Feb 22, 2011

Final comprehansive notes 3

Anti-Depressants Monoamine Oxidase Inhibitors (MAO)

Action:

· Causes increases concentration of neurotransmitters

Used for:

· Depression

· Chronic pain

Anti-Depressants

(Monoamine Oxidase Inhibitors)

Medications:

· Marplan

· Nardil

· Parnate

Anti-Depressants

(Monoamine Oxidase Inhibitors)

Side effects:

· Hypertensive Crisis (Sudden headache, diaphoretic, palpitations, stiff neck, intracranial hemorrhage) with food that contain Tyramine

Nursing Considerations:

· Avoid foods containing Tyramine: Aged cheese, liver, yogurt, herring, beer and wine, sour cream, bologna, pepperoni, salami, bananas, raisins, and pickled products

· Monitor output

· Takes 4 weeks to work

· Don’t combine with sympathomometics vasoconstrictors, and cold medications

Anti-Depressants

Selective Serontonin Reuptake Inhibitors (SSRI)

Action:

· Inhibits CNS uptake of serotonin

Used for:

· Depression

· Obsessive-Compulsive Disorder

· Bulimia

Anti-Depressants

Selective Serontonin Reuptake Inhibitors (SSRI)

Medications:

· Paxil

· Prozac

· Zoloft

Anti-Depressants

Selective Serontonin Reuptake Inhibitors (SSRI)

Side effects:

· Anxiety

· GI upset

· Change in appetite and bowel function

· Urinary retention

Nursing Considerations:

· Suicide precautions

· Takes 4 weeks for full effect

· Take in a.m.

· May urine to pinkish-red or Pinkish-brown

· Can be taken with meals

Anti-Depressants (Tricyclics)

Action:

· Inhibits reuptake of neurotransmitters

Used for:

· Depression

· Sleep apnea

Anti-Depressants (Tricyclics)

Medications:

· Norpramin

· Elavil

· Tofranil

Anti-Depressants (Tricyclics)

Side Effects:

· Sedation/Confusion

· Anticholinergics affects

· Postural Hypotension

· Urinary retention

Nursing Considerations:

· Suicide precautions/2-6 weeks to work

· Take at hs/Don’t abruptly halt

· Avoid alcohol/OTC /Photosensitivity

Insulin

(Regular, Humulin R)

Type: Fast acting

Onset: ½ -1 hr

Peak: 2-4 hr

Duration: 6-8 hr

Insulin

(NPH, Humulin N)

Type: Intermediate acting

Onset: 2hr

Peak: 6-12hr

Duration 18-26hr

Insulin

(Ultralente, Humulin U)

Type: Slow acting

Onset: 4hr

Peak: 8-20hr

Duration: 24-36hr

Insulin

(Humulin 70/30)

Type: Combination

Onset: ½ hr

Peak: 2-12hr

Duration: 24hr

Antidiabetic Agents

Action:

· Stimulates insulin release from beta cells in pancreas

Used for:

· Type 2 diabetes (NIDDM)

Antidiabetic Agents

Medications:

· Diabinese

· Orinase

· Dymelor

· Micronase

Antidiabetic Agents

Side Effects:

· Hypoglycemia

· Allergic skin reactions

· GI upset

Nursing Considerations:

· Take before breakfast

· Monitor glucose levels

· Avoid alcohol, sulfonamides, Oral Contraceptives, (MAO), aspirin because they help to make drug work better

Hypoglycemic Agent

Action:

· Stimulates liver to change glycogen to glucose

Used for:

· Hypoglycemia

Hypoglycemic Agent

Medication:

· Glucagon

Hypoglycemic Agent

Side Effects:

· Hypotension

· Bronchospasm

Nursing Considerations:

· May repeat in 15min

· Give carbohydrates orally to prevent secondary hypoglycemic reactions

Antidiarrheals

Action:

· Slows peristalsis

· Increases tone of sphincters

Used for:

· Diarrhea

Antidiarrheals

Medications:

· Kaopectate

· Lomotil

· Imodium

· Paregoric

Antidiarrheals

Side Effects:

· Constipation

· Anticholinergic effects (urinary retention, dry mouth)

Nursing Considerations:

