PHARMACOLOGY

Children- safety
Observe, report, teach about undesirable
effects
Meds no OTC w/o consultation
Pregnancy/lactating are out w/ meds
Liver must be intact
Interactions pharmacological, assess &
teach

Allergies- assess; do not administer med if
allergic
Nutrition must be considered; no crushing
sustained release tablets
Compliance w/ time & taking full course
Elderly- safety, evaluate outcomes for all
meds.



PHARMACOKINETICS

PO, IM, IV
GI mobility
Absorption
Drug-drug interaction
Metabolism
Protein/Tissue binding
Elimination
DRUG-DRUG INTERACTIONS
(THE MAD WAR)
Tricyclic antidepressants
Histamine antagonist (Tagamet)
Ethanol; Erythromycin

MAO inhibitors
Aminophylline; Aspirin
Digoxin; Dilantin; Diuretics



Warfarin
Azole (antifungal); Antacids
Rifampin

FOOD-DRUG INTERACTIONS
DRUG
Antacids (Calcium
carbonate)
Antibiotics
(erythromycin,
penicillin)
Tetracycline
Anticoagulants
(warfarin)

FOODS TO AVOID
Bran & whole grain
breads
Citrus fruit, colas


Calcium
Vitamin K

FOOD-DRUG INTERACTIONS
DRUG
MAO inhibitors
FOODS TO AVOID
Tyramine
DRUGS THAT CAN CAUSE
NEPHROTOXICITY
Acetaminophen (high doses, acute)
Acyclovir, parenteral (zovirax)
Aminoglycosides
Amphotericin B, parenteral (Fungizone)
Analgesic combinations cont.
acetaminophen, aspirin, or other salicylates
in high doses, chronically
Ciprofloxacin

DRUGS THAT CAN CAUSE
NEPHROTOXICITY
Cisplatin (platinol)
Methotrexate (high doses)
NSAIDs
Rifampin
Sulfonamides
Tetracyclines(except doxycycline &
minocycline)
Vancomycin, parenteral (Vancocin)

DRUGS THAT CAN CAUSE
NEPHROTOXICITY

DRUGS THAT CAN CAUSE
HEPATOTOXICITY
ACE inhibitor
Acetaminophen
Alcohol
Iron overdose
Erythromycins
Estrogens
Fluconazole (Diflucan)
Isoniazid (INH)

DRUGS THAT CAN CAUSE
HEPATOTOXICITY
Itraconazole (Sporanox)
Ketonazole (nizoral)
NSAIDs
Phenothiazines
Phenytoin (Dilantin)
Rifampin (Rifadin)
Sulfamethooxazole&trimethoprin (bactrim,septra
Sulfonamides

DRUGS THAT CAN CAUSE
OTOTOXICITY
Aminoglycosides
Bumetanide, parenteral (Bumex)
Cisplatin
Erythromycin (renal impairment&hi doses)
Ethacrynic acid (Edecrin)
Furosemide (Lasix)
Hydrochloroquine (Plaquenil)

DRUGS THAT CAN CAUSE
OTOTOXICITY
NSAIDs
Salicylates (chronic high doses, overuse)
Vancomycin, parenteral (high doses & renal
impairment)

POLYPHARMACY
The presentation of
numerous
medications.
CARDIOVASCULAR AGENTS
Cardiac Glycosides
LIZZY DIGGY
D- dig level 2ng/ml

I- increases myocardial contractility

G- GI or CNS signs indicate adverse effects
CARDIOVASCULAR AGENTS
Nitroglycerin
ANDY ANGINA
ACTION
Relaxes vascular smooth muscle
Decreases venous return
Decrease arterial BP
Decreases L ventricular workload
Decreases myocardial O2 consumption
CARDIOVASCULAR AGENTS
Nitroglycerin
ANDY ANGINA
ACTION
Relaxes vascular smooth muscle
Decreases venous return
Decrease arterial BP
Decreases L ventricular workload
Decreases myocardial O2 consumption
CVS AGENTS
ANTIARRYTHMIC: LIDOCAINE
LIDDY LIDOCAINE

Liddy Lidocaine is the strongman that puts the
lid on the trash can of PVCs. This drug
reduces sodium permeability, resulting in a
decrease in ventriculararrythmias & caediac
irritability. Observe for S/E like dizziness,
drowsiness & confusion.
CONCEPT:
ANTIHYPERTENSIVE MEDS
PRESSURE
Pressure (blood) monitor
Rise slowly to reduce orthostatic hypotension
Eating must be considered
Stay on medications
Skipping or stopping is a no-no
Undesirable responses
Remind to exercise, decrease alc
Eliminate smoking; educate



