A
1. ACETAMINOPHEN (Tylenol)
EFFECTS:
Analgesic (mild to moderate pain)
Antipyretic
NO anti-inflammatory effect
NO platelet effect
THERAPEUTIC LEVEL: 10 30 mg/dL
ANTIDOTE: Acetylcysteine (Mucomyst)
ADVERSE EFFECTS: hepatotoxic
2. AMINOGLYCOSIDES
STREPTOMYCIN/ GENTAMYCIN
Obtain Peak and trough level
o Peak level 30 minutes after taking the drug
o Trough level 30 minutes before the next dose
Adverse effects:
Neurotoxic
Ototoxic therapeutic to Menieres disease to relieve from vertigo (but this is the last resort
because it will lead to permanent deafness)
Nephrotoxic Monitor BUN
3. ANESTHESIA
REGIONAL
Epidural anesthesia
o Given in epidural space
o side effect: Hypotension
GENERAL
Intravenous
Inhalational
Action
Onset
Use
Route
Oral
Expressed in
Antidote
Laboratory
test
Usage
Effect
Milligrams
Vitamin K/ Phytonadione (AquaMEPHYTON)
Prothrombin time (PT)
Normal value:11 to 15 seconds
Long term therapy
Slow
HEPARIN
(Hepalean)
Blocks conversion of prothrombin to thrombin
30 seconds to 1 minute
Start therapy as soon as possible after thrombus appears as thrombi older than 7 days react
poorly to streptokinase***
5. ANTI DEPRESSANTS
3 common groups:
(1) TCA
(2) SSRI
(3) MAOI
Tricyclic Antidepressants (TCA) increases norepinephrine and/or serotonin in CNS by blocking the
reuptake of norepinephrine by presynaptic neurons
1. Imipramine (Tofranil)
2. Amitriptyline (Elavil)
Selective Serotonin Reuptake Inhibitor (SSRI) inhibits CNS neuron uptake of SEROTONIN***
(thus increasing the level of serotonin); DOES NOT AFFECT norepinephrine
1. Fluoxetine (Prozac)
2. Sertraline (Zoloft)
SIDE EFFECTS: hypotension, arrhythmias, blurred vision, constipation, urinary retention, dry
mouth
NURSING CONSIDERATIONS:
Check BP and PR
Changing from TCA to MAOI, patient must discontinue TCA for 14 days
SIDE EFFECTS: hypotension, headaches, arrhythmias, insomnia, dry mouth, weight loss, sexual
dysfunction
NURSING CONSIDERATIONS:
o Give drug in the MORNING
o Takes 4 weeks for full effect
o Changing from MAOI to SSRI, patient must discontinue MAOI for 2 weeks
o Changing from SSRI to MAOI, patient must discontinue SSRI for 5 weeks
o Monitor for weight
o Provide oral hygiene
2. isocarboxazid (Marplan)
3. phenelzine (Nardil)
SIDE EFFECTS: Hypertensive crisis happens if the drug is taken with tyramine-containing
foods
o S - weating
C - onstipation
o H - eadache, HPN
O - rthostatic hypotension
o U - rinary retention
P - hotophobia, dilated pupils
o N - ausea, Neck stiffness
A - granulocytosis
o T - achycardia
AVOID
o
o
o
o
o
o
o
o
o
o
6. ANTI-GOUT
ALLOPURINOL (Zyloprim) prevent production of uric acid by inhibiting the enzyme xanthine
oxidose
o USE: prophylactic for attacks of gout; clients with calcium oxalate calculi
o SIDE EFFECTS: hepatotoxic
DRUGG OF CHOICE to reduce serum uric acid by increasing its renal excretion
7. ANTI-PARKINSONS
Problem in PARKINSONS:
Decrease DOPAMINE
Increase ACETYLCHOLINE
USE: Schizophrenia
1. Haloperidol (Haldol)
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2. Chlorpromazine (Thorazine)
NURSING CONSIDERATIONS:
Take drug AFTER meals***
SIDE EFFECTS:
