I found even more differences between the pharma book and the RN drug guide in doing this, and have taken out certain of the adverse effects that Margi listed, I assume they come from the pharma book. We need to know:
- Indication for use
- Mechanism of action
- One adverse effect
Exam: what’s on it: a list of the drugs, with generic and brand name
Indication for use, Mechanism of action, 1 adverse.
From nutrition and electrolytes: Micro K, potassium and Calcium Carbonate
Resp: benadryl, robitussin DM [x2], alupent, singulair, vanceril, nedocromil
Cancer: cytoxan, neupogen, procrit.
Anti inflame: asprin, motrin, celebrex, toradol, zyloprim, amoxicillin, ancef, zithromax, vibramycin, garamycin, levoquin, bactrim, INH, diflucan, acyclovere,
Anti virals AZT, sustiva, cholestra, varicella
Bad bad drugs: heparin, warfarin, potassium, insulin [each kind onset/peak/duration: 4 types Regular, NPH, novalog, lantis], morphine
NUTRITION AND ELECTROLYTES
Micro K
Use: Correct potassium deficit: strengthen cardiac and muscle contraction. Pts at risk for hypokalemia: People on potassium wasting diuretics, loops, thiazides, etc. [HTN and CHF’ers.] Vit K is also given as the antidote for coumadin overdose.
Action: Transmits and conducts nerve impulses, contracts all 3 muscle types
Adverse: life threatening: dysrhythmias, resp distress, cardiac arrest.
Calcium Carbonate
Use: Hyperacidity as in acid indigestion, calcium supplement
Adverse: Hypercalcemia with alkalosis, hyperkalemia, metastatic calcinosis, hypercalciuria,
RESPIRATORY AGENTS
Diphenhydramine (Benadryl)
Action: compete with histamine for H1 receptor sites, prevent histamine (allergic) response.
Use: allergic rhinitis, itching, sleep aid, antitussive
Adverse effects: agranulocytosis, hemolytic anemia, thrombocytopenia [not for long term]
Antitussives [anti-cough]
Dextromethorphan Hydrobromide (Robitussin DM)
Action: suppress cough reflex by inhibiting cough control center in medulla; reduces viscosity of tenacious/stringy secretions.
Use: Temporary relief of cough spasms in nonproductive coughs due to colds, pertussis, and influenza.
Contraindications: COPD, chronic productive cough
Adverse effects: cardiovascular collapse, hallucinations, CNS depression with very large doses
Expectorants
Guaifenesin (Robitussin, Mucinex)
Action: Enhances reflex outflow of respiratory tract fluids by irritation of gastric mucosa. [yes, gastric mucosa] Comes from the Guiac tree which also is used for Stool Guiac Tests.
Use: loosen mucus: Aids in expectoration by reducing adhesiveness and surface tension of secretions.
Contraindications: Cough due to CHF, ACE inhibitor therapy, or tobacco smoking.
Adverse effects: none. Nausea and dizziness, the end.
Metaproterenol (Alupent)
Use: bronchodilator
Action: Stimulates adrenergic beta 2 receptors: causing bronchodilation, relaxation of smooth muscles of bronchi.
Adverse effects: tremors, tachycardia, dysrhythmias, cardiac arrest, paradoxical bronchoconstriction.
Montelukast ( Singulair)
Not for: acute asthma attack; used for prophylaxis and maintenance
Action: Leukotriene Receptor Antagonist; interrupts smooth muscle contraction/bronchoconstriction
adverse effects: none known!
Beclomethasone (Vanceril) inhaler
Type: glucocorticoid, long acting
Use: for Rx of asthma, COPD, allergies
Action: suppresses inflammation and adrenal function
Adverse: with excessive doses: symptoms of hypercorticism, hyperglycemia
Mast Cell Stabilizer
Nedocromil: inhaler
Use: Don’t use for acute asthma attack. prophylaxis of bronchial asthma; inhibits histamine release; maintenance.
Action: antiinflammatory; mast cell stabilizer: Inhibits activation of and mediators released from inflammatory cells (e.g., neutrophils, mast cells, monocytes).
