-antipsychotic drug
-increased mortality in elderly patients with dementia-related psychosis and suicidal thoughts and behaviors
-used for schizophrenia, acute treatment of manic and mixed episodes, maintenance treatment of bipolar I disorder, irritability associated with autistic disorder, agitation associated with schizophrenia or bipolar mania
-adverse effects include tardive dyskinesia,metabolic changes, orthostatic hypotension,leukopenia,neutropenia, seizures/convulstions,potential for cognitive and motor impairment,body temperature regulation,dysphagia
-injection, oral tablets, oral solution
Isotretinoin (Accutane)
-used for severe noduled acne
-all oral product used for the treatment of severe recalcitrant cystic acne
-anti-inflammatory effects
-pregnancy category X
-follow-up treatment may be needed
-side effects-sleep disturbances,dysrhythmias,hypotension,hepatitis,abdominal pain,distension,leukopenia
-suicide has occurred with drug but is not viewed as an adverse effect
Risedronate Sodium (Actonel)
-increases bone mass in men with osteoporosis
-treatment of Paget’s disease
-oral tablets only
-GI adverse effects,UTI,pharyngitis,hypocalcemia,hypophosphatemia,increase PTH,bone pain,osteonecrosis of the jaw
-Pregnancy C
-take 1/2 hour before food or drinks other than water
Amphetamine, dextroamphetamine mixed salts (Adderall)
-indicated for management of sustained ventricular tachycardia, ventricular fibrillation, and nonsustained ventricular tachycardia
-can cause hypothyroidism or hyperthyroidism
-fat loving, stores in fat
-adverse effect is corneal microdeposit,pulmonary toxicity,hepatotoxicity, SA node dysfunction
-incidence and severity of adverse effects is greater with higher dosages and longer therapy
-contraindicatd in those with severe sinus bradycardia, or second or third degree heart block
-toxicity with grapefruit juice
Anabolic steroids
-fluoxetine (Prozac), dulozetine (Cymbalta),
-cautious use in elderly due to toxicity
-serotonin syndrome can occur (hyperexcitation)
-drug indications such as warfarin and phenytoin
-assess suicidal risk during treatment
-assess cardiac, mental status, and neurologic status before giving drugs
antihistamine
-H2 antagonists (mediate acceleration of the heart rate and gastric acid secretion) cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid)
-goes against allergic disorders or allergies
-H1 antagonists mostly in this category (mediate smooth muscle contraction and dilation of capillaries
-adverse effects include drowsiness,dry mouth,changes in vision,difficult urinating,and constipation
Antitussive
-take with meals to avoid GI upset
-do not discontinue abruptly
-increases levels of acetylcholine in the brain by inhibiting acetylcholinesterase
-indicated in treatment of mild to moderate Alzheimer’s disease
-adverse effects are seizures, atrial febrillation, sinus bradycardia, AV block
-interacting drugs include anticholinergics and NSAIDs
-only for oral use, rapid-acting orally disintegrating tablet is available
Asprin (Anacin)
-antipyretic
-analgesic
-can be used with other agents
-avoid alcohol
-adverse effects include GI irritation/bleeding, nausea/vomiting/constipation,elevated liver enzymes,tinnitus, fluid retention,nephrotoxicity
-contraindication is flulike symptoms in children and teenagers
-Reye’s syndrome with children can occur
-oral and rectal forms
-foods acidifying urine may increase aspirin level
Lorazepam (Antivan)
-side effects-convulsions,drug fever,aseptic meningitis,hepatitis,enterocolitis,pseudomembranous colitis,renal failure,toxic nephrosis,leukopenia,neutropenia,thrombocytopenia,agrnulocytosis,hemolytic anemia,hypoprothrombinema,Henoch-Schenlein purpura,methemoglobinemia,eosinophilia I,Stevens-Johnson syndrome,toxic epidermal necrolysis,erythema multiforme,anaphylaxis,SLE
Ibandronate (Boniva)
-used in treatment of hypoparathyroidism and pseudohypoparathyroidism, vitamin D-dependent rickets, hypophosphatemia, and hypocalcemia
-side effects include anaphylaxis, myalgia, hypercalciuria
-large amounts of high calcium foods may cause hypercalcemia
calcium channel blockers?