HYPOtension
Agranulocytosis/ leukopenia (sore throat) serious side effect***
NEUROLEPTIC MALIGNANT SYNDROME (HYPERthermia/ diaphoresis, HYPERtension)
pink-red urine (normal: thorazine)
4 EFFECTS:
1) Anti platelet reduce risk of myocardial infarction and transient ischemic attack
2) Anti-inflammatory rheumatic fever, Kawasaki disease, rheumatoid arthritis
3) Antipyretic fever
4) Analgesic mild to moderate pain
ASPIRIN TOXICITY
Tinnitus early sign of salicylism
Metabolic acidosis late sign of salicylism
Epistaxis, nephrotoxic
NURSING CONSIDERATIONS:
ANTIDOTE: activated charcoal (can also give Ipecac syrup to induce vomiting of aspirin)
Give the drug with full stomach after meals Aspirin is ulcerogenic
Monitor CBC, Prothrombin time, renal and liver functions
If (+) ASA allergy, give other anti-platelet drug like Clopidogrel or Ticlopidine***
AVOID Aspirin in patients with viral infection to prevent Reyes Syndrome***
AVOID Aspirin with OHA causes hypoglycemia***
AVOID Aspirin with anticoagulant (Coumadin, Heparin) high risk for bleeding (additive effect)
10.
MODE OF ACTION:
block neurotransmitter acetylcholine
inhibits parasympathetic actions
B
11.
BETA-BLOCKERS
2 TYPES:
SELECTIVE
Beta 1 only
Atenolol, metoprolol
(Lopressor)
NON-SELECTIVE
Beta 1 and 2
propanolol (Inderal), timolol
(Blocadren),
decreasing aqueous humor formation and increases aqueous humor outflow (such as
glaucoma)
12.
BRONCHODILATOR
USE: bronchospasms, asthma
EXAMPLES:
BETA-ADRENERGIC: abuterol (Proventil, Ventolin), metaproterenol (Alupent)
XANTHINES: theophylline (Theo-Dur) PROTOTYPE, aminophylline (Truphylline)
THERAPEUTIC LEVEL OF THEOPHYLLINE: 10 20 mcg/ml
SIGN OF THEOPHYLLINE TOXICITY:
Tachycardia
nausea and vomiting
FOODS TO BE AVOID:
ICE TEA caffeine and caffeine containing foods because Theophylline is a xanthine derivative
which has same effect with caffeine
C
13.
14.
CHEMO DRUGS
Methotrexate (folic acid antagonists) - inhibits DNA (protein) synthesis causing cell death
do not give together with Vitamin B9
Tamoxifen is the primary hormonal agent used in breast cancer treatment today.
NURSING INTERVENTIONS FOR CHEMOTHERAPEUTIC SIDE EFFECTS
SIDE EFFECTS
Nausea and
vomiting
Constipation
Diarrhea
Pruritus/ urticaria
Stomatitis
Alopecia
Skin
pigmentation
Nail changes
Anemia
Neutropenia
Thrombocytopeni
a
Hemorrhagic
cystitis
Urine color
changes
NURSING INTERVENTIONS
Administer antiemetics befoore chemotherapy;
Withhold food and fluids for 4 to 6 hours before treatment
Increase fluids and fiber intake
Replace fluids, low fiber diet
Provide good skin care
Provide good oral care (water/ NSS); avoid hot and spicy
food
Reassure that it is temporary; encourage to wear wigs,
hats or head scarf
Reassure that it is temporary
Reassure that nails may grow normally after
chemotherapy
Bed rest; provide frequent rest periods
Protect from infection;
AVOID crowded places; fresh fruits and raw foods
Bleeding precaution
AVOID aspirin and anticoagulants, bruising, use of
straight razors;
USE a soft-bristle toothbrush
Provide 2 to 3 liters fluids per day
Reassure that it is harmless
D
15.