Adverse: none
CANCER DRUGS
Alkylating agent prototype: Cyclophosphamide (Cytoxan): Nitrogen Mustard
Uses: breast, lung, ovarian cancers; Hodgkin’s disease; leukemias; lymphomas
Action: inhibits protein synthesis through interference with DNA replication
Adverse effects: bone marrow depression [leukopenia, anemia, thrombocytopenia] cardiotoxicity, sterility, hepatotoxicity. Causes tissue necrosis if it infiltrates. Immunosuppresant. toxic epidermal necrolysis, Stevens-Johnson syndrome
Filgrastim (Neupogen)
Action: increases neutrophils
Use: to prevent post-treatment infections
Life threatening Adverse effects: MI, thrombocytopenia. Adverse: Neutropenia, dyspnea, hematuria.
D. Epoeitin Alfa (Erythropoietin) (Procrit)
1. Action: stimulates RBC production in bone marrow
Life threatening adverse effects: MI, CVA, Adverse: Seizures, hyperkalemia, HTN
ANTI-INFLAMATORY DRUGS
B. Prototype: Aspirin:
Use: analgesic, antipyretic, prevention of platelet aggregation, and anti-inflammatory
Action: by inhibiting prostaglandin synthesis, inhibiting hypothalamic heat-regulating center
adverse reactions: hemolytic anemia, ulceration, thrombocytopenia; anaphylaxis if hypersensitive: bronchospasm
Ketoralac: [Toradol]
Use: Exhibits analgesic, antiinflammatory, and antipyretic activity. Effective in controlling acute post-operative pain, Short-term management of pain;
Action: It inhibits synthesis of prostaglandins by inhibiting both COX-1 and COX-2 enzymes
Adverse: hemorrhage, severe renal and hepatic impact; should only be used short term.
Prototype: Celebrex (Celecoxib)
Use; analgesic, nsaid; cyclooxygenase-2 (cox-2 but not cox-1) inhibitor; antiinflammatory;
Action: Although an NSAID, unlike ibuprofen celecoxib inhibits prostaglandin synthesis by inhibiting cyclooxygenase-2 (COX-2, not COX-1)
Adverse: Increased risk of cardiovascular events.
Ibuprofen (Motrin)
Class: NSAID, cox-1 and cox-2 inhibitor; analgesic, antipyretic
Action: reduce inflammation and fever by inhibiting prostaglandin synthesis
Adverse reactions: aplastic anemia, toxic hepatitis, nephrotoxicity, GI bleeding, blood dyscrasias, cardiac dysrhythmias,
Antigout Drug
Allopurinol (Zyloprim)
1. action: reduces uric acid synthesis
Use: Antigout
2. caution with renal and hepatic disease
3. adverse effects: bone marrow disorders, Hepatotoxicity, Agranulocytosis, aplastic anemia, [drug guide doesn’t cite eye disorders]
ANTI-INFECTIVE DRUGS
Penicillin Prototype: Amoxicillin (Amoxil)
Use: Good for both gram negative and gram positive infections. Who gets it: kids with ear infections, UTI’s, etc.
action: inhibits enzyme in cell wall synthesis, bactericidal
adverse reaction: blood dyscrasias, anaphylaxis/respiratory distress
Cephalosporins
Cezazolin (Ancef), 1st generation
Use: Preop prophylaxis, UTI, bone, joint, soft tissue infections, bacteremia.
Action: Inhibits cell wall synthesis, destroys cell
adverse reactions: seizure, anaphylaxis
A. Macrolides: azithromycin (Zithromax)
Use: gm-positive and some gm-negative, with clients allergic to PCN, respiratory infections, gonorrhea
Action: inhibits steps of protein synthesis, bactiostatic or cidal
Adverse reaction: hepatoxicity
Doxycycline (Vibramycin)
Use: treat infections by uncommon bacteria
Action: inhibits steps of protein synthesis, cidal or static
Adverse: blood dyscrasias, hepatoxicity, CNS toxicity
Aminoglycosides:
Gentamicin (Garamycin)
Action: inhibits bacterial synthesis, cidal effect
Use: serious infections from gram-negative bacteria, PID, MRSA
Adverse: nephrotoxicity, liver damage [hepatomegaly]
D. Fluoroquinolones: Levofloxacin (Levaquin)
Action: interferes with DNA enzyme, cidal effect
Use: lower respiratory tract, renal, bone, joint infections
Adverse: seizures, dysrhythmias, encephalopathy, [drug guide says ‘none’]
Sulfonamides: May potentiate sulfonylurea-induced hypoglycemia
Co-trimoxazole/tmp-smz (Bactrim): combination of sulfamethoxazole (SMZ), a sulfonamide, and trimethoprim (TMP)
Use: complex UTI, bronchitis, PCP [Pneumocystis carinii pneumonitis: most common death in AIDS patients], burns.
