NCLEX RN DRUGS

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91 terms · 300 Medications You Need to Know for the Exam

Allergy and Asthma

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Antihistamines

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Cetirizine HCL(Zyrtec)

Relief of seasonal allergic rhinitis and perennial allergic rhinitis caused by molds, animal dander, and other allergies.
RN: Avoid alcohol during therapy.
Notify HCP for difficulty breathing or swallowing, and for hydroxyzine(Vistaril) allergy
SE: Drowsiness, Dry mouth, Diarrhea, Fatigue, Stomach pain, Vomiting
Rx; Preg Cat B

Fexofenadine(Allegra)

Management of rhinitis, allergies, chronic idiopathic urticaria
RN: Avoid alcohol, CNS depressants
Notify HCP is taking erythromycin or ketoconazole(Nizoral)
Patient's taking aluminum magnesium antacid; take a few hours before or after fexofenadine
SE: Drowsiness, Headache, Dizziness, Diarrhea, Vomiting, Pain, Cough, Hives, Rash, Itching, Difficulty breathing, Hoarseness, Swelling
60 mg: Onset within 1 hour, Peak 2-3 hours, and duration about 12 hours.
180 mg: Duration 24 hours
Rx; Preg Cat C

Hydroxyzine(Anx,Atarax,Vistaril)

Treatment of pruritus, pre-op anxiety and nausea/vomiting, to potentiate opioid analgesic and sedation
RN: Avoid use of alcohol of CNS depressants
Teaching: Dizziness/Drowsiness may occur; use caution in activities
PO: Onset 15-30 minutes, Duration 4-6 hours
Used in symptoms of alcohol withdrawal
Notify HCP: Diagnosis of glaucoma, ulcers, enlarged prostate gland, liver disease, hypertension, seizures, or hyperthyroidism
Observe of difficulty breathing, muscle weakness, and Increased anxiety
SE: Drowsiness, Dry mouth/nose/throat, Dizziness, Headache, Chest congestion, Reddening of skin
Rx; Preg Cat C

Loratadine(Alavert, Claritin)

Management of seasonal allergies
Avoid alcohol and CNS depressants
Take on empty stomach, 1 hours before or 2 hours after meals
Onset; 1-3 hours, Peak; 8-12 hours, Duration; 24 hours or more
OTC, Rx; Preg Cat B

Corticosteriods

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Beclomethasone(Beclovent, Beconase, Qvar)

Chronic asthma, seasonal or perennial rhinitis
Prevention of recurrence of nasal polyps after surg removal
Nasal: Onset; 5-7 days (can be up to 3 weeks), Peak up to 3 weeks
Inhaler: Onset 10 minutes
Use reg peak flow monitoring to determine resp. status
Rx; Preg Cat C
SE: Dysphonia, Hoarseness, Oropharyngeal fungal infection, Headache, Sore Throat, Dyspepsia, Unpleasant taste and smell, Rhinitis, Nausea, Cough, Angioedema, Back pain

Flunisolide(Aerobid,Nasalide)

Chronic asthma, seasonal or perennial rhinitis
Onset: Few days
Use reg peak flow monitoring to determine resp. status
Rx; Preg Cat C
SE: Dysphonia, Hoarseness, Oropharyngeal fungal infections, Headache, Sore Throat, Nasal Congestion/Cold symptoms, N/V/D, Unpleasant taste/upset stomach, and Epistaxis(nose bleed)

Fluticasone(Flonase)

Chronic asthma treatment, seasonal/perennial rhinitis
Nasal spray: Onset; within 2 days, Peak; 1-2 weeks
Use reg peak flow monitoring to determine resp. status
Rx; Preg Cat C
SE: Dysphonia, Hoarseness, Oropharyngeal fungal infections, Headache, Sore throat, Nasal congestion/Cold Sx, N/V/D, Unpleasant taste, upset stomach, Epistaxis(nose bleed), nasal irritation, Hives, Dyspnea, Dysphagia, Angioedema

Fluticasone Propionate Salmeterol(Advair Diskus)

Used when asthma is not well controlled w/ long-term inhaled corticosteriods, COPD
Oral Inhalation: Rinse mouth with water after inhalation
Twice-Daily Dosage: 12 hours apart, used long term
Use reg peak flow monitoring to determine resp. status
Peds: Monitor growth
Monitor: for glaucoma and cataracts, eosinophilic conditions, hypokalemia, and hyperglycemia
May decrease bone mineral density
May increase risk of pneumonia in pt w/ COPD
May cause worsening of infection
Check oral cavity for candida albicans
Rx; Preg Cat C
SE: N/V/D, Headache, Dysphonia, Hoarseness, Throat irritation, Cough, Oropharyngeal fungal infections, Muscle/Bone pain, Viral Resp. infections, Bronchitis

Mometasone(Nasonex Spray)

Used in chronic asthma treatment, seasonal/perennial rhinitis
Nasal Spray: Onset; few days, Peak; up to 3 weeks
Use reg peak flow monitoring to determine resp. status
Rx; Preg Cat C
SE: Dysphonia, Hoarseness, Oropharyngeal fungal infections, Headache, Sore throat, Nasal congestion/Cold Sx, N/V/D, Unpleasant taste, upset stomach

Triamcinolone(Nasacort AQ spray)