DIAZEPAM (Valium)
USE: Drug of choice for status epilepticus***
EFFECTS:
Anxiolytic
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Anti-convulsant
Muscle relaxant
NURSING CONSIDERATIONS:
DO NOT MIX with other drugs
DO NOT withdraw abruptly
AVOID alcohol, smoking, activities that requires alertness
May cause physical dependence
Oral form should be given BEFORE MEALS***
16.
DIGOXIN (Lanoxin)
Effects:
o (+) inotropic increases FORCE OF CONTRATION increase cardiac output increase kidney
perfusion increase urine output
o (-) chronotropic decreases HEART RATE decrease oxygen demand of the heart muscles***
Digoxin toxicity nausea, yellow color vision, arrhythmia, sign of hypokalemia (weakness, muscle
cramps)
17.
DIURETICS
CLASSIFICATIO
NS
Potassium
Sparing
SITE OF
ACTION*
**
Distal
tubule
EXAMPLES
INDICATIONS
Spironolactone (Aldactone)
Amiloride (Modiuretic,
Midamor)
Triamterene (Dyrenium)
Proximal
tubule
Acetazolamide (Diamox)
Menieres disease,
OPEN glaucoma
Loop of
Henle
Glomerulu
s
Furosemide (Lasix)
Bumetanide (Bumex)
Mannitol
Osmitrol
Glycerin
Urea
Hydrochlorothiazide
Chlorothiazide (Diuril)
Metolazone
KSPARING
Carbonic
Anhydrase
Inhibitors (CAI)
Loop Diuretics
KWASTING
Osmotic Diuretics
Thiazide and
Thiazide-like
Distal
tubule
SPECIAL NURSING
INTERVENTIONS
Avoid potassium-rich
foods (banana***,
potatoes, spinach,
broccoli, nuts, prunes,
tomatoes, oranges,
peaches, papaya)
NURSING CONSIDERATIONS:
1. Monitor blood pressure (first/ before) and weight (second/ after)
2. Administer in the MORNING
3. Administer with FOOD
EVALUATION: for effectiveness of therapy
Weight loss
Resolution of edema
Decreased congestion
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Normal BP
E
18.
EPINEPHRINE
Ideal drug for cardiac arrest
Drug of choice for STATUS asthmaticus
Therapeutic property for bronchial asthma and anaphylactic shock: bronchodilation effect
Epinephrine + anesthesia prolongs the function of anesthesia
G
19.
GASTRIC DRUGS
Classifications:
Cytoprotective agents coats/ cover the gastric lining (give BEFORE meals)
Histamine2 blockers decrease hydrochloric acid production (give WITH meals)
Antacid neutralize gastric acidity (give AFTER meals)
Proton Pump Inhibitor decrease hydrochloric acid production (give BEFORE meals)
Best time to give these drugs: at bedtime
H
20.
I
21.
AGE or
WEIGHT
TABLET
Ferrous sulphate 200mg + 250
mcg Folate
(60 mg elemental iron)
2 to 4 months
(4 to <6 kg)
4 to 12 months
(6 to <10 kg)
1 to 3 years
(10 to <14 kg)
3 to 5 years
(14 to <19 kg)
22.
SYRUP
Ferrous sulphate 150 mg
per 5 ml
(6 mg elemental iron per
ml)
2.5 ml (1/2 tsp)
0.6 ml
4 ml (3/4 tsp)
1 ml
tablet
5 ml (1 tsp)
1.5 ml
1 tab
7.5 ml (1.5tsp)
2 ml
AGE
100,000 IU
6 months to 12 months
12 months to 5 years
23.
DROPS
Ferrous sulphate 25
(25 mg elemental iron
per ml)
1
2 capsules
200,000 IU
capsule
1 capsules
Albendazole 400 mg
tablet
or 200 mg tablet
Mebendazole 500 mg
tablet
1
24 months to 59 months
24.