· Do not use with abdominal pain

· Monitor for urinary retention

· Give 2hr before or 3 hr after other meds

Antiemetics

Action:

· Increases GI motility

· Blocks effect of dopamine in chemoreceptor trigger zone

Used for:

· Vomiting

Antiemetics

Medications:

· Tigan

· Compazine

· Torecan

· Reglan

· Antivert

· Dramamine

Antiemetics

Side Effects:

· Sedation

· Anticholinergic effects

Nursing Considerations:

· Used before chemotherapy

· When used with viral infections may cause Reye’s syndrome (Toxic Encephalopathy)

Antifungals

Action:

· Impairs cell membrane

Used for:

· Candidiasis

· Oral thrush

· Histoplasmosis

Antifungals

Medications:

· Amphotericin B

· Nystatin

Antifungals

Side Effects:

· Hepatotoxicity

· Thrombocytopenia

· Leukopenia

· Pruritis

Nursing Considerations:

· Give with food

· Monitor liver function

· Good oral hygiene

Antigout Agents

Action:

· Decreases production and resorption of uric acid

Used for:

· Gout

Antigout Agents

Medications:

· Colchicine

· Probenecid

· Zyloprim

Antigout Agents

Side Effects:

· Agranulocytosis

· GI upset

· Renal calculi

Nursing Considerations:

· Monitor for renal calculi

· Give with food, milk, antacids

Antihistamines

Action:

· Block effects of histamine

Used for:

· Allergic rhinitis

· Allergic reactions to blood

Antihistamines

Medications:

· Chlor-Trimeton

· Benadryl

· Phenergan

Antihistamines

Side Effects:

· Drowsiness

· Dry mouth

· Photosensitivity

Nursing Considerations:

· Give with food

· Use sunscreen

· Avoid alcohol

Antihyperlipidemic Agents

Action:

· Inhibits cholesterol and triglyceride synthesis

Used For:

· Elevated cholesterol

· Reduce incidence of cardiovascular disease

Antihyperlipidemic Agents

Medications:

· Questran

· Lipid

Antihyperlipidemic Agents

Side Effects:

· Constipation

· Fat-soluble vitamin deficiency

Nursing Considerations:

· Take at hs or 30 min ac

· Administer 1hr before or 4-6 hr after other meds

Antihypertensives

Types: ACE Inhibitors

Action:

· Blocks ACE in lungs

Used for:

· Hypertension

· CHF

Antihypertensives

(ACE Inhibitors)

Medications:

· Capoten

· Vasotec

Antihypertensives

(ACE Inhibitors)

Side Effects:

· GI upset

· Orthostatic hypotension

· Dizziness

Nursing Considerations:

· Give 1hr ac or 3hr pc

· Change position slowly

Antihypertensives

Type: Beta-Adrenergic Blockers

Action:

· Blocks Beta-Adrenergic Receptors

· Decrease excitability/workload of heart, oxygen consumption

· Decrease

Used for:

· Hypertension

· Angina

· SVT

Antihypertensives

Type: Beta-Adrenergic

Medications;

· Nadolol

· Propranolol

· Tenormin

· Timoptic

Antihypertensives

Type: Beta-Adrenergic

Side Effects:

· Changes in heart rate

· Hypotension

· Bronchospasm

Nursing Considerations:

· Masks signs of shock and hypoglycemia

· Take with meals

· Do not discontinue abruptly

Antihypertensives

Type: Calcium Channel Blockers

Action:

· Inhibits movement of calcium across cell membranes

· Slow impulse conduction and depresses myocardial contractility

· Causes dilation of coronary arteries and decreases cardiac workload and energy consumption

Used for:

· Angina

· Hypertension

· Interstitial cystitis

Antihypertensives

Type: Calcium Channel Blockers

Medications:

· Procardia

· Calan

· Cardizem

Antihypertensives

Type: Calcium Channel Blockers

Side Effects:

· Hypotension

· Dizziness

· GI distress

Nursing Consideration:

· Monitor vital signs

· Do not chew or divide sustained-release tablets

Antihypertensives

Type: Centrally acting alpha-adrenergics

Action:

· Stimulates alpha receptors in medulla which causes a reduction in sympathetic in the heart

Used for:

· Hypertension

Antihypertensives

Type: Centrally acting alpha-adrenergics

Medications:

· Aldomet

· Catapres

Antihypertensives

Type: Centrally acting alpha-adrenergics

Side Effects:

· Sedation

· Orthostatic Hypotension

Nursing Considerations:

· Don’t discontinue abruptly

· Monitor for fluid retention

· Change position slowly

Antihypertensives

Type: Direct-acting vasodilators

Action:

· Relaxes smooth muscle

Used for:

· Hypertension

Antihypertensives

Medications

· Hydralazine

· Minoxidil

Antihypertensives

Side Effects:

· Tachycardia

· Increase in body hair

Nursing Considerations:

· Teach patient to check pulse

Antihypertensives

Type: Peripheral-acting alpha-adrenergic blockers

Action:

· Depletes stores of norepinephrine in sympathetic nerve endings

Used for:

· Hypertension

Antihypertensives

Medications:

· Reserpine

Antihypertensives

Side Effects:

· Depression

· Orthostatic Hypotension

· Brachycardia

Nursing Considerations:

· Give with meals or milk

· Change position slowly

Bipolar Disorder

Action:

· Reduces catecholamine release

Used for:

· Manic episodes

Bipolar Disorder Medications:

· Lithium (1-1.5meq/L)

· Tegretol

· Depakote

Bipolar Disorder

Side Effects:

· GI upset

· Tremors

· Polydipsia

· Polyuria

Nursing Considerations:

· Monitor serum levels

· Give with meals

· Increase fluid intake

Antineoplastic Agents

Type: Alkylating Agents

Action:

· Interferes with rapidly reproducing DNA

Used for:

· Leukemia

· Multiple myeloma

Antineoplastic Agents

Medications:

· Cisplatin

· Myleran

· Cytoxan

Antineoplastic Agents

Side Effects:

· Hepatotoxicity

· Ecchymosis

· Alopecia

· Epitaxis

· Infertility

· Bone Marrow Suppression

· Stomatitis

· GI disturbances: Anorexic, N/V, diarrhea

Nursing Considerations:

· Check hematopoietic (reproduction of RBC’s by bone marrow) function

· Force fluids

· Good mouth care

Antineoplastic Agents

Type: Antimetabolites

Action:

· Inhibits DNA polymerase

Used for:

· Acute lymphatic leukemia

· Cancer of colon, breast, pancreas

Antineoplastic Agents

Antimetabolites Medications:

· 5-FU

· Methotrexate

· Hydrea

Antineoplastic Agents

Antimetabolites

Side Effects:

· Nausea

· Vomiting

· Oral ulceration

· Bone marrow suppression

· Alopecia

Nursing Considerations:

· Monitor hematopoietic function

· Good mouth care

· Discuss body image changes

Antineoplastic Agents

Type: Antitumor Antibiotics

Action:

· Interferes with DNA and RNA synthesis

Used for:

· Cancer

Antineoplastic Agents

Antitumor Antibiotics

Medications:

· Adriamycin

· Actinomycin D

· Bleomycin

Antineoplastic Agents

Antitumor Antibiotics

Side Effects:

· Bone marrow suppression

· Alopecia

· Stomatitis

Nursing Considerations:

· Monitor vital signs

· Give antiemetic medications before therapy

Antineoplastic Agents

Type: Hormonal Agents

Action:

· Changes hormone input into sensitive cells

Used for:

· Cancer

Antineoplastic Agents

Type: Hormonal Agents

Medications:

· Diethylstilbestrol

· Tamoxifen

· Testosterone

Antineoplastic Agents

Type: Hormonal Agents

Side Effects:

· Leukpenia

· Bone pain

· Hypercalcemia

Nursing Considerations:

· Check CBC

· Monitor serum calcium

Antineoplastic Agents

Type: Vinca Alkaloids

Action:

· Interferes with cell division

Used for:

· Cancer

Antineoplastic Agents

Type: Vinca Alkaloids

Medications:

· Oncovin

· Velban

Antineoplastic Agents

Type: Vinca Alkaloids

Side Effects:

· Stomatitis

· Alopecia

· Loss of reflexes

· Bone marrow suppression

Nursing Considerations:

· Give antiemetic before administration

· Check reflexes

· Given with Zyloprim to decrease uric acid

Antiparkinson Agents

Action:

· Converted to Dopamine

· Stimulates postsynaptic Dopamine receptors

Used for:

· Parkinson’s disease

Antiparkinson Agents

Medications:

· Artane

· Cogentin

· L-Dopa

· Parlodel

· Sinemet

· Symmetrel

Antiparkinson Agents

Side Effects:

· Dizziness

· Ataxia

· Atropine-like effects: dry mouth, urinary retention

Nursing Considerations:

· Monitor for urinary retention

· Large doses of vitamin B6 reverse effects

· Avoid use of CNS depressants

Antiplatelet Agents

Action:

· Interferes with platelet aggregation

Used for:

· Venous thrombosis

· Pulmonary embolism

Antiplatelet Agents

Medications:

· Aspirin

· Persantine

Antiplatelet Agents

Side Effects:

· Hemorrhage

· Thrombocytopenia

Nursing Considerations:

· Check for signs of bleeding

· Give with food or milk

Antipsychotic Agents

Action:

· Blocks dopamine receptors in basal ganglia

Used for:

· Acute and Chronic psychoses

Antipsychotic Agents

Medications:

· Haldol

· Thorazine

· Mellaril

· Stelazine

Antipsychotic Agents

Side Effects:

· Akathisia (inability to sit still)

· Dyskinesia

· Dystonias

· Parkinson’s syndrome

· Tardive dyskinesias

· Leukopenia

Nursing Considerations:

· Check CBC

· Monitor vital signs

· Avoid alcohol and caffeine

Atypical Antipsychotic Agents

Action:

· Interferes with binding of dopamine in the brain

Used for:

· Acute and Chronic psychoses

Atypical Antipsychotic

Medications:

· Clozaril

· Risperdal

Atypical Antipsychotic

Side Effects:

· Extrapyramidal effects

· Anticholinergic

· Sedative

· Orthostatic hypotension

Nursing Considerations:

· Monitor blood

· Change positions slowly

· Use sunscreen

Antipyretic Agents

Action:

· Antiprostaglandin activity in hypothalamus

Used for:

· Fever

Antipyretic Agents

Medications:

· Tylenol (Acetaminophen)

Antipyretic Agents

Side Effects:

· GI irritation

Nursing Considerations:

· Monitor liver function

· Aspirin contraindicated for younger than 21 years old due to risk of Reye’s syndrome

Antithyroid Agents

Action:

· Reduce vascularity of thyroid

· Inhibits release of thyroid into circulation

Used for:

· Hyperthyroidism

Antithyroid Agents

Medications:

· Tapazole

· SSKI

Antithyroid Agents

Side Effects:

· Leukopenia

· Rash

· Thrombocytopenia

Nursing Considerations:

· Bitter taste

· May cause burning in mouth

· Give with meals

· Check CBC

Thyroid Replacement Agents

Action:

· Increases metabolic rate

Used for:

· Hypothyroidism

Thyroid Replacement

Medications

· Synthroid

· Cytomel

Thyroid Replacement

Side Effects:

· Nervousness

· Tachycardia

· Weight loss

Nursing Considerations:

· Monitor pulse and BP

· Monitor weight

· Take in a.m.

· Enhance action of anticoagulants, antidepressants, decrease action of insulin and digitalis

Antitubercular Agents

Action:

· Inhibits cell and protein synthesis

Used for:

· Tuberculosis

· To prevent disease in person exposed to organism

Antitubercular Agents

Medications:

· INH

· Ethambutol

· Streptomycin

· PAS

· PYZ

Antitubercular Agents

Side Effects:

· Hepatitis

· Peripheral Neuritis

Nursing Considerations:

· Check liver function tests

· Vitamin B6 given for peripheral neuritis (Pyridoxine)

· Used in combination

Antivirals

Action:

· Inhibits DNA and RNA replication

Used for:

· Recurrent HSV

· HIV infection

Antivirals

Medications:

· Zovirax

· AZT

· Videx

· Famvir

· Cytovene

Antivirals

Side Effects:

· Headache

· Dizziness

· GI symptoms

Nursing Considerations:

· Encourage fluids

· Not a cure, but relieves symptoms

Attention Disorder Agents

Action:

· Increases level of catecholamines

Used for:

· ADDH

· Narcolepsy

Attention Disorder Agents

Medications:

· Ritalin

· Cylert

· Dexedrine

Attention Disorder Agents

Side Effects:

· Restlessness

· Insomnia

· Tachycardia

· Palpitations

Nursing Considerations:

· Monitor growth rate

· Monitor liver enzymes

· Give in A.M.

