FINAL EXAM DRUGS

Prednisone classes
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Terms in this set (143)
Prednisone classes
tc: anti-inflammatory
pc: corticosteroid
Prednisone MOA
Inhibits prostaglandins; Suppresses the release of histamine;
Inhibits phagocytes & lymphocytes (so you're inhibiting your immune system)
Prednisone uses
Used for short term treatment of acute inflammation.
Prednisone AE
Cushing's syndrome (weight gain, muscle weakness, bruising, bones easily fracture);
Can mask the infection (so don't take if you have an active infection). The serious AE have to do with long-term use of it, not just taking it 1 time (such as gastric ulcers)
Prednisone nursing considerations
Cannot abruptly stop taking them if they have been taking them long-term. Don't take if have an active infection.
Prednisone pt education
Tell them they cannot abruptly stop taking them; they must taper off the drugs.
Ibuprofen class
NSAID (non-steroidal anti-inflammatory)
Ibuprofen MOA
inhibits prostaglandin synthesis by blocking COX
Ibuprofen uses
reduces inflammation, swelling, pain, redness, fever
Ibuprofen AE
Nausea, heartburn, epigastric pain, & dizziness. Long term use leads to risk of renal impairment & GI ulceration (check BUN & creatinine). Sets you up for blood clots (MI & strokes).
Ibuprofen nursing considerationsBBW: Can cause thrombotic events: Aches in my legs, abdominal pain, chest pain, headache, SOB, visual disturbances, calf pain in leg. S/S of GI ulceration = blood in stool.Ibuprofen pt educationIf an herb starts with "g", it is a natural anticoagulant & they keep your platelets from clotting. Don't take with anticoagulants. If you have active peptic ulcers, do not take NSAIDS.Acetaminophen (Tylenol) classestc: antipyretic & analgesic pc: centrally acting COX inhibitorAcetaminophen (Tylenol) MOAReduces fever by direct action at level of hypothalamus & dilation of peripheral blood vessels. Enables sweating & dissipation of heat. NOT ANTI-INFLAMMATOARY!Acetaminophen (Tylenol) usesTreatment of fever in children & for relief of mild to moderate pain when aspirin is contraindicated.Acetaminophen (Tylenol) AEAcute toxicity may result in liver failure. Signs of acute toxicity include N/V, chills, abdominal discomfort, & fatal hepatic necrosis. BBW: Potential to cause severe liver injury & allergic reactions.Acetaminophen (Tylenol) nursing considerationsTreatment for overdose is N-acetylcysteine. AST & ALT labsAcetaminophen (Tylenol) pt educationIf patient has liver problems already, they should not take acetaminophen. 4 grams/day is max dose.Cyclosporine classtc: immunosuppressantCyclosporine MOAinhibits helper T cells (it is less toxic to bone marrow cells)Cyclosporine usesPrescribed for transplant recipients, often with a corticosteroid such as prednisone. Used for psoriasis & xeropthalmia (eye condition).Cyclosporine AE75% of patients experience reduction in urine output. Some will experience hypertension & tremor. Other common effects are headache, gingival hyperplasia, & elevated hepatic enzymes.Cyclosporine nursing considerationsDo not administer if WBC <4,000 or platelets <75,000.Cefazolin classestc: antibacterial pc: cell wall inhibitorCefazoline MOA1st generation cephalosporin that inhibits cell wall synthesis of gram-positive organisms (broad spectrum). Considered bactericidal: binds to the bacterial cell wall, weakens it, and kill the organismCefazoline usesUsed for treatment and prophylaxis of bacterial infections, particularly those susceptible gram-positive organisms. Often given before surgeries to prevent any infections.Cefazoline AERash & diarrhea are the most common; superinfections are likely when drug is used for prolonged periods. Possible pain & redness at injection site.Cefazolin nursing considerationsAdminister IM injections deep into large muscle to prevent injury to surrounding tissues. Assess renal & hepatic function. Use caution in patients with CKD: have been shown to be capable of causing nephrotoxicity--Decreased urinary output, fluid retention, hypertension, hyperkalemia... monitor BUN & Creatinine for renal function and potassium levels.Cefazoline pt education1-7% of pt. allergic to penicillin have cross sensitivity to thisErythromycin classestc: antibacterial pc: macrolide; protein synthesis inhibitorErythromycin MOAIt inhibits protein synthesis and produces a bacteriostatic effect at low doses & a bactericidal effect at high