Pharmacology HESI

BASICS:

Pharmacokinetics- the process by which a drug is absorbed, distributed, metabolized and eliminated in the body.

Pharmacodynamics- the study of biochemical & physiological effects of drugs

Generic name: The name for the drug when it is ready for commercial distribution used to describe the active drugs in the
product. Manufactures must each come up with their own generic name.

Brand name: The name for the drug when it first becomes available it is patent gives the manufacturer exclusive use of the
name. Ex. Metform (Glucophage) Metformin (generic) Glucophage (Brand)

Absorption : When the drug passes from the site of administration into the fluids
Slow absorption:
orally (swallowed)
MM (oral and nasal mucosa)
Topical/transdermal (through skin)
Rectally (suppository)
Fast absorption:
Parenterally (injection- IV, IM, SC)
Inhaled through lungs
General principle The faster the absorption, the quicker the onset, the higher the addictiveness, but the shorter the
duration.

Distribution: When the drug reaches the site of action the bloodstream to tissues

Biotransformation : metabolism of the drug. Takes place in the liver.

Elimination: Elimination can occur in many ways E.g. kidneys, sweat, feces, saliva, breast milk, or exhaled through the
respiratory tract
Half Life - The amount of time for 50 % of serum concentration of the drug to be eliminated from the body

Synergistic effect: When the combined effects of 2 drugs taken simuulatenously produce an effect that is greater than that of
each drug alone.

Antagonists: When the combined effects of 2 drugs taken simuulatenously produce an effect that is less than that of each drug
alone.

Antiinfectives:

Broad-spectrum vs. narrow-spectrum antibiotics

Antimicrobials treat bacterial, viral, and fungal infections
Culture and sensitivity specimens should be collected prior to initiation of therapy.
Adverse effects: hypersensitivity & anaphylaxsis, nephrotoxicic, ototoxic, decrease efficacy of oral contraceptives, increase
warfarin activity, superinfection
Pencillins: Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes), Med of choice for syphilis, First choice
for meningitis, Prophylaxis against bacterial endocarditis, Extended spectrum against Pseudomonas, Proteus, Klebsiella
penicillin G, augumentin (amoxicillin-clavulanate)- broad spectrum, Nafcillin antistaphylococcal, Carbenicillin
antipseudomonas
Adverse effects: Anaphylaxis / Renal Impairment / Hyperkalemia (w doses)
contraindicated: Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction
Cephalosporins: Broad spectrum with TI for postop infections, meningitis, pelvic infections
1 degree cephalexin (keflex) & Cephapirin (cefadyl) 2 degree cefaclor (Ceclor) & Cefotetan (Cefotan) 3 degree
cefatrixaone (rocephin) & Cefotaxime (claforan) 4 degree cefepime (maxipime)
Adverse effects: Anaphylaxis
Contraindications: Allergies to Penicillin / Kidney Dysfunction, Caution with anticoagulants, antiplatelets, and
thrombolytics
interactions: ETOH intolerance (disulfiram reaction)
take w/ food
Carapenems: Broad spectrum effective for serious infections such as pneumonia, peritonitis, and UTIs. P. aeruginosa develops
resistance (use combo) [broadest spectrum available]
Imipenem (primaxin), meropenem (merrem IV)
monbactams: MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile
Vancomycin (vancocin), Aztreonam (Azactam), Fosfomycin (monurol)
adverse effects: Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis
Caution with renal impairment, Infuse over 60 minutes, Very low therapeutic index
TCAs: Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus fever / Rocky Mountain spotted fever /
Lyme disease / UTI & VI
Tetracycline hydrochloride (Sumycin), Doxycycline (Vibramycin), Minocycline

 adverse effects: GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity / superinfection of bowel

interactions: Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids
Give with water on an empty stomach (except doxycycline & minocycline)
bacteriostatic inhibitors (macrolides/ketolides): Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires
Azithromycin (Zithromax), Clarithromycin (Biaxin), Dirithromycin, Erythromycin, Clindamycin (Cleocin)
Toxic with: antihistamines, theophylline (asthma med), carbamazepine (anticonvulsant), warfarin
Administer on empty stomach with water IV is rarely used
Aminoglycosides: Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P. aeruginosa) Oral
paromomycin use for amebiasis and tapeworm.
Gentamicin , tobramycin sulfate, streptomycin, amikacin, neomycin, kanamycin, paromomycin
Adverse effects: Ototoxicity /nephrotoxicity
Sulfonamides & Trimethoprim: SulfamethoxazoleTrimethoprim (TMP-SMZ, Bactrim): Med of choice for UTI by E. coli and
Pneumocystis carinii (Cotrim, Septra, Sulfadiazine, Sulfamethoxazole, Sulfisoxazole)
take on empty stomach w/ full glass of water
Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min & Reduce dosages with renal dysfunction
Fluoroquinolones
Ciprofloxacin
Broad spectrum / prevention of inhaled anthrax
Adverse Rx: GI discomfort / Achilles tendon rupture / superinfection
infuse slowly for over 60min
Antimycobacterial
isoniazid (INH), streptomycin, ethambutol, pyrazinamide
treats active and latent tuberculosis
adverse effects: Peripheral neuropathy (administer 50-200 mg of vitamin B 6 daily) & hepatoticity
Antiviral
Acyclovir: Prevents reproduction of viral DNA
Never give IV bolus, Infuse over 1 hour min
Antiprotozoals
Proto: Amphotericin Others: flucytosine, miconazole, nystatin, griseofulvin, ketoconazole
permeability leakage of intracellular cations (static or cidal)
metronidazole (Flagyl)
Broad spectrum with anaerobic activity
Adverse rx: GI discomfort, metallic taste , darkening of urine, CNS symptoms

Pain & Inflammation

Analgesics relieve pain

Narcotics / NSAIDs / Antimigraine agents
Anti-inflammatory medications relieve inflammation
Salicylates / Glucocorticoids / Antigout / Disease-modifying antirheumatics drugs (DMARDs)
Some are antipyretic (salicylates, ibuprofen)
Salicylates and NSAIDs reduce platelet aggregation
Salicylates, NSAIDs, and glucocorticoids pose risk for ulceration
Acetaminophen has analgesic and antipyretic properties but not anti-inflammatory. It poses a risk for liver injury
NSAIDs Inflammation suppression / analgesia / fever, dysmenorrhea / suppression of platelet aggregation
Aspirin, Celecoxib (Celebrex), Ibuprofen, Naproxen, Ketorolac (Toradol), Valdecoxib (Bextra), Indomethacin
adverse effects: GI discomfort, aspirin induced ulceration and bleeding, Renal dysfunction, Reye syndrome (in kids with
viral illnesses), Salicylism (tinnitus, resp. alkalosis, dizziness)
interactions: Warfarin (increase bleeding), Glucocorticoids (increase gastric bleeding) use antiulcer prophylactic like
misoprostol (Cytotec) to prevent, Ibuprofen ( decrease antiplatelet effects of low-dose aspirin), EtOH (increase bleeding)
Give with food or milk to reduce GI discomfort. If cant tolerate 1 st generation, give 2nd generation (celecoxib).
ketorolac (Toradol) 1st generation NSAID: Short-term treatment of moderate to severe pain (post-op). Enhances opioid
analgesia without opioid adverse effects
Give no more than 5 days
Usually started parenteral and then transition to oral dose

Acetaminophen: Analgesic and antipyretic

Max 4 g daily, Antidote: acetylcysteine (Mucomyst),

adverse effects: Acute liver toxicity
interactions: EtOH risk to liver / Warfarin decrease levels of warfarin

Opioid Agonists:

morphine, fentanyl, meperidine, methadone, codeine, oxycodone

Moderate to severe pain / Sedation / bowel motility / Cough suppression
Adverse effects: Constipation, Respiratory depression, Urinary retention, Orthostatic Hypotension, Sedation
contraindications: Increases cardiac workload, Meperidine metabolites are neurotoxic
interactions: CNS depressants (barbiturates, phenobarbital, benzodiazepines, EtOH), Anticholinergics, antihistamines,
tricyclic antidepressant anticholinergic effects , MAOIs (hyperpyrexia, seizures), Antihypertensives
5. Withhold if RR<12, Have naloxone (Narcan) and resuscitation equipment available., Infuse IV slowly over 4-5 minutes