INSULIN
MODE OF ACTION: decreases blood sugar by
Increasing glucose transport across cell membranes
Enhancing conversion of glucose to glycogen
TYPE
ULTRA RAPID
Lispro (Humalog), Aspart (Novolog)
DESCRIPTION
Route: SQ
ONSET
> 15
minutes
PEAK
30 60
minutes
DURATION
34
hours
RAPID-ACTING:
Regular, Humulin R
Color: Clear
Route: IV, SQ
30 min 1
hr
2 4 hrs
6 8 hrs
INTERMEDIATE-ACTING:
NPH/ Neutral Protamine Hagedorn
(Insulin Isophane Suspension),
Humulin N
LONG-ACTING:
Ultralente (extended insulin zinc
suspension)
Humulin U
Color: Cloudy
Route: SQ
1 2 hrs
6 8 hrs
18 24 hrs
Color: Cloudy
Route: SQ
3 4 hrs
16 20 hrs
30 to 36 hrs
Area:
Abdomen fastest absorption
Deltoid
thigh
buttocks
AVOID:
massage and apply compression (increase absorption)
aspirate after injection
shake. Gently roll vial in between palms
Cold insulin lipodystrophy
STORAGE:
In room temperature last for 1 month
Refrigerated once opened last for 3 months
ADJUSMENT OF DOSE:
increase insulin requirement Infection, Stress, Illness
decrease insulin requirement Breast feeding (Antidiabetic effect)
25.
IRON SUPPLEMENTS
SIDE EFFECTS:
dark stools (tarry stool)
constipation
abdominal cramps
Tablet: give with citrus juice (orange, tomato)
Liquid: give with citrus juice (orange, tomato) and straw
IM: Z-track method (DO NOT massage)
8 | TOP DRUGS Prepared by: Brian Yu, 09175262468
BEST given with empty stomach (1 hour before meals*** or 2 hours after meals)
Citrus juice is AVOIDED with iron elixir preparation
L
26.
27.
LITHIUM
Anti-mania
Therapeutic Level: 0.5 1.5 mEq/L***
Lithium toxicity (nausea and vomiting, anorexia, abdominal cramps, diarrhea)
PREPARATIONS:
o Tablets: 300, and 450mg.
o Capsules: 150, 300, and 600 mg.
o Syrup: 300 mg/5 ml
(NO parenteral preparation)***
Maintain diet:***
o increase fluid (3L/day)
o Increase Na (3 gm/day)
M
28.
29.
30.
MAGNESIUM SULFATE
tocolytic agent
USE: premature labor, anticonvulsants in pregnancy induced hypertension (PIH)
Check:
o
deep tendon reflex (DTR) FIRST reflex lost with CNS toxicity
o Check RR (at least >12 breaths/ min
o Check urine output (at least 30 mL/ hr)
Therapeutic level = 4 to 8 mg/dL
ANTIDOTE: calcium gluconate
METRONIDAZOLE (Flagyl)
Anti-amoeba
AVOID alcohol (Metronidazole + Alcohol = Disulfiram-like effect)
N
31.
OINTMENT
applied to a hairless or clipped/ shaved area
new site should be used with each new dose
use ruled applicator paper that comes with ointment to measure dose
wear gloves during application
leave applicator on site and cover it with plastic wrap and secure it with tape
TRANSDERMAL PATCH
Apply a patch once a day only
Rotate site
Place patch in non-hairy area
Determine a base region and remove the old patch
Wear gloves during application
STORAGE:
store in original dark glass container in a cool, dry place.
date bottle when opening
discard after 6 months
NURSING CONSIDERATIONS:
Change position gradually to prevent dizziness
HEADACHE is a sign that the drug is taking effect. It will discontinue with long term use.
AVOID alcohol, hot baths
Carry drug at all times
DO NOT administer nitrates with sildenafil (Viagra), both drugs are vasodilator which may lead to
HYPOTENSON
32.
NONI JUICE
Scientific name: Morinda citrifolia
High in fiber
Use for diabetes clients
O
33.
OCTREOTIDE (SANDOSTATIN)***
Inhibits GROWTH HORMONE, GLUCAGON, INSULIN
2 formulations:
Sandostatinis a short acting version
Sandostatin LARis a long acting version.