Used in chronic asthma treatment, seasonal/perennial rhinitis
Nasal spray: Onset; few days, Peak; 3-4 days
PO/IM: Peak; 1-2 hours
Use reg peak flow monitoring to determine resp. status
Rx; Preg Cat C
SE: Dysphonia, Hoarseness, Oropharyngeal fungal infections, Headache, Sore throat, Nasal congestion/Cold Sx, N/V/D, Unpleasant taste, upset stomach, Epistaxis(nose bleed), Flu syndrome, Increased cough, Bronchitis

Analgesics

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Non-opioid Analgesic

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Acetaminophen(Acephen, Enducet, FeverAll, Genapap, Genebs, Liquiprin, Tylenol, Wygesic)

Mild pain or fever
PO: Onset; Less than a hour, Peak; 30 minutes-2 hours, Duration; 4-6 hours
Rectal: Onset; slow, Peak; 1-2 hours, Duration; 3-4 hours
Crushed or whole with full glass of water
Can give w/ food or milk to decrease GI upset
Chronic poisoning: rapid, weak pulse; dyspnea; cold, clammy extremities
Chronic overdose: bleeding, bruising, malaise, fever, sore throat, anorexia, and jaundice
Rx; Preg Cat C
SE: Anemia(long-term), Liver/Kidney failure, Dyspnea(prolonged high dose), Angioedema, Hives, Itching
No more than 4,000 mg

Aspirin

Mild/Moderate pain or fever, TIA, prophylaxis of MI, ischemic stroke, angina
PO: Onset; 15-30 minutes, Peak; 1-2 hours; Duration; 4-6 hours
Rectal: Onset; slow, 20%-60% absorbed if retained 2-4 hours
Long term use: Check of liver damage, dark urine, clay-colored stools, yellowing of the skin/sclera, itching, abdominal pain, fever, diarrhea
Arthritis: give 30 minutes before exercise, can take 2 weeks before full effect is felt
Discard tablets if vinegar-like smell
Don't give to children or teens with flu-like symptoms or chickenpox; Reye's Syndrome can develop
OTC; Preg Cat C
SE: N/V, Rash, Angioedema, Dyspnea, Melena, Tinnitus, GI bleeding

Celecoxib(Celebrax)

Acute/Chronic arthritis pain, primary dysmenorrheal pain relief within 60 minutes
Onset; 24-48 hours, Duration; 12-24 hours
Can take w/ or w/o meals
Increasing meals doesn't increase effectiveness
Don't take if allergic to sulfonamides, aspirin, or NSAIDs
Rx; Preg Cat C for the first and second trimester;
SE: Fatigue, Anxiety, Depression, Nervousness, N/V, anorexia, dry mouth, constipation, Angioedema, Hives, Dyspnea, Back pain, Tachycardia, Jaundice, Dysuria

Ibuprofen(Advil, Motrin B)

RA, Osteoarthritis, primary dysmenorrhea, gout, dental pain, , musculoskeletal disorder, fever
Onset; 30 minutes, Peak; 1-2 hours
Toxicity: Notify HCP if ringing/roaring in ears
Kidney damage: Notify HCP if changes in urinary pattern, increased weight, edema, increased pain in joints, fever or blood in urine
Use sunscreen to prevent photosensitivity
Avoid use w/ ASA, NSAIDs, and alcohol = risk of GI bleeding
Avoid using with anticoagulants
May increase risk of MI or stroke
OTC,Rx; Preg Cat B

Naproxen(Aleve(OTC), Anaprox, Anaprox DS, Naprelan, EC-Naprosyn, Naprosyn)

Management of mild/moderate pain
Treatment for rheumatoid, juvenile or gouty arthritis, osteoarthritis, primary dysmenorrhea
Pt's with asthma, ASA hypersensitivity, nasal polyps have increased risk of hypersensitivity
Toxicity: Contact if blurred vision, ringing/roaring in the ears
Notify if black, tarry stools or flu-like symptoms
Kidney damage: Notify HCP if changes in urinary pattern, increased weight, edema, increased pain in joints, fever or blood in urine
Avoid use with ASA, steroids or alcohol
May increase risk of MI or stroke
OTC, Rx; Preg Cat B
SE: GI bleeding, blood dyscrasias, tinnitus, headache, insomnia, vision changes, rash, angioedema, jaundice, tachycardia, back pain, nausea

Opioid

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Codeine

Management of moderate/severe pain, nonproductive cough
Po: onset; 30-45 minutes, Peak; 60-120 minutes, Duration; 4-6 hours
IM/subQ: onset; 10-30 minutes, Peak; 30-60 minutes, Duration; 4-6 hours
Don't give if resp are <12 per minute
Avoid use with alcohol, CNS depressants
Withdrawal: N/V, cramps, fever, faintness, anorexia
Long term use=physical dependency
Rx C-II, III, IV, V(depends on route); Preg Cat C
SE: Drowsiness, sedation, N/V, anorexia, resp. depression, constipation, orthostatic hypotension, dysuria, hives, dyspnea, syncope, angioedema, seizures

Hydrocodone Bitartrate & Acetaminophen(Lortab, Vicodin)