Opioid Antagonists: OD treatment, Reversal of opioid effects

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naloxone (Narcan), naltrexone, nalmefene

adverse effects: Tachycardia / Tachypnea, Abstinence syndrome (cramping, hypertension)
Naloxone has extensive first-pass modification, Observe for w/d symptoms or abrupt onset of pain
Adjuvant Pain meds: Enhance opioid effects thereby permitting lower opioid doses, Alleviate other symptoms that aggravate
pain, Treat neuropathic pain
1. TCAs, Anticonvulsants, CNS stimulants, Antihistamines, Glucocorticoids, Bisphosphonates
2. Adverse effects:
3. TCAs (neuropathic pain) Orthostatic hypotension, sedation, anticholinergic effects
4. CNS stimulants Weight loss, insomnia
5. Anticonvulsants (neuropathic pain) Bone marrow suppression
6. Antihistamines sedation
7. Glucocorticoids (increase ICP, nerve compression) Adrenal insufficiency, Hypokalemia, Glucose intolerance, GI
Ulcers, Osteoporosis
8. Bisphosphonate (CA bone pain) Flu-like symptoms, Injection site irritation
Migraine meds: Prevent inflammation and dilation of the intracranial blood vessels
Ergot Alkaloids (Ergotamine, ergotamine + caffeine)
1. Adverse effects: GI discomfort administer metoclopramide (Reglan), Ergotism (muscle pain, paresthesia) stop
medication, Physical dependence, abortion.
2. Contraindications: Renal or liver dysfunction / sepsis / CAD / pregnancy
3. Interactions: Sumatriptan (Imitrex) can lead to spastic rxn of blood vessels
Serotonin receptor antagonists (Sumatriptan (Imitrex), almotriptan (Axert))
1. adverse effects: Chest symptoms (not dangerous, self-resolving), Coronary vasospasm/angina, Teratogenic
2. contraindications: Pregnancy, hypertension, cardiac disease, CAD
3. interactions: Triptans & Ergot Alkaloids spastic reaction of blood vessels, MAOIs Concurrent use leads to MAOI
toxicity (space 2 weeks apart)
Beta-blockers (Metoprolol, atenolol)
1. adverse effects: Tiredness, fatigue, Asthma exacerbation, depression, bradycardia, hypotension
Anticonvulsant (Divalproex (Depakote))
1. Adverse effects: Neural tube defects
TCAs (Amitriptyline (Elavil))
1. adverse effects: Anticholinergic effects: dry mouth, constipation, urinary retention, tachycardia
Ca channel blocker (Verapamil)
1. Adverse effects: ortho hypotension, constipation
Rheumatoid Arthritis meds:
Cytotoxic medications methotrexate (Rheumatrex)
Gold salts aurothioglucose
Antimalarial agents hydroxychloroquine (plaquenil)
Biologic Response Modifiers etanercept (Enbrel)
Penicillamine Cuprimine, Depen
Immunosuppressants Cyclosporine
NSAIDs Naproxen

Cardiovascular Meds

ANS helps control pressure by adjusting cardiac output (HR x SV) and peripheral resistance.
The renin-angiotensin-aldosterone system helps control arterial pressure by:
1. Releasing angiotensin II potent vasoconstrictor of arterioles and veins
2. Releasing aldosterone promotes Na+ and H2O retention by kidneys

Vasopressin (ADH) is a potent vasoconstrictor and water reabsorption

Atrial natriuretic peptide (ANP) is a vasodilator and causes excretion of Na + and H2O by kidneys. It also inhibits renin
secretion.

Decreasing blood volume and dilating arterioles and veins help control BP

Epinephrine (Adrenaline) Catecholamine Adrenergic Agonist

1. absorption of local anesthetics or extravasated meds, Manage superficial bleeding, congestion of nasal mucosa,
BP, Treatment of AV block and cardiac arrest, congestion of nasal mucosa, Asthma

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Dopamine (Intropin) Catecholamine Adrenergic Agonist

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Adverse effects: Hypertensive crisis, Necrosis from extravasation, Dysrhythmias / myocardial O2 demand angina
interactions: MAOIs effect and duration, General anesthetics lead heart to be hypersensitive to epi dysrhythmias, adrenergic blockers (phentolamine), -adrenergic blockers (propanolol)
Stop infusion with evidence of extravasation; treat with -blocker (phentolamine)

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used for shock & HF

Adverse effects: Necrosis can occur from extravasation of high doses, Dysrhythmias / increase myocardial O2 demand
angina
contraindicated: Pheochromocytoma
Stop infusion with evidence of extravasation; treat with -blocker (phentolamine)
Adrenergic Receptors
1 Vasoconstriction of arterioles in skin, viscera, and mucous membranes, and veins
1 increase HR, increase contractility, increase AV conduction, Release of renin in kidneys
2 Vasodilation of arterioles in heart, lungs, and skeletal muscle, Bronchodilation, Relaxation of uterine smooth muscle,
Glycogenolysis in liver, Skeletal muscle contraction
Dopamine Vasodilation of renal blood vessels
Dobutamine (Dobutrex) Catecholamine
HF
Adverse effects: increased HR
-Adrenergic Blockers: Selective 1 blockade resulting in venous and arterial dilation
Proto: Prazosin (Minipress) Others: doxazosin mesylate (Cardura), Phentolamine (Regitine), ergotamine tartra
for HTN, Phentolamine: Extravasation of adrenergic agonists, Doxazosin mesylate: decrease symptoms of benign prostatic
hypertrophy
adverse effects: First-dose orthostatic hypotension (monitor BP for 2 hrs post-treatment)
Centrally Acting 2 Agonists decrease sympathetic outflow in CNS bradycardia, decrease CO, vasodilation, decrease BP
Proto: clonidine (Catapres) Others: guanfacine (Tenex), methyldopa (Aldomet)
for HTN, Severe cancer pain (epidural), Investigational: Migraine, flushing from menopause, withdrawal management
Adverse effects: Dry mouth (usually resolves in 2-4 weeks), Drowsiness & sedation, Rebound hypertension
interactions: Antihypertensives: Additive hypotensive effect, Prazosin, MAOIs, TCAs: Counteract effects of clonidine.,
CNS Depressants: Additive CNS depressant effect
Apply patch to hairless skin on torso or upper arm
Beta blockers Decreases HR, contractility, AV conduction
Cardioselective: metoprolol (Lopressor), Nonselective: propanolol (Inderal) - Others: Cardioselective: atenolol,
Nonselective: nadolol (Corgard)
For HTN, Dysrhythmias (block SA/AV cond.), Angina/MI (decrease O2 demand increase diastole time perfusion
decrease BP decrease O2), Hyperthyroidism, migraines, stage fright, pheochromocytoma, glaucoma, HF
adverse effects: B1 bradycardia, decreased CO, AV block, ortho hypotension. B2 bronchoconstriction, glycogenolysis
inhibited
Contraindications: AV block, sinus bradycardia. Nonselective should not be used in p/ts w/ asthma, bronchospasms, HF
interactions: 1: calcium-channel blockers verapamil (Calan) and diltiazem (Cardizem) intensify effects of -blockers. 2:
Insulin prevents glycogenolysis
ACE inhibitors Block production of angiotensin II arteriole vasodilation, excretion of Na + and H2O, retention of K+, and
possible pathological changes to vessels and heart
Proto: captopril (Capoten) Others: enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil), ramipril (Altace)
For HTN, HF, Peripheral neuropathy, MI (decrease risk of HF and mortality, Ramipril can prevent MI, stroke, or death in
high-risk patients
Adverse effects: Hyperkalemia, Angioedema (swelling in tongue/oropharynx) treat with epinephrine, Neutropenia,
Cough, First-dose orthostatic hypotension, Rash & dysgeusia,
interactions: Diuretics 1st-dose hypotension, NSAIDs decrease antihypertensive eff., K + supplements/K+ sparing diuretics
hyperkalemia
ARBs Blocks action of angiotensin arteriole vasodilation, excretion of Na + & H2O, retention of K+
ACE and ARB is that cough and hyperkalemia are not side effects of ARB.
For Stroke prevention (losartan), Mgt of heart failure / mortality prevention after MI (valsartan), Delay progression of
diabetic neuropathy (irbesartan, losartan), decrease hypertension (all)
adverse effects: Angioedema, fetal injury
ARBs can be taken with or without food
Ca Channel blockers
Proto: nifedipine (Adalat) Others: amlodipine (Norvasc), felodipine (Plendil), nicardipine (Cardene), verapamil
(Calan), diltiazem (Cardizem)
Nifedipine- vasodilation peripheral & arterioles
erapamil, Diltiazem: Above + decrease contractility, decrease HR, decrease AV conduction
for HTN All , All but Felodipine: Angina, Verapamil, Diltiazem: Hypertension, Angina, Dysrhythmias
adverse effects: Nifedipine: Tachycardia, peripheral edema, acute toxicity. Verapamil, Diltiazem: Orthostatic hypotension,

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peripheral edema, constipation, cardiac suppression, dysrhythmias, acute toxicity

