Pharmacology Classes Review

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AlexisSheasMommy
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Pharmacology Classes Review
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2011-01-29 17:45:13
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Eastern Suffolk Boces
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Review of classes including side effects
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  1. Antacids
    • Actions: They contain magnesium, aluminum, calcium and a
    • combination of these compounds. They slow down the rate of gastric
    • emptying and neutralize gastric acidity.
    • Uses: Gastritis, peptic ulcer, hiatal hernia and reflux esophagitis.
    • Adverse Reactions and Side Effects: Constipation, diarrhea, flatus,
    • abdominal distention, alkaluria.
    • Contraindications: Allergy and sensitivity
    • Implications: Assess epigastric pain, GI symptoms and renal problems
    • and electrolytes.

    • Examples of Medications in This Classification:
    • • aluminum carbonate
    • • calcium carbonate
  2. ANTIANGINALS
  3. This classification is further divided into:
    • • nitrates,
    • • calcium channel blockers, and
    • • b-adrenergic blockers.
    • Actions:
    • Nitrates - dilate coronary arteries, decrease preload and afterload.
    • Calcium channel blockers- also dilate coronary arteries, but they also
    • decrease SA/AV node conduction
    • β -Adrenergic blockers- slow the heart rate, thus decreasing O2 use.
    • Uses: Angina. Calcium channel blockers and β-blockers can also be
    • used for hypertension and dysrhythmias.
    • Adverse Reactions and Side Effects: Postural hypotension, fatigue,
    • dysrhythmias, headache, edema, dizziness.
    • Contraindications: Increased intracranial pressure, cerebral
    • hemorrhage and sensitivity.
    • Implications: Monitor for side effects and orthostatic B/P. Continue to
    • assess angina pain.
    • Examples of Medications in This Classification:
    • • propranolol
    • • verapamil hydrochloride
    • • nitroglycerine
  4. ANTICHOLINERGICS
  5. Actions: Inhibit acetylcholine (autonomic nervous system)
    • Uses: Many uses- some decrease GI, urinary and billiary motility;
    • others decrease GI secretions, decrease involuntary movement, and
    • relieve nausea, and vomiting.
    • Adverse Reactions and Side Effects: Dryness of the mouth, paralytic
    • ileus, constipation, urinary problems (retention and hesitancy)
    • dizziness and headache.
    • Contraindications: GI or urinary obstruction, narrow-angle glaucoma,
    • and myasthenia gravis.
    • Implications: Monitor urinary and bowel function as well as vital signs.
    • Keep the patient in bed for one hour after parenteral dose.
    • Examples of Medications in This Classification:
    • • atropine sulfate
    • • scopolamine
  6. ANTICOAGULANTS
  7. Actions: Prevent clot formation.
    • Uses: MI, pulmonary embolus, deep vein thrombosis, disseminated
    • intravascular clotting syndrome (DIC), and atrial fibrillation. It is also
    • used with dialysis.
    • Adverse Reactions and Side Effects: Hemorrhage, diarrhea, fever, rash
    • and blood disorders (leukopenia, thrombocytopenia, etc.) depending
    • on the specific drug.
    • Contraindications: Bleeding disorders, such as hemophilia and
    • leukemia, ulcers, blood dyscrasias, nephritis, endocarditis and
    • thrombocytopenia purpura.
    • Implications: Observe for bleeding (oral, black stools, stool occult
    • blood, ecchymosis, etc.). Monitor blood and BP (hypertension may
    • occur).
    • Examples of Medications in This Classification:
    • • warfarin sodium
    • • heparin
  8. ANTICONVULSANTS
  9. This classification is further divided into:
    • • barbiturates,
    • • hydantoins,
    • • succinimides,
    • • benzodiazepines and
    • • others.
    • Actions: Act to prevent seizures.
    • Uses: Depending on the specific drug, they prevent tonic-clonic
    • seizures, psychomotor seizures, status epilepticus, petit mal seizures
    • and cortical focal seizures.
    • Adverse Reactions and Side Effects:
    • Bone marrow depression, which can be life-threatening, GI problems,
    • CNS effects like confusion, ataxia and slurring of speech.
    • Contraindications: Sensitivity
    • Implications: Monitor hepatic and renal function, blood, mental status,
    • blood dyscrasias, and toxicity (ataxia, bone marrow depression,
    • nausea, vomiting, cardiovascular problems, Stevens-Johnson
    • syndrome)
    • Examples of Medications in This Classification:
    • • phenytoin
    • • diazepam
  10. ANTIDEPRESSANTS
  11. Actions:
    • MAOIs- inhibit MAO and thus they increase epinephrine,
    • norepinephrine, serotonin, and dopamine.
