MedMaster by NURSING.com

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dopamine

Inotropin

used to improve blood pressure, cardiac output, and urine output

Smaller doses result in renal vasodilation
Doses 2-10mcg/kg/min result in cardiac stimulation by acting on beta1 receptors
Doses >10mcg/kg/min stimulate alpha receptors leading to vasoconstriction (↑SVR)

inotropic, vasopressor

adrenergic

• Monitor hemodynamics closely: BP, HR, EKG, CVP, and PAOP if available
• Obtain parameters for hemodynamic values
• Titrate to obtain appropriate BP (more potent vasoconstrictors may be required)
• Irritation may occur at IV site
• Beta blockers may counteract therapeutic effects

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Dobutamine

Dobutrex

Short term management of heart failure

Dobutamine has a positive inotropic effect (increases cardiac output) with very
little effect on heart rate. Stimulates Beta1 receptors in the heart.

Inotropic

Beta-adrenergic agonist

• Monitor hemodynamics: hypertension, ↑HR, PVCs
• Skin reactions may occur with hypersensitivity
• Beta blockers may negate therapeutic effects of dobutamine
• Monitor cardiac output
• Monitor peripheral pulses before, during, and after therapy
• DO NOT confuse dobutamine with dopamine

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Divalproex

Depakote

Seizures, manic episodes, prevention of headache

Increases the level of GABA (inhibitory neurotransmitter) in CNS

Anticonvulsant, vascular headache suppressants

None

• May cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity,
pancreatitis
• Increases risk for bleeding with Warfarin
• Use caution with MAOIs
• Monitor liver function tests

Diphenoxylate/atropine

Lomotil

Treatment for diarrhea

Inhibits GI motility via anticholinergic effects

Antidiarrheal

Anticholinergic

• Contraindicated with angle-closure glaucoma, dehydration
• Structurally related to opioids so use caution with patients that have allergies to opioids
• May cause constipation, tachycardia, dizziness, ileus
• Monitor liver function as the medication is excreted by the liver
• Ensure that client is taking medication as prescribed and not double dosing

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Diphenhydramine

Benadryl

Allergy, anaphylaxis, sedation, motion sickness, antitussive

Antagonizes effects of histamine, CNS depression

Allergy, cold and cough remedy, antihistamine, antitussive

Antihistamine

• May cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick
secretions, hypotension, blurred vision, headache
• Anticholinergic effects (dry mouth, blurred vision, constipation, sedation)
• Assess purpose of medication prior to giving it
• Assess allergies, sleep patterns, cough and lung sounds
• Patient should avoid other over-the-counter cough and cold remedies

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Diltiazem

Cardizem

Hypertension, angina, SVT, AFib, aflutter

Inhibits calcium transport resulting in inhibition of excitation and contraction,
leads to depression of AV and SA node leading to decreased HR, leads to vasodi-
latation and decreased blood pressure.

Antianginals, antiarrhythmics, antihypertensive

Ca Channel Blocker (Benzothiazepine)

• Contraindicated in 2nd and 3rd AV block
• May cause arrhythmias, CHF, bradycardia, peripheral edema, gingival
hyperplasia
• Increases digoxin levels
• Don’t drink grapefruit juice
• Assess for signs of CHF
• Monitor EKG continuously
• Tell patient to change positions slowly
• Monitor serum potassium
• Instruct pt on how to take blood pressure

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Digoxin

Lanoxin

CHF, AFib, A-flutter

Positive inotropic effect (increases force of myocardial contraction), prolongs
refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is
given to increase cardiac output and slow the rate.

Antiarrhythmic, inotropics

Digitalis glycosides

• Excreted by kidneys
• Assess patient for hypersensitivity
• Contraindicated with uncontrolled ventricular arrhythmias
• Hypokalemia increase risk for toxicity
• Hypercalcemia ↑ risk for toxicity
• Use caution with diuretic use as they may cause electrolyte abnormalities
that can lead to toxicity
• Assess patient for cardiac arrhythmias including bradycardia
• Signs of toxicity include vision changes (blurred vision, yellow, green vision
disturbances)
• Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse

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Diazepam

Valium

Anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia,
management of alcohol withdrawal

Decreases the effects of voltage gated sodium channels to depresses the CNS

Antianxiety agents, anticonvulsants, sedative/hypnotics, skeletal muscle relax-
ants (centrally acting)

Benzodiazepine

• Contraindicated in hepatic dysfunction
• Use caution with renal impairment
• Can cause dizziness, drowsiness, lethargy, hypotension, physical depen-
dence, tolerance
• Instruct patient to take as directed
• Caution to avoid alcohol use
• Flumazenil (Romazicon) is the reversal agent

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Dexamethasone

Decadron

Manage cerebral edema, assess for Cushing’s Disease

Suppress inflammation and normal immune response. Used in inflammatory states
to decrease inflammation.

Antiasthmatics, corticosteroids

Corticosteroids

• Excreted by the liver – monitor liver profile
• Avoid in active untreated infections
• May cause CNS alterations
• May cause peptic ulcers
• May cause Cushingoid appearance (buffalo hump, moon face)
• Weight gain
• Osteoporosis
• Decrease wound healing
• May elevate blood sugars
• May increase cholesterol and lipid values

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Cyclosporine

Sandimmune

Prevention of rejection in transplantation, treatment of severe RA, management
of ulcerative colitis

Inhibits normal immune response primarily by decreasing the activity of T cells

Immunosuppressant, antirheumatics (DMARD)

Polypeptides (cyclic)

• May cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V,
gingival hyperplasia
• Increases immune suppression with corticosteroids
• Avoid grapefruit juice while taking this medications
• Assess for signs of organ rejection
• Monitor renal panel, liver enzymes
• Take medication as directed
• Lifelong therapy required for transplant patients
• Instruct pt on how to take blood pressure

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I am excited to bring to you the NURSING.com SOCK Method, with proven tips to help you master pharmacology. When I surveyed 200 nursing students, 66% said that their most difficult subject was nursing pharmacology. However, the issue is often overlooked.

There are a lot of schools that don't have dedicated pharmacology courses and instead roll it up into other parts of the program. But that is devastating to me because the one thing we do more than almost anything else in our careers as nurses is give medication.

So today I'm gonna introduce you to something called the SOCK Method for mastering nursing pharmacology. We are doubling down on our focus on pharmacology in this podcast. After listening to this, I am confident that you will be able to become a master of nursing pharmacology.

SOCK Method

• S – Side Effects
• O – Organs
• C – Class/Considerations/Cards
• K – Know (or Must Know)
• The Correct Order

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Cortisone

Cortone

Management of adrenocortical insufficiency (Addison’s Disease). Replace cortisol
in states of deficiency, suppress inflammation and normal immune response.

The adrenal glands sit on top of the kidneys.
The adrenal glands excrete steroid hormones, including cortisol that play a role in
increasing blood sugars, immune suppression, and metabolism of fat, protein, and
carbohydrates, as well as decreasing bone formation.

Antiasthmatics, corticosteroids

Corticosteroids

• Excreted by the liver – monitor liver profile
• Avoid in active untreated infections
• May cause CNS alterations
• May cause peptic ulcers
• May cause Cushingoid appearance (buffalo hump, moon face)
• Weight gain
• Osteoporosis
• Decrease wound healing
• May elevate blood sugars
• May increase cholesterol and lipid values

Codeine

Paveral

Management of pain, diarrhea, cough suppressant

Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility.

Allergy, cold, cough remedy, antitussive, opioid analgesic

Opioid agonist

• May cause alterations in mentation, hypotension, constipation, nausea,
vomiting
• Assess BP, pulse, and respiratory rate prior to administration and frequently
during administration
• Use caution if patient is receiving MAO Inhibitors
• Narcan (naloxone) is the antidote for opioid agonists

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Clopidogrel

Plavix

Atherosclerotic events, MI, CVA, PVD, acute coronary syndrome

Inhibits platelet aggregation

Antiplatelet agent

Platelet aggregation inhibitors

• May cause GI bleeding, neutropenia, hypercholesterolemia
• May increase risk for bleeding in warfarin, aspirin, heparin
• Can increase risk for bleeding with garlic, ginkgo, ginger
• Monitor for signs of bleeding
• Monitor bleeding times
• Monitor CBC and platelet count
• Discontinue use 5-7 days before surgery

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Clindamycin

Cleocin

Skin infections, respiratory tract infections, septicemia, intra-abdominal infections,
osteomyelitis

Bacteriostatic: inhibits protein synthesis

Anti-infectives

Lincosamide

• Arrhythmias, pseudomembranous colitis, diarrhea, phlebitis
• Monitor bowel function
• Assess for infection, obtain cultures prior to therapy
• Monitor liver function tests
• Monitor CBC

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Ciprofloxacin

Cipro

Urinary tract infections, gonorrhea, respiratory tract infections, bronchitis,
pneumonia, skin and bone infections, infectious diarrhea, abdominal infections

Inhibits bacterial DNA synthesis

Anti-infectives

Fluoroquinolone

• Contraindicated in allergies
• May cause QT prolongation, avoid use with other drugs that can cause QT
prolongation
• Can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis,
Stevens Johnson syndrome
• May decrease effects of phenytoin
• Monitor renal panel
• Assess for infection, obtain cultures prior to therapy
• Monitor liver function tests

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Cimetidine

Tagamet

Treatment of duodenal ulcers, GERD, heartburn, Zollinger Ellison syndrome,
prevention of GI bleeding in critical patients.

Inhibits action of histamine leading to inhibition of gastric acid secretion

Antiulcer agent

Histamine H2 antagonist

• Increases serum level of warfarin
• Can lead to respiratory infection (green sputum)
• Monitor for arrhythmias
• May cause agranulocytosis, aplastic anemia
• Monitor CBC during therapy
• Take medication as directed
• Instruct patient to increase fluid and fiber intake to decrease constipation

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Chlorpromazine

Thorazine

Second line treatment of schizophrenia and psychosis, nausea/vomiting, pre-op
sedation, acute intermittent porphyria, headache, bipolar

Exhibits anticholinergic activity, alters effects of dopamine in CNS

Antipsychotic, antiemetic

Phenothiazines (dopamine D2 receptor antagonist)

• May cause neuroleptic malignant syndrome, sedation, tardive dyskinesia,
hypotension, agranulocytosis
• Assess mental status prior to and during treatment
• Monitor blood pressure
• Ensure patient is taking medication
• Monitor CBC and liver function tests
• Instruct patient not to skip doses or double dose.

