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Critical Info About Drug Classes

Terms in this set (79)

Opioid
Morphine, Fentanyl
-CNS depression, respiratory distress (tx'd with Narcan (Naloxone) @ 10 bpm), constipation, urinary retention, IV fastest route, can do longer dosing with a patch.
-preform pain assessment and assess for severe pain
Non-opioid analgesics
Actaminophen (Tylenol), Tramadol
-Hepatotoxic (ETOH), up to 4g in hosp, 3g @ home, 2g liver fx or elderly, check other drugs for APAP, ---Antidote--acetylcysteine,
-mild to mod pain/fever , pain assess.
General Anesthetics
Propofal, Isoflurane
-Pt. needs to be ventilated, watch for malignant hyperthermia and give Dantrolene
-Monitor for VS (poss. decrease HR & BP) and resp status closely, used in surgery and some ICU sedation
Local Anesthesia
Lidocaine, Benzocaine
-Only works locally, usually topical, injected superficially or epidural, will be painful hen it wears off.
Neuromuscular Blocking Agent succinylchline, vercuronium (Norcuron)
-Paralyzes but no pain relief, needs to be on ventilator, antidote- neostigimine, can cause HR and BP to increase and malignant hyperthermia (Dantrolene), used in OR and to intubate.
Benzodiazepine (CNS Depressant)
valium/alprazolam (Xanax)
-Sedative/hypnotic/anxiolytic, don't use with ETOH or other CNS depressants, can cause dry mouth, drowsiness, sedation, urinary retention, don't stop abruptly, some like Ambien can cause sleepwalking.
Barbiturates (CNS Depressants)
Phenobarbital
-Mostly used for seizures, can get CNs depression or paradoxical reaction, don't take with ETOH and other CNS depressants, monitor drug levels if used for seizures, can interfere w/ REM sleep.
Muscle Relaxants (CNS Depressants)
Baclofen
-For muscle spasms, don't use with ETOH and other CNS depressants, can cause CNS depression, dry mouth, constipation -Dantrolene also in this class (malignant hyperthermia), watch bottles around kids.
CNS Stimulant
ADHD- mehylphenidate (Ritalin), Narcolepsy- modafinal (Provigil)
Wt. loss- phentermine (lonamin)
Migraines- sumatriptan (Imitrex)
Neonatal apnea- theophylline
-Can cause sympathetic stimulation (up HR, BP, tremors, anxiety, insomnia), can be addictive, caution w/cardiac pts., don't stop abruptly, avoid other CNS stimulants (ex. caffeine)
Anti-epileptics
phenytoin (Dilantin)
-For seizures (but also nerve pain and restless leg), often lifelong seizures, need to check blood levels, can cause drowsiness, vision changes, suicidal thoughts, gingival hyperplasia, hirsutism- only use NS w/ IV Dilantin, seizure journal, driving restrictions, don't stop abruptly.
Anti-Parkinsons Drug
Carbidopa-levodopa (Sinmet)
-On/off phenomenon/ wearing off phenomenon w/Sinmet, can also give with MAO inhibitors (no tyramines), dopamine modulators (short-term effect), COMT inhibitors (orange urine), receptor agonists, and anticholinergics (dry out, constipation)
-Can cause dizziness- assist w/walking, take early evening-insomnia, fluids/fiber for constipation, don't stop abruptly.
Anxioloytics (Psychotherapeutic drug)
Lorazepam (Ativan)
-Used for anxiety/seizures, don't mix w/ ETOH/ CNS depressants, can cause CNS depression, down BP, paradoxical rxn.
Mood stabilizers (Psychotherapeutic drug)
Lithium
-for Bi-polar disorder, monitor drug levels, effects Na+ so don't over-hydrate or dehydrate, can cause tremors/seizures/arrhythmias.
