ATI Pharm Mega File

281 terms by robert_bowman

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The combined A/B + drugs, should be all needed

Diazepam (Valium)

Benzodiazepine
Muscle relaxant, antispasmodic, sedative (enhances GABA)
Treats anxiety disorders, muscle spasms, alcohol withdrawal
Side effects: CNS depression, amnesia,, respiratory depression
Physical dependence - do not d/c abruptly
Avoid other CNS depressants
Antidote: flumazenil (Romazicon)
Taper dose to d/c

Buspirone (BuSpar)

Treats anxiety disorders
Abuse less likely than other anxiolytics
No sedation
Does not potentiate other CNS depressants
Dizziness, nausea
Caution w/ liver or renal disease
Do not use w/in 14 days of MAOIs (hypertensive crisis)
May take weeks for full effect
Do not take w/ erythromycin, grapefruit juice

Paroxetine (Paxil)

SSRI (anxiety)
Prevents serotonin reuptake
Causes CNS stimulation (can cause insomnia)
Early: nausea, tremor, fatigue
Later: sexual dysfunction
Hyponatremia
Serotonin syndrome
Bruxism
GI bleeding
Taper slowly to d/c
Do not take w/ MAOIs or TCAs (serotonin syndrome)
Take in the morning, takes several weeks for full effects, take w/ food for GI effects

Amitriptyline (Elavil)

Tricyclic antidepressant (TCA)
Blocks NE, serotonin reuptake
Used for depression, migraines
Can cause orthostatic hypotension, anticholinergic effects, sedation, cardiac toxicity, decreased seizure threshold, sweating
Avoid St. John's wort (serotonin syndrome, antihistamines, anticholinergics, alcohol, CNS depressants, MAOIs

Fluoxetine (Prozac)

SSRI (depression)
Can cause sexual dysfunction, CNS stimulation, weight loss/gain, serotonin syndrome, withdrawal syndrome, hyponatremia, bruxism, rash, fatigue, GI bleeding
Do not take w/ MAOIs or TCAs, St. John's wort, lithium
Caution w/ Coumadin, NSAIDs (suppresses platelet aggregation)
Take in the morning, takes several weeks for full effects, take w/ food for GI effects

Phenelzine (Nardil)

MAOI (increases NE, dopamine, serotonin)
Treats depression, bulemia, OCD
Can cause CNS stimulation, orthostatic hypotension, cheese effect, local rash (transdermal)
Do not take w/ SSRIs, caution w/ TCAs

Bupropion HCl (Wellbutrin)

Atypical antidepressant
Inhibits dopamine uptake
Can cause anticholinergic effects, seizures, suppress appetite
Avoid MAOIs

Lithium

Mood stabilizer
Used for bipolar disorder
Blocks serotonin receptors, decreases neuronal atrophy/increases neuronal growth
Can cause GI distress, fine hand tremors, polyuria and thirst, weight gain, renal toxicity, goiter and hypothyroidism, bradydysrhythmias, hypotension, electrolyte imbalance
Early toxicity: N/V/D, thirst, polyuria, muscle weakness, slurred speech
Low Na increases toxicity
NSAIDs increase toxicity
Avoid anticholinergics
Normal level 0.4-1.0mEq/L (toxicity > 1.5)

Carbamazepine (Tegretol)

Antiepileptic (also for bipolar, trigeminal neuralgia) (not for absence seizures)
Can cause blood dyscrasias (bleeding, bone marrow suppression), promotes ADH (edema, fluid overload), Stevens-Johnson
Hepatic autoinducer (alternate birth control, increase warfarin dosage)
Grapefruit juice (toxicity)
Phenytoin and phenobarbital decrease effects

Valproic acid (Depakote)

Antiepileptic (also bipolar)
Can use for absence seizures
Can cause N/V, hepatotoxicity, pancreatitis, thrombocytopenia
Increases levels of phenytoin and phenobarbital

Lamotrigine (Lamictal)

Antiepileptic (also bipolar)
Can cause double or blurred vision, Stevens-Johnson
Effect decreased by carbamazepine, phenytoin, phenobarbital
Half-life increased by valproic acid

Chlorpromazine (Thorazine)
Haloperidol (Haldol)

Conventional antipsychotic (positive symptoms)
Block dopamine, ACh, NE, histamine
Can cause:
Acute dystonia (treat w/ anticholinergics - benztropine/Cogentin or Benadryl) - EARLY
Parkinsonism (treat w/ antcholinergics or amantadine)
Akathisia (beta blocker, benzodiazepine, anticholinergic)
EPS or tardive dyskinesia - LATE
Neuroleptic malignant syndrome (d/c, antipyretics, Valium, dantrolene)
Anticholinergic effects, orthostatic hypotension, sedation, gynecomastia, seizures, sexual dysfunction, photosensitivity, agranulocytosis, dysrhythmias

Risperidone (Risperdal)
(Seroquel, Abilify, clozapine)