Bronchodilators

Action:

· Decreases activity of phosphodiesterase

Used for:

· COPD

· Preterm labor (Terbutaline)

Bronchodilators

Medications:

· Aminophylline

· Atrovent

· Brethine

· Proventil

· Primatene

Bronchodilators

Side Effects:

· Tachcyardia

· Dysrhythmias

· Palpitations

· Anticholinergic effects

Nursing Considerations:

· Monitor BP and HR

· When used with steroid inhaler, use bronchodilator first

· May aggravate diabetes

Cardiac Glycosides

Action:

· Increases force of myocardial contraction, slows rate

Used for:

· Left-sided CHF

Cardiac Glycosides

Medication:

· Lanoxin

(Digoxin)

Cardiac Glycosides

Side Effects:

· Bradycardia

· Nausea

· Vomiting

· Visual disturbances

Nursing Considerations:

· Take apical pulse

· Notify physician if adult <60,>

· Monitor potassium level

· Dose: 0.5-1 milligram IV or PO over 24 hr period

· Average: 0.25 mg

Cholinergics

Action:

· Inhibits destruction of acetylcholine

· Stimulate parasympathetic nervous system (increase bowel tone, increase bladder tone, constrict pupil)

Used for:

· Myasthenia gravis

· Post-operative

· Postpartum urinary retention

Cholinergics

Medications:

· Tensilon

· Prostigmin

Cholinergics

Side Effects:

· Bronchoconstriction

· Respiratory paralysis

· Hypotension

Nursing Considerations:

· Give with food or milk

· Monitor vital signs, especially respirations

· Antidote: Atropine Sulfate

· Toxicity: excessive salivation, excessive sweating, abdominal cramps, flushing

Diuretics

Action:

· Inhibits reabsorption of sodium and water

· Blocks effects of aldosterone

Used for:

· CHF

· Renal disease

Diuretics

Medications:

· HydroDIURIL

· Diamox

· Aldactone

· Lasix

· Hygroton

Diuretics

Side Effects:

· Dizziness

· Orthostatic Hypotension

· Leukopenia

Nursing Considerations:

· Take with food or milk

· Take in a.m.

· Monitor fluid and electrolytes

Iron: Imferon/Feosol, use straw if liquid form, no milk/antacids, take on empty stomach, tachycardi

Glucocorticoids

Action:

· Stimulates formation of glucose

· Alters immune response

Used for:

· Addison’s disease

· Crohn’s disease

· COPD

· Leukemias

Glucocorticoids

Medications:

· Solu-Cortef

· Decadron

· Deltasone

Glucocorticoids

Side Effects:

· Psychoses

· Depression

· Hypokalemia

· Stunted growth

· Buffalo Hump

Nursing Considerations:

· Monitor fluid and electrolyte balance

· Don’t discontinue abruptly

· Monitor for signs of infection

Mineralocorticoids

Action:

· Increases sodium reabsorption

· Potassium and hydrogen ion secretion in kidney

Used for:

· Adrenal insufficiency

Mineralocorticoids

Medications:

· Florinef

Mineralocorticoids

Side Effects:

· Hypertension

· Edema

· Hypokalemia

Nursing Considerations:

· Monitor BP, I&O, Weight, and Electrolytes

· Give with food

· Low-sodium, High-protein, High-potassium diet

Heavy Metal Antagonists

Action:

· Forms stable complexes with metals

Used for:

· Gold and arsenic poisoning

· Acute lead encephalopathy

Heavy Metal Antagonists

Medications:

· Desferal mesylate

· BAL in Oil

· EDTA

Heavy Metal Antagonists

Side Effects:

· Tachycardia

· Pain and induration at injection site (conjunct with Procaine in syringe)

