Medications and Classes Flashcards
Aspirin
CLASS:
non-opioid analgesics
non-steroidal anti-inflammatory drug (NSAID)
A.K.A acetylsalicylic acid (ASA)
antipyretics
Anti-platelet
INDICATION:
> pain, ever &Inflammation
prevention of blood clot
CONTRAINDICATION:
*** should NOT be given to children or teenagers with fever or chickenpox
> been associated with Reye’s syndrome
> Allergy
> Bleeding disorders
> Stomach ulcers
TOXICITY:
> Monitor for the onset of fever, ** tinnitus, headache, drowsiness, hyperventilation, agitation, ** confusion, lethargy, diarrhea, and sweating.
*** If these symptoms appear, withhold medication and notify a provider
EDUCATION:
> taken with or after meal
> Use antacids but 1-2 interval before taking
Reyes Syndrome - Aspirin related
> Reye’s syndrome is a serious condition that causes swelling in the liver and brain
S/S:
> confusion, seizures and loss of consciousness need emergency treatment
> Blood sugar usually drops while levels of ammonia and acidity in the blood rise
** Initial symptoms
> For children younger than age 2, the first symptoms of Reye’s syndrome may include:
1. Diarrhea.
2. Rapid breathing.
> For older children and teenagers, early symptoms may include:
1.Vomiting that doesn’t stop.
2. Being sleepy or sluggish.
NSAIDS
CLASS:
Anti-inflammatory, analgesic, and antipyretic
COMMON NSAIDS:
- Propionic Acids
fenoprofen (Nalfon)
flurbiprofen (Ansaid)
ibuprofen (Motrin, Advil)
ketoprofen (Orudis)
naproxen (Naprosyn)
oxaprozin (Daypro) - Acetic Acids
diclofenac (Voltaren, Cataflam)
etodolac (Lodine)
Indomethacin (Indocin)
ketorolac (Toradol)
nabumetone (Relafen)
sulindac (Clinoril)
tolmetin (Tolectin) - Fenamates
meclofenamate
mefenamic acid (Ponstel) - Oxicam Derivatives
meloxicam (Mobic)
piroxicam (Feldene)
CONTRAINDICATIONS:
- Allergy to NSAIDs or salicylate.
- Allergy to sulfonamides.
- CV dysfunction or hypertension.
- Peptic ulcer or known GI bleeding
- Pregnancy or lactation.
- Renal or hepatic dysfunction.
> Can alter metabolism and excretion of drug - Any other known allergies.
> Indicate increased sensitivity.
Morphine
CLASS:
Opioid analgesics
Controlled Substance Schedule: II
INDICATIONS:
Severe pain
** (the 20 mg/mL oral solution concentration should only be used in opioid-tolerant patients).
Pain associated with MI.
ACTION:
> Binds to opiate receptors in the CNS
Alters the perception of and response to pain
Produces generalized CNS depression
> Suppress the cough centre in the brain
> Pulmonary edema or left-sided heart failure
***Relieves SOB by dilating peripheral blood vessels, keeping more blood in the periphery, and decreasing cardiac preload.
CONTRAINDICATION
> Hypersensitivity
> Significant respiratory depression
> Acute or severe bronchial asthma
> Paralytic ileus
> May ↑ the anticoagulant effect of warfarin.
> Use with extreme caution in patients receiving MAO inhibitors within 14 days prior (may result in unpredictable, severe reactions) ** Initial dose should be lower
CONSIDERATIONS
> Assess LOC, BP, pulse, & RR before and periodically during administration
> Monitor for respiratory depression, especially during initiation or following dose increase; serious, life-threatening, or fatal respiratory depression may occur.
> Assess risk for opioid addiction, abuse, or misuse prior to administration.