Atypical antipsychotic (positive and negative symptoms)
Block serotonin, some dopamine, NE, ACh, histamine
Can cause DM or loss of glucose control, weight gain, hypercholesterolemia (esp. olanzapine, clozapine)
Orthostatic hypotension, anticholinergic effects, agitation, tremors
Seroquel - cataracts, eye exam q 6 months
Clozapine - agranulocytosis
Contraindicated w/ dementia
Risk for stroke

Methylphenidate (Ritalin)
Amphetamine (Adderall)

CNS stimulant (increases NE, serotonin, dopamine)
Used for ADHD
Causes CNS stimulation, weight loss, CV effects, psychosis
Do not d/c suddenly
Avoid MAOIs (htn), caffeine (CNS stimulation), OTC cough and cold (sympathomimetic)
Increases levels of Coumadin

Atomoxetine (Strattera)

NSRI (not a stimulant) (blocks NE reuptake)
Used for ADHD
Minimal side effects - weight gain, N/V, hepatotoxicity
Caution w/ heart disease
Avoid MAOIs (htn)

Meds to aid w/ alcohol detox

Benzodiazepines (maintain vitals, decrease seizures, decrease symptom intensity)
Carbamazepine (seizures)
Clonidine (decreased ANS response)
Propranolol (decreased cravings, ANS response)
Disulfiram (Antabuse) - maintenance
Naltrexone (ReVia) - suppresses cravings, pleasurable effects of alcohol
Acamprosate (Campral) - decreased anxiety, restlessness

Meds to aid opioid withdrawal

Methadone (Dolophine) - transfers dependence to methadone, then wean off
Clonidine (decreased ANS effects, does NOT reduce cravings)
Buprenorphine, combine w/ naloxone - detox and maintenance, may decrease cravings

Meds to aid nicotine withdrawal

Bupropion (Zyban) - decreases cravings and withdrawal symptoms
Nicotine replacement (gum, patch)

Neostigmine (Prostigmin)

Cholinesterase inhibitor (cholinergic agonist)
Treats myasthenia gravis
Reverse neuromuscular blockade
Cholinergic side effects
Antidote: atropine

Levodopa/carbidopa (Sinemet)

Parkinson's (dopaminergic)
Can cause N/V, dyskinesias, orthostatic hypotension, CV stimulation, psychosis, discolored sweat/urine
Do not use w/ MAOIs
Proteins interfere w/ absorption

Pramipexole (Mirapex)

Parkinson's (dopamine agonist)
Can cause drowsiness, orthostatic hypotension, psychosis, dyskinesias, nausea
Allows for lower dose of levodopa
Caution w/ liver or kidney impairment

Benztropine (Cogentin)

Parkinson's (anticholinergic) (blocks ACh)
Can cause N/V, anticholinergic effects, antihistamine effects
Contraindicated w/ narrow-angle glaucoma

Amantidine (Symmetrel)

Parkinson's (dopamine releaser)
Antiviral
Can cause confusion, dizziness, anticholinergic effects, discoloration of skin

Phenobarbital (Luminal)

Barbiturate
Can be used for epilepsy
Can cause CNS depression

Phenytoin (Dilantin)

Hydantoin (antiepileptic)
Can cause gingival hyperplasia, hirsutism, phlebitis, speed shock, sedation, double vision, dysrhythmias, hypotension
Decreases effects of contraceptive, Coumadin, glucocorticoids
Avoid alcohol, Valium, Tagamet, CNS depressants

Gabapentin (Neurontin)

Antiepileptic
Can be used for neuropathy pain
Can cause drowsiness, nystagmus, edema

Succinylcholine (Anectine)

Neuromuscular blocking agent (depolarizing)
Fills ACh receptors and causes sustained depolarization
Reversal agent: Pseudocholinesterase enzyme
Monitor for respiratory arrest, hypotension
Watch for signs of malignant htn (administer dantrolene)
Monitor for hyperkalemia

Pancuronium (Pavulon)

Neuromuscular blocking agent (non-depolarizing)
Blocks ACh binding and inhibits depolarization
Reversal agent: neostigmine

Cyclobenzaprine (Flexeril)

Muscle relaxant/antispasmodic
Enhances GABA
Used for muscle spasms due to injury
Causes CNS depression
Physical dependence - do not d/c abruptly

Baclofen (Lioresal)

Muscle relaxant
Enhances GABA
Used for cerebral palsy, SCI, MS
Causes CNS depression, nausea, constipation, urinary retention
Do not d/c abruptly

Dantrolene (Dantrium)

Muscle relaxant (peripherally acting)
Inhibits muscle contraction by preventing Ca release in skeletal muscles
Used for cerebral palsy, SCI, MS, malignant hyperthermia
Causes CNS depression, hepatotoxicity, muscle weakness

Bethanechol (Urecholine)

Muscarinic (cholinergic) agonist
Used for urinary retention
Causes cholinergic side effects (SLUDGE)
Take on empty stomach

Oxybutinin (Ditropan)
Tolterodine (Detrol)

Muscarinic (cholinergic) antagonist
Used for overactive bladder
Causes anticholinergic effects
Avoid antihistamines, TCAs, phenothiazines

Zolpidem (Ambien)