Contraindications: heart block, hypotension, bradycardia, aortic stenosis, severe heart failure
interactions:
1. Verapamil, Diltiazem,Nifedipine: : grapefruit toxicity.
2. -blockers: HF, AV block, bradycardia.
3. -blockers: Used to decrease reflex tachycardia
HTN Crisis Meds: Direct vasodilation of veins and arteries causing rapid decrease BP (preload/afterload)
Proto: nitroprusside Others: labetalol (Trandate), diazoxide (Hyperstat), fenoldopam (Corlopam), trimethaphan
(Arfonad)
For Hypertensive emergencies, decrease bleeding during surgery by producing controlled hypotension
adverse effects: Excessive hypotension, Cyanide poisoning: increase risk liver dysfunction; Give slowly (5 mcg/kg/min)
along with thiosulfate to deactivate cyanide, Thiocyanate poisoning: Can manifest as altered mental state/psychosis. Avoid
prolonged use (>3 d). Plasma thiocyanate should be <0.1 mg/mL
Discard solutions that are blue, red, or green. Protect solutions from light. Do not mix other meds nitroprusside.
Organic Nitrates decrease cardiac O2 demand by dilating veins and decreasing venous return (preload). Relaxes or prevents
spasms in coronary arteries thus increase O2 supply
Proto: nitroglycerine Others: isosorbide dinitrate (Imdur)
For treatment of angina (acute, variant, and prophylaxis), IV perioperative BP control, HF d/t acute MI
Adverse effects: Headache, Tolerance, Orthostatic hypotension, Reflex tachycardia - give metoprolol (Lopressor)
contraindications: Head trauma IICP
Interactions: Sildenafil (Viagra) Acute or fatal hypotension, EtOH, -blockers, Ca-blockers, diuretics additive
hypotensive effects
Cardiac Glycosides (+) inotropic increase SV, CO & (-) chronotropic > fill time increase SV, CO
digoxin (lanoxin)
For HF , Dysrhythmias, A-Fib
Adverse effects: GI effects, CNS effects (fatigue, vision changes), Dysrhythmias, cardiotoxicity: increase risk from
decrease K+, increase [digoxin], disease
Contraindications: v-fib, v-tach, 2/3 blocks
Interactions: Quinidine increase dig toxicity, Verapamil increase [digoxin], Sympathomimetics add to inotropic effect,
Loop & thiazide diuretics decrease K+ increase risk of digoxin dysrhythmia, ACE inhibitors / ARBs increase risk increase
K+ decrease therapeutic digoxin effects.
Check apical pulse: hold < 60 (adults), < 70 (kids), < 90 (infants), Therapeutic levels = 0.5-2 ng/mL, Treat bradycardia
atropine, Treat dysrhythmias phenytoin or lidocaine, Activated charcoal or cholestyramine can bind digoxin to prevent
absorption.

Antidysrhythmias
Sodium channel blockers: lidocaine (Xylocaine) Short-term use only for ventricular dysrhythmias
1. Never administer lidocaine that has epinephrine in it.
2. Calcium-channel blockers: verapamil (Calan), diltiazem (Cardizem) A-fib, SVT, A-flutter
3. Potassium channel blockers: amiodarone (Cordarone), bretylium, sotalol, dofetilide Conversion of A-fib (oral),
Recurrent V-tach & V-fib
4. Endogenous Glucoside: adenosine (Adenocard), ibutilide (Corvert) Paroxysmal SVT, Wolff-Parkinson Syndrome
1. Very short life (< 1 min), Administer by IV bolus, flushed with NS

Antilipids/STATINS Promote vasodilation / decrease plaque-site inflammation / decrease thromboembolism risk, decrease
LDL by increase LDL receptors in liver, increase HDL
1. For 1 hypercholesterolemia, increase HDL, Prevention of stroke and coronary events.
2. Adverse effects: Myopathy (monitor CK), Peripheral neuropathy, Hepatotoxicity evidenced by increase serum
transaminase
3. Atorvastatin or fluvastatin should be used with renal insufficiency, Lovastatin evening meal
1.

Respiratory Meds

2-Adrenergic Agonists Selectively activate 2 receptors resulting in bronchodilation: bronchospasm is relieved, histamine
release is inhibited, and ciliary motility is increased
1. Proto: albuterol (Proventil) Others: formoterol (Foradil), salmeterol (Serevent), terbutaline (Brethine)
2. Albuterol: Inhaled, short-acting and oral, long-acting. Formoterol, salmeterol: Inhaled, long-acting. Terbutaline: Oral, L-A.
3. Adverse effects: Inhaled: Minimal adverse effects, Oral: Tachycardia/angina d/t 1 in / tremors d/t 2 in skeletal muscle.
4. Contraindications: tachydysrhythmias
5. Inhale 3-5 sec, hold 10 sec, wait 60 sec for next dose, Use inhaled 2-agonist before using inhaled glucocorticoid

Methylxanthines Theophylline relaxes bronchial smooth muscle bronchodilation

1. Theophylline (Theolair)
2. Long-term control of asthma
3. Adverse effects: Mild toxicity GI distress & restlessness. Severe reactions.
1. Severe reactions can occur at increase therapeutic levels and include dysrhythmias and seizures. Effects unlikely @
<20 mcg/mL. Activated charcoal decrease absorption, lidocaine for dysrhythmias and diazepam for seizures.

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Interactions: Caffeine: increases CNS/ effects of theophylline. Also increases [theophylline], Cimetidine, ciprofloxacin:
increase [theophylline], Phenobarbital, phenytoin: decrease [theophylline]
Inhaled Anticholinergics Relief of bronchospasms associated with COPD, Relief of allergen-induced and exercise-induced
asthma.
Proto: ipratropium (Atrovent) Others: tiotropium (Spiriva)
Adverse effects: Local anticholinergic effects
Contraindicated: Peanut allergy
Usual adult dose is 2 puffs (1 minute apart), If taking two inhaled medications, separate by at least 5 minutes.
Glucocorticoids Prevent inflammation, suppress airway mucous production, and promote responsiveness of 2-receptors in
bronchial tree.
Proto: beclomethasone (QVAR) Others: budesonide (Pulmicort), fluticasone (Flovent), triamcinolone (Azmacort),
prednisone (Deltasone
For:
1. Inhaled: Long-term asthma prophylaxis
2. S-T, oral: Treat symptoms following acute asthma.
3. L-T, oral: Treat chronic asthma
4. Promote lung maturity and decrease RDS in fetuses at risk for preterm birth.
5. 1 adrenocortical insufficiency
Adverse effects: Inhaled: Dysphasia, candidiasis, bone loss. Oral (10d): decrease adrenal gland function / bone loss /
hyperglycemia / glucosuria / / infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances.
Interactions: Diuretics: increase hypokalemia, NSAIDs: increase GI ulceration, Glucocorticoids counteract effects of
insulin and oral hypoglycemics.
Oral are for short-term use, 3-10 days following acute attack
Mast Cell Stabilizers Anti-inflammatory: Stabilize mast cells, inhibiting histamine release, Suppress inflammatory cells
(e.g. eosinophils, macrophages)
Cromolyn (Intal) Others: nedocromil (Tilade)
For Management of chronic asthma, Prophylaxis of exercise-induced and allergen-induced asthma attacks, Allergic rhinitis
by intranasal route
Safest of all asthma meds / safe for kids
Contraindications: Propellant - CAD, dysrhythmias, and status asthmaticus
Take 15 min before exercise , Long-term prophylaxis may take several weeks
Leukotriene Modifiers Prevent effects of leukotrienes thus suppressing inflammation, airway edema, bronchoconstriction,
and mucus production.
Proto: montelukast (Singulair) Others: zileuton (Zyflo), zafirlukast (Accolate
Long-term asthma therapy in folks 12 YO
Adverse effects: Liver injury zileuton and zafirlukast. (nausea, anorexia, abdominal pain)
Zileuton given without regard to food. Zafirlukast taken food
Antitussive Opioids Suppresses cough center in the medulla oblongata.
Proto: codeine Others: hydrocodone
For Chronic, non-productive cough
Adverse effects: GI distress (nausea, constipation) take food, increase fluid/fiber, CNS sedation effects: Respiratory
depression (<12/min) naloxone, Potential for abuse, schedule II.
Contraindications: acute asthma, head trauma, liver/renal dysfunction, acute alcoholism
Mucolytics Enhance flow of secretions in the respiratory passages
Proto: acetylcysteine (Mucomyst) Others: hypertonic saline
For acute & chronic pulmonary disease increase secretions, Acetylcysteine is the antidote for acetaminophen poisoning,
cystic fibrosis
Adverse effects: Aspiration and bronchospasm
Contrandications/precautions: GI bleeding, Peptic ulcers / esophageal varices / severe liver disease
Has smell of rotten eggs, Dilute in fruit juice, IV: Loading dose, next dose over 4h, last dose over 16h.
Decongestants Stimulate 1-adrenergic receptors decreasing inflammation of nasal membranes
For Allergic rhinitis, sinusitis, and common cold
Adverse effects: Rebound congestion (Max 3-5 days, taper down use), CNS stimulation (rare topical), Vasoconstriction
Contraindications: Chronic rhinitis, CAD and hypertension
Oral do not lead to rebound congestion

Digestion & nutrition drugs

GI tract is the route of administration and the target of action

GI effects are common (abdominal pain, constipation, nausea)
When peptic ulcers are caused by H. pylori, non-antibiotics promote healing but only antibiotics will cure the disease.
Drug therapy for peptic ulcers is directed at controlling symptoms, facilitating healing, lowering risk for complications, and
preventing relapse
Prevention of emesis is more effective than treating it.


