Pharmacology ATI

 Digoxin (lanoxin) [anti dysrhythmic]SE: blurred/double vision

 Guaifenesin SE: can cause drowsiness
 Estrogen (premarin) SE: ↑ risk of Thromboembolism with s/s: SOB, severe headache, vomiting,
sudden acute pain in the calves, legs, chest, abdomen.
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Doxepin (Sinequan) [anticholinergic] SE: urinary retension, constipation, drying of nasal/oral secretons,
↑HR
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Albuterol (Proventil) [sympathomimetic/ adrenergic beta-2 agonist] Contraindicated: with MAOIs (can↑
action of albuterol and → HTN crisis); β-blockers can inhibit the therapeutic effects Use: invert canister,
shake before use, rinse mouth after use, w/new inhaler perform test spray
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Levothryoxine (T4) Indication: hypothyroidism RT dysfxn of hypothalamus, pituitary, or thyroid gland
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Cephalosporins (Keflex)-allergy to cephalosporins is considered a precaution for taking penicillins
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Phenobarbital [Barbiturates]; interventions for anticonvulsant therapy: assess for resp. depression,
excess sedation from toxic effects, IV at < 50mg/min, avoid extravasation (alkaline→skin damage)
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Sumatriptan (Imitrex): Use: when migraine symptoms appear and again in 1 hr if symptoms persist
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Route—fastest/most effective: intravenous
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Narcan [opioid antagonist]: therapeutic action: improvement of respiratory rate.
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Baclofen (Lioresal) Therapeutic action: ↓ frequency & severity of muscle spasms
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Erythromycin (Erythrocin) [macrolide] SE: liver toxicity
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Insulin: high dose (U-500) is 5 times stronger than U-100—divide dosage ordered by 5
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Spironolactone (Aldactone) [K sparing diuretic]—avoid foods w/ ↑ K such as salt substitutes
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Chloroquine phosphate (Aralen): Indic.: malaria prevention; Use: take weekly starting 1 week before
departure and continued for 4 weeks after return.
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Heparin (anticoagulant) Use: w/alteplase for acute MI
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Warfarin (Coumadin) Use:long-term prophylaxis of thrombosis [antidote—Vit K]
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Clopidogrel (Plavix) Use: reduce long-term risk of clotting w/ atherosclerosis and recent MI of CVA
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Alteplase (Activase) [antithrombolytic] Use: Acute MI/CVA (has short half-life)
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Methylphenidate (Concerta) Use: narcolepsy Precaution: avoid caffeine use
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Testosterone IM—If use to correct delayed puberty→assess bone maturation with bi-annual x-rays of
hand and wrist; monitor liver fxn (can ↑ hypoglycemia, potentiate sleep apnea, exacerbate heart failure
due to fluid retension.
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Diphenoxylate & Atropine (Lomotil) Caution: With Renal impairment ↓ elimination of atropine → ↑
anticholinergic effects of atropine like confusion
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Loperamide (Imodium) Use: anti-diarrheal (poorly absorbed from GI tract; difficulty crossing the blood-
brain barrier)
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Methylcellulose (Citrucel): bulk-forming agent with minimal Side Effects (SE)
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Psyllium (Metamucil): bulk-forming agent with minimal Side Effects (SE)
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Acetazolamide (Diamox) [diuretic] Indic: edema, epilepsy, acute mountain sickness, glaucoma (↓
intraocular pressure by ↓ amount of aqueous humor in the eye) Contra: allergy to sulfonamides
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Metoprolol (Lopressor) [β-blocker] Hold dose for dyspnea (sign of exacerbation of CHF)
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Propanolol (Inderal) Use. Dysrhythmia, HTN, angina; SE: bronchoconstriction/bronchospasm; can
block glyconeogenesis
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Norgestrel (Ovrette) Use: contraception; SE: excess progestin →weight gain from ↑ appetite; deficiency
of progestin: late breakthrough bleeding, amenorrhea; excess estrogen → edema
Medroxyprogesterone (Provera); Contra: smoking/tobacco products; Risks: Thromboembolism &
Cardiovascular complications; Interventions: use additional contraceptive measures w/antibiotic therapy
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IM injection site: locate dorsogluteal site
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Nausea tx: antiemetic plus cool, damp cloth to forehead, neck, and wrists.
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Allopurinol (Zyloprim) Ind. Gout; MofA: ↓ serum uric acid levels & urinary uric acid secretion;
Precaution: avoid foods that acidify urine such as corn
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TB—multi drug tx: Isoniazid(INH), Rifampin, pyrazinamide, ethambutol—to deal w/ resistant strains
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ACE Inhib. Lisinopril (Zestril) SE: dry/persistent cough for 1-2 wks from ↑ bradykinin
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Synergistic drugs: Effect of giving both drugs > than the drugs individually