doses; safe alternative to penicillin.Erythromycin usesEffective against most gram + & many gram - . Used to treat whooping cough, Legionnaires' disease, peptic ulcer disease (H. pylori), Chlamydia. Can be used against bacteria residing inside host cells (like Listeria).Erythromycin AEQT prolongation which can lead to death. The estolate salt of the drug can cause hepatotoxicity- jaundice, itching, abd. Pain, fatigue, anorexia, N/V, fever; monitor ALT and AST.Erythromycin nursing considerationsAdminister on an empty stomach with a full glass of water. Do not give with or immediately before/after fruit juices.Erythromycin pt educationdo not take with grapefruit juiceCiprofloxacin classestc: antibacterial pc: Fluoroquinolone; bacterial DNA synthesis inhibitorCiprofloxacin MOAInhibits bacterial DNA synthesis; broad spectrum, bactericidal drug.Ciprofloxacin usesUsed for respiratory infections, bone & joint infections, GI/GU infections, ophthalmic infections, sinusitis, & prostatitis. Drug of choice for post exposure prophylaxis to Bacillus anthracis (anthrax). Also used for post exposure prophylaxis to other potential biological warfare.Ciprofloxacin AEBBW: Tendinitis & tendon rupture. May cause extreme muscle weakness in patients with myasthenia gravis. Associated with cartilage toxicity (increases risk of tendon injury) Serious AE: dysrhythmias, hepatotoxicity, CNS AECiprofloxacin nursing considerationsWell absorbed orally. Take with food, but not antacids or mineral supplements because drug absorption is diminished.Ciprofloxacin pt educationBecause of risk for cartilage damage, drug not approved for under 18 years old because it can affect growing plates.Vancomycin (Vancocin) classestc: antibacterial pc: cell wall synthesis inhibitorVancomycin (Vancocin) MOAInhibits cell wall synthesis by binding to cell walls & altering cell membrane permeability. Bacteriocidal, narrow spectrumVancomycin (Vancocin) usesTypically reserved for severe infections from gram + organisms. Often used after bacteria have become resistant to other, safer antibiotics. Most effective drug for treating MRSA infections and C diff.Vancomycin (Vancocin) AEOtotoxicity (hearing must be evaluated frequently). Nephrotoxicity (can lead to uremia; peak & trough levels are used to monitor this risk). Red man syndrome: large amounts of histamine are released from body, resulting in symptoms such as hypotension with a flushing and a red rash of face, neck, trunk, upper body (occurs with rapid IV administration). If red man syndrome occurs: stop med -> call HCP -> wait for symptoms to stop -> resume but give over 2 hr.Vancomycin (Vancocin) nursing considerationsWhen administered via IV route, hypotension, pain, & thrombophlebitis frequently occur. To prevent this, each dose is diluted in at least 200 mL of saline & given over 60 mins. Injection sites should be rotated. Anticipate the need for Peaks and Troughs.Isoniazid (INH) classestc: anti-TB drug pc: mycolic acid inhibitorIsoniazid (INH) MOAInhibits synthesis of mycolic acids, which are essential components of mycobacterial cell walls which is the bacteria that causes TB.Isoniazid (INH) usesFirst line drug for treatment of M. tuberculosis. May be used alone for chemoprophylaxis (preventative), or in combination with other anti-tuberculosis drugs.Isoniazid (INH) AENeurotoxicity is a concern (pts may exhibit paresthesia or hands/feet, convulsions, optic neuritis, dizziness, coma, memory loss, & various psychoses). BBW: hepatotoxicity is a rare but fatal AE (look for jaundice, fatigue, elevated hepatic enzymes, or loss of appetite).Isoniazid (INH) nursing considerationsDon't take if patient has a severe hepatic impairment. Check ALT & AST.Isoniazid (INH) pt educationOlder adults and those with daily alcohol consumption are at greater risk of developing hepatotoxicity. Do not drink alc. while takingNystatin classestc: superficial antifungal pc: polyeneNystatin MOABinds to sterols in fungal cell membrane, causing leakage of intracellular contents as the membrane becomes weakened.Nystatin usesUsed to treat superficial fungal infections. Extensive superficial fungal infections may be treated with both oral & topical drugs to ensure infection is eliminated from deeper membranes.Nystatin AEWhen given topically, produces few AE other than minor skin irritation. When given PO, may cause diarrhea, nausea, vomiting.Nystatin nursing considerationsMedications may be "swished and swallowed" or "swished and spit" to treat candidiasis of the mouth/throat.Nystatin pt educationTeach that medication must be swished for 2 minutes if using that route.Metronidazole (Flagyl) classtc: anti-infective, antiprotozoanMetronidazole (Flagyl) MOAActs as antiprotozoal drug, but also has antibiotic activity against anaerobic bacteria (this is what makes it unique).Metronidazole (Flagyl) usesDrug of choice for nonmalarial protozoan infections. Treats most forms of amebiasis, but also used to treat some respiratory, skin, and CNS infections. Available in topical form to treat rosacea. Available in a combination drug form to treat H. pylori infection associated with peptic ulcer disease.Metronidazole (Flagyl) AEMost common: anorexia, nausea, diarrhea, dizziness, headache. Dry mouth, unpleasant metallic taste also may be experienced. Although rare, may cause bone marrow suppression.Metronidazole (Flagyl) nursing considerationsCI in the following patients: Blood disorders (rare chance of additional bone marrow suppression) During first month of pregnancy (BBW is that in lab animals, it has been shown to be carcinogenic) Alcoholics (interaction creates a disulfiram reaction)Metronidazole (Flagyl) pt educationDrinking alcohol while on this can cause disulfiram reaction which is basically a bad hangoverAcyclovir classestc: antiviral drug for herpesvirus pc: nuceloside analogAcyclovir MOAPrevents viral DNA synthesis & decreases the duration & severity of acute herpes episodes.Acyclovir usesUsed to treat HSV-1 and HSV-2. Effective against CMV and VZV at higher doses. Can be used prophylactically.Acyclovir AEFew AE when given PO or topically. Nephrotoxicity and neurotoxicity are possible when given IV. Resistance has developed in HIV/AIDS pts.Acyclovir nursing considerationsCheck BUN/ creatinine (they may increase). Has a short half-life requiring oral doses to be given up to 5 times/day.Acyclovir pt educationPt needs to use condoms and lesions need to heal before having any sex.Doxorubicin (Adriamycin) classestc: antineoplastic pc: antitumor antibiotic"Red Devil"Doxorubicin (Adriamycin)Doxorubicin (Adriamycin) MOAAttaches to DNA, distorting its double helical structure, preventing normal DNA & RNA synthesis.Doxorubicin (Adriamycin) usesIt is administered only by IV infusion. Prescribed for tumors (often breast cancer)Doxorubicin (Adriamycin) AEMost serious AE= cardiotoxicity. Acute N/V. Complete, but reversible, hair loss. BBW: Severe myelosuppression may occur. Cardiotoxicity, which may be acute or chronic. Severe local necrosis may result if extravasation occurs = Vesicant. Secondary malignancies may occur 1-3 years following therapy. Think Red = Heart and Devil = Bad!Doxorubicin (Adriamycin) nursing considerationsExtravasation can cause severe pain and extensive tissue damage. Skin contact or extravasation should be treated immediately with stopping/pulling back meds and local ice packs to reduce absorption of the drug. Pregnancy category D. Serum uric acid and AST levels may increase. Blood cell counts will diminish due to bone marrow suppression.Doxorubicin (Adriamycin) pt educationCI in pregnancy, severe hepatic impairment, myelosuppression, thrombocytopenia, and preexisting cardiac diseaseTamoxifen classestc: antineoplastic pc: estrogen receptor antagonistTamoxifen MOAEstrogen receptor antagonist.Tamoxifen usesAn oral antiestrogen that is a preferred drug for treating metastatic breast cancer. It is effective against breast tumor cells that require estrogen for their growth (ER-positive cells). It has no effect on ER-negative cancers. It's also approved for prevention of breast cancer in those who are high risk. Used as adjuvant treatment following mastectomy.Tamoxifen AEN/V common. Hot flashes, fluid retention, and vaginal discharges are relatively common. BBW: Increased risk of uterine cancer. Slightly increased risk for thromboembolic disease (including stroke, pulmonary embolism, & DVT)Tamoxifen nursing considerationsEstrogens will decrease the effectiveness of thisTamoxifen pt educationCI include anticoagulant therapy, preexisting endometrial hyperplasia, history of thromboembolic disease, pregnancy, and lactation.Atropine classestc: antidote for anticholinesterase poisoning pc: muscarinic cholinergic receptor blockerAtropine MOABlocks the parasympathetic actions of ACh and induces fight or flight. Causes increased HR, bronchodilation, decreased