is acidic (pH <5.5)
Caution: should not be given to pts with renal impairment (check BUN/creatine) do not use with sulfa drugs - increased risk of crystalluria
Pt teaching - consume acidic foods/fluids (cranberry juice, vitamin C)
Trimethoprim and sulfamethoxazole (Bactrim, Septra)
Used in treatment/prevention of acute/chronic UTIS - both lower and upper
SE: Gi upset, rash + prutitus (not associated with allergic reaction, worse with sun exposure)
Fluoroquinolones -floxacin
Treats lower and upper UTIS
SE: dizziness (elderly) photo sensitivity (sun protection and sun glasses)
Fosfomycin tromethamine (Monurol)
Treatment of lower UTI Single dose (improves compliance)
Bethanechol (Urecholine)
Treatment of hypotonic bladder (neurogenic, spinal cord injury or severe head injury)
Action: increases bladder tone of detrusor muscle
SE: GI distress (cholinergic effect) dizziness, fainting, may exacerbate asthma
Contraindicated with PUD, gastric ulcers, IBS, or urinary blockage
Oxybutynin (Ditropan)
Relieves spasms + prevents urinary urgency
SE: drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation, urinary retention (anticholinergic effects)
Assessment: avoid in glaucoma, GI or urinary obstruction, use cautiously with cardiac, renal, hepatic or prostate problems
Tolterodine Tartrate (Detrol)
Used to control and overactive bladder (which causes frequency) Decrease in urge and incontinence
SE: anticholinergic effects, dizziness, fainting, blurred vision