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Histamine2 (H2) Receptor Agonists Selectively block H2 receptors in parietal cells to suppress gastric acid secretion
Proto: ranitidine (Zantec) Others: cimetidine (Tagamet), nizatidine (Axid), famotidine (Pepcid)
For OTC for heartburn, sour stomach, and indigestion, Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger
syndrome), In conjunction with antibiotics to treat ulcers caused by H. pylori
Adverse effects: decreased libido / impotence, CNS effects (lethargy, depression, confusion) increase frequent in elderly
renal or liver dysfunction.
Contraindications: increased risk of bacterial colonization of stomach and respiratory tract
Interactions: Warfarin, phenytoin metabolizing enzymes inhibited by cimetidine increase levels, Concurrent use of
antacids decrease absorption H2-receptor antagonists
Stop drinking, stop smoking, eat smaller, more frequent meals, Ranitidine can be taken without regard to food.
Proton Pump Inhibitor decrease gastric acid secretion by irreversible inhibition of enzyme that produces it, Reduce basal
and stimulated acid production
Proto: omeprazole (Prilosec) Others: pantoprazole (Protonix), lansoprazole (Prevacid), esomeprazole (Nexium)
Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome)
Adverse Effects: Insignificant short-term treatmenT
Contraindications: increase risk pneumonia d/t increase pH promoting bacterial colonization
Interactions: Delayed absorption of Ampicillin, digoxin, iron, ketoconazole if concurrent
IV pantoprazole may cause thrombophlebitis, headache, or diarrhea.
Antacids Neutralize gastric acid and inactivate pepsin, Mucosal protection through stimulation of prostaglandin production
Proto: Al(OH)3 gel (Amphojel), Others: AlCO3, Mg(OH)2 (Milk of Magnesia), NaHCO3
For Peptic ulcer disease and GERD
Adverse effects: Al/Ca compounds constipation, Mg compounds diarrhea, Na+-containing fluid retention, Al(OH)3
hypophosphatemia, Mg2+ compounds toxicity with renal impairment.
Interactions: Aluminum-compounds bind to warfarin, tetracycline and decrease their absorption
Chew tablets thoroughly then take with 8 oz water or milk, Frequency of administration makes compliance difficult
Antiemetics
Ondansetron Chemo, radiation, postop
1. Adverse effects: Headache, diarrhea, dizziness
Prochlorperazine Chemo, opioids, postop
1. Adverse effects: EPS (Tx Benadryl or Ativan), hypotension, sedation, and anticholinergic effects.
Dexamethasone Combo for chemotherapy
Dronabinol Chemotherapy (CINV)
1. Adverse effects: Dissociation, dysphoria, hypotension, tachycardia
Scopolamine Motion sickness
Dimenhydrinate Motion sickness
Interactions: CNS depressants / Antihypertensives / Anticholinergics Additive Effects, Antagonists urinary retention,
asthma, and narrow-angle glaucoma, Combo therapy allows lower doses of each decreases side effects.
Laxatives
Bulk-forming {psyllium} Soften mass, increase bulk same as dietary fiber diarrhea, control stool, promote
defecation
Surfactant {docusate} increase H2O content Opioids, pain, straining, risk impaction, promote defecation
Stimulant {bisacodyl} increase peristalsis, H2O absorption (decrease colon, increase intestine) Colonoscopy prep,
short-term Tx d/t increased opioid use
Osmotic {Mg(OH) 3} increase intestine H2O increase mass increase stretching increase peristalsis Chemotherapy
(CINV)
Adverse effects: (Mg2 salts) Accumulate toxic levels of magnesium ( in renal dysfunction), (Na Salts) Accumulation:
in heart disease and hypertension
Interactions: Milk & antacids destroy enteric coating
Promote increase fiber foods and > 1.5 L
Antidiarrheals Activate opioid receptors in GI to decrease motility and increase absorption of water & Na +
Proto: diphenoxylate (Lomotil) Others: loperamide (Imodium), difenoxin (Motofen
At recommended doses, diphenoxylate has no CNS effects, increased diphenoxylate doses typical opioid responses.
Contraindications: increased risk of megacolon with inflammatory bowel disorders serious complications including
perforated bowel.
Interactions: CNS depressants increase depressive effect
Encourage use of electrolyte replacement drinks, Avoid plain water (no electrolytes) and caffeine (increases motility),
Manage dehydration (weight, VS, I&O) 0.45% NS may be prescribed
Prokinetic Augments action of acetylcholine to increase upper GI motility
metoclopramide (Reglan)
Postop and chemo-induced nausea and vomiting, Diabetic gastroparesis, GERD
Adverse effects: EPS: Restlessness, spasms of face & neck. Minimize EPS with benzodiazepine like lorazepam (Ativan),
Diarrhea, Sedation
Contraindications: Seizure disorder (increase seizure risk), GI perforation or bleeding, bowel obstruction, and hemorrhage,

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Kids and older adults due to increased risk of EPS

interactions: Concurrent EtOH or CNS depressant: increased seizure / sedation risks, Opioids and anticholinergics
decreases effects of metoclopramide.
Dose 10 mg dilute in 50 mL D5W or Ringers; Infuse over 15m

Nervous System Meds

Dopaminergics (Anti-Parkinsons) Levodopa taken up and converted to dopamine. Carbidopa augments levodopa by
preventing conversion to dopamine in intestine and periphery
1.
Levodopa, carbidopa, Sinemet
2. Symptomatic relief from dyskinesias
3. Adverse effects: Dyskinesias, Discoloration of sweat & urine, Nausea / drowsiness, ortho hypotension, psychosis
(clozapine), activiation of malignant melanoma
4. Contraindications: 2 wks from MAOI
5. Interactions: Proteins interfere with absorption and transport, Carbidopa, dopamine agonists, anticholinergics, COMT
inhibitors and dopamine releasers increase therapeutic effects.

Centrally acting cholinergics (anti-Parkinsons) Block ACh at muscarinic receptors which helps maintain ACh, dopamine
balance
1. Benztropine (Cogentin), trihexyphenidyl (Artane)
2. Adverse effects: Nausea (take food), Atropine-like effects (dry mouth, blurred vision, mydriasis, constipation),
Antihistamine effects (sedation, drowsiness)

Antiepileptic

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Barbiturates Partial seizures and generalized tonic-clonic seizures, Not effective against absence seizures
Phenobarbital (Luminal)
1. Adverse effects: CNS effects: Adults as sedation and anxiety, kids as irritability and hyperactivity, Toxicity:
Nystagmus, ataxia, respiratory depression, pinpoint pupils
Hydantoins Effective against all major forms except absence seizures
1. Phenytoin (Dilantin)
2. Adverse effects: CNS effects, skin rash, teratogenic, cardiovascular, endocrine, Vit D metabolism
3. Contraindications: sinus bradycardia, SA blocks, 2nd & 3rd degree AV blocks
4. Use IV route for status epilepticus, Antidysrhythmias

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Carbamazepine Partial seizures, tonic-clonic seizures, bipolar disorder, trigeminal neuralgia

Tegretol

Adverse effects: Cognitive function is minimally affected but CNS effects can occur, Hypo-osmolarity ( ADH
secretion), Blood dyscrasias

Contraindications: marrow suppression / bleeding disorders

Interactions: Grapefruit juice: inhibits metabolism [carbamazepine]

Valproic Acid Partial, generalized, and absence seizures, bipolar disorder, and migraines

Depakote

Adverse effects: GI effects (take food), Hepatotoxicity, Thrombocytopenia, Pancreatitis as evidenced by

nausea, vomiting, and abdominal pain

Contraindications/precautions: Avoid in children younger than 3 (hepatotoxicity), Liver disorders

Interactions: Phenytoin and phenobarbital: Concurrent use increases these medications

Gabapentin Single agent used for partial seizures, Neuropathic pain , Migraine prevention
1. Neurontin
2. Adverse effects: CNS effects (drowsiness, nystagmus)
Benzodiazepines Used in status epilepticus
1. Diazepam (Valium)
2. Adverse effects: Respiratory depression, Anterograde amnesia, Teratogenic

Muscle relaxants/antispasmodics
Diazepam Acts in CNS to enhance GABA and produce sedation, Acts in CNS to depress spasticity of muscles
1. Diazepam (Valium)
2. Relief of spasticity d/t Cerebral Palsy or MS, Anxiety & panic disorders, EtOH withdrawal, Relief of spasm d/t injury,
Insomnia, Status epilepticus, Anesthesia induction, Relief of spasm d/t injury
3. adverse effects: CNS depression, Physical dependence from long-term use
4. contraindications: Caution impaired liver or renal function
5. interactions: CNS depressants (EtOH, opioids, antihistamines, barbiturates): Additive CNS depressive effects with
concurrent use.