ACE INHIBITORS
PRIL SISTERS
Cough;C/I in renal artery stenosis
Hypotension;Hyperkalemia (S/E)
First dose-watch for hypotension
SVR; PVR decrease
Tx of MI
Release of aldosterone decrease
Occult diabetic nepropathy decrease
LVD after MI
ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
SARTAN SISTERS
Administer without regard to meals
Renal function test- review
Blocks vasoconstriction effect of renin-
angiotensin system
Salt substitution or K+ supplements- do not
use
ALPHA ADRENERGIC
BLOCKERS
MINIS SINS
Syncope; Sexual dysfunction

Increased drowsiness, orthostatic
hypotension, HR

Need to be recumbent for 3-4 hours after
initial dose
BETA ADRENERGIC
BLOCKERS
THE LOL TEAM
The LOL team blocks hypertension by
blocking (decreasing) the contractility in
the heart, the renintern release from the
kidneys, & the sympathetic output from the
vasomotor center of the brain.
BETA BLOCKER ACTIONS
B1 BLOCKERS AFFECT- affect the Beta1
receptors in the heart. They decrease the
excitability, cardiac workload, O2
consumption, renin release & lower BP

B2 BLOCKERS AFFECT
Stimulate the beta receptors in the lung, relax
bronchial smooth mm, increase vital
capacity, & decrease airway resistance
BETA BLOCKER ACTIONS
B1 BLOCKERS AFFECT- affect the Beta1
receptors in the heart. They decrease the
excitability, cardiac workload, O2
consumption, renin release & lower BP

B2 BLOCKERS AFFECT
Stimulate the beta receptors in the lung, relax
brochial smooth mm, increase vital
capacity, & decrease airway resistance
BLOCKER
Bradycardia
Lipidemia (inc); Libido (decrease)
brOnchospasm
CHF; Conduction abnormalities
Konstriction peripheral vascular
Exhaustion; Emotional depression
Reduces recognition of hypoglycemia
CALCIUM CHANNEL
BLOCKERS
my rate is slower & my pressure is down!

Major undesirable effects of Ca2+ channel
block include: headache(most common),
hypotension, syncope, peripheral edema&
bradycardia.
CENTRAL ALPHA2
AGONISTS
CATAPRES
C is at her eyes because the adrenergic hormone is
released from the brain
A is at her nose because the risk factors of
hypotension, hepatotoxicity & hemolytic anemia
are as clear as the nose on her face
T is at her chin as it drops w/ transient drowsiness
A is body wide because arterial P all over the body is
lowered
CENTRAL ALPHA2
AGONISTS
CATAPRES
P indicates paradoxical HPN w/ propanolol
R is at her baseline feet to remind you to
record V/S
E on her belt may expand because she may
have a wt.gain; evaluate her liver
S is tapered down her dress because the drugs
should be slowly tapered down & not
stopped suddenly
VASODILATORS
DILLY DILATOR
Directly acts on vascular smooth mm, causing
vasodilation
Increases renal & cerebral blood flow
Lupus-like rxn (fever, facial rash, mm & joint ache,
splenomegaly)
Assess for peripheral edema of hands & feet
Take with food
Other- headache, dizziness, anorexia, tachycardia,
hypotension)
Review BP
DIURETICS
DIURETIC
Diet- inc K+ for all except aldactone
Intake & output daily wt.
Undesirable effects: F&E imbalance
Review HR, BP, & electrolytes
Elderly- careful
Take w/ or after meals & in am
Increase risk of orthostatic hypotension; move
slowly
Cancel alcohol
LOOP DIURETICS
LOU LA BELL
Lou La Bell goes spinning over the falls
because she has lost so much fluid from
diuresing. Her ears are ringing & she is
dizzy from a decrease in her BP. She has
lost K+ in the falls. Loop diuretics act in the
ascending loop of henle & 1 common drug
is LASIX.
LOOP DIURETICS
LOU LA BELL
Remember, THIAZIDES at the distal tubule
(major differences bet. Undesirable effects
of THIAZIDES & LOOPS is that LOOPS
may cause ototoxicity & hypocalcemia).
K+ SPARING DIURETICS
ALAN- ALDACTONE
Low Na+

Elevated T waves from hyperkalemia

Agranulocytosis w/triamterene

K+ level must be monitored

OSMOTIC DIURETICS
(BUSTER BRAIN MAN)
Oliguria, edema, inc. ICP- indications
Stops reabsorption of water
Mannitol
Output of urine, electrolytes- monitor
Tissue DHN- UE
Increased frequency/volume of urination
Circulatory overload- UE
ANTICOAGULANT:
WARFARIN
(CORA COUMADIN)
Check VS. platelet ct., PT
Observe for bleeding
Review bleeding protocol (i.e. electric razors,
soft toothbrushes)
Avoid ASA, may use acetaminophen
ANTICOAGULANT: HEPARIN
SODIUM
(HARRY HEPARIN)
Harry Heparin is getting his anticoagulant IV
or SQ in the abdomen. His soft toothbrush
will help keep gums from bleeding & his
electric razor will keep him from bleeding
when he shaves. Even the band-aid when
pulled off his arm may cause a big bruise.
If Harrys PTT is >1.5-2.5 x control, he may
bleed too freely.

