Transcript Document

Must Know Drugs:
Psych, Complex, Peds/OB,
Community
Compiled by Hannah Giboney
Psych
Valproic Acid (Depakote, Depakene)
Ziprasidone (Geodon)
Lithium carbonate
• Anticonvulsant
• Uses: partial, generalized and absence seizures, bipolar d/o,
and migraine h/a
• S/E: GI effects, hepatotoxicity, pancreatitis,
thrombocytopenia
• Contraindications: liver d/o
• Interactions: phenytoin and phenobarbital
Bupoprion (Wellbutrin, Zyban)
• Atypical antidepressant; smoking deterrant
• S/E: h/a, dry mouth, constipation, increased HR, nausea,
restlessness, weight loss, seizures
• Contraindications: seizure d/o, pts on MAOIs
• Interventions: monitor for seizures, sip on fluids for dry
mouth, fiber for constipation; take daily, emphasize
compliance (1-3 weeks before effects); don't d/c abruptly
Risperidone (Risperdal)
Olanzapine (Zyprexa)
• Atypical Antipsychotic
• Uses: schizophrenia, levodopa-induced psychosis
• S/E: agranulocytosis, seizures, DM, weight gain, heart
muscle inflammation
• Contraindications: agranulocytosis,
immunosuppressive/anticancer meds, seizure d/o, DM
• Interventions: signs of DM/weight gain, monitor for seizures,
CBC
Paroxetine (Paxil)
• SSRI
• Uses: major depression, OCD, bulimia, PDD, panic d/o,
PTSD
• S/E: sexual dysfunction, weight gain, Serotonin synd (272hr--mental confusion, agitation, anxiety), w/d syndrome,
hypoNa, rash, sleepiness, lightheadedness
• Contraindications: pts on MAOIs, Warfarin, TCAs, Lithium,
NSAIDs, or anticoagulants
• Interventions: take w/ food, take daily, encourage
compliance, no effects until 1-3 weeks
Benztropine mesylate (Cogentin)
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Anti-parkinson: Centrally-acting anticholinergic
Symptomatic relief from dyskenesias
S/E: NV, anticholinergic effects, antihistamine effects
Contraindications: pts w/ narrow-angle glaucoma
Interventions: warn about possible sudden loss of effects of
meds, may be weeks-months before noticeable effects
Haloperidol (Haldol) Decanoate
Fluphenazine (Prolixin-Decanoate)
• Conventional Antipsychotic
• Uses: schizophrenia, bipolar d/o, tourette's synd, delusional
d/o, schizoaffective d/o, dementia, huntington's chorea
• s/e: seizures, EPS, anticholinergic effects, neuroleptic
malignant syndrome
• contraindications: pts in a coma, severe depression,
parkinson's, prolactin-dependent breast cancer, severe
hypotension; pts on anticholinergic agents, CNS
depressants or levodopa
• Interventions: take on a regular schedule, 4-6 weeks before
effects
Complex
Epinephrine (Adrenalin)
• Adrenergic Agonist
• Used for cardiac stimulation in cardiac arrest; for
bronchodilation in asthma or allergic/anaphylactic reactions;
produces mydriasis; produces local vasoconstriction when
combined with local anesthetics and prolongs anesthetic
action by decreasing blood blow to the site
• S/E: dysrhythmias, tachycardia, angina, restlessness,
urgency or urinary incontinence
• Interventions: monitor VS, lung sounds, UOP & ECG;
administer through a large vein
Norepinephrine (Levophed)
• Adrenergic Agonist
• Stimulates the heart in cardiac arrest; vasoconstricts and
increases the BP in hypotension and shock
• S/E: dysrhythmias, tachycardia, angina, restlessness,
urgency or urinary incontinence
• Interventions: monitor VS, lung sounds, UOP & ECG;
administer through a large vein
Dopamine Hydrochloride (Intropin)
• Adrenergic Agonist
• Increases BP and cardiac output through positive inotropic
action and increases renal blood flow through its action on
alpha and beta receptors
• Used to treat mild renal failure caused by low cardiac output
• S/E: dysrhythmias, tachycardia, angina, restlessness,
urgency or urinary incontinence
• Interventions: monitor VS, lung sounds, UOP & ECG;
administer through a large vein
Lidocaine (Xylocaine)
• Class IB antidysrhythmic: sodium channel blocker. Local
Anesthetic.
