Azathioprine – do prego test 1st

enoxaparin/lovenox- (self admin ch 25?)

-tx: Anticoagulant-PE, cerebrovascular accident, MI w/thrombolytic therapy
-labs: measure CBC, platelet count & hematocrit. Keep aPTT at 1.5-2x baseline value.
-s/e: hemorrhage, Low platelet count (thrombocytopenia), hypersensitivity (itching/rash/hives),
neurological injury from hematoma during LP
-pt teaching: Report bruising, petechiae, hematomas, black tarry stools, calf pain, itching
hives/rash. tenderness/swelling, sob, don't take NSAIDS/aspirin
Heparin
-Monitor activated partial thromboplastin time (aPTT)
-antidote: Protamine sulfate

Warfarin/coumadin (ch 25)

Tx: venous thrombosis & secondary PE, ischemic cerebrovascular accidents, thromboembolism
in pts w/heart valves, recurring mi &TIAs
-labs: PT, INR (monitor)
-s/e: Hemorrhage, toxicity from overdose (administer vitaminK)
-pt teaching: Stop taking if signs of hemorrhage, report bruising, petechiae, hematomas/black
tarry stools, wear Med ID bracelet, avoid excessive alcohol & OTC NSAIDs

Digoxin- (withholding ch 21)

-s/e: n/v, anorexia, h/a,
-signs of toxicity: visual disturbances yellow &/or blurry vision), cardiac dysrhythmias
Glycoside used for HF & dysrhythmia
Digoxin (Lanoxin) - Cardiac glycoside - Positive inotrope, negative chronotrope and
dromotrope. Used for HF, a-fib
Can cause dysrhythmias, bradycardia, GI effects (EARLY), vision changes (EARLY)
Hypokalemia = toxicity; hyperkalemia = decreased effects
Avoid verapamil Hold if pulse < 60
Therapeutic level = 0.5-2.0ng/mL
Antidote: cholestyramine or Digibind
Interacts w/ many meds
digoxin toxicity
report yellow-tinged vision to your provider

calcium gluconate
antidote for magnesium sulfate toxicity

Captopril, (ACEI) blocks angiotensin II

-Tx of HTN, HF, Diabetic Neuropathy, L ventricular dysfunction following MI
-s/e: Severe Hypotension, dry cough d/t bradykinin, rash, metallic taste in mouth, Angioedema,
Hyperkalemia, neutropenia (decrease in WBC)
Acei: report dry cough
can cause hypotension after initial dose. take one hour before meals (food reduces absorption)
serum creatinine levels normal is between 0.6 and 1.3
Aldactone/Spironolactone
-Tx: HTN, HF from MI, Aldosterone antagonist
-s/e: Hyperkalemia, monitor potassium, BUN & creatinine.
-Report muscle twitching, weakness/paralysis in extremities

Hydromorphone/Dilaudid-
-tx: Moderate to severe pain, opiate agonist
-s/e: respiratory depression, sedation/dizziness, constipation, n/v, orthostatic hypotension,
urinary retention, cough suppression, potential for abuse

ibuprofen/motrin-
-tx: inflammation, mild to moderate pain, fever, dysmenorrhea

Opioids stimulate Mu & Kappa receptors & produce euphoria, respiratory depression,
dependence analgesia & sedation.
NSAIDs interfere w/production of prostaglandins & inhibits mild pain & inflammation

-antacid: Chew tablets

-enteric coated swallow whole to prevent contact w/stomach acid.

Albuterol/Proventil-
Tx: long term management of asthma, prevention of exercised induced asthma, ongoing asthma
exacerbations
s/e: Tachycardia, heart palpitations, angina, tremors
-pt: teaching: Report chest pain & heart palpitations, report increase in pulse, avoid caffeine,
notify provider if tremors interfere w/ADLs

Clonidine/Catapres-
-tx: HTN, severe pain (epidural), migraines, withdrawal, ADHD, Tourettes
-s/e: drowsiness, dizziness, dry mouth, rebound hypertensive crisis if abruptly discontinued
-pt teaching: take at bedtime, don't perform hazardous activities ‘til CNS effects are known, Suck
hard candies, chew gum/sip water (dry mouth), Do not abruptly stop taking med.

Phenylephrine (Neo-synephrine)-
-tx: Allergic rhinitis, sinusitis & cold
-s/e: CNS stimulation (anxiety, agitation, insomnia), increased BP, tachycardia/palpitations,
rebound congestion w/prolonged use

Levothyroxine/Synthroid
-tx: hypothyroid.
-se: Hyperthyroidism

Anti-hypertensive teaching
hyperkalemia, angioedema (ace inhibitors), h/a, hypotension, non productive dry cough (ACEI),
diarrhea/abdominal pain, reflex tachycardia (CCB), lightheadedness, facial flushing, peripheral
edema of feet & legs, bradycardia, depression

Metronidazole/flagyl-
-pt teaching: take just before w/or after a meal if GI symptoms, report severe GI symptoms, h/a,
vertigo, seizures/peripheral neuropathy, pain in mouth, difficulty eating, vaginal
burning/discharge & prostatitis. darkening of the urine may occur,

metformin
-tx: lower blood sugar in type 2 diabetics-decreases glucose absorption in intestines, increases
insulin sensitivity decreases production of glucose by liver
-s/e: vitamin (B12, folic acid) deficiencies, ND, anorexia, lactic acidosis
-pt teaching: avoid drinking alcohol, taking tagamet, report weakness, fatigue, lethargy or
hyperventilation, maintain adequate carbohydrate & fluid intake, report weakness, fatigue, pallor
or reddened tongue.

simvastatin (Zocor) statin

-tx: Coronary heart disease, Reduces LDL (bad) & VLDL (triglicerides), increases HDL (good).
-s/e: Pain in muscles, joints & liver toxicity.
-Monitor: Myopathy, CPK levels, LFTa.
-Teaching: Report muscle pain & joint pain, abdominal pain & jaundice. comply w/liver testing

gemfibrozil (Lopid)
-tx: Reduces high levels of plasma triglycerides, Reduces LDL Cholesterol
-s/e: N/V/D. Gallstones. liver toxicity, myopathy.
-Monitor: GI symptoms, gall bladder, CPK if muscle pain, liver function.
-Teaching: Report GI, inability to tolerate fried foods, Muscle & joint pain, abdominal pain,
jaundice & fatigue.

psyllium (Metamucil)
-tx: Constipation (Fiber supplements). Non digestible, absorbs water from intestine to form a
mass that adds bulk to stool.
-s/e: excessive amounts causes diarrhea.
-Monitor: Give 8 oz water each dose, I&O, bowel function.
-Teaching: Water, report diarrhea, increase fluids & activity.

docusate sodium (Colace) docusate sodium and senna (Peri- Colace)

-tx: (Stool softeners) constipation- change surface tension, increases absorption of water into
stool, stimulates intestinal motility.
-s/e: Diarrhea & mild cramps
-Monitor: diarrhea and dehydration
-Teaching: Stop if diarrhea occurs, drink fluids, increase exercise & fluid intake, high fiber foods

bisacodyl (Dulcolax)
-tx: Constipation from opioid/slow intestinal transit. (Stimulant laxative) Stimulates intestinal
motility (colon) & acts on intestinal wall by decreasing fluid absorption & increasing secretion of
water and electrolytes from intestinal wall.
-s/e: Diarrhea, cramps, burning and laxative abuse.
-Monitor: Dehydration, rectal discomfort, bowel elimination patterns, I&O.
-Teaching: Report diarrhea, drink fluids, rectal discomfort, bleeding & discharge.

ondansetron (Zofran)
-tx: n/v from chemo, radiation & post op. (serotonin antagonist).
-s/e: h/a, dizziness, diarrhea
-Monitor: Persistent headache, dizziness, severe diarrhea & dehydration.
-Teaching: Report headache, dizziness, lie down & change positions slowly.

prochlorperazine (Compazine)
-tx: Severe n/v from anesthesia & chemo.
-s/e: Muscle spasms, tremors, rigidity, hypotension, sedation.
-Monitor: BP, ambulation, restlessness, anxiety.
-Teaching: Report restlessness, anxiety, dizziness, and B{, Sit lie down if drowsy.

dimenhydrinate (Dramamine)
-tx: Motion sickness (Antihistamines)
-s/e: Sedation, drowsy, dizzy, dry mouth, constipation and urinary retention.
-Monitor: Ambulating, bowel patterns, urinary retention.
-Teaching: Sit/lie down, change positions gradually, increase fluid and fiber intake.

metodopramide (Reglan)
-tx: n/v from chemo, opioids, radiation.
-s/e: Sedation, dry mouth, diarrhea.
-Monitor ambulation, dehydration.
-Teaching: Sit/lie down, drink fluids, change position slowly.