Local anesthetics decrease pain by blocking local conduction of pain impulses\

1. Amide type: Lidocaine Ester type: tetracaine, procaine
2. Adverse effects: Hypotension, bradycardia, heart block, cardiac arrest, CNS excitation -- treat midazolam (Versed) or
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diazepam, Allergic reactions (more likely esters), decrease uterine contractility., Freely cross placenta, Urinary retention
(call after 8 hrs), Spinal headache (lay flat for 12 hrs)
Contraindications: CI in dysrhythmias and/or heart block, Caution with liver/kidney dysfunction, heart failure, myasthenia
gravis
IV anesthetics Adjunct to inhalation anesthesia, Induction & maintenance of anesthesia, Midazolam & an opioid result in
conscious sedation, Ketamine can be used with children, Amnesia
Barbiturates: Thiopental (Pentothal), Ketamine (Ketalar), Benzodiazepines: Diazepam (Valium), midazolam (Versed),
lorazepam (Ativan), Propofol (Diprivan)
1. Adverse effects: Respiratory and cardiovascular depression, PropofolBacterial infection (use opened vial within 6
hrs), Ketamine: Psychologic reaction (premedicate with diazepam to decrease risk)
2. Contraindications: Ketamine should be avoided with psychiatric disord: ers
3. Interactions: CNS depressants and stimulants: Additive effects, Opioid analgesics: Constipation and urinary retention
4. Midazolam (Versed): inject over >2 minutes, Propofol (Diprivan): inject into large vein; prep site with lidocaine.
Antipsychotics conventional Dopamine, acetylcholine, histamine, & norepinephrine receptors in brain and periphery are
blocked. Symptom inhibition d/t dopamine2 blockade in brain.
chlorpromazine (Thorazine), : haloperidol (Haldol), Others: fluphenazine, molindone, perphenazine, thiothixene
For Delusional disorder, Bipolar disorder, Schizoaffective disorder, Huntingtons chorea, Schizophrenia, Dementia,
Tourettes Syndrome
Adverse effects: Anticholinergic effects, Parkinsonism, Tardive dyskinesia, Akathisia, Dystonia, Neuroleptic malignant
syndrome
Interactions: Levodopa: Counteracts antipsychotics by stimulating dopamine receptors, CNS depressants: Additive effects
Consider depot preparations, Protect liquid prep from , Early EPS symptoms with anticholinergics, -blockers,
benzodiazepines
Antipsychotics atypical Action results from blocking serotonin and dopamine receptors (block other receptors, too)
decrease Pr developing EPS or tardive dyskinesia
Proto: clozapine Others: risperidone, olanzapine, quetiapine
For Psychosis induced by levodopa therapy, Severe schizophrenia
Adverse effects: Agranulocytosis (WBC<3000/cc, Neu<1500/cc), Wt. Gain, Myocarditis (dyspnea, increased RR, lethargy,
chest pain, palpitations), New onset diabetes, seizures
Immunosuppressive medications: Avoid
Antidepressants TCAs Block reuptake of norepinephrine and serotonin in synaptic space
Proto: amitriptyline (Elavil) Others: imipramine (Tofranil), doxepin (Sinequan)
Depression & bipolar disorders
Adverse effects: Anticholinergic effects, Toxicity evidenced by dysrhythmias, confusion, & agitation followed by seizures,
Orthostatic hypotension, Cardiac toxicity @ increased doses
Interactions: MAOIs hypertension, Antihistamine & anticholinergics additive effects, Epi/Norepi increase amounts of
adrenergics because reuptake is blocked by TCA, Ephedrine/amphetamine decrease responses to these d/t uptake inhibition
keeps them from reaching site of action in nerve terminal, EtOH, benzodiazepines, opioids, antihistamines Additive
CNS depression
SSRIs Block reuptake of serotonin in synaptic space
Proto: fluoxetine (Prozac) Others: citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
For Major depression, Panic disorders, PTSD, Bulimia, OCD
Adverse effects: Sexual dysfunction, Weight gain, Serotonin syndrome 2-72 hrs (confusion, anxiety, agitation,
hallucinations), Withdrawal syndrome, Sleepiness, faintness, hyponatremia
Contraindciations: MAOI
Intreractions: NSAIDs & anticoagulants fluoxetine suppresses platelets increase bleeding risk, MAOIs increase risk of
serotonin syndrome, TCA & Lithium increase levels of these
MAOI Block MAO in brain increase norepinephrine and serotonin available for impulses
Proto: phenelzine (Nardil) Others: isocarboxazide
For Atypical depression, OCD, Bulimia nervosa
Adverse effects: Hypertensive crisis from dietary tyramine (increase HR, increase BP): Induce vasodilation with IV
phentolamine (-blocker) or sublingual nifedipine., Orthostatic hypotension, CNS stimulation
Contrandications: CI: SSRIs, pheochromocytoma, cardiovascular disease & renal insufficiency
interactions: Indirect sympathomimetic release NE causing hypertensive crisis, TCA hypertensive crisis, SSRIs serotonin
syndrome, Meperidine hyperpyrexia, Tyramine-rich foods hypertensive crisis (aged cheese, salami, avocados, bananas,
protein, & red wine), Vasopressors (phenylethylamine, caffeine) hypertension, Antihypertensives additive hypotensive
effect
Mood stabilizers Lithium causes serotonin receptor blockade, Lithium use will evidence decrease neuronal apathy and/or
increase in neuronal growth.
Proto: Lithium, mood-stabilizing anticonvulsants: valproic acid (Depakote), carbamazepine (Tegretol)
For Bipolar / alcoholism / bulimia / schizophrenia
Adverse effects: GI effects, usually transient (give milk), Tremors (give -blocker like propanolol), Polyuria ,Renal
toxicity, Goiter/hypothyroidism ,Teratogenic
contraindications: Caution renal dysfunction, heart disease, Na + depletion & dehydration

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Interactions: Diuretics decrease Na+ decrease lithium excretion toxicity, NSAIDs increase renal absorption lithium
toxicity (aspirin OK), Anticholinergics abdominal discomfort from urinary retention & polyuria
Maintain adequate sodium intake and 8-12 glasses of H2O, Plasma lithium levels must be monitored (> 1.5 mEq/L is toxic)
Sedative hypnotics benzodiazepines Enhance the action of gamma-aminobutyric acid (GABA)
Proto: diazepam (Valium) Others: alprazolam (Xanax), lorazepam (Ativan), chlordiazepoxide (Librium)
For Anxiety, Muscle spasms, Anesthesia, Seizures, Panic disorder, Insomnia, EtOH w/d
Adverse effects: CNS depression, Respiratory depression, Anterograde amnesia, Paradoxical response, Acute toxicity (treat
oral charcoal, treat IV flumazenil)
interactions: CNS depressants additive effects
Sedative hypnotics non benzodiazepine Enhance action of GABA in CNS leading to prolonged sleep duration. They do
not function as antianxiety, muscle relaxant, or antiepileptic agents.
Proto: zolpidem (Ambien) Others: zaleplon (Sonata), eszopiclone (Lunesta) , trazodone (Desyrel)
for Management of insomnia
adverse effects: Daytime sleepiness and light headedness
Interactions: CNS depressants additive effects, decreases Food absorption when taken with food
Anxiolytic non-barbiturate Treatment of Generalized Anxiety Disorder
Buspirone (BuSpar)
adverse effects: CNS effects, No sedation
contraindications: Erythromycin, ketoconazole, and grapefruit juice increases effects of buspirone, Does NOT potentate
CNS depressants
Take with meals to prevent gastric irritation
CNS stimulants Release norepinephrine and dopamine and prevent their reuptake in CNS.
Proto: methylphenidate (Ritalin) Others: amphetamine, dextroamphetamine (Dexedrine), Adderall, caffeine
For ADHD, narcolepsy, obesity
Adverse effects: CNS stimulation, Cardiovascular effects (dysrhythmias, chest pain, BP), Weight loss
Contraindications/precautions: Caution: hyperthyroidism, heart disease, glaucoma, Hx of drug abuse, MAOIs
interactions: MAOIs hypertensive crisis, Caffeine increases CNS stimulant effects, Phenytoin, warfarin, phenobarbital
Inhibited metabolism of these levels, OTC cold & decongestants increases CNS stimulant effects