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Cephalexin

Keflex

Skin infections, pneumonia, UTI, otitis media

Bactericidal: binds to bacterial cell wall leading to cell death

Anti-infectives

Cephalosporin 1st generation

• Contraindicated with cephalosporin and serious penicillin allergies.
• May need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis
at IV site, anaphylaxis
• Assess infection and allergies
• Obtain cultures prior to therapy
• Monitor bowel function
• May lead to superinfection
• May cause elevated liver enzymes

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Celecoxib

Celebrex

Osteoarthritis, rheumatoid arthritis, acute pain

Decreases pain and inflammation by inhibiting synthesis of prostaglandins

Antirheumatics/NSAID

Cox 2 inhibitor

• Use caution with cardiovascular disease
• Increases risk for MI, CVA, thrombosis
• May cause GI bleeding, Stevens-Johnson syndrome, dermatitis
• Notify provider for new-onset abdominal pain or black stool

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Cefdinir

Omnicef

Treatment of skin infections, otitis media

Bactericidal, binds to bacterial cell wall causing cell death

Anti-infectives

Cephalosporin 3rd generations

• Contraindicated in cephalosporin and possibly penicillin allergies
• May need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at
IV site, anaphylaxis
• Assess infection and allergies
• Obtain cultures prior to therapy
• Monitor bowel function
• Monitor for bleeding
• May lead to superinfection

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Cefaclor

Ceclor

Treatment of respiratory tract infections, skin infections, otitis media

Bactericidal, binds to bacterial cell wall causing cell death

Anti-infectives

Cephalosporin 2nd generations

• Contraindicated in cephalosporin and possibly penicillin allergies
• May need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at
IV site, anaphylaxis
• Assess infection and allergies
• Obtain cultures prior to therapy
• Monitor bowel function
• May lead to superinfection

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Carbidopa/levodopa

Sinemet

Parkinson’s disease

Levodopa is converted to dopamine and works as a neurotransmitter, carbidopa
prevents the destruction of levodopa allowing it to cross the blood brain barrier

Antiparkinson agent

Dopamine Agonist

• 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

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Captopril

Capoten

Hypertension, management of CHF, decrease progression of DM neuropathy

Block conversion of angiotensin I to angiotensin II, increases renin levels and
decreases aldosterone leading to vasodilation

Antihypertensives

ACE Inhibitor

• Can cause neutropenia – check WBCs regularly
• Use cautiously with potassium supplements and potassium sparing diuretics
• Use cautiously with diuretic therapy
• Administer 1 hour before meals
• Monitor blood pressure often
• Monitor weight and fluid status
• Monitor renal profile
• Monitor CBC frequently
• May lead to Rhabdomyolysis
• Dry cough

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Calcium carbonate

Tums/Rolaids

Treatment of hypocalcemia, prevention of postmenopausal osteoporosis, treat-
ment of hyperkalemia and hypermagnesemia, used as antacid

Calcium is essential for nervous, muscular, and skeletal systems, helps maintain
cell membranes, aids in transmission of nerve impulses and muscle contraction,
aids in blood formation and coagulation

Mineral and electrolyte replacements/supplements

Antacids

• May cause cardiac arrest and arrhythmias
• Monitor hemodynamics
• May causes hypotension, bradycardia, and arrhythmias
• Hypercalcemia can increase risk for digoxin toxicity
• Instruct pt on foods that contain Vitamin D and encourage adequate intake
• Monitor parathyroid hormone

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calcium acetate

PhosLo

treatment of hypocalcemia, prevention of post-menopausal osteoporosis, treatment of hyperkalemia and hypermagnesaemia, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD. Binds to phosphate in food and prevents absorption.

calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation

mineral and electrolyte replacements/supplements

antacids

• may cause cardiac arrest and arrhythmias
• phlebitis at site of insertion
• monitor hemodynamics
• may cause hypotension, bradycardia, and arrhythmias
• hypercalcemia can increase risk for digoxin toxicity
• administer slowly
• instruct pt on foods that contain Vitamin D and encourage adequate intake.
• monitor parathyroid hormone

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butorphanol

Stadol

moderate to severe pain, labor pain, sedation

alters perception and response to pain by binding to opiate receptors in CNS

Opioid Analgesic

opioid agonists/antagonists

• use caution with concurrent use of MAOIs
• may cause confusion, hallucinations, sedation
• monitor for CNS depression
• assess blood pressure pulse and respirations during administration
• administer slowly through an IV line

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Buspirone

Buspar

Management of anxiety

Relieves anxiety by binding to dopamine and serotonin receptors

Antianxiety

Azapirone

• Do not administer concurrently with MAOI or grapefruit juice
• May lead to dizziness, drowsiness, fatigue, and weakness
• Patient may experience chest pain, palpitations, tachycardia
• Instruct patient to take as directed
• Instruct patient to avoid alcohol and other CNS depressants

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Bupropion

Wellbutrin

Depression, smoking cessation, treat ADHD in adults

Not well understood, ↑ dopaminergic and noradrenergic transmission via reuptake

Antidepressants, smoking deterrents

Aminoketones

• May lead to seizures, suicidal thoughts
• Do not administer if patient is taking MAOI
• Use caution with renal and liver impairment
• Assess mental status
• Instruct patient to avoid alcohol (may lead to hallucinations, seizures,
anxiety)

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Bismuth subsalicylate

Kaopectate, Pepto-Bismol

Diarrhea, heartburn, indigestion, H. pylori associated ulcer

Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins.

Antidiarrheal, antiulcer, antacid

Absorbent

• Contraindicated in aspirin hypersensitivity
• Increase risk for impaction with geriatric and pediatric patients
• Monitor liver profile
• Bismuth may interfere with radiologic exams

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Bisacodyl

Dulcolax

Treatment of constipation, bowel regimen

Stimulates enteric nerves to cause peristalsis which leads to fluid accumulation in the colon

Laxatives

Stimulant laxatives

• May lead to hypokalemia
• May cause abdominal pain and cramps
• Not for use within 1 hour of taking milk product
• Assess for abdominal distention and bowel function
• Instruct patient to drink 1500-2000 mL/day during therapy
• Monitor fluid and electrolyte levels
• Instruct patient to take as ordered

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Benztropine

Cogentin

Treatment for Parkinson’s disease

Exhibits anticholinergic properties (blocks acetylcholine) in the CNS to reduce rigidity and tremors

Antiparkinson agent

Anticholinergic

• 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

Azithromycin

Zithromax

URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis

Inhibits bacterial protein synthesis

Agents for atypical mycobacterium, anti-infectives

Macrolide

• May lead to pseudomembranous colitis, pain, diarrhea, nausea,
Stevens-Johnson syndrome, angioedema
• May increase risks for warfarin toxicity
• Monitor patient for signs of anaphylaxis
• Instruct patient to notify physician for diarrhea, or blood or pus in stool
• Instruct patient to take medication exactly as prescribed

Atorvastatin

Lipitor

Management of high cholesterol (hypercholesterolemia), primary prevention of cardiovascular disease

Lowers total cholesterol as well as LDL while slightly increasing HDL. Inhibits HMG-CoA reductase which plays a role in the liver in cholesterol formation

Lipid-lowering agent

HMG-CoA reductase inhibitor

Simvastatin (Zocor), rosuvastatin (Crestor)

• Contraindicated in active liver disease
• May cause rhabdomyolysis
• Monitor renal function
• Monitor serum cholesterol before, about 4 weeks after starting, and fre-
quently during drug therapy
• Monitor liver function tests
• Instruct patient to report muscle weakness (sign of rhabdomyolysis)

Atropine

Atropen

Decreases oral and respiratory secretions, treats sinus bradycardia and heart block, treatment of bronchospasm

Atropine is an anticholinergic which means that it inhibits the effects of the parasympathetic nervous system, specifically acetylcholine. This inhibition causes increase in HR, bronchodilation, decreased GI and respiratory secretions.

Antiarrhythmic

Anticholinergic, antimuscarinic

• Avoid in acute hemorrhage, tachycardia, and angle closure glaucoma
• Monitor patient for tachycardia and palpitations
• May cause urinary retention in elderly patients
• Patients may experience constipation due to slowed GI motility

Amlodipine

Norvasc

Hypertension, angina

Blocks transport of calcium into muscle cells inhibiting excitation and contraction

Antihypertensive

Ca channel blocker

• May cause gingival hyperplasia
• Grapefruit juice may increase drug level
• Monitor blood pressure and pulse prior to and during therapy
• Monitor intake and output
• Assess for signs of CHF
• Assess characteristics of angina
• Instruct patient of interventions for hypertension and how to take blood
pressure

amoxicillin

Moxatag

skin infections, respiratory infections, sinusitis, endocarditis prophylaxis, lyme disease

Inhibits synthesis of bacterial cell wall leading to cell death.

anti-infectives, antiulcer agent

aminopenicillins

• contraindicated with penicillin allergy
• may cause seizures
• assess for rash, anaphylaxis
• excreted by kidneys – monitor renal labs
• monitor patient for diarrhea – bloody stool should be reported immediately

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Acetylsalicylic Acid

Aspirin

Rheumatoid arthritis, osteoarthritis, ischemic stroke, and MI prophylaxis

Inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases

Antipyretics, non-opioid analgesics

Salicylates

• Use caution in bleeding disorders, chronic alcohol use
• May lead to Stevens-Johnson syndrome, laryngeal edema, and anaphylaxis
• Increases risk for bleeding with warfarin, heparin, and clopidogrel
• Increased risk for GI bleeding with NSAID use
• Monitor liver function tests
• Concurrent use with alcohol may increase risk for GI bleeding
• Aspirin with viral infections can cause Reye’s syndrome

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Amlodipine

Norvasc

Hypertension, angina

Blocks transport of calcium into muscle cells inhibiting excitation and contraction

Antihypertensive

Ca channel blocker

• May cause gingival hyperplasia
• Grapefruit juice may increase drug level
• Monitor blood pressure and pulse prior to and during therapy
• Monitor intake and output
• Assess for signs of CHF
• Assess characteristics of angina
• Instruct patient of interventions for hypertension and how to take blood
pressure

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Ampicillin

Principen

Skin infections, soft tissue infections, otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia

Bactericidal, broader spectrum than penicillin, binds to cell wall leading to bacterial cell death

Anti-infective

Aminopenicillin

• Contraindicated in penicillin allergy, use caution in renal insufficiency
• May lead to seizures, diarrhea, anaphylaxis, superinfection
• Assess for infection
• Monitor liver function tests
• Instruct patient on signs of superinfection: furry overgrowth on tongue,
vaginal itching, loose and foul smelling stool
• Pt should not use with oral contraceptive use.

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Amitriptyline

Elavil

Depression, anxiety, insomnia, parkinson’s

Increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects

Antidepressant

Tricyclic antidepressant

• Contraindicated in MI, heart failure, QT prolongation, glaucoma
• May increase risk for suicidal ideation
• May cause arrhythmias, hypotension, EKG changes
• May cause alterations in blood glucose levels
• May lead to general sedation and lethargy
• Do not use within 2 weeks of MAOIs
• Instruct pt to take medication exactly as instructed
• Monitor for orthostatic hypotension
• May lead to photosensitivity, instruct patient to use sunscreen
• May turn urine blue/green color.