• suppress dysrhythmias by inhibiting abnormal pathways of
electrical conduction through the heart; block conduction of
pain impulses in certain area
• S/E: fluid retention; orthostatic hypotension, constipation;
CNS excitation; spinal h/a, urinary retention
• Interventions: monitor HR, RR, BP, ECG; monitor serum
drug levels; ensure administration of correct form; IV form
must have an infusion pump; limit fluid & salt intake; monitor
resp/thyroid/neruo functions; increase fiber
Adenosine (Adenocard)
• Antidysrhythmic
• Restoration of normal sinus rhythm (SVT only)
• S/E: orthostatic hypotension, constipation; fluid retention
(weight gain, peripheral edema, SOB)
• Interventions: monitor HR, RR, BP, ECG; maintain
therapeutic serum drug levels; do not give w/ food that
affects absorption; IV form must have an infusion pump; limit
fluid & salt intake; monitor resp/thyroid/neruo functions;
increase fiber intake
Eptifibatide (Integrillin) & Abciximab
(ReoPro)
• Antiplatelet: GPIIb/IIIa Inhibitor
• Inhibit the aggregation of platelets in the clotting process,
prolonging the bleeding time
• Used in the prophylaxis of long-tem conplications following
myocardial infarction, coronary revascularization, stents, and
brain attacks (stroke)
• Contraindications: pts w/ bleeding d/o and known sensitivity
• S/E: GI bleeding, bruising, hematuria, tarry stools
• Interventions: determine sensitivity before administration,
monitor VS, give w/ food if GI bleeding occurs, monitor
bleeding time & for S/E r/t bleeding; educate pt how to take
& how to monitor for S/E
Tissue Plasminogen Activator (tPA)
• Thrombolytic
• Activate plasminogen which generates plasmin (an enzyme
that dissolves clots)
• Uses: 4-6 hours onset of MI; arterial thrombosis, DVT,
occluded shunts or catheters & pulmonary emboli
• Contraindications: internal bleeding; hx of stroke, intracranial
problems, recent surgery; hepatic/renal dz; uncontrolled
HTN; recent CPR
• S/E: bleeding, dysrhythmias, fever, allergic rxns
• Interventions: aPTT, PT, fibrinogen level, hematocrit, and
platelet count; monitor VS & pulses; monitor for bleeding,
excretions for occult blood, for neruo changes, hypotension,
tachycardia; avoid injection; direct pressure over puncture
site 20-30min; electric razor & brush teeth gently
Nesiritide (Natrecor)
• Vasodilator,diuretic
• recombinant version of human BNP that vasodilates arteries
and veins
• used in treatment of decompensated HF
• S/E: hypotension, confusion, dizziness, dysrhythmias
• Interventions: give by continuous IF infusion via pump,
monitor BP, cardiac rhythm, urine output, body weight,
monitor for signs of resolving HF
Propofol (Diprivan)
• IV General Anesthetic: loss of consciousness & eliminate
response to painful stimuli
• Uses: adjunct to inhalation anesthetics,
induction/maintenance of anesthesia, amnesia
• S/E: resp/CV depression, bacterial infection
• Interventions: use open vial w/n 6hr; injected into a large
vein after IV lidocaine has been injected into the site to
decrease pain
• Interactions: CNS depressants/stimulants, opioid analgesics\
• Implicated in Michael Jackson’s death
Midazolam Hydrochloride (Versed)
• Benzodiazepine: anxiolytic
• Action: Depress CNS, muscle-relaxing, anticonvulsant
• Contraindications: acute narrow-angle glaucoma; use
cautiously in children & adults; abrupt w/d can be lifethreatening
• S/E: phlebitis at IV site, apnea, laryngospasm,resp depression,
cardiac arrest
• Toxicity: somnolence, confusion, diminished reflexes, coma,
agitation, restlessness, discomfort, anxiety