motility of GI tract, mydriasis, & decreased secretions from glands.Atropine usesTreats hypermobility of GI tract like IBS, suppresses secretions during surgery, increases HR, dilates pupils. Treats reflex bradycardia & hypertrophic pyloric stenosis in infants.Atropine AEThink sympathetic responses: dry mouth, constipation, urinary retention, & increased HR.Atropine nursing considerationsOral & SQ doses are NOT interchangeable. Monitor BP, pulse, and RR before admin and 1 hour after SQ dose. Contraindicated in glaucoma or obstructive disorders of the GI or GU systems.Atropine pt educationPhysostigmine is an antidote for atropine poisoning that quickly reverses the coma caused by large doses of atropine.Bethanechol (Urecholine) classestc: nonobstructive urinary retention drug pc: muscarinic cholinergic receptor drugBethanechol (Urecholine) MOADirect-acting parasympathomimetic (cholinergic) that interacts with muscarinic receptors to cause actions typical of parasympathetic stimulation.Bethanechol (Urecholine) usesWorks in GI & GU system, where it stimulates smooth muscle contraction after general anesthesia. It also treats nonobstructive urinary retention in patients with atony (lack of muscle tone) of the bladder.Bethanechol (Urecholine) AEThink parasympathetic: increased salivation, sweating, abd. Cramping, & hypotension that could lead to fainting.Bethanechol (Urecholine) nursing considerationsMonitor BP, pulse, & respirations before administration & for at least 1 hour after SQ administration. Use caution in patients with GI obstruction, active ulcer, inflammatory disease, urinary obstruction, or COPD.Bethanechol (Urecholine) pt educationPatients with asthma should not take this drug. Atropine is an antidote for overdose.Phenylephrine (Neo-Synephrine) classestc: nasal decongestant; anti-hypotensive drug pc: adrenergic drugPhenylephrine (Neo-Synephrine) MOASelective alpha-adrenergic agonist available in different forms (intranasal, ophthalmic, IM, SQ, IV). Think sympathetic stimulation (anti-SSLLUDD).Phenylephrine (Neo-Synephrine) usesIt reduces nasal congestion by constricting small blood vessels in the nasal mucosa. Reverses acute hypotension caused by spinal anesthesia or vascular shock.Phenylephrine (Neo-Synephrine) AECan cause burning of the mucosa in the nose & rebound congestion if used for too long. Ophthalmic preparations can cause narrow-angle glaucoma secondary to their mydriatic effect. Can also increase BP leading to reflex bradycardia. BBW: Severe reactions, including death, may occur with IV infusion even when appropriate dilution is used to avoid rapid diffusion.Phenylephrine (Neo-Synephrine) nursing considerationsThis drug should not be used in patients with acute pancreatitis, heart disease, hepatitis, or narrow-angle glaucoma. Parenteral administration can cause tissue injury with extravasation.Phenylephrine (Neo-Synephrine) pt educationTreatment with an alpha blocker such as phentolamine may be indicated to decrease BP.Escitalopram (Lexapro) classestc: antidepressant; anti-anxiety pc: SSRIEscitalopram (Lexapro) MOAIt increases the availability of serotonin by inhibiting its reuptake. By inhibiting the reuptake, more is available for use.Escitalopram (Lexapro) usesAn antidepressant. Used for conditions of GAD and major depression. Off-label uses include treatment of panic disorder.Escitalopram (Lexapro) AEDizziness, nausea, insomnia, somnolence, confusion, & seizures. BBW: suicidal ideation; especially in children, adolescents, and young adults. Avoid taking with MAOIs; May cause Serotonin Syndrome (autonomic hyperactivity, hyperthermia, rigidity, diaphoresis, hypertension). Combination with MAOIs can also cause neuroleptic malignant syndrome: (hyperthermia, confusion, rigidity, variable B/P, sweating, tachycardia)Escitalopram (Lexapro) nursing considerationsCareful in older adults because long duration. Titrate dosages slowly. Increments should be separated by at least 1 week.Escitalopram (Lexapro) pt educationNot approved for < 12 years old.Lorazepam (Ativan) classestc: sedative-hypnotic; anxiolytic; anesthetic adjucnt pc: benzodiazepine; GABA-A receeptor agonistLorazepam (Ativan) MOAA benzodiazepine that acts by potentiating the effects of GABA; a CNS depressant.Lorazepam (Ativan) usesto promote sleepLorazepam (Ativan)AE have to do with CNS depression: drowsiness, sedation, amnesia, weakness, disorientation.Lorazepam (Ativan) nursing