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Pr: Moeprazole (Prilosec)
- Antiulcer drug
- Proton pump inhibitor
- Use: First PPI approved for PUD.
- Available in OTC & Prescription.
- Reduces acid, binds to enzyme H+, K+ ATPase.
- Takes 2 hours to reach therapeutic levels, lasts up to 72 hours.
- Short term 4-8 weeks, peptic ulcers, GERD.
- Longer for Zollinger-Ellison syndrome.
- Most effective for this syndrome.
- Only available in oral.
- Alerts: Admin before breakfast on empty stomach.
- My be administered with antacids.
- Should not be crushed or chewed.
- Adverse Effects: Headache, nausea, diarrhea, rash and abdominal pain.
- Contraindications: Not approved for <18.
- Lab Tests: May increase ALT, AST
- Herbal: St John's Wort and Gingko may decrease the plasma concentration of omeprazole.
Pr: Ranitidine (Zantac)
- Antiulcer Drug
- H2 Receptor antagonist
- Use: Blocks H2 receptors decreasing acid production.
- Short term 4-8 weeks, gastric ulcer could take longer.
- IV and IM avail for acute, stress induced bleeding ulcers.
- Tritec is a combination drug of ranitidine and bismuth citrate.
- Avail as dissolving tab for children and infants more than 1 month.
- Alerts: Admin at bed time.
- Adverse Effects: Mild and uncommon.
- Does not cross blood brain barrier, so it does not cause CNS depression or confusion.
- Contraindications: No OTC for children <12.
- Lab Values: May increase ALT, AST.
- Herbal: B12 deficiency may occur.
Pr: Aluminum Hydroxide
- Antiheartburn agent
- Use: used in combination with other antacids.
- Most commonly combined with magnesium.
- Neutralizes the acid in the stomach by raising ph.
- Does NOT reduce acid secretion.
- Alerts: Admin 2 hours before or after other drugs.
- Adverse Effects: Can cause constipation.
- Contraindication: Do not use if bowel obstruction is suspected.
- Interactions: Do not take with other drugs.
- Herbal: May inhibit absorption of iron.
Miscellaneous PUD Drugs
- Misoprostol (Cytotec): Inhibits acid production.
- Given to pts. taking high doses of NSAIDs or corticostoids.
- Pregnancy Category X
Pr: Psyllium Mucilloid (Metamucil)
- Bulk type laxative.
- Use: Natural Product that absorbs water into the fecal matter.
- May be taken daily.
- May need 1-3 days to take therapeutic effect.
- Frequent use may cause small reduction in cholesterol.
- Alert: mix with at least 8oz of water, fruit juice or milk, follow each dose with an additional 8 oz of liquid.
- Observe order adults fro aspiration.
- Adverse Effects: Insufficient water may cause obstructions in intestine or esophagus.
- Contraindications: Do not admin to undiagnosed abdominal pain, obstruction or impaction.
- Drug Interactions: reduces the absorption of warfarin, digoxin and antibiotics.
- Lab Test: May increase serum glucose level.
Pr: Diphenoxylate with Atropine (Lomotil)
- Antidiarrheal opioid
- Use: Slows paristalsis.
- Acts within 45-60 in.
- Not recommended for children.
- Alert: if admin to children follow pkg for liquid amount.
- Adverse Effect: Dizziness or drowsiness.
- Schedule V. No analgesic properties.
- Contraindications: Severe liver disease, obstructive jaundice, severe dehydration, narrow angle glaucoma.
- Drug Interactions: Other CNS Depressants, Hypertensive crisis if taken with MAO inhibitors.
- OD: Naloxone (Narcan) parenterally.
Pr: Sulfasalazine (Azulfidine)
- For IBD
- 5-amnosalicylate, sulfonamide
- Use: Anti-inflammatory for mild colitis.
- Alternate drug for Rheumatoid arthritis.
- Alerts: Do not admin if patients have allergies to sulfonamide or furosemide (lassie).
- Not approved for children under 2.
- Do not crush or chew extended release.
- Adverse Effects: GI-related nausea, vomiting, diarrhea, dyspepsia and abdominal pain.
- Headache is common.
- Impairs male fertility which reverses once drug is disc.
- Contraindication: Heptic conditions, may cause hepatotoxicity.
- Diabetes or hypoglycemia, may increase insulin production.
- Dehydration, may cause crystalluria.
- OD: will cause abdominal pain, anuria, drowsiness, gastric distress, nausea, seizures and vomiting. Treatment is supportive.