Diazepam (Valium) -Benzodiazepine

Muscle relaxant, antispasmodic, sedative (enhances GABA)
Treats anxiety disorders, muscle spasms, alcohol withdrawal
Side effects: CNS depression, amnesia,, respiratory depression
Physical dependence - do not d/c abruptly. Taper dose to d/c
Avoid other CNS depressants
Antidote: flumazenil (Romazicon)

penicillin (injection s/s to report)

allergy cross sensitivity with cephalosporins

clindamycin
can cause C.diff, diarrhea

Buspirone (BuSpar)
Treats anxiety disorders
Abuse less likely than other anxiolytics, No sedation, Doesn’t potentiate other CNS depressants
Dizziness, nausea, Caution w/ liver or renal disease, Don’t use w/in 14 days of MAOIs
(hypertensive crisis). May take weeks for full effect. Don’t take w/erythromycin, grapefruit juice

Paroxetine (Paxil)-SSRI (anxiety)

Prevents serotonin reuptake
Causes CNS stimulation (can cause insomnia)
Early: nausea, tremor, fatigue
Later: sexual dysfunction
Hyponatremia
Serotonin syndrome, Bruxism, GI bleeding
Taper slowly to d/c. Do not take w/ MAOIs or TCAs (serotonin syndrome)
Take in the morning, takes several weeks for full effects, take w/ food for GI effects

Amitriptyline (Elavil) - Tricyclic antidepressant (TCA)

Blocks NE, serotonin reuptake
Used for depression, migraines
Can cause orthostatic hypotension, anticholinergic effects, sedation, cardiac toxicity, decreased
seizure threshold, sweating, urinary retention & constipation
Avoid St. John's wort (serotonin syndrome, antihistamines, anticholinergics, alcohol, CNS
depressants, MAOIs

Fluoxetine (Prozac) - SSRI (depression)

Can cause sexual dysfunction, CNS stimulation, weight loss/gain, serotonin syndrome,
withdrawal syndrome, hyponatremia, bruxism, rash, fatigue, GI bleeding
Do not take w/ MAOIs or TCAs, St. John's wort, lithium. Caution w/ Coumadin, NSAIDs
(suppresses platelet aggregation) Take in the morning, takes several weeks for full effects, take
w/ food for GI effects
suppresses platelet aggregation so avoid NSAIDs

Phenelzine (Nardil) - MAOI (increases NE, dopamine, serotonin)

Treats depression, bulemia, OCD
Can cause CNS stimulation, orthostatic hypotension, cheese effect, local rash (transdermal)
Do not take w/ SSRIs, caution w/ TCAs

Bupropion HCl (Wellbutrin) - Atypical antidepressant

Inhibits dopamine uptake
Can cause anticholinergic effects, seizures, suppress appetite
Avoid MAOIs

Lithium - Mood stabilizer

Used for bipolar disorder
Blocks serotonin receptors, decreases neuronal atrophy/increases neuronal growth
Can cause GI distress, fine hand tremors, polyuria and thirst, weight gain, renal toxicity, goiter
and hypothyroidism, bradydysrhythmias, hypotension, electrolyte imbalance
Early toxicity: N/V/D, thirst, polyuria, muscle weakness, slurred speech
Low Na increases toxicity, NSAIDs increase toxicity, Avoid anticholinergics
Normal level 0.4-1.0mEq/L (toxicity > 1.5)

Carbamazepine (Tegretol)
Antiepileptic (also for bipolar, trigeminal neuralgia) (not for absence seizures)
Can cause blood dyscrasias (bleeding, bone marrow suppression), promotes ADH (edema, fluid
overload), Stevens-Johnson Hepatic autoinducer (alternate birth control, increase warfarin
dosage) Grapefruit juice (toxicity) Phenytoin and phenobarbital decrease effects
can accelerate the inactivation of oral contraceptives

Valproic acid (Depakote) - Antiepileptic (also bipolar)

Can use for absence seizures
Can cause N/V, hepatotoxicity, pancreatitis, thrombocytopenia
Increases levels of phenytoin and phenobarbital

Lamotrigine (Lamictal) - Antiepileptic (also bipolar)

Can cause double or blurred vision, Stevens-Johnson
Effect decreased by carbamazepine, phenytoin, phenobarbital
Half-life increased by valproic acid

Chlorpromazine (Thorazine) Haloperidol (Haldol) - Conventional antipsychotic (positive

symptoms) Block dopamine, ACh, NE, histamine
Can cause:
Acute dystonia (treat w/ anticholinergics - benztropine/Cogentin or Benadryl) - EARLY
Parkinsonism (treat w/ antcholinergics or amantadine)
Akathisia (beta blocker, benzodiazepine, anticholinergic)
EPS or tardive dyskinesia - LATE
Neuroleptic malignant syndrome (d/c, antipyretics, Valium, dantrolene)
Anticholinergic effects, orthostatic hypotension, sedation, gynecomastia, seizures, sexual
dysfunction, photosensitivity, agranulocytosis, dysrhythmias
given to prevent vomiting, can cause sedation and has an adverse effect of akathisia which
is a type of restlessness

Risperidone (Risperdal) (Seroquel, Abilify, clozapine – things to report)

Atypical antipsychotic (positive and negative symptoms)
Block serotonin, some dopamine, NE, ACh, histamine
Can cause DM or loss of glucose control, weight gain, hypercholesterolemia (esp. olanzapine,
clozapine)
Orthostatic hypotension, anticholinergic effects, agitation, tremors
Seroquel - cataracts, eye exam q 6 months
Clozapine - agranulocytosis
Contraindicated w/ dementia
Risk for stroke
Methylphenidate (Ritalin) Amphetamine (Adderall) CNS stimulant (increases NE, serotonin,
dopamine) Used for ADHD
Causes CNS stimulation, weight loss, CV effects, psychosis
Do not d/c suddenly
Avoid MAOIs (htn), caffeine (CNS stimulation), OTC cough and cold (sympathomimetic)
Increases levels of Coumadin
Atomoxetine (Strattera)
NSRI (not a stimulant) (blocks NE reuptake)
Used for ADHD
Minimal side effects - weight gain, N/V, hepatotoxicity
Caution w/ heart disease
Avoid MAOIs (htn)

Cholinesterase inhibitor (cholinergic agonist)

Treats myasthenia gravis
Reverse neuromuscular blockade
Cholinergic side effects
Antidote: atropine

Levodopa/carbidopa (Sinemet) - Parkinson's (dopaminergic)

Can cause N/V, dyskinesias, orthostatic hypotension, CV stimulation, psychosis, discolored
sweat/urine
Do not use w/ MAOIs
Proteins interfere w/ absorption
Pramipexole (Mirapex)
Parkinson's (dopamine agonist)
Can cause drowsiness, orthostatic hypotension, psychosis, dyskinesias, nausea
Allows for lower dose of levodopa
Caution w/ liver or kidney impairment

Benztropine (Cogentin) - Parkinson's (anticholinergic) (blocks ACh)

Can cause N/V, anticholinergic effects, antihistamine effects
Contraindicated w/ narrow-angle glaucoma

Amantidine (Symmetrel) - Parkinson's (dopamine releaser) Antiviral

Can cause confusion, dizziness, anticholinergic effects, discoloration of skin

Phenobarbital (Luminal) - Barbiturate

Can be used for epilepsy
Can cause CNS depression

Phenytoin (Dilantin) - Hydantoin (antiepileptic)