ANTIPLATELET: ASPIRIN
(ANNIE ASPIRIN)
Fever

Inflammation

Reduces TIAs due to fibrin platelet embolus

Eliminates (reduces) death with hx of MI
ANTIPLATELET: ASPIRIN
(ANNIE ASPIRIN)
Annie is busy firing at platelets to reduce
the blood coagulation in her body especially
with MI or TIA. She is holding her stomach
as this med can cause stomach irritation.
THROMBOLYTIC AGENTS
(ADAM ASE)
CBC, hgb, hct- monitor
Look for dysrythmias
Observe for bleeding
The V/S must be monitored
Adam ASE will dissolve the clog in this
sink just as he dissolves the CLOT in a
blood vessel. He will use t-PA or another
thrombolytic agent that ends in ASE
BILE- ACID SEQUESTRANT
LDL is low 15-30%

Increase fluids & fiber

PT monitoring

Increase in GI distress- constipation

Decreases absorption of many meds
FIBRIC ACID
Liver or renal dse- WARNING
Increases effect of warfarin or sulfonylureas
VLDL, LDL, triacylglycerols & cholesterol-
monitor
Encourage diet low in fat, cholesterol &
sugars
R avoid alcohol
HMG CoA INHIBITORS
(L.L. STATIN)
Officer LL (lipid lowering) Statin has
stopped the liver mobile & its driver.
Cholesterol. These drugs lower cholesterol
and can be highly toxic to the liver. Drugs
that are in this group end in statin.
NIACIN
Note liver fxn tests- regular intervals
Itching & flushing UE
Aspirin before Niacin may decrease UE of
vasodilation
Contraindications: hepatic dse, Px
Instruct to take w/ food & at bedtime
No high cholesterol foods
Do not think that the knowledge you presently
possess is changeless, absolute truth. Avoid
being narrow-minded & bound to present
views. Learn & practice non-attachment
from view in order to be open to receive
others viewpoints. Truth is found in life &
not merely in conceptual knowledge. Be
ready to learn throughout your entire life &
to observe reality reality in yourself & the
in the world at all times. Thich Nhat Hanh
BRONCHODILATORS
Breathing & coughing techniques
Relaxation techniques
Evaluate HR & BP
Arm identification
Tremors
Have 8 or more glasses of fluids
Emphasize no smoking
ANTIHISTAMINES
CLARITIN + ALCOHOL + CNS depressant=
SLEEP

CLARITIN + MAOIs = DRYNESS

Antihistamines (Claritin) combined w/ alc &
CNS depressant may result to sleep.
Antihistamines & MAOIs may result in
dryness.
BETA2 ADRENERGIC
AGONISTS
(MAX AIR)
Max air is smiling because he has been able to
relieve bronchospasms from asthma & other
respiratory diseases. He has plenty of air to
breathe & air blow up the balloons in the R
hand. His L hand is shaky & weak. His
heart is beating fast & his BP is up from
undesirable effects of his medication.
XANTHINES
(AMILY TOXICITY)
Amily represents some of the most commonly
occurring undesirable effects nausea (1
st

sign of toxicity), arrythmias, tachycardia,
nervousness and tremors (later sign of
toxicity)
CORTICOSTEROID
INHALERS (AZMA)
ACTION= decreased respiratory tract edema

Zero improvement- contact provider

Must taper off gradually

Asthma control
LEUKOTRIENE RECEPTOR
ANTAGONIST
(LOOK ! A TRAIN!)
It is OK to board the train in the town of
Chronic, but it is too late by the time the
train goes to the town of Acute (asthma).

ANTI- INFECTIVE AGENTS
ANTIBIOTICS
Monitor superinfections.
Evaluate renal/liver functions.
Diarrhea- take yogurt.
Inform provider prior to taking other meds.
Cultures prior to initial dose.
Alcohol is out, ask about allergy.
Take full course (of pills).
Evaluate cultures, WBC, T, blood.


