Solution Manual For Essentials of Pharmacology for Health Professions, 9th Edition by Bruce Colbert,

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Instructor Manual Colbert, Essentials of Pharmacology for Health Professions, 9e, © 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Table of Contents Worksheets for Textbook Part II ................................................................................................................... 3 Worksheet 1 for Chapter 11 ...................................................................................................................... 3 Fat-Soluble Vitamins (see Table 11-1) ....................................................................................................... 3 Worksheet 2 for Chapter 11 ......................................................................................................................... 6 Water-Soluble Vitamins (see Table 11-1) .................................................................................................. 6 Worksheet 3 for Chapter 11 ......................................................................................................................... 9 Water-Soluble Vitamins and Minerals (see Tables 11-1, & 11-3) .............................................................. 9 Worksheet 1 for Chapter 12 ....................................................................................................................... 13 Drugs for the Skin .................................................................................................................................... 13 Worksheet 2 for Chapter 12 ....................................................................................................................... 20 Drugs for the Skin .................................................................................................................................... 20 Worksheet for Chapter 13 .......................................................................................................................... 22 Autonomic Nervous System Drugs .......................................................................................................... 22 Worksheet for Chapter 14 .......................................................................................................................... 26 Cardiovascular Drugs ............................................................................................................................... 26 Worksheet for Chapter 15 .......................................................................................................................... 41 Urinary System Drugs .............................................................................................................................. 41 Worksheet for Chapter 16 .......................................................................................................................... 49 Gastrointestinal Drugs ............................................................................................................................. 49 Worksheet for Chapter 17 .......................................................................................................................... 61 Respiratory Drugs .................................................................................................................................... 61 Worksheet for Chapter 18 .......................................................................................................................... 70 Eye Medications ...................................................................................................................................... 70 Worksheet for Chapter 19 .......................................................................................................................... 79 Analgesics, Sedatives, and Hypnotics ...................................................................................................... 79 Worksheet 1 for Chapter 20 ....................................................................................................................... 87 Psychotropics .......................................................................................................................................... 87 Worksheet 2 for Chapter 20 ....................................................................................................................... 94 Psychotropics (Continued) ...................................................................................................................... 94 Worksheet 3 for Chapter 20 ....................................................................................................................... 99

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Drug Abuse .............................................................................................................................................. 99 Worksheet for Chapter 21 ........................................................................................................................ 101 Musculoskeletal and Anti-Inflammatory Drugs ..................................................................................... 101 Worksheet 1 for Chapter 22 ..................................................................................................................... 106 Anticonvulsants and Antiparkinsonian Drugs ........................................................................................ 106 Worksheet 2 for Chapter 22 ..................................................................................................................... 112 Other Antiparkinsonian Drugs, and Alzheimer’s Drugs ......................................................................... 112 Worksheet 1 for Chapter 23 ..................................................................................................................... 116 Endocrine System Drugs........................................................................................................................ 116 Worksheet 2 for Chapter 23 ..................................................................................................................... 122 Insulins .................................................................................................................................................. 122 Worksheet for Chapter 24 ........................................................................................................................ 124 Reproductive System Drugs .................................................................................................................. 124 Worksheet for Chapter 25 ........................................................................................................................ 137 Anti-Infective Drugs ............................................................................................................................... 137

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheets for Textbook Part II Worksheet 1 for Chapter 11 Fat-Soluble Vitamins (see Table 11-1) Vitamins

Sources

Causes of Deficiencies

Signs of Deficiencies

Symptoms of Overdose

Interactions and Cautions

A

Animal

Malabsorption of fats or diarrhea

Retarded growth

Irritability, lethargy, headache

Cautions:

Oily saltwater fish Dairy products Eggs Plants Dark-green leafy vegetables Deep yellow or orange fruit and vegetables

Obstruction of bile Presence of mineral oil in the intestines Overcooking of vegetables in an open container (heat and air cause oxidation)

Faulty bone and tooth development Night blindness Dry skin Xerophthalmia (dry eyes)

Joint pain, myalgia Stunted growth, fetal malformations Jaundice, nausea, diarrhea Dry skin and hair

Prolonged infection or fever

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Caution should be used in patients with kidney or liver problems or diabetes Interactions: Long-term use of large doses of vitamin A is contraindicated for women who are, or may become, pregnant. Fetal malformations have been reported following maternal ingestion of large doses of vitamin A, either before or during pregnancy

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Vitamins

Sources

Causes of Deficiencies

Signs of Deficiencies

Symptoms of Overdose

Interactions and Cautions

Animal

Softening bones:

Convulsions

Cautions:

Fish oils

Rickets (in children)

Kidney stones, kidney damage

Osteomalacia (in adults)

Muscle/bone pain

Poorly developed teeth

Nausea, anorexia

Muscle spasms

Fetal disorders

Not to exceed the RDA of vitamin D especially in patients with cardiovascular diseases, kidney diseases, pregnancy, breast feeding

Fortified milk Plants Fortified cereals

Interactions: D

Digitalis, thiazide diuretics; mineral oil may interfere with intestinal absorption of vitamin D

Plants

Alcohol abuse

Vegetable oils

Malabsorption syndromes

Seeds, nuts

Pathologic conditions of liver and pancreas

Wheat germ, cereals E

Destruction of RBCs, muscle weakness

Prolonged bleeding time

Premature infants or lowbirth-weight neonates

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Interactions: Vitamin E supplements should be taken at the lowest dosage necessary while on anticoagulant therapy because of increased risk of bleeding Excessive use of mineral oil may decrease absorption

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Vitamins

Sources

Causes of Deficiencies

Signs of Deficiencies

Symptoms of Overdose

Interactions and Cautions

Animal

Reduced prothrombin in the blood due to insufficient clotting factors in the newborn

Prolonged blood clotting time

Jaundice in infants

Cautions:

Egg yolk, cheese Liver Plants

K

Blood in urine and stool

Vegetable oil Malabsorption syndromes Green leafy Coumarin vegetables overdose Cabbage, Prolonged use broccoli of salicylates, quinine, longterm parenteral nutrition, or broad-spectrum antibiotics

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Patients receiving anticoagulant therapy should be consistent in the amount of vitamin K–rich foods they eat daily in order to keep prothrombin and other vitamin K– dependent clotting factor levels stable

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet 2 for Chapter 11 Water-Soluble Vitamins (see Table 11-1) Vitamin

Sources

Animal Pork, beef, liver Oysters

Causes of Deficiencies Chronic alcoholism

GI upset, constipation

Malabsorption

Neuritis, mental disturbance

Plants

B1 (thiamine)

Signs of Deficiencies

Yeast

Cardiovascular problems

Whole and enriched grains, wheat germ

Muscle weakness, fatigue

Symptoms of Overdose

Interactions and Cautions

None known

Beans, peas, collard greens, nuts, asparagus Oranges

Animal Milk Meat, liver

B2 (riboflavin)

Chronic alcoholism Poor diet

Glossitis Cheilosis Dermatitis

Plants

Photophobia

Green vegetables

Vision problems, itching eyes, rough skin

Cereals Enriched bread

None

Yeast

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Vitamin

Sources

Animal Pork, beef, chicken, tuna, salmon Plants

B6 (pyridoxine)

Causes of Deficiencies Chronic alcoholism Cirrhosis Malabsorption syndromes

Whole-grain cereals, wheat germ

Signs of Deficiencies Anorexia, nausea, vomiting

Symptoms of Overdose

Interactions and Cautions

Seizures in newborns

Cautions:

None

Interactions:

Dermatitis Neuritis, depression

Legumes, peanuts, soybeans Bananas

Animal Seafood/shellfish Meat, poultry, liver Eggs B12 (cobalamin, Milk, cheese cyanocobalamin) Plants

Vegetarian diets without meats, eggs, or milk products

Nerve, muscle, and mental problems

Pernicious Gastrectomy or anemia intestinal resections

Overdose in pregnant women may result in newborns with seizures who have developed a need for greater-thannormal amounts of pyridoxine

Neomycin Colchicine

Malabsorption syndromes Pernicious anemia

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Vitamin

Sources

Causes of Deficiencies

Signs of Deficiencies

Animal

Improper diet

Organ meats

Chronic alcoholism

Increased risk of neural tube defects

Plants Green leafy vegetables Avocado, beets B9 (folic acid)

Broccoli, kidney beans Orange juice

Liver pathology Intestinal obstruction Malabsorption syndromes

Symptoms of Overdose

Interactions and Cautions

None

Cautions: Never give to someone with undiagnosed anemia

Macrocytic anemia Irritability, behavior disorders

Interactions: Phenytoin, barbiturates

Malnutrition Renal dialysis or prolonged use of some medications

Animal Milk Eggs Fish B3 (niacin)

Poultry

Pellagra

Headache, flushing

Cautions:

Patients with Increased liver disease, blood gallbladder glucose and disease, gout, uric acid diabetes

Plants Legumes, nuts Green vegetables

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet 3 for Chapter 11 Water-Soluble Vitamins and Minerals (see Tables 11-1, & 11-3) Vitamin/Mi neral

Sources

Causes of Deficiencies

Fruits

Diet lacking Scurvy fresh fruit and Poor healing vegetables Muscle Alcoholism cramps/weakness Infections Ulcerated Smoking gums/mouth, loose teeth

All citrus, cantaloupe Plants Broccoli C (ascorbic acid)

Tomatoes Brussels sprouts Cabbage

Signs of Deficiencies

Capillary fragility (bruising)

Symptoms of Interactions Overdose and Cautions Raised uric acid level, gout

Interactions:

Aspirin, barbiturates, GI distress tetracyclines, estrogens, oral Kidney stones contraceptives, Rebound alcohol, and scurvy in smoking neonates

Green peppers

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Vitamin/Mi neral

Sources

Causes of Deficiencies

Signs of Deficiencies

Symptoms of Interactions Overdose and Cautions

Oranges, bananas Insufficient oral intake Dried fruits due to Tomatoes surgery, anorexia, or weightreduction diets

Muscular weakness

Confusion

Cautions:

Cardiac arrhythmias

Weakness

Lethargy

Cardiac arrhythmias

Cardiac disease, renal impairment, gastric or intestinal ulcers, mental confusion

Mental apathy and confusion

Diarrhea or vomiting Diabetic ketoacidosis Diaphoresis (excessive perspiration)

Potassium (K)

Diuretic use, especially thiazides and furosemide loop diuretics Digoxin toxicity Long-term use of corticosteroids or long-term use of laxatives Kidney disease

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Vitamin/Mi neral

Sources

Causes of Deficiencies

Milk, cheese, yogurt

Pregnancy and Osteoporosis breast feeding Osteomalacia Hypoparathyr Rickets in children oidism Cardiac myopathy Long-term use Tetany and leg of corticosteroids cramps , some diuretics, or anticonvulsant s

Sardines Salmon Green vegetables except spinach

Calcium (Ca)

Signs of Deficiencies

Symptoms of Interactions Overdose and Cautions Constipation

Cautions:

Cardiac Cardiac disease, arrhythmias if renal disease, IV calcium respiratory not injected conditions slowly Interactions: Digitalis (resulting in potentiation), tetracycline (resulting in antagonism)

Chronic diarrhea Pancreatitis Renal failure Lack of weightbearing exercise

Meat Liver Eggs Poultry

Dried fruits

Internal bleeding, ulcers, and GI tumors

Dried beans

Pregnancy

Prune juice

Infancy

Spinach

Iron (Fe)

Hemorrhage and excessive menstrual flow

Paleness of the skin and/or mucous membranes Lethargy and weakness Vertigo

Shock

Interactions:

Vomiting

Vitamin C or orange juice taken at the same time enhances iron absorption

Diarrhea or constipation Black stools

Air hunger Decline in mental skills

Irregular heartbeat Puberty at and cardiac function time of growth Cravings for nonfood spurt items, such as ice, Hemodialysis clay, or starch

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Coffee or tea within 2 h of iron reduces iron absorption by as much as 50% Tetracycline absorption is inhibited by oral iron preparations

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Vitamin/Mi neral

Sources

Causes of Deficiencies

Signs of Deficiencies

Symptoms of Interactions Overdose and Cautions when taken within 2 h Antacids decrease iron absorption (should not be given at same time)

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet 1 for Chapter 12 Drugs for the Skin Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Antipruritics

Relieve itching from allergic reactions, poison ivy, hives, and insect bites

Skin irritation

Open wounds or prolonged use (for corticosteroids)

Clean area before application

Local anesthetics 1. Benzocaine (Lanacane, Americaine, Orajel)

Rash Stinging and a burning sensation Allergic reactions (-caines)

2. Dibucaine (Nupercainal)

Sedation from antihistamines

Antihistamines

Hypersensitivity (severe allergic) reaction to the active drug or any component of the formulation

1.

Diphenhydramine (Benadryl)

Rub gently until medication vanishes Use caution if patient has allergies Avoid contact with eyes or mucous membranes Avoid covering with dressings unless ordered by a health care provider

Corticosteroids 1. Various (Diprolene, Temovate)

Avoid prolonged use (not longer than one week) Discontinue if condition worsens or irritation develops Trim children’s fingernails to reduce possibility of infection from scratching

Emollients and Protectants 1. Ammonium lactate (AmLactin, Lac-Hydrin)

Soothe, soften, protect (via creation of a lipid barrier), and seal out wetness in

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

2. Vitamins A and D (A & D, Desitin—with zinc oxide) 3. Zinc oxide (Balmex) Keratolytics 1. Coal tar (Balnetar, Polytar, Neutrogena T/Gel) 2. Salicylic acid 3. Sulfur (Clearasil, Salex, Fostex, Compound W)

Enzyme Preparations

minor dermatological conditions, such as diaper rash, irritation, abrasions, and minor burns Control conditions of abnormal scaling of the skin, such as dandruff, seborrhea, and psoriasis

Severe skin Open areas of skin irritation, pruritis, Hypersensitivity or stinging (severe allergic) Irritation of eyes reaction to the active or mucous drug or any membranes component of the formulation Photosensitivity

Promote peeling of the skin in conditions such as acne, hard corns, calluses, and warts

Systemic effects in allergic individuals or with multiple applications and prolonged use (e.g., headache and GI symptoms)

Remove dead or damaged tissue

Use only as directed, for entire treatment period, even if improved Avoid contact with eyes and mucous membranes Avoid prolonged use Discontinue and seek medical aid if irritation occurs Avoid contact with surrounding tissues when applied as a caustic to corns or calluses

For use on necrotic skin tissue only

1. Collagenase (Santyl)

If a topical antibiotic is to be applied to an infected site, the antibiotic is applied before collagenase Avoid using detergents, povidone-iodine, and heavy metal (e.g., mercury, silver) containing agents that will inhibit the enzymatic activity

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

of collagenase Scabicides and Pediculicides

Treatment of scabies or lice

1. Permethrin (Elimite, Nix, RID) 2. Lindane (Kwell)

Slight local irritation, rash, or conjunctivitis

Acutely inflamed, raw, or weeping surfaces

Dermatitis with frequent application

Lindane should be avoided during pregnancy, during breast feeding, and with infants, small children, and older adults and those who weigh less than 110 lb or those with known uncontrolled seizure disorders

3. Pyrethrins (RID) 4. Ivermectin (Stomectol, Sklice)

Follow directions carefully Thoroughly launder (130°F) clothing and bedding and dry using the hot cycle of a dryer for at least 20 min Large items (e.g., pillows, comforters) may be bagged in plastic for two weeks Use caution to prevent accidental oral ingestion Use caution with infants who might suck thumbs Inform sexual partner if condition is present in pubic area Alert school to head lice infestation

Antifungals 1. Clotrimazole (Mycelex, Lotrimin, GyneLotrimin) 2. Ketoconazole (Nizoral, Nizoral A-D)

Treatment of monilial infections such as thrush, diaper rash, vaginitis, athlete’s foot, body ringworm, jock itch

Contact dermatitis Itching, burning, and irritation

Vaginal preparations should not be used during pregnancy except under medical supervision

3. Miconazole

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Carefully wash and dry affected areas Expose to air whenever possible With genital fungus, avoid tight undergarments,

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

(Monistat, Lotrimin AF)

pantyhose, and wet bathing suits

4. Nystatin (Mycostatin)

With athlete’s foot, use open sandals instead of sneakers

5. Terbinafine (Lamisil AT, Lamisil) 6. Tolnaftate (Tinactin)

Follow application instructions carefully. Use for entire time, even if asymptomatic Remove any stains with soap and warm water Continue prescribed vaginal treatment even during menstruation, or if symptomatic relief occurs, until entire regimen is completed Consult a health care provider before vaginal preparations are used during pregnancy For oral suspensions or lozenges, apply after meals and after thorough rinsing of mouth.

