-
_____ are most effective analgesics available
opioids
-
Opioid Narcotic Drugs
- morphine
- demerol
- codeine
- fenanyl
- oxyvodone
- ...etc
-
Opioids key points
- STOP if resp. < or = 12
- evaluate 1 hr after admin
- abstinence syndrome
- titrate carefully
***NARCAN ANTIDOTE***
-
Pentazocine (Talwin)
- Agonist-antagonist
- less analgesia than morphine
- Careful with opioid addcits w/drawl
- oral, sc, or IM
***Narcan antidote***
-
Codeine
- Opioid
- cross placenta
- not for ppl w/ productive cough, chest tube or pneu.
-
Morphine
- contra fro ppl w/ biliary tract surgery
- onset 15-30 mins
- contra - resp conditions, incr. ICP or head injury, hepatic or renal dysfunction
- reassess 60 mins fter admin
- 1st choice for PCA
-
Demerol
- Opioid
- should not exceed 48 hours
-
NSAIDS
- ibuprofen and celebrex
- Black box warning MI/Stroke
- RA, pain, migraine, fever
- * GI upset, peptic ulcer, hepatocity
- d/c pre-op 5 1/2 lives
- old ppl renal impairment
- avoid vacines
-
celebrex
- NSAID
- SULFA ALLERGY
- MI or Stroke rish
- less gastci ulceration
-
GOUT drugs
- colchine- acute
- allopurinol- chronic
-
colchicine
- Acute gout
- 1st sign of attack
- *vesicant
- purine diet
- oral or IV
- contra: card., hep., renal
-
allopurinpol
- chronic- not acute gout
- lowers uric acid
- Increase fluids -> 2.5-3 L/day
-
Acetaminophen
- mild pain/fever
- * No RA or Inflammation
- Antidote mucamyst
- 4,000 mg Q24/hr MAX dose
- hepatotoxcity
-
Salicylates
- aspirin
- inflam., headache, arthritis, fever, tendonities
- 81mg for antiplatelet- irreversable
- contra: kids w/ chickenpox for flu sypt. -> Reye
- Salic. poisioning- no antidotes
- give w/ milk and food- GI distress
- monitor- GI, bleeding, anemia, tinnitis, hepatox., renal funct.
-
RA Drugs
- (NSAIDS and Aspirin)
- DMARDs
- - methotrexate- nonbio.
- - embrel- bio
-
Etanercept (embrel)
- RA
- Biologic
- weekly injections
-
Methotrexate
- RA
- non bio DMARD
- 1st DMARD choice
- immunosupressive
- contras:
- -immunosupressed
- - bld dyscrasia
- -preg/lact.
- 10-12 glasses h2o/day
- folic acis interferes
- 3-6 weeks
- photosenstivity
-
Cholest. lowering catergories
- statins
- fibric acid derivaties
- cholesterol absorp. inhib.
- nicotonic acid
- bile acid sequestriants
-
Statins
- Chol. lowering
- lower LDL, raise HDL
- Lovastatin
- ( provastatin
- lipitor
- crestor
- zocor)
-
lovastatin
- statin
- cholest. lowering
- high 1st pass effect
- contra: preg X and liver disease
- NO GRAPEFRUIT
- liver test
- take in PM
- report muscle pain, tenderness or weakness
-
Fenofibrate (tricor, lipofen)
Gemfibrizol
- cholest. lowering
- fibric acid derivatives
- lowers tri and VLDL
- take w/ statin
- AE: liver and hyperglycemia
-
Ezetimibe (zetia)
- Chol. lowering
- chol. absorp. inhib
- kids >10 yo
- oral
- lowers LDL not HDL or tri.
- works in instest.
-
Nicin or Vit B3
- lowers cholest.
- nicotinic acid
- lowers tri and LDL raises HDL
take NSAIDS 30-60 mins prior
-
Cholestryamin and colestipol
- cholest lowering
- bile acid sequestraints
- last resort
- works in lower GI
- constipat.
-
HTN Med cat.