Sedative-hypnotic (non-benzodiazepine)
Enhance GABA
Can cause daytime sleepiness
Low risk of abuse, tolerance, dependence
Avoid CNS depressants

Ramelteon (Rozerem)

Melatonin agonist
Used for insomnia
Can cause sleepiness, hormonal effects (amenorrhea, decreased libido, infertility, galactorrhea)
Take on empty stomach (fat decreases absorption)
Avoid CNS depressants

IV anesthetics

Barbiturate: thiopental (Pentothal)
Benzodiazepines: midazolam (Versed), diazepam (Valium)
Other: propofol (Diprivan), ketamine (Ketalar)
Opioid: Fentanyl (Sublimaze)
Can cause respiratory depression, CV depression, high risk for hypotension
Propofol: bacterial infection
Ketamine: hallucinations

Albuterol (Proventil, Ventolin)

Beta-2 agonist
Inhaled = short-acting, oral = long-acting
Rescue or maintenance (asthma)
Minimal adverse effects of inhaled
Oral can cause tachycardia and angina (alpha-1), tremors (beta-2 in skeletal muscle)
Beta blockers will cancel effects
MAOIs and TCAs increase risk of tachycardia and angina
Use before using glucocorticoid inhaler

Salmeterol (Serevent)

Beta-2 agonist
Long term maintenance for asthma

Theophylline (Theolair)

Methylxanthine
Used for long-term control of asthma
Therapeutic range: 5-15mcg/mL
Early toxicity: GI distress, restlessness
Late toxicity: dysrhythmias, seizures
Caffeine increases theophylline levels
Phenobarbital and phenytoin decrease levels
Tagamet and fluoroquinolones increase levels

Ipratropium (Atrovent)
Tiotropium (Spiriva)

Inhaled anticholinergic
Used for COPD, asthma
Cause anticholinergic effects
Contraindicated w/ peanut allergy
Caution w/ narrow-angle glaucoma and BPH

Beclomethasone diproprionate (QVAR)
(Pulmicort, Advair, Flovent)

Inhaled glucocorticoid
Maintenance for asthma
Can cause candidiasis

Prednisone (Deltazone)
(Prednisolone)

Oral glucocorticoid
Long term use can cause suppression of adrenal gland function, bone loss, hyperglycemia, myopathy, PUD, infection, edema, hypokalemia
Caution w/ K-wasting diuretics
Avoid NSAIDs (GI bleeds)
Must increase insulin or oral hypoglycemic doses

Hydrocortisone sodium succinate (Solu-Cortef)
Methylprednisone sodium succinate (Solu-Medrol)

IV glucocorticoids

Cromolyn sodium (Intal)

Anti-inflammatory (mast cell stabilizer)
Inhibits release of histamine
Used for chronic asthma, allergic rhinitis
Safest of all asthma meds

Montelukast (Singulair)

Leukotriene modifier
Long term asthma therapy
Take once daily at bedtime (oral)

Codeine

Opioid antitussive
Can cause drowsiness, respiratory depression, GI distress
Has potential for abuse
Avoid CNS depressants
Contraindicated w/ asthma, head trauma, liver/renal dysfunction, acute alcoholism

Dextromethorphan

Antitussive
Mild nausea, dizziness, sedation
Small potential for abuse
May cause high fever w/in 2 weeks of MAOIs

Guaifenesin (Mucinex)

Expectorant
Can cause GI upset, drowsiness, rash
Should increase fluid intake

Acetylcysteine (Mucomyst)

Mucolytic
Antidote for Tylenol poisoning
Used in CF, pulmonary diseases w/ lots of secretions
Can cause aspiration and bronchospasm (oral)
Smells like rotten eggs (mix w/ syrupy drink)

Phenylephrine

Decongestant
Alpha-1 agonist
Used for allergic rhinitis, common cold
Can cause rebound congestion w/ topical agents (faster, shorter duration)
Can cause CNS stimulation (rare)
Causes vasoconstriction (caution w/ htn, CAD)

Diphenhydramine (Benadryl)
Promethazine (Phenergan)

Antihistamine (1st generation)
Used for allergies, anaphylaxis, motion sickness, insomnia
Can cause sedation, anticholinergic effects, GI discomfort
Avoid CNS depressants

Loratidine (Claritin)
(Zyrtec, Allegra)

Antihistamine (2nd generation)
Non-sedating

Furosemide (Lasix)

Loop diuretic
Block Na and Cl reabsorption in ascending loop
Can be used w/ renal impairment
Used for pulmonary edema, edema caused by liver/cardiac/kidney disease, htn
Also used for hypercalcemia related to kidney stone formation
Can cause dehydration, hyponatremia, hypochloremia, hypotension, ototoxicity, hypokalemia (and hyperglycemia, hyperuricemia, decreased Ca and Mg)
Can cause dig toxicity due to hypokalemia, lithium toxicity due to hyponatremia
Antihypertensives have additive effect
NSAIDs reduce diuretic effect
Daily weights and I/O
Take early in the day

Hydrochlorothiazide (Hydrodiuril)