    • Tricyclics- block the reuptake of serotonin and norepinephrine in the
    • nerve endings, thus increasing the actions of both in the nerve cells.
    • Uses: Depression. Nocturnal enuresis in children.
    • Adverse Reactions and Side Effects: Orthostatic hypotension, mouth
    • dryness, dizziness, drowsiness, urinary retention, hypertension, renal
    • failure and paralytic ileus.
    • Contraindications: Hypertrophy of the prostate, seizure disorders,
    • renal, hepatic and cardiac disease.
    • Implications: Monitor standing and lying BP, blood, mental status,
    • hepatic function. Observe for extrapyramidal symptoms and urinary
    • retention. Withdrawal symptoms occur with abrupt cessation.
    • Examples of Medications in This Classification:
    • • sertraline
    • • amitriptylyline
    • • bupropion
    • • phenelzine
  12. ANTIDIABETIC MEDICATIONS
  13. Antidiabetics are also subdivided into the following groups:
    • • insulins of varying kinds, and
    • • oral hypoglycemic agents.
    • Actions:
    • Insulin- lowers blood sugar, potassium and phosphate
    • Oral hypoglycemic agents- stimulate the β -cells of the pancreas to
    • release insulin.
    • Uses: Diabetes and ketoacidosis
    • Adverse Reactions and Side Effects: Hypoglycemia, hepatotoxicity,
    • allergic responses
    • Contraindications: Sensitivity. Oral agents are contraindicated for
    • juvenile diabetes and ketoacidosis.
    • Implications: Monitor blood glucose, assess for hypoglycemia, rotate
    • insulin injection sites, and use human insulin with pork or beef
    • sensitivity.
    • Examples of Medications in This Classification:
    • • insulin
    • • glyburide
  14. ANTIDIARRHEALS
  15. Actions: Varying. Come decrease water content of stool, some slow
    • down GI peristalsis.
    • Uses: Diarrhea
    • Adverse Reactions and Side Effects: Constipation, paralytic ileus,
    • abdominal pain.
    • Contraindications: Colitis
    • Implications: Used for short term therapy (48 hours or less). Monitor
    • electrolytes and bowel response.
    • Examples of Medications in This Classification:
    • • bismuth subgallate
    • • kaolin and pectin mixtures
  16. ANITDYSRHYTHMICS
  17. Uses: Atrial and ventricular arrhythmias (atrial fibrillation, PVCs, and
    • tachycardia), hypertension, and angina
    • Adverse Reactions and Side Effects: Hypotension, bradycardia, other
    • arrhythmias and various other wide ranging side effects.
    • Contraindications: Various. Check each medication.
    • Implications: Monitor rate and rhythm, blood pressure, potassium,
    • dependent edema and I & O
    • Examples of Medications in This Classification:
    • • digoxin
    • • procainamide
    • • quinidine
    • • acebutolol
    • • bretylium
    • • verapamil
  18. ANTIFUNGALS
  19. Actions: Decreases sodium, potassium and nutrients in the cell and
    • increases cell permeability.
    • Uses: Fungal infections such as cryptococcosis, aspergillosis,
    • histoplasmosis, blastomycosis, coccidiomycosis, , phycomycosis, and
    • candidiasis
    • Adverse Reactions and Side Effects: Renal, liver damage and failure,
    • gastroenteritis, hypokalemia, anorexia, nausea and vomiting.
    • Contraindications: Sensitivity and bone marrow depression.
    • Implications: For IV administration, use a filter, check for
    • extravasation and protect from light (cover with foil). Monitor vital
    • signs, I & O, blood, weight, renal and hepatic function, hypokalemia
    • and ototoxicity.
    • Examples of Medications in This Classification:
    • • nystatin
    • • amphoteracin B
  20. ANTIHISTAMINES
  21. Actions: Antagonists of histamine.
    • Uses: Allergies, pruritus and rhinitis.
    • Adverse Reactions and Side Effects: Most cause drowsiness, headache,
    • urinary retention, blood dyscrasias, thickened bronchial secretions and
    • GI effects
    • Contraindications: Sensitivity, asthma, peptic ulcer, narrow angle
    • glaucoma.
    • Implications: Monitor urinary, respiratory and cardiac status. Also
    • monitor for blood dyscrasias.
    • Examples of Medications in This Classification:
    • • diphenhydramine hydrochloride
    • • chlorpheniramine maleate
  22. ANTIHYPERTENSIVES
  23. This classification is further divided into:
    • • angiotensin-converting enzyme (ACE) inhibitors,
    • • b-adrenergic blockers,
    • • calcium channel blockers,
    • • centrally acting adrenergics,
    • • diuretics,
    • • peripherally acting antiadrenergics, and
    • • vasodilators.