- ACE inhibitors
- diuretics
- beta blockers
- CA channel blockers
-
captopril
- ACE inhib.
- HTN, CHF. diabet. nephropahty, LV dystfunct. post MI
- BLACK BOX FOR PREG.
- loweres aldosterone
- --> prevents Na and H2O retension- Lowers BP
- AE:
- -cough
- -rash-
- 1st does hypertenstion- monitor 2-3 hrs
- 1hr before meals
-
Diuretics
- ALL SULFA BASED
- -Lasix
- Thiazide diu.
- Osmotic diu.
- Potassium sparing diu.
Block Na and Cl reabsorption
-
Lasix
- Loop diuretics
- SULFA BASED
- most effective
- most freq. used
- oral or IV
- eat K+ foods
- ototoxic
- hyperK
- hyperglycemia
- No DIG
-
Hydrochlorothiazide (HCTZ)
- Thiazide Diuretic
- 1st choice for HTN
- lower diuresis than Loop
- prevents ostroprosis
- Diabete Insipidus (rentention in these pts ?)
- NO PREGGERS
- careful w/ dig
-
Spirondactone
- HTN
- Potassium sparing diuretic
- cant use ACE or ARB
- Can't use salt sub.
- hyper Ca
- contra- loop diu.
-
Mannitol
- Osmotic Diuretic
- HTN
- Head injuries
- prophylaxis of renal fail.
- pulls h2o into nephron
- reduces increase ICP or Intra-ocular pressure
-
Antidysrythmics Cat.
- Na Channel blockers
- Beta agonists/catecholamine
- Ca Channel blockers
- Cardic gyloside
-
Lidocaine
- antidysrythmic
- Na channel blocker
- slow inpulse atria/ventricals & HIS purkinje system
- IV only
- short term
- small thep. range
- NOT SAME AS LOCAL
-
B1
B2
- B1- increase contraction and rate
- B2- lungs and uterus (increase bro-dilation) slows labor
-
Propranolol
- Beta blocker (B1 and B2)
- dysrhythmia
- HTN
- angina
- MI
- decrease:
- -HR
- -contraction
- -velocity of conduction
-
Beta blockers
OLOL
- propranolol
- acebutolol
- semolol
- sotalol
- heart to decrease CO
- decrease outflow to periphery
- prevents renin release
-
metoprolol (lopressor)
- Beta blocker B1 only
- HTN
- angina
- HF
- MI
-
Acebutolol
- Beta Blocker
- B1 only
- ok w/ asthma
-
Veapamil
- Ca Channel blocker
- Dysrhythamias
- angina
- essential HTN
- vasodilation- reduced arterial pressure
- increases coronary perfusion
- NO: DIG, Grapefruit, Beta blockers
-
Diltiazem
- Ca Channel blocker
- similar to verapamil
- bigger 1st pass effect
- less likely to cause constipation than Verapamile
-
Nifedipine
- Ca Channel blocker
- dangerous
- angina
- HTN
- * reflex tachycardia
-
A1
A2
Dop.
- A1- pupil dilation- vasoconstriction
- A2- dc pain and lowe symp. outflow
- dop- remal vessels
-
Epinephrine
A1, A2, B1, B2
-
catecholamin
- beta-agn ^Beta
- stimulates- epi
-
Digoxin
- Cardiac Gylcoside
- ^contraction
- slows down rate
- hoards Ca
- ** antidote- phentoin**
- for:
- HF
- Atrial Fib and flutter
- supraventricular tachcardia
- small thera. range
- TAKE PULSE: don't give if <60
-
Heprain
- Anticoagulant
- rapid acting
- prevent and treat DVT
- only parenteral
- ** Antidote: PROMINE SULFATE
- Ok with preggers
- watch platelet count <100,000 STOP
-
Low Molecular Weight Heparin
- Prevents DVT
- treatment of DVT
- 1 or 2x a day
- **ANTIDOTE: Protamine Sulfate**
- subQ
-
Warfarin (coumadin)
- Vit K antagonist
- prevent throb.