AMINOGLYCOSIDES
(AMINO MICE)
Gentamycin Amikacin Kanamycin
Neomycin Strepnomycin Tobramycin

3 Amino Mice
One cant feel. Vestibular fxn&audiograms.
One cant hear. Should be studied in Pt. care
One cant pee. Plans.

AMINOGLYCOSIDES
(AMINO MICE)
Grab BUNs & creatinine quick as you can.
Our 3 Amino Mice will assist in
remembering 3 major UE of this category
of drugs: ototoxicity, nephrotoxicity, &
neurotoxicity).

CEPHALOSPORINS
(CEF THE GIANT)
Get nausea, vomiting, diarrhea
Increase in glucose values
Anaphylaxis may occur; alcohol may cause
vomiting
Nephrotoxicity
Thrombocytopenia
Giant a powerful antibiotic that can destroy
several types of bacteria. 1
st
generation.
FLUOROQUINOLONES
(T.T. FLOXACIN)
Theophylline
Anticoagulant
Digoxin

TAD may result in drug toxicity when taken
w/ the fluoroquinolones. This group of
drugs ends in floxacin & used to treat UTIs
as well as a wide range of Gm- & Gm+
infections.
MACROLIDE
ANTIBIOTIC:ERYTHROMYCIN
(MACROLIDE GIRL)
GI disturbances UE
IV site-check for irritation
Reduces activity of med if given with acids
(fruit juices) or food
Liver function tests
PENICILLINS
(PENICILLIN)
PEN the antibiotic has his destroyer laser
aimed at several types of bacteria. He is a
broad spectrum antibiotic.
SULFONAMIDES
(SULFA)
Sunlight sensitivity UE
Undesirable effects rash, renal toxicity
Look for UO, fever, sore throat & bleeding
Fluids galore!
Anorexia, anemia - UE

TETRACYCLINES
(TETRA CYCLINES)
S unlight sensitivity
T ake with full glass of H2O
antacid, iron, milk
P ut drug into empty stomach
VANCOMYCIN
HYDROCHLORIDE
(RUDOLPH THE RED - NECK REINDEER)
Rudolph the red-neck reindeer
Had an adverse side effect
From the drug Vancomycin,
Must keep all labs in check.

Caution with renal failure
Hearing loss and allergies,
Take a temp. & blood cultures,
Specially a CBC!!!



ANTITUBERCULAR:
ISONIAZID
(INA TUBERCULOSIS)
L iver enzymes-monitored
U se cautiously w/ renal dysfunction
No alcohol
G ive pyridoxine-prevent peripheral
neuropathy
S hould take on empty stomach
screen vision
ANTITUBERCULAR:
ISONIAZID
(INA TUBERCULOSIS)
Tuberculosis has undesirable effects from
INH. She is nauseated, has an enlarged
liver, tingling in her feet (peripheral
neuropathy), & her secretion have turned
orange. LUNGS will help you recall some
in preventions.
ANTITUBERCULAR:
RIFAMPIN
(REDMAN RIFAMPIN)
many Drug - drug interactions.
Do not take alcohol.
Dont stop taking .
Dizzy dont drive.
Does havoc the liver.
Dyscrasias
He is taking some rest & relaxation.

ANTIFUNGAL:
AMPHOTERICIN B
(AMPHOTERRIBLE)
Amphoterrible is a monster. He treats monster
infections such as histoplasmosis & other
life threatening fungal infections. He has a
terrible habit of creating irregularities in the
heart (arrythmias). The X marks the spot of
the kidney since 80% of clients receiving
this drug may develop some nephrotoxicity.
ANTIFUNGALS
(ZOLE)
Z OLE many drug interactions can occur
O bserve hygiene measures to control
infection
L iver Function Tests monitor
E ducate to take with food.
ANTIPROTOZOAL,
AMEBICIDE: FLAGYL
FLAGYL
F lushing
A LCOHOL will cause these effects
I ncreased vomiting
N ausea
T achycardia

If Flagyl is mixed w/ alcohol, there will be a
disulfiram-like rxn, & that is why this lady feels
FAINT.
ANTIVIRALS
(THE VIR HOUSE OF SHINGLES)
The haunted house of shingles (herpes zoster),
chicken pox (varicella), herpes simplex & the
cytomegaly virus is most often repaired w/ drugs
that include VIR in them. Acyclovir (Zovirax),
Famciclovir (Famvir), & Valacyclovir (Valtrex)
are a few of these drugs.
The house is shaky&haunted because the recipient of
these drugs may experience a headache&shakes
from chills. Its enough to make you throw up.