Pr: Prochlorperazine (Compazine)
- Phenothiazine Antipsychotic
- Use: Blocks dopamine receptors in the brain.
- Usually given rectally but is also available in tablet, capsule and IM.
- Alerts: Admin 2 hours before or after antacids and antidiarrheals.
- Adverse Effects: Dry mouth, sedation, constipation, orthostatic hypotension, and tachycardia.
- If used too long can show symptoms of Parkinson's Disease.
- Contraindications: Profound CNS, comatose, children younger than 2 or less than 20 lbs, narrow angle glaucoma, severe hepatic or cardio impairment.
- Interactions: CNS depressants, antacids, antidiarrheals.
- OD: CNS stimulant (dextroamphetaminie) or antiparkinson drug for extrapyramidal symptoms.
Pr: Sibutramine (Meridia)
- Antiobesity, appetite suppressant.
- Uses: Treat Obesity.
- 5-10% weight loss over 6-12 months.
- Alerts: Allow 2 weeks after disc. MAOI before starting.
- Not approved for under 16.
- Adverse Effects: Headache, constipation, insomnia and xerostomia.
- Containdications: Patients with eating disorders, MAO inhibitors, may raise blood pressure.
- Interactions: Drug-Drug: May cause +BP if used with decongestants, cough and allergy medications.
- OD: Beta adrenergic blockers.
Pr: Pancelipase (Cotazym, Pnacrease)
- Pancreatic Enzyme
- Use: Contains lipase, amylase and protease from pork origin to replace in patients not producing enough.
- i.e. pancreatitis and cystic fibrosis.
- Alert: Powder may be sprinkled on food.
- Avail in tablet and capsule also.
- 1-2 hours before or with meals.
- Adverse Effects: High doses = hyperuricemia.
- Contraindications: Allergies to pork products.
- Drug-Drug Interaction: Decreases iron absorption.
- OD: patients are treated symptomatically.
Pr: Vitamin A
- Lipid soluble vitamin
- Use: Growth, bones teeth, wound healing, night vision.
- Topical, oral, parental.
- Alerts: Peg A, Peg X at higher than RDA.
- Adverse Effects: Long term ingestion - drying and scaling of skin, alpaca, fatigue, anorexia, vomiting, leukopenia.
- Contraindications: Fetal harm in higher than RDA dose.
- Water Soluble Vitamin
- Use: Reverse symptoms of deficiency. Folic acid deficient Pregnancy. Alcoholics have low Folic acid levels.
- Contraindications: Anemia other than that caused by the Folic Acid deficiency.
Pr: Magnesium Sulfate (MgSO4)
- Magnesium supplement.
- Severe hypomagnesemia.
- Alert: monitor patient with IV for decreased cardiac function.
- Monitor every 6 hours.
- Give over 6 hours.
- Adverse effects: Monitor to prevent toxicity,OD.
- Contraindications: serious cardiac disease, oral in contraindicated in undiagnosed abdominal pain.
- OD: Calcium Gluconate is the antidote.
Pr: Desmopressin (DDVAP, Stimate)
- Antidiuretic hormone replacement
- vasopressin analog
- Use: Synthetic analog of human AHD increasing reabsorption of water.
- Controls acute symptoms of diabetes insipidus.
- Oral is preferred, although there is nasal spray and parenteral forms are available.
- Lasts up to 20 hours.
- Causes contraction in the smooth muscle in the vascular system, uterus and GI tract.
- Can be used to manage bleeding in Hemophelia A and Von Willebrands disease.
- Helps control bed wetting in children.
- Alerts: Given undiluted over 1 minuted IV
- Monitor for serious water intoxication.
- Adverse effects: Water intoxication-drowsiness, headache, and listlessness, convulsions and finally coma.
- Contraindications: DI caused by kidney disease because it worsens fluid retention.
- Caution in patients with coronary artery disease, hypertension, hyponatremia and thrombi.
- Young children and older adults are more prone to water toxicity and hyponatremia.
- Interactions: Increased diuretic with NSAIDs, decreased with lithium, alcohol, heparin, and epinephrine.
- OD: treatment includes water restriction and osmotic diuretics.
Pr: Levothyroxine (Synthroid)
- Thyroid hormone.
- Thyroid Hormone Replacement.
- Use: Synthetic form of T4 used in hypoactive thyroid (or myxedema) patients.
- Loss of weight, improved tolerance to environmental temp, increased activity and increased pulse rate.