Amiodarone

Cordarone

a-fib, ventricular arrhythmias, SVT, ACLS protocol for v-fib and v-tach

Prolongs phase 3 of the action potential, makes the heart more tolerant to arrhythmias, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation

Antiarrhythmic class III, potassium channel blocker

None

• May lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension
• Increases risk for QT prolongation
• Increases digoxin levels
• Increases activity of warfarin
• Monitor EKG continuously while on therapy
• Assess for signs and symptoms of ARDS
• Monitor liver function test
• Check dosage with another RN
• Teach pt to monitor pulse daily and report abnormalities
• Avoid drinking grapefruit juice

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Hey guys, let's talk about acyclovir. Also known as Zovirax, acyclovir comes in a tablet form, which you can see here in this picture, but also in a capsule, oral suspension IV, and even a topical ointment. Okay, guys, remember that the therapeutic class is what the drug does to the body and the pharmacologic class is the actual chemical effect that the drug has. So acyclovir is an antiviral medication that helps to slow the growth of viral infections in the body. The pharmacologic class of acyclovir is it is a purine analog, which, long story short, means it blocks the replication of the viral DNA. So, guys, the action of acyclovir is that it interferes with the viral DNA synthesis, meaning it stops the spread of the virus. Acyclovir is used to treat infections that are caused by the herpes virus, like genital or oral herpes, herpes, zoster, or shingles, and varicella, also known as chickenpox. Important: acyclovir will not cure the herpes virus; it only stops the growth and treats the symptoms. So side effects aren't super common with acyclovir, but the ones that we often see are an overall sense of malaise or fatigue, nausea, vomiting, and a headache.

So guys remember to assess your patient for renal impairment or seizure disorders because acyclovir can make these issues worse. Use caution in immunocompromised. Patients' doses may need to be altered. Monitor the lesions to see if the treatment is working and remember to teach your patient to use protection with sexual intercourse, and to always take the full dose of the medication. Guys, I once had a patient in a clinic that was under the impression that they would be cured of general herpes after taking acyclovir. Remember to teach your patient that this medication will not cure only help the disease process. That's it for acyclovir or Zovirax. Now go out and be your best self today and as always happy nursing.

Alprazolam

Xanax

Anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis

Works in CNS to produce anxiolytic effect causing CNS depression.

Antianxiety agent

Benzodiazepine

• Use caution with existing CNS depression, sleep apnea, renal dysfunction,
hepatic dysfunction.
• May cause CNS depression, drowsiness, lethargy
• May lead to physical dependence, may experience tolerance effect
• Assess anxiety and mental status
• Romazicon (flumazenil) is the antidote for overdose
• Grapefruit juice may increase blood levels

Alendronate

Fosamax

Osteoporosis (aging, menopause, corticosteroid induced)

Inhibits osteoclast activity leading to inhibition of resorption of bone

Bone resorption inhibitor

Bisphosphonates

• Take first thing in the morning with full glass of water 30 min prior to eating
• Assess serum calcium and vitamin D
• May lead to muscle pain

Albuterol

Proventil

Bronchodilator used to prevent airway obstruction in asthma and COPD

Binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways

Bronchodilator

Adrenergic

• May decrease the effectiveness of Beta Blockers
• Use caution with
○ Heart disease
○ Diabetes
○ Glaucoma
○ Seizure disorder
• Overuse of inhalers can lead to bronchospasm
• Monitor for chest pain and palpitations
• Can decrease digoxin levels

Acetaminophen

Tylenol

Pain, fever

Inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response

Antipyretic, non-opioid analgesic

• Do not exceed 4g of acetaminophen per day to limit risk for liver, renal,
and cardiac damage
• Overdose will lead to hepatotoxicity
• Acetadote is the antidote for overdose
• May increase risk for bleed with warfarin therapy
• May alter blood glucose measurements

venous thrombosis, pulmonary embolism, A-fib, myocardial infarction

disrupts liver synthesis of Vitamin K dependent clotting factors

Anticoagulant

coumarins

• contraindicated with bleeding, severe hypertension
• can cause bleeding
• aspirin and NSAIDs can increase risk of bleeding
• azole antifungals increase effects of warfarin
• cimetadine(Tagamet) increases warfarin levels
• obtain full history of supplements and herbs
• large amounts of vitamin K may antagonize effects of warfarin
• assess for signs of bleeding
• therapeutic levels: PT 1.3-1.5, INR 2.5-3.5
• instruct patient to report any signs of bleeding
• patient should not drink alcohol
• bleeding times need to be monitored frequently
• vitamin K is antidote

Isoptin

hypertension, angina, SVT, migraine

prevents transport of calcium, leading to decreased contraction, decreases SA and AV node conduction

antianginals, antiarrhythmic, antihypertensive, vascular headache suppressants

Ca Channel Blocker

• don’t use with 2nd and 3rd degree heartblock
• don’t use with systolic BP < 90
• may cause anxiety, confusion, cough, dyspnea, arrhythmias, CHF, bradycardia, hypotension,
elevated liver enzymes, Steven’s Johnson syndrome, hyperglycemia, gingival hyperplasia
• grapefruit juice can increase effects
• can increase levels of digoxin
• monitor heart rhythm, intake and output, blood pressure
• assess angina

Pitressin

management of diabetes insipidus, VT/VF unresponsive to initial shock, GI hemorrhage

increases water permeability of the kidney’s collecting duct and distal convoluted tubule leading to water retention, also increases peripheral vascular resistance leading to increased BP

hormone

antidiuretic hormone

• use caution with HF and CV disease
• contraindicated in renal failure and hypersensitivity to pork
• monitor BP, HR, and EKG during therapy
• monitor urine specific gravity and osmolality
• weigh patient and assess for edema
• monitor electrolyte panel
• do not use with alcohol

Vancocin

life threatening infections, sepsis

bactericidal, inhibits cell wall synthesis

anti-infectives

glycopeptides

• can cause ototoxicity, nausea, vomiting, nephrotoxicity, anaphylaxis, red-man syndrome
• assess for infection
• obtain culture prior to initiating therapy
• monitor blood pressure
• dose dependent draw serum trough levels frequently
• administer over at least 60 minutes to avoid skin irritation

Lopressor, Toprol XL

tachyarrhythmias, HTN, angina, prevention of MI, heart failure management, may be used for migraine
prophylaxis

blocks the stimulation of beta1 receptors in the SNS, does not usually effect on beta2 receptors (cardioselective)

antianginal, antihypertensive

beta blocker

• monitor hemodynamics
• may lead to bradycardia, pulmonary edema
• use caution with MAOIs
• assess I&Os and monitor for signs of CHF

Doxycycline

treatment of infection, gonorrhea and syphilis with penicillin allergy, chronic bronchitis

bacteriostatic by inhibiting protein synthesis

anti-infectives

Tetracyclines

• use caution with liver impairment
• may cause pseudomembranous colitis, diarrhea, nausea, vomiting, photosensitivity, rash
• may increase effects of warfarin
• assess for infection
• obtain culture prior to initiating therapy
• monitor renal and liver labs
• instruct patient to complete entire dose

Brethine, Brethaire

asthma, COPD, preterm labor

produces smooth muscle relaxation, bronchodilator, and inhibits hypersensitivity reactions

bronchodilators

adrenergics

tocolytics

• may cause nervousness, restlessness, tremors
• beta blockers can reduce effect
• assess respiratory status
• monitor maternal/fetal vital signs if using for preterm labor
• monitor for hypoglycemia
• may cause decreased potassium level

Feosol

Prevention and treatment of iron-deficiency anemia

Iron is essential for hemoglobin, myoglobin and enzymes, it is transported to
organs where it becomes part of iron stores

Antianemics

Iron supplements

• May cause seizures, hypotension, constipation, epigastric pain, diarrhea, skin
staining, anaphylaxis
• Assess nutritional status, bowel function
• Monitor hemoglobin, hematocrit, iron levels
• May cause elevated liver enzymes
• Take on an empty stomach to increase absorption/vitamin c helps with
absorption
• Use z-track for IM injections

bronchitis, UTI, diarrhea, pneumonia, multiple types of infection

bacteriacidal by preventing metabolism of folic acid

anti-infectives, antiprotozoals

folate antagonists, sulfonamides

• may cause renal damage, Steven Johnsons Syndrome – rash, pseudomembranous colitis, nausea,
vomiting, diarrhea, rash, agranulocytosis, aplastic anemia, phlebitis
• contraindicated with sulfa allergies
• monitor CBC
• obtain cultures prior to initiating therapy
• monitor intake and output
• instruct patient to complete dose
• drink 8-10 glasses of water

Carafate

management of GI ulcers, GI injury prevention from high dose aspirin and NSAID treatment

reacts with gastric acid to form a paste that adheres to ulcer

antiulcer agent

GI protectant

• use caution in renal failure patients
• concurrent use of antacids may decrease the effect of sucralfate – administer 30 min before or after
• administer on empty stomach 1 hour before meals

Streptase

pulmonary embolism, DVT, occluded lines, arterial thrombus

converts plasminogen to plasmin which degrades fibrin clots

Thrombolytic

plasminogen activators

• contraindicated with active bleeding, hypersensitivity, bronchospasm, intracranial hemorrhage,
hypotension
• begin therapy as soon as possible
• monitor vital signs continuously
• monitor closely for bleeding
• monitor hemodynamics
• avoid invasive procedures

Aldactone

potassium loss, hypertension, edema, CHF

inhibits sodium reabsorption while sparing potassium and hydrogen

Diuretics

potassium sparing diuretics

• contraindicated with hyperkalemia
• monitor intake and output
• monitor blood pressure
• monitor potassium levels and renal panel

Zoloft

major depressive disorder, OCD, anxiety

inhibits uptake of serotonin allowing for higher quantities available within synaptic cleft

Antidepressant

SSRI

• do not use with MAOIs
• can cause neurolyptic malignant syndrome, suicidal thoughts, drowsiness, insomnia, diarrhea,
dry mouth, tremors, serotonin syndrome, sexual dysfunction
• monitor mood changes in patient
• takes 1-4 weeks for therapy to be effective.

reversible airway obstruction, exercise induced asthma

bronchodilation through stimulation of beta 2 adrenergic receptors

bronchodilators

adrenergics

• instruct patient to avoid excessive use
• can cause headache palpitations tachycardia, abdominal pain, paradoxical bronchospasm
• beta blockers and decrease effectiveness
• assess respiratory status
• may increase glucose levels
• always take bronchodialtor first

Rimactane

tuberculosis

inhibits RNA synthesis

Antitubercular

rifamycins

• can turn body fluids red
• may cause diarrhea, nausea, vomiting, confusion
• assess lung sounds and sputum characteristics
• evaluate renal and liver function tests
• instruct patient not to skip or double dose
• must complete entire dose (6-12 month therapy)