No food or liquids for at least 1 h after treatment For vaginal infections, refrain from intercourse until treatment is complete Consider treating

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

partner if reinfection occurs Antivirals 1. Acyclovir (Zovirax) 2. Docosanol (Abreva)

Antibacterials 1. Mupirocin (Bactroban)

Decrease duration of viral shedding, duration of pain and itching and the time required for crusting and healing of lesions Treat impetigo caused by Staphylococcus aureus and certain species of Streptococci

Local, hypersensitivity and systemic reactions

Read and follow carefully all directions on the package Check all ingredients carefully for possible allergies

Treat secondarily infected traumatic skin lesions

If there is no improvement, the condition worsens, or there are other untoward reactions (e.g., inflammation, itching, rash, or swelling), stop the medication and consult a health care provider

Reduce the risk of infection in patients with high risk during institutional outbreaks of MRSA

Antiseptics 1. Chlorhexidine (Hibiclens, Peridex) 2. Povidoneiodine (Betadine)

Inhibit the growth of bacteria

Chlorhexidine:

Chlorhexidine:

Dermatitis and irritation

Pregnancy

Photosensitivity

Not for frequent use for total body bathing

Allergic reactions, especially in the Not for use in eyes or

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Rinse chlorhexidine thoroughly Avoid use of chlorhexidine on open skin lesions, mucous membranes, and

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

genital area

ears

genital areas

Povidone-iodine:

Povidone-iodine:

Skin irritations or burns

Allergies to iodine

Avoid getting chlorhexidine or povidone-iodine in the eyes or ears; flush thoroughly

Allergic reactions

Open wounds Newborns

Use caution with povidone-iodine in anyone with allergies Burn Medications 1. Silver sulfadiazine (Silvadene, SSD)

Prevention or treatment of burn infections

Pain, burning, and itching Allergic reactions Staining of the skin temporarily

2. Mafenide (Sulfamylon)

Impaired kidney or liver function (cumulative effects)

Use aseptic technique to prevent infection

History of allergy, especially to sulfa drugs

Watch for allergic reactions Keep careful intake and output record Keep area covered with sterile dressing

Sunscreens

Prevent sunburn Decrease risk of skin cancer and early aging

Use sunscreen with SPF ≥ 30 Apply to dry skin at least 15–30 min prior to sun exposure Reapply every 2 h Use waterresistant sunscreens when swimming or sweating Limit sun exposure between 10 A.M. and 4 P.M. Wear sunprotective

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

clothing

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet 2 for Chapter 12 Drugs for the Skin Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Acne Medications

Treatment of acne

For all:

Topical medications

Anti-infective drugs (see also Chapter 17)

Skin irritation, mild stinging, redness, dry skin

Pregnancy, breastfeeding

Use preparations every day as directed; often takes several weeks to be effective (your acne may actually get worse during the first few weeks of treatment and then start to improve)

1. Sulfur 2. Salicylic acid (Clearasil, Neutrogena) 3. Benzoyl peroxide (PanOxyl) Topical antibiotics 1. Clindamycin 2. Erythromycin Oral antibiotics 1. Tetracycline 2. Erythromycin Systemic hormones 1.

Contraceptives Retinoids 1. Isotretinoin (Claravis) 2. Tretinoin (Retin-A)

Rare (see Chapter 17)

Use in patients with skin diseases (dermatitis, eczema, sunburn, etc.) may increase risk of skin irritation Benzoic acid or paraben hypersensitivity Avoid exposure to the eyes or mucous membranes, can cause severe irritation

Do not use benzoyl peroxide with other topical acne products or retinoids Avoid prolonged exposure to sunlight (UV)—use sunscreen and protective clothing Avoid drugs such as sulfas that make you more sensitive to the sun Avoid multivitamins or nutritional supplements that contain vitamin A, tetracycline antibiotics, certain antacids (aluminum hydroxide), and certain birth

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

control pills (progestin-only) while taking isotretinoin Make sure you receive, read, and understand the Accutane Medication Guide every time you get a prescription or refill

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 13 Autonomic Nervous System Drugs Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Adrenergics

Cardiac stimulation

Palpitations

Angina

Nervousness

Coronary insufficiency

Check dose carefully—only small amounts

1. Epinephrine (Adrenalin, EpiPen, EpiPen Jr) 2. Ephedrine 3. Dopamine 4. Isoproterenol (Isuprel)

Increase blood flow to skeletal muscles

Tremor Tachycardia

Hypertension Cardiac arrhythmias

Peripheral vasoconstriction

Cardiac arrhythmias

Bronchodilation

Anginal pain

Dilation of pupils

Hypertension

Organic brain syndrome

Hyperglycemia

Hyperthyroidism

5.

Norepinephrine (Levophed)

Closed-angle glaucoma

Tissue necrosis (when applied to laceration of periphery; e.g., nose, fingers, and toes due to blood flow restriction)

6.

Phenylephrine (NeoSynephrine)

Headache and insomnia Adrenergic Blocker Treatment of hypertension, 1. Propranolol cardiac (Inderal, Inderal arrhythmias, LA) angina pectoris, migraine headaches Tremor

Hypotension Bradycardia Fatigue or lethargy Bronchospasm Nausea and vomiting

Abrupt discontinuation (decrease over several weeks)

Rise slowly from reclining position to avoid postural hypotension

Congestive heart failure or atrioventricular block

Possible slow heartbeat. Report dizziness, difficulty breathing, or excessive weakness to health care provider

Hypotension

Hypoglycemia

Asthma COPD

Confusion

Diabetes (can mask signs of hypoglycemia)

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If you have

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

diabetes, check with your health care provider before changing diet or dose of your diabetic medication Avoid alcohol, antihistamines, muscle relaxants, tranquilizers, and sedatives. They potentiate central nervous system (CNS) depression and sedation Report sexual dysfunction or depression to a health care provider for possible dosage regulation or change to different medication Do not discontinue medication abruptly except on advice of health care provider Consult a health care provider before using over-the-counter (OTC) cold preparations Cholinergics 1. Bethanechol (Urecholine)

Treatment of nonobstructive urinary retention, neuromuscular

Nausea, vomiting, and diarrhea

Benign prostatic hypertrophy (BPH) GI disorders

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Immediately report to health care provider or emergency room

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

2. Neostigmine (Prostigmin) 3. Pilocarpine (Isopto Carpine, Salagen)

blockade reversal, myasthenia gravis, xerostomia (dry mouth), openangle glaucoma

Muscle cramps and weakness Slowing of the heart

Asthma Cardiac disorders Hyperthyroidism

Hypotension

4.

Pyridostigmine (Mestinon, Mestinon Timespan)

Sweating, excessive salivation, lacrimation (discharge of tears), and flushing

any symptoms of prolonged GI distress, excessive perspiration, slow heartbeat, or depressed respiration Avoid combination of cholinergic medications with heart medications or cholinergic blockers

Respiratory depression Bronchospasm Acute toxicity or cholinergic crisis is treated with atropine sulfate IV Cholinergic Blockers

Fever

1. Atropine

Antispasmodic and antisecretory for GI or GU hypermotility

2.

Glycopyrrolate (Robinul)

Preoperative and preanesthetic uses

Headache

Closed-angle glaucoma

Dry mouth

GI or GU obstruction

3. Scopolamine (Transderm Scop, Donnatal)

Neuromuscular block and other spastic disorders

Constipation and urinary retention

Cardiac arrhythmias

4. Homatropine (Isopto Homatropine)

Antidote for insecticide poisoning, cholinergic crisis, or mushroom poisoning

Falls, delirium, and cognitive impairment (especially in older adults)

Hypothyroidism

Emergency treatment of bradycardia and atrioventricular heart block with

Flushing Blurred vision

Asthma or other chronic obstructive pulmonary disease

Hypertension

Hepatic or renal disease

Palpitations, tachycardia, (abnormally fast heart beat)

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Expect dried secretions Possible blurring of vision Report fast heartbeat or palpitations, feeling faint or falls, trouble passing urine Avoid oral anticholinergics with chronic obstructive lung disease and asthma, use inhalants only as prescribed, never use OTC

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

hypotension Dilation of pupils (mydriatic) Prevention and treatment of bronchospasm (bronchodilator; e.g., Atrovent HFA inhaler)

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 14 Cardiovascular Drugs Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Cardiac Glycosides

Increase the force of myocardial contractions

Toxic side effects Anorexia

Severe pulmonary disease

Nausea, vomiting

Hypothyroidism

Abdominal cramping, distention, and diarrhea

Acute myocardial infarction Severe heart failure

Check apical pulse before administering digoxin—if the apical pulse rate is <60, hold digoxin and contact health care provider

Impaired renal function; hypokalemia, hypomagnesemia

Recognition and immediate reporting of side effects

Arrhythmias not caused by heart failure

Hold medication if any side effect occurs, until health care provider can be consulted

1. Digoxin (Lanoxin)

Primarily treatment of heart failure Sometimes used to treat atrial fibrillation or flutter

Headache Fatigue, lethargy Muscle weakness Vertigo Restlessness, irritability, tremors, and seizures Visual disturbances, including blurring, diplopia (double vision), or halos

Acute myocarditis

Pregnancy, breast feeding High doses in older adults

Cardiac arrhythmias, especially bradycardia Electrolyte imbalance Insomnia

Avoid taking any other medication at the same time without health care provider’s approval, especially antacids and cold remedies Avoid abrupt withdrawal, after prolonged use; must be reduced gradually under health care provider supervision

Confusion and mental disorders especially with older adults

Check heart rate on a regular basis Antiarrhythmics

Suppress

Beta-blockers:

Beta-blockers:

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Report adverse

26

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

1. Procainamide 2. Lidocaine (Xylocaine) 3. Propafenone (Rythmol, Rythmol SR) 4. Metoprolol (Lopressor) (a betaadrenergic blocker with other uses) 5. Amiodarone (Cordarone, Pacerone) 6. Verapamil (Calan) (a calcium channel blocker with other uses) 7. Adenosine (Adenocard) 8. Procainamide

various types of cardiac arrhythmias

Hypotension with vertigo and syncope Bradycardia, with heart block and cardiac arrest CNS symptoms, including dizziness, irritability, confusion, nightmares, insomnia, visual disturbances, weakness, sleepiness, lassitude, or fatigue GI symptoms, including nausea, vomiting, and diarrhea or constipation Rash or hematological effects Bronchospasm, especially with history of asthma Hypoglycemia

Withdrawal after prolonged use

side effects immediately

Withdrawal before surgery is controversial

Hold medication if there are side effects, until health care provider is notified

Diabetes Renal and hepatic impairment Asthma and allergic rhinitis Bradycardia Heart block Congestive heart failure Use with children, pregnancy, breast feeding COPD Calcium channel blockers: Heart block Heart failure Angina Hepatic and renal impairment

Impotence, rare

Pregnancy, breast feeding

Calcium channel blockers:

Use with children

Hypotension with vertigo

Adenosine:

Bradycardia, with heart block

Second- or thirddegree heart block or symptomatic bradycardia

Edema

Amiodarone:

Constipation

Second- or thirddegree heart block, marked sinus bradycardia due to severe sinus node dysfunction, and

Headache

Nausea Abdominal discomfort Procainamide:

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Rise slowly from reclining position Modify lifestyle to reduce stress Mild exercise on a regular basis as approved by the health care provider Do not discontinue medicine even if feeling well Take proper dose on time as prescribed, without skipping any dose If medication is forgotten, do not double the dose Take medication with a full glass of water on an empty stomach, 1 h before or 2 h after meals Avoid taking any other medications, including OTC medicines, unless approved by health care provider Do not take grapefruit juice

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Hypotension Tacychardia Conduction defects Hypersensitivity reactions Adenosine: Facial flushing, Lightheadedness, Headache Dyspnea Chest pressure Amiodarone: Some are severe and potentially fatal, and include: Pulmonary fibrosis Cardiac arrhythmias, induction or worsening of heart failure; hypotension Nausea, vomiting, constipation, anorexia Hepatitis Hyperthyroidism or hypothyroidism Neurotoxicity Visual disturbances; optic neuropathy and/or neuritis Dermatologic reactions, especially photosensitivity Lidocaine: Usually of short duration, are dose related, and can include: CNS

when bradycardia has caused syncope Cardiogenic shock Thyroid disease Iodine hypersensitivity Older adults Lidocaine: Patients hypersensitive to local anesthetics Heart block Respiratory depression Pregnancy, breast feeding Use with children Procainamide: AV block and conduction defects

with calcium channel blockers EKG monitoring and availability of resuscitative equipment are necessary during IV administration of lidocaine Discard expired medicines and renew the prescription Avoid comparisons with other patients on similar drugs Contact the health care provider immediately with any concerns regarding medicines

Electrolyte imbalance Digoxin toxicity Heart failure, hypotension Myasthenia gravis Older adults Use with children, pregnancy, and breast feeding Hepatic or renal disorders Hypersensitivity to “ester-type” local anesthetics Lupus Propafenone: Caution asthma or acute

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

symptoms, including tremors, seizures, dizziness, confusion, and blurred vision Hypotension, bradycardia, and heart block Dyspnea, respiratory depression, respiratory arrest

bronchospasm, second- or thirddegree heart block, cardiogenic shock, heart failure, bradycardia, marked hypotension, electrolyte imbalance

Procainamide: Diarrhea, anorexia, nausea, vomiting, abdominal pain Tachycardia, QT prolongation, hypotension, syncope Anticholinergic effects, including dry mouth, blurred vision, confusion, constipation, urinary retention Vascular collapse and respiratory arrest with IV administration Vision abnormalities or hearing disturbances (with quinidine) Blood dyscrasias, including anemia, clotting deficiencies, leukopenia Hepatic disorders; fever Dermatological effects, including

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

rash, pruritis, urticarial Propafenone: Dizziness Nausea, vomiting Unusual taste Constipation Blurred vision Angina, heart failure, palpitations, arrhythmia, fatigue Headache Dyspnea Rash Weakness Antihypertensives (Hypotensives) Beta-adrenergic blockers 1. Atenolol (Tenormin) 2. Carvedilol (Coreg, Coreg CR)

Treatment and management of hypertension

Hypotension

Thiazide diuretics:

Bradycardia

See Chapter 15

Hydralazine: Tachycardia Thiazide diuretics: See Chapter 15

3. Metoprolol (Lopressor, Toprol XL) 4. Nebivolol (Bystolic) 5. Propranolol (Inderal, Inderal LA) Calcium channel blockers 1. Amlodipine (Norvasc) 2. Diltiazem (Cardizem CD, Cardizem LA, Diltiazem SR) 3. Nifedipine (Procardia XL, Adalat

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Routine monitoring of blood pressure at home, keep a log of blood pressure readings, and share this information with health care provider Immediately report any adverse side effects Take medication on time as prescribed by the health care provider; do not skip a dose or double a dose Do not discontinue the medicine, even if feeling well, without

30

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

CC) 4. Verapamil (Calan SR, Isoptin SR)

consulting the health care provider first Potential of confusion with various name extensions designating extended-release formulations (CC, CD, CR, LA, SR, XL) Rise slowly from reclining position to reduce lightheadedness Take care in driving a car or operating machinery if medication causes drowsiness (ask health care provider, nurse, or pharmacist about the specific medication Potentiation of adverse side effects by alcohol Reduce or stop smoking to help lower blood pressure Importance of lifestyle modifications, such as exercise, quitting smoking, limiting alcohol usage, and a healthy diet Following the health care provider’s instructions

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

regarding appropriate diet—may include a low-salt or low-sodium or weight-reduction diet Avoid hot tubs and hot showers Mild exercise on a regular basis as approved by the health care provider Always swallow the extendedrelease products intact Do drink grapefruit juice with calcium blockers See Chapter 15 for thiazide diuretics Antihypertensives (ACE Inhibitors) 1. Benazepril (Lotensin) 2.