Thiazide diuretic
Blocks Na and Cl reabsorption in distal convoluted tubule
Cannot use w/ impaired renal function
Used for essential htn, edema of CHF/liver/kidney disease
Can cause dehydration, hypokalemia, hyperglycemia
Can cause dig toxicity due to hypokalemia, lithium toxicity due to hyponatremia
Antihypertensives have additive effect
NSAIDs reduce diuretic effect
Take early in the day

Spironolactone (Aldactone)

K-sparing diuretic
Blocks aldosterone (K retention, Na and water excretion)
Combined w/ other diuretics for K-sparing effects
Used for CHF, primary hyperaldosteronism
Can cause hyperkalemia, menstrual irregularities, impotence
Do not use w/ severe renal failure or anuria
Risk of hyperkalemia w/ ACE inhibitors, K supplements

Mannitol (Osmitrol)

Osmotic diuretic
Draws fluid into vascular space
Used for cerebral edema and to reduce intraocular pressure
Can cause heart failure, renal failure, fluid and electrolyte imbalances
IV infusion using filter needle (crystallization)

Captopril (Capoten)

ACE inhibitor
Blocks angiotensin II production causing vasodilation, Na/water loss, K retention, reduction of cardiac remodeling
Used for htn, CHF, MI, nephropathy
Ramipril to prevent MI,, stroke, death
Can cause first dose orthostatic hypotension, cough (bradykinin), hyperkalemia, rash and altered taste, angioedema, neutropenia
Can increase levels of lithium
NSAID use may decrease effects

Losartan (Cozaar)

ARB
Blocks action of angiotensin II causing vasodilation, Na/water loss, K retention
Used for htn, CHF, following MI, stroke prevention, nephropathy
No cough or hyperkalemia

Nifedipine (Procardia)

CCB
Blocks Ca channels (arterioles)
Used for angina, htn
Can cause reflex tachycardia, peripheral edema
Toxicity: administer Ca
Beta blockers can reduce reflex tachycardia
Grapefruit juice increases toxicity

Verapamil (Calan)
Diltiazem (Cardizem)

CCB
Block Ca channels (arterioles and heart)
Used for angina, htn, dysrhythmias, migraines
Can cause orthostatic hypotension, peripheral edema, constipation, bradycardia, HF, dysrhythmias
Toxicity: administer Ca
Can increase dig levels
Stagger beta blockers to avoid HF, AV block, bradycardia
Grapefruit juice increases toxicity

Prazosin (Minipress)

Alpha-1 blocker (sympatholytic)
Causes venous and arterial dilation, prostatic and bladder muscle relaxation
Used for primary htn, BPH
Can cause first dose orthostatic hypotension
Avoid NSAIDs (may decrease anti-htn effects)

Clonidine (Catapres)

Alpha-2 agonist (centrally acting)
Decreases sympathetic outflow
Used for primary htn, migraine, ADHD, alcohol withdrawal
Can cause sedation, dry mouth, rebound htn
Do not d/c abruptly
Contraindicated w/ anticoagulants
Do not use w/ prazosin, MAOIs, TCAs, CNS depressants
Twice daily dosing w/ larger dose at bedtime

Metoprolol (Lopressor)

Cardioselective beta-1 blocker
Decreased ino- chron- dromotrope
Used for htn, angina, tachydysrhythmias, HF, MI
Also used for hyperthyroidism, migraines, stage fright, pheochromocytoma, glaucoma
Can cause bradycardia, decreased CO, AV block, orthostatic hypotension
Do not d/c abruptly

Propranolol (Inderal)

Nonselective beta blocker
Used for htn, angina, dysrhythmias, migraines
Causes bronchoconstriction - avoid w/ asthma
Can cause fatigue, bradycardia, hypotension
Inhibits glycogenolysis (hypoglycemia, symptoms may be masked)
Take w/ food to increase absorption

Nitroprusside (Nitrostat)

Vasodilator
Used for hypertensive emergencies
Can cause hypotension, cyanide poisoning
Do not administer in same infusion w/ other meds, may be light brown color, protect from light

Digoxin (Lanoxin)

Cardiac glycoside
Positive inotrope, negative chronotrope and dromotrope
Used for HF, a-fib
Can cause dysrhythmias, bradycardia, GI effects (EARLY), vision changes (EARLY)
Hypokalemia = toxicity; hyperkalemia = decreased effects
Avoid verapamil
Hold if pulse < 60
Therapeutic level = 0.5-2.0ng/mL
Antidote: cholestyramine or Digibind
Interacts w/ many meds

Epinephrine (Adrenaline)

Adrenergic agonist (catecholamine)
Alpha-1, beta-1, beta-2
Slows absorption of anesthetics, manages superficial bleeding, decreased nasal congestion, increased BP, treatment of AV bock and cardiac arrest
Can cause htn, dysrhythmias, angina
Avoid MAOIs (prolong effects) ,TCAs
General anesthetics can cause dysrhythmias
Beta blockers block action at beta receptors
Use an IV pump, titrate dose
Antidote: Phentolamine

Dopamine (Intropin)