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Furosemide (Lasix) [loop diuretic] Intervention: check BP before giving to determine baseline; can
cause ↓ BP by ↓ circulatory volume or by relaxing venous smooth muscle
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Ticlopidine (Ticlid) Indic: prevent coronary artery thombosis; Intervention: check platelet count
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PRBC (packed red blood cells) used as blood replacement when fluid overload is a concern
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IV medications: Intervention: assess site for redness/swelling before administration
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Collagenase (Santy) Use: Debride ulcers
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Interferon Use: Prevent viral replication
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Isotretinoin (Accutane) Contra: pregnancy w/ 2 forms of birth control due to teratogenic effects
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Vaccine—adv. of live vs attenuated/killed vaccine: long-lasting active immunity vs partial (passive)
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Epoetin Alfa (Procrit) Indic: treat anemia; SE: headache, HTN, seizures RT Hct rises too quickly
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Urofollitropin (Fertinex) Dosage: admin. IM based on dose in preceding cycles SE: ovarian
hyperstimulation syndrome.
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Hypertensive crisis S/S: flushed skin, headache, visual changes
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Acetylcysteine (Mucomyst) Indic: prevent liver damage following acetaminophen (Tylenol) overdose.
Most effective if given shortly after ingestion; some protection up to 24 hrs.
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Montelukast (Singulair) Indic: prevent asthma exacerbations;Dose: daily at bedtime; SE: well tolerated
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Metoclopramide (Reglan)-Has increased sedation when given with Morphine
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Mannitol-Caution with pts with heart disease (can precipitate CHF and pulmonary ededa)
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Opiate overdose causes Respiratory depression. Narcan antidote shorter acting. May need > 1 dose.
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Diphenhydramine (Benadryl) Precaution: avoid other CNS depressants such as: alcohol,
benzodiazepines, kava kava
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Anaphylaxis rxn—S/S: bronchoconstriction, angioedema, hypotension
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Mafenide acetate (sulfamylon) Interventions: Admin PRN analgesics 30 min prior to tx; apply after daily
tubbing to remove previous cream; Monitor fluid & electrolyte/acid-base balances; schedule wound care
> 1 hr before meals; wear sterile gloves when applying
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Zidovudine (AZT)-Dose: take at the times prescribed to prevent resistance development
SE: bone marrow suppression, hepatotoxic, nephrotoxic
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Thrombocytopenia (< 150,000) Assess: platelet count
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Prothrombin time:Indic:evaluate adequacy of extrinsic system & common pathway in clotting
mechanism
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Sulfisoxazole (Gantrisin): Use: UTI
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Cyclosporine (Neoral): Intervention: Mix w/ orange juice or milk to ↑ palatability; mixed & dispense in
a glass container (since drug binds to plastic); grapefruit juice ↑ cyclosporine levels & ↑ risk of toxicity;
administer immediately after mixing (can separate & settle)
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Hexacholorphene (pHisoHex) [antiseptic solution] Caution: CNS stimulation if sufficient amts are
absorbed through skin or mucous membranes; avoid if pregnant/breastfeeding
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Auranofin (Ridaura) [gold salt] Indic: slows the progression of rheumatoid arthritis; takes 4-6 months of
therapy to achieve therapeutic effect; SE: renal toxicity (less toxic through oral route than IM route),
severe blood dyscrasias, GI rxns,
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Thiazides—SE: hyperuricemia (common SE); assess: uric acid levels
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Simvastatin (Zocor)—SE: muscle weakness/aches; Assess: Creatine Kinase (released w/severe muscle
injury)
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Amitriptyline (Elavil) [tricyclic antidepressant] SE: orthostatic hypotension, sedation, & confusion
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Drug dosage error—all care providers involved are responsible
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Narcotic (opiate) analgesic—SE: papillary constriction, ↓BP, ↓HR, ↓ GI mobility
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Antihistamines—Indic: allergy-induced symptoms
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Mucolytic—Indic: ↓ viscosity of mucus plugs making them easier to expel
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Antitussive—Indic: used to suppress a cough
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Decongestant—Indic: used to treat nasal congestion
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Bulk-forming laxatives (Metamucil) Use: take w/lg amounts of water to prevent a gel-like mass to ↑
constipation
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Gentamicin (Garamycin) [aminoglycoside antibiotic]; SE: nephrotoxicity & ototoxicity