Captopril

Treatment and management of hypertension

Infrequent, usually mild, and can include: Rash or photosensitivity Loss of taste perception; metallic taste

3. Enalapril (Vasotec) 4. Lisinopril (Prinivil, Zestril)

Collagen disease Heart failure

See Antihypertensives

Angioedema Pregnancy, breast feeding Use with children

Blood dyscrasias

5. Ramipril (Altace)

Renal impairment

6. Trandolapril (Mavik)

Severe hypotension Chronic dry cough or nasal congestion Hyperkalemia

Angiotensin Receptor Blockers (ARBs) 1. Losartan (Cozaar)

Treatment and management

Relatively uncommon and include:

Renal impairment Pregnancy, breast feeding, use with

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

See Antihypertensives

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

2. Olmesartan (Benicar)

of hypertension

3. Telmisartan (Micardis)

Dizziness

children

Orthostatic hypotension Upper respiratory tract infections

4. Valsartan (Diovan)

Hyperkalemia Other Antihypertensives Antiadrenergic agents 1. Prazosin (Minipress)

Treatment and management of hypertension

Peripheral vasodilator 1. Hydralazine

Prazosin:

Prazosin:

See Chapter 15

See Chapter 15

See Antihypertensives

Hydralazine:

Hydralazine:

Prazosin:

Tachycardia and palpitations

Lupus

See Chapter 15

Headache and flushing

Coronary artery disease

Orthostatic hypotension

Rheumatic heart disease

Renal disease

GI effects, including Pregnancy nausea, vomiting, diarrhea, constipation Blood abnormalities Edema and weight gain Coronary Vasodilators (Coronary) 1. Nitroglycerin (Nitrostat tabs S.L., Nitrolingual spray, caps E.R., Nitro-Bid oint 2%, Nitro-Dur, Minitran) (tabs, SL, ointment, patch, spray) 2.

Isorbidedinitrateisosor bide (Isordil, Dilatrate [SR]) 3. Isorbidedinitrate with hydralazine (BiDil) 4. Isosorbide mononitrate (Imdur)

Treatment of angina

Headache

Glaucoma

Postural hypotension

GI hypermotility or malabsorption

Sit down when taking fast-acting tabs

Dizziness Weakness

Intracranial pressure

Rise slowly from reclining position

Syncope

Severe anemia

Transient flushing

Hypotension

Rash and skin irritation with transdermal

Caution:

No alcohol or phosphodiesteras e inhibitors (Cialis, Viagra, etc.) while on these drugs

Blurred vision Dry mouth Hypersensitivity reaction

Nitrates taken for chronic angina may require periods of drugfree intervals to avoid the development of nitrate tolerance and lessening of anti-anginal effects

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Use time-release capsules or tablets for prevention of angina Take timedrelease capsules or tablets on an empty stomach

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

with a full glass of water Allow sublingual tablets, to dissolve under the tongue or in the cheek pouch and do not chew or swallow them Repeat sublingual, tablets, or spray at 5-min intervals if no relief of pain. May repeat up to three times.

If chest pain is not relieved or worsens 5 min after a dose, EMS should be activated Do not discontinue abruptly Store nitroglycerin tablets and capsules in glass containers only with tightly fitting metal screw tops away from heat Prevention of angina attacks by administering a sublingual tablet or spray before physical exertion or emotional stress if approved by health care provider See Chapter 9 for patient education regarding

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

administration of nitroglycerin ointment or patch Immediately report unexpected, persistent, or worsening sensations or symptoms to health care provider Antilipemic Agents Statins 1. Atorvastatin (Lipitor) 2. Lovastatin (Mevacor)

Treatment of elevated serum cholesterol Fibric acid derivatives:

3. Pravastatin (Pravachol)

Lower triglyceride levels

4. Rosuvastatin (Crestor)

Omega-3 fatty acids:

5. Simvastatin (Zocor)

Lower triglyceride levels

Bile acid sequestrants 1. Cholestyramine (Questran, Questran Light) 2. Colesevelam (Welchol)

GI upset (all)

Statins:

Continue diet

Statins:

Hepatic or renal disease

and aerobic exercise

Existing myalgia or muscle weakness

Take medications with meals

Mild GI disturbances, headache, rash, fatigue Myalgia and muscle weakness Rhabdomyolysis (rare) Elevated liver enzymes Cholestyramine: Constipation, gas, cramps, heartburn, nausea, anorexia, abdominal pain, and bloating

Pregnancy, breastfeeding, Use with children Gemfibrozil, HIV, and hepatitis C protease inhibitors Cholestyramine: Biliary cirrhosis and obstruction GI obstruction or fecal impaction

Report side effects immediately to health care provider With cholestyramine, importance of a high-fiber diet, and/or a stool softener, fatsoluble vitamin/folic acid supplements, and not taking other medication within 4h

Niacin:

Niacin:

1. Niacin (Niaspan, Slo-Niacin)

GI upset, dyspepsia, blurred vision

Fibric acid derivatives

Fatigue

Hepatic, gallbladder, or peptic ulcer disease

1. Fenofibrate (Antara, Lofibra, Tricor, Trilipix)

Skin flushing, itching, and irritation

Diabetes

2. Gemfibrozil (Lopid)

Glucose intolerance

Pregnancy, breast feeding

Hyperuricemia!

Avoid grapefruit juice while taking statins

Use with children (<10 years old)

Give health care provider a list of

Nicotinic acid

Cholesterol absorption inhibitor 1. Ezetimibe (Zetia)

Hepatotoxicity

Glaucoma Gout

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Expect facial flushing with niacin Take most statins at night

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

1. Fish oil (OTC)

Fibric acid derivatives:

Fibric acid derivatives:

Combinations

GI complaints

1.

Atorvastatin/amlodipin e (Caduet)

Cholethiasis, jaundice

Gallbladder, hepatic, or renal disease or peptic ulcer

2.

Ezetimibe/simvastatin (Vytorin)

dyscrasias

Omega-3 fatty acids

Blood Myopathy

3. Lovastatin/niacin (Advicor)

Hypersensitivity reactions (rare)

Gemfibrozil with

Increased risk of pulmonary emboli

Ezetimibe:

Ezetimibe: Abdominal pain

Omega-3 fatty acids:

Omega-3 fatty acids:

Nausea

Caution when used concurrently with anticoagulants, platelet inhibitors, and thrombolytic agents

Diarrhea Fishy aftertaste

Oral coumarin derivative 1. Warfarin (Coumardin, Jantoven) Factor X inhibitors 1. Apixaban (Eliquis) 2. Rivaroxaban (Xarelto) Thrombin inhibitor 1. Dabigatran (Pradaxa) Anticoagulants Injectable

Galllbladder disease

Arthralgia

Heartburn

Prevent formation of blood clots or decrease the extension of existing clots

statins

Moderate-tosevere hepatic insufficiency

Back pain

Anticoagulants

Pregnancy, breast feeding, and use in children

Major hemorrhage

GI disorders

Thrombocytopenia

Ulceration of the GI tract

Minor bleeding Blood in urine Osteoporosis with long-term heparin use

Hepatic and renal dysfunction Blood dyscrasias Pregnancy After stroke may increase risk of fatal cerebral hemorrhage Patients with prosthetic heart valves Lumbar puncture,

Unfractionated

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

all current medicines, herbs, nonprescription drugs, or dietary supplements All factors being the same, medication will probably be for life Administer ezetimibe at least 1 or 2 h before or 2 or 4 h after administering antacids and bile acid sequestrants, respectively

Read the FDAapproved Medication Guide dispensed with oral anticoagulants Importance of compliance with taking medications as prescribed and required laboratory monitoring (if any) Take medication as prescribed at

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

heparin 1. Heparin

epidural anesthesia

Low-molecular-weight heparins 1. Dalteparin (Fragmin) 2. Enoxaparin (Lovenox)

the same time every day Avoid eating large amount of grapefruit or drinking grapefruit or cranberry juice

Factor X inhibitor

Always wear closed-toed shoes

1. Fondaparinux (Arixtra)

Use a night light to prevent falls If prescribed, carry vitamin K for emergency use Avoid smoking, the use of alcohol and OTC medications There are many interactions with warfarin derivatives— always check before administering any other medicine No alcohol Report any bleeding immediately See Chapter 9, Subcutaneous Injection of Heparin Daily observation of skin, gums, urine, and stools and immediate reporting of any signs of bleeding Avoiding sports and activities that

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

may cause bleeding Take special care with shaving (electric razor only), teeth brushing,or dental floss Wear an ID tag or carry an ID card Immediately report severe or continued headache or backache, rash, dizziness, joint pain or swelling, tarry stools, abdominal distention, vomiting of material resembling coffee grounds, or nosebleed Avoid abrupt discontinuation of the new oral anticoagulants Avoid switching between brands and taking other medications without the health care provider’s approval, especially OTC aspirin, antiinflammatory drugs, and antacids Platelet inhibitors 1. Aspirin (Ecotrin, Ascriptin)

Prevent platelet clumping

Dipyridamole:

Dipyridamole:

Usually transient, can include:

Caution with older adults

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Provide education on modifying risk factors for CHD

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

2. Dipyridamole (Persantine)

Also used in the 3. Dipyridamole with pharmacologi c aspirin (Aggrenox) management ADP Receptor of post-acute Antagonists coronary syndrome 1. Clopidogrel (ACS) and (Plavix) prior to and 2. Prasugrel (Effirnt) following 3. Ticagrelor (Brilinta) percutaneous coronary intervention (PCI) with coronary stenting to prevent stent thrombosis

Headache

Aspirin:

Dizziness

Bleeding disorders

Weakness Nausea, vomiting, diarrhea Flushing Rash Aspirin: Gastric irritation GI effects See Chapter 19

See Chapter 19 ADP receptor antagonists: Active pathological bleeding (e.g., peptic ulcer) History of intracranial hemorrhage,TIA, or stroke

and stroke: abstinence from all forms of tobacco, weight control, low-fat and lowcholesterol diet, and aerobic exercise on a regular basis Do not start taking aspirin without health care provider consultation Take aspirin with food

ADP receptor antagonists: Reduction of atheroscleroti c events (myocardial infarction, stroke, and vascular death) in patients with a history of recent stroke, recent MI, or established peripheral vascular disease Thrombolytic Agents 1. Alteplase t-PA (Activase, Cathflo) 2. Reteplase r-PA (Retavase) 3. Tenecteplase TNKt-PA (TNKase)

Dissolution and liquification of the fibrin in an existing clot, resulting in clot dissolution, reperfusion of organs, and

Bleeding Intracranial hemorrhag

Preexisting coagulation problems Uncontrolled hypertension

Administer in an ER or ICU setting Close monitoring of hemodynamics and vital signs

Severe chronic heart failure Recent stroke

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39

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

restoration of blood flow to tissues Hematopoetic Agents ESAs 1. Darbepoetinalfa (Aranesp) 2. Epoetin alfa (Epogen, Procrit)

Regulation of the production and development of blood cells, normally in the bone marrow Epoetin alfa: Stimulates the bone marrow to produce more red blood cells Ilgrastim: Involved in the regulation and production of neutrophils in response to host defense needs

Epoetin alfa:

Filgrastim:

Hypertension— especially in dialysis patients

Use with caution in patients with sickle cell disorders

Flu-like symptoms GI effects Rash Chest pain Increased mortality, MI, stroke, serious cardiovascular thrombosis of vascular access, and venous thromboembolic events Increased risk of tumor progression or recurrence Filgrastim: Bone pain is common Headache Dermatological reactions

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 15 Urinary System Drugs Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Thiazides

Treatment of edema from many causes

Hypokalemia

Diabetes

Hyponatremia

History of gout

Treatment of hypertension

Hypercalcemia

Severe renal disease

Diet with potassium-rich foods or potassium supplements (check with the health care provider first)

1.

Hydrochlorothiazi de (Microzide) 2. Metolazone (Zaroxolyn)

Prophylaxis of calculus (stone) formation in those with hypercalciuria

Muscle weakness or spasm GI reactions (e.g., anorexia, nausea, vomiting, diarrhea) Postural hypotension, vertigo, and headache

Impaired liver function Prolonged use (periodic serum electrolyte checks indicated and potassium supplements may be necessary to prevent hypokalemia)

Fatigue, weakness, and lethargy

Older adults due to greater sensitivity to thiazides (may cause low sodium)

Skin conditions (e.g., rash and photosensitivity; rare)

Patients with sulfonamide hypersensitivity

Hyperglycemia Increased uric acid

If diuretic prescribed for hypertension, a low-sodium diet may be prescribed by the health care provider Notify health care provider of persistent and/or severe side effects Take with food in the morning Rise slowly from reclining positions to counteract postural hypotension Limit alcohol intake Avoid other medications unless consulting a health care provider

Loop Diuretics

Edema associated

Fluid and

Cirrhosis and other

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Take potassium

41

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs 1. Furosemide (Lasix) 2. Bumetanide (Bumex) 3. Torsemide (Demadex)

Purpose

Side Effects

Contraindications or Cautions

Patient Education

with impaired renal function, heart failure, or hepatic disease

liver disease— careful monitoring required

supplements as prescribed

Pulmonary edema

electrolyte imbalance with dehydration, circulatory collapse, chest pain

Ascites caused by malignancy or cirrhosis

Hypokalemia with weakness Hypocalcemia

Hypertension (if thiazides ineffective, loop diuretics sometimes combined with other antihypertensives especially in patients with kidney disease)

Hypotension GI effects, including anorexia, nausea, vomiting, diarrhea, and abdominal pain Hyperglycemia

Kidney impairment Alkalosis and dehydration Patients on digoxin Allergies to sulfa drugs Diabetes History of gout Pregnancy, breast feeding Use with children under 18 years of age (Demadex)

Increased uric acid

Rash, urticaria, pruritus, and photosensitivity

2. Triamterene

Rise slowly from reclining position Avoid alcohol Report sudden changes in urinary output, especially decrease Report abrupt or severe weight loss

Do not take any other prescribed or OTC drugs without consulting the health care provider first

Headache, muscle cramps, mental confusion, dizziness

1. Spironolactone (Aldactone)

Take with food before 6 P.M.