Action: inhibits protein synthesis, cidal effect
Adverse: renal failure, bone marrow disorders,
Anti-tubercular agents:
Isoniazid (INH)
Action: inhibits cell-wall synthesis
Use: TB treatment and prophylaxis
Adverse: blood dyscrasias, hepatoxicity
Antifungal Drugs
2. Prototype: Fluconazole (Diflucan)
Use: treat Candida infections and meningitis
Action: increases permeability of cell membrane
Adverse: No adverse [really.] Cautious use with renal/hepatic impaired pts or AIDS pts.
A. Non-HIV Anti-Viral Prototype: Acyclovir sodium (Zovirax)
Use: treat HSV-2 and HSV-2 [Herpes]
Action: interferes with viral DNA synthesis
Adverse: nephrotoxicity/acute renal failure, seizures, bone marrow depression
ANTIVIRAL DRUGS
Zidovudine (AZT) first HIV drug developed in the 80’s. Used for post-exposure prophylaxis and maintenance.
Use: HIV infected clients and prevention of maternal-fetal HIV transmission
Action: inhibits viral enzyme transcriptase: being incorporated into growing DNA chains by viral reverse transcriptase, thereby terminating viral replication.
Adverse: anemia, seizures, neutropenia [bone marrow impact] [Drug guide: Bone marrow depression, granulocytopenia, anemia]
Efavirenz (Sustiva)
use: treat HIV-1 infections with other anti-retroviral agents—used in a cocktail
action: binds to reverse transcriptase—halts RNA change to DNA, blocks enzyme activity and HIV-1 replication
adverse: [drug guide: Stevens-Johnson syndrome, toxic epidermal necrolysis] allergic, convulsions, liver failure, suicide
caution: history of mental illness, drug abuse
Protease Inhibitors: Lopinavir/Ritonavir (Kalestra)
Use: treatment of HIV-I infections with other agents
Action: inhibits protease, prevents production of mature HIV particles
Adverse: hyperglycemia, DM,[convulsions, paralysis, palpitations, tach]
C. Prototype: Varicella (Varivax)
Use: prevention of chickenpox
Action: stimulates active immunity against natural disease
Adverse: anaphylaxis, thrombocytopenia, Stevens-Johnson syndrome [skin rash]
BAD BAD DRUGS:
INSULINS
Humalog (Lispro): Rapid acting
Onset: <15>
Peak: 0.5-1hr
Duration: 3-4hr
Adverse: Hypoglycemic Coma
Regular:
Short acting, only insulin given IV
Onset: 0.5-1hr
Peak: 2-4hr
Duration: 5-7hr
Adverse: Hypoglycemic Coma
NPH: [Insulin Isophane]
Intermediate acting
Onset: 1-2hr
Peak: 4-12hr
Duration: 18-24hr
Adverse: Hypoglycemic Coma
Lantus: [Insulin Glargine]
Long duration
Onset: 3-4hr
Peak: Unknown
Duration: 10-24hr
Adverse: Hypoglycemia, hypokalemia.
Morphine Sulfate
Use: severe acute and chronic pain, pre-op med, support anesthesia, resp distress
Action: narcotic opiate agonist
Adverse: cardiac arrest, resp. depression
Potassium Chloride
Use: potassium replacement
Action: intracellular cation, important for cardiac rhythm regulation
Adverse: very narrow therapeutic range, easy to become hyperkalemic and have dysrhythmias or hypokalemic and have cardiac arrest
Heparin
Use: venous thrombosis, pulmonary embolism, thrombolitic complications
Action: inhibits fibrin formation, inactivates clotting factors
Adverse: spontaneous bleeding, bronchospasm, anaphylactoid reactions
Coumadin
Use: DVT, pulmonary embolism, TIA, prophylactic for cardiac valves
Action: inhibits hepatic synthesis of vitamin K, decreases clotting factors in veins
Adverse: bleeding, nothing fatal until overdosage
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