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Digoxin [cardiac glycoside] that ↓ HR. Interv: assess apical HR for 1 min. Contact DR if HR < 60bpm
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Lorazepam (ativan) [benzodiazepine]: SE: adbrupt cessation can →seizures RT physical addiction
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Dantrolene sodium (Dantrium)—SE: hepatitis (highest risk for women 35yrs or taking lg doses)
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Synergistic effect—effect of combined drugs greater than either of drugs alone
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Zidovudine (AZT)—only anti-retroviral drug that reduces maternal-fetal transmission of HIV virus
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Didanosine (Videx)—
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Nevirapine (Viramune)—
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Saquinavir (Fortovase)—
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Acetaminophen (Tylenol)- SE: Liver damage w/ high doses
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Diuretic therapy—Assess: K+ values to prevent dysrhythmias; ↓ Na+, ↓ Cl-, & ↓ Mg 2+
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Gold Salts—bind to erythrocytes; SE: fatal bone marrow suppression, leucopenia, thrombocytopenia,
anemia; assess: Lab-CBC
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Psuedoephedrine (Sudafed) [sympathomimetic/decongestant]—increases BP, HR, RR; Contraindication:
HTN
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Sustained-release medication—Use: do not open, crush, or chew the medication
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K+--necessary for: nerve & muscle cells (esp. those in the heart), impulse transmission
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Anticonvulsant drugs—MofA: increase seizure threshold
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Asthma therapy—Use: use albuterol (sympathomimetic drug) first to open up airways and allow other
inhaled drugs to be dispersed further down the bronchial tree
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Ipratropium bromide (atrovent)
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Beclomethasone dipropionate (Beclovent)
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Greatest absorption of drug by IV route
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Acyclovir (Zovirax)—SE: nephrotoxicity (crystallization of drug in nephron→renal tubular obstruction)
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Digoxin toxicity—can be from ↓K+ (hypokalemia)
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Fluoxetine (Prozac) [SSRI]—Teach: effects may not be seen for weeks; Dosage starts at 20mg, can be
increased after 2 wks gradually up to 80mg/day divided into 2 doses
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Succinylcholine [depolarizing NMBA] common SE: muscular pain/stiffness
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HCTZ (HydroDIURIL) [thiazide diuretic]—SE: may induce hyperglycemia (diabetics need to ↑ insulin)
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Hypoglycemics—MofA: increase insuling produced by pancreas; Contra: ineffective w/Type 1 DM RT
inadequate production of insulin by pancreas
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Vecuronium (Norcuron) [nondepolarizing NMBA]—MofA: causes relaxation of muscles & total flaccid
paralysis, but does not affect CNS, diminish pain, or consciousness
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Insulin duration (Regular-6-8hrs); Onset ½ - 1hr; peaks 2-4hrs
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Tolerance—body develops natural resistance to drug effects, need to increase dosage
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Addiction—physical or psychological need for a drug
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Substance abuse—inappropriate, excessive, self-admin of drug for non-medical purposes
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Tissue dependence-occurs when actual changes in cells, secondary to physical addition causes body to
need the drug for homeostasis
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Metabolism of 95% of all drugs occurs in the liver. Other sites—lungs, skin; kidney excretes most drugs
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Acetylcysteine (Mucomyst)-used in treatment of Acetaminophen (Tylenol) overdose
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MAOI—interactions: foods w/ tyramine (causes release of NE→ hypertensive episode)
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Antidysrhythmic agents—alter the dysfunction in the electrical system of the heart.
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Prednisone (Deltasone) [corticosteroid] suppresses endogenous cortisol production, so abrupt stopping
of drug can result in acute adrenal insufficiency can occur
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FDA pregnancy categories: A—human studies safe; B- animal studies safe, but no human studies have
been done; C- Animal studies unsafe, no human studies, D- evidence of fetal risk, X-cause abnormalities
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Tamoxifen citrate (Nolvadex)—type of hormonal antineoplastic agent: anti-estrogen
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Aluminum hydroxide (amphojel)—long term use SE: constipation (antiacids w/Mg alone cause
diarrhea; Often Al & Mg are combined to balance their side effects)
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Corticosteroids—can interfere with effect of a vaccine since they depress the immune system and can