considerationsWhen administering IV have airway/resuscitation equipment available. Very long acting (12-24 hr) so use with caution in older adults. Pregnancy category D. Do not give with other CNS depressants.Lorazepam (Ativan) pt educationTreatment of overdose: flumazenil.Zolpidem (Ambien) classestc: sedative-hypnotic pc: nonbenzodiazepine GABA receptor agonistZolpidem (Ambien) MOAA sedative-hypnotic. It is not a benzodiazepine but it is a GABA agonist.Zolpidem (Ambien) usesshort term insomnia management (7-10 days)Zolpidem (Ambien) AESleep walking/Sleep driving!Zolpidem (Ambien) nursing considerationsRapid onset. Give immediately before bedtime. Do not give with other CNS depressants. Schedule IV medication.Zolpidem (Ambien) pt educationMake sure they're not taking another sleep aid (CNS depressant). Reversed with Flumazenil.Diazepam (Valium) classestc: antiseizure drug pc: benzodiazepine; GABA receptor agonistDiazepam (Valium) MOABlocks action potentials (prolongs hyperpolarization) by potentiating GABA.Diazepam (Valium) usesTreats all types of epilepsy/seizures EXCEPT partial seizures (all general seizures). Also used for status epilepticus. Tolerance may develop after 4 weeks, so this is for short term control of seizures.Diazepam (Valium) AECNS depression (sleepy, lightheaded, difficulty concentrating, dizzy). Amnesia of events occurring after dosing (esp. IV administration). Respiratory depression. Abuse. Fetal harm (birth defects).Diazepam (Valium) nursing considerationsPotential for abuse; drug often used illegally. Monitor respirations prior to administration.Diazepam (Valium) pt educationTreatment of overdose: Flumazenil. Pregnancy category D. Use reliable contraception/ report pregnancy immediately. Avoid alcohol, driving, & hazardous activities.Valproic Acid (Depakene) classestc: antiseizure drug pc: valproateValproic Acid (Depakene) MOADesensitizes sodium channels, increases availability of GABA, and slows calcium channelsValproic Acid (Depakene) usestreats all types of seizuresValproic Acid (Depakene) AELimited CNS depression, visual disturbances, ataxia, vertigo, headache. Additional adverse reactions: gastrointestinal effects, hepatotoxicity (BBW), pancreatitis.Valproic Acid (Depakene) nursing considerationsTherapeutic levels: 50-100 mcg/mL. Check ALT/ASTValproic Acid (Depakene) pt educationHighly Teratogenic** Causes neural tube defects (spina bifida). Women of child-bearing age should take supplemental folic acid (5mg/day). Patient should be taught the signs of pancreatitis (abdominal pain, nausea, vomiting, and anorexia) and hepatotoxicity/hepatitis (reduced appetite, malaise, nausea, abdominal pain, jaundice).Imipramine (Tofranil) classestc: antidepressant; treatment of nocturnal enuresis in children pc: tricyclic antidepressantImipramine (Tofranil) MOABlocks the reuptake of norepinephrine & serotonin so more is available.Imipramine (Tofranil) usesfor major depressionImipramine (Tofranil) AEOrthostatic hypotension, sedation and anticholinergic effect (anti-SSLUDD); cardiac dysrhythmias.Imipramine (Tofranil) nursing considerationsAll patients should have a EKG/ECG before starting on medication. Caution should be taken with patients who are or may become suicidal as TCAs can be used for overdose and are lethal.Imipramine (Tofranil) pt educationSt. John's wort used concurrently may cause Serotonin syndrome.Phenelzine (Nardil) classestc: antidepressant pc: monoamine oxidase inhibitor (MAOI)Phenelzine (Nardil) MOAinhibit MAO, which is the enzyme that breaks down dopamine, norepinephrine, epinephrine, and serotonin (because it's nonselective). By decreasing the effectiveness of MAO, the MAOIs limit the breakdown of norepinephrine, dopamine, and serotonin in the CNS. This creates higher levels of these neurotransmitters to alleviate symptoms of depression.Phenelzine (Nardil) usesUsed to manage symptoms of depression & panic disorder. Used as a last resort because of their added AE.Phenelzine (Nardil) AEHypertensive crisis can result from interaction of MAOIs and food containing tyramine (avocado, banana, aged foods)Phenelzine (Nardil) nursing considerationsAll of the MAOIs cause irreversible inhibition (this is the washout period). Irreversible effect: Lasts about 2 weeks.Phenelzine (Nardil) pt educationMAOI's and SSRI's used at the same time can cause serotonin syndrome: autonomic hyperactivity, hyperthermia, rigidity, diaphoresis, hypertension