Can cause gingival hyperplasia, hirsutism, phlebitis, speed shock, sedation, double vision,
dysrhythmias, hypotension
Decreases effects of contraceptive, Coumadin, glucocorticoids
Avoid alcohol, Valium, Tagamet, CNS depressants
phenytoin (ch 13 – a/e)
commonly causes gingival hyperplasia. nystagmus is a serious reaction that should be reported.
can decrease absorption of calcium and vitamin D. normal serum levels are 10-20 mcg/mL

Gabapentin (Neurontin) - Antiepileptic

Can be used for neuropathy pain
Can cause drowsiness, nystagmus, edema

Succinylcholine (Anectine) - Neuromuscular blocking agent (depolarizing)

Fills ACh receptors and causes sustained depolarization
Reversal agent: Pseudocholinesterase enzyme
Monitor for respiratory arrest, hypotension
Watch for signs of malignant htn (administer dantrolene)
Monitor for hyperkalemia

Pancuronium (Pavulon) - Neuromuscular blocking agent (non-depolarizing)

Blocks ACh binding and inhibits depolarization
Reversal agent: neostigmine
neostigmine
nausea is a common adverse effect, can cause bradycardia and increase salivation

Cyclobenzaprine (Flexeril) - Muscle relaxant/antispasmodic

Enhances GABA
Used for muscle spasms due to injury
Causes CNS depression
Physical dependence - do not d/c abruptly

Baclofen (Lioresal) - Muscle relaxant

Enhances GABA
Used for cerebral palsy, SCI, MS
Causes CNS depression, nausea, constipation, urinary retention
Do not d/c abruptly

Dantrolene (Dantrium) - Muscle relaxant (peripherally acting)

Inhibits muscle contraction by preventing Ca release in skeletal muscles
Used for cerebral palsy, SCI, MS, malignant hyperthermia
Causes CNS depression, hepatotoxicity, muscle weakness

Bethanechol (Urecholine) - Muscarinic (cholinergic) agonist

Used for urinary retention
Causes cholinergic side effects (SLUDGE)
Take on empty stomach

Oxybutinin (Ditropan) Tolterodine (Detrol) - Muscarinic (cholinergic) antagonist

Used for overactive bladder
Causes anticholinergic effects
Avoid antihistamines, TCAs, phenothiazines
side effects include dry mouth, blurred vision, and photophobia

Zolpidem (Ambien) - Sedative-hypnotic (non-benzodiazepine)

Enhance GABA
Can cause daytime sleepiness
Low risk of abuse, tolerance, dependence
Avoid CNS depressants

Ramelteon (Rozerem) - Melatonin agonist

Used for insomnia
Can cause sleepiness, hormonal effects (amenorrhea, decreased libido, infertility, galactorrhea)
Take on empty stomach (fat decreases absorption)
Avoid CNS depressants
IV anesthetics

Albuterol (Proventil, Ventolin) - Beta-2 agonist

Inhaled = short-acting, oral = long-acting - for bronchospasm (rinse your mouth)
Rescue or maintenance (asthma)
Minimal adverse effects of inhaled
Oral can cause tachycardia and angina (alpha-1), tremors (beta-2 in skeletal muscle)
Beta blockers will cancel effects
MAOIs and TCAs increase risk of tachycardia and angina
Use before using glucocorticoid inhaler

Salmeterol (Serevent) - Beta-2 agonist

Long term maintenance for asthma

Theophylline (Theolair) Methylxanthine

Used for long-term control of asthma
Therapeutic range: 5-15mcg/mL
Early toxicity: GI distress, restlessness
Late toxicity: dysrhythmias, seizures
Caffeine increases theophylline levels
Phenobarbital and phenytoin decrease levels
Tagamet and fluoroquinolones increase levels

Ipratropium (Atrovent) Tiotropium (Spiriva) - Inhaled anticholinergic

Used for COPD, asthma
Cause anticholinergic effects
Contraindicated w/ peanut allergy
Caution w/ narrow-angle glaucoma and BPH

Beclomethasone diproprionate (QVAR) (Pulmicort, Advair, Flovent) - Inhaled

glucocorticoid
Maintenance for asthma
Can cause candidiasis

Prednisone (Deltazone)(Prednisolone) - Oral glucocorticoid

Long term use can cause suppression of adrenal gland function, bone loss, hyperglycemia,
myopathy, PUD, infection, edema, hypokalemia
Caution w/ K-wasting diuretics
Avoid NSAIDs (GI bleeds)
Must increase insulin or oral hypoglycemic doses

Hydrocortisone sodium succinate (Solu-Cortef) Methylprednisone sodium succinate (Solu-

Medrol) - IV glucocorticoids
Cromolyn sodium (Intal) - Anti-inflammatory (mast cell stabilizer)
Inhibits release of histamine
Used for chronic asthma, allergic rhinitis
Safest of all asthma meds

Montelukast (Singulair)
Leukotriene modifier
Long term asthma therapy
Take once daily at bedtime (oral)

Codeine - Opioid antitussive

Can cause drowsiness, respiratory depression, GI distress
Has potential for abuse
Avoid CNS depressants
Contraindicated w/ asthma, head trauma, liver/renal dysfunction, acute alcoholism

Dextromethorphan -Antitussive
Mild nausea, dizziness, sedation
Small potential for abuse
May cause high fever w/in 2 weeks of MAOIs

Guaifenesin (Mucinex) - Expectorant

Can cause GI upset, drowsiness, rash
Should increase fluid intake

Acetylcysteine (Mucomyst) -Mucolytic

Antidote for Tylenol poisoning (acetaminophen toxicity)
Used in CF, pulmonary diseases w/ lots of secretions
Can cause aspiration and bronchospasm (oral)
Smells like rotten eggs (mix w/ syrupy drink)

Phenylephrine – Decongestant - Alpha-1 agonist

Used for allergic rhinitis, common cold
Can cause rebound congestion w/ topical agents (faster, shorter duration)
Can cause CNS stimulation (rare)
Causes vasoconstriction (caution w/ htn, CAD)

Diphenhydramine (Benadryl) Promethazine (Phenergan) - Antihistamine (1st generation)

Used for allergies, anaphylaxis, motion sickness, insomnia
Can cause sedation, anticholinergic effects, GI discomfort
Avoid CNS depressants
treats uticaria (hives)

Loratidine (Claritin)(Zyrtec, Allegra) - Antihistamine (2nd generation)

Non-sedating
Furosemide (Lasix)
Loop diuretic
Block Na and Cl reabsorption in ascending loop
Can be used w/ renal impairment
Used for pulmonary edema, edema caused by liver/cardiac/kidney disease, htn
Also used for hypercalcemia related to kidney stone formation
Can cause dehydration, hyponatremia, hypochloremia, hypotension, ototoxicity, hypokalemia
(and hyperglycemia, hyperuricemia, decreased Ca and Mg)
Can cause dig toxicity due to hypokalemia, lithium toxicity due to hyponatremia
Antihypertensives have additive effect
NSAIDs reduce diuretic effect
Daily weights and I/O
Take early in the day

Hydrochlorothiazide (Hydrodiuril) - Thiazide diuretic

Blocks Na and Cl reabsorption in distal convoluted tubule
Cannot use w/ impaired renal function
Used for essential htn, edema of CHF/liver/kidney disease
Can cause dehydration, hypokalemia, hyperglycemia
Can cause dig toxicity due to hypokalemia, lithium toxicity due to hyponatremia
Antihypertensives have additive effect
NSAIDs reduce diuretic effect
Take early in the day

Spironolactone (Aldactone) - K-sparing diuretic

Blocks aldosterone (K retention, Na and water excretion)
Combined w/ other diuretics for K-sparing effects
Used for CHF, primary hyperaldosteronism
Can cause hyperkalemia, menstrual irregularities, impotence
Do not use w/ severe renal failure or anuria
Risk of hyperkalemia w/ ACE inhibitors, K supplements

Mannitol (Osmitrol) - Osmotic diuretic

Draws fluid into vascular space
Used for cerebral edema and to reduce intraocular pressure
Can cause heart failure, renal failure, fluid and electrolyte imbalances
IV infusion using filter needle (crystallization)