-prevent calcium from entering into the coupling process prevents muscle contraction and promotes muscle relaxation
-relaxation causes dilation which increases blood flow to the ischemic heart which in turn increases the oxygen supply and helps shifts the supply/demand ratio back to normal
-adverse effects include hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea, rash, flushing, peripheral edema
-Diltiazem (Cardizem), Nifedipine (Procardia, Adalat), Verapamil HCl (Calan, Isoptin), Nisoldipine (Sular), Felodopine (Plendil), Nicardipine (Cardene), Amlodipine (Norvasc)
Celecoxib (Celebrex)?
-indicated for the treatment of osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea
-not to be used in known sulfa allergy
-adverse effects include stroke, MI, tachycardia, CHF, GI bleeding/ulercation, nephrotoxicity, hematuria, oliguria, azotemia, blood dyscrasias, platelet aggregation, serious, sometimes fatal Stevens-Johnson syndrome, toxic epidermal necrolysis
Clonazepam (Klonopin)/PO?
-most often used to increase the resorption of water by collecting ducts in the kidneys to prevent or control polydipsia, polyuria, and dehydration in patients with diabetes insipidus due to a deficiency of endogenous posterior pituitary vasopressin or in patients with polyuia and polydipsia resulting from trauma or surgery in the pituitary region
-contraindicated in patients with nephrogenic diabetes insipidus
-side effects include anaphylaxis
Digoxin (Lanoxin)?
-contraindicated in those with ventricular tachycardia and fibrillation
-loading dose is often given due to long duration of action
-side effects include hypokalemia, anaphylaxis, impaired respiratory function, rapid respiratory rate, CHF, atrial fibrillation
Phenytoin (Dilantin)?
-Indicated for the management of tonic clonic and partial seizures
-Contraindications include known drug allergy and heart conditions that involve bradycardia or blockage of electrocardiac function
-Most common adverse effects are gingival hyperplasia, ventricular fibrillation, hepatitis, nephritis, agrnualocytosis, leukopenia, aplastic anemia, thrombocytopenia, megaloblastic anemia, lupus erythematosus, Stevens-Johnson syndrome, toxic epidermal necrolysis
Oxybutynin (Ditropan)?
-adverse effects of dermatitis, upset stomach or vomiting, dizziness, headache, unpleasant taste
-potential drug interactions of amiodarone, cyclosporine, phenytoin, methotrexate, keoconazole, barbiturates
-contraindicated for patients with AIDS, TB, connective tissue diseases, multiple sclerosis
Epoetin alga (Epogen)?
-used to treat anemia that is associated with end-stage renal disease, chemotherapy-induced anemia, and for anemia associated with zidovudine therapy
-contraindicated in cases of uncontrolled hypertension and when hemoglobin levels are above g/dL for cancer patients and 12g/dL for renal patients
-use in patients with head or neck cancers or patients at risk for thrombosis is controversial as these medications increase tumor growth and risk for thrombosis
Rivastigmine (Exelon)?
-side effects include life-threatening brain infection, cardiac dysrhythmias, heart failure, hypertension, MI, supraventricular tachycardia, GI obstruction/perforation, renal failure, leukopenia, neutropenia, thrombocytopenia, fatal mucocutenaous infections, angioedema, bronchospasm, ARDs, toxic epidermal necrolysis, tumor lysis syndrome, Stevens-Johnson syndrome, exfoliative dermatitis
Feverfew (Chrysanthemum parthenium)?
-adverse effects include nausea, vomiting, constipation, diarrhea, altered taste sensations, muscle stiffness, and joint pain
-possible increase in bleeding with the use of aspirin and other NSAIDs, dipyridamole, warfarin
-contraindicated in those allergic to ragweed, chrysanthemums, and marigolds, as well as those about to undergo surgery
Metronidazole (Flagyl)?
-widely used to treat intraabdominal and gynecologic infections that are caused by such organisms
-indicated for the treatment of protozoal infections such amebiasis and trichomoniasis
-avoid alcohol
-side effects include seizures, psuedomembranous colitis, albuminuria, neurotoxicity, leukopenia, bone marrow, depression, aplasia
flu vaccination?