Antidepressants (Psychotherapeutic drug)
Fluoxetine (Prozac)
-Mainly for depression, can cause CNS depression, dry mouth, urinary retention, sexual dysfunction, avoid MAOs-> hypertensive crisis/tyramines, poss. serotonin syndrome
Antipsychotics (Psychotherapeutic drug)
haloperidol (Haldol)
quetiapine (Seroquel)
-Used for psychosis, schizophrenia, some anxiety, don't take with CNS depressants/ ETOH,
-careful with BP meds, can cause postural hypotention and EPS (extrapyramidal movements), dry mouth, confusion.
Adrenergics
epinephrine (adrenalin)
dopamine (Intropin)
-Used to improve CV (ex. cardiac arrest) and broncho-dilate (asthma)
-Stimulate sympathic nervous system (catecholamines)
-(^HR, ^electrical conduction, ^myocardial force, ^BP, ^CO) and broncho-dilation (albuterol) -can overstimulate tremors, palpitation, arrhythmias.
Beta Blockers
metoprolol (Lopressor)
"-olols"
-Ant-sympathetic at beta receptors, used for angina, arrhythmias, HTN, heart failure-don't withdraw abruptly, can get broncho- constriction, hypotention-hold for HR <60.
Alpha Blockers
doxazosin (Cardura)
"-osins"
-Anti-sympathetic at alpha receptors, used mostly for angina, HTN, and BPH, first dose phenomenon.
Cholinergic
bethanechol (Urecholine)
-Mimic effects of PNS, used to decrease eye pressure, tx urinary retention by ^ bladder tone, myasthenia gravis, Alzheimers (Exelon), can get HR and BP changes, seizures, bronchospasms.
Anti-cholinergics
oxybutynin (Ditropan)
-Blocks PNS, used for overactive bladder, bradycardia, and muscle rigidity, can cause ^HR, arrhythmias, constipation, dry up, urinary retention.
Ace Inhibitors
enalopril (Vasotec)
"-prils"
-Anti-hypertensives, Na/K exchange to cause diuresis-monitor K+ for hyperkalemia and watch for dehydration, can cause first dose effect and dry, persistent cough, monitor BP.
Angiotensin II receptor blocker (ARBs)
losartan (Cozaar)
"-sartans"
-Anti-hypertensive, vasodilator, can cause upper respiratory infection and headache, monitor BP
Ca+ Channel Blocker
amlodipine (Norvasc)
-Anti-hypertensive and angina, works on smooth muscle,
-monitor BP, don't give with acute MI, avoid grapefruits juice,
-adverse- can cause very low BP, constipation.
Nitrates
nitroglycerin (Nitrostat)
-For angina-chest pain-SL, maintenance-ointment or patch, pain>stop/rest> nitro x1 > if no effect call 911, can take up to 3 nitro SL, once every 5 min,
-watch for headache, should sting under tongue if working, store in dark glass vial w/metal lid, no cotton, can develop tolerance, IV nitro in non-PVC tubing
Cardiac glycosides
digoxin (Lanoxin)
-Positive inotropic effect- for heart failure and a-fib, can cause HR and BP changes-with toxicity
-can get decrease HR, green tinged vision, halos around lights, nausea, and arrhythmias- tx severe toxicity with Dig immune fab-watch electrolytes closely.
Anti-arrythmics
cordarone (amiodarone), lidocaine
-Ones we see on tests and in emergencies:
-Procainamide (Pronestyl/vtach, afib conversion,
-Lidocaine/vtach, vfib,
-Amidarone (Nexterone)/vtach, vfib, afib conversion,
-Diltiazem (Tiazac)/afib, PACs, PVSs, -Verapamil (calan)/afib, SVT
- all can cause arrhythmias in addition to treating them, monitor EKG, IV infusions on pump.
Anticoagulants (Coagulation modifiers)
warfarin sodium (Coumadin), heparin, enoxaparin (Levenox)
-All used to prevent new clots from forming, esp. for post-op and immobile pts.,
-Warfarin takes long to take effect, is given po, and is monitored by PT/INR, don't change amt of dark, green, leafy veggies, antidote is vit k or FFP, need freq lab draws to get right blood level
-Heparin-given IV or SQ for short-term monitored w/ PTT, antidote: protamine sulfate
-Lovenox- given SQ, no lab monitoring, used for short-term.