Adrenergic agonist (catecholamine)
Low dose: dopamine (renal blood vessel dilation)
Moderate: dopamine, beta-1
High: dopamine, beta-1, alpha-1 (vasoconstriction)
Used for shock, HF
Can cause dysrhythmias, angina, necrosis w/ extravasation
Diuretics promote beneficial effects of dopamine

Dobutamine (Dobutrex)

Adrenergic agonist (catecholamine)
Beta-1
Used for HF
Can cause increased HR

Nitroglycerin

Organic nitrate
Dilates veins and decreases venous return
Used for angina
Can cause headache, orthostatic hypotension, reflex tachycardia
Tolerance can develop
Contraindicated w/ head injury
Avoid alcohol, Viagra
Cautions w/ anti-htn meds

Ranolazine (Ranexa)

Antianginal
Lowers cardiac oxygen demand
Used for angina in combination w/ amlodipine (Norvasc), a beta blocker, or an organic nitrate
Can cause QT prolongation, elevated BP
Avoid grapefruit juice, HIV protease inhibitors, macrolides, azole antifungals, verapamil
Can increase levels of dig and simvastatin

Procainamide (Pronestyl)
Quinidine

Anti-dysrhythmic
Can cause SLE, neutropenia, QT prolongation, hypotension

Lidocaine (Xylocaine)

Anti-dysrhythmic, local anesthetic
Can cause drowsiness, seizures, respiratory arrest, hypotension, cardiosuppression

Propafenone (Rythmol)

Anti-dysrhythmic
Can cause bradycardia, HF, dizziness

Amiodarone (Cordarone)

Anti-dysrhythmic
Can cause pulmonary toxicity, sinus bradycardia, AV block, visual disturbances, liver and thyroid dysfunction, GI effects, phlebitis, hypotenson

Adenosine (Adenocard)

Anti-dysrhythmic
Causes transient asystole
Used to convert SVT to normal sinus rhythm
Can cause sinus bradycardia, hypotension, dyspnea, facial flushing
Rapid IV push followed by saline bolus
Half life of 8-10 seconds

Gemfibrozil (Lopid)

Antilipemic (fibrate)
Decreased triglycerides, increases HDL
Can cause GI distress, gallbladder stones, myopathy, hepatotoxicity
Increases risk of bleeding w/ Coumadin
Take 30 min before breakfast and dinner

Atorvastatin (Lipitor)

Antilipemic (HMG CoA reductace inhibitor)
Decrease LDL, increase HDL
Protects against MI and stroke in diabetics
Can cause hepatotoxicity, myopathy, peripheral neuropathy
Rosuvastatin: avoid in Asians
Risk of rhabdo w/ fibrates, ezetimibe
Grapefruit juice can increase levels
Take in evening

Ezetimibe (Zetia)

Antilipemic (cholesterol absorption inhibitor)
Help lower LDL w/ modified diet
Can combine w/ statin
Can cause hepatitis, myopathy
Levels increased w/ cyclosporine

Colesevelam (WelChol)
Colestyramine (Questran)

Antilipemic (bile-acid sequesterants)
Decrease LDL
Can cause GI distress, decreased absorption of fat-soluble vitamins, constipation
Take other meds 1 hour before or 4 hours after
Take w/ food or add powder to 4-8oz fluid

Niacin

Antilipemic
Decrease LDL and triglyerides
Can cause GI distress, facial flushing, hyperglycemia, hepatoxicity, hyperuriemia
Take aspirin 30 minutes prior to prevent flushing

Heparin
Enoxaparin (Lovenox)

Anticoagulant
Inhibits formation of fibrin
Used to prevent clotting (stroke, DVT, PE, prophylaxis, DIC)
Must be given IV or subQ
Can cause hemorrhage, heparin-induced thrombocytopenia (HIT)
Antidote: protamine sulfate
Avoid aspirin, NSAIDs
Monitor aPTT (60-80 seconds)

Warfarin (Coumadin)

Anticoagulant
Antagonizes vitamin K
Used for DVT, a-fib or prosthetic heart valves, prevention of MI or stroke
Can cause hemorrhage, hepatitis
Antidote: vitamin K
Monitor INR (2-3)

Aspirin (Ecotrin)

Antiplatelet
Used to prevent MI, stroke
Can cause GI effects, hemorrhagic stroke, prolonged bleeding, tinnitus
Do not give to children or adolescents
Avoid NSAIDs, anticoagulants
May decrease action of beta blockers
Corticosteroids may decrease aspirin effects and increase risk for GI bleed
Caffeine may increase absorption

Abciximab (ReoPro)

Antiplatelet
Used to prevent MI, stroke
Used in acute coronary syndromes
Can cause hypotension, bradycardia, prolonged bleeding
Avoid NSAIDs, anticoagulants

Clopidogrel (Plavix)

Antiplatelet
Used to prevent MI, stroke
Can cause prolonged bleeding
Avoid NSAIDs, anticoagulants

Pentoxifylline (Trental)

Antiplatelet
Used to prevent MI, stroke
Used for intermittent claudication
Can cause N/V
Avoid anticoagulants
May increase levels of theophylline