Relief of moderate/moderately severe pain
Use with CNS depressants and/or alcohol may result in addictive CNS depression
Maybe habit forming
Avoid alcohol
Use with caution with patient with pulmonary considerations
Rx C-III; Preg Cat C
SE: Dizziness, drowsiness, constipation, n/v, resp. depression, sedation, impairment of mental and physical performance, rash, pruritus

Hydromorphone(Dilaudid)

Moderate to severe pain and nonproductive cough
PO: onset; 15-30 minutes, Peak; 30-60 minutes, Duration; 4-6 hours
IM: onset; 15 minutes, Peak; 30-60 minutes, Peak; 4-5 hours
IV: onset; 10-15 minutes, Peak; 15-30 minutes, Duration; 2-3 hours
SubQ: onset; 15 minutes, Peak: 30-90 minutes, Duration; 4 hours
Rectal: duration; 6-8 hours
Don't give if resp. are less than 12 per minutes
Avoid use with alcohol, CNS depressants
Withdrawal: N/V, cramps, fever, faintness, anorexia
Physical dependence from long term use
Elderly pts may require lower doses
Rx C-II; Preg Cat C
SE: Drowsiness, sedation, N/V, anorexia, resp. depression, constipation, cramps, orthostatic hypotension, confusion, headache, rash

Meperidine(Demerol)

Management of moderate to severe pain, pre-op sedation, post-op and OB analgesia
PO: onset; 10-15 minutes, peak; 30-60 minutes, duration; 2-4 hours(usually 3)
IM: onset; 10-15 minutes, peak; 30-50 minutes, duration; 2-4 hours(usually 3)
IV: onset less than 5 minutes, peak; 5-7 minutes, duration; 2-4 hours(usually 3)
SubQ: onset; 10-15 minutes, peak; 30-50 minutes, duration; 2-4 hours(usually 3)
Don't give if resp are less than 12 per min
Avoid use of alcohol or CNS depressants
Withdrawal: nausea, vomiting, cramps, fever, faintness, anorexia
Physical dependency from long term use
Don't co-infuse w barbiturates, aminophylline, heparin, morphine, methicillin, phenytoin, sodium bicarbonate, sulfadiazine or sulfisoxazole
Rx C-II; Preg Cat C
SE: Drowsiness, sedation, resp depression, euphoria, orthostatic hypotension, confusion, headache, bradycardia, diaphoresis, urticaria

Methadone(Dolophine, Methadose)

Relief of pain, detoxification/maintenance of narcotic addiction
PO: onset; 30-60 minutes, peak; 30-60 min, duration; 4-6 hours(w continuous dosing, duration may increase to 22-48 hours)
IM: onset; 10-20 min, peak; 60-120 min, duration; 4-5 hours(w continuous dosing duration may increase to 22-48 hours)
IV: onset and peak; 15-30 min, duration; 3-4 hours
Don't give if resp are less than 12 per min
Avoid w alcohol, CNS depressants
Withdrawal: nausea, vomiting, cramps, fever, faintness, anorexia
Physical dependency from long term use
Rx C-II; Preg Cat C
SE: Drowsiness, sedation, nausea, vomiting, anorexia, resp despression, constipation, cramps, orthostatic hypotension, rash, arrhythmias, syncope, agitation, diaphoresis, hypokalemia, pulmonary edema

Morphine(Astramorph PF, Avinza, Duramorph, Infumorph, Kadian, MS Contin)

Management of severe pain
Continuous dosing is more effective, maybe given by PCA
PO: onset; 15-60 min, peak; 30-60 min, duration; 3-6 hours
IM: onset; 10-15 min, peak; 30-50 min, duration; 2-4 hours(usually 3)
IV: onset; less than 5 min, peak; 18 min, duration; 2-4 hours(usually 3)
SubQ: onset; 10-15 min, peak; 30-50 min, duration; 2-4 hours(usually 3)
Withdrawal: nausea, vomiting, cramps, fever, faintness, anorexia
Physical dependency from long term use Monitor: increased respiratory and CNS depression when given w cimetidine, clomipramine, nortriptyline, or amitriptyline
Rx C-II; Preg Cat C
SE: Resp depression, sedation, euphoria, orthostatic hypotension, bradycardia, diaphoresis, urticaria

Oxycodone(OxyContin; with aspirin (Percodan), with acetaminophen(Percocet)

Management of moderate to severe pain
PO: peak; 30-60 min, duration; 4-6 hours
Controlled-release: peak; 3-4 min, duration; 12 hours
Don't give if resp are less than 12 per minute
Avoid use w/ alcohol or CNS depressants
Withdrawal: nausea, vomiting, cramps, fever, faintness, anorexia
Physical dependency from long term use
Rx C-II; Preg Cat C(Controlled release); Preg Cat C(Percocet)
SE: Drowsiness, sedation nausea, vomiting, anorexia, constipation, cramps, confusion, headache, rash, euphoria, urinary retension, orthostatic hypotension

Anticoagulants

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Dabigatran Etexilate(Pradaxa)

Used for prevention of stroke in pt with nonvascular atrial fibrillation
Keep in original package(blister pack or manufacturer bottle) until administered
PO: may take w/o regard to meals
Don't crush or chew capsule
Closely monitor for signs of bleeding
Increased risk of bleeding when combined with aspirin, other antiplatelets, or anticoagulants
Reduced dose required in renally impaired patients
Stop med 24 hours before surgery
Rx; Preg Cat C
SE: Dyspepsia, abdominal discomfort, epigastric pain, GI hemorrhage, bleeding, hematoma, anemia