-particularly useful against Pseudomonas, Proteus, and Klebsiells organisms
-effective against staphylococci and streptococci
-side effects include seizures, neurotoxicity, ototoxicity, hepatic necrosis, oliguria, hematuria, renal damage, azotemia, renal failure, nephrotoxicity, agranulocytosis, thrombocytopenia, leukopenia, eosinophilia
Ginko (Gingko biloba)?
-adverse effects include stomach or intestinal upset, headache, bleeding, allergic skin reaction
-interactions with aspirin, NSAIDS, warfarin, heparin, anticonvulsants, ticlopidine, clopidogref, dipyridamole, tricyclic antidepressants
Glucagon?
-used for bacterial meningitis, cerebral edema, collagen diseases, dermatologic diseases, endocrine disorders, GI diseases, ophthalmic disorders
-adverse effects include moon facies, hyperglycermia, psychosis, convulsions, peptic ulcers with possible perforation, pancreatitis, fragile skin, hirsutism
Isoniazid (INH)?
-slow acetylators, medication accumulators since there is not enough of the enzyme to break it down
-side effects include toxic encephalopathy, seizures, jaundice, fatal hepatitis, agrnulocytosis, hemolytic, aplastic anemia, thrombocytopenia, eosinophilia, methemoglobineummoa
-do not give with high tyramine foods
Labetalol (Normodyne)?
-colonic bacteria digest lactolose to produce lactic acid, formic acid, and acetic acid, which created a hyperosmotic environment that draws water into the colon and produces a laxative effect
-reduced ammonia levels by converting ammonia to ammonium
-contraindicated in patients on a low-galactose diet
-side effects: anorexia, abdominal cramps, diarrhea, flatulence, distention, belching
-do not use with other laxatives
Terbinafine (Lamisil)
-available in a topical cream, gel, and spray for treating superficla dermatologic infections, including athlete’s foot, jock ithc, and ringworm
-tablet form is available for systemic use and is used primarily to treat onychomycoses of the fingernails or toenails
-side effects: neutropenia, Stevens-Johnson syndrome
-contraindicaited in chronic/active hepatic disease, renal disease
-interacionts: dextromethorphan, rifampin, cycloSPORINE, cimetidine
Glargine (Lantus)
-once injected, forms microprecipitates that are slowly absorbed over the next 24 hours
-dosed once daily
-side effects: anaphylaxis, lipohypertrophy, swelling, redness
-interactions: salicylate, alcohol, beta blockers, anabolic steroids, fenfluramine, phenylbutazone, sulfinpyrazone, guanethidine, oral hypoglycemics, MAOIs, tetracycline, thiazides, thyroid hormones, oral contraceptives, corticosteroids, estrogens, DOBUTamine, epINEPHrine
Furosemide (Lasix)
-used in the management of pulmonary edema and the edema associated with heart failure, liver disease, nephrotic syndrome, and ascites
-used in the treatment of hypertension, usually that caused by heart failure
-contraindicated in patients who have shown a hypersensitivity to it or to the sulfonamides and in patients with anuria, hypovolemia, or electrolyte depletion
-pregnancy C
-side effects-circulatory collapse, loss of hearing, renal failure, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, anemia, Stevens-Johnson syndrome
-interactions-lithium, nondepolarizing skeletal muscle relaxants, digoxin, antihypertensives, nitrates, aminoglycosides, cisplatin, vancomycin
Atorvastatin (Lipitor)
-Used to lower total and LDL cholesterol levels as well as triglyceride levels
-Been shown to raise levels of HDL
-Dosed once daily, usually with the evening meal or at bedtime
-Dosed at any time of day, bedtime dosing provides peak drug levels in a time frame that correlates better with the natural diurnal rhythm of cholesterol production in the body
-side effects:liver dysfunction, rhabdomyolysis
-interactions: azole antifungals, cycloSPORINE, erythromycin, niacin, gemfibrozil, clofibrate, digoxin, oral contraceptives, erythromycin, warfarin, colestipol
-pregnancy X
Lithium
-Levels required to produce a therapeutic effect are close to the toxic levels
-Manages acute mania
-Half life is between 18 and 24 hours
-Patient’s sodium levels require monitoring
-Indicated for the treatment of manic episodes in bipolar disorder as well as for maintenance therapy to prevent such episodes
-Contraindications to lithium therapy are relative and include dehydration, known sodium imbalance, and major renal or cardiovascular disease, because all of these conditions increase the risk of lithium toxicity
-Adverse effects tend to correlate with sodium levels
-Toxicity effects include GI discomfort, tremor, confusion, somnolence, seizures, and possibly death