    • Actions:
    • Angiotensin-converting enzyme inhibitors- dilatation of the arterial and
    • venous systems occur through the suppression of renin-angiotensin I
    • to angiotensin II conversion
    • Centrally acting adrenergics- inhibit impulses in the CNS and the
    • sympathetic nervous system, decreases cardiac output, blood pressure
    • and pulse rate
    • Peripherally acting antiadrenergics- inhibit the release of
    • norepinephrine thus decreasing sympathetic vasoconstriction
    • Vasodilators- reduce blood pressure, cardiac rate and cardiac output
    • because these medications relax and dilate the smooth muscle of the
    • arteries
    • b-Blockers, calcium channel blockers, and diuretics are discussed in
    • another section below.
    • Uses: Hypertension, heart failure, angina and some dysrhythmias
    • Adverse Reactions and Side Effects: Hypotension, tachycardia,
    • bradycardia, nausea, vomiting and headache.
    • Contraindications: Heart block, hypersensitivity
    • Implications: Check for edema, monitor renal function, blood and for
    • symptoms of congestive heart failure.
    • Examples of Medications in This Classification:
    • • captopril
    • • propranolol hydrochloride
    • • reserpine
    • • nitroprusside sodium
  24. ANITIINFECTIVES
  25. Antiinfectives are divided further into the following groups:
    • • penicillins,
    • • cephalosporins,
    • • aminoglycosides,
    • • sulfonamides,
    • • tetracyclines,
    • • monobactam,
    • • erythromycins, and
    • • quinolones.
    • Actions: Inhibit the growth and/or replication of susceptible bacteria
    • Uses: Infection
    • Adverse Reactions and Side Effects: Diarrhea, nausea, vomiting, bone
    • marrow depression and anaphylaxis (life threatening)
    • Contraindications: Hypersensitivity. Most people allergic to penicillins
    • are also allergic to the cephalosporins.
    • Implications: Observe bowel pattern and urinary output. Monitor renal
    • function, blood and for signs of a superinfection and bleeding.
    • Examples of Medications in This Classification:
    • • penicillin
    • • tetracycline
  26. ANTIPARKINSON AGENTS
  27. This classification is further divided into:
    • • cholinergics and
    • • dopamine antagonists.
    • Actions:
    • Cholinergics- block acetylcholine receptors
    • Dopamine antagonists- activate dopamine receptors
    • Uses: Parkinson’s disease
    • Adverse Reactions and Side Effects: Involuntary movement, insomnia,
    • nausea, vomiting, orthostatic hypotension, dry mouth, numbness and
    • headache
    • Contraindications: Sensitivity and narrow angle glaucoma
    • Implications: Monitor respirations, blood pressure and changes in
    • mental and behavioral status
    • Examples of Medications in This Classification:
    • • levodopa
    • • entacapone
  28. ANTIPSYCHOTIC AND NEUROLEPTIC AGENTS
  29. Again, this classification is subdivided. The groups are:
    • • phenothiazines,
    • • thioxanthenes,
    • • butyrophenones,
    • • dibenzoxazepines,
    • • dibenzodiazepines,
    • • indolones and
    • • other heterocyclic compounds.
    • Actions: All of these pharmacological agents block the dopamine
    • receptors in the brain, the area that involves psychotic behavior
    • Uses: Schizophrenia, mania, paranoia, and anxiety. They are also
    • sometimes used for unrelieved hiccups, nausea, vomiting, and
    • pediatric behavioral problems as well as pre-operative relaxation.
    • Adverse Reactions and Side Effects: Some symptoms (EPS, dystonia,
    • akathisia and tardive dyskinesia) can be controlled with
    • antiparkinsonian medications. Others side effects include dry mouth,
    • photosensitivity, agranulocytosis, hypotension, and life threatening
    • cardiac problems and laryngospasm.
    • Contraindications: Coronary disease, severe hypertension, severe
    • depression, bone marrow depression, blood dyscrasias, parkinsonism,
    • cerebral arteriosclerosis, narrow angle glaucoma and children less than
    • 12 years of age. Cautiously used with the elderly.
    • Implications: Monitor CBC, liver function, I & O, blood pressure lying
    • and standing (orthostatic hypotension), EPS (antiparkinsonian agents
    • should be used for this). Observe for dizziness, palpations,
    • tachycardia, changes in affect, level of consciousness, gait and sleep
    • patterns.