Captopril (Capoten) - ACE inhibitor

Blocks angiotensin II production causing vasodilation, Na/water loss, K retention, reduction of
cardiac remodeling
Used for htn, CHF, MI, nephropathy
Ramipril to prevent MI,, stroke, death
Can cause first dose orthostatic hypotension, cough (bradykinin), hyperkalemia, rash and altered
taste, angioedema, neutropenia
Can increase levels of lithium
NSAID use may decrease effects

Losartan (Cozaar) - ARB

Blocks action of angiotensin II causing vasodilation, Na/water loss, K retention
Used for htn, CHF, following MI, stroke prevention, nephropathy
No cough or hyperkalemia

Nifedipine (Procardia) - CCB

Blocks Ca channels (arterioles)
Used for angina, htn
Can cause reflex tachycardia, peripheral edema
Toxicity: administer Ca
Beta blockers can reduce reflex tachycardia
Grapefruit juice increases toxicity

Verapamil (Calan) Diltiazem (Cardizem) - CCB

Block Ca channels (arterioles and heart)
Used for angina, htn, dysrhythmias, migraines
Can cause orthostatic hypotension, peripheral edema, constipation, bradycardia, HF,
dysrhythmias
Toxicity: administer Ca
Can increase dig levels
Stagger beta blockers to avoid HF, AV block, bradycardia
Grapefruit juice increases toxicity

Prazosin (Minipress) - Alpha-1 blocker (sympatholytic)

Causes venous and arterial dilation, prostatic and bladder muscle relaxation
Used for primary htn, BPH
Can cause first dose orthostatic hypotension
Avoid NSAIDs (may decrease anti-htn effects)

Clonidine (Catapres) - Alpha-2 agonist (centrally acting)

Decreases sympathetic outflow
Used for primary htn, migraine, ADHD, alcohol withdrawal
Can cause sedation, dry mouth, rebound htn
Do not d/c abruptly
Contraindicated w/ anticoagulants
Do not use w/ prazosin, MAOIs, TCAs, CNS depressants
Twice daily dosing w/ larger dose at bedtime

Metoprolol (Lopressor) - Cardioselective beta-1 blocker

Decreased ino- chron- dromotrope
Used for htn, angina, tachydysrhythmias, HF, MI
Also used for hyperthyroidism, migraines, stage fright, pheochromocytoma, glaucoma
Can cause bradycardia, decreased CO, AV block, orthostatic hypotension
Do not d/c abruptly

Propranolol (Inderal) - Nonselective beta blocker

Used for htn, angina, dysrhythmias, migraines
Causes bronchoconstriction - avoid w/ asthma
Can cause fatigue, bradycardia, hypotension
Inhibits glycogenolysis (hypoglycemia, symptoms may be masked)
Take w/ food to increase absorption

Nitroprusside (Nitrostat) - Vasodilator

Used for hypertensive emergencies
Can cause hypotension, cyanide poisoning
Do not administer in same infusion w/ other meds, may be light brown color, protect from light

Epinephrine (Adrenaline) Adrenergic agonist (catecholamine) - Alpha-1, beta-1, beta-2

Slows absorption of anesthetics, manages superficial bleeding, decreased nasal congestion,
increased BP, treatment of AV bock and cardiac arrest
Can cause htn, dysrhythmias, angina
Avoid MAOIs (prolong effects) ,TCAs
General anesthetics can cause dysrhythmias
Beta blockers block action at beta receptors
Use an IV pump, titrate dose
Antidote: Phentolamine

Dopamine (Intropin) - Adrenergic agonist (catecholamine)

Low dose: dopamine (renal blood vessel dilation)
Moderate: dopamine, beta-1
High: dopamine, beta-1, alpha-1 (vasoconstriction)
Used for shock, HF
Can cause dysrhythmias, angina, necrosis w/ extravasation
Diuretics promote beneficial effects of dopamine

Dobutamine (Dobutrex) - Adrenergic agonist (catecholamine) Beta-1

Used for HF Can cause increased HR
Nitroglycerin - Organic nitrate (admin of topical ointment ch 22)
Dilates veins and decreases venous return
Used for angina
Can cause headache, orthostatic hypotension, reflex tachycardia
Tolerance can develop
Contraindicated w/ head injury
Avoid alcohol, Viagra
Cautions w/ anti-htn meds

Ranolazine (Ranexa) - Antianginal

Lowers cardiac oxygen demand
Used for angina in combination w/ amlodipine (Norvasc), a beta blocker, or an organic nitrate
Can cause QT prolongation, elevated BP
Avoid grapefruit juice, HIV protease inhibitors, macrolides, azole antifungals, verapamil
Can increase levels of dig and simvastatin

Procainamide (Pronestyl) Quinidine - Anti-dysrhythmic

Can cause SLE, neutropenia, QT prolongation, hypotension

Lidocaine (Xylocaine) - Anti-dysrhythmic, local anesthetic

Can cause drowsiness, seizures, respiratory arrest, hypotension, cardiosuppression

Propafenone (Rythmol) - Anti-dysrhythmic

Can cause bradycardia, HF, dizziness

Amiodarone (Cordarone) - Anti-dysrhythmic

Can cause pulmonary toxicity, sinus bradycardia, AV block, visual disturbances, liver and
thyroid dysfunction, GI effects, phlebitis, hypotenson

Adenosine (Adenocard) - Anti-dysrhythmic

Causes transient asystole. Used to convert SVT to normal sinus rhythm
Can cause sinus bradycardia, hypotension, dyspnea, facial flushing
Rapid IV push followed by saline bolus
Half life of 8-10 seconds

Gemfibrozil (Lopid) Antilipemic (fibrate)

Decreased triglycerides, increases HDL
Can cause GI distress, gallbladder stones, myopathy, hepatotoxicity
Increases risk of bleeding w/ Coumadin
Take 30 min before breakfast and dinner

Atorvastatin (Lipitor) - Antilipemic (HMG CoA reductace inhibitor)

Decrease LDL, increase HDL. Protects against MI and stroke in diabetics
Can cause hepatotoxicity, myopathy, peripheral neuropathy
Rosuvastatin: avoid in Asians
Risk of rhabdo w/ fibrates, ezetimibe
Grapefruit juice can increase levels. Take in evening

Ezetimibe (Zetia) - Antilipemic (cholesterol absorption inhibitor)

Help lower LDL w/ modified diet
Can combine w/ statin
Can cause hepatitis, myopathy
Levels increased w/ cyclosporine

Colesevelam (WelChol) Colestyramine (Questran) =Antilipemic (bile-acid sequesterants)

Decrease LDL
Can cause GI distress, decreased absorption of fat-soluble vitamins, constipation
Take other meds 1 hour before or 4 hours after
Take w/ food or add powder to 4-8oz fluid

Niacin - Antilipemic
Decrease LDL and triglyerides
Can cause GI distress, facial flushing, hyperglycemia, hepatoxicity, hyperuriemia
Take aspirin 30 minutes prior to prevent flushing

Heparin Enoxaparin (Lovenox) – Anticoagulant

Inhibits formation of fibrin report bruising
Used to prevent clotting (stroke, DVT, PE, prophylaxis, DIC)
Must be given IV or subQ
Can cause hemorrhage, heparin-induced thrombocytopenia (HIT)
Antidote: protamine sulfate
Avoid aspirin, NSAIDs
Monitor aPTT (60-80 seconds)

Warfarin (Coumadin) - Anticoagulant

Antagonizes vitamin K
Used for DVT, a-fib or prosthetic heart valves, prevention of MI or stroke
Can cause hemorrhage, hepatitis
Antidote: vitamin K
Monitor INR (2-3)
oral contraceptives can decrease the actions of warfarin

Aspirin (Ecotrin) - Antiplatelet

Used to prevent MI, stroke
Can cause GI effects, hemorrhagic stroke, prolonged bleeding, tinnitus from ototoxicity
Do not give to children or adolescents
Avoid NSAIDs, anticoagulants
May decrease action of beta blockers
Corticosteroids may decrease aspirin effects and increase risk for GI bleed
Caffeine may increase absorption
acute salicylate poisoning can cause respiration alkalosis leading to hyperventilation in the early
stages

Abciximab (ReoPro) - Antiplatelet

Used to prevent MI, stroke
Used in acute coronary syndromes
Can cause hypotension, bradycardia, prolonged bleeding
Avoid NSAIDs, anticoagulants