Limit exposure to sunlight with furosemide, due to photosensitivity

Tinnitus, hearing impairment, and blurred vision

Potassium-Sparing Diuretics

Notify health care provider immediately of side effects

Used when potassium depletion can be dangerous

Hyperkalemia

Renal insufficiency

Dehydration or weakness

Cirrhosis and other liver disease

May counteract the increased glucose and uric acid levels

GI symptoms, including nausea, vomiting, and

Pregnancy, breast feeding

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Avoid potassium-rich foods and salt substitutes Report signs of excessive dehydration

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

associated with thiazide diuretic therapy

diarrhea

Diuretic therapy of choice in patients with cirrhosis

Profound weight loss

Shown to reduce deaths in patients with severe heart failure

Gynecomastia (enlargement of breast tissue in males) with spironolactone

Seldom used alone but are usually combined with thiazide diuretics to increase the diuretic and hypotensive effects and to reduce the danger of hyperkalemia Combination of Potassium-Sparing and Thiazide Diuretics

Contraindications or Cautions

Patient Education Report GI symptoms, persistent headache, mental confusion, or irregular heartbeat

Fatigue, lethargy

Hypotension

Monitor weight and report sudden, excessive weight loss Rise slowly from reclining position Take medications after meals

See Thiazides

See Thiazides

See Thiazides

See Thiazides

See PotassiumSparing Diuretics

See PotassiumSparing Diuretics

See PotassiumSparing Diuretics

See PotassiumSparing Diuretics

Reduce intracranial or intraocular pressure

Fluid and electrolyte imbalance

Kidney failure

CNS symptoms, including headache, vertigo, mental confusion,

Severe pulmonary edema

Immediately report side effects to health care provider

1. Spironolactone and hydrochlorothiazi de (Aldactazide) 2. Triamterene and hydrochlorothiazi de (Dyazide) Osmotic Agents 1. Mannitol (Osmitrol)

Heart failure

Pregnancy, breast feeding

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

None

Always encourage large fluid intake to facilitate excretion of uric acid crystals

nausea, and vomiting Tachycardia Hypertension and hypotension Allergic reactions Severe pulmonary edema Anti-Gout Medication 1. Colchicine (Colcrys)

Uricosuric Agents 1. Probenecid (Benemid)

Treatment of acute gouty arthritis (must be given within 24 h of symptom onset for maximum effectiveness) and in the chronic management of gout

Rash, alopecia

Treatment of chronic gout and frequent disabling attacks of gouty arthritis

Rare but can include:

History of uric acid kidney stones

Headache

History of peptic ulcer

Potentiates penicillin effect with some infections

GI upset, nausea, vomiting, diarrhea Blood disorders, bone marrow suppression

Nausea and vomiting Kidney stones and renal colic if large volume of fluids is not maintained

Advise patients to avoid alcohol (increases risk of adverse GI effects and increases serum urate concentrations)

Renal impairment Hematologic disease

Hypersensitivity reactions, rash, hypotension, and anaphylaxis are rare

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Drink large amounts of fluid Avoid taking large doses of aspirin products (aspirin doses of 325 mg per day or less are okay) Take other medications at the same time only with health care provider’s order Take

44

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education medication with food Report rash immediately

Xanthine Oxidase Inhibitors 1. Allopurinol (Zyloprim) 2. Febuxostat (Uloric)

Antispasmodics 1. Tolterodine (Detrol) 2. Oxybutynin (Ditropan) 3. Darifenacin (Enablex) 4. Fesoterodine (Toviaz) 5. Solifenacin (VESIcare) 6. Hyoscyamine (Levsin)

Treatment of chronic gout Also used to prevent renal calculi in people with a history of frequent stone formation and prevention of acute hyperuricemia during radiation of certain tumors or antineoplastic therapy

Treatment of incontinence and neurogenic bladder

Rash Allergic reactions, also fever, chills, nausea, vomiting, diarrhea, drowsiness, and vertigo

Impaired renal function History of hypersensitivity reactions Liver disease Pregnancy, breast feeding

Severe hypersensitivity reactions are rare but increase in older adult patients with renal impairment who receive allopurinol and thiazide diuretics in combination Drying of all secretions Drowsiness and dizziness Headache; fatigue Urinary retention Constipation Blurred vision Mental confusion especially with

Drink large quantities of water Take medications after meals Stop medication and report rash to health care provider immediately Avoid alcohol Avoid other medications unless prescribed by health care provider

Older adults Hepatic or renal disease Obstructive uropathy Bladder or GI obstruction, or ulcerative colitis Cardiovascular disease Prostatic hyperplasia Use with children—

© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Possible interactions with other drugs Report side effects that are troublesome for possible dosage adjustment Report effectiveness; inform patients that it may take several months to see effects

45

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

older adults

Use caution when driving or operating machinery

Nausea and vomiting

contraindicated for those under age 6.

Ditropan XL is used effectively in children 6 years of age or older

Rash, urticaria, allergic reactions

Pregnancy, breast feeding

Tachycardia, palpitations

Narrow-angle glaucoma

Avoid alcohol or other sedatives that potentiate drowsiness Do not crush or chew extendedrelease formulations (Enablex, Toviaz) Do not cut or trim patches (Oxytrol) Bladder retraining, toileting programs, and pelvic-floor exercises (Kegels) may also be prescribed to improve bladder function

Cholinergic 1. Bethanechol (Urecholine)

Stimulate contraction of the urinary bladder in cases of nonobstructive urinary retention, postoperatively or postpartum

GI cramping Diarrhea Nausea and vomiting Sweating and salivation Headache Bronchial constriction

Obstruction of the GI or urinary tract

None

Hyperthyroidism Peptic ulcer, irritable bowel syndrome Asthma Cardiovascular disease— bradycardia

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46

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Slow heartbeat or reflex, tachycardia, and orthostatic hypotension

Parkinsonism

Patient Education

Seizure disorders Pregnancy, breast feeding

Urinary urgency Urinary Analgesic 1.

Phenazopyridine (Pyridium, AZO Standard [OTC])

Relieve burning, pain, discomfort, and urgency associated with cystitis

Rare for the most part but can include:

Impaired kidney function, especially in older adults

Urine will be orange-red and may stain fabric

Headache or vertigo

May interfere with blood glucose measurements and various urine ketone and protein kidney tests

Tears may stain contact lenses

Mild GI disturbances Orange-red urine (common)—may stain fabric, and tears may stain contact lenses

Phenazopyridin e is only temporarily effective against discomfort and is not effective against infections

BPH Treatment

Antiandrogens:

Antiandrogens:

Antiandrogens:

Antiandrogens:

Antiandrogens

Reduce prostate size and associated urinary obstruction (e.g., urgency, nocturia)

Impotence

Patients should be screened for cancer, infection, or other urinary dysfunctions

Alpha-blockers:

Gynecomastia (including breast tenderness and enlargement)

Crushed tablets and soft gelatin capsules should not be handled by pregnant women

1. Finasteride (Proscar) 2. Dutasteride (Avodart) Alpha-blockers 1. Doxazosin (Cardura) 2. Tamsulosin (Flomax) 3. Terazosin

Relax smooth muscle in the bladder neck and prostate, increasing urine flow and improving symptoms of BPH Treatment of hypertension

Decreased libido Decreased ejaculate

Side effects diminish after the first year of treatment

Antiandrogens can affect a blood test called PSA, used for screening of prostate cancer Liver function abnormalities may be exacerbated

Alpha-blockers:

Alpha-blockers:

Dizziness, headache, nasal congestion

Patients with a history of serious or life-threatening sulfonamide allergy

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47

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Orthostatic hypotension

(with Flomax)

Palpitations (not Flomax) Ejaculation dysfunction, decreased libido, impotence

Phosphodiesterase Inhibitor 1. Tadalafil (Cialis)

Patient Education

Notify ophthalmologist of current or previous treatment with alpha-blockers— may be at risk for intraoperative floppy iris syndrome during cataract surgery

Treatment of erectile dysfunction Treatment of the signs and symptoms of BPH

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48

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 16 Gastrointestinal Drugs Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

Antacids

Neutralize gastric hydrochloric acid

Constipation (with aluminum or calcium carbonate antacids)

Heart failure

Avoid prolonged use of OTC (no longer than two weeks) antacids without medical supervision because of the danger of masking symptoms of GI bleeding or GI malignancy and causing the stomach to increase excess acid

1. Aluminum hydroxide gel 2. Calcium carbonate 3. Aluminum/magnesium 4. Combinations with simethicone

Also used at times as supplemental agents in the management of esophageal reflux

Chronic kidney disease or history of renal calculi

Diarrhea (with magnesium antacids)

Cirrhosis of the liver or edema

Electrolyte imbalance

Dehydration or electrolyte imbalance

Urinary calculi and renal complications

Avoid using antacids at the same time as any other medications because of many interactions

Osteoporosis (with aluminum antacids) Belching and flatulence (with calcium carbonate and sodium bicarbonate)

Agents for the Treatment of Ulcers and Gastroesophageal Reflux Disease

Avoid the use of antacids entirely or use with caution if patient has cardiac, renal, or liver disease or fluid retention

H2-blockers:

H2-blockers:

H2-blockers:

Diarrhea

Renal disease

Dizziness

Pregnancy, breast feeding

1. Cimetidine (Tagamet HB [OTC])

Reduce gastric acid secretion by acting as histamine2 receptor antagonists

2. Famotidine (Pepcid)

Proton pump

H2-blockers

Rash Headache

Gastric mucosal agents:

Mild gynecomastia

Cytotec:

For patients taking agents for the treatment of ulcers and GERD, avoid smoking Close communication with the health care provider for

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49

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

3. Ranitidine (Zantac)

inhibitors:

with cimetidine (occurs infrequently and is reversible)

Women of childbearing age (unless woman is capable of using effective contraceptives)

possible dosage regulation of other medications taken at the same time

Long-term treatment of 1. Esomeprazole severe GERD, (Nexium) prevention of 2. Lansoprazole (Prevacid) NSAIDinduced 3. Omeprazole (Prilosec) ulcers, and treatment of 4. Pantoprazole hypersecretor (Protonix) y conditions 5. Rabeprazole (Aciphex) Gastric Proton pump inhibitors

Gastric mucosal agents 1. Misoprostol (Cytotec) 2. Sucralfate (Carafate)

mucosal agents: Cytotec: Inhibits gastric acid secretion and protects the mucosa from the irritant effect of certain drugs Carafate: Coats stomach

Mental confusion, especially in older adults, less with Pepcid Proton pump inhibitors: Diarrhea, constipation, nausea, vomiting, abdominal pain Increased risk for pneumonia or intestinal (Clostridium difficile) infection

Pregnancy Children under age 12 Carafate: Rare, with constipation occurring occasionally

Structuring of environment to reduce stress factors and decrease tension in order to facilitate healing of ulcers Do not take antacids, if ordered, within 2 h of taking cimetidine, ranitidine, or any other drug Take medication on regular basis and avoid abrupt withdrawal

Headache, dizziness

Proton pump inhibitors:

Long-term use on a regular basis of agents that reduce gastric acid can possibly result in vitamin B12 deficiency and hypomagnesemi a, especially in older adults

Taking proton pump inhibitors, Nexium, Prevacid, and Prilosec on an empty stomach; Aciphex and Protonix can be given without regard to meals

In patients older than age 50, long-term therapy (at least one year),

Proton pump inhibitors Delayed-release dosage forms should not be chewed, broken,

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50

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

particularly at high doses, associated with an increased risk of hip, wrist, or spine fractures

or crushed Proton pump inhibitors available as SR caps may be opened and sprinkled on apple sauce or yogurt, given with fruit juices, and swallowed immediately with water (do not chew or crush)

Gastric mucosal agents: Cytotec: Diarrhea, nausea, and abdominal pain (occurs early in treatment and is usually selflimiting; take with food to minimize)

Self-medication with OTC PPIs is not intended for immediate relief of heartburn Gastric mucosal agents:

Menstrual irregularities (begin therapy on the second or third day of next normal menstrual period)

Cytotec: Take Cytotec with meals and at bedtime with food, and avoid magnesium products to lessen incidence of diarrhea

Spontaneous abortion, possibly incomplete, with potentially dangerous uterine bleeding, maternal or fetal death Antispasmodics/Anticholine rgics

Calm the bowel

Dry mouth, constipation

Patient Education

Carafate: Take Carafate 1 h before meals, on an empty stomach, and not within 2 h of any other medicine Glaucoma (narrow angle)

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51

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

1. Dicyclomine (Bentyl)

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Decrease motility (smooth muscle tone) in the GI tract

Blurred vision, dizziness, drowsiness

Cardiovascular disease

Urinary retention Tachycardia, palpitations Confusion (especially in older adults)

Patient Education

Unstable cardiac disease Obstructive GI disease, ulcerative colitis Obstructive uropathy (BPH, bladder obstruction) Myasthenia gravis Breast feeding

Agents for Inflammatory Bowel Disease Salicylates 1. Sulfasalazine (Azulfidine) 2. Mesalamine (Rowasa) Glucocorticoids 1. Prednisone 2. Prednisolone 3. Hydrocortisone enema

Antidiarrheal Agents

Salicylates:

Salicylates:

Salicylates:

Glucocorticoids:

Antiinflammatory activity in the GI tract

Anorexia

See Chapter 23

Management of ulcerative colitis

Diarrhea, dyspepsia, abdominal pain, cramps, bloating (with rectal administration)

Allergy to salicylates or sulfonamides with sulfasalazine (can cause anaphylaxis or asthma attacks)

Glucocorticoi ds:

Nausea and vomiting

Treatment of moderate-tosevere active forms of inflammatory bowel disease in patients who are inadequately controlled with salicylates

Headache

Reduce the

Transient

Weakness Dizziness rash Glucocorticoids: See Chapter 23

Allergy to sulfites (Rowasa enema) Renal impairment Hepatic impairment (with sulfasalazine) Glucocorticoids: See Chapter 23 Salicylate

Avoid self-

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52

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

Salicylates

number of loose stools

constipation on occasion

(including aspirin) hypersensitivity

medication for longer than 48 h without consulting a health care provider

1. Kaopectate 2. Pepto-Bismol Opiate agonists 1. Diphenoxylate with atropine (Lomotil) 2. Loperamide (Imodium) Probiotics 1. Lactobacillus acidophilus (Lactinex) 2. Lactobacillus GG (Culturelle) 3. Saccharomyces boulardii (Florastor)

Discoloration of tongue and stool (black color) Ringing in ears With Lomotil, anticholinergic effects (e.g., drying of secretions, blurred vision, urinary retention, lethargy, confusion, or flushing) With Lomotil or Imodium, abdominal distention, nausea, or vomiting

Children (<12 years old) or teenagers recovering from chickenpox or influenza (risk of Reye’s syndrome)

If fever develops, contact a health care provider

Coagulation abnormalities, ulcers

Diet of a bland nature, excluding roughage, and including foods containing natural pectin

Pregnancy, breast feeding

Adequate fluid intake

Diarrhea caused by infection or poisoning

Contact health care provider immediately if complications develop, condition worsens, or blood appears in stool

Fever over 101°F Young children (under three years of age) and pregnancy Clostridium difficile colitis associated with broad-spectrum antibiotics Obstructive jaundice Caution with older adults

Do not use bismuth subsalicylate if allergic to salicylates (including aspirin) and in children or teenagers recovering from chickenpox or influenza Consider all sources of salicylate if taking aspirin or other medications containing

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53

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

salicylate, so that toxic levels are not reached Do not take these medications if diarrhea is caused by infection or food poisoning Antiflatulent 1. Simethicone (Mylicon)

Bulk-Forming Laxative 1. Psyllium (Metamucil) 2. Cellulose derivatives 3. Polycarbophil

Used in the symptomatic treatment of gastric bloating and postoperative gas pains

None

Apply only to infant colic because of limited information on safety in children

Avoid gas-forming foods

Evacuation of the intestine in simple constipation unrelieved by natural methods

None

Patients with acute abdominal pain, partial obstruction, dysphagia, or esophageal obstruction

Dissolve all bulkforming products completely in one full glass of liquid and follow that glass with another glass of fluid to prevent obstruction Administer immediately when dissolved, before thickening occurs

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54

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

Stool Softeners

Used to promote evacuation of the intestine, especially for pregnancy, breastfeeding and children with hard, dry stools

Are rare, with occasional mild, transitory GI cramping or rash

Acute abdominal pain or prolonged use without medical supervision

Discontinue with any signs of diarrhea or abdominal pain

1. Docusate (Surfak, Doxidan, Colace)

Caution to avoid stool softeners that also contain stimulant laxatives

Avoid using for longer than one week without medical supervision Take large quantities of fluids to soften stool Interaction with mineral oil, which leads to mucosal irritation and systemic absorption of mineral oil Checking package label to be sure that no cathartics are included

Emollients 1. Mineral oil

Used to promote evacuation of the intestine

Seepage of oil from rectum, causing anal irritation Malabsorption of vitamins A, D, E, and K only with prolonged oral use

Children under five years old

Avoid frequent or prolonged use

Bedridden, debilitated, or geriatric patients

Caution with anyone who might have trouble swallowing or who might aspirate the oil

Patients with dysphagia, gastric retention, or hiatal hernia Pregnancy

Never take mineral oil at bedtime

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55

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

Prolonged use

Interaction with docusate (stool softener), which can facilitate absorption of mineral oil, possibly increasing risk of toxicity

Concomitant use of stool softeners

Saline Laxative 1. Milk of magnesia 2. Citrate of magnesia

Used to promote evacuation of intestine

Electrolyte imbalance CNS symptoms, including weakness, sedation, and confusion Edema Cardiac, renal, and hepatic complications