Streptokinase (Streptase)
Alteplase (Activase, tPA)

Thrombolytic
Dissolves clots that have already formed
Used for acute MI, DVT, PE, ischemic stroke (alteplase)
Can cause serious risk of bleeding, hypotension, allergic reaction
Avoid NSAIDs, anticoagulants
Must be used w/in 4-6 hours of onset
Continuous monitoring
Antidote: aminocaproic acid (Amicar)

Epoetin alfa (Epogen)

Erythropoietic growth factor
Used for anemia w/ chronic renal failure, chemo
Can cause htn (elevated Hct), increased risk of stroke or MI (Hgb > 12)

Filgrastim (Neupogen)

Leukopoietic growth factor
Used for neutropenia (cancer)
Can cause bone pain, leukocytosis (WBC > 100,000)

Sargramostim (Leukine)

Granulocyte macrophage CSF
Stimulates bone marrow to produce WBCs
Used after bone marrow transplant
Can cause diarrhea, weakness, malaise, bone pain, leukocytosis, thrombocytosis
d/c for ANC > 20,000, WBC > 50,000, platelets > 500,000

Oprelvekin (Neumega, Interleukin -11)

Thrombopoietic growth factor
Used during chemotherapy
Can cause fluid retention, dysrhythmias, blurred vision, allergic reaction

Ranitidine (Zantac)
Cimetidine (Tagamet)
Famotidine (Pepcid)

H2 receptor antagonist
Used for PUD, GERD
Combine w/ antibiotics for H. pylori
Tagamet may decrease libido and cause impotence; may cause lethargy, depression, confusion in older adults; may increase levels of warfarin, phenytoin, theophylline, lidocaine
May promote bacterial colonization due to decreased gastric acidity
Do not take antacids w/in one hour

Omeprazole (Prilosec)

Proton pump inhibitor
Inhibits enzyme that produces gastric acid
Used for PUD, GERD
Insignificant side effects w/ short term treatment
Long term use increases risk of gastric cancer and osteoporosis
May increase levels of dig
Take once a day prior to eating in the morning
Monitor for GI bleeding

Sucralfate (Carafate)

Mucosal protectant
Coats and protects ulcer (up to 6 hours)
Used for duodenal ulcers
Increase fiber and fluids to prevent constipation
No systemic effects
May interfere w/ absorption of phenytoin, dig, warfarin, cipro
Antacids interfere w/ absorption
Take on empty stomach (one hour before meals and bedtime)

Aluminum hydroxide (Amphojel)

Antacid
Neutralize gastric acid
Used to treat PUD, relieve GERD symptoms
Al and Ca can cause constipation
Mg can cause diarrhea, toxicity w/ renal impairment
Na results in fluid retention
Aluminum hydroxide can lead to hypophosphatemia
Al compounds bind to warfarin and tetracycline
Take w/ 8 oz water or milk
Take other meds one hour before or after

Misoprostol (Cytotec)

Prostaglandin E analog
Used w/ NSAIDs to prevent gastric ulcers
Can induce labor
Can cause diarrhea, abdominal pain, dysmenorrhea, spotting
Take w/ meals and at bedtime

Dexamethasone (Decadron)

Glucocorticoid
Antiemetic used for chemo-induced N/V

Aprepitant (Emend)

Substance P antagonist
Combine w/ glucocorticoid or serotonin antagonist
Has extended duration of action
Can cause fatigue, diarrhea, dizziness, liver damage

Ondansetron (Zofran)

Serotonin antagonist
Used for emesis related to chemo, radiation, postop
Can cause headache, diarrhea, dizziness

Prochlorperazine (Compazine)
Metoclopramide (Reglan)
Promethazine (Phenergan)

Dopamine antagonist
Used for emesis related to chemo, opioids, postop
Can cause EPS (admin Benadryl), hypotension, sedation, anticholinergic effects

Dronabinol (Marinol)

Cannabinoid
Used for chemo N/V and as an appetite stimulant in AIDS
Can cause dissociation/dysphoria, hypotension, tachycardia

Scopolamine (Transderm Scop)

Anticholinergic
Used for motion sickness
Can cause sedation, anticholinergic effects

Dimenhydrinate (Dramamine)
Hydroxyzine (Vistaril)

Antihistamine
Used for motion sickness
Can cause sedation, anticholinergic effects

Psyllium (Metamucil)

Bulk-forming laxative
Softens fecal mass and increases bulk

Docusate sodium (Colace)

Surfactant laxative
Lower surface tension of stool to allow water in
Used for constipation during pregnancy, from opioid use, w/ hemorrhoids

Bisacodyl (Dulcolax)

Stimulant laxative
Stimulates peristalsis
Used for colooscopy prep, short term use for constipation

Magnesium hydroxide (Milk of Magnesia)

Osmotic laxative
Draw water into the intestine
Low dose - to prevent painful elimination (hemorrhoids)
High dose - for colonoscopy pre
Also used for rapid evacuation after poisoning or helminth therapy
Can lead to Mg toxicity
May cause dehydration