Enoxaparin(Lovenox)

Anticoagulation during acute coronary syndrome, prophylaxis and treatment for venous thromboembolism
Injection: SubQ; can be given IV during cardiac procedures
Don't use in pt w/ history of heparin induced thrombocytopenia
Use w/ caution in pt w/ impaired renal function or morbid obesity
Monitor: signs for bleeding or excessive bruising
Stop med 12-24 hours before surgery
Rx; Preg Cat C
SE: bleeding, bruising, injection site hematoma, injection site ecchymosis, hematuria, increase AST/ALT

Heparin

Prophylaxis and treatment of thromboembolic disorders in very low doses(10-100 units), to maintain patency of IV catheters(heparin flush)
Therapeutic PTT @ 1.5-2.5 times the control w/o signs of hemorrhage
IV: peak; 5 min, duration 2-6 hours(give over 1 min)
Injection: give deep subQ; never IM(danger of hematoma), onset; 20-60 min, duration; 8-12 hours
Antidote: Protamine sulfate within 30 min
Hemorrhage: bleeding gums, epistaxis(nosebleed), unusual bleeding, black or tarry stools, hematuria, fall in hematocrit or blood pressure, guaiac-positive stools
Avoid ASA-containing product and NSAIDs
Wear medical information tag
Abrupt withdrawal may precipitate increased coagulability
Rx; Preg Cat C
SE: Can produce hemorrhage from any body site(10%), tissue irritation/pain at injection site, anemia, thrombocytopenia, fever

Rivaroxaban(Xarelto)

Stroke prevention in nonvascular atrial fibrillation prevention and treatment of venous thromboembolism
Dose reduction required in renal impairement
PO: give dose greater than 15 mg with food, lower doses maybe given without regard to food
Stop med 24 hours before surgery
Monitor closely for signs of bledding or excessive bruising
Rx; Preg Cat C
SE: bleeding, bruising, epistaxis, peripheral edema, nausea, dyspepsia, hematoma, anemia, thrombocytopenia

Warfarin(Coumadin, Jantoven)

Management of pulmonary emboli, deep vein thrombosis, MI, atrial dysrhythmias, postcardiac valve replacement
Therapeutic PT @ 1.5-2.5 times the control, INR @ 2.0-3.0
Onset; 12-24 hours, peak; 1.5-3 days, duration; 3-5 days
Avoid foods high in vitamin K, many green leafy vegetables
Don't interchange brands; potencies may not be equivalent
Don't take any drug or herb w/o physician approval-- may change effect
Avoid ASA-containing products or NSAIDs
Oral anticoagulants may cause red-orange discoloration of alkaline urine, interfering w/ some lah tests
Wear medical information tag
Rx; Preg Cat X
SE: Hemorrhage, diarrhea, rash, fever, angina syndrome, syncope, anemia, dermatitis, jaundice, elevated liver enzymes, anaphylactic reactions

Anticonvulsants

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Carbamazepine(Carbatrol, Epitol, Equetro, Tegretol, Tegretol XR)

Management of seizures, trigeminal neuralgia, diabetic neuropathy
Avoid driving and other activities requiring alertness the first 3 days
Monitor blood levels, CBC regularly, esp. during first 2 month; periodic eye exams
Take w/ food or milk to decrease GI upset; tablets(non-extended-release) may be crushed, extended-release capsules may be opened and mixed with juice or soft foods(no grapefruit products)
Urine may turn pink to brown
Avoid abrupt withdrawal; discontinue gradually
Avoid use with alcohol, CNS depressants
Inform physician before taking any new medication or herbal med
Rx; Preg Cat D
SE: myelosuppression, dizziness, drowsiness, ataxia, diplopia, rash, photosensitivity, depression, nausea, vomiting, dyspepsia, aplastic anemia, Stevens-Johnson syndrome, suicide attempts in bipolar patients

Divalproex Sodium(Depakote, Depakote ER)

Management of seizures, manic episodes assoc. w/ bipolar disorder(delayed-release only), migraine prophylaxis(delayed or extended-release only)
Take w/ or immediately after meals to lessen GI upset;swallow whole
Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent convulsions
Monitor blood levels, platelets, bleeding time, and liver function tests
Delayed-release products:peak blood level 3-5 hours, duration; 12-24 hours
Extended-release products: onset; 2-4 days, peak blood level 7-14 hours, duration; 24 hours
Wear medical information tag
Rx; Preg Cat D
SE: Sedation, drowsiness, dizziness, mental status and behavioral changes, nausea, vomiting, constipation, diarrhea, heartburn, prolonged bleeding time, hepatotoxicity, teratogenicity, pancreatitis, thrombocytopenia, headache, diplopia, tremor, alopecia, multiorgan hypersensitivity

Gabapentin(Gabarone,Neurontin)

Used for management of seizures and postherpetic neuralgia, and diabetic neuropathy
Don't take within 2 hours of antacid use
Avoid abrupt withdrawal after long-term use; discontinue gradually over a week to prevent convulsions
Give w/o regard to meals; can open capsules and put in juice or applesauce
Don't crush or chew capsules
Use caution w/ hazardous activities
Wear medical information tag
Rx; Preg Cat C
SE: Drowsiness, ataxia, diplopia, rhinitis, constipation, memory problems, uncontrolled shaking, back or joint pain, edema, flu-like symptoms, seizures