- anticoagulant
- 2-3 days for peak
- ** antidote Vit K**
- check INR
- watch Vit K foods
- Preg- cat X
-
Pradaxa
- anticoag.
- atrial fib- prevention of stroke pr syst. embolism
- knee or kid replacement
-
Xaltro
- anticoag
- less bleeding and less monitoring
-
Penicillin G
- narrow spectrum
- IM or IV
- least toxic of all antibiotics, not common cause of drug allergiy
- PCN V or VK is oral
-
cefazolin (ancef)
- cephalosporin
- PCN allergy
- B.C.
- C.dif- rare but can cause
- no alchol
- oral kept in fridge
- take w/ food
-
cefepime (maxipime)
- cephalosporin
- grestest spectrum
- penetrates CSF
-
Vancomycin
- Last resort
- can be toxic
- used for c. dif and MRSA
- nephrotoxicity
- ototoxicity
- peak and trough
- admin over at least 60 Mins
-
Gentamicin
- bactericidal
- Serious infection
- ototoxic
- nephrotoxic
- neurtoxic
- Benifical w/ PCN
- NO:
- -Loop
- -vanc
- -Nsaid
- -cehalosporins
- Infuse over 30=60 mins min.
- peak and trough
-
-
tetracycline
- broad spectrum
- Rickettsia
- pneumoniae
- chlamydia
- inhib. grows- not kill
- Photo sensitivity and rash- causes
- Preg- D
- discolors fetal teeth
- no mineral salts
- empty stomach
-
-
Rifampin and Isoniazid
TB
-
Acyclovir (Zovirax)
- antiviral
- Herpes and chickenpox
- nephrotoxic
-
Amantadine (symetryl)
- antiviral
- treats parkinsionism
-
Oseltamivir (tamiflu)
- take w/in 48 hours of onset
- take with food
- antiviral
-
albuterol
- Bronchodilators Prototype drug
- Beta 2 Agonists
- short acting
- acute and exercise induced
-
ipratropium bromide (Atrovent)
- Respiratory Anticholinergic Agents
- short acting
- AE: Most common- dry mouth and irritation of pharynx
- No peanut allergy
-
Tiotropium (Spiriva)
- Anticholinergic inhaler
- long acting
- pill poping inhaler
- prevents bronchospasm
- Will not help with acute attack
- Do NOT swallow capsules
- Most common AE: dry mouth, (sugarless candy canhelp)diminishes over time
-
Glucocorticoid inhalers
- Oropharyngeal candidiasis*
- *Rinse mouth/Gargle after each use, use a spacer
- Dysphonia (hoarseness, speaking difficulty)
- *Bone loss in premenopausal women
- Take lowest dose possible
- *Take calcium and vitamin D
- *Perform weight bearing exercises
-
Acetylcysteine (Mucomyst).
- break down mucus
- Administered by a nebulizer or by direct instillation into the trachea.
- Reserved for patients who have major difficultymobilizing and coughing up secretions
-
pseudoephedrine
- Decongestant
- Reduction of volume of nasal mucus,
- temporary relief of nasal congestion
- decrease inflamination
- Vasoconstriction of nasal arterioles/mucus membranes
- ^fluid intake, humidification, avoid smoke filled places,
- *Rebound congestion, dizziness, weakness,tremor, urinary retention, caution: OTC meds:
-
fexofenadine (Allegra).
- Antihistamines:
- Relieves seasonal & perennial allergy symptoms
- Block the action of histamine (H1 receptor) released during inflammatory response to an antigen
- Restores normal airflow through the upper respiratory system
- No grapefruit
-
cromolyn Na
- Mast Cell Stabilizer drugs
- A preventative drug that decreases episodes of asthma/bronchospasm (nasal: rhinitis)induced by different antigens (exercise, pollutants, allergans)
- Mast Cell Stabilizer drugs
- An anti-inflammatory agent, shields mast cells and prevents them from rupture & degradation after contactwith antigen, prevents release of histamine, possibly leukotriene's, & other chemical mediators by an unclear mechanism, possibly due to influx of calcium
- **Does NOT cause bronchodilation**
-
Dextromethorphan (DMX)
- Antitussive
- Suppress cough reflex
- Used to treat constant nonproductive cough
- Directly affects the cough Center in the Medulla
-
Benzonatate
Tessalon/ Tessalon perles
- Non-narcotic,
- anesthetizes stretch receptors in respiratory system to reduce cough reflex
- Used in endoscopy
-
Methylprednisolone
- systemic steriod
- immuno supress
- taper
-
prednisone
systemic steriod
-
Omeprazole (priolsec)
- Pro. pump inhib.