Clopidogrel (Plavix) - Antiplatelet

Used to prevent MI, stroke
Can cause prolonged bleeding
Avoid NSAIDs, anticoagulants

Pentoxifylline (Trental) - Antiplatelet

Used to prevent MI, stroke
Used for intermittent claudication
Can cause N/V
Avoid anticoagulants
May increase levels of theophylline

Streptokinase (Streptase) Alteplase (Activase, tPA) - Thrombolytic

Dissolves clots that have already formed
Used for acute MI, DVT, PE, ischemic stroke (alteplase)
Can cause serious risk of bleeding, hypotension, allergic reaction
Avoid NSAIDs, anticoagulants
Must be used w/in 4-6 hours of onset
Continuous monitoring
Antidote: aminocaproic acid (Amicar)

Epoetin alfa (Epogen) - Erythropoietic growth factor

Used for anemia w/ chronic renal failure, chemo
Can cause htn (elevated Hct), increased risk of stroke or MI (Hgb > 12)

Filgrastim (Neupogen) - Leukopoietic growth factor

Used for neutropenia (cancer)
Can cause bone pain, leukocytosis (WBC > 100,000)

Sargramostim (Leukine) - Granulocyte macrophage CSF

Stimulates bone marrow to produce WBCs
Used after bone marrow transplant
Can cause diarrhea, weakness, malaise, bone pain, leukocytosis, thrombocytosis
d/c for ANC > 20,000, WBC > 50,000, platelets > 500,000
Oprelvekin (Neumega, Interleukin -11) - Thrombopoietic growth factor
Used during chemotherapy
Can cause fluid retention, dysrhythmias, blurred vision, allergic reaction
thrombopoietic growth factor so we want to see platelet count in the expected range
(150,000-350,000)

Ranitidine (Zantac) Cimetidine (Tagamet) Famotidine (Pepcid) - H2 receptor antagonist

Used for PUD, GERD
Combine w/ antibiotics for H. pylori
Tagamet may decrease libido and cause impotence; may cause lethargy, depression, confusion in
older adults; may increase levels of warfarin, phenytoin, theophylline, lidocaine
May promote bacterial colonization due to decreased gastric acidity
Do not take antacids w/in one hour

Omeprazole (Prilosec) - Proton pump inhibitor

Inhibits enzyme that produces gastric acid
Used for PUD, GERD
Insignificant side effects w/ short term treatment
Long term use increases risk of gastric cancer and osteoporosis
May increase levels of dig
Take once a day prior to eating in the morning
Monitor for GI bleeding

Sucralfate (Carafate) - Mucosal protectant

Coats and protects ulcer (up to 6 hours)
Used for duodenal ulcers
Increase fiber and fluids to prevent constipation
No systemic effects
May interfere w/ absorption of phenytoin, dig, warfarin, cipro
Antacids interfere w/ absorption
Take on empty stomach (one hour before meals and bedtime)

Aluminum hydroxide (Amphojel) - Antacid

Neutralize gastric acid
Used to treat PUD, relieve GERD symptoms
Al and Ca can cause constipation
Mg can cause diarrhea, toxicity w/ renal impairment
Na results in fluid retention
Aluminum hydroxide can lead to hypophosphatemia
Al compounds bind to warfarin and tetracycline
Take w/ 8 oz water or milk
Take other meds one hour before or after

Misoprostol (Cytotec) - Prostaglandin E analog

Used w/ NSAIDs to prevent gastric ulcers
Can induce labor
Can cause diarrhea, abdominal pain, dysmenorrhea, spotting
Take w/ meals and at bedtime

Dexamethasone (Decadron) - Glucocorticoid

Antiemetic used for chemo-induced N/V

Aprepitant (Emend) - Substance P antagonist

Combine w/ glucocorticoid or serotonin antagonist
Has extended duration of action
Can cause fatigue, diarrhea, dizziness, liver damage

Ondansetron (Zofran) - Serotonin antagonist

Used for emesis related to chemo, radiation, postop
Can cause headache, diarrhea, dizziness

Prochlorperazine (Compazine) Metoclopramide (Reglan) Promethazine (Phenergan)

Dopamine antagonist
Used for emesis related to chemo, opioids, postop
Can cause EPS (admin Benadryl), hypotension, sedation, anticholinergic effects

Dronabinol (Marinol) - Cannabinoid

Used for chemo N/V and as an appetite stimulant in AIDS
Can cause dissociation/dysphoria, hypotension, tachycardia

Scopolamine (Transderm Scop) - Anticholinergic

Used for motion sickness
Can cause sedation, anticholinergic effects

Dimenhydrinate (Dramamine) Hydroxyzine (Vistaril) - Antihistamine

Used for motion sickness treats uticaria (hives)
Can cause sedation, anticholinergic effects

Psyllium (Metamucil) - Bulk-forming laxative

Softens fecal mass and increases bulk

Docusate sodium (Colace) - Surfactant laxative

Lower surface tension of stool to allow water in
Used for constipation during pregnancy, from opioid use, w/ hemorrhoids

Bisacodyl (Dulcolax) - Stimulant laxative

Stimulates peristalsis
Used for colooscopy prep, short term use for constipation

Magnesium hydroxide (Milk of Magnesia) - Osmotic laxative

Draw water into the intestine
Low dose - to prevent painful elimination (hemorrhoids)
High dose - for colonoscopy pre
Also used for rapid evacuation after poisoning or helminth therapy
Can lead to Mg toxicity
May cause dehydration

Diphenoxylate plus atropine (Lomotil) - Antidiarrheal

Decrease intestinal motility
Does not affect CNS at recommended doses
Atropine discourages abuse (anticholinergic side effects)

Loperamide (Imodium) - Antidiarrheal

Meperidine analog
Not a controlled substance

Metoclopramide (Reglan) - Prokinetic agent

Controls N/V by blocking dopamine and serotonin receptors; augments ACh
Used for postop and chemo N/V, management of GERD and gastroparesis
Can cause EPS (admin Benadryl), sedation, diarrhea
Avoid CNS depressants, opioids, anticholinergic

Alosetron (Lotronex) - Used for IBS-D in women that has lasted > 6 months
Blocks 5-HT3 receptors resulting in firm stool and decrease in urgency and frequency of
defecation
Can cause constipation

Lubiprostone (Amitiza) - Used for IBS-C and chronic constipation

Increases fluid secretion in intestine, promotes motility
Can cause diarrhea, nausea (take w/ food)

Sulfasalazine (Azulfidine) - 5-aminosalicylate,, DMARD

Decrease inflammation by inhibiting prostaglandin synthesis
Used for IBD (Crohn's, UC), RA
Can cause agranulocytosis, hemolytic and macrocytic anemia,, hepatic dusfunction, bone
marrow suppression

Methotrexate (Rheumatrex) - Cytotoxic agent (antimetabolite), DMARD

Folic acid analog
Slows RA, antineoplastic (stops cell reproduction), organ rejection
Can cause increased risk for infection, hepatic fibrosis, bone marrow suppression, GI ulcers,
N/V, hyperuricemia/renal damage, fetal death
Protect skin from sunlight
NSAIDs, salicylates, sulfonamides can increase toxicity
May reduce dig level
Take on an empty stomach, once per week
Antidote: leucovorin
immunosuppressant, bone marrow suppression. advise client to report fever, sore throat,
or other indications of infection
change type of antibiotic
reports uticaria (hives) or indications of an allergic reaction

Hydroxychloroquinone (Plaquenil) - Antimalarial, DMARD

Used for RA
Can cause retinal damage

Etanercept (Enbrel) Infliximab (Remicade) - DMARD

Used for RA
Can cause irritation at injection site, risk of infection (TB), severe skin reactions, HF, blood
dyscrasias
Etanercept: avoid live vaccines

Aurothioglucose (Solganal) - Gold salt, DMARD

Used for RA
Can cause renal toxicity, blood dyscrasias, hepatitis, GI discomfort
Toxicity: severe pruritis, rash, stomatitis