Zantac

duodenal ulcers, GERD, heartburn, esophagitis, GI bleed

inhibits action of histamine in gastric parietal cells, decreases gastric acid secretion

antiulcer agents

histamine H2 antagonists

• may cause arrhythmias, agranulocytosis, aplastic anemia, confusion
• assess abdominal pain
• monitor for blood in stool
• monitor CBC

Seroquel

schizophrenia, depressive disorder, mania

dopamine and serotonin antagonist

antipsychotic, mood stabilizers

none

• may cause neurolyptic malignant syndrome, seizures, dizziness, palpitations, weight gain,
anorexia
• QT interval prolongation
• don’t use with CNS depressants
• assess weight frequently
• monitor liver function test and CBC
• may increase cholesterol

PTU

hyperthyroidism

inhibits thyroid hormones

Antithyroid Agent

none

• hepatotoxicity, nausea, vomiting, agranulocytosis
• monitor symptoms of hyperthyroidism
• monitor for hypothyroidism
• monitor WBC and liver function tests
• weight patient frequently
• may cause leukopenia, thrombocytopenia, jaundice
• take with meals

Inderal

hypertension, angina, arrhythmias, cardiomyopathy, alcohol withdrawal, anxiety

blocks Beta 1 and 2 adrenergic receptors

antianginal, antiarrhythimic (class II beta blockers), antihypertensive, headache suppressant

beta blocker

• contraindicated in CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block
• monitor hemodynamic parameters (HR, BP)
• may cause bradycardia, CHF, pulmonary edema
• masks symptoms of hypoglycemia associated with diabetes mellitus
• advise to change positions slowly to prevent orthostatic hypotension
• instruct patient on how to take blood pressure
• stopping abruptly may result in life threatening arrhythmias
• monitor daily intake and output
• advise patient to notify physician for difficulty breathing

Diprivan

anesthesia, induction, sedation,

hypnotic, produces amnesia with no analgesic properties

general anesthetic

none

• use cautiously with CVD, lipid disorder, increased ICP
• can cause apnea, bradycardia, hypotension
• burning and pain at insertion site
• can turn urine green
• assess respiratory status and hemodynamics
• maintain patent airway
• assess level of sedation

Phenergan

allergic reactions, nausea and vomiting, sedation

Blocks the effects of histamine, histamine plays a role in the immune response. Plays an inhibitory role on the chemoreceptor trigger zone in the medulla leading to an antiemetic effect. Possess anticholinergic properties producing CNS depression.

antiemetic, antihistamine, sedative/hypnotic

phenothiazine

• IV administration may cause damage to tissue, hypertension, impaired liver function
• monitor for neuroleptic malignant syndrome, confusion, sedation
• may cause CNS depression
• assess sedation level and anticholinergic effects

decreases excitability and slows conduction velocity through the heart

antiarrhythmic (Class IA Na Channel Blocker)

• may cause ventricular arrhythmias, seizure, asystole, heart block
• monitor EKG continuously may cause widening of QRS complex
• may cause hypotension keep patient supine
• monitor for signs of agranulocytosis monitor CBC frequently
• can cause drug induced lupus syndrome

Dilantin

tonic clonic seizures, arrhythmias, neuropathic pain

interferes with ion transport, shortens action potentials and decreases automaticity blocks sustained
high frequency repetitive firing of action potentials.

antiarrhythmics, anticonvulsants

hydantoins

• monitor serum phenytoin levels
• therapeutic levels 10-20 mcg/mL
• use cautiously in all patients
• can cause suicidal thoughts, ataxia, extrapyramidal symptoms, hypotension, tachycardia, arrhythmias, gingival hyperplasia, nausea, rash, drug induced hepatitis, agranulocytosis, Steven’s Johnson syndrome
• concurrent administration of enteral feedings may decrease absorption
• monitor for hypersensitivity
• assess seizures
• assess hemodynamics

Pyridium

urological pain

provides analgesia to the urinary tract mucosa

nonopioid analgesics

urinary tract analgesics

• will turn urine red or orange
• may cause headache, vertigo, hepatic toxicity
• monitor renal function

Paxil

major depressive disorder, OCD, anxiety, PTSD

block reuptake of serotonin in CNS

antianxiety agent, antidepressant

SSRI

• do not use with MAOIs
• can cause neurolyptic malignant syndrome, suicidal thoughts, serotonin syndrome, constipation,
diarrhea, insomnia
• decrease effectiveness of digoxin
• increase bleeding with warfarin
• assess for suicidal thoughts

GERD, heartburn, reduce the risk of GI bleed in critically ill patients

prevents the transport of H ions into the gastric lumen by binding to gastric parietal cells, ↓ gastric acid production

antiulcer agents

proton-pump inhibitors

• can cause hyperglycemia, abdominal pain
• decreases absorption of certain drugs
• may increase bleeding with warfarin
• assess for occult blood
• assess liver enzymes
• assess symptoms of heart burn
• administer slowly via IV push

Creon

pancreatic insufficiency, ductal obstruction

replacement of pancreatic enzymes: lipase, amylase, protease

digestive agent

pancreatic enzyme

• contraindicated with pig products allergy
• can cause shortness of breath, nausea, diarrhea, rash
• assess nutritional status
• monitor for steatorrhea
• may increase uric acid levels
• instruct patient to follow diet
• take with meals and snacks

Pitocin

labor induction, postpartum bleeding

stimulates uterine smooth muscle

hormones

oxytocics

• can cause ICH in fetus
• can cause asphyxia in fetus
• may cause coma and seizures in mother
• may cause painful contractions
• assess fetus
• assess contractions
• monitor blood pressure
• assess maternal electrolytes
• may cause uterine tetany

Oxycontin

pain

binds to opiate receptors in CNS altering the perception and sensation of pain

Opioid Analgesic

opioid agonists, opioid agonists/nonopioid, analgesic combinations

• may cause respiratory depression, constipation, confusion , sedation, hallucinations, urinary retention
• use caution with increased intracranial pressure
• don’t use with MAOIs
• assess hemodynamics
• assess pain
• may elevate pancreatic enzymes
• can cause physical dependence
• assess bowel function

Zofran

nausea/vomiting

blocks effects of serotonin on vagal nerve and CNS

antiemetic

5-HT3 antagonist

• administer slowly over 2-5 minutes – fatal QT prolongation and VTach, respiratory arrest
• may cause headache, constipation, diarrhea, dry mouth
• asses nausea and vomiting
• assess for extrapyramidal symptoms
• monitor liver function tests

omeprazole

Prilosec

GERD, ulcers, Zollinger-Ellison syndrome, reduce the risk of GI bleed in critically ill patients, heart burn

prevents the transport of H ions into the gastric lumen by binding to gastric parietal cells, ↓ gastric acid production

antiulcer agent

proton-pump inhibitor

• take 30-60 minutes prior to eating
• capsules should be swallowed whole
• instruct patient to report black tarry stool

olanzapine

Zyprexa

schizophrenia, mania, depression, anorexia nervosa, nausea/vomiting related to chemotherapy

antagonizes dopamine and serotonin

antipsychotic, mood stabilizers

thienobenzodiazepines

• do not use while breastfeeding
• can cause neurolyptic malignant syndrome, seizures, suicidal thoughts, insomnia, tardive
dyskinesia, agranulocytosis, constipation, tremors
• assess mental status
• monitor hemodynamics
• assess blood sugars
• assess intake and output
• monitor liver function tests

Mycostatin

candidiasis, denture stomatitis

causes leakage of fungal cell contents

Antifungal

none

• may cause diarrhea, nausea, vomiting
• can be used to soak dentures
• assess mucus membrane

norepinephrine

Levophed

treatment of severe hypotension and shock

increase blood pressure and cardiac output by stimulating alpha-adrenergic receptors in the blood vessels, demonstrates minor beta activity

vasopressor

• monitor BP continuously if possible or every couple of minutes
• double check all concentrations with additional nurse
• may result in rebound hypotension due to tissue ischemia when discontinued
• monitor EKG and CVP
• if patient is awake instruct them to report headaches, dizziness, or chest pain

nitroprusside

Nitropress

hypertensive crisis, cardiogenic shock

peripheral vasodilation of arteries and veins decreasing preload and afterload

antihypertensive

vasodilator

• monitor HR, BP, and EKG continuously during therapy
• may cause cyanide toxicity
• sympathomimetics may decrease effectiveness
• PAOP monitoring may help with MI and CHF patients

nifedipine

Procardia

hypertension, angina, migraines, CHF

blocks calcium transport resulting in inhibition of contraction causing systemic vasodilatation

antianginals, antihypertensives

Ca Channel Blocker

• use caution in heart block, decreased blood pressure
• don’t consume grapefruit juice while taking medication
• may cause arrhythmias
• may cause elevated liver function tests
• may cause gingival hyperplasia, Steven’s Johnson syndrome
• monitor blood pressure and pulse
• monitor calcium levels
• instruct patient on taking heart rate and blood pressure

naproxen

Aleve

pain, dysmenorrhea, fever, inflammation

inhibits prostaglandin synthesis

nonsteroidal anti-inflammatory agents, nonopioid analgesics, antipyretics

none

• use caution with GI bleeding
• may increase risk for stroke and MI
• can cause GI bleeding, anaphylaxis, Steven’s Johnson syndrome
• aspirin can decrease blood levels and effectiveness
• assess pain
• patients should remain up-right for 30 minutes after administration

nalbuphine

Nubain

pain, analgesia during labor, sedation before surgery, supplement to balance anesthesia

alters perception and response to pain, causes CNS depression

Opioid Analgesic

opioid agonists/analgesics

• use caution with head trauma
• can cause dizziness, headache, nausea, vomiting, respiratory depression
• do not use with MAOIs
• assess pain
• may cause respiratory depression in newborn
• asses hemodynamic parameters
• may elevate pancreatic enzymes
• Narcan (naloxone) is the antidote

morphine

MS Contin

pain, pulmonary edema, MI

Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS.

opioid analgesic

opioid agonist

• may cause alterations in mentation, hypotension, constipation, nausea, vomiting
• assess BP, pulse, and respiratory rate prior to administration and frequently during administration
• use caution if patient is receiving MAO Inhibitors
• Narcan (naloxone) is the antidote for opioid agonists

montelukast

Singulair

prevent or treat asthma, manage seasonal allergies, prevent exercise-induced bronchoconstriction

disrupts the effects of leukotrienes which effect airway edema, smooth muscle constriction, and cellular activity

allergy, cold, and cough remedies, bronchodilators

Leukotriene Antagonist

• assess respiratory status
• assess liver function tests
• medication does not treat acute asthma attacks

midazolam

Versed

sedation, conscious sedation, anesthesia, status epilepticus

acts to produce CNS depression, may be mediated by GABA

antianxiety agent, sedative/hypnotics

Benzodiazepine

• assess level of sedation during and for 2-6 hours following
• monitor blood pressure, pulse, respirations during IV administration
• may lead to apnea, cardiac arrest, respiratory depression
• antidote for overdose is Romazicon (flumazenil)