interfere with body’s ability to produce antibodies
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Furosemide (lasix)—used for treatment of HTN in clients with renal dysfunction
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Mannitol (Osmitrol) is an osmotic diuretic and is not used in the treatment of HTN
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Triaterene/hydrochlorthiazide (maxzide)—a thiazide diuretic that is ineffective when urine output is low
or renal dysfnx is present
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Levothyroxine (synthroid)—overdose s/s: those that mimic hyperthyroidism: tremor & wt loss;
undermedicated s/s: cold,dry,scaly skin; depression; slow cognitive ability
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Liver & kidney disease—causes increase in length of duration of action of medication
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Auditory canal in children—straighten by holding pinna of ear down & back
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H. pylori—4 medications needed to eradicate the pathogen & ↓ risk of recurrence of ulcer (2 different
antibiotics; bismuth; medication to ↓ gastric acidity in the stomach)
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Dopamine (Intropin)—Dose for cardiac shock: Intermediate doses ↑ CO; other uses: low doses ↑ renal
perfusion & urine output; high doses (>10mcg/kg/min) α effects predominate→vasoconstriction & ↑BP
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Parkinson’s—associated with ↓ of dopamine in the substantia nigra (brain)
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Terbutaline (Brethine)—SE: tachycardia
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Gout treatment: drugs that lower uric acid level in the blood→ ↓ doposition of urate crystals in joints
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Dexamethasone (Decadron)—effects on blood glucose: glucocortoid steroids & stress ↑ blood glucose
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Narcotics—MofA: alter perception of pain at the spinal cord & higher levels in the CNS
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Diuretics—pt. education: take during the day, report any changes in daily wt.
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Oral Iron supplement—adverse SE: gastric irritation→anorexia, nausea, vomiting, constipation
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Amphotericin B (Fungione)—SE: ↓K; ↓Mg; ↓Cl; ↓ Ca; nephrotoxicity (80% of pts)
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Anti-hypertensive medications—SE: orthostatic hypotension
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Trimethoprim/Sulfamethoxazole (Bactrim)[sulfonamide antibiotic]—SE: crystalluria that can clog the
kidneys; to prevent ↑ fluids to 2-3 liters per day unless contraindicated
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Triazolam (Halcion)[benzo]—use: do not take with alcohol
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Theophylline—therapeutic serum level: 10-20mcg/mL
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Drug distribution via IV altered with CHF
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Diphenhydramine (Benadryl)—SE: drowsiness
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Treatment for constipation in children—glycerine suppositories (↑ osmotic pressure-draws fluid into
colon) castor oil-distasteful & ↓ absorption of fat-soluble vitamins;
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Intradermal route used to admin: tuberculin test (PPD)
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Cromolyn sodium (Intal)—indication: asthma prophylaxis (mast cell stabilizer→↓ release of histamine,
bradykinin, and serotonin that start a cascade of allergy symptoms)
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IM site for 18 month old child: vastus lateralis
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Metronidazole (Flagyl)—education: avoid alcohol (drug inhibits alcohol metabolism→accumulation)
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Fluticasone (Flovent) [inhaled steroid]—Indic: decrease inflammation of the bronchi
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Status epilepticus: tx given via IV route
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Fexofenadine [2nd generation antihistamine]: differs from 1st generation by ↓ sedation
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Neostigmine (Prostigmin)—MofA in pt w/ myasthenia gravis: ↑ level of Ach at neuromuscular junction
increases strength of muscle contraction
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Calcium therapy need adequate amts of : vit. C
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Naloxone (Narcan): narcotic antagonist
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Barbiturate overdose RT: respiratory depression
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Penicillin allergy may ↑ risk for allergy to : cephalosporins
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Transdermal patch—education: rotate the site each time you change the patch
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Proton pump inhibitors for treatment of: GERD
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Acetaminophen Tylenol: safe for children with flu-like symptoms
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Ibuprofen (Motrin)—Most common SE: GI distress
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Maximum IM injection into dorsogluteal site: 3 mL
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Phenobarbital (Luminal)—assess: respiratory depression