> can cause constipation -> fiber supplement
EXAMPLES:
codeine
fentanyl citrate
hydrocodone
hydromorphone hydrochloride
levorphanol tartrate
meperidine hydrochloride
methadone hydrochloride
morphine sulfate
oxycodone
oxymorphone
propoxyphene
remifentanil
tramadol
Phenytoin (Dilantin)
10 - 20 milligrams per liter (mg/L)
CLASS:
Antiepileptic, Antiarrhythmic, group 1b, Hydantoin
INDICATIONS:
> Control of grand mal (tonic-clonic) and psychomotor seizures
> Prevention and treatment of seizures occurring during or following neurosurgery
Potentially Fatal:
1. Toxic epidermal necrolysis (TEN),
> severe form of SJS, when 30% of the skin surface is affected
2. Stevens-Johnson syndrome (SJS)
>starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Then the top layer of affected skin dies, sheds and begins to heal after several days.
CONTRAINDICATIONS:
> Pregnancy. IV admin in sinus bradycardia, heart block, or Stokes-Adams syndrome.
CONSIDERATIONS:
1. Do not use solutions that have haziness or a precipitate
2. WARNING: Administer IV slowly to prevent severe hypotension; the margin of safety between full therapeutic and toxic doses is small. Continually monitor patient’s cardiac rhythm and check BP frequently and regularly during IV infusion
3. Monitor injection sites carefully; drug solutions are very alkaline and irritating.
4. Do not discontinue this drug abruptly or change dosage, except on the advice of your health care provider
OVERDOSE S/S:
Coma
Confusion
Seizures (occasionally)
Dizziness
Fever
Low blood pressure
Muscle rigidity or spasms
Sleepiness
Side-to-side eye movement (nystagmus)
Slurred speech
*** Swollen gums
Tremor (unintentional trembling)
Unsteadiness
Prednisone
CLASS: corticosteroid ( anti-inflammatory)
EXAMPLES: cortisone, dexamethasone, prednisone
INDICATIONS:
Asthma
allergic reaction
Irthritis
Inflammatory bowel disease and adrenal, blood or bone marrow conditions
** replaces cortisone**
can cause:
1. weight gain in chest, abdomen, face (round face) - (CUSHING SYNDROME)
2. HTN
3. loss of bone density
4. thin skin, bruises, stretch marks, unexpected hair growth (CUSHING SYNDROME)
5. reduce muscle mass
6. mood changes
7. hyperglycaemia
CONSIDERATIONS:
1. can’t stop usage suddenly, needs to be titrated.
2. may compromise immune system
3. may interact with many meds like NSAIDS - speak to MD before taking OTC
Heparin
CLASS:
anticoagulants, antithrombotics
ACTION:
inhibitis the clotting factors in the blood
ROUTE:
injection or through an intravenous (IV) infusion
ANTIDOTE:
Protamine
INDICATIONS:
1. typically used in patients who are at high risk of developing blood clots, such as those who have had surgery, are bedridden,
2. Kidney dialysis - prevent clots
3. certain types of surgery - prevent blood clots from forming during and after surgery
4. Stroke, Heart Attacke, A-fib, PE, DVT
PRECAUTION/CONTRAINDICATIONS:
1. Uncontrolled hypertension. Heparin can increase blood pressure, so it should be used with caution in patients with uncontrolled hypertension. (C)
2. bleeding (P/C)
3. Hepatic or renal impairment - Heparin is cleared from the body by the liver and kidneys (P)
4. elderly - older patients may be more sensitive to the effects of heparin, constant adjustment of dose may be needed. (P)
5. ulcers (P)
6. Severe thrombocytopenia, active bleeding (C)
** Digoxin **
Heparin can increase the level of digoxin in the blood, which can lead to potentially dangerous side effects.
CONSIDERATIONS:
1. Vitamin K-rich foods. Vitamin K is a nutrient that helps the blood to clot. Foods that are rich in vitamin K, such as leafy green vegetables, can reduce the effectiveness of heparin.
2. Alcohol - can thin blood
3. Grapefruit - Grapefruit contains compounds that can interfere with the breakdown of certain medications, including heparin - > higher level in heparin
LABS:
aPTT/PTT -Looks at intrinsic and common pathway
*should be obtained before heparin administration as baseline values
Warfarin
CLASS:
anticoagulants
***BEERS drug
INDICATIONS:
Prophylaxis and treatment of:
Venous thrombosis,
Pulmonary embolism,
Atrial fibrillation with embolization.