Lamotrigine(Lamictal)

Used for management of seizures, abnormal mood disorders
In pediatric patients, stop at first sign of rash; all patients should notify clinician of rashes
Take divided doses w/ meals or just after to decrease adverse effects
Use caution with hazardous activities until stabilized
Avoid abrupt withdrawal; stop gradually to prevent increase in frequency of seizures
Wear medical information tag
Rx; Preg Cat C
SE: Ataxia, dizziness, headache, nausea, vomiting, anorexia, diplopia, blurred vision, abdominal pain, dysmenorrhea, loss of coordination, mood changes, irritability, insomnia, depression

Phenobarbital(Luminal)

Management of epilepsy, febrile seizures in children, sedation; insomnia
IV: slow rate--- resuscitation equipment should be available
IM: inject deep into large muscles mass to prevent tissue sloughing, can give subQ, onset 10-30 min
PO: onset; onset 20-60 mins, peak; 8-12 hours, duration; 6-10 hours
Use caution w/ hazardous activities until stabilized, drowsiness usually diminishes after initial weeks of therapy
Nystagmus may indicate early toxicity
Long-term use withdrawal symptoms; vomiting, sweating, abdomen/muscle cramps, tremors, and possibly convulsions
Vitamin D supplements are indicated for long-term use
Rx C-IV; Preg Cat C
SE: drowsiness, lethargy, rash, GI upset, initially constricts pupils, resp depression, ataxia, nightmares, unusual bleeding, dyspnea, dysphagia, excitement in children

Phenytoin(Dilantin)

Management of seizures, migraines, trigeminal neuralgia, bell's palsy
PO: take divided doses, with or immediately after meals to decrease adverse effects
May color urine and sweat pink/red/brown
May cause increase in blood sugar
IV administration may lead to cardiac arrest-- have resuscitation equipment available; never mix in IV w/ any other drug or dextrose
Avoid abrupt withdrawal to prevent convulsions
Don't use antacids or antidiarrheals until stabilized
Use caution with hazardous activities until stabilized
Folic acid supplements are indicated for long-term use
Wear medical information tag
Rx; Preg Cat D
SE: drowsiness, ataxia, nystagmus, blurred vision, hirsutism, lethargy, GI upset, Gingival hypertrophy, suicidal behavior, skin rash

Pregabalin(Lyrica)

Treatment of neuropathic pain, diabetic pain, pain after shingles, fibromyalgia and partial onset seizures in adults w/ epilepsy who already take one or more drugs for seizures
Take around the same time every day, 2-3 times daily; full therapeutic effects may require 4 weeks
Avoid abrupt withdrawal after long-term use; discontinue gradually
Avoid use w/ alcohol
Use caution in potentially hazardous activities
May increase the risk for suicidal thoughts or behavior
Rx; Preg Cat C
SE: dizziness, tiredness, weakness, headache, nausea, vomiting, constipation, flatulence, bloating, mental status and behavioral changes, anxiety, lack of coordination, loss of balance, unsteadiness, uncontrollable shaking or jerking of a part of the body; muscle twitching, increased appetite, weight gain, swelling of the arms, hands, feet, ankles, or lower legs, back pain, infection, angioedema, neuropathy

Topiramate(Topamax, Topiragen)

Use for management of seizures, prophylaxis of migraine headache, cluster headache, bulimia
Give w/o regards to meals; can open capsules and put in juice or applesauce
Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent seizures and status epilepticus
Use caution with hazardous activities until stabilized
Increase fluid intake to prevent formation of kidney stones
Stop drug immediately if eye problems; could lead to permanent loss of vision
Use sunscreen and protective clothing to prevent photosensitivity
Wear medical information tag
Rx; Preg Cat C
SE: dizziness, drowsiness, fatigue, impaired concentration/memory, nervousness, speech problems, nausea, weight loss, vision problems, ataxia, photosensitivity, behavior problems, mood problems, anorexia

Valproate(Depacon)

Used for management of seizures, manic episodes associated w/ bipolar disorders, prevent migraines
Avoid abrupt withdrawal after long-term use; discontinue gradually to prevent convulsions
Maybe given w/ food to decrease GI irritation
Monitor blood levels, platelets, bleeding time, and liver function tests
Onset of anticonvulsants effect: 2-4 days, peak blood level at end of infusion, duration; 6-24 hours
Rx; Preg Cat C
SE: sedation, drowsiness, dizziness, mental status and behavioral changes, nausea, vomiting, constipation, diarrhea, heartburn, prolonged bleeding time, hepatotoxicity, teratogenicity, pancreatitis

Valproic acid(Depakene, Myproic Acid)

Used for management of seizures, mania, prevent migraine headache
Take with or immediately after meals to lessen GI upset
Swallow capsules whole(no crushing, or chewing)
Avoid abrupt withdrawal after long-term use; discontinue gradually o prevent convulsions
Monitor blood levels, platelets, bleeding time, and liver function tests
Onset; 2-4 days, peak blood level of syrup 15-120 minutes, of capsules; 1-4 hours, duration 6-24 hours(varies with age)
Wear medical information tag
Rx; Preg Cat D
SE:sedation, drowsiness, dizziness, mental status and behavioral changes, nausea, vomiting, constipation, diarrhea, heartburn, prolonged bleeding time, hepatotoxicity, teratogenicity, pancreatitis