Drugs for ETOH abuse

Withdrawal Symptoms -> Usually start within 12-72 hours / Persist 5-7 days Can be mild: nausea, anxiety, tremors,
Can be life-threatening: hallucinations, cramps, tremors, seizures, Increased HR, BP, T
2. Support meds Benzodiazepines (chlordiazepoxide, diazepam, lorazepam) decreases DT and risk of seizures, decreases
intensity of symptoms ---- Adjuncts (carbamazepine, clonidine, propanolol) decreases seizure, decreases craving, depress
autonomic response (decreases HR, BP, T)
3. Maintenece meds Disulfiram (Antabuse) EtOH, aldehyde syndrome occurs (nausea, extreme vomiting,
hypotension) Can progress to respiratory and cardiac depression, seizures, and death Naltrexone (ReVia) decreases
Opioid antagonist that decreases craving and pleasurable effects Acamprosate (Campral) decreases unpleasant effects of
abstinence (anxiety, etc)
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Drugs for opioid abuse

Withdrawal symptoms Self-limiting in 7-10 days Begins with sweating and rhinorrhea, progressing from tremors and
irritability to weakness, nausea, vomiting, muscle/bone pain, and spasticity. NOT life-threatening.
2. Detox meds Methadone substitution Prevents withdrawal syndrome.
3. Matienence meds Methadone Long-term maintenance. Dependence is transferred to methadone. Clonidine (Catapres)
Control autonomic hyperactivity (nausea, vomiting) Buprenorphine (Subutex) Opioid agonist/antagonist Naloxone
(Suboxone) Opioid agonist/antagonist
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Drugs for nicotine abuse

withdrawal symptoms Abstinence syndrome is evidenced by irritability, nervousness, restlessness
support meds Bupropion (Zyban) decreases craving and symptoms of withdrawal. Nicotine Pharmaceutical
replacement to alleviate symptoms
3. Chew gum over 30 minutes; avoid eating and drinking within 15 minutes of gum Gum not recommended for use longer
than 6 months Avoid use of all nicotine products while pregnant or breastfeeding.
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Blood meds

Anticoagulants (parenteral) Intrinsic factors and thrombin conversion are inhibited by heparin
Proto: Heparin Others: enoxaparin, tinzaparin (Innohep)
For Evolving stroke, PE, MI, DVT, Adjunct during surgery, dialysis, abdominal surgery, or joint replacement, DIC
adverse effects: Hypersensitivity reaction (chills, fever, urticaria), Hemorrhage 2 heparin OD (treat protamine sulfate),
Heparin-induced thrombocytopenia (stop if PLT < 100,000/cc)
4. contraindications: low PLT or uncontrollable bleeding, Surgery of eye, brain, spinal cord; regional anesthesia; lumbar
puncture
5. interactions: Anti-platelet agent additive risk of bleeding
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Monitor aPTT levels Q4-6h and then QD (60-80 sec)

protamine sulfate for heparin OD --- Administer slowly (20 mg/min or 50 mg in 10 min)
Anticoagulant (oral) Antagonizes vitamin K / prevents synthesis of 4 intrinsic factors & prothrombin
warfarin (coumadin)
for Prevention of venous thrombosis, Prevention of thrombi in A-fib and with prosthetic heart valves
Adverse effects: Hemorrhage (Tx with vitamin K)
contraindications: Surgery of eye, brain, spinal cord; regional anesthesia; lumbar puncture, low PLT counts, uncontrolled
bleeding, vit. K , liver problems, alcoholism
PT therapeutic level = 18-24 sec (normal = 11-12.5 sec), Onset takes 8-12 hrs, full effect takes 3-5 days
Antidote : Vitamin K (Phytonadione)
Antiplatelets Prevent platelet clumping by inhibiting arterial clotting enzymes and factors
Proto: Aspirin Others: ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), abciximab (Reo Pro)
for Primary prevention of acute MI, Prevention of stroke, Prevention of reinfarction, Acute coronary syndromes
(abciximab and tirofiban {Aggrastat})
adverse effects: GI effects (concurrent PPI / enteric-coated / take food), Hemorrhagic stroke
ASA (81 mg) for prevention / ASA (325 mg) during initial acute MI episode
Thrombolytic Clot dissolution by plasminogenplasmin which destroys fibrinogen
Proto: streptokinase Others: alteplase (tPA), tenecteplase, reteplase
for Acute MI / DVT / Massive PE / Ischemic stroke (alteplase)
adverse effects: Serious risk of bleeding from different sites Streptokinase, Hypotension (infuse slowly), Allergic reaction
or anaphylaxis
contraindications: Hx of intracranial hemorrhage. Brain tumors / pericarditis / Recent head or facial trauma / internal
bleeding
Admin within 4-6 hours of onset, IV aminocaproic acid for excessive fibrinolysis, Administer H 2 antagonists such as
ranitidine (Zantec) or PPI such as omeprazole (Prilosec) to prevent GI bleeding.
Iron preparations Increase iron level for RBC development and oxygen transport capacity
Proto: Ferrous sulfate Others: Iron Dextran
Treat and prevent iron-deficiency anemia
adverse effects: Teeth staining (liquid) {Dilute / Drink straw / Rinse}, GI distress: {take food if necessary but decreases
absorption}, Anaphylaxis (parenteral): IV is safer / Deep IM Z-track / Infuse slowly
Vitamin C increase absorption but increases side effects, Antacids or tetracyclines decrease absorption
Take on empty stomach to increase absorption, Anticipate dark green or black stool
Vitamin B12 (Cyanocobalamin) Necessary to convert folate (required for DNA production) from inactive form

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for Treatment of B12 deficiency, Megaloblastic (macrocytic) anemia related to B 12 deficiency

adverse effects: Hypokalemia 2 increases RBC production
interactions: Folic acid supplements mask signs of B12 deficiency
Intranasal spray / oral / IM / SC, Injections are painful; reserved for reduced ability to absorb.

Folic Acid Folic acid is essential in DNA production & erythropoiesis (RBC, WBC, PLT)
1. Tx of macrocytic anemia, Prevention of neural tube defects in pregnancy

Hamatopoietic Growth factors Act on bone marrow to increase RBC production

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Epoetin alfa (Epogen, Procrit)

For Anemia of chronic renal failure or chemotherapy, HIV patients taking zidovudine (Retrovir), Anemia in patients
schedule for elective surgery
adverse effects: Hypertension 2 increased Hct, high risk for CV event (MI, stroke, arrest) high Hgb > 12 g/dL or > 1 g in
2 weeks
contraindications: uncontrolled HTN
RBC production requires iron, folate, and vitamin B12, Monitor Hgb and Hct 2x per week until target range is reached
Granulocyte colony stimulating factor Medications stimulate bone marrow to increase production of neutrophils.
filgrastim (Neupogen)
decrease infection risk with neutropenia (e.g. cancer)
adverse effects: Bone pain, Leukocytosis: decrease dose / interrupt treatment if WBC > 50,000/cc, ANC > 20,000/cc, or
platelets > 500,000/cc.
Filgrastim should not be agitated nor mixed, Monitor CBC 2x per week
Whole blood Increases circulating blood volume
For Acute blood loss, extensive burns, dehydration, shock
adverse effects: Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids), Acute hemolytic rxn (fever, tachycardia,
hypotension): VS Q5m for 15m, Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m,
Anaphylaxis: VS Q5m for 15m IM or IV epinephrine, Mild allergy: If respiration uncompromised, antihistamines and
restart, Circulatory overload: Place upright / O2 and diuretics / slower rate
Requires countersign, Assess site & patency, Use 19 ga, filter, Y-tubing, Assess before, during, & after, increase Hgb 1-2
g/dL per unit, Complete in 2-4 hours, no mix
Packed RBCs # of RBCs
For Erythroblastosis fetalis, Hemoglobinopathies, Severe symptomatic anemia (Hgb<6 g/dL), Med-induced hemolytic