Penicillamine (Cuprimine) - DMARD

Used for RA
Can cause bone marrow suppression
Toxicity: severe pruritis, rash

Cyclosporine (Sandimmune) - DMARD, IL-2 suppressant

Used for RA, organ rejection
Can cause risk for infection, hepatotoxicity, nephrotoxicity, hirsutism
Avoid grapefruit juice
Decreases levels: phenytoin, phenobarbital, rifampin, carbamazepine, trimethoprim-
sulfamethoxazole
Increases levels: ketoconazole, erythromycin, amphotericin B
Amphotericin B, aminoglycosides, NSAIDs increase risk of nephrotoxicity

Calcium citrate (Citracal) - Ca supplement

Can cause hypercalcemia (> 10.5mg/dL) - tachycardia, elevated BP, bradycardia, hypotension,
muscle weakness, constipation, N/V
Glucocorticoids reduce Ca absorption

Raloxifene (Evista) - Selective estrogen receptor modulator

Decreases bone resorption
Used for postmenopausal osteoporosis, protect against breast cancer
Increases risk of PE, DVT
Can cause hot flashes
Should consume adequate Ca and vit D, perform weight-bearing exercise
Alendronate sodium (Fosamax) - Bisphosphonate
Decrease action of osteoclasts
Used for osteoporosis, hyperparathyroidism
Can cause esophagitis, GI disturbances, musculoskeletal pain, visual disturbances, osteonecrosis
of the jaw, risk of hyperparathyroidism
Take on empty stomach in early morning w/ at least 8oz water, wait 2 hours to take antacids or
Ca, avoid lying down for 30 minutes

Calcitonin (Fortical) - Inhibits osteoclasts

Used for osteoporosis, hyperparathyroidism
Can cause nausea, nasal dryness and irritation (intranasal)
Contraindicated w/ allergy to fish protein
Can decrease lithium levels
Monitor for hypocalcemia (Chvostek's or Trousseau's sign)
Encourage diet high in Ca and vit D

Morphine sulfate - Opioid agonist

Produces analgesia, respiratory depression, euphoria, sedation, decreased GI motility
Can also cause urinary retention, orthostatic hypotension, cough suppression, biliary colic,
emesis
Opioid overdose triad: coma, respiratory depression, pinpoint pupils
Caution w/ head injuries
Meperidine: lowers seizure threshold
Antidote: naloxone

Butorphanol (Stadol) - Opioid agonist-antagonist

Low potential for abuse, less respiratory depression, less analgesic effect
Do not use w/ opioid agonists
Do not use w/ patient that is dependent on opioids

Naloxone (Narcan) - Opioid antagonist

Used to treat opioid overdose (RR below 12 & shallow)
Half-life is less than half-life of narcotic
Titrate to reduce respiratory depression w/o full reversal of pain management
Rapid infusion may cause htn, tachycardia, N/V

Colchicine (Colgout) - Anti-gout med

Used for acute gout attacks
Can cause GI distress, thrombocytopenia, bone marrow suppression, hepatic necrosis
Take w/ food (Jason says empty stomach!)
Avoid aspirin, loop diuretics, alcohol

Allopurinol (Zyloprim) - Anti-gout med

Inhibits uric acid production
Can cause hypersensitivity reaction, renal injury, hepatitis, N/V
Slows metabolism of warfarin
Ergotamine (Ergostat) Ergot alkaloid (anti-migraine)
Used to abort a migraine
Can cause N/V (admin Reglan), ergotism (muscle pain, paresthesias in fingers and toes, cold
pale extremities), physical dependence, fetal abortion
take one tablet at the onset of a migraine

Sumatriptan (Imitrex) - Serotonin receptor agonist (anti-migraine)

Used to abort a migraine
Can cause chest pressure, angina, vertigo
Do not use w/ MAOIs

Divalproex (Depakote ER) - Anticonvulsant (anti-migraine)

Can cause neural tube defects, liver toxicity, pancreatitis
Do not use w/ benzodiazepines

Lispro (Humalog) - Rapid-acting insulin

Onset < 15 min
Peak 30-60 min
Duration 3-4 hours
Regular (Humulin R)
Short-acting insulin
Onset 30-60 min
Peak 2-3 hours
Duration 5-7 hours

NPH (Humulin N) - Intermediate-acting insulin

Onset 1-2 hours
Peak 4-12 hours
Duration 18-24 hours
Glargine (Lantus)
Long-acting insulin
Onset 1 hour
Peak (none)
Duration 10-24 hours

Tolbutamide (Orinase) Glipizide (Glucotrol) - Oral hypoglycemic (sulfonylurea)

Results in insulin release from pancreas
Can cause hypoglycemia
Glipizide: disulfiram reaction
Take 30 minutes before meal

Repaglinide (Prandin) - Oral hypoglycemic (meglitinide)

Results in insulin release from pancreas
Can cause hypoglycemia
Avoid gemfibrozil
Eat w/in 30 minutes, 3x/day

Metformin (Glucophage) - Oral hypoglycemic (biguanide)

Reduces production of glucose in liver
Increases muscles' glucose uptake and use
Also used to treat polycystic ovary syndrome
Can cause GI effects, B12 and folic acid deficiency, lactic acidosis
Acute renal failure w/ concurrent use of iodine contrast media
Take w/ breakfast/dinner, or dinner

Rosiglitazone (Avadia) - Oral hypoglycemic (thiazolidinediones/glitazones)

Decreases insulin resistance
Results in increased glucose uptake and decreased glucose production
Can cause fluid retention, elevated LDL, hepatotoxicity
Take w/ or w/o food

Acarbose (Precose) - Oral hypoglycemic (alpha glucosidase inhibitor)

Slows carbohydrate absorption and digestion
Can cause intestinal effects, risk for anemia (decreased iron absorption), hepatotoxicity (long
term use)
Take w/ first bite of food (3x/day)

Sitagliptin (Januvia) - Oral hypoglycemic (gliptin)

Augments incretin hormones (promotes insulin release and decreases glucagon secretion)
Lowers fasting and postprandial blood glucose levels
Generally well tolerated
Take once a day w/ or w/o food

Pramlintide (Symlin) - Amylin mimetic (hypoglycemic, subQ)

Decreases postprandial glucose levels (decreased gastric emptying, inhibits glucagon, satiety)
May be used w/ insulin (do not mix)
Oral medication absorption is delayed (stagger one hour before or 2 hours after)

Exenatide (Byetta) - Incretin mimetic (hypoglycemic, subQ)

Lowers fasting and postprandial blood glucose
Promotes insulin release, decreases glucagon, slows gastric emptying
Do NOT use w/ insulin
Can cause N/V/D, pancreatitis
Oral medication absorption is delayed, esp. oral contraceptives and antibiotics (stagger one hour
before or 2 hours after)

Glucagon - Hyperglycemic agent

Increases blood glucose levels
Turn patient to left side after admin (N/V)
Levothyroxine (Synthroid) - Thyroid hormone
Synthetic T4
Can cause signs of hyperthyroidism
Stagger binding agents, antacids, Fe and Ca supplements 3 hours
Take before breakfast daily
Must take for life, do not switch brands

Propylthiouracil (PTU) - Antithyroid medication

Block synthesis of thyroid hormones
Can cause signs of hypothyroidism, agranulocytosis
May increase levels of anticoagulants and digoxin

Somatropin (Genotropin) - Growth hormone

Stimulates overall growth
Can cause hyperglycemia, hypothyroidism
Avoid glucocorticoids

Vasopression (Pitressin) Desmopressin (DDAVP) - ADH hormone

Promote reabsorption of water and vasoconstriction
Used for diabetes insipidus and during cardiac arrest (Vasopression)
Can cause reabsorption of too much water, MI from vasoconstriction

Hydrocortisone (Hydrocortone) Prednisone, Dexamethasone - Glucocorticoid

Adrenal hormone replacement
Used for adrenocortical insufficiency (Addison's), cancer, inflammation, allergic reactions
Can cause osteoporosis, adrenal suppression, peptic ulcer, infection
Must taper doses

Fludrocortisone acetate (Florinef) - Mineralocorticoid

Adrenal hormone replacement
Used for adrenal insufficiency
Can cause htn, edema, HF, hypokalemia
Must taper doses