PYRIDIUM
(MR. P.O.)
G I disturbance
U rine turns yellow orange
S lera & skin
H emolytic anemia

Mr. P.O. was not happy w/ his pain but after taking
Pyridium the pain from his UTI must be gone.
Remember Pyridium turns urine ORANGE.
ANTINEOPLASTIC AGENTS
A life is not measured by the games that are
won, but that you in the moment and
learned to have FUN.
Michael Dooley
UNDESIRABLE EFFECTS
FROM ANTICANCER DRUGS
B one marrow depression

A lopecia

R etching- nausea/vomiting

F ear and anxiety
S tomatitis
ANTINEOPLASTIC AGENTS
C BC, platelets- monitor
A tiemetics before drug
N ephrotoxicity- UE
C ounseling regarding reproduction issues
E ncourage handwashing, avoid crowds
R ecommend a wig for alopecia
ALKYLATING AGENTS
(NITROGEN MUSTARD)
B one marrow depression
(leukopenia,thrombocytopenia)
A norexia/alopecia
D istressful nausea & vomiting

@ destroying malignant neoplasm
ANTIMETABOLITES
M onitor CBC & platelets weekly
E valuate renal fxn tests
T emp assessment q 4-6 hrs
A sepsis- strict
B leeding, anemia, & nausea- report
O ral hygiene- brush w/ soft toothbrush
L ots of fluids (2-3L/day)


ANTIMETABOLITES
I ntake & output, nutritional intake- monitor
T he Protocols for handling & administering-
follow
E mphasize protective Isolation


ANTI-INFLAMMATORY
AGENTS
We are all on the way up the mountain & we
need each others help.
Jon Kabat-Zinn
NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS
(NSAIDs)
N o alcohol
S E: BIRTH (bone marrow dep,inc GI
distress,renal toxicity, tinnitus&hepatotoxicity)
A spirin sensitivity- do not give
I nhibits prostaglandins
D o take w/ food
S top 5-7 days before surgery

ANTIGOUT: ALLOPURINOL
(ZYLOPRIM)
GOUT
G ulp 10-12 glasses (8oz) of fluid daily
I distress- UE
O utput & input- monitor closely
U ric acid production decreased
se no alcohol
T ake after meals
GASTROINTESTINAL
AGENTS
Every dream you dream
Will one day come true,
So dream your dreams
All they need is you!

Michael Dooley
ANTACIDS
AUNT ACIDS FAMILY

ALUMINUM MAGNESIUM
Mag & Al have a Hx of an ulcer. While the
ant-acids, may help in coating their
stomachs, they may also experience UE.
Als problem is constipation. Mag has a
problem w/ diarrhea.
ANTI-ULCER MEDICATIONS:H2
HISTAMINE ANTAGONISTS
(NO WINE JUST DINE)
CIMETIDINE FAMOTIDINE
NIZATIDINE RANITIDINE
D ont take w/ antacids
I nform provider of bleeding
N o smoking, alc or NSAIDs
E levate head of bed

CHOLNERGIC BLOCKERS
(ANTICHOLINERGICS)
ANTICHOLINERGICS
Cant pee
Cant see
Cant spit
Cant shit
PROTON PUMP INHIBITOR
P risolec
U E: headache, GI disturbances
M aximum of 16 weeks for Protonix
P rotonix
PEPSIN INHIBITOR:
CARAFATE (CARA)
C onstipation- UE
A dminister on an empty stomach
R isk of Aluminum toxicity w/ Al antacids
A dminister antacids 30 min. before or after med

Carafate will form a protective coating on the ulcer
surface. It protects against pepsin&acid

ANTIDIARRHEAL: LOMOTIL
D rowsiness, dizziness, dry mouth, DHN
I nhibits gastric mobility
A lcohol is out
R eport if there is a narcotic drug Hx
R esponse of a drug determined prior to driving
H abit forming- only take prescribed dose
E lectrolytes- monitor w/ severe diarrhea; encourage
clear liquids
A ssess frequently of BM; bowel sounds
BULK FORMING:
METAMUCIL
(SILLY PSYLLIUM)
Silly got his name by taking Psyllium
(Metamucil) w/ a jigger of H2O instead of a
BIG glass of H2O. Now hes sweating
because this bulk-forming laxative that
expands has bulked his bow tie instead of
his stool.
ENDOCRINE AGENTS
Learning is finding what you already know.
Doing it is demonstrating that you know it.