Anti-infectives

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Aminoglycosides

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Amikacin, Gentamicin, Tobramycin(Amikin, Garamycin, Tobrex)

Treatment of severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissue, acute PID
IV over 30 minutes to 1 hour
IM by deep slow injection
Never subQ
Careful monitor blood levels
Check peak-- 2 hours after med is given
Check trough-- at time of dose/prior to med
Monitor for signs of superinfection(diarrhea, URI, coated tongue)
Immediately report hearing or balance problems
Encourage fluid to 8-10 glasses/day
Rx; Preg Cat D
SE: Use during pregnancy can result in bilateral congential deafness, ototoxicity; cranial nerve VIII, nephrotoxicity, allergic reaction; fever, difficulty breathing, rash, vertigo, tinnitus

Amphotericin B(Abelcet, Amphotec, Fungizone)

Treatment of histoplasmosis, skin infections, septicemia, meningitis in HIV patients
Don't mix with other drugs
Monitor VS; report fever or changes in function, especially nervous system
Check for hypokalemia
Meticulous care and observation of injection site
Potential benefits must be balanced against serious side effects
Rx; Preg Cat B
SE: Blood, kidney, heart, liver abnormalities, GI upset, hypokalemia-induced muscle pain, CNS disturbances, inefficient hearing, skin irritation and thrombosis if IV infiltrates, rash, fever, malaise, hypotension, headache, nephrotoxicity

Fluconazole(Diflucan)

Used in treatment of vaginal, esophageal, or systemic candidiasis; cryptococcal meningitis
Prothrombin time is increased after warfarin usage
Take missed dose as soon as noticed, but do not double dose
Reduces metabolism of tolbutamide, glyburide, and glipizide
Glucose levels should be monitored, especially in diabetics
Rx; Preg Cat C
SE: nausea, headache, abdominal pain, diarrhea, taste distortion

Antimalarials

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Hydroxychloroquine(Plaquenil)

Management of malaria, lupus erythematosus, rheumatoid arthritis
Peak; 1-2 hours
Take at same time each day to maintain blood level
Give w/ meals to decrease GI distress
For malaria, prophylaxis should be started 2 weeks before exposure and continue for 4-6 weeks after leaving exposure areas
Rx; Preg Cat C
SE: eye disturbances, nausea, vomiting, anorexia, rash, headache, loss of hair

Quinine Sulfate

Treatment of malaria, nocturnal leg cramps
Peak; 1-3 hours
Take at same time to maintain blood level
Avoid OTC cold meds, tonic water
May increase digoxin levels
OTC, Rx; Preg Cat X
SE: eye disturbances, nausea, vomiting, anorexia

Antiprotozoal

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Metronidazole(Flagyl, Flagyl ER)

Treatment of a wide variety of infection, including trichomoniasis and giardiasis
IV: immediate onset
PO: peak; 1-2 hours
Urine may turn dark reddish-brown
Avoid hazardous activities
Treatment of both partners is necessary in trichomoniasis
Don't drink alcohol or preparations containing alcohol during and 48 hours after use, disulfiram-like reactions can occur
Rx; Preg Cat B
SE: headache, dizziness, nausea, vomiting, diarrhea, abdominal cramps, metallic taste

Antituberculars

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Isoniazid(INH)

Prevention and treatment of TB
PO/IM: onset; rapid, peak;1-2 hours, duration; up to 24 hours
Contact clinician if signs of hepatitis; yellowing of the eyes and skin, nausea, vomiting, anorexia, dark urine, unusual tiredness or weakness
Contact clinician if signs of peripheral neuropathy; numbness, tingling, or weakness
Monitor liver test,
Rx; Preg Cat C
SE: Peripheral neuropathy, liver damage

Antivirals

Acyclovir(Zovirax)
Oseltamivir Phosphate(Tamiflu)
Valacyclovir HCL(Valtrex)
Zidovudine(AZT,Retrovir)

Acyclovir(Zovirax)

Treatment for herpes, varicella
IV: onset; immediate, peak; immediate
PO: absorbed minimally, onset; unknown, peak; 90 minutes
Don't break, crush, or chew capsules
PO: take without regard to meals with a full glass of water
If dose is missed, take as soon as remembered, up to 1 hours before next dose
Contact clinician if sore throat, fever, and fatigue; could be signs of superinfection
May cause acute renal failure; monitor renal function
Thrombocytopenic purpura
Rx; Preg Cat B
SE: headache, blood dyscrasias, nausea, vomiting, diarrhea

Oseltamivir Phosphate(Tamiflu)

Used as prophylaxis in adults for influenza, including avian bird flu
Used to treat uncomplicated acute flu symptoms in patients that are symptomatic for 2 days or less
Shouldn't be used as a substitute for influenza vaccinations
Maybe taken without regards to meals
Rx; Preg Cat C
SE: nausea, vomiting, dizziness, headache, fatigue, cough

Valacyclovir HCL(Valtrex)