Management of MI
Prevention of thrombus formation and embolization after prosthetic valve placement.
EXCRETION:
Primarily metabolized by the liver
ORAL ONLY
CONTRAINDICATED:
Uncontrolled bleeding;
Open wounds;
Active ulcer disease;
Recent brain, eye, or spinal cord injury or surgery;
Severe hepatic impairment;
Uncontrolled hypertension;
OB: Pregnancy.
ASSESSMENT:
Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; tarry, black stools; hematuria; fall in hematocrit or BP; guaiac-positive stools, urine, or nasogastric aspirate)
LABS: PT/INR
TOXICITY:
Withholding 1 or more doses of warfarin is usually sufficient if INR is excessively elevated or if minor bleeding occurs. If overdose occurs or anticoagulation needs to be immediately reversed, the antidote is ** vitamin K (phytonadione) **
** anticoagulant effect may persist for 2–5 days following discontinuation
Benztropine
CLASS:
antiparkinson agents, Anticholinergic - blocks acetylcholine neurotransmitter
*BEERS DRUG
ACTION:
Exhibits anticholinergic properties (blocks acetylcholine) in the CNS to reduce rigidity and tremors
Nursing Considerations
- May lead to arrhythmias, hypotension, palpitations, and tachycardia
- Anticholinergic effects like constipation, dry mouth
- Assess for extrapyramidal symptoms
- Instruct patient to take as directed
- Instruct patient to maintain good oral hygiene
Carbidopa/ Levodopa
CLASS:
Antiparkinsonian, Dopamine agonist
ACTION:
Levodopa is converted to dopamine and works as a neurotransmitter, carbidopa
prevents the destruction of levodopa allowing it to cross the blood brain barrier
Nursing Considerations
- May cause orthostatic hypotension
- May cause dark urine
- Weeks to months to take effect
- Do not use with MAOIs
- Do not use with glaucoma, melanoma
- Assess for parkinsonian symptoms
- Instruct patient to take as directed
Potassium Salts
GENERIC NAMES:
potassium salts , potassium acetate , potassium chloride ,potassium gluconate
ACTIONS:
> Maintaining intracellular tonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle, maintenance of normal renal function
> Prevention and correction of potassium deficiency
> IV: Treatment of cardiac arrhythmias due to cardiac glycosides
CONTRAINDICATIONS:
> allergy to tartrazine, aspirin
> Renal impairment
> Addison’s Dse.
ADVERSE EFFECTS:
> Dermatologic: Rash
> GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction, GI bleeding, GI ulceration or perforation
> Hematologic: Hyperkalemia—increased serum K+, ECG changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of QTc interval)
> Local: Tissue sloughing, local necrosis, local phlebitis, and venospasm with injection
CONSIDERATIONS:
> serum levels before and during therapy
> oral drug after meals or with food and a full glass of water to decrease GI upset
>Monitor IV injection sites regularly for necrosis, tissue sloughing, phlebitis.
> Monitor cardiac rhythm
> Caution patient that expended wax matrix capsules will be found in the stool
> Do not use salt substitutes -> hyper
Magnesium Sulfate
CLASS:
Salt substitutes mineral and electrolyte replacements/supplements
INDICATIONS:
> Treatment/prevention of hypomagnesemia.
> Prevention and treatment of seizures associated with severe eclampsia or pre-eclampsia.
** decreases BP
ACTION:
> Plays an important role in neurotransmission and muscular excitability.
> Magnesium plays a role in the transport of calcium (and potassium) ions across cell membranes.