Richard Bach
CORTICOSTEROIDS
(CUSHY CARL)
C ushing-like Sx
bU ffalo hump
S odium; Sweating
H eadache; Hyperglycemia
I ncrease in BP, HR appetite
N ot healing quickly
G I upset


CORTICOSTEROIDS
(CUSHY CARL)
some people get Cold
Na+ up
K+ down
Glucose up
Ca2+ down

Labs opposite w/ that of addisons dse



THYROID PREPARATIONS
(MORBID MATILDA)
T SH, T3, T4- monitor
H ypo/Hyperthyroidism- monitor
R eview how to take a pulse
O bserve clinical improvement in 3-4 days
I ncrease metabolic rate- action
D o not change brands of drug

Synthroid gives Matilda a boost so she will be less
tired.
ANTITHYROID
(GO GETTER GERTRUDE)
Everything is running EXCEPT my periods!
I need PTUT for my BIG thyroid!

B leeding
I nfection
G ive w/ food

HYPOGLYCEMIA
T remors; Tachycardia
I rritability
R estless
E xcessive hunger
D iaphoresis; Depression


HYPOGLYCEMIA
Hot & dry
Your sugars high
Your insulin is what you need.

Cold & clammy
You need some candy,
And milk will help indeed.


DIABETES
D iet, wt.loss, exercise
I dentification- medical alert bracelet
A void alcohol & other meds
B lood sugar & urine sugar
E d.about antidiabetic agents
T herapy decreases signs, not a cure
E d. foot care, no smoking, stressors
S igns & Sx of Hyper/Hypoglycemia; skin care
ANTIDIABETIC: METFORMIN
(METFORMIN)
Metformin The Mets (glucophage) bats against
high blood sugar. He scores the winning home run
by decreasing hepatic glucose production &
intestinal absorption of glucose, while improving
insulin sensitivity. Prior to playing, he must
to.check his renal fxn. A major complication
w/this med is LACTIC ACIDOSIS.
ANTIDIABETIC DRUGS:
SULFONYLUREAS
G limepiride are better for Grandmother
lipizide

Chlorpropramide is not good for Grandmother
due to its long duration of action.
Grandmother has a shorter span to live than
her grandchild, so she needs the agent w/
shorter duration of action.
INSULIN SENSITIZER:
AVANDIA
S igns of anemia, inc liver enzymes: UE
U se barrier contraceptives
G lucose urine & serum- monitor
A dminister w/ meals
R osiglitazone (Avandia)

This VAN is improving the action of insulin,
w/c helps in the mgt. of diabetes.
INSULIN
RAPID ACTING: CLEAR
Regular Humulin R Semilente
Actrapid Crystalline Zinc
Peak: 2-4 H

INTERMEDIATE ACTING: CLOUDY
NPH Humulin N
Lente Monotard
Peak: 6-8 H
INSULIN
LONG ACTING: CLOUDY
Ultralente
Peak: 16-20 H
SC; DO NOT shake; massage

CENTRAL NERVOUS
SYSTEM AGENTS
The greatest danger confronting us is not any
particular kind of thought, but absence of
thought.
Henry Commager
NARCOTIC ANALGESICS
(DROOPY DEUTERONOMY)
D epressed respirations
D izzy
D rowsy
D rug dependence
D ecreased BP
D ecreased GI peristalsis & UO

NARCOTIC ANTAGONISTS
(PERKY PERKOLATOR)
P erspiration increase
P ulse increase
P ain increase
P ressure increase
MIOTICS
(MIOTICS: CONSTRICT EYES)
MIOTICS
O
NO ATROPINE!
S GLAUCOMA:
T TUNNEL AHEAD
R
I CARpine
C CARbachol
T piloCAR



ANTICONVULSANT AGENTS
Dont go outside you house to see the
flowers, my friend, dont bother with
excursion. Inside your body there are
flowers. One flower has a thousand petals.
That will do for a place to sit. Sitting there
you will have a glimpse of beauty inside the
body & out of it, before the gardens & after
the gardens.
kabir
ANTICONVULSANT:
DILANTIN
DILANTIN (DIAL AT TEN)
G ingival hyperplasia
U se alternate birth control
M outh care-preventive dental check-up
S oft toothbrush, dont stop abruptly
ANTIEPILEPTIC AGENT:
NEURONTIN
(CAESAR)
C NS: dizziness, insomnia-UE
Antacids decrease
Eat food with drug
Support group for epileptics
Alert tag indicating specific drug
Report U E
ANXIOLYTICS,
ANTIDEPRESSANTS,
AND ANTIPSYCHOTIC
AGENTS
ANTIANXIETY:
BENZODIAZEPINES
(ANTIANXIETY)
A void abrupt discontinuation after prolonged use
N ot give if increase BP renal/hepatic dysfunction or
hx of drug abuse
X anax, Ativen, Serax-a few examples
I ncrease in 3Ds-drowsiness, dizziness, decreased
BP
E nnances action of GABA (inhibitory transmitter)



ANTIANXIETY:
BENZODIAZEPINES
(ANTIANXIETY)
T each to rise slowly from supine
Y es,alcohol should be avoided


MISCELLANEOUS ANTIANXIETY
AGENTS: NONBENZODIAZEPINES
(BUSPAR BUS)
NO sudden STOPS
Get on the Buspar bus to decrease anxiety.
The seats recline for the UE of dizziness &
drowsiness. Smiles can be seen after taking
the drug for a week.