Long-term use Heart failure or other cardiac disease Edema, cirrhosis, or renal disorders Those taking diuretics Acute abdominal pain

Use caution as products of different strengths are available Avoid saline cathartics with certain medical conditions Avoid frequent or regular use of saline cathartics

Colostomy Stimulant Laxatives 1. Senna (X-prep, Senokot) 2. Castor oil 3. Bisacodyl (Dulcolax)

Used to produce strong peristaltic activity

Abdominal cramps or discomfort Nausea Loss of normal bowel function with prolonged use Electrolyte disturbances and dehydration with prolonged use Discoloration of urine with senna

Acute abdominal pain or abdominal cramping— danger of ruptured appendix Ulcerative colitis Use with children Pregnancy, breast feeding Long-term use

Patients taking stimulant laxatives should be given strong warnings against frequent or prolonged use because of danger of laxative dependence and loss of normal bowel function Bisacodyl tablets should not be crushed or chewed or taken within 1 h after milk or antacids due to gastric irritation

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56

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Osmotic Laxatives

Used to promote evacuation of intestine

Nausea, vomiting, flatulence, and abdominal cramps

1. Glycerin 2. Lactulose 3. Polyethylene glycol (PEG) 4. Sorbitol

Chloride Channel Activator 1. Lubiprostone (Amitiza)

Also used to treat encephalopat hy (brain and nervous system damage) in hepatic failure precipitated

by GI bleeding and other conditions Used to promote evacuation of intestine

Contraindicatio ns or Cautions

Patient Education

Severe diarrhea, bowel obstruction

High-fiber diet to prevent constipation, including roughage

Glycerin: Rectal irritation or cramping pain Miralax—high doses can cause electrolyte imbalances with prolonged or excessive use

Nausea, diarrhea Headache Abdominal bloating/pain and flatulence

Renal/hepatic impairment Pregnancy and breast feeding

Adequate fluid intake Developing good bowel habits Regular exercise to develop muscle tone Avoiding any laxative with acute abdominal pain, nausea, vomiting, or fever Avoiding laxatives if any medical condition is present, unless prescribed by a

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57

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

health care provider Antiemetics Anticholinergics 1. Dimenhydrinate (Dramamine) 2. Scopolamine (Transderm-Scop) 3. Meclizine (Antivert) Antidopaminergics 1. Metoclopramide (Reglan) 2. Prochlorperazine 3. Promethazine (Phenergan) Serotonin receptor antagonists 1. Dolasetron (Anzemet) 2. Ondansetron (Zofran)

Used to prevent nausea, vomiting, or motion sickness Meclizine (Antivert): Also used for symptomatic treatment of vertigo associated with the vestibular system

Confusion, anxiety, restlessness (especially with older adults) Sedation, drowsiness Vertigo Weakness Headache Diarrhea, depression (with Reglan) Dry mouth Blurred vision Extrapyramidal reactions, especially in children and older adults Cardiac arrhythmias, QT prolongation with high doses or IV administration if too fast Meclizine (Antivert): Dry mouth, confusion, urinary retention, drowsiness

Pregnancy, breast feeding Use with children and adolescents (increased risk of movement disorders) with antidopaminergi cs Debilitated, emaciated, or older adult patients Angle-closure glaucoma Prostatic hypertrophy Cardiac arrhythmias Hypertension Seizure disorders (seizure threshold lowered) COPD and asthma (Phenergan suppresses cough reflex)

Take these medications under medical supervision Determine the cause of nausea and vomiting Take these medications under medical supervision only Determine cause of nausea and vomiting Report effectiveness and any complications Take only as directed Do not combine with any other CNS depressants, selective serotonin reuptake inhibitor (SSRI) antidepressants, alcohol, or muscle relaxants unless prescribed by a health care provider Apply TransdermScop patch behind the ear 4 h before anticipated exposure to

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58

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

motion (do not cut patch) effective up to 72 h. Take Dramamine orally 30 min before exposure to motion. Both drugs also available for IM injection for patients who have already developed motion sickness Meclizine (Antivert): Not recommended for children under age 12 Antidopaminergics : It is not recommended for children under age 12. Caution with older adults. Not for long-term use Peripherally Acting MuOpioid Receptor Antagonists

1. Movantik

Treatment of constipation caused by chronic or acute opioid use

Nausea, diarrhea, flatulence

GI obstruction, disruption to the blood brain barrier, hepatic impairment

Take on an empty stomach 1 h before or 2 h after the first meal of the day Avoid grapefruit/grapefr uit juice Do not take any other laxatives Stop use when

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59

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects with Frequent Use

Contraindicatio ns or Cautions

Patient Education

opioid use stops

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60

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 17 Respiratory Drugs Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Sympathomimetics (Adrenergics)

Increase the vital capacity of the lungs and decrease airway resistance

Potentiation of theophylline effects with increased risk of toxicity

First administration should be observed by medical personnel for hypersensitivity reactions

Follow directions carefully regarding dosage and administration

Short-acting betaagonists (SABAs) 1. Albuterol sulfate (Proair HFA, Proventil HFA, Ventolin HFA) 2. Levalbuterol (Xopenex, Xopenex HFA) Long-acting beta agonists (LABAs) 1. Arformoterol (Brovana) 2. Formoterol (Foradil Aerolizer, Perforomist)

SABAs: Managing acute exacerbations of asthma; also known as rescue medications LABAs: For prophylactic treatment; maintenance medications

GI—nausea, vomiting, decreased appetite Cough, throat irritation, hoarseness, sinusitis CNS stimulation —nervousness, tremor, dizziness, headache

3. Salmeterol (Serevent Diskus)

Tachycardia, palpitations, arrhythmias

Other

Angina

1. Epinephrine (Adrenalin)

Hypertension

2. Racepinephrine (Asthmanefrin [OTC])

Hyperglycemia Hypokalemia

Contact health care provider if effectiveness decreases Close monitoring for cardiovascular effects Due to a prolonged onset of action, longacting beta agonists should not be used to treat an acute asthma attack or bronchospasm

Differences between rescue medications and long-term controllers Proper technique for inhaler use capsules used with DPIs must not be swallowed Use of spacers for patients who have difficulty using MDIs Watch for cardiac or CNS problems and other possible side effects Drink adequate fluids Importance of quitting smoking and avoiding second-hand smoke, fumes, or pollution Report any adverse side effects Avoid any new medications,

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61

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education including OTC drugs, without consulting the health care provider first Avoid changing brands of medicine without consulting the health care provider or pharmacist

Anticholinergics Short-acting

Relieve bronchospasm

1. Ipratropium bromide (Atrovent HFA, Atrovent)

Cardiac effects— changes in heart rate, palpitations CNS stimulation— headache, drowsiness, dizziness, confusion, agitation

2.

Ipratropium/albutero l (combination of anticholinergic and sympathomimetic) (Combivent Respimat, DuoNeb)

Cautions: Not indicated for patients with unstable cardiac status, history of heart attacks, glaucoma, drug sensitivity, or prostatic hypertrophy

See Sympathomimetic s

Thickened secretions and mucus plugging; dry mouth, metallic taste

Long-acting 1. Tiotropium (Spiriva Handi Haler)

Constipation, abdominal pain Bronchodilators Xanthines 1. Theophylline (Theo-24, Elixophyllin)

Relax the smooth muscle in the bronchial tree for relief of bronchospasms

Can be mild, or severe with acute toxicity including:

Caution when administering theophylline applies to:

GI distress— nausea, vomiting, epigastric pain, abdominal cramps,

Sudden cessation of tobacco smoking

See Sympathomimetic s

Cardiovascular, kidney,

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62

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

anorexia, or diarrhea

pulmonary, or liver dysfunctions

CNS stimulation— nervousness, insomnia, irritability, headache, tremors, seizures

Diabetes

Cardiac effects— palpitation, tachycardia, arrhythmias Urinary frequency Hyperglycemia Corticosteroids 1. Beclomethasone (Beconase AQ QVAR HFA) 2. Budesonide (Pulmicort Flexhaler, Pulmicort Respules, Rhinocort Aqua) 3. Budesonide with formoterol (Symbicort)

Relieve inflammation, reduce swelling, decrease bronchial hyperresponsiveness to triggers, and suppress symptoms in acute and chronic reactive airway disease

Throat irritation Dry mouth Hoarseness Coughing Oral fungal infections Increased susceptibility to pneumonia

Patient Education

Peptic ulcer Glaucoma Use with children Older adults IV injection Patients undergoing influenza immunization or who have influenza Pregnancy, breast feeding Viral, bacterial, or fungal infections

See Chapter 23

Hypertension Congestive heart failure Diabetes Hypothyroidism Cirrhosis Renal failure

4. Fluticasone (Flovent HFA, Flonase) 5. Fluticasone with salmeterol (Advair Diskus, Advair HFA) 6. Nometasone (Asmanex Twisthaler,

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63

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Leukotriene inhibitors:

Leukotriene inhibitors:

These are not effective for acute exacerbations of asthma or immediate symptom relief

1. Montelukast (Singulair)

Leukotriene inhibitors:

Behavior and mood changes, sleep disturbances, suicidal ideation

Hepatotoxicity

Leukotriene inhibitors

Help control the inflammatory process of asthma and prevent asthma symptoms and acute attacks

2. Zafirlukast (Accolate)

Prevention of exercise-induced bronchoconstrictio n and treatment of chronic asthma

Nasonex) 7. Triamcinolone (Nasacort AQ) Asthma Prophylaxis and Treatment of Chronic Asthma

Mast-cell stabilizer 1. Cromolyn (Intal)

Montelukast: Headache Dizziness Nausea Dyspepsia Pain Fatigue Respiratory infections and fever Cromolyn: Throat irritation Cough Bronchospasm Nose burning, stinging, sneezing with nasal solution Nausea or headache

Pregnancy, breast feeding Use with children less than 12 years for zafirlukast

Proper technique for inhaler use

Use with children less than 2 years for montelukast

Complications of inhaled corticosteroids without proper precautions

Treatment of acute episodes of asthma Cromolyn: Cardiovascular disorders Proper use on regular schedule

Side effects to expect

Rinse mouth with mouthwash or water after treatment Always rinse and air dry equipment after use Administer bronchodilator before corticosteroid when the two inhaled medications are ordered at the same time Report side effects to health care provider especially respiratory distress

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64

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education Do not smoke

Mucolytics and Expectorants 1. Acetylcysteine (Mucomyst) 2. Guaifenesin (Mucinex, Robitussin)

Mucolytics:

Expectorants:

Mucolytics:

Decrease the hypersecretion and help liquefy pulmonary secretions

Infrequent, usually not serious and include:

Asthma

Nausea, vomiting

Respiratory insufficiency

Drowsiness, dizziness, headache

Inadequate cough mechanism, or gag reflex depression

Expectorants: Increase secretions, reduce viscosity, and help expel sputum

History of bronchospasm

Maintain adequate fluid intake Consult a health care provider if cough persists for more than a week or is recurrent, or accompanied by a fever

Expectorants: Patients with persistent or chronic cough Asthmatics prone to bronchospasm Cardiovascular disease, hypertension, diabetes, glaucoma, hyperthyroidism, prostatic hypertrophy, especially with combination products Pregnancy, breast feeding Antitussives Narcotic 1. Codeine 2. Codeine with guaifenesin

Prevent coughing in Respiratory patients not depression requiring a Constipation productive cough Urinary retention with

Addiction-prone patients (codeine) Asthma COPD

Not recommended as cough suppressants in coughs associated with upper

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65

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

(Cheratussin AC) 3. Codeine with promethazine (Phenergan with Codeine)

Side Effects

Contraindication s or Cautions

Patient Education

narcotic antitussives

Use with other CNS depressants

respiratory infection (URI)

Sedation

Caution with use with children:

New black-box warning—added to the drug label of codeinecontaining products about the risk of codeine used to manage pain in children after a tonsillectomy and/or adenoidectomy

Dizziness Nausea, vomiting

4. Hydrocodone 5. Hydrocodone with homatropinea (Hydromet) 6. Hydrocodone with chlorpheniramine (Tussionex)

Some CNS side effects, behavioral disturbances, respiratory depression reported, especially with large doses Ester-type anesthetic

Nonnarcotic 1. Benzonatate (Tessalon) 2.

Dextromethorphan (Delsym)

Read and carefully follow the directions on the product label Start with a low dose of antitussive and increase only if cough suppression does not occur

3.

Dextromethorphan with guaifenesin (Robitussin DM)

Avoid use with alcohol and other CNS depressants

4.

Diphenhydramine (Benadryl)

Caution those operating machinery because of sedative effects

Antihistamines

First generation:

First generation:

First generation:

First generation:

First generation

Provide symptomatic relief of allergy symptoms caused by histamine release; some also used in the

Drying of secretions, especially of the eyes, ears, nose, and throat

COPD

Avoid frequent or prolonged use

1. Azelastine (Astelin, Astepro) 2.

Chlorpheniramine (Chlor-Trimeton,

Sedation,

Asthma Persons operating machinery or

Do not use to sedate children; no self-medication (check with the

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66

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Aller-Chlor)

symptomatic treatment of vertigo associated with pathology of the middle ear or in the prevention and treatment of motion sickness

dizziness, tachycardia, and hypotension, especially in older adults

driving a car

Muscular weakness and decreased coordination; cognitive impairment

Cardiovascular disorders

health care provider first) in those with COPD or cardiovascular disorders, BPH, older adults, and children

3. Clemastine (Tavist Allergy) 4.

Diphenhydramine (Diphenhist, Benadryl Allergy, Benadryl) Second generation 1. Certrizine (Zyrtec) 2. Desloratadine (Clarinex) 3. Fexofenadine (Allegra) 4. Levocetirazine (Xyzal) 5. Loratadine (Claritin, Alavert)

Diphenhydramine: Also approved as an antitussive, night time sleep aid, and antiemetic Second generation: Provide symptomatic relief of allergy symptoms

Urinary retention and constipation Visual disorders Paradoxical excitement, insomnia, and tremors, especially in children GI—nausea, vomiting, anorexia Nasal irritation, epistaxis, bitter taste with nasal spray Second generation: Usually mild, can include: Headache, Dizziness

Older adults Closed-angle glaucoma

BPH Use with children under the age of six years Pregnancy, breast feeding Seizure disorders Second generation: Asthma Renal and hepatic impairment Hydroxyzine (Vistaril) Allergy with Zyrtec Driving or operating machinery Pregnancy, breast feeding, use in children less than two years of age

Caution with those driving or operating machinery Do not use with alcohol or any other CNS depressant drugs Second generation: Avoid any other drug, including OTC, without consulting health care provider first Report symptoms such as fainting, dizziness, or palpitations to health care provider immediately Use caution with driving or operating machinery until you know how these drugs affect you

Fatigue, Drowsiness Dry mouth

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67

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Cardiovascular disorders

Use decongestants for only a few days (three days for nasal; seven days for oral) to avoid rebound congestion

Pharyngitis Claritin/allegra: Rare Decongestants 1. Oxymetazoline (Afrin) 2. Phenylephrine (Neo-Synephrine, Sudafed PE)

Shrink swollen mucous membranes and help open nasal airway passages

Anxiety Nervousness Insomnia Tremor Seizures

3.