- don't crush or chew
- caps can be sprinkled
- H.pylori
- take b4 meals
-
H2 receptor antagonist
- GI
- blocks histamin
- prevents stress ulcers
- report black stool
- check IV every hr
- Cimetidine (tagament)- confusion w/ old ppl
- others:
- Famotidine (Pepcid)
- Nizatidine (Axid)
- Ranitidine (Zantac)
-
Antacids
- Mg not for renal pts
- don't take Ca, milk or Vit D
- white stool
- local acting
- don't take with other meds
-
Lactulose
- Hyperosmotic Laxative
- draws in H2O
- bowel distenstion and peristalysis
- good for Liver pts- lowers amonia
-
PEG
- Hyperosmotic Laxative
- draws in H2O
- bowel distenstion and peristalysis
- explosive dia.
- flush NG tube
-
Castor Oil
Basicodyl
Senna
- Stimulant Lax.
- irritates mucosa
- good for nacotics
-
Fibercon
metamucil
citrucel
- Bulk forming lax.
- Good for MI or ICP _don't bare down
- ^ H20
- long onset
-
Docusate Sodium
- Stool softener
- MI/ICP/HERNIA
- avoid strain
-
Metoclopramide
(Reglan)
- Prokinietic Agents
- ^GI motility
- nausa in chemo
- Tardive dyskinesia
-
Scopolamine (Transderm Scoop)
- Antiemetics
- Anticholinergic: Antihistimines
- patch
- give b4 nausa activities
-
Promethazine
(Phenergan)
- Antiemetic
- Phenothiazies: Antidopaminergics
- severe nausa
-
Droperidol
(Inapsine)
- Antiemetic
- extraprymidal effects
-
Synthroid (Levothyroxine Sodium)
- For Hypothyriod
- b4 food or meds
- no NSAIDS
- Notify if pulse > 100
- lifelong
-
Glyburide (DiaBeta)
- Adjunct TX to lower blood glucose levels in DM type 2.
- stimulation of pancreatic beta cells.
- SULFA ALLERGY
-
Meglitinides Repaglinide (Prandin)
- Adjunct TX to lower blood glucose levels in DM type 2.
- preferred in patients whoare elderly or w/decreased renal function
- Only taken if food is eaten
-
Metformin:Pharmacodynamics
- Decreases hepatic glucose production, decreases intestinal absorption of glucose,
- and improves insulin sensitivity by increasing peripheral glucose uptake in skeletal muscle and adipose tissue cells
-
Vasopressin
- diabetes Insipidous
- IM SubQ
- Mont. I&O
-
Epoetin Alfa (Epogen, Procit)
- stim. RBC
- amenia w/ chronic kid. disease
- ^ iron
- ck RBC b4 and after
- not uncontrolled HTN
- dont shake vial
-
Filgrastim (neupogrn)
- Stimulates WBC
- prevents chemo induced neutropenia
- dont use for bone cancer
- can cause bone pain
- fridge- then room temp
- monitor for infection
- no UV light
- not w/ chemo- after
-
Sagramostin (leukine)
- WBC
- aplastic anemia
- inhibits grow of tumor
-
Oprelvekin (Neumega)
- Thrombopoietic Growth Factor
- Platelet
- overstim.- bld will clot too much
- teach to be careful w/ bleeding
- refridge and light sensitive
-
Phenytoin (Dilantin)
- Anticonvulsant
- used for partial and general tonic-clonic
- decreases BC/ not for preggers
- gingival hyperplasia
- feedings far away w/ NG
- slow IV- hypotension and dysrhythmias
- ataxia (gait)
- liver toxix
-
Phenobarbital (Luminal)
- Anticonvulsant Barbituate
- tonic clonic & acute spisodes caused by status epil.