Sandostatin
subcutaneous injection***
It may be necessary to take the shot several
times a day.
Sandostatin LAR
intramuscular injection
This medication is generally given once every 4 weeks
Sandostatin LAR should NOT be given by S.C. or IV
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34.
routes.
The preferred site for injection is the hip, because it is
painful given into the arm.
OXYTOCIN (Pitocin)
stimulate uterine contraction
USE: postpartum bleeding, labor induction
ADVERSE EFFECTS: uterine hyperstimulation, arrhythmias, tachycardia, hypertension
Given IM or IV (IV via piggyback and delivered with an infusion pump)
Observe fetal hypoxia or distress
P
35.
36.
37.
PANCREATIC ENZYMES
USE: aid in digestion; cystic fibrosis
Give WITH MEALS***
Expected outcome of the drug is absence of steatorrhea***
EXAMPLES: pancreatin (Dizymes), pancrelipase (Cotazym)
PHENYTOIN (Dilantin)
USE: seizure
SIDE EFFECT: gingival hyperplasia, may turn urine pink, red, or red-brown
ADVERSE EFFECTS: hepatotoxic, Steven-Johnsons syndrome
DO NOT administer IM
Give drug with NSS BEFORE AND AFTER (flushing) drug administration
Provide oral hygiene, Use soft, bristled toothbrush
Takes 7 to 10 days to achieve therapeutic serum level
Therapeutic level: 10 20 mg/ dl
PRE-OPERATIVE MEDICATIONS
PURPOSE: to facilitate anesthesia induction***
PRE-OP DRUGS
MUSCLE
RELAXANT
OPIATE AGONISTS
(Narcotic
analgesic)
Increases pain
threshold thus
needing lesser
amount of
anesthesia
Decrease mucus and
saliva production
ANTICHOLINERGIC
38.
MODEOF ACTION
STEROIDS
Examples
Midazolam
Diazepam
Lorazepam
Alprazolam
Morphine
sulfate
Fentanyl citrate
Codeine
Diphenhydrami
ne
Atropine sufate
Scopolamine
Hydrobromide
WATCH
OUT
BP
RR
Antidote: naloxone
(narcan)
HR
Causes constipation
THERAPEUTIC EFFECTS:
Anti-inflammatory
Hormonal replacement
SIDE EFFECTS:
Long term use: Adrenal insufficiency***, osteoporosis
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39.
hypocalcemia, GI ulcer
NURSING CONSIDERATIONS:
Give with food
Give in the morning (before 9 am)
Take medication with breakfast (corresponds to biorhythms and reduces gastric irritation)
Watch out for infection
Taper the dose (abrupt withdrawal may lead to acute adrenal crisis)
Parenteral form: Give IM avoid SQ
Oral form: Give it WITH food or milk, may cause gastric irritation
AVOID sunlight
DIET: Restrict sodium, alcohol and caffeine; high potassium foods
Carry extra medication during travel.
Adjust medications during periods of acute or chronic stress such as pregnancy or infections;
contact health care provider.
PARASYMPATHETIC
PNS (Cholinergic)
Glaucoma, GERD
Prostigmine
Anticholinesterase
Sleep and digest response
Acetylcholine slowly release but
long acting
T
40.
LEVOTHYROXINE (Synthroid)
USE: hypothyroidism (myxedema), cretinism (congenital hypothyroidism)
SIDE EFFECTS: insomnia, tachycardia, diarrhea
NURING CONSIDERATIONS:
Taper the dose
Monitor vital signs (temperature, BP, PR)
12 | TOP DRUGS Prepared by: Brian Yu, 09175262468
SIDE EFFECTS:
agranulocytosis (sore throat)
paresthesias
bleeding (inhibits vitamin K)
Taper the dose
Monitor vital signs (temperature, BP, PR)
AVOID iodine, iodine containing foods and sea foods
ORAL form: dilute with water or juice (to improve taste) and use straw (to prevent discoloration)