-Most serious adverse effects is cardiac dysrhythmia. Other effects include drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements, ataxia, and hypotension
-Long term treatment may cause hypothyroidism
-Potentially interacting drugs include the thiazide diuretics, angiotensin converting enzyme inhibitors, and nonsteroidal inflammatory drugs, all of which can increase toxicity
-Longer elimination half-life
-Greater affinity for factor Xa
-contraindicated in patients with an indwelling epidural catheter
-given for prophylaxis and treatment
-does not require any lab monitoring and can be given at home for the treatment of DVT or pulmonary embolism
-never give heparin and this drug to the same person
-interactions:anticoagulants, salicylates, NSAIDs, antiplatelets, thrombolytics
-side effects: hemorrhage, hypochronic anemia, thrombocytopenia, bleeding
Nitrofurantoin (Microdantin)
-indicated primarily for UTI caused by E.coli, S. aureus, Klebsiella spp., and enterobacter spp
-contraindicated in significant renal function impairment, because the drug concentrates in the urine
-adverse effects: GI discomfort, dizziness, headache, skin reactions, blood dyscrasias, ECG changes, possibly irreversible peripheral neuropathy, and hepatotoxicity
-do not break, assess blood count, notify prescriber of diarrhea containing mucus or pus occurs, take with food or milk, urine may turn rust-yellow to brown
Cefepime (Maxipime)
-broad-spectrum cephalosporin that most closely resembles ceftazidime in its spectrum of action
-increased activity against many enterobacter spp (gram-negative) as well as gram-positive organisms
-indicated for the treatment of uncomplicated and complicated UTIs, uncomplicated skin and skin structure infections and pneumonia
-side effects: seizures, heart failure, bleeding, pseudomembranous colitis, proteinuria, nephrotoxicity, renal failure, leukopenia, thrombocytopenia, agranulocytosis, eosinophilia, pancytopenia, hemolytic anemia, anaphylaxis, serum sickness, Stevens-Johnson syndrome
Calcitonin (Miacalcin)
-side effects: MI, transient tachycardia, numbness, peripheral vascular ischemia
-pregnancy X
-contraindicated in Raynaud’s disease
-report side effects including increased vasoconstriction starting with cold extremities, then paresthesia, weakness
-headaches may occur after discontinuing after long use
Morphine Sulfate
-used for the treatment of glaucoma and ocular hypertension
-adverse effects: burning, eye pain, and lacrimation, conjunctival hyperemia, localized melanin deposits in the conjunctiva, and release of pigment granules from the iris
-dipivefrin (Propine), epinephryl (Epinal), apraclonidine (Iopidine) and brimonidine (Alphagan P)
Naloxone hydrochloride (Narcan)
-no agonist morphine-like properties and works as a blocking drug for the opioid drug
-does not produce analgesia or respiratory depression
-drug of choice for the complete or partial reversal of opioid-induced respiratory depression
-side effects: ventricular tachycardia, fibrillation, hepatotoxicity
-assess withdrawal of cramping, hypertension, anxiety, vomiting
-administer only with resuscitative equipment
Pentamidine (NebuPent, Pentam 300)
-inhibits protein and nucleic acid synthesis
-used for the treatment of active pneumocytosis and for prophylaxis of P. jirovecii pneumonia in patients at high risk for initial or recurrent pneumocystitis infection, such as patients with HIV and AIDS
-hypersensitivity is more common via inhalation
-need to be used with caution in patients with blood dyscrasias, hepatic or renal disease, diabetes mellitus, cardiac disease, hypocalcemia, or hypertension
-side effects: dysrhythmias, acute pancreatitis, acute renal failure, increased serum creatinine, renal toxicity, leukopenia, thrombocytopenia, anaphylaxis, Stevens-Johnson syndrome, bronchospasm
-renal problems, toxicity may occur rapidly
-report sore throat, fever, fatigue
Esomeprazole (Nexium)
-side effects: hepatic failure, hepatitis, heart failure, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis
-swallow caps whole
-report severe diarrhea, abdominal pain, black tarry stools
-hypoglycemia may occur
-avoid alcohol, salicylates, NSAIDs
nitroglycerin (Nitro-Bid)
-When given orally, it goes to the liver to be metabolized before it can become active in the body. During this process, a very large amount of the nitroglycerin is removed from the circulation. This is called a large first-pass effect. Administered other routes to avoid first-pass effect
-Tablets administered by the sublingual route are used for the treatment of chest pain or angina of acute onset.