- strong sedative effect
- inactivated BC and Warfarin
-
Diazepam (Valium)
Lorazepan (Ativan)
(seizures)
- benzo
- ** antidote Flumazenil (romazicon)
-
Carbidopa-Levodopa
- Parkinson’s Disease
- Dopaminergics
- taper slowly
-
Selegiline
- Parkinson’s Disease
- Dopaminergics
- extends levodopa
-
Entacapone (Comatan)
- Parkinson’s Disease
- COMT Inhibitors
- liver failure
- for wearing off effect
-
Bethanechol
(Urecholine)
- Cholinergics
- Muscarinic Agonists
- WET
- rest and digest
- makes you pee (fast- bedpan)
- can decrease HR and cause Hypotenstion
- **ANTIDOTE: ATOPINE***
- I&O
-
Pilocarpine
- Cholinergics
- Muscarinic Agonists
- WET
- rest and digest
- Eye drops- reduces eye pressure in glaucoma
-
Acetylcholine
- Cholinergics
- Muscarinic Agonists
- WET
- rest and digest
-
Oxybutin (Ditropan)
- Anticholinergics
- Overactive Bladder for Women
- DRY
- FIGHT OR FLIGHT
-
Atropine
- Anticholinergics
- pre-op
- DRY
-
Anti psychotics w/ elderly
double rate of mortality
-
SSRI
- Most common for depression
- NO Preg- HTN in infants
- NO MAOIs or alcohol
- serotonin sydrome
- used for:
- depression
- OCD
- Panic
- Social Phob
- GAD
- PMDD
- PTSD
-
SSRI drugs
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
-
SNRIs used for
- Used for depression,
- peripheral neuropathic pain in diabetics,
- general anxiety disorder.
- Off-label use- Fibromyalgia, neuropathicpain/chronic pain, stress urinary incontinence.
-
SNRIs drugs
- Venlafaxine (EffexorXR)
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
-
SNRIs
General
- often better tolerated
- Warnings
- – Uncontrolled angle-closure glaucoma,
- -ESRD,
- -chronic hepatitis.
- Drug Interactions- Absolute contraindicated with MAOIs.
-
Tricyclic Antidepressants
- Blocks re-uptake of norepinephrine and serotonin into nerve endings.
- Orthostatic Hypotension – Most serious and commonadverse effect.
- NO MAOI
- Toxicity- don't give more than a week supply at a time- SI risk
-
Tricyclic Antidepressants
Therapeutic Uses:
- – Depression
- – Bipolar Disorder
- – Fibromyalgia
- – Neuropathic pain
- – Chronic Insomnia
- – Attention-Deficit/Hyperactivity Disorder
- – Pain Disorder
- – Obsessive-compulsive Disorder
-
Monoamine Oxidase Inhibitors(MAOIs)
- Inhibits the enzyme MAO that breaks down norepinephrine and serotonin.
- More dangerous than other antidepressants.
- Orthostatic Hypotension
- – Hypertensive Crisis with dietary Tyramine
-
Oral MAOIs–
- Isocarboxazid (Marplan)–
- Phenelzine (Nardil)–
- Tranylcypromine (Parnate)
-
Transdermal MAOI–
Selegiline (Emsam)
-
Buproprion (Wellbutrin, Wellbutrin SR)
- smoking cess.
- Can actually INCREASE libido, may promote compliance
- Can also cause psychosis (normally stopped at agitation)
-
Mirtazapine (Remeron)
- Atypical Antidepressants
- More wt gain and sedation/somnolence
-
Trazodone (Desyrel, Trialodine)
- Atypical Antidepressants
- Does not work well alone, often given to treat insomnia causedby other antidepressants.
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