- Start slow and low and work your way up.
- Alert: Same time every day, prefer morning to avoid insomnia.
- Adverse Effects: Rare but include, hyperthyroidism (graves disease), palpitations, dysrhythmias, anxiety, insomnia, weight loss and heat tolerance. Long term use can develop osteoporosis in women.
- Contraindications: Severe cardiovascular conditions. Severe adrenal insufficiency can cause serious adrenal crisis. DM can be worsened. Black box warning not to use as weight loss drug.
- Interactions: Increases effects of warfarin, increasing bleeding. Co-admin with epinephrine and norepinephrine can cause cardiac insufficiency.
- Herbal: 4 hours after iron or calcium supplements to prevent interference with drug absorption.
- OD: Treatment is symptomatic.
Pr: Propylthiouracil (PTU)
- Preferred drug for Hyperthyroidism.
- Antithyroid agent.
- Use: Patients with Hyperthyroidism. Interferes with the synthesis of T3 and T4 in the thyroid gland. Also prevents the conversion of T4 to T3 in the target tissue.
- Can take several days to 6-12 weeks. Effects include weight gain, reduction in anxiety, less insomnia, and slower pulse rate.
- Short half life, administered several times a day.
- Alerts: Admin with meals to avoid GI distress.
- Adverse Effects: Over treatment produces hypothyroidism. Rash and tangent leucopenia most frequent. Some experience agranulocytosis. TSH values and blood are need to establish proper doses.
- Contraindications: Increases anticoagulant actions. Iodine containing agents can antagonize drug.
- OD: will cause signs of hypothyroidism, treatment includes thyroid agent, atropine for bradycardia and symptomatic treatment as needed.
Pr: Hydrocortisone (Cortef, Hydrocortone)
- Adrenal hormone
- Identical to natural hormone cortisol
- Use: Drug of choice for adrenocortical insufficiency.
- Alert: Use exactly as prescribed and at the same time every day.
- Administer with food.
- Adverse Effects: Cushings syndrome at high doses.
- Contraindications: Known infections, unless being treated with anti-infectives. Diabetes, osteoporosis, psychosis, liver disease, hypothyroidism.
- Interactions: Estrogens potentiate the effects. Use of NSAIDS with this increases chance of peptic ulcer.
Pr: Human Regular Insulin (Humulin, Novalin)
- Anti diabetic agent, pancreatic hormone
- Short-Acting Hypoglycemic Agent
- Use: Maintain Blood Glucose Levels
- As mono therapy for Type 1 DM.
- In combo with oral med for type 2 DM.
- For Emergency treatment of Ketoacidosis.
- For Gestational Diabetes.
- Alerts: Has food and not hypoglycemic before admin insulin.
- Regular is the only insulin for IV injection.
- Rotate injections sites.
- 30 minutes before meals.
- Adverse Effects: Hypoglycemia from taking too much, not good timing with meal or skipping a meal. Weight gain is possible.
- Contraindications: Caution with pregnancy, renal impairment, fever, thyroid disease,, older adults, children and infants.
- Hypoglycemia. Hypokalemia may be worsened.
- Interactions: Hypoglycemic event potentiated by alcohol, MAOIs, anabolic steroids.
- OD: treated with food or glucagon or glucose.
Pr: Metformain (Glucophage)
- Antidiabetic agent
- Hypoglycemic agent: biguanide
- Use: Preferred hypoglycemic to manage Type 2 DM.
- reduces glucose levels. Approved for children 10 and above.
- Alerts: Do not crush or chew.
- Serum glucose levels must be taken every 3 months.
- Discontinue immediately if signs of acidosis are present.
- Adverse Effects: Gi related, nausea, vomiting, metallic taste, diarrhea and anorexia. Rarely causes lactic acidoses which is fatal. Increased risk in patients with renal impairment, liver disease, severe infection, excessive alcohol, shock or hypoxemia.
- Contraindications: Impaired renal function. History of acidosis, heart failure, renal failure, serious infection.2 days prior and 2 days after IV radiographic contrast.
- Interactions: Alcohol, captopril, furosemide.
- OD: Hemodialysis.
Pr: Estradiol and norethindrone (ortho-novum)
- Combination Oral Contraceptive
- Estrogen / Progestin
- Use: Taken for 21 days followed by placebo for 7 days.
- Alert: Pregnancy Category X
- If dose is missed, take two tablets the next day.
- Adverse Effect: nausea, breast tenderness, weight gain, breakthrough bleeding.