    • Examples of Medications in This Classification:
    • • haloperidol
    • • chlorpromazine
  30. ANTITUSSIVES and EXPECTORANTS
  31. Actions:
    • Antitussives- suppression of the cough reflex
    • Expectorants- decrease the viscosity of thick, tenacious secretions
    • Uses: The expectorants are used with a cough associated with
    • bronchitis, TB, pneumonia, cystic fibrosis and COPD. Antitussives are
    • used for nonproductive coughs.
    • Adverse Reactions and Side Effects: Dizziness, drowsiness and nausea
    • Contraindications: Iodine sensitivity, pregnancy, lactation and
    • hypothyroidism. Caution with the elderly and those with asthma
    • Implications: Monitor the cough and the sputum. Increase fluid intake
    • and humidification to thin secretions.
    • Examples of Medications in This Classification:
    • • guaifenesin
    • • codeine
  32. ANTIVIRALS
  33. Actions: Interferes with the DNA needed for viral replication
    • Uses: HIV infections, herpes (herpes simplex virus and herpes
    • genitalis), encephalitis (herpes simplex) and varicella zoster
    • encephomyelitis
    • Adverse Reactions and Side Effects: Nausea, vomiting, diarrhea,
    • headache, anorexia, vaginitis, moniliasis, blood dyscrasias, renal
    • failure and metabolic encephalopathy which could be fatal
    • Contraindications: Immunosuppressed patients with herpes zoster and
    • hypersensitivity. Caution with pregnancy, lactation, renal and liver
    • disease and dehydration
    • Implications: Assess for renal and liver problems. Observe for signs of
    • infection and allergic reactions (itching, rash, urticaria). Monitor the
    • blood for dyscrasias.
    • Examples of Medications in This Classification:
    • • acyclovir sodium
    • • cidofovir
  34. BARBITURATES
  35. Actions: Decreases impulse transmission to the cerebral cortex
    • Uses: Epilepsy, sedation, insomnia, anesthesia, cholestasis with some
    • medications in this classification.
    • Adverse Reactions and Side Effects: Drowsiness, nausea, blood
    • dyscrasias and Stevens-Johnson syndrome
    • Contraindications: Allergy, poor liver function, porphyria, pregnancy
    • (category D). Caution with the elderly renal or hepatic disease (slowed
    • metabolism)
    • Implications: Monitor seizure control, blood, hepatic and renal
    • function. Observe for toxicity (insomnia, hallucinations, hypotension,
    • pulmonary constriction; cold, clammy skin; cyanosis of lips, nausea,
    • vomiting, delirium, weakness)
    • Examples of Medications in This Classification:
    • • phenobarbital
    • • secobarbital
  36. BENZODIAZEPINES
  37. Actions: Decreases anxiety by potentiating g-aminobutyric acid and
    • other CNS inhibitory transmitters
    • Uses: Anxiety secondary to phobic disorders and other conditions,
    • acute alcohol withdrawal and pre-operative relaxation.
    • Adverse Reactions and Side Effects: Physical dependence and abuse,
    • dizziness, drowsiness, orthostatic hypotension, and blurred vision
    • Contraindications: Narrow angle glaucoma, infants less than 6 months
    • old, hypersensitivity, lactation (diazepam) and liver disease
    • (clonazepam). Caution with the elderly as well as those with renal
    • and/or hepatic disease
    • Implications: Monitor lying and standing blood pressure (notify MD if
    • B/P drops 20 mm Hg or more), pulse, hepatic and renal function and
    • signs of dependency. Administer with milk or food to prevent GI
    • symptoms.
    • Examples of Medications in This Classification:
    • • diazepam
    • • clonazepam
  38. BETA BLOCKERS
  39. β-Blockers are divided into two categories:
    • • selective blockers and
    • • nonselective blockers.
    • Actions:
    • Selective blockers- block the stimulation of b1-receptors in the cardiac
    • smooth muscle with chronotropic and inotropic effects.
    • Nonselective blockers- lowers blood pressure (plasma renins are
    • reduced) without a reduction in heart rate or reflex tachycardia.
    • Uses: Hypertension, angina prophylaxis and ventricular dysrhythmias
    • Adverse Reactions and Side Effects: Orthostatic hypotension, diarrhea,
    • nausea, vomiting, bradycardia, blood dyscrasias, CHF and
    • bronchospasm
    • Contraindications: Heart block, cardiogenic shock and CHF. Cautious
    • use with the elderly and those patients with COPD, coronary artery
    • disease, asthma, renal disease, thyroid disease, pregnancy.
    • Implications: Monitor blood pressure, I&O, daily weights, pulse and
    • renal function. Observe for edema and take the apical and radial pulse
    • before administration in order to determine if significant changes have
    • occurred.