Pseudoephedrine (Sudafed)

Palpitations Tachycardia Hypertension

Hyperthyroidism Diabetes Older adults— especially those with glaucoma or BPH Pregnancy, breast feeding

Headache

Discontinue with side effects

Cerebral hemorrhage

Avoid combining with other medications without health care provider consultation

Reduced cardiac output and reduced urine output Burning, stinging, sneezing, and dryness with nasal preparations Smoking Cessation Aids Nicotine replacement products 1. Nicotine (Nicorette, Commit, Nicoderm CQ, Nicotrol NS, Nicotrol inhaler)

Avoid when cardiac or thyroid conditions or diabetes are present

Nicotine replacement products:

Nicotine replacement products:

Nicotine replacement products:

Nicotine replacement products:

Lessen withdrawal symptoms by slowly lowering the level of nicotine in the body

Mechanical problems with chewing gum, especially if patient has dentures

Patients with dental problems that might be exacerbated by chewing gum

Warn patients not to smoke

Bupropion: Decreases cravings

Cardiac

Drug abuse and/or

Proper disposal of product to avoid accidental ingestion by children and pets

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68

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classification and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

2. Bupropion (Zyban)

for cigarettes and lessens nicotine withdrawal

irritability

overdependence

Bupropion:

Chewing too fast—may cause lightheadedness , nausea, heartburn, vomiting, throat and mouth irritation

Overdosage

See Chapter 20

Pregnancy and breast feeding

Varenicline:

3. Oral antidepressant Nicotinic receptor agonist/antagonist 1. Varenicline (Chantix)

Varenicline: Alleviates the symptoms of nicotine craving and withdrawal

Skin reaction at application site

Severe unstable cardiovascular disease Bupropion: See Chapter 20

Bupropion:

Varenicline:

See Chapter 20

Serious psychiatric disorders such as schizophrenia, bipolar, and major depression

Varenicline: Mild-tomoderate nausea and vomiting

Report side effects to health care provider Take after a meal with fluids to lessen GI upset

Sleep disturbance Abnormal dreams

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69

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 18 Eye Medications Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Anti-Infective Drugs

Treatment of superficial infections of the eye caused by susceptible organisms

Hypersensitivity reactions such as conjunctivitis, irritation, local burning, stinging, blurred vision, rash, and urticaria in allergic persons

Anyone allergic to the drug

Anti-infective ophthalmic preparations:

Ophthalmic antibiotic preparations Antiviral ophthalmic preparations 1. Trifluridine (Viroptic)

Treatment of herpes simplex, keratitis (inflammation of the cornea), or conjunctivitis

Viral and fungal diseases of the ocular structure

Use only as directed Check dosage and for frequency Careful instillation into the lower conjunctival sac to avoid contamination of the tip of the dropper or ointment tube Possible hypersensitivity reactions in patients with allergies of any kind Discontinue medication and report immediately to a health care provider any signs of sensitivity (e.g., burning and itching) Careful handwashing to prevent spread of infection to other eye or other persons Do not use eye

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70

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education makeup or wear contact lenses while treating eye infections and replace any contact eye makeup and contacts due to possible contamination When using more than one ophthalmic product at the same time, space them at least 5 min apart (to ensure maximum absorption) and administer the more viscous preparation (i.e., ointment, suspension) last Trifluridine: Dose is one drop to the lower conjunctival sac of the infected eye up to nine times daily at 2h intervals while awake (maximum 9 drops/eye/day or 21 days per episode)

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71

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

AntiInflammatories

To relieve inflammation of the eye or conjunctiva in allergic reactions, burns, postoperatively, or irritation from foreign substances

Corticosteroids:

Corticosteroids:

Corticosteroids:

Increased intraocular pressure, depends on drug, dose, frequency, and length of treatment—less likely with fluorometholone

Acute bacterial, viral, or fungal infections

Should not be used for extended periods because of the danger of masking the symptoms of infection or slowing the healing process

Reduced resistance to bacteria, viruses, and fungi

NSAIDs:

Corticosteroids:

Corticosteroids 1.

Fluorometholone (FML) 2. Prednisolone (Pred Forte) 3.

Dexamethasone (Maxidex) NSAIDs 1. Flurbiprofen (Ocufen) 2. Ketorolac (Acular, Acular LS) Ophthalmic immunologic agent 1. Cyclosporine (Restasis)

Also useful in acute stages of eye injury to prevent scarring, for severe symptoms, or when the condition is unresponsive to other medications NSAIDs: Treatment of postoperative inflammation following cataract surgery Cyclosporine: Increases tear production

Primary openangle glaucoma Pregnancy Prolonged use

Caution with those allergic to aspirin or other NSAIDs

Delayed healing of Cyclosporine: corneal wounds, thinning of cornea, Caution with corneal ulceration patients with active ocular Stinging, burning, infections; topical or ocular pain has not been studied in patients Increased risk of with a history of developing herpes keratitis cataracts NSAIDs: Relatively safe, with few local or systemic side effects Ketorolac may sting or burn during application, alleviate this discomfort by refrigerating solution before use Cyclosporine: Mild and transient include ocular

Patients should avoid rubbing their eyes since this can worsen the condition Follow directions carefully regarding time and amount Lowered resistance to infection—do not use long term Administration (i.e., pressure on tear duct at inner corner to reduce systemic absorption) Avoid wearing contact lenses if eyes are red Remove lenses prior to using product; contacts may be reinserted for most products if eyes are not red Do not use leftover eye medication for

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72

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

burning, itching, stinging, pain, and blurred vision

Carbonic Anhydrase Inhibitors (CAIs) 1.

Acetazolamide (Diamox [oral]) 2. Trusopt (topical)

Decrease the formation of aqueous humor and have a diuretic effect.

Used in the adjunctive treatment of open-angle glaucoma or shortterm preoperatively to reduce intraocular pressure in angleclosure glaucoma, and is given with miotics Trusopt: Treatment of open-angle glaucoma Used as an adjunct to beta-blockers

new eye inflammation Discard drug when no longer needed

Acetazolamide:

Acetazolamide:

Nausea, vomiting

COPD

Diarrhea and constipation

Diabetes

Thirst, taste alteration; frequent urination Drowsiness Fatigue Confusion Seizures Numbness, muscular weakness, and tingling with high doses Blood dyscrasias; electrolyte imbalance

Patient Education

Electrolyte, hematological, hepatic, pulmonary, and renal disorders Sulfonamide hypersensitivity

Report side effects and response to the health care provider for appropriate dosage regulation Importance of follow-up with the health care provider

Pregnancy, breast feeding Trusopt: Sulfonamide hypersensitivity Concurrent ophthalmic and oral CAIs use

Hepatic and renal disorders (can lead to kidney stones) Photosensitivity Trusopt: Burning or stinging, blurred vision Bitter taste Direct-Acting Miotics

Increase the aqueous humor

Blurred vision and myopia

Angle-closure glaucoma with

Follow directions carefully regarding

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73

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

1. Pilocarpine HCl (Isopto Carpine, Pilocar)

outflow. Used in treatment of open-angle glaucoma or in short-term treatment of closed-angle glaucoma before surgery

Twitching, stinging, and burning

acute inflammation

time and amount

2. Pilocarpine gel (Pilopine HS)

Ocular pain and headache Photophobia and poor vision in dim light Aggravation of inflammatory processes of the anterior chamber of the eye

History of retinal detachment or retinal degeneration

Administer by closing tear duct after instillation

Acute inflammatory processes

Report side effects to health care provider for possible dose adjustment

Soft contact lenses in place

Take at bedtime to reduce side effects

Corneal abrasion

No night driving

Angle-closure glaucoma secondary to pupillary block from excessive miosis Cataracts, retinal detachment (due to ciliary muscle spasm) Systemic effects with frequent or prolonged use or high doses, especially in children, can include: Nausea, vomiting, and diarrhea Increased lacrimation, salivation, and sweating Hypotension, bradycardia

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74

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Bradycardia, heart failure, and heart block

Administer by closing tear duct after instillation to reduce systemic effects

Bronchospasm Beta-Adrenergic Blockers 1. Timolol (Timoptic) 2. Timolol 0.5% with dorzolamide 2% (Cosopt)

Decrease rate of aqueous humor production. Used to lower intraocular pressure in openangle glaucoma

Ocular irritation, tearing, conjunctivitis, or diplopia Transient blurred vision with the gel formulation Aggravation of preexisting cardiovascular or pulmonary disorders, which may cause bradycardia, hypotension, dizziness, and bronchospasm

3. Betaxolol (Betoptic S)

Patients receiving oral beta-blocker drugs Asthma and COPD Use with children Pregnancy, breast feeding Diabetes Hyperthyroidism Closed-angle glaucoma

Caution in patients with cardiac or pulmonary disorders or who are taking oral beta-blockers Importance of regular eye examinations Continuous use of medications for glaucoma; do not discontinue abruptly When administering more than one ophthalmic medication, allowing time interval (at least 5 min) between medications Ophthalmic solutions should always be used before gels and suspensions to optimize absorption of each medication

Alpha-Agonists 1. Brimonidine (Alphagan P)

Decrease production of aqueous humor and increase

Conjunctival redness, itchiness, stinging

Report side effects to the health care provider

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75

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

2. Brimonidine 0.2% with timolol 0.5% (Combigan)

outflow

Dizziness, drowsiness, dry mouth, and headache

Prostaglandin Analog

Increase aqueous outflow

1. Latanoprost (Xalatan)

Used to reduce intraocular pressure by increasing the outflow of aqueous humor

2. Travoprost (Travatan Z)

Alternative for those whom topical betablocker therapy is contraindicated

May be used concomitantly with other topical ophthalmic drugs to lower IOP

Blurred vision Burning, macular edema, stinging Slow, gradual change in the color of the iris (change may be permanent) Change in length, thickness, and pigmentation of eyelashes

Contraindications or Cautions

immediately May cause fatigue or drowsiness in some patients; take caution when engaging in hazardous activities Active intraocular Inform patients inflammation (may about the worsen condition) possibility of iris color change Contact lens wearers Contact health care provider Hepatic and renal immediately if disease ocular reactions Pregnancy, breast develop feeding, use in Prostaglandin children analogs contain a preservative that may be absorbed by contact lenses.

Remove lenses prior to administration of the drug and wait 15 min before reinserting

Systemic effects, including upper respiratory tract infection, muscle and joint pain

Mydriatics 1. Atropine 2.

Cyclopentolate (Cyclogyl) 3.

Phenylephrine (AK-Dilate)

Used to dilate the pupil for ophthalmic examinations

Increased intraocular pressure Local irritation, tearing, burning sensation (transient) Blurred vision (common) Flushing, dryness of skin, and fever Decreased

Patient Education

Angle-closure glaucoma Infants Phenylephrine Similar to those of epinephrine

Administer by closing tear duct after administration Use aseptic technique to prevent contamination of medication Blurred vision and sensitivity to light are to be expected (wear dark glasses

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76

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

salivation and sweating

Patient Education or stay out of bright light)

Confusion Phenylephrine Similar to those of epinephrine Local Anesthetics 1. Tetracaine (TetraVisc) 2. Proparacaine (Alcaine)

Used for minor surgical and diagnostic procedures, removal of foreign bodies, or painful injury

Rare, except with prolonged use but may include hypersensitivity (transient stinging), reactions such as anaphylaxis in those allergic to the “-caine” local anesthetics

Prolonged use due to danger of corneal erosion, delayed wound healing, and keratitis

Necessity of wearing an eye patch after use of tetracaine because of loss of blink reflex

Contraindicated for those allergic to “-caine” local anesthetics

Avoid touching or rubbing the eye until the anesthesia has worn off

Reactions Otic (Ear) Medications 1.Ciprofloxacin and dexamethasone (Ciprodex)

Used for outer ear infections

Minor side effects of burning or stinging

Use the drops for the prescribed amount of days.

2.Ciprofloxacin and hydrocortisone (Cipro HC) 3.Polymixin B, neomycin, and hydrocortisone (Cortisporin)

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77

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Topical Analgesics and AntiInflammatory Agents

Used to treat the pain and inflammation associated with ear infections.

Minor side effects of burning or stinging

Must be paired with a systemic antibiotic

None

If the earwax removal is not successful you may need to see an ENT specialist

1.Acetic acid and hydrocortisone (Vosol HC) 2.Benzocaine and antipyrine (Auralgan) Agents for Earwax Buildup

Always paired with a systemic antibiotic

Contraindications or Cautions

Patient Education

Soften, loosen, and remove excessive earwax

1. Carbamide peroxide (Debrox)

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78

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 19 Analgesics, Sedatives, and Hypnotics Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Opioids

Sedation

Head injury

1. Butorphanol

Used to alter the perception of pain

2. Codeine

Confusion, euphoria, restlessness, agitation

Cardiac disease, hypotension

Tramadol:

Headache

CNS depression

Dizziness

GI, hepatic, renal, and thyroid disease

Potential for physical and psychological dependence and tolerance with opioids, sedatives, and hypnotics

3. Fentanyl citrate (Duragesic) 4. Hydrocodone (Vicodin, Lortab) 5. Hydromorphone (Dilaudid) 6. Meperidine (Demerol) 7. Methadone (Dolophine) 8. Morphine sulfate immediate release (morphine) 9. Morphine extended release (MS Contin, Kadian) 10. Oxycodone (Percodan, Oxycontin, Percocet) 11. Tramadol (Ultram) 12. Tapentadol (Nucynta)

A centrally acting synthetic analog of codeine Has less potential for abuse or respiratory depression (although both may occur) Currently not classified as a controlled substance on the federal level

Hypotension and bradycardia Urinary retention; sexual dysfunction

COPD, asthma Sleep apnea

Nausea/vomiting Pregnancy, breast (usually resolves within feeding a few days) and Use with children constipation Respiratory depression Older adults Physical and/or emotional dependence; tolerance Blurred vision Seizures with large doses Flushing, rash, and pruritus (opiate agonists cause histamine release, especially codeine, morphine, and meperidine)

Debilitated patients Driving or operating machinery Addiction prone, suicidal, and alcoholic Opiate agonist hypersensitivity Abrupt drug discontinuation in patients taking opioids chronically

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Take only limited doses for short periods of time, except to relieve pain in terminal illness Caution with interactions; do not take any medications (except under close medical supervision) that potentiate CNS depression (e.g., psychotropics, alcohol, muscle relaxants, antihistamines, antiemetics, cardiac medications, and antihypertensive s) Serious potential side effects with prolonged use or overdose of opioids, sedatives, and

79

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education hypnotics Tolerance with prolonged use, with increasingly larger doses required to achieve the same effect Potential for overdose of sedatives or hypnotics and paradoxical reactions with older adults Withdrawal after prolonged use of sedatives and hypnotics possibly leading to rebound effects with nightmares, hallucinations, or insomnia Mental alertness and physical coordination impairment causing accidents or falls Caution regarding OTC analgesic and sleep aid combinations and checking ingredients on the label; being aware of possible side effects with those containing

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80

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education aspirin Do not discontinue abruptly Proper storage and disposal of these medications

Opioid Antagonist 1. Naloxone (Narcan)

Nonopioid Analgesics

Treatment of opioid overdose and in the operating room, delivery room, and newborn nursery for opiateinduced respiratory depression

1. Acetylsalicylic acid (ASA) (Ecotrin, Ascriptin)

Relief of mildto-moderate pain, fever, and antiinflammatory conditions

2. Aspirin (Bufferin)

Acetaminophe n:

3. Combinations of ASA and acetaminophen (Tylenol)

For mild-tomoderate pain and fever only; not antiinflammatory

Prolonged bleeding time

GI ulcer and bleeding

Bleeding and frequent bruising

Bleeding disorders in patients taking anticoagulants

Gastric distress, ulceration, and bleeding Tinnitus and hearing loss with overdose Hepatic dysfunction Renal insufficiency, decreased urine output with sodium and water retention, renal failure Drowsiness, dizziness, headache, sweating,

Asthma Use with children younger than age 15 with influenzalike illness (because of the danger of Reye’s syndrome) Treatment of pain with NSAIDs after heart surgery Pregnancy

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Minimized by administration with food or milk or by using an aspirin buffered with antacids or in enteric-coated form—keep out of reach of children (especially flavored children’s aspirin) Do not take with alcohol May increase or decrease the effects of some medications

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

euphoria, depression

Breast feeding

Acetaminophen:

Rash

Vitamin K deficiency

Use caution with frequent use and alcohol ingestion because of potential liver damage

Coma, respiratory failure, or anaphylaxis, which can result from hypersensitivity or overdosage, especially with children

Allergy to ASA Acetaminophen:

Hypersensitivity to acetaminophen Poisoning—keep out of or any component of the reach of children combination (especially flavored product children’s aspirin) Acetaminophen: Severe liver toxicity Renal insufficiency (decreased urine output) Rash or urticaria Blood dyscrascias Adjuvant Analgesics