Flagyl

intra-abdominal infections, gynecoligical infections, skin infections, bone and joint infections, CNS
infections, septicemia, endocarditis, amebic liver abscess, peptic ulcer disease

Inhibits DNA and protein synthesis in bacteria, bactericidal

anti-infectives, antiprotozoals, antiulcer agents

none

• do not take with alcohol-disulfiram reaction
• assess for infection before and during treatment
• obtain cultures before therapy
• monitor neurologic status: parasthesia, weakness, ataxia, or seizures
• monitor intake and output, daily weights
• may alter liver enzyme tests

metoclopramide

Reglan

prevention of nausea, vomiting, hiccups, migraines, gastric stasis

accelerates gastric emptying by stimulating motility

antiemetic

Dopamine D2 receptor antagonist, prokinetic

• do not use with GI obstruction
• may cause extrapyramidal reaction, neurolyptic malignant syndrome, tardive dyskinesia,
arrhythmias, blood pressure alterations, hematologic alterations, facial movements, sedation
• can decrease effects of levodopa
• assess nausea/vomiting
• monitor liver function tests

methylphenidate

Ritalin, Concerta

ADHD, narcolepsy

improves attention span in ADHD by producing CNS stimulation

central nervous system stimulant

none

• can cause sudden death, hypertension, palpitations, anorexia, hyperactivity, insomnia
• may decrease effects of Warfarin and Phenytoin
• do not use with MAOIs
• monitor cardiovascular system
• monitor for behavioral changes
• monitor for dependence
• do not consume caffeinated beverages
“Drug Holiday” used to assess dependence and status

Methergine

treatment of post-partum hemorrhage

stimulates uterine muscles causing uterine contraction

oxytocic

ergot alkaloids

• can cause hypertension, cramps, nausea, vomiting, dyspnea
• monitor BP, heart rate, uterine response
• assess calcium levels – effectiveness ↓ with hypocalcemia
• monitor uterine bleeding and notify physician of any changes

Mathadose

withdrawal symptoms, pain

Suppresses withdrawal symptoms. Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility.

opioid analgesic

opioid agonist

• use caution if patient is receiving MAO Inhibitors
• may cause QT prolongation, hypotension, respiratory depression, dependence, confusion, sedation
• assess pain, vital signs, bowel function
• may increase pancreatic enzyme levels
• assess withdrawal symptoms

metformin

Glucophage

management of Type II DM, PCOS

decreases glucose production in the liver, decreases absorption, increases cellular insulin sensitivity

Antidiabetic

Biguanide

• do not use with renal dysfunction, metabolic acidosis
• may cause diarrhea, nausea, vomiting, lactic acidosis
• monitor patient closely for ketoacidosis and lactic acidosis, discontinue medication immediately
if acidotic
• may cause metallic taste
• instruct patient that medication does not cure diabetes

meperidine

Demerol

moderate to severe pain, sedation

Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS.

Opioid Analgesic

opioid agonists

• may cause alterations in mentation, hypotension, constipation, nausea, vomiting
• assess BP, pulse, and respiratory rate prior to administration and frequently during
administration
• use caution if patient is receiving MAOIs
• Narcan (naloxone) is the antidote for opioid agonists
• can cause seizure
• may increase pancreatic enzyme levels
• assess bowel function

mannitol

Osmitrol

increased ICP, oliguric renal failure, edema, increased intraocular pressure

inhibits reabsorption of water and electrolytes by increasing osmotic pressure, excreted by kidneys

diuretic

osmotic diuretic

• may cause phlebitis at IV site
• may cause dehydration, fluid and electrolyte imbalances
• monitor neuro status
• administer via a filter

magnesium sulfate

MgSO4

treatment of hypomagnesaemia, hypertension, preterm labor, torsade de pointes, asthma, anticonvulsant with eclampsia

magnesium plays a role in muscle excitability

mineral and electrolyte replacements/supplements

minerals/electrolytes

• use caution with renal insufficiency
• may cause decreased respiratory rate, arrythmias, hypotension, muscle weakness
• monitor EKG and respiratory status
• monitor Mg levels
• ensure dosage with secondary practitioner
• Calcium gluconate is the antidote
  • Magnesium toxicity results in respiratory depression and loss of deep tendon reflexes

losartan

Cozaar

hypertension, DM neuropathy, CHF

inhibits vasoconstrictive properties of angiotensin II

antihypertensives

angiotensin II receptor antagonist

• may cause hypotension, tacycardia, angiodema, hyperkalemia
• may increase digoxin levels
• assess blood pressure and heart rate
• assess fluid levels
• monitor daily weights with CHF
• monitor renal and liver
• instruct patient on how to take blood pressure

lorazepam

Ativan

anxiety, sedation, seizures

general CNS depression by potentiating inhibitory neurotransmitters

anesthetic adjuncts, antianxiety agents, sedative hypnotics

Benzodiazepine

• use caution with COPD and sleep apnea
• avoid alcohol use
• antidote is Flumazenil (Romazicon)
• may cause apnea, cardiac arrest, bradycardia, hypotension
• use caution with other CNS depressants
• administer slowly and dilute to decrease complications

loperamide

Imodium

acute diarrhea, decrease drainage post ileostomy

inhibits peristalsis, reduces the volume of feces while increasing the bulk and viscosity

antidiarrheal

• may lead to constipation – insure proper use
• assess bowel function
• assess fluid and electrolyte levels

lithium

Lithizine

mania

alters cation transport and neurotransmitter reuptake

Mood Stabilizer

none

• do not administer with NSAIDs
• monitor drug blood levels frequently
• may cause seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors
• Ace Inhibitors may increase serum levels
• instruct patient to maintain adequate fluid intake
• therapeutic level: 0.5-1.5 mEq/L

lisinopril

Prinivil

hypertension, management of CHF

block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone
leading to vasodilation

antihypertensives

ACE Inhibitor

• dry cough
• first dose hypotension
• use cautiously with potassium supplements and potassium sparing diuretics
• use cautiously with diuretic therapy
• administer 1 hour before meals
• monitor blood pressure often
• monitor weight and fluid status
• monitor renal profile
• monitor liver function tests

• may cause angioedema

Levaquin

urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone
infections

inhibits DNA synthesis in bacteria

Anti-infective

fluoroquinolone

• contraindicated in allergies
• may cause QT prolongation, avoid use with other drugs that can cause QT prolongation
• can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson
syndrome

• increases the risk for tendinitis or tendon rupture

• may decrease plasma concentration of phenytoin
• monitor renal panel
• assess for infection, obtain cultures prior to therapy
• monitor liver function tests

Carbidopa/levodopa

Sinemet

Parkinson’s disease

Levodopa is converted to dopamine and works as a neurotransmitter, carbidopa
prevents the destruction of levodopa allowing it to cross the blood brain barrier

Antiparkinson agent

Dopamine Agonist

• 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

levetiracetam

Keppra

Seizures

decreases severity and incidence of seizures by inhibiting presynaptic calcium channels and reducing neurotransmitter realease

anticonvulsants

pyrrolidines

• May cause suicidal thoughts, dizziness, weakness
• May alter RBC, WBC, and liver function
• May cause somnolence
• Should be infused over 15 minutes

radioactive iodine

none

thyroidectomy pretreatment, thyrotoxic crisis, radiation exposure

inhibits the release of thyroid hormones

Antithyroid Agent, control of hyperthyroidism

none

• may cause GI bleeding, diarrhea, hypothyroidism, goiter
• monitor for hypersensitivity

heparin

Hep-Lock

Venous thromboembolism prophylaxis and treatment, low dose used to ensure patency of IV catheters

increases the inhibitory effect of antithrombin on factor Xa

anticoagulant

antithrombotic

• monitor for signs of bleeding
• monitor platelet count
• may cause hyperkalemia
• have patient report any signs of bleeding

lamotrigine

Lamictal

seizures r/t epilepsy, bipolar

Inhibits sodium transport in neurons

anticonvulsant

• may cause suicidal thoughts, dizziness, behavior changes, nausea, vomiting, photosensitivity,
rash, Stevens-Johnson Syndrome
• use caution with oral contraceptive use
• assess mental status
• assess for seizures
• do not discontinue use abruptly

lactulose

Kristalose

Constipation, portal-systemic encephalopathy

draws water into the stool and softens stool, inhibits ammonia passing into the colon

laxative

osmotic

• use caution with DM
• may cause cramps, abdominal distention, hyperglycemia
• assess mental status, ammonia levels, abdominal distention
• patient should average 2-3 bowel movements per day

ketorolac

Toradol

pain

pain relief due to prostaglandin inhibition by blocking of the enzyme cyclooxygenase (COX)

nonsteroidal anti-inflammatory agents, nonopioid analgesics

pyrroziline carboxylic acid

• may cause GI bleeding, Stevens-Johnson Syndrome, anaphylaxis, drowsiness
• should not exceed 5 days of therapy
• bleeding risk increased with garlic, ginger, and ginkgo
• may decrease effectiveness of hypertensive medications and diuretics

isoniazide

INH

tuberculosis

Inhibits synthesis of mycobacterial cell wall

Antitubercular

none

• can cause jaundice
• may cause peripheral neuropathy, seizures, hepatitis
• patient should avoid high amounts of tyramine (pickled meats, aged/smoked meats, alcohol, exotic/aged cheese)
• monitor liver function tests
• complete full course of therapy (6-12 months)
• often used in combination with Rifampin

indomethacin

Indocin

Inflammatory disorders when patients do not respond to other medications

Decreases pain and inflammation by inhibiting prostaglandin synthesis

antirheumatics, ductus arteriosus patency adjuncts (IV only), nonsteroidal anti-inflammatory agents

none

• monitor for hepatitis and GI bleeding
• monitor for dizziness, drowsiness, and headache
• assess for anaphylactic reaction
• aspirin may decrease effectiveness
• monitor renal labs
• shake suspension before administration
• patient should wear sunscreen and protective clothing to protect against photosensitivity

ibuprofen

Advil / Motrin

Mild to moderate pain, inflammatory states

Decreases pain and inflammation by inhibiting prostaglandins

antipyretics, antirheumatics, nonopioid analgesics, nonsteroidal anti-inflammatory agents

nonopioid analgesics

• may cause GI bleeding, hepatitis, Stevens-Johnson Syndrome
• may cause anaphylaxis
• monitor for headache, nausea, vomiting, constipation
• therapy should be discontinued after first sign of rash
• monitor renal and liver labs
• patient should avoid using alcohol

hydromorphone

Dilaudid

moderate to severe pain

alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex

Opioid Analgesic, allergy, cold and cough remedies, antitussive

opioid agonist

• Assess BP, respirations, and pulse before and during administration – medication causes general
CNS depression
• Narcan (nalaxone) is the antidote for overdose
• use caution with concurrent use of MAOI – avoid use within 14 days of each other
• may be used as an antitussive
• advised to dilute with NS prior to administration and to administer slowly to decrease CNS
depression