CONCEPT: DEPRESSION
(ANTIDEPRESSANTS)
D riving is out until response to drug has been
achieved
E ffect has a delayed onset of 7-21 days
P lanning Px- consult w/ provider of care
R elieves Sx , not a CURE
E valuate V/S
S topping drug abruptly is OUT!
CONCEPT: DEPRESSION
(ANTIDEPRESSANT)
S afety measures (i.e., change position slowly)
I nstruct client to report UE
O bserve for suicidal tendencies
N o alcohol or CNS depressants
SELECTIVE SEROTONIN REUPTAKE
INHIBITORS (SSRIs)
(PAXIL)
CNS
C NS system stimulation; nervousness,
headache
N ausea, anorexia, vomiting
S kin rash; Sexual dysfunction

Paxil packs extra baggage when taking SSRIs.
TRICYCLIC
ANTIDEPRESSANTS
(TINA TRICYCLE)
T rimipramine H ypotension
I mipramine A nticholinergic
N ortriptyline T achycardia
A mitriptyline Sedation

TRICYCLIC
ANTIDEPRESSANTS
(TINA TRICYCLE)
Tina tricycle is sitting on the curb as she is
sleepy & cant pee, cant see, cant see.
Obviously she should not be driving heavy
machinery while taking TCAs. The 3
wheels represent that the therapeutic effects
may have a 3 wk delay of onset.

MONOAMINE OXIDASE
INHIBITOR (MAOI)
(THE TYRANT KING)
The tyrant king loves good food, but can
develop a life threatening hypertensive
crisis if he eats or drinks products
containing TYRAMINE while taking MAO
inhibitors. The TYRANT is No Popular
Man (Nardil, Parnate, Marplan).
ANTIMANIC MEDICATION
(BIPOLAR CLOWN)
L evel therapeutic (0.5-1.0 mEq/L)
I ncreased urination
T hirst increased
H eadache; Hand tremors
I ncrease fluids
U nsteady
M ortons Salt-adequate intake
ANTIPSYCHOTICS
(STANCE)
S edation; Sunlight sensitivity
T ardive dyskinesia; Tachycardia; Tremors
A nticholinergic; Agranulocytosis
N euroleptic malignant syndrome
C ardiac arrhythmias (orthostatic hypotension)
E xtrapyramidal (akathesia); Endocrine
(change in libido)
REPRODUCTIVE
AND WOMENS
HEALTH-RELATED
AGENTS

OXYTOCINS
(PITOCIN)
P ressure is elevated
I ntoxication w/ H2O
T itanic contractions
O xygen decrease in fetus
C ardiac arrhythmia
I rrenegularity in fetal heart rate
N ausea and vomiting

MAGNESIUM SULFATE
(A ROAD BLOCK TO PIH & SEIZURES)
Magnesium SO4, a CNS depressant reduces or
stops convulsions in the OB client.
MAG SULFATE
Decreased BP
Decreased Pee Pee
Drop in RR
Patellar reflex there aint
Give antidote calcium gluconate
FOSAMAX
(JOSEPHINE BONE-A-PART)
Bone mass rebuilds

Only take w/ full glass of H2O, no food

Nausea- never lie down after taking

Esophageal irritation
SELECTIVE ESTROGEN RECEPTOR
MODULATOR (SERM)
SERM
SERM is a gift to Josephine whose bones
are coming apart. Selective Estrogen
Receptor Modulator are used to prevent
osteoporosis in postmenopausal women.
These drugs do not turn on breast or uterine
receptors. The benefit is there is no
increased risk of breast or endometrial CA.
ESTROGEN
(ESTROGEN)
Estrogen builds strength in bones (reducing
bone loss) & protects the heart from cardiac
disease. Estrogen also has been linked to the
prevention of Alzheimers. Estrogen helps
maintain the functioning of the female
reproductive system.
VITAMINS, MINERALS,
ELECTROLYTES
Dont be afraid to take a big step if one is
indicated. You cant cross a chasm in two
small jumps.