-Used for the prevention of angina when patients find themselves in situations likely to provoke an attack
-side effects: collapse
-contraindications: severe anemia, increased intracranial pressure, cerebral hemorrhage, closed-angle glaucoma
-never use ED drugs
Nalbuphine (Nubain)
-restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects which include oily spotting, flatulence, and fecal incontinence
-contraindications: chronic malabsorption syndrome, cholestasis, breastfeeding
-take a multivitamin containing fat-soluble vitamins 2 hours before or after orlistat
pencillin
-reduces risk of stroke, MI, peripheral arterial disease in high-risk patients, acute coronary syndrome, TIA, unstable angina
-side effects: GI bleeding, pancreatitis, glomerulonephritis, bleeding, neutropenia, aplastic anemia, intracranial hemorrhage, toxic epidermal necrolysis, Stevens-Johnson syndrome
-report diarrhea, skin rashes, subcutaneous bleeding, chills, fever, sore throat
-administer with food
Lansoprazole (Prevacid)
-capsules can be opened and mixed with apple juice for administration via NG tube
-side effects: CVA, MI, shock, hematuria, hemolysis
-used for GERD, severe erosive esophagitis, duodenal ulcers, gastric ulcers
-report severe diarrhea
-avoid alcohol, salicylates, ibuprofen
-swallow caps whole before eating
Metoclopramide (Reglan)
-used for the treatment of delayed gastric emptying and gastroesophageal reflux and also as an antiemetic
-contraindicated in patients with seizure disorder, pheochromocytoma, breast cancer, or GI obstruction and alsi in patients with a hypersensitivity to it or to procine or procainamide
-EPS can occur especially in young adults
-side effects: suicide ideation, seizures, neutropenia, leukopenia, agranulocytosis
-protect fromlight, avoid driving, alcohol, other CNS depressants
Regular (Humulin R, Novolin R)
-broad-spectrum bactericidal drug that kills the offending organism by inhibiting protein synthesis
-used either alone in the prevention of TB or in combination with other antitubercular drugs in its treatment
-contraindicated in patients with know drug allergy to it or any other rifamycin
-may cause urine, saliva, tears, and sweat to be red-orange colored
-side effects: psuedomembranous colitis, pancreatitis, hematuria, acute renal failure, hemoglobinuria,, hemolytic anemia, eosinohpilia, thrombocytopenia, leukopenia
-report flulike symptoms
Montelukast (Singulair)
-work by blocking leukotriene D4 receptors to augment the inflammatory response
-offers the advantage of being approved for use in children 2 years of age and older
-fewer adverse effects and drug interactions
-side effects: abdominal pain, dyspepsia
-check OTC medications
Tiotropium Bromide (Spiriva)
-prevention of bronchospasm associated with chronic bronchitis or emphysema and not for the management of acute symptoms
-side effects: dry mouth or throat, nasal congestion, heart plapitations, GI distress, urinary retention, increased intraocular pressure, headache, coughing, and anxiety
St. John’s Wort
-adverse effects: moon facies, hyperglycemia, psychosis, heart failure, edema, hypertension, convulsions, headache, vertigo, mood swings, psychic impairment, nervousness, insomnia, growth suppression, Cushing’s syndrome
Levothyroxine (Synthroid)
-most commonly prescribed synthetic thyroid hormone
-chemically pure
-effects are more predictable
-administered once a day
-pregnancy category A
-side effects: thyroid storm, cardiac arrest
-avoid OTC, iodine food, iodized salt, soybeans, tofu, turnips, high-iodine seafood, some bread
-don’t switch brands, discontinued after giving birth
Edrophonium (Tensilon)