• Interventions: liver/renal function test results & CBC, reduced
dose for elderly & impaired liver function; fall precautions; avoid
alcohol, taper dose to stop
Mannitol (Osmitrol)
• Osmotic diuretic
• increase osmotic pressure of glomerular filtrate
• used for oliguria, prevent RF, decrease ICP, decrease IOP;
used with chemotherapy to induce diuresis
• S/E: F&E imbalance, pulmonary edema, NV, H/A,
tachycardia, hypoNa, dehydration
• Interventions: monitor VS, weight, UOP, electrolyte levels,
lungs & heart sounds, dehydration, neuro status, IOP, ICP;
change position slowly, do not give if med has crystallized in
vial
Naloxone Hydrochloride (Narcan)
• Opioid Antagonist
• Treat resp depression from opioid OD
• Interventions: monitor BP, HR, RR Q 5min, then Q 15min,
then Q 30min until pt is stable
• Place pt on cardiac monitor to monitor rhythm, auscultate
breath sounds, have resuscitation equipment available; don't
leave unattended, monitor pt for several hours
Sodium bicarbonate (bicarb)
• Orally: Antacids
• Action: Reacts w/ gastric acid to produce neutral salts or
salts of low acidity; inactivate pepsin and enhance mucosal
protection but don't coat the ulcer crater to protect it from the
acid and pepsin; elevates gastric pH above 5
• Uses: PUD and GERD
• take on a schedule; chew thoroughly and follow w/ water or
milk; shake liquid prep before administration; allow 1 hour
between antacid and other meds
• S/E: rapid onset, liberating carbon dioxide, increasing
intraABD pressure, and promotes flatulence; used w/
caution w/ HTN and HF; can cause systemic alkalosis in pts
w/ Renal Impairment
Sodium bicarbonate (bicarb)
• IV: Weak alkaline; used to treat acidosis (esp metabolic),
• Action: Shifts carbonic acid/carbon dioxide equilibrium
toward base raising blood pH
• Uses: acidosis, hyperkalemia, cardiac arrest
Peds/OB
Mg sulfate
• CNS depressant
• Produce uterine relaxation & suppress uterine activity in order
to prevent preterm birth. Used for preeclamptic pts to prevent
seizures.
• S/E: depress resp, depress DTRs, hypotension, extreme
muscle weakness, flushing, decreased UOP, pulmonary
edema, serum Mg levels >9 mg/dL
• Contraindications: Mother: severe (pre)eclampsia, vaginal
bleeding, intrauterine infection, cardiac dz.
Fetus:
gestational age >37wks, cervical dilation >4cm, fetal demise,
lethal fetal anomaly, chorioamnionitis, acute fetal distress,
and chronic intrauterine growth restriction
• Interventions: use controller pump; monitor DTRs, resp
& UOP; Mg levels, keep Ca gluconate at bedside (antidote)
Oxytocin (Pitocin)
• stimulates smooth muscle of the uterus & induces contraction
of the myocardium; intranasal/IM/IV
• Uses: induce/augment labor, control postpartum bleeding,
promote milk letdown; induce/complete abortion
• S/E: rare; allergies, dysrhythmias, BP changes, uterine rupture,
water intoxication; nasal vasoconstriction (intranasal); uterine
hypertonicity; hypotension/rebound HTN; postpartum
hemorrhage
• Interventions: monitor VS/weight/I&O/LOC/lung sounds, the
freq, duration, force of contractions & resting uterine tone, fetal
HR Q 15min; give IV via infusion monitoring device; don't leave
unattended; monitor for hypertonic contractions, uterine
hyperstimulation or nonreassuring fetal HR, signs of water
intoxication; document. If necessary, turn on her side,
increase IV NS rate, & give O2 via face mask
Betamethasone
• Corticosteroid that increases the production of surfactant
• Use: pt in preterm labor 28-32 wks gestation whose labor
can be safely inhibited for 48 hours
• S/E: decreased resistance to infection; pulmonary edema