hydrochlorothiazide

HydroDiuril

Hypertension, CHF, renal dysfunction, cirrhosis, glucocorticoid therapy

Increases sodium and water excretion and produces arterial vasodilation

antihypertensives, diuretics

thiazide diuretics

• May cause dizziness, hypokalemia, hyponatremia, hypophosphatemia, hypomagnesemia,
dehydration
• Hypokalemia can increase risk for digoxin toxicity
• Monitor blood pressure and intake and output
• Monitor electrolyte levels
• Patient should take medication at the same time each day even if feeling better
• Instruct patient on how to take blood pressure

hydralazine

Apresoline

hypertension

arterial vasodilation by unclarified mechanism

anti-hypertensive

vasodilator

• may cause tachycardia, sodium retention, arrhythmias, angina
• use caution with MAOIs
• monitor blood pressure
• instruct patient on how to take blood pressure

haloperidol

Haldol

Schizophrenia, mania, aggressive and agitated patient

Alters the effect of dopamine

Antipsychotic

butyrophenones

• extrapyramidal symptoms, tardive dyskinesia
• use caution in QT prolongation
• may cause seizures, constipation, dry mouth, agranulosytosis
• assess for hallucinations
• monitor hemodynamics
• monitor for neuroleptic malignant syndrome (fever, muscular rigidity, altered mental status, and
autonomic dysfunction)
• monitor CBC with differential

guaifenesin

Mucinex

Cough suppression, expectorant

Decreases viscosity of and mobilizes secretions

allergy, cold and cough remedies, expectorant

none

• patient should avoid over the counter cold medications
• assess lung sounds
• maintain adequate fluid intake

glucagon

GlucaGen

severe hypoglycemia, antidote for beta blockers and calcium channel blockers

stimulates production of glucose from stores, relaxes GI tract

hormones

pancreatics

• may cause anaphylaxis
• may cause hypotension
• assess for signs of hypoglycemia, neuro status
• monitor serum glucose levels
• teach patient signs of hypoglycemia

Glipizide

Glucotrol

Type 2 diabetes mellitus

Stimulates release of insulin from the beta cells in the pancreases and leads to increased sensitivity to insulin

Anti-diabetic

Sulfonylureas

• May cause aplastic anemias, hypoglycemia, photosensitivity, dizziness,
drowsiness, headache, diarrhea
• Monitor CBC, assess for allergy to sulfonamides
• Beta blockers may increase signs of hypoglycemia
• Instruct patient on how to check blood sugars and
• Instruct patient on importance of carrying source of sugar in case of
hypoglycemia

Gentamicin

Cidomycin

Treatment of gram negative infections when penicillin is ineffective

Inhibits bacterial protein synthesis

Anti-infectives

Aminoglycoside

• Causes tinnitus-hearing loss/do not administer with penicillin
• Use caution in renal impairment
• Assess for infection
• Obtain cultures prior to therapy
• Monitor liver function tests
• Monitor blood levels of drug

Gabapentin

Neurontin

Seizures, peripheral neuropathy, neuropathic pain, prevention of migraines

Exact method of action unknown, may play a role in stabilizing neural membranes

Analgesic adjuncts, anticonvulsants, mood stabilizers

None

• May cause suicidal thoughts, confusion, depression, drowsiness, ataxia, facial
edema, hypertension
• Monitor pt closely for changes in behavior and depression
• Assess seizure activity
• Assess pain level
• Patient should take medications exactly as prescribed

Furosemide

Lasix

Edema, hypertension

Prevents reabsorption of sodium and chloride in the kidneys, increase excretion of
water, sodium, chloride, magnesium, potassium

Diuretics

Loop diuretics

• Use caution with liver disease
• May cause hypotension, dry mouth, excessive urination, dehydration,
electrolyte abnormalities, metabolic alkalosis
• Hypokalemia may lead to increase risk of digoxin toxicity
• Monitor renal panel
• Use caution with other antihypertensives
• Causes arthritic symptoms/do not administer with aminoglycosides due to
ototoxicity

Fluticasone

Flovent, Flonase

prophylactic asthma treatment

locally acting anti-inflammatory

antiasthmatics, anti-inflammatory (steroid)

Corticosteroids, Inhalation

• use cautiously with untreated infections and suppressed immune function
• may cause headache, insomnia, bronchospasm, nasal congestion, adrenal suppression
• monitor patient’s respiratory status
• may lead to decreased bone density
• instruct patients using corticosteroids and bronchodilators that they need to use
bronchodilators first.
• instruct patient to stop smoking

Fluoxetine

Prozac

Depressive disorder, OCD, bulimia, panic disorder, bipolar, anorexia, ADHD, DM
neuropathy, obesity

Inhibits reuptake of serotonin allowing it to persist longer in the synaptic cleft

Antidepressant

SSRI

• Do not use while taking MAOIs
• May cause suicidal thoughts, drowsiness, anxiety, sexual dysfunction,
insomnia, palpitations
• Monitor closely for serotonin syndrome
• Concurrent use with certain medications may lead to QT prolongation
• Monitor mood changes and assess for suicidal ideation
• Monitor nutrition status
• May cause elevated liver enzymes
• Instruct pt to maintain good oral hygiene

Fentanyl

Sublimaze

Supplement to general anesthesia, continuous IV infusion for purpose of analgesia

Binds to opiate receptors in CNS altering perception of pain, producing CNS
depression

Opioid Analgesic

Opioid agonists

• Use caution with increased ICP, head trauma, adrenal insufficiency
• Avoid use with MAOIs
• May cause apnea, laryngospasm, decreased respirations, bradycardia,
hypotension
• Do not consume grapefruit while taking this medication
• Monitor hemodynamics during administration
• Assess patient pain scale frequently

Famotidine

Pepcid

Short term treatment of active ulcer, GERD, treatment of heartburn, indigestion,
management of Zollinger Ellison syndrome, prevention of GI bleeding in critically
ill patients, management of symptoms associated with overuse of NSAIDs

Blocks action of histamine located in gastric parietal cells, inhibits gastric acid
secretion

Antiulcer agent

Histamine H2 antagonist

• May cause arrhythmias, agranulocytosis, aplastic anemias
• Assess for abdominal pain and occult blood
• Monitor CBC
• Instruct pt to increase fluid and fiber intake to prevent constipation

Escitalopram

Lexapro

Major depressive disorder, anxiety disorder, PCD, PTSD, social phobia

Increases the extracellular levels of serotonin in the synaptic cleft by selectively
inhibiting its reuptake

Antidepressant

SSRI

• Contraindicated with MAOI
• May cause suicidal thoughts, insomnia, drowsiness, diarrhea, nausea,
serotonin syndrome
• May cause QT prolongation with certain medications
• Assess for sexual dysfunction
• May take 4-6 weeks for full affect to take place
• Monitor for serotonin syndrome (mental changes, NV, tachycardia,
hyperthermia)

Erythromycin

E-Mycin

Useful in place of penicillin when patient cannot take penicillin, upper and lower
respiratory tract infections, otitis media, skin infections, pertussis, syphilis,
rheumatic fever

Bacteriostatic: suppresses bacterial protein synthesis

Anti-infective

Macrolide

• Causes QT prolongation, ventricular arrhythmias
• Diarrhea
• Asses infection
• Monitor liver function tests
• Instruct patient to finish medication dosage even if they are feeling better
• Medication should not be shared

Epoetin

Epogen

Anemia

Stimulates erythropoiesis (production of RBCs)

Antianemic

Hormones

• Assess dialysis shunts

• Contraindicated in albumin hypersensitivity

• May cause

  • Seizures

  • CHF

  • MI

  • CVA

  • Hypertension

• Do not shake vial

• Initiate seizure precautions

• Monitor

  • Bleeding times

  • Signs of anemia

Epinephrine

Adrenalin, EpiPen

Asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct

Affects both beta1 and beta2 also has alpha agonist properties resulting in bron-
chodilation and increases in HR and BP. Inhibits hypersensitivity reactions.

Antiasthmatic, bronchodilator, vasopressor

Adrenergic agonist

• Side effects include: angina, tachycardia, hypertension, restlessness,
nervousness, hyperglycemia
• Use with MAOI may lead to hypertensive crisis
• Patients should not use stimulants (caffeine, guarana, etc)
• Excessive use may cause bronchospasm
• Assess lung sounds, pulse, BP, and other hemodynamic parameters
• Monitor for chest pain
• Instruct patient to use as directed
• Patient should insure adequate fluid intake to liquefy secretions
• Mouth should be rinsed after inhalation
• Beta blockers may negate effects
• May increase blood glucose levels

Lovenox

Prevention of VTE, DVT, and PE

Prevents thrombus formation by potentiating the inhibitory effect of antithrom-
bin on factor Xa and thrombin. Enoxaparin is a low molecular weight heparin.

Anticoagulant

Antithrombotic

• Contraindicated in pork hypersensitivity
• Monitor for signs of bleeding
• Administer in subcutaneous tissue
• DO NOT eject air bubble prior to injection
• DO NOT aspirate or massage site

Enalapril

Vasotec

hypertension, management of CHF

Block conversion of angiotensin I to angiotensin II, increases renin levels and
decreases aldosterone leading to vasodilation

Antihypertensives

ACE Inhibitor

• May cause hypersensitivity (allergic) reactions and angioedema (swelling of face, lips, tongue, throat)

• Can cause neutropenia – check WBCs regularly

• Use cautiously with potassium supplements and potassium sparing diuretics.
• Use cautiously with diuretic therapy
• Administer 1 hour before meals
• Monitor blood pressure often
• Monitor weight and fluid status
• Monitor renal profile
• Monitor CBC frequently
• Dry cough

dopamine

Inotropin

used to improve blood pressure, cardiac output, and urine output

Smaller doses result in renal vasodilation
Doses 2-10mcg/kg/min result in cardiac stimulation by acting on beta1 receptors
Doses >10mcg/kg/min stimulate alpha receptors leading to vasoconstriction (↑SVR)

inotropic, vasopressor

adrenergic

• Monitor hemodynamics closely: BP, HR, EKG, CVP, and PAOP if available
• Obtain parameters for hemodynamic values
• Titrate to obtain appropriate BP (more potent vasoconstrictors may be required)
• Irritation may occur at IV site
• Beta blockers may counteract therapeutic effects

Dobutamine

Dobutrex

Short term management of heart failure

Dobutamine has a positive inotropic effect (increases cardiac output) with very
little effect on heart rate. Stimulates Beta1 receptors in the heart.