    • Examples of Medications in This Classification:
    • • metroprolol
    • • propranolol
  40. BRONCHODILATORS
  41. This classification is further subdivided into:
    • • anticholinergics,
    • • α/β -adrenergic agonists,
    • • β -adrenergic agonists, and
    • • phosphodiesterase inhibitors.
    • Actions:
    • Anticholinergics- inhibit the interaction of acetylcholine at receptor
    • sites on bronchial smooth muscle
    • α/β −adrenergic agonists- increase the diameter of nasal passages and
    • relax bronchial smooth muscle
    • β-adrenergic agonists- relax the smooth muscle of the bronchii
    • Phosphodiesterase inhibitors- increased smooth muscle relaxation in
    • the respiratory system
    • Uses: Asthma, bronchospasm, COPD, emphysema, Cheyne-Stokes
    • respirations
    • Adverse Reactions and Side Effects: Dyspnea, bronchospasm, anxiety,
    • tremors, throat irritation, nausea and vomiting.
    • Contraindications: Narrow angle glaucoma, severe cardiac disease,
    • tachydysrhythmias and sensitivity. Cautious use with hypertension,
    • seizure disorders, pregnancy and lactation, hyperthyroidism and
    • prostatic hypertrophy
    • Implications: Assess for a therapeutic response (absence of dyspnea
    • and/or wheezing) and patient/family education about the use of the
    • inhaler
    • Examples of Medications in This Classification:
    • • albuterol
    • • aminophylline
  42. CALCIUM CHANNEL BLOCKERS
  43. Actions: Inhibits the flow of calcium ions across the cell membrane of
    • cardiac and vascular smooth muscle, thus relaxing the coronary
    • vascular smooth muscle, dilating the coronary arteries, slowing SA/AV
    • node conduction, and dilating peripheral arteries.
    • Uses: Angina, hypertension, and dysrhythmias.
    • Adverse Reactions and Side Effects: Dysrhythmias, edema, fatigue,
    • headache, and drowsiness.
    • Contraindications: Systolic blood pressure of less than 90 mm HG,
    • Wolff-Parkinson-White syndrome, 2nd or 3rd degree heart block, sick
    • sinus syndrome, and cardiogenic shock. CHF may get worse in the
    • presence of edema. Cautious use with hepatic and renal disease.
    • Implications: Monitor blood pressure, pulse and respirations.
    • Administer at bedtime and before meals.
    • Examples of Medications in This Classification:
    • • verapamil
    • • felodipine
  44. CARDIAC GLYCOSIDES
  45. Actions: Cardiac output and cardiac contractility are enhanced by
    • making more calcium available.
    • Uses: CHF and tachycardia
    • Adverse Reactions and Side Effects: Cardiac changes, hypotension, GI
    • symptoms, blurred vision, yellowish-green halos and headache.
    • Contraindications: Hypersensitivity, ventricular fibrillation, ventricular
    • tachycardia and carotid sinus syndrome. Caution among patients with
    • imbalances of potassium, magnesium and/or calcium, acute MI, severe
    • respiratory disease, AV block, renal or liver disease, hypothyroid and
    • the elderly.
    • Implications: Assess vital signs, check apical rate for one full minute
    • prior to administration (if less than 60, hold the dose and notify the
    • MD), electrolytes (sodium, potassium, chloride and magnesium), renal
    • and hepatic function. Monitor I & O. If K level is less than 3mg/dl,
    • potassium supplements may be ordered.
    • Examples of Medications in This Classification:
    • • digitoxin
    • • digoxin
  46. CHOLINERGICS
  47. Actions: These medications prevent the destruction of acetylcholine,
    • thus increasing its concentration, which enhances the transmission of
    • impulses.
    • Uses: Myasthenia gravis, bladder distention, urinary distention, and
    • postoperative paralytic ileus
    • Adverse Reactions and Side Effects: Bronchospasm, laryngospasm,
    • respiratory depression, convulsion, paralysis, respiratory arrest,
    • nausea, vomiting and diarrhea
    • Contraindications: Renal or intestinal obstruction. Cautious use with
    • children, lactation, bradycardia, hypotension, seizure disorders,
    • bronchial asthma, coronary occlusion, and hyperthyroidism
    • Implications: Monitor vital signs, I & O. Assess for urinary retention,
    • bradycardia, bronchospasm, hypotension, respiratory depression.