- Cardiovascular adverse effects can be HTN and thromboembolic disorders.
- Contraindications: Any heart related issues, known or suspected carcinoma of the breast, suspected or known pregnancy.
- Interactions: Some antibiotics, barbiturates, anticonvulsants.
- Herbal: breakthrough bleeding with the use of St. John's Wort.
Pr: Conjugated Estrogens (Enjuvia, Premarin, Cenestin)
- Estrogen; hormone replacement therapy
- Use: Used for Menopause
- Alerts: Use calibrated dosage applicator for vaginal cream.
- For IM or IV reconstitute first removing 5mL of air and injecting dilutent in to the vial.
- IV push slowly.
- Pregnancy X category.
- Adverse Effects: Acute pancreatitis, nausea, fluid retention, edema, berate tenderness, mental depression, decreased libido, higher risk of uterine cancer.
- Contraindication: Pregnancy, breast cancer, hepatic impairment.
- Interactions: decreased anticoagulants, increased corticosteroid.
Pr: Medroxyprogesterone Acetate (Provera)
- Hormone; agent for dysfunctional uterine bleeding
- Use: Synthetic progestin for endometrium of the uterus.
- Alert: Give PO with meals to avoid gastric distress.
- Observe IM for abscess, lump or discoloration.
- Pregnancy Category X.
- Adverse Effects: Menstrual irregularities, breakthrough bleeding, breast tenderness.
- Black box warning: may cause loss of bone mineral density.
- Contraindications: Pregnancy. Breast Cnacer.
- Herbal: St Johns Wort decreases effectiveness.
Pr: Ocytocin (pitocin)
- Drug to induce labor; uterine stimulant
- Hormone; oxytocic
- Use: Natural hormone excreted by pituitary, drug of choice to induce labor. Postpartum to reduce hemorrhage.
- Alerts: Pregnancy Category X
- Allergic reactions higher in IM or IV injection rather than IV infusion.
- Adverse Effects: Painful uterine contraction.
- Contraindications: Unfavorable fetal positions, fetal distress.
- Interactions: vasoconstrictors may cause severe hypertension.
- OD: immediate discontinuation.
- Male sex hormone
- Androgen; anabolic steroid; antineoplastic
- Use: delayed puberty and hypogonadism in males.Promotes enlargement of the sexual organs, growth of facial hair and deepening of the voice. In adults it restores masculine characteristics and increases libido. Erectile dysfunction in men caused by low androgen levels.
- FDA approved for inoperable breast cancer in women.
- Alerts: Alternate patch site daily, rotating sites every seven days.
- Give IM injection into gluteal muscles.
- Pregnancy category X
- Adverse Effects: Virilization in women. Increased libido. Edema. Excess can metabolize to estrogen and cause feminization.
- Contraindications: Breast or prostate cancer. Women who are pregnant.
- Interactions: poetiate anticagulants.
- Herbal: Hepatotoxicity if used with echinacea.
Pr: Sildenafil (Viagra)
- Drug for treating impotence
- Phosphodiesterase (PDE)- inhibitor
- Use: relaxes smooth muscle in the corpora cavernosa allowing blood flow to the penis. Results in a firmer, longer lasting erection in men. Onset in an hour, can last up to 4.
- Pulmonary arterial hypertension. Improves exercise capacity in these patients.
- Alert: Avoid with meals, especially high fat meals because absorption is decreased.
- Avoid Grapefruit juice.
- Adverse effects: headache, dizziness, flushing, rash and nasal congestion. Hypotension if taking with nitrates.
- Contraindications: Nitrates. Cardio issues and anatomical deformations to the penis.
- Interactions: Nitrates = Hypotension. Erythromycin, cimetidine, ketoconazole need lower doses of viagra.
- Herbal: grapefruit juice increases plasma concentrations and may cause adverse effects.
Pr: Finasteride (proscar)
- Drug for BPH
- 5-alpha reductase inhibitor
- Use: Inhibits 5-alphs reductase, the enzyme responsible for converting testosterone to one of it's metabolites. Promotes shrinking of the prostate. Also used to promote hair regroup (propecia).
- Alert: May crush tablets.
- Pregnant nurse or pharmacist must where gloves as absorption may occur and cause harm to a male fetus.
- Should not donate blood.
- Adverse effects: impotence, infertility, diminished libido, ejaculatory dysfunction.
- Contraindication: hypersensitivity to the drug.
- Interactions: testosterone will reduce the effect of both drugs.