Diphenoxylate plus atropine (Lomotil)

Antidiarrheal
Decrease intestinal motility
Does not affect CNS at recommended doses
Atropine discourages abuse (anticholinergic side effects)

Loperamide (Imodium)

Antidiarrheal
Meperidine analog
Not a controlled substance

Metoclopramide (Reglan)

Prokinetic agent
Controls N/V by blocking dopamine and serotonin receptors; augments ACh
Used for postop and chemo N/V, management of GERD and gastroparesis
Can cause EPS (admin Benadryl), sedation, diarrhea
Avoid CNS depressants, opioids, anticholinergic

Alosetron (Lotronex)

Used for IBS-D in women that has lasted > 6 months
Blocks 5-HT3 receptors resulting in firm stool and decrease in urgency and frequency of defecation
Can cause constipation

Lubiprostone (Amitiza)

Used for IBS-C and chronic constipation
Increases fluid secretion in intestine, promotes motility
Can cause diarrhea, nausea (take w/ food)

Sulfasalazine (Azulfidine)

5-aminosalicylate,, DMARD
Decrease inflammation by inhibiting prostaglandin synthesis
Used for IBD (Crohn's, UC), RA
Can cause agranulocytosis, hemolytic and macrocytic anemia,, hepatic dusfunction, bone marrow suppression

Methotrexate (Rheumatrex)

Cytotoxic agent (antimetabolite), DMARD
Folic acid analog
Slows RA, antineoplastic (stops cell reproduction), organ rejection
Can cause increased risk for infection, hepatic fibrosis, bone marrow suppression, GI ulcers, N/V, hyperuricemia/renal damage, fetal death
Protect skin from sunlight
NSAIDs, salicylates, sulfonamides can increase toxicity
May reduce dig level
Take on an empty stomach, once per week
Antidote: leucovorin

Hydroxychloroquinone (Plaquenil)

Antimalarial, DMARD
Used for RA
Can cause retinal damage

Etanercept (Enbrel)
Infliximab (Remicade)

DMARD
Used for RA
Can cause irritation at injection site, risk of infection (TB), severe skin reactions, HF, blood dyscrasias
Etanercept: avoid live vaccines

Aurothioglucose (Solganal)

Gold salt, DMARD
Used for RA
Can cause renal toxicity, blood dyscrasias, hepatitis, GI discomfort
Toxicity: severe pruritis, rash, stomatitis

Penicillamine (Cuprimine)

DMARD
Used for RA
Can cause bone marrow suppression
Toxicity: severe pruritis, rash

Cyclosporine (Sandimmune)

DMARD, IL-2 suppressant
Used for RA, organ rejection
Can cause risk for infection, hepatotoxicity, nephrotoxicity, hirsutism
Avoid grapefruit juice
Decreases levels: phenytoin, phenobarbital, rifampin, carbamazepine, trimethoprim-sulfamethoxazole
Increases levels: ketoconazole, erythromycin, amphotericin B
Amphotericin B, aminoglycosides, NSAIDs increase risk of nephrotoxicity

Calcium citrate (Citracal)

Ca supplement
Can cause hypercalcemia (> 10.5mg/dL) - tachycardia, elevated BP, bradycardia, hypotension, muscle weakness, constipation, N/V
Glucocorticoids reduce Ca absorption

Raloxifene (Evista)

Selective estrogen receptor modulator
Decreases bone resorption
Used for postmenopausal osteoporosis, protect against breast cancer
Increases risk of PE, DVT
Can cause hot flashes
Should consume adequate Ca and vit D, perform weight-bearing exercise

Alendronate sodium (Fosamax)

Bisphosphonate
Decrease action of osteoclasts
Used for osteoporosis, hyperparathyroidism
Can cause esophagitis, GI disturbances, musculoskeletal pain, visual disturbances, osteonecrosis of the jaw, risk of hyperparathyroidism
Take on empty stomach in early morning w/ at least 8oz water, wait 2 hours to take antacids or Ca, avoid lying down for 30 minutes

Calcitonin (Fortical)

Inhibits osteoclasts
Used for osteoporosis, hyperparathyroidism
Can cause nausea, nasal dryness and irritation (intranasal)
Contraindicated w/ allergy to fish protein
Can decrease lithium levels
Monitor for hypocalcemia (Chvostek's or Trousseau's sign)
Encourage diet high in Ca and vit D

Morphine sulfate

Opioid agonist
Produces analgesia, respiratory depression, euphoria, sedation, decreased GI motility
Can also cause urinary retention, orthostatic hypotension, cough suppression, biliary colic, emesis
Opioid overdose triad: coma, respiratory depression, pinpoint pupils
Caution w/ head injuries
Meperidine: lowers seizure threshold
Antidote: naloxone

Butorphanol (Stadol)

Opioid agonist-antagonist
Low potential for abuse, less respiratory depression, less analgesic effect
Do not use w/ opioid agonists
Do not use w/ patient that is dependent on opioids

Naloxone (Narcan)