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anemia
Adverse effects: Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids), Acute hemolytic rxn (fever, tachycardia,
hypotension): VS Q5m for 15m, Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m,
Anaphylaxis: VS Q5m for 15m IM or IV epinephrine, Mild allergy: If respiration uncompromised, antihistamines and
restart
Requires countersign, Assess site & patency, Use 19 ga, filter, Y-tubing, Assess before, during, & after, increase Hgb 1-2
g/dL per unit, Complete in 2-4 hours, no mix
Platelet concentrate increase platelet count
For Thrombocytopenia (< 20,000/cc), Active bleeding (platelets < 80,000/cc)
Adverse effects: Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids), Febrile nonhemolytic rxn (most common)
(fever, headache): VS Q5m for 15m, Mild allergy: If respiration uncompromised, antihistamines and restart
Requires countersign, Assess before, during, & after, Assess site & patency, Use special platelet kit (smaller filter, shorter
tube
Fresh Frozen Plasma Replaces coagulation factors
For DIC, Massive hemorrhage, Extensive burns, shock, Antithrombin III deficiency, Thrombotic thrombocytopenic
purpura, Reverse warfarin effects, Replacement therapy for factors II, V, VII, IX, X, & XI
Adverse effects: Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids), Acute hemolytic rxn (fever, tachycardia,
hypotension): VS Q5m for 15m, Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m,
Anaphylaxis: VS Q5m for 15m IM or IV epinephrine, Mild allergy: If respiration uncompromised, antihistamines and
restart, Circulatory overload: Place upright / O2 and diuretics / slower rate
Requires countersign, Assess before, during & after, Assess site & patency, no mix
Albumin Expands circulating blood volume by oncotic pressure
For Hypovolemia, burns, Adult respiratory distress, Hemolytic disease of the newborn, Cardiopulmonary bypass surgery,
Hypoalbuminemia
adverse effects: Risk for fluid volume excess such as pulmonary edema
Contraindications: CHF, Renal insufficiency
Must administer IV: Slowly using an infusion pump, Can be administered whole blood, plasma, saline, or glucose.

Endocrine Meds

Carbohydrate, fat, and protein metabolism are all affected by diabetes

All people with type 1 diabetes require insulin for management of blood glucose
People with type 2 diabetes require insulin when undergoing surgery, experiencing high levels of physiologic stress (e.g.
infection), and during pregnancy.

Insulin is classified two ways:

1. Type How its made
1. Natural or regular
2. Addition of protein to prolong duration (NPH)

Insulin analogs
1. Lispro and Aspart insulins have shorter durations than Regular insulin
2. Glargine insulin has a longer duration than Regular insulin.

Oral hypoglycemics used for type 2 diabetes when diet/exercise are not enough

Types of insulin:

onset how soon the insulin starts to lower the BG

peak- time the insulin is working the hardest to lower the BG

duration- how long the insulin lasts the length of time it keeps lowering the BG
1. Rapid acting- Lispro (Humalog), Aspart (Novolog) , Glulisine (Apidra)
1. 10-30 min onset 30min-3hr peak 3-4hr duration
1. Warning- due to it's rapid onset, have food ready or ingested when using Humalog or Humulin
2. Lispro can only mix w/ NPH, Lenter, Ultralente
2. Short- acting Regular (Humulin, Novolin ), Velosulin (use in insulin pump)
1. 30 min-1hr onset 2-5hr peak 5-7hr duration
1. regular insulin is the ONLY insulin that can be given IV
2. regular insulin can mix with ALL insulins.
3. intermediate- acting NPH (N)
1. 1.5-4hr onset 4-12hrs peak 18-24hrs duration
4. long-acting Insulin glargine (Lantus), Insulin detemir (Levemir)
0.8-4hr onset minimal peak 10.4-24hrs duration

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Biguanides decrease HEPATIC (liver) glucose formation.

"Metformin (Glucophage)"
It increases peripheral glucose uptake & decreases both basal & postmeal BG
Take it w/ food
mointor LL & KK

LACTIC ACIDOSIS -adverse reaction

hold 24-48 hrs before & after ivy dye
Sulfonylurea agents inhibit K+ channels in BETA CELLS which increases insulin release (3 main drugs)
"Glipizide (Glucotrol)"
take 30 min before meals
KK function
Adverse effects --> HYPOGLYCEMIA, disulfram like effects (GI disturbances)
Avoid NSAIDs (pg 1428 -- all the meds that interact w/ Sulgonylurea agents)
"Glimepiride (Amaryl)"
used as single therapy or in combo w/ Metformin
longer acting
"Micronase (Glyburide)"
Thiazolidinediones Bind to PPAR-Y receptor which eventually increases glucose transport into cell by working on the cell
membrane & improving tissue sensitivity to insulin (2 main drugs)
"Pioglitazone (Actos)"
monitor weight, assess for edema & SOB
full therapeutic response may not be evident for 8-12 wks after therapy
Rosiglitazone (Avandia)"
LL function tests
SERIOUS se of HEART problems (black box warning)
same as above
Alpha- Glucosidase inhibitors stops/delays the breakdown of DISACCHARIDES (disaccharides are normally broken down
to monosccharides so they can be absorbed by the small intestine --> less carbs absorbed means less glucose) (2 main drugs)
"Acarbose (precose)"
Farting (flatulence)
other GI disturbances
take w/ 1st bite of each meal
Acarbose works ONLY when taken at beginning of meal, if not taken, it should not betaken until next meal.
avoid foods that increase GI discomfort
associated w/ elevation in serum transaminease levels (monitor LL function)
"Miglitol (Glyset)" -- same as above
Miglitinide Analogs similar action & adverse effect to Sulfonylureas.
"Nateglinide (Starlix)"
rapidly absorbed & stimulates insulin secretion within 20 min
taken just before meals to control mealtime hyperglycemia & improves overall glycemic control
adverse effect HYPOGLYCEMIA
if skipping meal, also skip dose to reduce risk of hypoglycemia
Incretin Memetics (GLP-1 agonist)
Exenatide (Byetta)
increases insulin secretion by increasing CAMP levels within the cell
decreases glucagon release
Adverse effects PANCREATITIS, GI disturbances
Antithyroid Block thyroid hormone synthesis // Prevent oxidation of Iodine // T 4 T3
propylthiouracil
For Graves disease, Adjunct to thyroid irradiation, Produce euthyroid state prior to thyroid removal, Emergency
thyrotoxicosis treatment
adverse effects: Overmedication hypothyroidism (drowsiness, weight gain, edema, bradycardia, cold intolerance, dry
skin), Agranulocytosis Monitor for early signs (fever, pharyngitis) Tx: Neupogen
contraindications: Marrow depression or immunosuppression
interactions: increases anticoagulant effects
Take at consistent time and with meals (decreases GI distress), Hyperthyroidism may get -adrenergic blocker
(propranolol) to decrease tremors

Radioactive iodine Destroys thyroid cells at high doses

1. For Hyperthyroidism (high dose), Thyroid cancer (high dose), low doses: Thyroid function studies
2. Adverse effects: Marrow suppression (anemia, leukopenia, thrombocytopenia), Radiation sickness: Hematemesis,
epistaxis, intense nausea, vomiting
3. Take on empty stomach, Void frequently // Limit contact to hr/day/person // increase fluids, Dispose of body wastes per
protocol, Avoid coughing and expectorating

Anti-diuretic hormone Promote H2O reabsorption in kidneys (desmopressin preferred), Vasoconstriction due to smooth
muscle contraction (vasopressin)

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vasopressin (Pitressin) desmopressin (DDAVP)

For Diabetes insipidus, cardiac arrest
adverse effects: Overhydration (sleepiness, pounding headache)
contraindications: CAD or decreased peripheral circulation (risk for gangrene)
Monitor site carefully; extravasation can cause gangrene.

SE of Cancer meds:

Bone marrow suppression Avoid crowds, check for bleeding gums

GI discomfort Give antiemetic (ondansetron) with dexamethasone, metoclopramide or granisetron at outset
Alopecia Occur 7-10 days after, persist max of 2 months after
Mucositis Frequent oral care, soft toothbrush, EtOH mouthwash
Reproductive toxicity Sperm banking, Avoid gravid on meds.
Hyperuricemia or high uric acid increase fluids, I&O, Give allopurinol if high uric acid
Extravasation of vesicants such as carmustine, dactinomycin, daunorubicin, and vincristine