For the treatment of genital herpes
Used to treat herpes zoster(shingles)
Used to treat herpes labialis(cold sores)
Patients should drink plenty of fluids during treatment
Avoid sexual contact when lesions are visible
Use w/ caution in pregnancy and nursing mothers
Rn; Preg Cat B
SE: nausea, vomiting, diarrhea, abdominal cramps, headache, rash, fatigue, dizziness

Zidovudine(AZT,Retrovir)

Management of HIV infections and prevention of HIV following needlestick
GI upset and insomnia resolve after 3-4 weeks
PO: peak; 30-90 mins
Rx; Preg Cat C
SE: fever, headache, malaise, nausea, vomiting, diarrhea, dizziness, insomnia, dyspepsia, anorexia, rash

Cephalosporins First Generation

Cefadroxil(Duricef)
Cephalexin(Keflex)
Cefaclor(Ceclor, Ceclor CD)

Cefadroxil(Duricef)

Treatment for upper and lower resp tract, urinary tract, and skin infections, otitis media, tonsillitis, and UTIs
Peak; 60-90 min, duration; 12-24 hours
Take for 10-14 days to prevent superinfection
Possible cross-allergy to penicillin
May alter results(false positive) of urine glucose
Rx; Preg Cat B
SE: diarrhea, angioedema, rash

Cephalexin(Keflex)

Treatment for upper and lower resp tract, urinary tract and skin infection, bone infection, otitis media
Peak; 1 hour, duration; usually 6 hours, but maybe up to 12 hours with decreased renal function
Take for 10-14 days to prevent superinfections
Possible cross-allergy to penicillin
Maybe cause false positive of urine glucose
Rx; Preg Cat B
SE: diarrhea, anaphylaxis, nausea, rash, headache

Cefaclor(Ceclor, Ceclor CD)

Treatment of resp tract, urinary tract, bone, joint, and skin infections, otitis media
Peak; 30-60 min, extended-release peak; 1.5-2.5 hours
Take for 10-14 days to prevent superinfection
May cause false positive in urine glucose
Rx; Preg Cat B
SE: diarrhea

Cephalosporins Second Generation

Cefotetan
Cefoxitin(Mefoxin)
Cefprozil(Cefzil)
Cefuroxime(Ceftin, Zinacef)

Cefotetan

Treatment of resp tract, urinary tract, bone, joint, and skin infections, GYN and gonococcal infections, intra-abdominal infections
IM/IV: peak; 1.5-3 hours or at end of infusion
Avoid alcohol
May cause falsely elevated serum or urine creatinine values
Rx; Preg Cat B
SE: diarrhea, rash, nausea

Cefoxitin(Mefoxin)

Treatment of resp tract, urinary tract, bone and skin infections, GYN and gonococcal infections, peritonitis, septicemia
IM: peak; 20-30 min
IV: peak; at end of infusion
Take for 10-14 days to prevent superinfection
Avoid alcohol
Eat yogurt or buttermilk to maintain intestinal flora
May cause false positive urine glucose
Rx; Preg Cat B
SE: diarrhea, rash

Cefprozil(Cefzil)

Treatment for pharyngitis/tonsillitis, otitis media, secondary bacterial infection of acute bronchitis, and acute bacterial exacerbation of chronic bronchitis, acute sinusitis
Peak; 90 minutes
May cause false positive Coombs test
May cause elevated levels in ALT, AST
May cause false positive urine glucose
Rx; Preg Cat B
SE: diarrhea, rash

Cefuroxime(Ceftin, Zinacef)

Treatment of resp tract, urinary tract, bone and skin infections, gonococcal infections, meningitis, septicemia
Take for 10-14 days to prevent superinfection
May cause increased BUN and serum creatinine
May cause false positive urine glucose
Rx: Preg Cat B
SE: diarrhea, rash

Cephalosporin Third Generation

Cefdinir(Omnicef)
Cefepime(Maxipime)
Cefotaxime(Claforan)
Cefpodoxime(Vantin)

Cefdinir(Omnicef)

Treatment of acute exacerbations of chronic bronchitis, sinusitis, pharyngitis, otitis media, tonsillitis, skin infection
Take for 10-14 days to prevent superinfection
Don't give antacids or iron supplement within 2 hours
May cause false positive for urine ketones or glucose
May cause increased GGT
Rx; Preg Cat B
SE: nausea, vomiting, diarrhea, anorexia, rash, headache, vaginal yeast infection

Cefepime(Maxipime)

Treatment of resp tract, urinary, and skin infection
IV: peak; 30 minutes
IM: peak 2 hours
May cause positive Coombs test
May cause false positive for urine glucose
Rx; Preg Cat B
SE: nausea, vomiting, diarrhea, anorexia, elevated liver function tests, rash, headache

Cefotaxime(Claforan)

Treatment for resp tract, intra-abdominal/GYN infections, gonococcal infections, meningitis, septicemia, bacteremia
IV: onset; 5 minutes
IM: onset; 30 minutes
Monitor for superinfection
Yogurt or buttermilk may help maintain normal intestinal flora
Monitor I/O
May cause falsely elevated serum or urine creatinine
Rx; Preg Cat B
SE: nausea,vomiting, diarrhea, anorexia, rash

Cefpodoxime(Vantin)