-can also be used to differentiate between mytasthenia gravis and cholinergic crisis
-side effects: seizures, paralysis, loss of consciousness, AV block, cardiac arrest, respiratory depression, bronchospasm, constriction, laryngospasm, respiratory arrest
Tetracycline
-contraindicated in patients who have had hypersensitivity reactions to them in the past and in lactating women
-side effects: hepatotoxicity, hepatitis, eosinophilia, neutropenia, thrombocytopenia, leukocytosisi, hemolytic anemia, exfoliative dermatitis, angioedema, Stevens-Johnson syndrome
-avoid sun exposure, milk products, antacids
Theophylline
-used for bronchial asthma, bronchospasm of COPD, chronic bronchitis, emphysema
-Aminophylline is a prodrug of this medication, turns into theophylline when taken
-side effects: seizures, dysrhythmias
-take with 8oz of water for GI effects
-notify prescriber of nausea, vomiting, anxiety, insomnia, seizures
Trimethobenzamide (Tigan)
-lacks addictive properties of opioids
-adverse effects: renal impairment, edema, GI pain, dyspepsia, nausea, CV thrombotic events, MI, stroke, GI bleeding, perforation, blood dyscrasias
-short-term use
-not indicated for treatment of minor pain or chronic pain
-report changes in urine pattern
-report blurred vision or ringing, roaring in ears
Vancomycin
-antibiotic of choice for treatment of MRSA
-not active against gram-negative bacteria, fungi, or yeast
-used in caution in those with preexisting renal dysfunction, or hearing loss, as well as elderly patients and neonates
-red man syndrome-flushing and/or itching of the head, face, neck, and upper trunk area
-side effects: cardiac arrest, vascular collapse, nausea, pseudomembranous colitis, nephrotoxicity, fatal uremia, leukopenia, eosinophilia, neutropenia, anaphylaxis, superinfection
-complete entire course of drug
-report sore throat, fever, fatigue
Sildenafil (Viagra)
-side effects: peripheral neuropathy, seizures, CNS depression, CHF, pancreatitis, hepatic failure, leukopenia, granulocytopenia, thrombocytopenia, anemia, lactic acidosis, anaphylaxis
-report numbness/tingling in extremities, report signs of infection, anemia, bleeding
-hair may be lost
Vitamin D
-does not carry the concerns over drug interactions that cinemtidine has
-side effects: anaphylaxis (rare), hepatotoxicity
-reduce acid secretion
-take with meals for prolonged effect
-decreased abdominal pain, heartburn
-gynecomastia, impotence may occur may are reversible
-avoid breastfeeding
Diclofenac potassium (Zipsor)
-NSAIDs
-Upset stomach, nausea, heartburn, diarrhea, constipation, gas, headache, drowsiness, and dizziness may occur
Acyclovir (Zovirax)
-side effects: seizures, oliguria, proteinuria, hematuria, glomerulonephritis, acute renal failure, thrombotic thrombocytopenia purpura, hemolytic uremic syndrome
-take without regard to meals, take with water
-sexual partners need to be told
-does not cure, controls symptoms
-report sore throat, fatigue, fever
-take in equal intervals around the clock
-seek dental care for gingival hyperplasia
Vasopressin (Pitressin, Pressyn)
-side effects: thyroid storm, cardiac arrest, menstrual irregularities
-take same time each day, in the morning
-crush and mix with water
-report excitability, irritability, anxiety
-discontinue after birth
Methimazole (Tapazole)
-side effects: jaundice, hepatitis, nephritis, agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, lymphadenopathy
-assess weight daily
-administer with meals to decrease GI effects
-take same time each day
-don’t breastfeed
-report redness, swelling, sore throat, mouth lesions, fever
-avoid iodine
-do not skip or double dose