Inotropic

Beta-adrenergic agonist

• Monitor hemodynamics: hypertension, ↑HR, PVCs
• Skin reactions may occur with hypersensitivity
• Beta blockers may negate therapeutic effects of dobutamine
• Monitor cardiac output
• Monitor peripheral pulses before, during, and after therapy
• DO NOT confuse dobutamine with dopamine

Divalproex

Depakote

Seizures, manic episodes, prevention of headache

Increases the level of GABA (inhibitory neurotransmitter) in CNS

Anticonvulsant, vascular headache suppressants

None

• May cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity,
pancreatitis
• Increases risk for bleeding with Warfarin
• Use caution with MAOIs
• Monitor liver function tests

Diphenhydramine

Benadryl

Allergy, anaphylaxis, sedation, motion sickness, antitussive

Antagonizes effects of histamine, CNS depression

Allergy, cold and cough remedy, antihistamine, antitussive

Antihistamine

• May cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick
secretions, hypotension, blurred vision, headache
• Anticholinergic effects (dry mouth, blurred vision, constipation, sedation)
• Assess purpose of medication prior to giving it
• Assess allergies, sleep patterns, cough and lung sounds
• Patient should avoid other over-the-counter cough and cold remedies

Diltiazem

Cardizem

Hypertension, angina, SVT, AFib, aflutter

Inhibits calcium transport resulting in inhibition of excitation and contraction,
leads to depression of AV and SA node leading to decreased HR, leads to vasodi-
latation and decreased blood pressure.

Antianginals, antiarrhythmics, antihypertensive

Ca Channel Blocker (Benzothiazepine)

• Contraindicated in 2nd and 3rd AV block
• May cause arrhythmias, CHF, bradycardia, peripheral edema, gingival
hyperplasia
• Increases digoxin levels
• Don’t drink grapefruit juice
• Assess for signs of CHF
• Monitor EKG continuously
• Tell patient to change positions slowly
• Monitor serum potassium
• Instruct pt on how to take blood pressure

Digoxin

Lanoxin

CHF, AFib, A-flutter

Positive inotropic effect (increases force of myocardial contraction), prolongs
refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is
given to increase cardiac output and slow the rate.

Antiarrhythmic, inotropics

Digitalis glycosides

• Excreted by kidneys
• Assess patient for hypersensitivity
• Contraindicated with uncontrolled ventricular arrhythmias
• Hypokalemia increase risk for toxicity
• Hypercalcemia ↑ risk for toxicity
• Use caution with diuretic use as they may cause electrolyte abnormalities
that can lead to toxicity
• Assess patient for cardiac arrhythmias including bradycardia
• Signs of toxicity include vision changes (blurred vision, yellow, green vision
disturbances)
• Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse

Diazepam

Valium

Anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia,
management of alcohol withdrawal

Decreases the effects of voltage gated sodium channels to depresses the CNS

Antianxiety agents, anticonvulsants, sedative/hypnotics, skeletal muscle relax-
ants (centrally acting)

Benzodiazepine

• Contraindicated in hepatic dysfunction
• Use caution with renal impairment
• Can cause dizziness, drowsiness, lethargy, hypotension, physical depen-
dence, tolerance
• Instruct patient to take as directed
• Caution to avoid alcohol use
• Flumazenil (Romazicon) is the reversal agent

Dexamethasone

Decadron

Manage cerebral edema, assess for Cushing’s Disease

Suppress inflammation and normal immune response. Used in inflammatory states
to decrease inflammation.

Antiasthmatics, corticosteroids

Corticosteroids

• Excreted by the liver – monitor liver profile
• Avoid in active untreated infections
• May cause CNS alterations
• May cause peptic ulcers
• May cause Cushingoid appearance (buffalo hump, moon face)
• Weight gain
• Osteoporosis
• Decrease wound healing
• May elevate blood sugars
• May increase cholesterol and lipid values

Cyclosporine

Sandimmune

Prevention of rejection in transplantation, treatment of severe RA, management
of ulcerative colitis

Inhibits normal immune response primarily by decreasing the activity of T cells

Immunosuppressant, antirheumatics (DMARD)

Polypeptides (cyclic)

• May cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V,
gingival hyperplasia
• Increases immune suppression with corticosteroids
• Avoid grapefruit juice while taking this medications
• Assess for signs of organ rejection
• Monitor renal panel, liver enzymes
• Take medication as directed
• Lifelong therapy required for transplant patients
• Instruct pt on how to take blood pressure

Cortisone

Cortone

Management of adrenocortical insufficiency (Addison’s Disease). Replace cortisol
in states of deficiency, suppress inflammation and normal immune response.

The adrenal glands sit on top of the kidneys.
The adrenal glands excrete steroid hormones, including cortisol that play a role in
increasing blood sugars, immune suppression, and metabolism of fat, protein, and
carbohydrates, as well as decreasing bone formation.

Antiasthmatics, corticosteroids

Corticosteroids

• Excreted by the liver – monitor liver profile
• Avoid in active untreated infections
• May cause CNS alterations
• May cause peptic ulcers
• May cause Cushingoid appearance (buffalo hump, moon face)
• Weight gain
• Osteoporosis
• Decrease wound healing
• May elevate blood sugars
• May increase cholesterol and lipid values

Codeine

Paveral

Management of pain, diarrhea, cough suppressant

Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility.

Allergy, cold, cough remedy, antitussive, opioid analgesic

Opioid agonist

• May cause alterations in mentation, hypotension, constipation, nausea,
vomiting
• Assess BP, pulse, and respiratory rate prior to administration and frequently
during administration
• Use caution if patient is receiving MAO Inhibitors
• Narcan (naloxone) is the antidote for opioid agonists

Plavix

Atherosclerotic events, MI, CVA, PVD, acute coronary syndrome

Inhibits platelet aggregation

Antiplatelet agent

Platelet aggregation inhibitors

• May cause GI bleeding, neutropenia, hypercholesterolemia
• May increase risk for bleeding in warfarin, aspirin, heparin
• Can increase risk for bleeding with garlic, ginkgo, ginger
• Monitor for signs of bleeding
• Monitor bleeding times
• Monitor CBC and platelet count
• Discontinue use 5-7 days before surgery

Clindamycin

Cleocin

Skin infections, respiratory tract infections, septicemia, intra-abdominal infections,
osteomyelitis

Bacteriostatic: inhibits protein synthesis

Anti-infectives

Lincosamide

• Arrhythmias, pseudomembranous colitis, diarrhea, phlebitis
• Monitor bowel function
• Assess for infection, obtain cultures prior to therapy
• Monitor liver function tests
• Monitor CBC

Ciprofloxacin

Cipro

Urinary tract infections, gonorrhea, respiratory tract infections, bronchitis,
pneumonia, skin and bone infections, infectious diarrhea, abdominal infections

Inhibits bacterial DNA synthesis

Anti-infectives

Fluoroquinolone

• Contraindicated in allergies
• May cause QT prolongation, avoid use with other drugs that can cause QT
prolongation
• Can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis,
Stevens Johnson syndrome
• May decrease effects of phenytoin
• Monitor renal panel
• Assess for infection, obtain cultures prior to therapy
• Monitor liver function tests

Tagamet

Treatment of duodenal ulcers, GERD, heartburn, Zollinger Ellison syndrome,
prevention of GI bleeding in critical patients.

Inhibits action of histamine leading to inhibition of gastric acid secretion

Antiulcer agent

Histamine H2 antagonist

• Increases serum level of warfarin
• Can lead to respiratory infection (green sputum)
• Monitor for arrhythmias
• May cause agranulocytosis, aplastic anemia
• Monitor CBC during therapy
• Take medication as directed
• Instruct patient to increase fluid and fiber intake to decrease constipation

Chlorpromazine

Thorazine

Second line treatment of schizophrenia and psychosis, nausea/vomiting, pre-op
sedation, acute intermittent porphyria, headache, bipolar

Exhibits anticholinergic activity, alters effects of dopamine in CNS

Antipsychotic, antiemetic

Phenothiazines (dopamine D2 receptor antagonist)

• May cause neuroleptic malignant syndrome, sedation, tardive dyskinesia,
hypotension, agranulocytosis
• Assess mental status prior to and during treatment
• Monitor blood pressure
• Ensure patient is taking medication
• Monitor CBC and liver function tests
• Instruct patient not to skip doses or double dose.

Cephalexin

Keflex

Skin infections, pneumonia, UTI, otitis media

Bactericidal: binds to bacterial cell wall leading to cell death

Anti-infectives

Cephalosporin 1st generation

• Contraindicated with cephalosporin and serious penicillin allergies.
• May need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis
at IV site, anaphylaxis
• Assess infection and allergies
• Obtain cultures prior to therapy
• Monitor bowel function
• May lead to superinfection
• May cause elevated liver enzymes

Celecoxib

Celebrex

Osteoarthritis, rheumatoid arthritis, acute pain

Decreases pain and inflammation by inhibiting synthesis of prostaglandins

Antirheumatics/NSAID

Cox 2 inhibitor

• Use caution with cardiovascular disease
• Increases risk for MI, CVA, thrombosis
• May cause GI bleeding, Stevens-Johnson syndrome, dermatitis
• Notify provider for new-onset abdominal pain or black stool

Cefdinir

Omnicef

Treatment of skin infections, otitis media

Bactericidal, binds to bacterial cell wall causing cell death

Anti-infectives

Cephalosporin 3rd generations

• Contraindicated in cephalosporin and possibly penicillin allergies
• May need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at
IV site, anaphylaxis
• Assess infection and allergies
• Obtain cultures prior to therapy
• Monitor bowel function
• Monitor for bleeding
• May lead to superinfection

Ceclor

Treatment of respiratory tract infections, skin infections, otitis media

Bactericidal, binds to bacterial cell wall causing cell death

Anti-infectives

Cephalosporin 2nd generations

• Contraindicated in cephalosporin and possibly penicillin allergies
• May need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at
IV site, anaphylaxis
• Assess infection and allergies
• Obtain cultures prior to therapy
• Monitor bowel function
• May lead to superinfection

Calcium carbonate

Tums/Rolaids

Treatment of hypocalcemia, prevention of postmenopausal osteoporosis, treat-
ment of hyperkalemia and hypermagnesemia, used as antacid

Calcium is essential for nervous, muscular, and skeletal systems, helps maintain
cell membranes, aids in transmission of nerve impulses and muscle contraction,
aids in blood formation and coagulation

Mineral and electrolyte replacements/supplements

Antacids

• May cause cardiac arrest and arrhythmias
• Monitor hemodynamics
• May causes hypotension, bradycardia, and arrhythmias
• Hypercalcemia can increase risk for digoxin toxicity
• Instruct pt on foods that contain Vitamin D and encourage adequate intake
• Monitor parathyroid hormone

Captopril

Capoten

Hypertension, management of CHF, decrease progression of DM neuropathy

Block conversion of angiotensin I to angiotensin II, increases renin levels and
decreases aldosterone leading to vasodilation

Antihypertensives

ACE Inhibitor

• Can cause neutropenia – check WBCs regularly
• Use cautiously with potassium supplements and potassium sparing diuretics
• Use cautiously with diuretic therapy
• Administer 1 hour before meals
• Monitor blood pressure often
• Monitor weight and fluid status
• Monitor renal profile
• Monitor CBC frequently
• May lead to Rhabdomyolysis
• Dry cough

Stadol

moderate to severe pain, labor pain, sedation

alters perception and response to pain by binding to opiate receptors in CNS

Opioid Analgesic

opioid agonists/antagonists

• use caution with concurrent use of MAOIs
• may cause confusion, hallucinations, sedation
• monitor for CNS depression
• assess blood pressure pulse and respirations during administration
• administer slowly through an IV line

Buspirone

Buspar

Management of anxiety

Relieves anxiety by binding to dopamine and serotonin receptors

Antianxiety

Azapirone

• Do not administer concurrently with MAOI or grapefruit juice
• May lead to dizziness, drowsiness, fatigue, and weakness
• Patient may experience chest pain, palpitations, tachycardia
• Instruct patient to take as directed
• Instruct patient to avoid alcohol and other CNS depressantss

Bupropion

Wellbutrin

Depression, smoking cessation, treat ADHD in adults

Not well understood, ↑ dopaminergic and noradrenergic transmission via reuptake

Antidepressants, smoking deterrents

Aminoketones

• May lead to seizures, suicidal thoughts
• Do not administer if patient is taking MAOI
• Use caution with renal and liver impairment
• Assess mental status
• Instruct patient to avoid alcohol (may lead to hallucinations, seizures,
anxiety)

Bismuth subsalicylate

Kaopectate, Pepto-Bismol

Diarrhea, heartburn, indigestion, H. pylori associated ulcer

Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins.