David Lloyd George
VITAMIN: PYRIDOXINE (B6)
I N H (Isoniazid)
N
C
R
E
A
S
E ANTI-TUBERCULIN
VITAMIN: PYRIDOXINE (B6)
L evodopa ANTI-PARKINSONISM
O
W
E
R
Our B6 is telling you that B6 should be increased
when taking INH.
B6 should be lowered to prevent toxicity when
taking Levodopa
MINERAL: IRON
(IDA USES)
Iron improves IDA, anemia in Px,
malnutrition & blood loss.
Take iron with vit. C, swallow whole tablet or
capsule (do not crush), do not take with
milk or antacid, take liquid iron w/ a straw,
& increase fluid, fiber & exercise.
ELECTROLYTE: POTASSIUM
(K+)
Potassium sparing diuretics- monitor K+
Output monitor closely
Take with food
Ace inhibitors- monitor K+
Signs of digitalis toxicity if K+ is low
Serum K+ level 3.5-5.0 mEq/L

ELECTROLYTE: POTASSIUM
(K+)
IV site monitored for infiltration
Undesirable effects: N/V, cardiac arrythmias
Medical follow-up

SUPPLEMENT: CALCIUM
(Ca2+)
Better teeth
Osteoporosis
Normal Ca2+ (8.5-10.5 mg/dl)
EKG changes- UE
Sunshine

COMPLEMENTARY AGENTS
Health is the state which medicine has
nothing to say.

W.H. Auden
COENZYME Q10
E vitamin helps preserve Co-Q10
N ausea, vomiting, anorexia-U E
alZheimers, schizophrenia, CHF-indications
Y es, it has ANTI-AGING effects
Mackeral, Salmon, Sardines-inc.in vit.E
Effectiveness of Co-Q10 is decreased w/
oral antidiabetics
ECHINACEA
Echinacea is giving a powerful boost to the
immune system so colds, flu, sore throats
will heal quickly and smiles will return
EVENING PRIMROSE
R heumatoid arthritis, PMS, menopause: ind
O il of Evening Primrose-best source of GLA
S eizures high risk if herb is taken w/
phenothiazines
E ducation-dont use if client has a Hx of
breast CA or seizures.
FEVERFEW
(MYRA MIGRAINE)
M ay cause mouth ulcers
Y ou cant use during Px
R educes pain
A nticoagulants may cause bleeding

Feverfew reduces the pain headache & photophobia.
It has also stimulated Myras appetite & her dress
size is about to outgrow her big hair.
GARLIC
O bserve for bleeding if taking anticoagulants
D oes also have antitumor & antimicrobial
effects
O dorless garlic supplements are available
R evaluate BP & lab reports
Garlic also helps her yeast infection. Decrease
cholesterol, triglycerides, BP.
GINGKO BILOBA
A few weeks on Gingko Biloba & he receives
the benefits of increased memory &
decreased depression. He can just feel the
better blood flow through his brain & can
now think like Einstein!
GINSENG
GINSENG BEAR GETS TO THE FINISH
LINE FIRST! He has taken his tonic that
improves stamina & fights fatigue. Needless
to say, the 2
nd
bear in the race did not take
his ginseng.
KAVA-KAVA
K a w/ interacts w/ CNS depressants
A dvise to w/ food
V isual & mild GI disturbances: UE
A lprazolam given w/ Kava may cause a coma
Kava-Kava has been restless, nervous,
anxious,& unable to sleep, but she is now
floating on her cloud of calm. She will not
be able to stay on her cloud for too long,
because this herb also acts as a diuretic.
SAW PALMETTO BERRY:
SERENOA REPENS
S tomach problems & headaches may occur
A lters PSA (prostate-specific antigen) test.
May cause false.
W atch for bloody urine


ST. JOHNS WORT

W atch the sun
O K for stings & bites
R educes viral infections
T aking MAOIs & SSRIs may cause serious
UE.
St. johns Wort calms the emotions & is used
for depression.
1 kg = 2.2 lbs
= 1000 gm
1 gm = 1000 mg
= 1 cc/ml
= 15 grains
60 mg = 1 grain
1L = 1000 ml = 1 quart
1 pint = 500 ml
1 gal = 4L = 4 quarts
1 oz = 30 ml
1 glass = 240 cc
1 dram = 15 ml = 1 tbsp
1tsp = 5 ml
1 tbsp = 3 tsp = 15 ml
1 ml = 15 minims/gtts = 60 mgtts
1 gtt = 4 mgtts

C = F 32 X 5/9
OD Once a day

Bid twice a day

Tid three times a day

Qid four times a day
Q4h every four hours

Q8h every eight hours

HS at bed time

Q6H every six hours
QOD- very other dAy

AC before meals

PC after meals

Q 3H every three hours