secondary to Na and fluid retention; elevated blood glucose
levels in pt w/ DM
• Interventions: monitor maternal VS, lung sounds, for edema,
signs of infection, WBC, blood glucose levels
Concerta, Adderall, Ritalin
• CNS Stimulant: amphetamines
• stimulate the cerebral cortex of the brain; increase alertness &
sensitivity to stimuli
• Uses: narcolepsy and ADHD; adjunctive therapy for exogenous
obesity
• S/E: irritability, restlessness, tremors, tachycardia,
dysrhythmias, HTN, dry mouth, anorexia/weight loss, ABD
cramping, diarrhea/constipation, hepatic failure, psychoses,
impotence, dependence and tolerance, high potential for abuse
• Interventions: monitor VS, mental status, CBC, WBC, platelet;
degree of inattention, impulsivity, hyperactivity, sleepiness;
height/weight/growth of child; take before food; avoid
caffeine/alcohol; take >6hrs before bed
Atomoxetine (Strattera)
• CNS stimulant
• S/E: tachycardia, anorexia/weight loss, elevated BP,
dizziness, agitation
• Interventions: monitor CNS s/e, BP; obtain baseline ECG;
avoid OTC; take last dose >6hr before bed (>14hr if XR);
monitor height/weight in children; several weeks before
therapeutic effect
Fluticasone/Salmeterol (Advair)
• Corticosteroid + long acting bronchodilator
• Uses: prevent asthma attacks or flare-ups of COPD (not for
acute attacks or dyspnea)
• S/E: h/a, churg-strauss syndrome
• Caution: DM, glaucoma, seizure d/o, pheochromocytoma
• Interactions: beta-blockers, ketoconazole, MAOIs
• Interventions: assess VS, resp status; allow 1-2min between
inhalations; take regardless of symptoms; do not use as
rescue inhaler
Montelukast (Singulair)
• Leukotriene modifier
• Action: inhibit bronchoconstriction caused by specific
antigens & reduce airway edema and smooth muscle
contraction
• Use: prophylaxis/treatment of chronic bronchial sthma
• Contraindication: pts w/ hypersensitivity & breast-feeding
mothers; use w/ caution w/ impaired hepatic function
• Interaction: inhaled glucocorticoids increase risk of upper
resp infection
• S/E: H/A, NV, dyspepsia, diarrhea, generalized pain,
myalgia, fever, dizziness
• Intervention: monitor VS, lung sounds (rhonchi/wheezing),
liver function lab values, for cyanosis; take 1hr before or 2 hr
after meals; increase fluid intake; don't self-d/c
Terbutaline (Brethine)
• beta-adrenergic agonist
• Used to stop preterm labor by relaxing smooth muscles,
inhibiting uterine activity & causing bronchodilation
• s/e: SOB, coughing, tachypnea, pulmonary edema,
tachycardia, palpitations, chest pain, hypotension, fluid
retention, decreased urine production, tremors, dizziness,
muslce cramps, weakness, h/a, hypokalemia,
hyperglycemia, hypocalcemia
• interventions: monitor for s/e; put pt on her side; monitor VS,
weight, I&O, fluid restriction, comfort measures
dinoprostone (Cervidil)
• prostaglandin E2
• “ripen” the cervix (dilation and effacement), stimulate uterine
contractions, given vaginally
• Uses: preinduction cervical ripening, induction of labor,
induction of abortion
• S/E: diarrhea, NV, stomach cramps, fever, chills, fllushing,
h/a, hypotension, tachysystole (>12 contractions in 20min
w/o alteration in fetal HR pattern), hyperstimulation of
uterus, fetal passage of meconium
• Contraindications:
• Interventions: monitor VS, cervical ripening, Bishop score,
s/e; void before administration, maintain supine position w/
lateral tilt or side-lying for 30-40min
Erythromycin
• Opthalmic ointment or drops are bacteriostatic & bactericidal
• Use: prophylactic measure to protect against N. gonorrhoeae & C.