Treatment of resp tract, urinary tract, and skin infections, otitis media, and STD infections
Take for 10-14 days to prevent superinfection
Give 1-2 hours after antacid
Give w/ food to enhance absorption
Rx; Preg Cat B
SE: nausea, vomiting, diarrhea, anorexia, urticaria, cough

Fluoroquinolones

Ciprofloxacin(Cipro)
Levofloxacin(Levaquin)

Ciprofloxacin(Cipro)

Treatment of infection caused by E. coli and other bacteria, chronic bacterial prostatitis, acute sinusitis, post-exposure inhalation anthrax
Contraindicated in children less than 18 years of age
Take 2 hours pc or 2 hours before an antacid or iron preparation
Take at equal intervals around the clock
Avoid caffeine
Encourage fluids to 8-10 glasses/day
May cause false positive in opiate screening tests
Don't infuse with other medications
Rx; Preg Cat C

Levofloxacin(Levaquin)

Treatment of infections such as endocarditis, tuberculosis, anthrax, pneumonia, chronic bronchitis, and infection involving the sinus, urinary tract, kidney, prostate or skin
Infused injection over 60-90 minutes, once every 24 hours
Teach patient to avoid sunlamps and tanning beds and to limit time in sun
Avoid activities that require alertness or coordination
Monitor for hepatotoxicity
May increase risk for suicidal thoughts or behaviors
Monitor blood sugar; may cause hypoglycemia or hyperglycemia
Teach patient to notify physician immediately for change in heartbeat
Rx; Preg Cat C
SE: headache, nausea, vomiting, diarrhea, constipation, stomach pain, dizziness, heartburn, vaginal itching and/or discharge, tendon rupture or tendinitis, irritation, pain, tenderness, redness, warmth or swelling at the injection spot, seizures, confusion, rash, hallucinations, paranoia, angioedema

Glycopeptides

Vancomycin(Vancocin)

Vancomycin(Vancocin)

Treatment of resistant staph infections, colitis, staph enterocolitis, endocarditis prophylaxis for dental procedures(used for c. difficile)
PO: poor absorption
IV:peak 5 minutes, duration; 12-24 hours
Give @ least 60 minutes(IV); don't infuse with other drugs
Give antihistamines if "red man syndrome"' decreased blood pressure, flushing of face and neck
Contact clinician if signs of superinfection; sore throat, fever, fatigue
Rx; Preg Cat C
SE: liver damage, nephrotoxicity, tinnitus or hearing loss

Lincosamides

Clindamycin HCL phosphate(Cleocin HCL, Cleocin Phosphate of IM)

Clindamycin HCL phosphate(Cleocin HCL, Cleocin Phosphate of IM)

Treatment of infections caused by Staphylococcus, Streptococcus, and other organisms
PO: peak; 45 minutes, duration 6 hours
IM: peak 3 hours, duration 8-12 hours
May cause increase in AST, ALT, CPK
Rx; Preg Cat B
SE: nausea, vomiting, diarrhea, abdominal pain, vaginitis, rash, jaundice

Macrolides

Azithromycin(Zithromax)
Clarithromycin(Biaxin, Biaxin XL)
Erythromycin(Ery-tab, Erythrocin)

Azithromycin(Zithromax)

Treatment of mild to moderate infections of the resp tract, skin, nongonococcal urethritis, cervicitis, acute pharyngitis/tonsillitis, community acquired pneumonia
PO: rapid onset, peak end of infusion, duration 24 hours
IV: rapid onset, peak end of infusion, duration 24 hours
PO: don't take with antacids; can take with or without food
Monitor for signs of superinfection (diarrhea, perineal itching, oral ulcers)
If treatment for nongonococcal urethritis or cervicitis, sexual partners need treatment also
Rx; Preg Cat B
SE: nausea, vomiting, diarrhea

Clarithromycin(Biaxin, Biaxin XL)

Used for resp infections, pharyngitis/tonsillitis, sinusitis
Treatment maybe 7-14 days depending on organism and extent of infection
Should be taken w/ food
Poss increase in theophylline and carbamazepine levels
Rx; Preg Cat C
SE: nausea, taste abnormalities, diarrhea, dyspepsia, headache

Erythromycin(Ery-tab, Erythrocin)

Treatment for infections, including chlamydia and syphilis
PO: give 1 hr ac/2 hour pc w/ full glass of water (avoid citrus); some formulations can given without regards to meals
PO: onset; 1 hours, peak; up to 4 hours, duration; 6-12 hours
IV: onset rapid, peak @ end of infusion, duration; 6-12 hours
Take @ equal intervals around the clock
Can be used in patients w/ compromised renal function
Monitor for signs of superinfection (diarrhea, perineal itching, oral ulcers)
Rx; Preg Cat B
SE: abdominal cramps, pain @ injection site, nausea,vomiting,diarrhea, rash, anaphylaxis

Penicillins

Amoxicillin, Ampicillin, Penicillin (Bicillin, DisperMox, Larotid, Moxatag, Omnipen, Wycillin)

Amoxicillin, Ampicillin, Penicillin (Bicillin, DisperMox, Larotid, Moxatag, Omnipen, Wycillin)

Treatment of resp infections, scarlet fever, otitis media, pneumonia, skin and soft tissue infections, gonorrhea
Take careful history of penicillin reaction; observe for 20 min post IM injection
PO for penicillin and penicillin:

Sulfonamides

Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

...

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