Antidiarrheal, antiulcer, antacid

Absorbent

• Contraindicated in aspirin hypersensitivity
• Increase risk for impaction with geriatric and pediatric patients
• Monitor liver profile
• Bismuth may interfere with radiologic exams

Bisacodyl

Dulcolax

Treatment of constipation, bowel regimen

Stimulates enteric nerves to cause peristalsis which leads to fluid accumulation in the colon

Laxatives

Stimulant laxatives

• May lead to hypokalemia
• May cause abdominal pain and cramps
• Not for use within 1 hour of taking milk product
• Assess for abdominal distention and bowel function
• Instruct patient to drink 1500-2000 mL/day during therapy
• Monitor fluid and electrolyte levels
• Instruct patient to take as ordered

Benztropine

Cogentin

Treatment for Parkinson’s disease

Exhibits anticholinergic properties (blocks acetylcholine) in the CNS to reduce rigidity and tremors

Antiparkinson agent

Anticholinergic

• 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

Zithromax

URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis

Inhibits bacterial protein synthesis

Agents for atypical mycobacterium, anti-infectives

Macrolide

• May lead to pseudomembranous colitis, pain, diarrhea, nausea,
Stevens-Johnson syndrome, angioedema
• May increase risks for warfarin toxicity
• Monitor patient for signs of anaphylaxis
• Instruct patient to notify physician for diarrhea, or blood or pus in stool
• Instruct patient to take medication exactly as prescribed

Lomotil

Treatment for diarrhea

Inhibits GI motility via anticholinergic effects

Antidiarrheal

Anticholinergic

• Contraindicated with angle-closure glaucoma, dehydration
• Structurally related to opioids so use caution with patients that have allergies to opioids
• May cause constipation, tachycardia, dizziness, ileus
• Monitor liver function as the medication is excreted by the liver
• Ensure that client is taking medication as prescribed and not double dosing

Atropine

Atropen

Decreases oral and respiratory secretions, treats sinus bradycardia and heart block, treatment of bronchospasm

Atropine is an anticholinergic which means that it inhibits the effects of the parasympathetic nervous system, specifically acetylcholine. This inhibition causes increase in HR, bronchodilation, decreased GI and respiratory secretions.

Antiarrhythmic

Anticholinergic, antimuscarinic

• Avoid in acute hemorrhage, tachycardia, and angle closure glaucoma
• Monitor patient for tachycardia and palpitations
• May cause urinary retention in elderly patients
• Patients may experience constipation due to slowed GI motility

Atenolol

Tenormin

Hypertension, angina, prevention of MI

Blocks the stimulation of beta1 receptors in the SNS with minimal effect on beta2 receptors

Antianginal, antihypertensive

Beta blocker

• Contraindicated in CHF, pulmonary edema, cardiogenic shock, bradycardia,
heart block
• Monitor hemodynamic parameters (HR, BP)
• May cause bradycardia, CHF, pulmonary edema
• Masks symptoms associated with diabetes mellitus
• Advise to change positions slowly to prevent orthostatic hypotension
• Instruct patient on how to take blood pressure

Acetylsalicylic Acid

Aspirin

Rheumatoid arthritis, osteoarthritis, ischemic stroke, and MI prophylaxis

Inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases

Antipyretics, non-opioid analgesics

Salicylates

• Use caution in bleeding disorders, chronic alcohol use
• May lead to Stevens-Johnson syndrome, laryngeal edema, and anaphylaxis
• Increases risk for bleeding with warfarin, heparin, and clopidogrel
• Increased risk for GI bleeding with NSAID use
• Monitor liver function tests
• Concurrent use with alcohol may increase risk for GI bleeding
• Aspirin with viral infections can cause Reye’s syndrome

Ampicillin

Principen

Skin infections, soft tissue infections, otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia

Bactericidal, broader spectrum than penicillin, binds to cell wall leading to bacterial cell death

Anti-infective

Aminopenicillin

• Contraindicated in penicillin allergy, use caution in renal insufficiency
• May lead to seizures, diarrhea, anaphylaxis, superinfection
• Assess for infection
• Monitor liver function tests
• Instruct patient on signs of superinfection: furry overgrowth on tongue,
vaginal itching, loose and foul smelling stool
• Pt should not use with oral contraceptive use.

amoxicillin

Moxatag

skin infections, respiratory infections, sinusitis, endocarditis prophylaxis, lyme disease

Inhibits synthesis of bacterial cell wall leading to cell death.

anti-infectives, antiulcer agent

aminopenicillins

• contraindicated with penicillin allergy
• may cause seizures
• assess for rash, anaphylaxis
• excreted by kidneys – monitor renal labs
• monitor patient for diarrhea – bloody stool should be reported immediately

Amlodipine

Norvasc

Hypertension, angina

Blocks transport of calcium into muscle cells inhibiting excitation and contraction

Antihypertensive

Ca channel blocker

• May cause gingival hyperplasia
• Grapefruit juice may increase drug level
• Monitor blood pressure and pulse prior to and during therapy
• Monitor intake and output
• Assess for signs of CHF
• Assess characteristics of angina
• Instruct patient of interventions for hypertension and how to take blood
pressure

Amiodarone

Cordarone

a-fib, ventricular arrhythmias, SVT, ACLS protocol for v-fib and v-tach

Prolongs phase 3 of the action potential, makes the heart more tolerant to arrhythmias, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation

Antiarrhythmic class III, potassium channel blocker

None

• May lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension
• Increases risk for QT prolongation
• Increases digoxin levels
• Increases activity of warfarin
• Monitor EKG continuously while on therapy
• Assess for signs and symptoms of ARDS
• Monitor liver function test
• Check dosage with another RN
• Teach pt to monitor pulse daily and report abnormalities
• Avoid drinking grapefruit juice

Alprazolam

Xanax

Anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis

Works in CNS to produce anxiolytic effect causing CNS depression.

Antianxiety agent

Benzodiazepine

• Use caution with existing CNS depression, sleep apnea, renal dysfunction,
hepatic dysfunction.
• May cause CNS depression, drowsiness, lethargy
• May lead to physical dependence, may experience tolerance effect
• Assess anxiety and mental status
• Romazicon (flumazenil) is the antidote for overdose
• Grapefruit juice may increase blood levels

Alendronate

Fosamax

Osteoporosis (aging, menopause, corticosteroid induced)

Inhibits osteoclast activity leading to inhibition of resorption of bone

Bone resorption inhibitor

Bisphosphonates

• Take first thing in the morning with full glass of water 30 min prior to eating
• Assess serum calcium and vitamin D
• May lead to muscle pain

Albuterol

Proventil

Bronchodilator used to prevent airway obstruction in asthma and COPD

Binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways

Bronchodilator

Adrenergic

• May decrease the effectiveness of Beta Blockers
• Use caution with
○ Heart disease
○ Diabetes
○ Glaucoma
○ Seizure disorder
• Overuse of inhalers can lead to bronchospasm
• Monitor for chest pain and palpitations
• Can decrease digoxin levels

Insulin Regular

Humulin R/Novolin R

hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver,
prevents breakdown of fat and protein

antidiabetics, hormones

pancreatics

• assess for symptoms of hypoglycemia or hyperglycemia
• monitor body weight over time
• may cause decreased inorganic phosphates, potassium, and magnesium
• monitor blood sugars every 6 hours, monitor A1C every 3-6 months

Insulin NPH

Humulin N, Novolin N

hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver,
prevents breakdown of fat and protein

antidiabetics, hormones

pancreatics

• assess for symptoms of hypoglycemia or hyperglycemia
• monitor body weight over time
• may cause decreased inorganic phosphates, potassium, and magnesium
• monitor blood sugars every 6 hours, monitor A1C every 3-6 months

Insulin detemir, Insulin glargine

Levemir, Lantus

hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver,
prevents breakdown of fat and protein

antidiabetics, hormones

pancreatics

• assess for symptoms of hypoglycemia or hyperglycemia
• monitor body weight over time
• may cause decreased inorganic phosphates, potassium, and magnesium
• monitor blood sugars every 6 hours, monitor A1C every 3-6 months

View the lesson: https://bit.ly/CalciumAcetatePhosLoNursingConsiderations

calcium acetate

PhosLo

treatment of hypocalcemia, prevention of post-menopausal osteoporosis, treatment of hyperkalemia and hypermagnesaemia, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD. Binds to phosphate in food and prevents absorption.

calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation

mineral and electrolyte replacements/supplements

antacids

• may cause cardiac arrest and arrhythmias
• phlebitis at site of insertion
• monitor hemodynamics
• may cause hypotension, bradycardia, and arrhythmias
• hypercalcemia can increase risk for digoxin toxicity
• administer slowly
• instruct pt on foods that contain Vitamin D and encourage adequate intake.
• monitor parathyroid hormone

View the lesson: https://bit.ly/AcyclovirZoviraxNursingConsiderations

Acyclovir

Zovirax

Genital herpes, herpes zoster, chicken pox

Interferes with viral DNA synthesis

Antiviral

Purine analogues

• May cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea
• Monitor renal panel during administration
• Assess lesions
• Instruct patient to use proper protection during sexual intercourse

Acetaminophen

Tylenol

Pain, fever

Inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response

Antipyretic, non-opioid analgesic

• Do not exceed 4g of acetaminophen per day to limit risk for liver, renal,
and cardiac damage
• Overdose will lead to hepatotoxicity
• Acetadote is the antidote for overdose
• May increase risk for bleed with warfarin therapy
• May alter blood glucose measurements