Tricyclics 1. Amitriptyline 2. Nortriptyline (Pamelor) 3. Desipramine

Used to enhance analgesic effect with opioids and nonopioids, produce analgesia alone, or reduce the side effects of analgesics Tricyclic antidepressant s used treatment of fibromyalgia and nerve pain associated

Tricyclic antidepressants

Tricyclic antidepressants

Tricyclic antidepressants

(more so with amitriptyline) can include:

Hypersensitivity

Take at bedtime

Recovery phase of myocardial infarction

Rise slowly from recumbent positions

Serotonin norepinephrine reuptake inhibitors:

Use caution with patients with prostatic hypertrophy, urinary retention, increased intraocular pressure, and glaucoma

Dry mouth, urinary retention, delirium, constipation Sedation Orthostatic hypotension Tachyarrhythmias Heart block in cardiac patients Serotonin norepinephrine

Narrow-angle glaucoma Hepatic (duloxetine, venlafaxine) or renal (milnacipran)

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Anticonvulsants:

82

Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

(Norpramin)

with herpes, arthritis, diabetes, and cancer, migraine or tension headaches, insomnia, and depression

reuptake inhibitors:

impairment

Sleep disturbance, headache, nausea, stomach pain

Abrupt discontinuation

Use caution with patients with allergies, hepatitis, cardiac disease, and renal disease

Serotonin norepinephrine reuptake inhibitors 1. Duloxetine (Cymbalta) 2. Milnacipran (Savella) 3. Venlafaxine (Effexor XR) Anticonvulsants

Serotonin norepinephrin e reuptake inhibitors:

2. Gabapentin (Neurontin)

Treatment of diabetic neuropathy and fibromyalgia

3. Lamotrigine (Lamictal)

Anticonvulsant s:

4. Pregabalin (Lyrica)

Management of nerve pain associated with neuralgia, herpes zoster (shingles), and cancer

1. Carbamazepine (Tegretol)

Diarrhea, constipation, dizziness, and sweating. Venlafaxine has the potential to increase blood pressure and heart rate Anticonvulsants: Sedation, dizziness, and confusion Nausea, vomiting, constipation, and anorexia Ataxia and unsteadiness Hepatitis (not Lyrica)

Patients with a history of suicidal ideation/behavior s, and substantial alcohol use Anticonvulsants: Hypersensitivity

Do not confuse Lamictal (anticonvulsant) with Lamisil (antifungal)

Psychiatric conditions (increased risk of suicidal ideation and behavior) Pregnancy SA (sinoatrial) and AV (atrioventricular) block (Tegretol)

Rash, Stevens–Johnson Hemolytic syndrome (Lamictal— disorders start low, slow titration (Tegretol) upward) Abrupt Bone marrow discontinuation suppression BPH Nystagmus, diplopia, blurred vision Gingivitis (gabapentin) Weight gain and peripheral edema (pregabalin)

Local Anesthetic 1. Lidocaine (Lidoderm)

Management of postherpetic neuralgia and other forms of

Generally mild and transient and include:

Sensitivity to local anesthetics

Erythema, edema, and hives

Hepatic disease

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The lidocaine patch must be applied to intact skin. Patches may be cut into

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Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

neuropathic pain, including diabetic neuropathy and musculoskelet al pain

Allergic reactions

Nonintact skin

smaller sizes with scissors before removal of the release liner

Pregnancy, breastfeeding, use with children Handling and disposal to prevent access by children or pets

To reduce the potential for serious adverse effects, patches are worn only once for up to 12 h within a 24-h period and then removed It may take up to two weeks to achieve desired outcomes

Antimigraine Agents Serotonin receptor agonists (SRAs) 1. Eletriptan (Relpax) 2. Frovatriptan (Frova) 3. Rizatriptan (Maxalt, MLT) 4. Sumatriptan (Imitrex) 5. Zolmitriptam (Zomig, Zomig-ZMT)

Treatment of migraine headaches Also effective in treatment of nausea and vomiting associated with migraines

Malaise, fatigue, dizziness, drowsiness Nausea, vomiting, diarrhea Asthenia, tingling, paresthesias, flushing Pain or pressure in the chest, neck, or jaw Arrhythmias, angina, palpitations, myocardial infarction, cardiac arrest

Patients with cerebrovascular or cardiovascular disease; uncontrolled hypertension Peripheral vascular disease Hepatic or renal disease Use in older adults (who are more likely to have decreased hepatic function and more pronounced blood pressure increases and are at risk for coronary artery disease) Pregnancy, breast

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

feeding, use in children Sedative-Hypnotics

Promote sleep

Benzodiazepines

Ramelteon acts on melatonin receptors, mimicking the actions of melatonin to trigger sleep onset

1. Ramelteon (Rozerem) 2. Temazepam (Restoril) 3. Triazolam (Halcion) Nonbenzodiazepin es

Dependence and abuse potential are eliminated, not classified as a controlled substance

Daytime sedation, confusion, and headache—hangover effect

Hypersensitivity

See Opioids

Severe liver impairment

Increased risk of falls (especially in older adults or with longacting hypnotics)

Coadministration of ketoconazole antifungals or protease inhibitors itraconazole with triazolam

Administer Ramelteon within 30 min of going to bed with a high fatty meal or snack

Dependence/withdraw al symptoms Amnesia, hallucinations, and bizarre behavior may occur more often with triazolam (Halcion) than with other benzodiazepines

Severe renal impairment

3. Zaleplon (Sonata)

Metallic aftertaste with Lunesta

Older adults

Melatonin receptor agonist

Sleep walking and engaging in complex tasks (i.e., sleep eating, sleep driving, and sleep sex)

Addiction prone

1. Eszopiclone (Lunesta) 2. Zolpidem (Ambien)

1. Ramelteon (Rozerem)

Porphyria (with BZDs) Abrupt discontinuation

Debilitated patients

Renal impairment Liver impairment Depressed and mentally unstable, suicidal individuals Pregnancy, breast feeding Use with children COPD Sleep apnea Ramelteon:

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Contraindicated with fluvoxamine (Luvox), which inhibits the metabolism of Ramelteon. Do not use Ramelteon with melatonin due to potential for additive sedative effects

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet 1 for Chapter 20 Psychotropics Classifications and Purpose Drugs

Side Effects

Contraindications or Cautions

Patient Education

CNS Stimulants

Nervousness

Caffeine:

Insomnia

Prolonged, high intake of caffeine in any form may produce tolerance, habituation, and psychological dependence

Warn patients about the potential side effects utilizing the Patient Medication Guide that is given out each time these products are dispensed

Stimulants 1. Caffeine citrate (Cafcit) 2.

Amphetamine mixtures (Adderall, Adderall XR) 3.

Lisdexamfetami ne (Vyvanse) 4.

Methylphenidat e (Ritalin, Concerta, Daytrana Patch) 5. Modafinil (Provigil)

Promote CNS functioning Caffeine citrate: Treatment of neonatal apnea to stimulate the CNS’s respiratory drive Amphetamine mixtures and methylphenidate: Treatment of attention-deficit hyperactivity disorder (ADHD) in children over age 6 and narcolepsy Modafinil: Treatment of narcolepsy, sleep apnea, and shiftwork sleep disorder in adults and adolescents (.>16 years old) Potential for abuse and dependence appears to be lower than that for the amphetamines and methylphenidate

Irritability Seizures or psychosis from overdose Tachycardia Palpitations Hypertension or arrhythmias Dizziness, headache, and blurred vision (dilated pupils with photophobia) Gastrointestinal (GI) disturbances, including anorexia, nausea, vomiting, abdominal pain, and dry mouth Habituation and dependence possible with prolonged use Modafinil: Infrequent and include: Mild headache, dizziness, nausea, and anorexia Anxiety, insomnia, depression, and

Physical signs of withdrawal such as headaches, irritation, nervousness, anxiety, and dizziness may occur upon abrupt discontinuation of the stimulant.

Excessive consumption of caffeine (especially when taken with alcohol or other drugs) can lead to life-threatening irregular heartbeats, heart attacks, and seizures Treatment of obesity Anxiety or agitation History of drug dependence, alcoholism, or eating disorders

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Caution patients about the potential for abuse and the need to take medications only as prescribed by health care provider Medication should be taken early in the day to reduce insomnia Abrupt withdrawal may result in depression, irritability, fatigue, agitation, and disturbed sleep Parents of children receiving amphetamines and

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Purpose Drugs

Side Effects

Contraindications or Cautions

Patient Education

mood changes

Hyperthyroidism

Hypertension, palpitations, tachyarrythmia

Cardiovascular disorders

methylphenidate should watch for signs of tics, gastric disturbance, insomnia, weight loss, or nervousness, and report these immediately to the health care provider

Closed-angle glaucoma (not modafinil) Pregnancy, breast feeding Abrupt withdrawal, depression results Use with MAOI may cause hypertensive crisis Caution with sustained release preparations differing designations (CD, ER, LA, SR) and their respective dosing requirements Pediatric precautions: Prolonged administration of CNS stimulants to children with ADHD has been reported to cause at least a temporary suppression of normal weight and/or height patterns in some patients, and therefore close monitoring is required. Growth rebound has been

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Warn patients about potential dangerous cardiovascular side effects Do not chew or crush sustained release products Parents and caregivers should be educated about the potential for abuse with stimulants and signs of abuse such as running out of medication early, rapid weight loss, and unusual changes in behavior Warn those taking modafinil about the necessity for regular sleep in sufficient amounts to restore mental

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Purpose Drugs

Side Effects

Contraindications or Cautions

Patient Education

observed after discontinuation, and attainment of normal adult weight and height do not appear to be compromised.

CNS stimulants, including amphetamines, have been reported to exacerbate motor and vocal tics and Tourette disorder, and clinical evaluation for these disorders in children and their families should precede use of the drugs. Children should also be observed carefully for development of tics while receiving these drugs

and physiological functioning to an optimal level Caffeine: Those who are pregnancy (due to a higher risk of miscarriage) breastfeeding should avoid or limit their consumption of foods, beverages, and drugs containing caffeine All sources of caffeine should be included when calculating one’s daily intake

Modafinil: Cautions for the use of modafinil include: Possible causes of fatigue and sleepiness should be determined before stimulant medicines are prescribed to increase wakefulness.

Without adequate investigation, some common disorders, such as diabetes

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Classifications and Purpose Drugs

Side Effects

Contraindications or Cautions

Patient Education

and sleep apnea, might go undiagnosed.

Reducing the necessary amount of restorative sleep for prolonged periods of time can result in mental and physical problems, especially neurological and cardiovascular effects Selective Norepinephrine Reuptake Inhibitor for ADHD Nonstimulant 1. Atomoxetine (Strattera)

Tricyclics 1. Amitriptyline 2. Desipramine (Norpramin) 3. Doxepin 4. Imipramine (Tofranil) 5. Nortriptyline (Pamelor)

Treatment of ADHD in adolescents and children more than six years old and adults

Dry mouth, reduced appetite, fatigue

Narrow-angle glaucoma

Nausea, vomiting, constipation, dyspepsia

Cerebrovascular, heart disease

Noncontrolled drug that does not have a potential for abuse, has less insomnia, has less effect on growth

Urinary hesitation/retention

Potentiate norepinephrine and serotonin activity by blocking their reuptake

Dryness of mouth

Treatment of depression

Increased risk of suicidal tendencies in children and adolesents (“blackbox” warning)

Increased appetite and weight gain Drowsiness Dizziness Blurred vision Constipation Urinary retention, especially with BPH Sexual dysfunction

Hepatic disease Possible growth disturbance during treatment

Cardiovascular, GI, renal, or liver disorders Older adults Glaucoma Obesity Seizure disorders Pregnancy, breast feeding Concomitant use

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May be lethal in overdose May have delayed action, elevating the mood and increasing alertness after 2–4 weeks.

Frequently given at bedtime because of a mild sedative

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Purpose Drugs

Side Effects

Contraindications or Cautions

Postural with MAOIs hypotension, cardiac arrhythmias, SSRIs—increase tricyclic blood and palpitation levels Confusion, especially in older adults

Patient Education effect Use with caution (if at all) in the older adult— may increase risk of falls. Tricyclics may be more effective than SSRIs in some severe depression Used as an adjunct in neuropathic pain control

MAOIs 1. Isocarboxazid (Marplan) 2. Phenelzine (Nardil) 3.

Tranylcypromin e (Parnate)

Increase the concentrations of serotonin, norepinephrine, and dopamine in the neuronal synapse by inhibiting the MAO enzyme that degrades or breaks down these neurotransmitters Treatment of depression

Nervousness, agitation Insomnia Headache Stiff neck Hypertension Hypertensive crisis (could be fatal) Tachycardia, palpitations, chest pain

Patients with cerebrovascular, heart, liver, and renal disease

Abrupt discontinuation

Rarely used today because of potential serious side effects and numerous food, herbal, and drug interactions.

They cannot be given until two weeks after tricyclics and other interacting drugs have been discontinued.

Typically reserved for treatment of refractory or atypical depression or those associated with panic disorder or phobias

Liver or renal impairment

Therapy may be required for

Use with children under 16 years of age Pregnancy, breast feeding

Nausea, vomiting, and diarrhea Blurred vision

SSRIs 1. Citalopram

Selectively block the reabsorption

Sexual dysfunction Nausea and other

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Classifications and Purpose Drugs (Celexa) 2. Escitalopram (Lexapro) 3. Fluoxetine (Prozac) 4. Paroxetine (Paxil) 5. Sertraline (Zoloft)

of the neurotransmitter serotonin, thus helping to restore the brain’s chemical balance First-line medication for treatment of depression

Side Effects

Contraindications or Cautions

Patient Education

GI effects are the most common side effects during the first two weeks of therapy but are often transient in nature

Suicide prone

several months or longer.

Symptomatic relief may require 1–4 weeks, and there is prolonged elimination of the drug.

Insomnia, anxiety, nervousness, tremor, drowsiness, fatigue, dizziness, headache Bleeding Hyponatremia

Diabetes Bipolar disorders— may precipitate manic attacks Underweight, eating disorders Pregnancy (especially paroxetine), breast feeding Abrupt discontinuation

QT prolongation with citalopram (Celexa) that can lead to abnormal heart rhythm, which can be fatal

Selective Norepinephrine Reuptake Inhibitors (SNRIs) 1.

Desvenlafaxine (Pristiq) 2. Duloxetine (Cymbalta) 3. Venlafaxine (Effexor XR)

Inhibit the reuptake of both serotonin and norepinephrine

See Chapter 19

See Chapter 19

Do not significantly affect cognition in older adults.

Fluoxetine and escitalopram (Lexapro) are the only antidepressants recommended for treatment of MDD in adolescents (aged 12–17 years), and fluoxetine is also approved for children aged eight years and older See Chapter 19

Treatment of depression Used for treatment of chronic pain (neuropathic pain, fibromyalgia, musculoskeletal pain)

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Purpose Drugs

Side Effects

Contraindications or Cautions

Heterocyclics

Drowsiness, common (except bupropion)

Suicide prone

1. Buproprion (Wellbutrin) 2. Mirtazapine (Remeron) 3. Trazodone

Treatment of depression Buproprion: Useful in helping to reduce relapse rates in persons who are quitting smoking and for patients who experience sexual dysfunction with other antidepressants Mirtazapine: Useful in treating agitated depression, mixed anxiety and depression, and fibromyalgia Trazodone: Useful in higher doses in older adult patients for agitation secondary to dementia and to treat activation side effects caused by the SSRIs

Insomnia, restlessness, agitation, anxiety (with bupropion) Dry mouth, nausea, dizziness, confusion

Patient Education

Patients with anorexia, bulimia (buproprion) Seizure disorders Cardiac disorders Liver disorders

Priapism or impotence— discontinue the drug (trazodone) Weight gain (mirtazapine, trazodone) Buproprion: Risk for seizures, which increases with higher doses Trazodone: Highly sedating

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet 2 for Chapter 20 Psychotropics (Continued) Classifications and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Antimanics

Treatment of bipolar disorders

Lithium:

Lithium:

Lithium:

GI distress, usually initially and resolves

Seizure disorders

Establish maintenance dose by monitoring blood levels

1. Lithium (Lithobid) 2. Carbamazepine (Tegretol, Tegretol XR) 3. Lamotrigine (Lamictal) 4. Valproate (Depakote DR, Depakene, Depakote ER) 5.