-All watch for bleeding- gums, tarry stool, urine, use of electric razors, no contact sports.
Anti-platelet drugs (Coagulation modifiers)
aspiring, clopidogrel (Plavix)
-Prevent platelets from sticking and causing new clots for people prone to strokes or heart attacks, don't give if someone needs to clot like w/ recent surgery, watch for bleeding.
Thrombolytic drugs (Coagulation modifiers)
tPA, rPA
-Only ones that break up existing clots w/ heart attacks and stroke, do not give to pts that have had a clot such as recent surgery, watch for bleeding and severe allergic rxn.
Antifbrolytic drugs (Coagulation modifiers)
-Promote clot formation, not common, no exemplar (you may hear the names such as hemabate in OB or DDAVP (desmopressin).
Antilipemics
atorvastatin (Lipitor)
-All end up trying to reduce high cholesterol, types: Statins- take @ night to be at level by breakfast, monitor for muscle issues, grapefruit issues- bole acid sequestrans usually powder you need to mix
-Niacin is given @ higher doses over what you take just as a vitamin- Fibrates-ezetimbe (Zetia), all can effect liver and clotting so need to be careful w/ blood thinners (warfarin) and alcohol, try and take other meds at other times, monitor lipid levels.
Diuretics
-Take in morning, check fluid balance, watch electrolytes ad BP (orthostatic hypotension), pts. to track wt. (help with HTN, heart failure, etc)
Carbonic anhydrase inhibitors
(Diuretics)
-Most common, decrease H+ excreted (so Na+ can be excreted w/water), can lead to acidosis
Loops (Diuretics)
furosemide (Lasix)
-very powerful, can give IV, high risk for hypokalemia, pts. need foods high in K+ and or K+ supplements, can cause arrhythmias.
Osmotics (Diuretics)
mannitol (Osmitrol)
-Iv only w/filter, acts like a sponge to pull water from tissues>blood vessels>urine, used most with cerebral swelling and help kidneys when damaged, can cause seizures, clots.
Potassium sparring (Diuretics)
spironolactone (Aldactone)
-Not super strong, used for maintenance, removes water and Na+ but little K+, tell pts. not to eat a lot of high K+ foods or they could develop hypekalemia.
Thiazides (Diuretics)
hydrochlorothiazide (HydroDIURIL)
-Excrete water and Na+, very little K+, can cause impotence, avoid black licorice.
Antacids
aluminum hydroxide (Amphogel)
-For acid stomach- can cause constipation.
H2 antagonist
famotidine (Pepcid)
-For acid stomach, prevent stress ulcer for pts. in hospital caution with elderly.
Proton Pump Inhibitors
lansoprazole (Prevacid)
-For stomach acid, prevent stress ulcer for pts. in hospital, can cause poss osteoporosis and pneumonia (new sudies).
Antidiarrheals
diphenoxylate (Lomotil)
-Can coat colon, absorb germs, decrease motility, or give good flora-check fluid status, never give if pt. has bloody diarrhea.
Laxatives
docusate sodium (Colace)
-Can work w/ fluid, movement, irritation, to produce stool, monitor for dehydration, electrolyte imbalance, potential for abuse for wt loss, long term use can lead to dependence, don't give w/ tender or distended abdomen.
antiemetics
ondansetron (Zofran)
-For nausea/vomiting (esp. post op and with chemo), work by blocking vomiting center in brain, can be give po or IV.
-give 30-60 mins before chemo, don't take with ETOH, don't drive right after, watch for low BP, can dry out and cause CNS depression.