trachomatis
• Interventions: cleanse neonate's eyes before instilling drops or
ointment, instill into conjunctival sacs w/n 1hr after delivery; don't
flush eyes after instillation
– Oral
• Various bacterial infections; otitis media, bronchitits
• Adverse effect: GI UPSET; DIARRHEA
Ferrous Fumarate (Hemocyte F)
• Antianemic: iron supplement (same as ferrous sulfate, but
different concentration of iron)
• Uses: treat/prevent Fe-def anemia
• Contraindications: non-Fe-def anemia
• S/E: NV, constipation, dark stools, epigastric pain, teeth
staining (liquid)
• Interactions: tetracyclines, ascrobic acid, antiulcer meds
• Intervention: assess nutritional status, bowel function;
monitor CBC/BMP; monitor for toxicity/OD (stomach pain,
fever, NV); warn about stools; instruct to take 1hr
before/after food (unless GI discomfort)
Rhogam
• Uses: prevent anti-Rh (D) antibody formation in Rh-neg pts
exposed to Rh-positive blood (from baby)
• S/E: elevated temp, site tenderness
• contraindications: Rh-positive women, hx of systemic
allergic rxn to preps containing human immunoglobulins; not
for newborn infant
• Intervention: IM injection at 28 wks gestation & w/n 72hr
after delivery; not IV; monitor for temp elevation
Vitamin K (AquaMEPHYTON)
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necessary to assist in production of active prothrombin
Use: prophylaxis & tx of hemorrhagic dz of the newborn
S/E: hyperbilirubinemia in newborn
Interventions: protect med from light; give during early
neonatal period, in lateral aspect of mid-3rd of the vastus
lateralis muscle of thigh; monitor for bruising at injection site
and for bleeding from cord; monitor for jaundice and bilirubin
level
Amoxicillin, Amoxicillin-clavunalate
(Augmentin)
• Broad-Spectrum Penicillin; clavunalate helps make it
penicillinase resistant
• Action: inhibit growth of bacteria; beta-lactamase resistant
• Uses: prophylaxis bacterial endocarditis; 1st choice for
meningitis
• S/E: GI effects (upset stomach, sore mouth, furry tongue);
superinfections; hypersenxitivity rxns (anaphylaxis)
• Interventions: assess for allergies, monitor lab values,
monitor I&O, encourage fluid intake, initiate safety
precautions (CNS effects); IV, IM
• Educate: importance of compliance
Zidovudine (AZT)
• NRTI
• Uses: tx HIV and AIDS; prophylaxis in exposed healthcare
workers, HIV+ mothers, HIV+ sexual partners
• Action: inhibit the activity of reverse transcriptase
• S/E: NV, anemia, leukopenia, myopathy, fatigue, h/a
• use 3 or 4 meds (highly active antiretroviral therapy:
HAART) to delay or reverse loss of immune function,
preserve health, and prolong life
Community
Rifampin
• 1st-line TB agent to inhibit bacterial RNA synth; used with at
least one other anti-TB med
• Contraindication: pts w/ hypersensitivity
• Interactions: decreases effects of oral anticoagulants, oral
hypoglycemics, Chloromycetin, Lanoxin, Norpace, Mexitil,
Diflucan, Dolophine, Dilantin, Calan, and others.
• S/E: hypersensitivity rxn, heartburn, NVD, red-orange body
secretions, vision changes, hepatotoxicity, hepatitis,
increased uric acid levels, blood dyscrasias, colitis
• Intervention: CBC, uric acid, LFT; monitor stools (colitis);
mental status
• Education: warn about s/e; take as prescribed; avoid alcohol
Isoniazid (INH)
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1st-line med for TB
bactericidal; used in combo w/ other anti-TB meds
Contraindications: pts w/ hypersensitivity or w/ acute liver dz
Interactions: increase risk of toxicity or Tegretol & Dilantin; may
decrease ketoconazole concentrations; tyramine foiods
• S/E: hypersensitivity rxns, peripheral neuritis, neurotoxicity,
hepatotoxicity, pyridoxine (vit B6) deficiency, irritation at inj site
w/ IM, NV, dry mouth, dizziness, hyperglycemia, vision
changes, hepatitis
• Interventions: monitor LFT, CBC, blood glucose levels; give 1hr
before or 2hr after food & 1hr before Al antacids; pyridoxine
reduces risk of neurotoxicity; total compliance
lamivudine (Epivir)
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NNRTIs
Uses: HIV and AIDS
Action: inhibit the activity of reverse transcriptase
S/E: nausea, nasal congestion
use 3 or 4 meds (highly active antiretroviral therapy:
HAART) to delay or reverse loss of immune function,
preserve health, and prolong life
Bicillin
• PCN G
• Action: inhibit growth of bacteria (gram positive narrow
spectrum: S. pneumo, S. pyogenes, syphillis);
• Uses: prophylaxis becterial endocarditis; 1st choice for
meningitis;
• S/E: GI effects (sore mouth, furry tongue); superinfections;
hypersenxitivity rxns (anaphylaxis)
• Interventions: assess for allergies, monitor lab values,
monitor I&O, encourage fluid intake, initiate safety
precautions (CNS effects); IV, IM
• Educate: importance of compliance