Nursing Considerations:

· Monitor I&O and kidney function

· Administered with local anesthetic

· Seizure precautions

H2 Receptor Blockers

Action:

· Inhibits action of histamine and gastric acid secretion

Used for:

· Ulcers

· Gastroesophageal reflux

H2 Receptor Blockers

Medications:

· Tagamet

· Zantac

H2 Receptor Blockers

Side Effects:

· Dizziness

· Confusion

· Hypotension

· Impotence

Nursing Considerations:

· Take with meals and hs

· Smoking decreases effectiveness

· Monitor liver function and CBC

Immunosuppressants

Action:

· Prevents production of T cells and their response to interleukin-2

Used for:

· Prevents rejection for transplanted organs

Immunosuppressants

Medications:

· Sandimmune

Immunosuppressants

Side Effects:

· Hepatotoxicity

· Nephrotoxicity

· LeuKopenia

· Thrombocytopenia

Nursing Considerations:

· Take once daily in a.m.

· Used with adrenal corticosteroids

· Monitor renal and liver function tests

Miotics (Constricts Pupil)

Action:

· Causes constriction of sphincter muscles of iris

Used for:

· Ocular surgery

· Open-angle glaucoma

Miotics

Medications:

· Isopto-Carpine

· Eserine

· Carbacel

Miotics

Side Effects:

· Headache

· Photophobia

· Hypotension

· Bronchoconstriction

Nursing Considerations:

· Apply pressure on lacrimal sac for 1min

· Avoid sunlight

· May experience transient brow pain and myopia

Mydriatics (Dilates Pupil)

Action:

· Anticholinergic actions leaves pupil under unopposed adrenergic influence

Used for:

· Diagnostic procedures

· Acute iritis

· Uveitis

Mydriatics

Medications:

· Atropine sulfate

· Cyclogyl

Mydriatics

Side Effects:

· Tachycardia

· Blurred vision

· Photophobia

· Dry mouth

Nursing Considerations:

· Contraindicated with glaucoma

· Apply pressure on lacrimal sac for 1min.

· Wear dark glasses

Narcotics

Action:

· Acts on CNS receptor cells

Used for:

· Moderate to severe pain

· Preoperative

· Postoperative

Narcotics

Medications:

· Morphine Sulfate

· Codeine

· Demerol

· Dilaudid

· Percodan

Narcotics

Side Effects:

· Dizziness

· Sedation

· Respiratory depression

· Hypotension

· Constipation

Nursing Considerations:

· Safety precautions

· Avoid alcohol

· Monitor vital signs

· Use narcotic antagonist if necessary (Narcan)

Antianginals

Action:

· Relaxes smooth muscle

· Decreases venous return

Used for:

· Angina

· Peri-operative hypertension

· CHF

Antianginals

Medications:

· Nitroglycerine

· Isosorbide

Antianginals

Side Effects:

· Hypotension

· Tachycardia

· Headache

· Dizziness

Nursing Considerations:

· Check expiration date

· Teach when to take medication

· May take Q5min x3 doses

· Wet with saliva and place under tongue

NSAIDS

Action:

· Inhibits prostaglandin synthesis

Used for:

· Arthritis

· Mild to moderate pain

· Fever

NSAIDS

Medications:

· Motrin

· Indocin

· Naprosyn

NSAIDS

Side Effects:

· GI upset

· Dizziness

· Headache

· Bleeding

· Fluid retention

Nursing Considerations:

· Take with food or after meals

· Monitor liver and renal function

· Use cautiously with aspirin allergy

· Check for bleeding

Thrombolytics

Action:

· Dissolves or lyses blood clots

Used for:

· Acute Pulmonary Emboli

· Thrombosis

· MI

· Contraindicated in: hemophilia, CVA, Trauma, not used in patients over 75 years old, not used in patients taking anticoagulants

Thrombolytics

Medications:

· Streptokinase

· Urokinase

· Tissue Plasminogen Activator

Thrombolytics

Side Effects:

· Bleeding

· Bradycardia

· Dysrhythmias

Nursing Considerations:

· Monitor for bleeding

· Have Amino Caproic Acid Available

· Check pulse, color, sensation of extremities

· Monitor EKG