Cytarabine (Cytosar-U) - Cytotoxic antimetabolite

Inhibits RNA/DNA synthesis
Can cause liver disease, pulmonary edema, arachnoiditis (admin dexamethasone)
May reduce dig level
Do not use w/ gentamicin
Monitor for neurotoxicity (nystagmus)

Mercaptopurine (Purinethol) - Cytotoxic antimetabolite

Interrupts RNA/DNA synthesis
Can cause liver toxicity, mucositis, gastric ulcers
Reduce dosage w/ allopurinol
May reduce action of warfarin and pancuronium
Doxorubicin (Doxil) - Antitumor antibiotic
Binds to DNA and alters its structure
Can cause bone marrow suppression, N/V alopecia, acute cardiac toxicity/dysrythmias
Extravasation causes severe tissue damage
Discolors urine (orange-red)

Vincristine (Oncovin) - Antimitotic (cytotoxic antineoplastic)

Can cause peripheral neuropathy, alopecia
Extravasation causes severe tissue damage
Antidote: hyaluronidase
Do not give intrathecally

Paclitaxel (Taxol) - Antimitotic (cytotoxic antineoplastic)

Can cause anaphylaxis, bone marrow suppression, bradycardia, heart block, MI, alopecia
Do not use w/ hypersensitivity to castor oil

Cyclophosphamide (Cytoxan) - Alkylating agent (cytotoxic antineoplastic)

Kills rapidly growing cells by interrupting DNA/RNA synthesis
Can cause bone marrow suppression, N/V, acute hemorrhagic cystitis, alopecia

Carmustine (BiCNU) - Alkylating agent (cytotoxic antineoplastic)

Kills rapidly growing cells by interrupting DNA/RNA synthesis
Crosses blood-brain barrier
Can cause bone marrow suppression, N/V, pulmonary fibrosis, liver/kidney toxicity

Cisplatin (Platinol-AQ) - Alkylating agent (cytotoxic antineoplastic)

Kills rapidly growing cells by interrupting DNA/RNA synthesis
Can cause bone marrow suppression, N/V, renal toxicity, hearing loss

Topotecan (Hycamtin) Irinotecan - Topoisomerase inhibitor (cytotoxic antineoplastic)

Interrupts DNA synthesis
Can cause bone marrow suppression, N/V, alopecia, cholinergic diarrhea
Antidote: atropine

Asparaginase (Elspar) - Antineoplastic

Interrupts DNA in leukemia cells
Can cause N/V, hypersensitivity reaction, alopecia, liver and pancreas toxicity, renal toxicity

Hydroxyurea (Hydrea) - Antineoplastic

Interrupts DNA synthesis
May cross blood-brain barrier
Can cause N/V, bone marrow suppression

Procarbazine (Matulane) - Antineoplastic

Interrupts DNA/RNA synthesis
May cross blood-brain barrier
Can cause N/V, bone marrow suppression, peripheral neuropathy

Leuprolide (Lupron) - Prostate cancer medication - Hormonal agent

Testes stop producing testosterone
Can cause hot flushes, decreased libido, decreased bone density, arrhythmias, pulmonary edema
Increase Ca and vit D intake
Prostate symptoms may worsen at beginning of treatment

Flutamide (Eulexin) - Prostate cancer medication - Hormonal agent

Blocks androgen receptors
Can cause thrombocytopenia, gynecomastia, N/V/D, hepatitis
May increase effects of warfarin

Tamoxifen (Nolvadex) - Breast cancer medication

Hormonal agent
Stops growth of estrogen-dependent breast cancer cells
Can cause endometrial cancer, hypercalcemia, N/V, PE, hot flushes, vaginal discharge or
bleeding
Increase Ca and vit D intake

Interferon alpha - Biologic response modifier

Increases immune response, decreases production of cancer cells
Used for hairy cell leukemia, CML, malignant melanoma, Kaposi's syndrome
Can cause flu-like symptoms, bone marrow suppression, hypotension, edema, peripheral
neuropathy, skin rashes

Diuretic (effects- UO ch19)

-labs: monitor serum electrolyte levels, esp. hypokalemia, monitor blood glucose, uric acid
-s/e: hyperkalemia, menstrual irregularities (potassium sparing), electrolyte imbalance,
hypotension, ototoxicity, hyperglycemia, increased uric acid levels
-pt teaching: eat foods rich in potassium, report confusion, muscle twitching/weakness, irregular
pulse, nausea. If diabetic, monitor blood glucose closely, report symptoms of gout, monitor BP,
report onset of hearing loss (loop diuretics)/ringing in ears, in potassium sparing diuretics, watch
for signs of hyperkalemia

Osmotic diretics
-Reduce intracranial pressure and intraocular pressure by raising serum osmolality and drawing
fluid back into the vascular and extravascular space.

Loop diuretics
Work on the ascending limb of the loop of Henle to block reabsorption of sodium and chloride
and to prevent reabsorption of water

Thiazide diuretics
Work in the early distal convoluted tubule to block the reabsorption of sodium and chloride and
prevent the reabsorption of water that this site

Potassium sparing diuretics

Work in the early distal convoluted tubule to block the reabsorption of sodium and chloride and
prevent the reabsorption of water that this site

Meds to aid w/ alcohol detox

Benzodiazepines (maintain vitals, decrease seizures, decrease symptom intensity)
Carbamazepine (seizures)
Clonidine (decreased ANS response)
Propranolol (decreased cravings, ANS response)
Disulfiram (Antabuse) - maintenance
Naltrexone (ReVia) - suppresses cravings, pleasurable effects of alcohol
Acamprosate (Campral) - decreased anxiety, restlessness

Meds to aid opioid withdrawal

Methadone (Dolophine) - transfers dependence to methadone, then wean off
Clonidine (decreased ANS effects, does NOT reduce cravings)
Buprenorphine, combine w/ naloxone - detox and maintenance, may decrease cravings

Meds to aid nicotine withdrawal

Bupropion (Zyban) - decreases cravings and withdrawal symptoms
Nicotine replacement (gum, patch)
Neostigmine (Prostigmin)

Barbiturate: thiopental (Pentothal) –

Benzodiazepines: midazolam (Versed), diazepam (Valium)
Other: propofol (Diprivan), ketamine (Ketalar)
Opioid: Fentanyl (Sublimaze)
Can cause respiratory depression, CV depression, high risk for hypotension
Propofol: bacterial infection
Ketamine: hallucinations

ceftazimide
cross sensitivity to penicillin allergy, assess for shortness of breath or other signs of anaphylaxis

OTC oral decongestants

patients with a history of hypertension should know that these can constrict blood vessels
tamoxifen
side effects include menstrual irregularities, hot flashes, and bruising
allergic reaction to IV cefazolin
give parenteral epinephrine for uticaria (hives), dyspnea, anxiety, and hypotension

enalapril
monitor for hyperkalemia due to potassium retention from kidneys and assess for palpitations
trimethoprim/sulfamethoxazole
risk of photosensitivity. warn patient to report a vesicular crusty rash as a sign of stevens-johnson
syndrome

donepezil
side effects include dyspnea (severe, alert provider), dyspepsia, diarrhea, and dizziness
calcium channel blocker
report pedal edema to the provider

T3 normal range 70-205ng/dL

T4 normal range 4-12mcg/dL
TSH normal range 0.5-4.0 mIU/L

fluconazole
treats oropharyngeal and systemic candidiasis

sodium polystyrene sulfate

client at risk for cardiac dysrhythmias from hyperkalemia should be given this first

hydrochloric acid - H2 receptor antagonist

decrease stomach acid secretion

ferrous sulfate
take on an empty stomach, black stools are common and harmless, antacids and food reduce
absorption

insulin glargine
do not mix in syringe with other medications, steady levels in the body with no peaks, given
once a day at the same time every day

tetracycline PO
should be taken in the morning to prevent esophageal ulceration and can be taken with food to
avoid GI discomfort

atropine sulfate
for inhibitors overdose

salmeterol
long acting bronchodilator that prevents bronchospasms and improves breathing

amphotericin B
fever and chills are a sign of an infusion reaction that requires immediate intervention. can cause
hypotension and cardiac dysrhythmias, hypokalemia, and nephrotoxicity.