Chemotherapetic agents
methotrexate, aclitaxel (Taxol), cisplatin (Platinol)
-Used to treat cancer and some autoimmune (rheumatoid arthritis)
-4 biggest side effects: alopecia, GI tract issues, bone marrow suppression (red cells, white cells, platelets), an chemo brain, handle w/special precautions (PPE), monitor CBC, watch for extravasation, neutropenic precautions in hospital.
Antimetabolites (Chemo agent)
-Effect raw cell material, also cardio and resp. side effects, interacts with warfarin.
Miotic inhibitor (Chemo agent)
-Slows cell division
Camptothecins (Chemo agent)
interferes w/DNA, diarrhea and cannot give colony stimulating factor.
Antineoplastic enzymes (Chemo agent)
Interferes with DNA.
Alylating drugs (Chemo agent)
-Damages DNA, nephrotoxicity and neurotoxicity.
Cytotoxic antibiotics (Chemo agent_
-Damages DNA, cannot use these antibiotics to treat inf. too toxic, can cause cardiomyopathy.
Hormonal drugs (Chemo agent)
-Used for breast and prostate cancer treatment otherwise may be palliative.
Hematopoietic drugs
epoetin alfa (Epogen) for RBCs
filgrastim (Neupogen) for WBCs
-Increase blood cells from bone marrow (chemo pts, kidney pts), can also give for plts. but less common, expensive, monitor CBC, can get flu-like symptoms.
Biologic response modifiers
-change body's immune fx, asses for allergies to eggs, full chemistry and hematology labs before starting, teaching signs of inf.
Interferon (Biologic response modifier)
-Synthetic interferon cytokines like in our bodies, can both increase immune fx (esp. against virus and cancer) and dampen immune fx (for autoimmune disease such as MS), can get flu-like symptoms and extreme fatigue.
Monoclonal antibodies (Biologic response modifier)
adalimumab (Humira)
-Synthetic antibodies mostly used for cancer, autoimmune and with transplants, can get flu-like symptoms.
Interleukins (Biologic response modifier)
-Synthetic interleukins like in our body, anti-tumor but can get very toxic (whole body massive fluid retention)
Disease-modifying anti-rheumatic drugs (Biologic response modifier)
methotrexate
-anti-inflammatory, anti-arthritis, and immune dampening, several weeks to see effect, watch for same side effects as chemo.
Immunosuppressants
cyclosporine (Sandimmune)
-Big ones used mostly to prevent transplant rejection, dampens immune system response to transplant but then pt will always be immunocompromised, life-long tx.
-narrow therapeutic windows, issues w/grapefruit juice, neurotoxic, hepatotoxic, nephrotoxic
-very close monitoring w/ physical exam and labs, may give with oral anti-fungals to prevent thrush, etc., monitor closely for any sign of inf.
Antihistamines
diphenhydramine (Benadryl)
-Block histamine so dry out, often used for allergies, can cause dry mouth, urinary retention, constipation, drowsiness, (anti-cholinergic and CNS effects), not for acute asthma attacks (doesn't work fast enough), don't use ETOH or other CNS depressants.
Decongestants
Adrenergics (constrict blood vessels, stop swelling)
Nasal steroids (anti-inflamatory)
Inter nasal anti-cholinergics (drying)
-Adrenergics, can cause sympathetic stimulation and steroids/anticholinergics can dry out too much, avoid caffeine and other CNS stimulants-if respt. symptoms >1 week see doctor, may be inf.
Antitussives
-Suppress cough by working on brain or numbing, only for non-productive coughs where the cough may be harmful, can cause dizziness/sedation, if cough>1 wk see MD.
Expectorants
-Help bring up mucus, thin secretions, increase fluids while taking.
Respiratory Drugs
-Drink adequate fluids, avoid triggers for bronchospasm, assess resp. status and effectiveness (peak flow meter), if using bronchodilator first, wait few minutes and then do steriod.
Bronchodilators (Resp. Drugs)
albuterol (Proventil)
-Mostly used for asthma, short-acting like albuterol mostly used for rescue but some for maintenance, can cause sympathetic stimulation.