> bronchodilator
CONTRAINDICATION:
> Hypermagnesemia
> Hypocalcemia -> will transport more Calcium into cells
> Anuria
> Heart block
SIDE EFFECT:
> Diarrhea: common
CV: arrhythmias, bradycardia, hypotension
Derm: flushing, sweating
GI: diarrhea ** common
Metabolic: hypothermia
MS: muscle weakness
Neuro: drowsiness
Resp: ↓ respiratory rat
CONSIDERATIONS:
> monitor deep tendon reflex - may lose it
> assess for respiratory depression
** hypotension, respiratory depression, and narcosis develop with increasing hypermagnesemia.
** Cardiac arrest may occur when blood magnesium concentration is > 15 mg/dL
Monoamine oxidase inhibitors (MAOI)
CLASS:
Anti-depressant
Psychotropics
ACTION:
> increase the availability of norepinephrine, serotonin, and dopamine in the brain.
> work by inhibiting the activity of an enzyme called monoamine oxidase, which breaks down certain neurotransmitters such as serotonin, norepinephrine, and dopamine.
INDICATION:
> TX-resistant depression (second line of Tx)
> depression, panic disorder, and social phobias
**last resort treatment for depression
EXAMPLES: (PTIS)
Phenelzine
Tranylcypromine
Isocarboxazid
Selegiline
COMMON SIDE EFFECTS:
> Dry mouth
> Nausea, diarrhea or constipation
> Headache
> Drowsiness
> Insomnia
> Dizziness or lightheadedness
> Skin reaction at the patch site
** HYPERTENSIVE CRISIS
> dangerous increase in blood pressure:
> headache, nausea, vomiting, sweating, and palpitations
> in some cases, hypertensive crisis can lead to a stroke or heart attack.
** SEROTONIN SYNDROME
> build up of serotonin in the body
> mild (shivering and diarrhea)
> severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.
CONSIDERATION:
*** Tyramines (food containing) - > natural serotonin production [ avocado, banana, aged cheese, pepperoni, salami, red wine, chocolates] = hypertensive crisis
> interact with many meds. including OTC cold meds = hypertensive crisis
> switching anti depressant med will need 2 weeks wash out period)
Serotonin Syndrome
SEROTONIN SYNDROME
> can be related to Monoamine oxidase inhibitors (MAOI) overdose
> build up of serotonin in the body
> mild (shivering and diarrhea)
> severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.
DRUG INTERACTION CAN CONTRIBUTE TO SEROTONIN SYNDROME:
> St. John’s wort, ginseng and nutmeg
> anti-migrane meds
>opioid pain meds
2nd anti depressant
>over the counter cough med
S/S:
> Agitation or restlessness
> Insomnia
> Confusion
> Rapid heart rate and high blood pressure
> Dilated pupils
> Loss of muscle coordination or twitching
> Muscle rigidity
> Heavy sweating
> Diarrhea
> Headache
> Shivering, Goose bumps
SEVERE S/S:
> High fever
> Tremor
> Seizures
> Irregular heartbeat
> Unconsciousness
Disulfiram
CLASS:
Anti-alcoholic drug, Enzyme inhibitor
EXAMPLE:
Antabuse
ACTION:
> Inhibits aldehyde dehydrogenase, the oxidative enzyme of acetaldehyde, a metabolite of alcohol. The latter is accumulated in the blood, thus producing unpleasant symptoms of disulfiram-alcohol reaction when a patient has taken small amounts of alcohol.
INDICATION:
Aids in the management of selected chronic alcoholics who want to remain in a state of enforced sobriety
SIDE EFFECTS:
Drowsiness, fatigue, lassitude, psychotic reactions, peripheral and optic neuropathies, hepatotoxicity, garlic-like or metallic after-taste, GI upset, body odour, bad breath, headache, impotence.
POTENTIALLY FATAL:
Respiratory depression, CV collapse, arrhythmias, myocardial infarction, acute CHF, convulsions, sudden death
CONTRAINDICATION:
>Hypersensitivity, CVS diseases; peripheral neuropathy, psychosis.
*** Not to be used in patients with alcohol intoxication.
CONSIDERATIONS:
> Do not administer until patient has abstained from alcohol for at least 12 hr.
** alcohol containing products - cough med, mouth washes
> Monitor liver function tests before, in 10–14 days, and every 6 mo during therapy to evaluate for hepatic impairment