    • Examples of Medications in This Classification:
    • • neostigmine
    • • bethanechol
  48. CHOLINERGIC BLOCKERS
  49. Actions: Blocks the autonomic nervous system’s acetylcholine
    • Uses: Prevention of surgical secretions, to decrease the motility of the
    • urinary, biliary and GI tracts, reverses neuromuscular blockade. Some
    • are used for parkinsonian symptoms secondary to the use of
    • neuroleptic medications
    • Adverse Reactions and Side Effects: Constipation and dryness of the
    • mouth.
    • Contraindications: GU or GI obstruction, angle closure glaucoma,
    • myasthenia gravis, and hypersensitivity. Cautious use among the
    • elderly and with patients who have prostatic hypertrophy or
    • tachycardia
    • Implications: Monitor urinary status and I & O with particular attention
    • to any dysuria, frequency or retention. The medication may be
    • discontinued with these signs. Observe mental status and for
    • constipation. Administer oral doses with milk or food and administer
    • parenteral doses slowly with the person in a recumbent position to
    • prevent postural hypotension
    • Examples of Medications in This Classification:
    • • atropine
    • • scopolamine
  50. CORTICOSTEROIDS
  51. This classification is also subdivided. These groups are:
    • • glucocorticoids and
    • • mineralcorticoids.
    • Actions:
    • Glucocorticoids- increase capillary permeability and suppress the
    • movement of fibroblasts and leukocytes, thereby decreasing
    • inflammation.
    • Mineralcorticoids- increase potassium and hydrogen excretion in the
    • distal tubule by increasing the resorption of sodium
    • Uses:
    • Glucocorticoids- decrease inflammation. Some are used for adrenal
    • insufficiency, allergies and cerebral edema.
    • Mineralcorticoids- adrenal insufficiency
    • Adverse Reactions and Side Effects: Insomnia, euphoria, behavioral
    • changes, peptic ulcer (GI irritation), sodium and fluid retention,
    • hypokalemia, hyperglycemia, and carbohydrate intolerance (metabolic
    • reactions)
    • Contraindications: Fungal infections, amebiasis, hypersensitivity, and
    • lactation. Caution with the elderly, children and pregnant women,
    • diabetes, seizures, peptic ulcers, glaucoma, CHF, hypertension,
    • impaired renal function, myasthenia gravis and ulcerative colitis
    • Implications: GI symptoms can be prevented when the dose is given
    • with food or milk. Monitor blood sugar, potassium, weight, I & O,
    • plasma cortisol levels, adrenal insufficiency and for any signs of
    • infection. Observe for mood changes, particularly depression
    • Examples of Medications in This Classification:
    • • cortisone
    • • dexamethasone
    • • hydrocortisone
  52. DIURETICS
  53. This classification of medications is subdivided into:
    • • thiazides and thiazide-like diuretics,
    • • loop diuretics,
    • • carbonic anhydrase inhibitors,
    • • osmotic diuretics, and
    • • potassium-sparing diuretics.
    • Actions:
    • Thiazides and thiazide-like diuretics- slow resorption in the distal
    • tubule, thus increasing the excretion of sodium and water
    • Loop diuretics- inhibit the resorption of sodium and chloride in the loop
    • of Henle.
    • Carbonic anhydrase inhibitors- decrease the sodium-hydrogen ion
    • exchange in the tubule, thus increasing sodium excretion
    • Osmotic diuretics- decrease the absorption of sodium by increasing the
    • osmotic pressure of glomerular filtrate
    • Potassium-sparing diuretics- decrease potassium excretion by
    • interfering with sodium resorption at the distal tubule
    • Uses: Hypertension and edema with CHF
    • Adverse Reactions and Side Effects: Hypokalemia, hyperglycemia and
    • hyperuricemia (mostly with thiazides), blood dyscrasias, aplastic
    • anemia, volume depletion, and dehydration (thiazides, loop diuretics,
    • and carbonic anhydrase inhibitors)
    • Contraindications: Electrolyte imbalances (K, Cl, Na), anuria,
    • dehydration. Caution among the elderly as well as in the presence of
    • renal or hepatic disease
    • Implications: A potassium supplement may be needed. Monitor
    • electrolytes, blood sugar, and lying and standing blood pressures.
    • Observe for signs of hypokalemia and metabolic alkalosis. The
    • medication should be given in the morning to prevent the need for
    • frequent nocturnal voiding.
    • Examples of Medications in This Classification:
    • • furosemide
    • • hydrochlorothiazide
  54. HISTAMINE H2 ANTAGONISTS
  55. Actions: Inhibits histamine in the parietal cells, thereby inhibiting the
    • secretion of gastric acid secretion
    • Uses: Gastric and duodenal ulcers, gastroesophageal reflux disease
    • Adverse Reactions and Side Effects: Thrombocytopenia, neutropenia
    • agranulocytosis, aplastic anemia, confusion (not ranitidine), diarrhea
    • and headache.