Opioid antagonist
Used to treat opioid overdose
Half-life is less than half-life of narcotic
Titrate to reduce respiratory depression w/o full reversal of pain management
Rapid infusion may cause htn, tachycardia, N/V

Colchicine (Colgout)

Anti-gout med
Used for acute gout attacks
Can cause GI distress, thrombocytopenia, bone marrow suppression, hepatic necrosis
Take w/ food (Jason says empty stomach!)
Avoid aspirin, loop diuretics, alcohol

Allopurinol (Zyloprim)

Anti-gout med
Inhibits uric acid production
Can cause hypersensitivity reaction, renal injury, hepatitis, N/V
Slows metabolism of warfarin

Ergotamine (Ergostat)

Ergot alkaloid (anti-migraine)
Used to abort a migraine
Can cause N/V (admin Reglan), ergotism (muscle pain, paresthesias in fingers and toes, cold pale extremities), physical dependence, fetal abortion

Sumatriptan (Imitrex)

Serotonin receptor agonist (anti-migraine)
Used to abort a migraine
Can cause chest pressure, angina, vertigo
Do not use w/ MAOIs

Divalproex (Depakote ER)

Anticonvulsant (anti-migraine)
Can cause neural tube defects, liver toxicity, pancreatitis
Do not use w/ benzodiazepines

Lispro (Humalog)

Rapid-acting insulin
Onset < 15 min
Peak 30-60 min
Duration 3-4 hours

Regular (Humulin R)

Short-acting insulin
Onset 30-60 min
Peak 2-3 hours
Duration 5-7 hours

NPH (Humulin N)

Intermediate-acting insulin
Onset 1-2 hours
Peak 4-12 hours
Duration 18-24 hours

Glargine (Lantus)

Long-acting insulin
Onset 1 hour
Peak (none)
Duration 10-24 hours

Tolbutamide (Orinase)
Glipizide (Glucotrol)

Oral hypoglycemic (sulfonylurea)
Results in insulin release from pancreas
Can cause hypoglycemia
Glipizide: disulfiram reaction
Take 30 minutes before meal

Repaglinide (Prandin)

Oral hypoglycemic (meglitinide)
Results in insulin release from pancreas
Can cause hypoglycemia
Avoid gemfibrozil
Eat w/in 30 minutes, 3x/day

Metformin (Glucophage)

Oral hypoglycemic (biguanide)
Reduces production of glucose in liver
Increases muscles' glucose uptake and use
Also used to treat polycystic ovary syndrome
Can cause GI effects, B12 and folic acid deficiency, lactic acidosis
Acute renal failure w/ concurrent use of iodine contrast media
Take w/ breakfast/dinner, or dinner

Rosiglitazone (Avadia)

Oral hypoglycemic (thiazolidinediones/glitazones)
Decreases insulin resistance
Results in increased glucose uptake and decreased glucose production
Can cause fluid retention, elevated LDL, hepatotoxicity
Take w/ or w/o food

Acarbose (Precose)

Oral hypoglycemic (alpha glucosidase inhibitor)
Slows carbohydrate absorption and digestion
Can cause intestinal effects, risk for anemia (decreased iron absorption), hepatotoxicity (long term use)
Take w/ first bite of food (3x/day)

Sitagliptin (Januvia)

Oral hypoglycemic (gliptin)
Augments incretin hormones (promotes insulin release and decreases glucagon secretion)
Lowers fasting and postprandial blood glucose levels
Generally well tolerated
Take once a day w/ or w/o food

Pramlintide (Symlin)

Amylin mimetic (hypoglycemic, subQ)
Decreases postprandial glucose levels (decreased gastric emptying, inhibits glucagon, satiety)
May be used w/ insulin (do not mix)
Oral medication absorption is delayed (stagger one hour before or 2 hours after)

Exenatide (Byetta)

Incretin mimetic (hypoglycemic, subQ)
Lowers fasting and postprandial blood glucose
Promotes insulin release, decreases glucagon, slows gastric emptying
Do NOT use w/ insulin
Can cause N/V/D, pancreatitis
Oral medication absorption is delayed, esp. oral contraceptives and antibiotics (stagger one hour before or 2 hours after)

Glucagon

Hyperglycemic agent
Increases blood glucose levels
Turn patient to left side after admin (N/V)

Levothyroxine (Synthroid)

Thyroid hormone
Synthetic T4
Can cause signs of hyperthyroidism
Stagger binding agents, antacids, Fe and Ca supplements 3 hours
Take before breakfast daily
Must take for life, do not switch brands

Propylthiouracil (PTU)

Antithyroid medication
Block synthesis of thyroid hormones
Can cause signs of hypothyroidism, agranulocytosis
May increase levels of anticoagulants and digoxin

Somatropin (Genotropin)

Growth hormone
Stimulates overall growth
Can cause hyperglycemia, hypothyroidism
Avoid glucocorticoids

Vasopression (Pitressin)
Desmopressin (DDAVP)

ADH hormone
Promote reabsorption of water and vasoconstriction
Used for diabetes insipidus and during cardiac arrest (Vasopression)
Can cause reabsorption of too much water, MI from vasoconstriction

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