Fluid & Electrolyte Meds

High ceiling loop diuretics In upper Loop of Henle to block reabsorption of Na +/Cl-/H2O Extensive diuresis.
Proto: furosemide (Lasix) Others: ethacrynic acid (Edcrin), bumetanide (Bumex), Torsemide (Demadex)
Reserved for conditions unresponsive to other diuretics (e.g. edema d/t liver, cardiac or renal disease; hypertension), Works
well with renal impairment
adverse effects: Dehydration (output < 30 mL/hr), Hypotension,, hypokalemia, Hyperglycemia, hyperuricemia,
interactions: Digoxin toxicity r/t increase K+, , NSAIDs blunt diuretic effect, Antihypertensives Additive hypotensive
effect
Daily weights, Infuse slowly (20 mg/min), increase K+ foods (avocado, strawberry, banana, potato, spinach, tomato, meat,
carrots), decreased Mg2+ signs: muscle twitch and tremor
Thiazide Diuretics In early DCT to block Na+/Cl-/H2O reabsorption promote diuresis when renal function is not impaired.
1. hydrochlorothiazide (HydroDIURIL) chlorothiazide (Diuril), indapamide
2. For 1st choice essential hypertension, Edema of mild-to-moderate heart failure and liver/kidney disease.
3. Adverse effects: Dehydration, hypokalemia, hyperglycemia
4. same as above
K+ sparing diuretics Block aldosterone action resulting in K+ retention and Na+/H2O excretion.
1.
spironolactone (Aldactone) triamterene (Dyrenium), amiloride (Midamore)
2. Combined with other diuretics for K+-sparing effect, HF, Blocks aldosterone in hyperaldosteronism
3. adverse effects: Hyperkalemia (insulin injection drives K+ back into cell), Endocrine effects: Irregular menses or impotence
4. interactions: ACE inhibitors (lisinopril) hyperkalemia,
5. Triamterene may color urine blue
Osmotic diuresis increase blood osmolality thus attracting fluid (e.g. 3 rd spacing, CSF, intraocular)
1.
mannitol (Osmitrol) urea, glycerin, isosorbide
2. For decreased ICP, Prevent renal failure in hypovolemic shock or severe hypotension., Promote Na + retention and H2O
excretion in hyponatremia and fluid V excess
3. Adverse effects: Heart failure / pulmonary edema, Renal failure (urine < 30 mL/hr, creatinine > 1.2 mg/dL, BUN > 20
mg/dL
4. contraindications: Lasix complements through renal excretion of fluid drawn by osmotics.
5. Most effective given as a bolus, Use filter to prevent crystals, Monitor serum osmolarity and every 6 hours / urine
osmolarity daily
Sodium Polystyrene (Kayexalate) Promotes K+ excretion and Na+ absorption, primarily in large intestine
1. Treat hyperkalemia
2. adverse effects: Electrolyte (Ca2+, K+, Na+, Mg2+) imbalance
3. interactions: Ca2+- or Mg2+-containing antacids or laxatives may decrease efficacy, Digoxin and K+-sparing diuretics should
undergo frequent K+ monitoring
4. Given orally or rectally, Mix with juice, Retain enema for 30-60 minutes; irrigate non-Na +-containing solution
Sodium bicarbonate Systemic alkalinizer used to correct metabolic acidosis (pH < 7.35)
K+ supplements
1.
Potassium Chloride (K-Dur) K+ gluconate, K+ phosphate, K+ bicarbonate
2. Never give IV push, Use infusion pump, Assess site for irritation, phlebitis, infiltration d/c immediately if present, Dilute
to no more than 40 mEq/L || give no faster than 10 mEq/hr.

Reproductive System Drugs

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Oxytocics increase strength, frequency, and duration of uterine contractions

1. oxytocin (Pitocin), methylergonovine (Methergine)
2. For: Methergine: Emergency intervention for serious postpartum hemorrhage, Oxytocin: Labor induction or

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enhancement // Delivery of afterbirth // Control of postpartum bleeding // Fetal stress testing // Milk letdown
(intranasal)
3. Adverse effects: Methergine: Hypertensive crisis (IV): Headache, nausea, BP, Oxytocin: Uterine rupture {Relax
myometrium Mg(SO4)}
4. Contraindications: Methergine: Hypertension, Cardiovascular, renal, or hepatic failure. Oxytocin: unripened cervix,
Hx of multiples, uterine surgery // immature lungs, cephalopelvic disproportion, prolapsed umbilical cord, fetal
distress.
5. Use infusion pump and gradually increase rate, contractions longer than 60 sec, freq > q 2-3 min STOP infusion
Tocolytic Selectively activates 2-adrenergic receptors uterine smooth muscle relaxation
1. Terbutaline sulfate (Brethine), magnesium sulfate, ritodrine
2. For: Delay of preterm labor
3. adverse effects: Tremors, anxiety, headache ( 2 skeletal muscle side effects), Tachycardia, palpitations, chest pain ( 1
side effects)
Oral contraceptives decrease fertility by inhibiting ovulation, thickening cervical mucous, and making lining of
endometrium less favorable to implantation.
1. Ovcon 35 Necon, ortho-novum
2. Prevent pregnancy
3. adverse effects: Hypertension, Thromboembolic events, Breakthrough or abnormal uterine bleeding, Cervical cancer
4. Take for 21 days followed by 7 days with no drug, 1 missed dose: Take 2 next time / 2 missed doses: double-up x 2
days

Maternity meds

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Rh (D) immune Globulin (RhoGAM)

prevention of anti-RH (D) antibody formation is most successful if the med is adminsitred 2x at 28 wks of gestation &
again within 72hrs after delivery
Use : to prevent isoimmunization in RH-negative p/ts who are exposed or potentially exposed to Rh-positive red blood
cells by transfusion, termination of pregnancy, amniocentesis, chorionic villus sampling, abdominal trauma, or bleeding
during pregnancy or bith process
adverse effects/contranindications: elevated temp, tenderness at injection site, contraindicated for Rh-positive p/ts,
contraindicated in p/ts w/ hx of systemic allergic rxs to preparationscontaining human immunioglobulins, not adminstered
to a newborn.
Adminster via IM never IV monitor injection site for tenderness & elevated temp.
this drug does not benefit if p/t has already develiped a positive antibody titer to the Rh antigen
Tocolytics Anti-contraction labor repressants
they produce uterine relaxation & suppress uterine activity in an attempt to halt uterine contractions & prevent preterm
birth
adverse effects/contraindications: (maternal contraindications) severe preeclampsia & eclampsia, active vaginal bleeding,
intrauterine infection, cardiac disease, & medical or obstetric condition that contraindicates continuation of pregnancy.
(fetal contraindications) estimated gestational age greater than 37 wks, cervical dilation greater than 4 cm, fetal demise,
lethal fetal anomaly, chorioamnionitis, acute fetal distress.
Interventions position p/t on side, monitor daily wt & I & O
Indomethacin (indocin): prostglandin inhibitor, relaxes uterine smooth MM.
1. Adverse effects N/V, dyspepsia, dizziness
2. used when other methods fail only if gestational age is <32 wk
Magnesium Sulfate: CNS depressant; relaxes smooth MM. Used for preeclamptic p/ts to prevent seizures.
1. Adverse effects- depressed respirations & DTRs, hypotension, extreme MM weakness, flushing, low UOP, pulmonary
edema
2. use IV controller pump for adminstration
Nifedipine (procardia, adalat, Nifedical): Ca channel blocker; relaxes smooth MM by blocking Ca entry.
1. Adverse effects tachycardia, hypotension, dizziness, headache , nervousness, facial flushing, fatigue, nausea
2. follow agency protocol for admin.
Terbutaline (brethine): B-adrenergic agonist; relaxes smooth MM by inhibiting uterine acticity & causing bronchodilation.
1. Adverse effects tachycardia, palpitations, pulmonary edema, chest pain, myocardial ischemia, hypotension, termors,
hypokalemia, hyperglycemia
2. monitor & report adverse rx
Betamethasone & Dexamethasone
corticosteroids that increase the production of surfactant to accelerate fetal lung maturity & reduce the incidence or
severity of respiratory distress syndrome.
Uterine stimulants (oxytocics): Ocytocin (Pitocin)
oxytocin stimulates the smooth MM of the uterus & increases the force, frequency, & duration of uterine contractions.
Used to induce labor.
Ergot alkaloids:
ergonvoine maleate or ergometrine (ergotrate Maleate) & methylergonovine maleate (methergine)
Directly stimulate uterine MM, increase force & frequency of contractions, & produce a firm tetanic contraction of the

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Can produce arterial vasoconstriction & vasospasm of the coronary arteries; not admin before the delivery of the placenta,;
check BP before admin an ergot alkaloid can cause sever hypertension
Rubella vaccine:
sub Q before hospital discharge to a nonimmune pospartum p/t
admin if rubella titer is less than 1:8
contraindicated in a p/t w/ an allergy to duck eggs
don't get pregnant 1-3 months after immunization
PEDIATRICS
Most oral ped meds are in liquid or suspension form b/c usually they are unable to swallow a tab
Conversion by body wt:
1 lb = 16oz
I kg = 2.2 lb

Respiratory meds (PEDS)

Quick relief (Rescue meds)
1. Short acting B2 agonists (for bronchodilation)
2. Anticholinergics (for relief of acute bronchospasm)
3. Systemic corticosteriods (for anti-inflammatory action to treat reversible airflow obstruction)

Long term control (preventer meds)

1. corticosteroids
2. antiallergic meds
3. NSAIDs
4. long acting B2 agonists
5. leukotriene modifers
monoclonal antibody