Anti-cholinergics (Resp. Drugs)
ipratropium (Atrovent)
-Used for maintenance not acute attacks, can get dry mouth, heart palpitations.
Xanthine derivatives (Resp. Drugs)
theophylline
-Bronchodilators for asthma, great risk of sympathetic stimulation (may start IV for acute attack but then change to one with less sympathetic stim), GI tract irritation, arrhythmias,^blood sugars.
Leukotriene receptors agonists (Resp. Drugs)
-Don't broncho-dilate, counteracts substances causing inflammation and broncho-constriction, maintenance for asthma, can cause H/A and liver issues.
Corticosteroids (Resp. Drugs)
-Oral or inhaled anti-inflammatory for asthma maintenance takes weeks to see effect, can cause coughing, dry mouth and oral fungal inf, rinse after puff to, down change for oral fungal.
Antibiotics
-Treat bacterial inf., work at different points in cellular reproduction cycle, get culture before starting, need to maintain blood levels, metabolized in liver, excreted in kidneys, keep hydrated, need to teach about superinfections.
Penicillins (Antibiotics)
ampicllin, amoxicillin
"-cillins"
-Good for strep and staph, PO/IM/IV, high risk for allergic rxn, can cause severe GI side effects, can decrease effectiveness of birth control pills, take on empty stomach
Cephalosporins (Resp. Drugs)
cefazolin (Ancef)
-Good for UTIs and post-op inf., PO/IM/IV, can cause psudo-membranous colitis, nephrontoxicity, ^bleeding w/warfarin,
-NO ALCOHOL (disulforam-like reaction, N/V severe), take with food.
Carbapenems
imipenem/cilastin (Primaxin)
-For serious inf. (pneumonia, peritonitis, urosepsis), broad spectrum, Im/IV, can cause GI side effects, can be cross sensitive w/penicillin allergies, if hx of seizures can change seizure med effectiveness.
Monobactams
vancomycin
-Used for MRSA, C.Diff, IM/IV (rare PO), can cause ototoxicity, nephrotoxicity, infusion rxn, (^hr, decrease BP), issues with liver, red man syndrome if given too fast, give IV over 1 hr., need to draw peak and trough around 3rd dose, may pre-dose with antihistamines.
Tetracyclines
doxycycline
- Used of ten with acne, H.pylori, can give PO/IM/IV, teeth discoloration in young kids, GI irritation, photosensitivity, bone marrow suppression, can decrease effectiveness of birth control pills, do not give w/dairy, iron, laxatives, antacids, best w/empty stomach.
Macrolides/Licosamides
erythromycin
-Can use instead of penicillin for those w/allergy, PO/IM/IV, used for pertussis, whooping cough, other lung inf. can cause GI side effects, confusion/uncontrollable emotions, ^bleeding w/warfarin, take on empty stomach.
Aminoglycosides
gentamycin
Use for E.coli, tapeworms, IM/IV, can cause ototoxicity, nephrotoxicity, bone marrow suppression, GI effects, BP changes, don't give w/diuretics, don't give to pts, w/ myasthenia gravis or Parkinson's, ^respt effects w/ anesthetics and neuromuscular blockers.
Sulfonamides
trimethoprim-sulfamethoxazole (Bactrim)
-Used for UTIs, ear infections, bronchitis, PO, can cause GI effects, bone marrow suppression, Steven-Johnson syndrome, crystals in urine, take on empty stomach and hydrate well.
Quinolones
ciprofloxacin (Cipro)
-For resp, GI, and urinary inf, PO/IV, wathc for Achilles' tendon rupture (don't give <18yo), H/A, dizziness, bone marrow suppresion, photosensitivity, don't take w/dairy, antacids, laxatives, can ^effects of warfarin and theophylline.
Miscellaneous
-nitrofurantoin (Macrodantin)- for UTIs, turn urine brown, peripheral neuropathy, dysuria
-linezolid (zyvox)- for MRSA and VRE, PO/IV, ^BP w/tyramines.
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