Insulin—oral hypoglycemic agents are contraindicated during pregnancy—use insulin instead

Drug absorption—affected by route of administration
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Eye drop administration: depress the lower lid and place the medication in the lower conjunctival sac.

Pain medication admin in terminally ill: give medication on a regular time interval rather than PRN

Ventricula dysrhythmias in emergency setting—drug of choice: lidocaine hydrochloride (Xylocaine)
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Diltizem (Cardizem)—used for SVT
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Tocainide HCl (Tonocard)—used to prevent ventricular arrhythmias

Propranolol (Inderal)—used to prevent/control SVT (esp. assoc. w/ excessive catecholamines)

Unconscious type 1 diabetic—best intervention: admin glucagons IM

Anti-convulsant for infants/children: Phenobarbital (often admin w/ phenytoin)

Types of immunity: passive—immune: globulins/serums; active: illness or vaccination; innate: present
at birth; artificial-active: conveyed from one person to another (meternal-fetal transmission)
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Bipolar—drug of choice: lithium
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Tricyclic drugs—used in treatment of depression
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MAOI drugs—used in treatment of depression
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Benztropine mesylate—used to treat extrapyramidal effects w/ use of phenothiazines

Nasal congestion—treat with decongestant
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Anti-tussive—treat cough

Mucolytic—used to decrease the viscosity of mucus plugs making them easier to expel

Antibiotics—SE: ↑ risk for fungal infection (destroys good bacteria & allows overgrowth of fungus)

Niacin—SE: vasodilation & facial flushing
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Atropine—use: severe symptomatic bradycardia
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Verapamil (Calan)—use: ↓ HR
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Phenytoin (Dilantin)—therapeutic level: 10-20 mcg/mL

Decreased biotransformation of drugs in children→slowing the metabolism of many drugs
(biotransformation = metabolism)
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Insulin—peak: NPH—6-12 hrs

Penicillin—most common SE: nausea/vomiting/diarrhea

Sympathomimetics: mimic SNS → ↑ BP
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Beta-adrenergic blockers: block SNS →↓BP, ↓HR, ↓ arterial pressure, ↓ CO

Muscarinic antagonist AKA anticholinergic agents: block PSNS→ SNS responses

Diphenoxylate HCl (Lomotil)—SE: dry mouth (from added atroprine to discourage abuse)