    • Contraindications: Hypersensitivity. Cautious use with children less
    • than 16 years of age, hepatic or renal disease, organic brain
    • syndrome, lactation and pregnancy
    • Implications: Monitor I & O, creatinine, BUN and gastric pH. The pH
    • should be maintained above 5. Give slowly IV over 30 minutes to avoid
    • bradycardia and administer oral doses with meals to prolong the effect
    • of the medication
    • Examples of Medications in This Classification:
    • • cimetidine
    • • ranitidine
  56. IMMUNOSUPPRESSANTS
  57. Action: Inhibits lymphocytes
    • Uses: Prevention of organ transplant rejection
    • Adverse Reactions and Side Effects: Proteinuria, renal failure,
    • albuminuria, hematuria, hepatotoxicity, oral Candida, gum
    • hyperplasia, headache and tremors
    • Contraindications: Hypersensitivity. Caution with severe hepatic or
    • renal disease and pregnancy
    • Implications: Monitor liver and kidney function, and drug blood levels.
    • Observe for signs of hepatotoxicity, which can include itching, light
    • colored stools, jaundice and dark urine. Administer with meals to avoid
    • GI symptoms
    • Examples of Medications in This Classification:
    • • cyclosporine
    • • azathioprine
  58. LAXATIVES
  59. Actions:
    • Bulk laxatives – absorb water thus adding bulk to the stool
    • Lubricants- increase water retention in the stool
    • Stimulants- speed up peristalsis
    • Saline laxatives- pull water into the intestines
    • Osmotics- enhance peristalsis and increase distention
    • Stool softeners- reduce the surface tension of liquids within the bowel.
    • Uses: Constipation, as a bowel prep and a stool softener
    • Adverse Reactions and Side Effects: Cramping, diarrhea, and nausea
    • Contraindications: Megacolon, abdominal pain, nausea, vomiting,
    • impaction, GI obstruction or perforation, gastric retention and colitis.
    • Caution with large hemorrhoids and rectal bleeding
    • Implications: Monitor blood, I & O, and urine electrolytes. Administer
    • only with water to enhance absorption. Do not administer within one
    • hour of taking an antacid, cimetidine or drinking milk.
    • Examples of Medications in This Classification:
    • • psyllium
    • • docusate sodium
    • • magnesium hydroxide
    • • mineral oil
    • • bisacodyl
  60. NEUROMUSCULAR BLOCKING AGENTS
  61. This classification is divided into:
    • • depolarizing blockers and
    • • nondepolarizing blockers.
    • Actions: Inhibition of nerve impulse transmission
    • Uses: The facilitation of endotracheal intubation and skeletal muscle
    • relaxation (surgery, general anesthesia and mechanical ventilation)
    • Adverse Reactions and Side Effects: Apnea, respiratory depression,
    • bronchospasm, and bradycardia
    • Contraindications: Hypersensitivity. Cautious use with collagen, thyroid
    • and cardiac disease, lactation, pregnancy, children less than two years
    • of age, dehydration, electrolyte imbalances, and myasthenia gravis
    • Implications: Monitor potassium and magnesium (imbalances may
    • increase the action of this medication), vital signs every 15 minutes
    • until recovery, and I & O. IV doses must be given over 1 to 2 minutes
    • by a person qualified and competent to do so (usually an
    • anesthesiologist)
    • Examples of Medications in This Classification:
    • • gallamine
    • • pancuronium
  62. NONSTEROIDAL ANTIINFLAMATORIES
  63. Actions: Decreases prostaglandin synthesis
    • Uses: Mild to moderate pain, arthritis and dysmenorrhea
    • Adverse Reactions and Side Effects: Blood dyscrasias, nephrotoxicity
    • (oliguria, azotemia, hematuria and dysuria), abdominal pain,
    • cholestatic hepatitis, anorexia, dizziness and drowsiness.
    • Contraindications: Asthma, severe liver and/or renal disease,
    • hypersensitivity. Cautious use with the elderly, children, lactation,
    • pregnancy and for patients with GI, cardiac and/or bleeding disorders.
    • Implications: Monitor blood, renal and hepatic function. Baseline
    • hearing and eye exams are recommended so that changes can be
    • identified. Toxicity may be signaled with tinnitus and/or blurred vision.
    • Examples of Medications in This Classification:
    • • ibuprofen
    • • naproxen
  64. OPIOID ANALGESICS
  65. This classification includes:
    • • opiates and
    • • nonopiates.