epoetin alfa
if client's hematocrit rises too rapidly can lead to hypertension, increased blood pressure and
possibility of seizures.

baclofen
decreases the frequency and severity of muscle spasms. improves muscle function and can
decrease the seizure threshold

magnesium sulfate toxicity

CNS depression, decreased level of consciousness, lethargy, decreased blood pressure, depressed
deep tendon reflexes

atorvastatin
monitor CK which rise in response to enzymes released during injury

INR
monitor in patients taking warfarin

ESR
monitor in clients who have myeloma, rhuematoid arthritis, and lupus

tuberculosis (TB)
given isoniazid, rifampin, pyranamide, and ethambutol to eliminate various combinations of
resistant strains

verapamil
can cause orthostatic hypotension, take with food to avoid GI distress, medication should be
tapered off not stopped abruptly

indomethacin
NSAID that reduces pain and inflammation. Adverse effects include dizziness, vertigo, muscle
weakness, nausea, vomitting, and annorexia

acetazolamide
parethesia is an adverese effect which causes tingling of the fingers, also this drug may cause
hypertension

propylthiouracil
increased ability to focus means the medication is effective. also has an adverse effect of
decreasing WBC

metronidazole
antibuse like reaction when combined with alcohol

fluticasone
use a spacer and rinse the mouth after inhalation to avoid oral candidiasis
furosemide
adverse effects include dizziness, hypokalemia, and urinary frequency
decreases potassium, should not be given if K levels are less than 3.5

chlordiazepoxide
prevents delirium tremens for clients experiencing acute alcohol withdrawal

disulfiram or acamprosate
helps to maintain abstinence from alcohol

propranolol
decreases cravings during alcohol withdrawal

clonidine
minimize diaphoresis during alcohol withdrawal

mannitol
can develop heart failure which manifests as peripheral edema. adverse effects include vomiting,
increased thirst, and muscle cramps

doxycycline
a tetracycline antibiotic is contraindicated in pregnancy because of the adverse effects on
developing bones and teeth

heparin
thrombocyptopenia when platelet count is less than 100k due to this drug. therapeutic when
aPTT is 2x control

prednisone
long term therapy requires bone density scans to monitor possibility of osteoporosis

benztropine
may develop tachycardia, constipation, or urinary retention

albuterol
fast acting for acute asthma attacks

montelukast
long term asthma control and prevention of exercise induced bronchospasms

beclomethasone
inhaled corticosteroid for long term control of asthma

nedocromil
mast cell stabilizer for long term control of asthma
metoclopramide
has CNS effects including sedation

valproic acid
report indications of liver injury such as jaundice

RBC normal range 4.2-6.1 million/uL

WBC normal range 5,000-10,000/uL
platelet count normal range 150,000-400,000 mm^3
Hemoglobin normal range (Hgb) 12-18g/dL
Hematocrit normal range (Hct) 37-52%

dopamine
catecholamine used to increase blood pressure in the event of a cardiogenic shock

atropine
anticholinergic agent given during a cholinergic crisis

prefilled epinephrine injector

massage site for ten seconds after injection to promote absorption

warfarin therapeutic INR is 2-3. Recommended 3-4.5 for those with recurrent systemic embolism
potassium normal range 3.5-5.0
aPTT therapuetic range 30-40 seconds or 1.5-2x the normal range

desmopressin
check specific gravity of urine, creatinine clearance, and serum osmolality for signs of renal
function and water intoxication
pregnancy during chemotherapy
high risk of fetal malformations

methadone
given for opioid addiction

modafinil
given for methamphetamine addiction

disulfiram
given for alcohol addiction

bupropion
given for nicotine addiction

rosuvastatin
adverse effects include myopathy which can progress to fatal rhabdomyolysis. report muscle
pain or tenderness
fetanyl
constipation can occur; naloxone can be given in acute care setting for respiratory depression

pegfilgrastim
given to increase WBC production

mannitol IV
decreases intraocular pressure, auscultate lungs, check blood pressure and urine output
isoniazid and rifampicin
treats tuberculosis

miratazapine
treats depression

temazepam
treats insomnia

infliximab
for moderate to severe Chron's disease or arthritis

acetominophen overdose
when you exceed 4,000mg/day

celecoxib
those with hypersensitivity reactions to a sulfonamide may have a cross sensitivity to thiazide
diuretics. do not take with tmp/smx

tranylcypromine
orthostatic hypotension common, avoid tyramine foods (figs and overripe bananas), has GI
effects, also causes weight gain

lithium
NSAIDs can significantly increase lithium levels, do not take Ibuprofen

ciprofloxacin
risk of tendon rupture

steps for insulin

put air in NPH vial, put air in regular vial, draw up regular insulin, then draw up NPH

methylphenidate
minimize adverse effects by maintaining age appropriate weight

spironolactone
K-sparing diuretic that can cause lethargy and diarrhea
prednisone
reduces antibody responses and can increase the risk of infection

timolol
can cause conjunctivitis but previous conjunctivitis is not a contraindication. can worsen
bradycardia. given with loratadine can cause dry eyes which are managed with eye drops

sumatriptan
can cause coronary vasospasms resulting in angina

transdermal nitroglycerine
check blood pressure one hour after applying the patch. place where there is no hair and rotate
placement to avoid irritation

sprionolactone and enalapril

observe for potassium retention and hyperkalemia

warfarin
report dark tarry stools which may indicate GI bleeding

isotretinoin
teratogenic. 2 mandatory pregnancy tests before initial prescription and one before monthly
refills

diphenoxylate/atropine
decreases intestinal motility and peristalsis. monitor for abdominal distension.

prednisone long term therapy

monitor for edema, hyperglycemia, weight gain, and insomnia

magnesium sulfate
electrolyte replacement and also anti-convulsant

protamine sulfate
antidote for reversal of heparin

metoprolol
monitor for bilateral crackles in the lungs indicative of reduced cardiac output and heart failure

methotrexate
stomatitis (sores in mouth) is a sign of toxicity. takes three to six weeks to see anti-inflammatory
effects, should be taken once weekly

trimethoprim/sulfamethoxazole
drink 8-10 glasses of water a day to decrease the chance of renal damage
lisinopril
a buildup of bradykinin can cause a dry cough and lead to life-threatening consequences, also
report facial edema

atenolol
lowers blood pressure by decreased vascular resistance
signs of hypoglycemia
sweating, hunger, and tachycardia

oxytocin
stop giving when contractions persist for 60seconds or longer, happen every 2-3minutes, have a
contraction pressure of 50mmHg or greater, or resting uterine pressure is above 15-20mmHg

pilocarpine eye drops

for glaucoma, taken for client's entire lifetime, can interfere with vision, has systemic effects.
transient brow pain may occur but usually disappears within 2 weeks.

risedronate
sit up for 30-60 minutes after taking to reduce the GI effects of esophagitis and dyspepsia.
calcium and antacids can decrease absorption (2 hours before or after). take in the morning
before food.

cyclosporine
nephrotoxicity

allopurinol
may interfere with hepatic drug metabolizing enzymes responsible for inactivating warfarin
therby extending the anticoagulant effects placing the client at risk for bleeding

zidovudine
can cause severe anemia, need to monitor hemoglobin levels

isosorbide mononitrate
should be held if systemic blood pressure is below expected reference range due to possibility of
hypotension

epoetin alfa
stimulates bone marrow production of red blood cells and increases hemoglobin

ABC airway, breathing, circulation (hypotension)

pyelography
contrast medium, assess for shellfish allergy

gentamicin
can cause permanent hearing loss

lactobacillus acidophilus
recolonizes the intestinal flora

Here are some helpful hints to learn drug classifications by suffixes:

Drug Classification (Drugs “Endings” and their Classification)
-caine Local Anesthetics
-cillin Antibiotics
-dine H2 Blockers (Anti-Ulcers)
-done Opioid Analgesics
-ide Oral Hypoglycemics
-lam Anti-Anxiety Agents
-micin Antibiotics
-mycin Antibiotics
-mide Diuretics
-nium Neuromuscular Blocking Agents
-olol Beta Blockers
-oxacin Antibiotics
-pam Anti-Anxiety Agents
-pril ACE Inhibitors
-sone Steroids