    • Actions: Depression of the pain impulse transmission at the level of
    • the spinal cord
    • Uses: Moderate to severe pain
    • Adverse Reactions and Side Effects: GI (constipation, nausea,
    • vomiting, anorexia, cramps), sedation, respiratory depression,
    • circulatory depression and increased intracranial pressure
    • Contraindications: Upper airway obstruction, bronchial asthma,
    • hypersensitivity, addiction. Cautious use with renal, hepatic,
    • respiratory and heart disease.
    • Implications: Monitor respiratory, urinary and mental status, level of
    • consciousness. An antiemetic can be used for nausea and vomiting.
    • Continue to assess level of pain
    • Examples of Medications in This Classification:
    • • codeine
    • • fentanyl
  66. SALICYLATES
  67. Actions: Antipyretic (inhibits the heat regulation center in the
    • hypothalamus), anti-inflammatory (inhibits prostaglandin), analgesic
    • (inhibits prostaglandin)
    • Uses: Mild to moderate pain, inflammation (arthritis), fever, and
    • thromboembolitic disorders
    • Adverse Reactions and Side Effects: Rash, GI symptoms,
    • hepatotoxicity, blood dyscrasias, hearing problems and tinnitus (a sign
    • of possible toxicity)
    • Contraindications: Frequently occurring hypersensitivity.
    • Contraindicated with a vitamin K deficiency, GI bleeding, a bleeding
    • disorder, children with Reye’s syndrome. Caution with Hodgkin’s
    • disease, hepatic and renal failure, anemia
    • Implications: Monitor renal and hepatic function, blood. Observe for
    • signs of hepatotoxicity (clay colored stool, dark urine, diarrhea, yellow
    • sclera and skin, itching, fever, abdominal pain) and ototoxicity (ringing
    • or roaring in the ears, tinnitus)
    • Examples of Medications in This Classification:
    • • aspirin
    • • salsalate
  68. THROMBOLYTICS
  69. Actions: These medications convert plasminogen into plasmin which is
    • able to break down the fibrin of clots
    • Uses: Pulmonary emboli, deep vein and arterial thrombosis, with or
    • after MI, arteriovenous cannula occlusion
    • Adverse Reactions and Side Effects: Anaphylaxis, GI, GU, intracranial
    • retroperitoneal bleeding, and anaphylaxis. The most common side
    • effects are decreased Hct, urticaria, headache, and nausea.
    • Contraindications: Hypersensitivity, people with CNS neoplasms,
    • bleeding, renal or hepatic disease, hypertension, COPD, subacute
    • bacterial endocarditis, rheumatic valvular disease, cerebral embolism
    • or thrombosis or hemorrhage, and recent surgery
    • Implications: Monitor vital signs and neuro signs q 4 hours, be alert for
    • internal bleeding (temperature of more than 104 degrees),
    • arrhythmias, retroperineal bleeding (leg weakness, back pain, and
    • poor pulses), allergic responses (rash, fever, itching, chill),
    • ecchymosis, hematuria, hematemesis, epistaxis. Monitor blood before
    • and during therapy. Thrombolytics are not effective if the thrombi is
    • more than one week old. Use 0.8 mm filter with IV administration
    • Examples of Medications in This Classification:
    • • streptokinase
    • • urokinase
  70. THYROID MEDICATIONS
  71. Actions: Increase metabolism cardiac output, blood volume, oxygen
    • consumption, and respiratory rate
    • Uses: Thyroid replacement
    • Adverse Reactions and Side Effects: Palpitations, tachycardia,
    • insomnia, tremors, angina, weight loss, dysrhythmias, thyroid storm.
    • Contraindications: MI, adrenal insufficiency and thyrotoxicosis.
    • Cautious use with the elderly, pregnant and lactating women, and for
    • patients with diabetes, hypertension, angina, and cardiac disease
    • Implications: Administer at the same time of day. Check the blood
    • pressure before each dose. Monitor I & O, weight, cardiac status and
    • for irritability, excitability and nervousness
    • Examples of Medications in This Classification:
    • • thyroid
    • • levothyroxin
  72. VASODILATORS
  73. Actions: Various modes for each. Check a drug reference book for
    • specifics
    • Uses: Hypertension, angina, intermittent claudication, vasospasm,
    • arteriosclerosis
    • Adverse Reactions and Side Effects: Both hypotension and
    • hypertension, changes in EKG, nausea, headache
    • Contraindications: Tachycardia, acute MI and thyrotoxicosis. Cautious
    • use with peptic ulcer and uncompensated heart disease
    • Implications: Administer with meals to reduce any GI symptoms.
    • Check bleeding times and cardiac status
    • Examples of Medications in This Classification:
    • • amyl nitrate
    • • hydralazine

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