Olanzapine/fluoxet ine (Symbyax)

Lithium:

Approved for treatment of mania Cardiac and for treatment and arrhythmias prophylaxis of bipolar and disorder hypotension Olanzapine/fluoxetine Thirst and : polyuria First FDA-approved (dehydration combination product may cause for the depressive acute toxicity) phase of bipolar Weight gain disorder Tremors can be treated with propranolol

Parkinsonism Cardiac disorders Renal disorders Older adults and debilitated patients Thyroid disease

Thyroid problems— hypothyroidism , goiter

Serum levels are checked seven days after starting or changing the lithium dose and once a stable dose is established every 6–12 months to maintain a level of 0.8–1.25 mEq/mL. Patients must be monitored and alerted for signs of toxicity Take lithium with meals

Antianxiety Medications Benzodiazepines 1. Alprazolam (Xanax) 2.

Chlordiazepoxide 3. Clorazepate

Benzodiazepines:

Depression

Short-term-only treatment of anxiety disorders, some psychosomatic disorders and insomnia, alcohol withdrawal, nausea and vomiting

Hallucinations Confusion Agitation Bizarre behavior

Mental depression Suicidal tendencies Depressed vital signs Pulmonary disease,

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Do not take grapefruit juice with benzodiazepines Potentially lethal overdose when mixed with alcohol or opioids

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(Tranxene) 4. Diazepam (Valium Diastat) 5. Lorazepam (Ativan) 6. Midazolam (Versed) 7. Oxazepam Other anxiolytics 1. Buspirone (Buspar) 2. Hydroxyzine (Vistaril)

Used as muscle relaxants, anticonvulsants, preprocedure or preoperatively for sedation induction Midazolam: Used preoperatively to relieve anxiety and provide sedation, light anesthesia, and amnesia of operative events Drug of choice for short surgical procedures

Amnesia Drowsiness, lethargy Headache Ataxia, tremors Increased risk of falls in older patients by ~50% Rash and itching Sensitivity to light Midazolam:

Buspirone:

Depressed respiration with For treatment of large doses, generalized anxiety disorder but not other especially in older adults anxiety disorders; does not have activity and those with COPD against depression Paradoxical reactions (agitation or involuntary movements) occur occasionally Nausea and vomiting occasionally Buspirone: Fewer and less severe, may include: Dizziness, drowsiness Headache

respiratory depression Pregnancy, breast feeding Use with children Liver or kidney dysfunction Older adults and debilitated patients (paradoxical reactions), prolonged elimination time Persons operating machinery Midazolam:

Midazolam: Dosage must be individualized dosage for age, weight, clinical condition, and procedure Buspirone: Takes up to 2–4 weeks for optimum effect; therefore, ineffective on a PRN basis It has little potential for tolerance or dependence— may be used for as long as a year

Electrolyte imbalance, renal impairment Congestive heart failure Use with children Pregnancy Acute narrowangle glaucoma Watch for apnea, hypoxia, and/or cardiac arrest Monitor respiratory status continuously during parenteral use Have facilities and equipment for respiratory

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GI effects Hydroxyzine: Drowsiness, ataxia, dizziness Urinary retention, Mydriasis Antipsychotic Medications Phenothiazines 1. Chlorpromazine

Block dopamine receptors. Atypical antipsychotics block both serotonin and transiently block dopamine receptors Relief of symptoms of psychoses including delusion, hallucinations, agitation, and combativeness

2. Fluphenazine 3. Perphenazine 4. Prochlorperazine 5. Thioridazine 6. Trifluoperazine Butyrophenone 1. Haloperidol (Haldol) Atypical 1. Aripiprazole (Abilify) 2. Clozapine (Clozaril Fazaclo ODT) 3. Olanzapine (Zyprexa) 4. Paliperidone

Relief of nausea and vomiting

Typical antipsychotics: Side effects differ based upon the potency Postural hypotension, tachycardia, bradycardia, and vertigo Anticholinergic effects (see Chapter 13): dry mouth, constipation, urinary retention, blurred vision, fever, confusion, restlessness, agitation, and headache

and cardiovascular support readily available Monitor vital signs carefully for changes in blood pressure or decrease in heart rate Hydroxyzine: GI, hepatic, respiratory, and urinary disorders Closed-angle glaucoma Older adults Pregnancy (especially first trimester) Seizure disorders Parkinsonian syndrome Cerebrovascular disease Severe depression Pregnancy

Blood dyscrasias Jaundice, rash, photosensitivity Cautions: or Older adults hypersensitivity reactions Children Prolactin elevation Extrapyramidal reactions (EPS), severe CNS adverse effects,

Hepatic, renal, or cardiovascular disease Prostatic hypertrophy

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Assess patients receiving antipsychotic medication for TD at the start of treatment and at least every six months with the Abnormal Involuntary Movement Scale (AIMS) Potential for psychological and/or physical dependence with prolonged use Caution in taking medication only in prescribed dosage and for limited period of time under medical supervision Report adverse side effects to health care provider at once Avoid chemical abuse and obtain professional treatment when these conditions

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(Invega, Invega Sustenna) 5. Quetiapine (Seroquel, Seroquel XR) 6. Risperidone (Risperdal, Risperdal Consta) 7. Ziprasidone (Geodon)

include:

Diabetes

Parkinsonian symptoms; for example, tremors, drooling, dysphagia— more common in older adults Tardive dyskinesia (TD) (involuntary, and may be irreversible, abnormal orofacial movements such as tics)— more common in older adults, especially females Dystonic reactions (spasms or abnormal muscle tone of the head, neck, or tongue)— more frequent in children Akathisia (uncontrollable motor restlessness)— more common in children Atypicals: Agranulocytosis with clozapine (can be fatal) Metabolic effects (increased risk

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exist Possible severe withdrawal reactions (e.g., seizures) after prolonged use of psychotropic medications Do not withdraw abruptly Medical supervision is indicated for prolonged administration of any of the psychotropic drugs Caution with interactions Do not take other medications including eye drops except under close medical supervision Do not take grapefruit juice with the benzodiazepines , especially alprazolam and diazepam Older adult patients are more at risk for the side effects Rise slowly Avoid operating machinery or driving while taking these drugs

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of hyperglycemia, insulin resistance, diabetes, weight gain, and elevated cholesterol)

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Avoid taking any OTC drugs, alcohol, or herbal supplements without medical supervision

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet 3 for Chapter 20 Drug Abuse Drug

Side Effects and Signs of Abuse Emotional lability, irritability, anorexia Mental impairment, confusion, amnesia, neurotoxicity Occupational deterioration, social withdrawal Continuous chewing or teeth grinding, resulting in trauma or ulcers of the tongue and lip Photophobia—frequently wearing sunglasses indoors

Amphetamines

Paranoid syndrome with hallucinations with prolonged use of high doses Tooth decay (meth mouth) Cardiovascular symptoms: strokes to circulatory collapse Dilated pupils, diaphoresis, and hyperpyrexia Mental disturbances such as confusion, delirium, belligerence, combativeness, restlessness, paranoia, and suicidal or homicidal tendencies Fatigue and depression following CNS stimulation Short-term memory loss, impaired learning, and slowed intellectual performance Perceptual inaccuracies, impaired reflex reaction (dangerous with driving) Apathy, lethargy, decreased motivation Increased heart rate, anxiety, and panic attacks

Marijuana

Lung irritation, chronic cough, frequent respiratory infections Reduced testosterone level and sperm count Reduced estrogen level, crossing of placental barrier, and transmission through mother’s milk; miscarriage and still-birth possible Delayed development of coping mechanisms in children and adolescents Euphoria, agitation, excitation Hypertension, chest pain, tachycardia, cardiac arrhythmias, or cardiac failure

Cocaine

Tremors, seizures Hallucinations, psychosis, possible violent behavior Respiratory failure, strokes, and possible death from circulatory collapse

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Perforated nasal septum from prolonged nasal use

Increased pulse and heart rate and rise in blood pressure and temperature Possible “flashbacks” months later Hallucinogens

Panic, paranoia (lack of control) Possible psychotic episodes; chronic mental disorders Possible physical injury to self or others

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Worksheet for Chapter 21 Musculoskeletal and Anti-Inflammatory Drugs Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Skeletal Muscle Relaxants

Reduce muscle spasm, cause alterations in the perception of pain, and produce a sedative effect, promoting rest and relaxation of the affected part

Drowsiness

Hypersensitivity to the muscle relaxant

Inform patient to take care with driving due to potential side effects

Dantrolene:

Headache

Causes a direct effect on skeletal muscles

Confusion and nervousness

1. Baclofen (Lioresal) 2. Carisoprodol (Soma) 3. Cyclobenzaprine (Flexeril) 4. Dantrolene (Dantrium) 5. Methocarbamol (Robaxin) 6. Tizanidine (Zanaflex)

Used in the management of spasticity resulting from upper motor neuron disorders such as multiple sclerosis or cerebral palsy.

Ineffective for ALS Not indicated for the treatment of muscle spasms resulting from rheumatic disorders or musculoskeletal trauma

Dizziness Dry mouth Weakness

Pregnancy, breast feeding

Tremor, ataxia

Cautions:

Seizures

History of drug abuse

Slurred speech Blurred vision Hypotension GI symptoms, including nausea, vomiting, diarrhea, or constipation Urinary problems, including enuresis, frequency, or retention

Impaired kidney function Liver disorders Blood dyscrasias COPD Cardiac disorders Older adults Abrupt discontinuation Closed-angle glaucoma

Respiratory depression Hypersensitivity reactions including liver toxicity with dantrolene and tizanidine

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Avoid other CNS depressants at the same time due to serious CNS depression Take other medications only as prescribed by a health care provider Importance of following the health care provider’s orders regarding rest and physical therapy and exercises as prescribed to strengthen the weak muscles The acronym PRICE (prevention, rest, ice, compression [elastic bandage], elevation) represents

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

appropriate care initially for musculoskeletal injuries to extremities Take medication only as long as absolutely necessary and observe caution regarding prolonged use, which could lead to physical or psychological dependence and withdrawal symptoms (e.g., seizures from abrupt baclofen or diazepam [Valium] withdrawal after prolonged use) NSAIDs Nonselective (traditional) NSAIDs 1. Diclofenac (Voltaren XR, Voltaren, Flector) 2. Ibuprofen (Motrin, Motrin IB, Advil [OTC], Caldolor) 3. Indomethacin (Indocin) 4. Ketorolac 5. Naproxen (Naprosyn, Anaprox, Aleve

Inhibit synthesis of prostaglandins Treatment of musculoskeletal system malfunctions caused by inflammation

GI ulceration and bleeding—may not be preceded by warning signs or symptoms Epigastric pain Nausea Heartburn and GERD Myocardial infarction, thromboembolism, stroke, hypertension, heart failure Fluid retention, peripheral edema

Asthma—may manifest aspirin sensitivity as bronchospasm Cardiovascular disorders—may cause fluid retention and edema Kidney disease Liver dysfunction History of GI ulcer or inflammatory bowel disease Blood dyscrasias, especially clotting disorders or

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Administration with milk or meals to reduce gastric side effects Caution with dosage—follow health care provider’s directions carefully regarding amount of drug Discontinue drug and report to health care provider any sign of abnormal

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[OTC])

Constipation

anemia

Partially selective NSAIDs

Tinnitus and hearing loss

Children with viral infections

1. Etodolac

Headache or dizziness

GERD

2. Meloxicam (Mobic) 3. Nabumetone Selective COX-2 inhibitor 1. Celecoxib (Celebrex) Combinations 1.

Diclofenac/misopr ostol (Arthrotec)

Visual disturbances Hematuria and albuminuria Rash, hypersensitivity reactions, bronchospasm (especially with aspirin) Blood dyscrasias, especially prolonged bleeding time; anemia Liver toxicity Celebrex: Celebrex (and the partially selective NSAIDS): potential to cause fewer gastric problems and pose less risk of GI bleeding unless used concurrently with aspirin

Older adults Pregnancy, breast feeding Those with aspirin and NSAID hypersensitivity Those with sulfonamide hypersensitivity should not take Celebrex Traditional NSAIDs and the COX-2s can increase the risk of adverse events (recurrent MI or death) in patients who have a history of or who are at high risk for cardiovascular disease If NSAIDs are prescribed, current evidence suggests that naproxen may have the best cardiovascular safety profile

bleeding (gums, stool, urine, and bruising), epigastric pain or nausea, ringing in the ears or hearing loss, visual disturbances, weight gain or edema, and skin rash Avoid taking any other drugs, including prescribed or OTC, without checking first with a health care provider or pharmacist When taking gout medications, always take large amounts of fluids Avoid alcohol Avoid taking large amounts of aspirin or other NSAIDs with kidney, liver, or heart disease or with history of GI ulcer (with these conditions, take only under medical supervision) Patients with asthma may manifest

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sensitivity to aspirin and other NSAIDs The danger that GI ulceration and bleeding can occur without previous warning signs or symptoms Discontinue NSAIDs 7–14 days (or as directed) before elective surgery or dental procedures Do not take Celebrex if allergic to sulfa Osteoporosis Therapy Hormones Selective estrogen receptor modifier 1. Raloxifene (Evista) Calcitonin-salmon 1. Calcitoninsalmon (Miacalcin)

Prevention and treatment of osteoporosis

Raloxifene:

Raloxifene:

Hot flashes

Raloxifene:

Muscle cramps in the legs

Pregnancy and women with a history of thromboembolic disorders

Increases bone mineral density, decreases bone reabsorption, and reduces fracture risk without promoting breast or endometrial cancer

Parathyroid hormone

Calcitoninsalmon:

1. Teriparatide (Forteo)

Increases spinal bone density and provides an analgesic effect in acute vertebral fractures

Bisphosphonates 1. Alendronate (Fosamax)

Calcitonin-salmon: Local nasal effects (e.g., irritation, redness, rhinitis, and epistaxis [nose bleed]) Teriparatide: Nausea Hypotension, dizziness, Arthralgia (joint pain) and leg cramps

Teriparatide: Safety and efficacy beyond two years/lifetime has not been established and is not recommended Bisphosphonates: Hypocalcemia Renal failure Drugs associated with gastric irritation (ASA,

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Take with a full glass of water at least 30 min before the first food, beverage, or medication of the day Do not lie down or eat or drink anything else for at least 30 min after taking Contact health care provider if patient experiences pain while swallowing, difficulty swallowing, or worsening heartburn;

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2. Ibandronate (Boniva) 3. Risedronate (Actonel)

Teriparatide:

Bisphosphonates:

Increases GI calcium absorption and renal tubular reabsorption of calcium, increasing bone mineral density, bone mass, and strength

GI distress, nausea, Drugs that are dyspepsia, nephrotoxic esophagitis Inability to sit Abdominal pain upright for 30–60 min after taking Chest pain drug Bone and Caution with musculoskeletal bisphosphonates pain and active upper

Bisphosphonates: Nonhormonal— act directly to inhibit bone reabsorption, thereby increasing bone mineral density at the spine and hip, as well as decreasing the incidence of first and future fractures also indicated for management of Paget’s disease of the bone, incidence of first and future fractures

NSAIDs)

GI problems; for example, dysphagia, GERD, gastritis, or ulcers Caution: Upper GI problems

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thigh or groin pain Take supplemental calcium and vitamin D Do weightbearing exercises Calcitoninsalmon: Store the unopened bottle of calcitonin in the refrigerator.

Once the pump has been activated, store at room temperature in an upright position.

Discard all unrefrigerated bottles after 30 days

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Worksheet 1 for Chapter 22 Anticonvulsants and Antiparkinsonian Drugs Classifications and Drugs

Purpose

Side Effects

Contraindicatio ns or Cautions

Patient Education

Anticonvulsants

Prophylactic treatment of seizures

Carbamazepine:

Carbamazepine:

Ataxia, syncope, visual difficulties

Kidney, liver, or cardiovascular disease

Read the provided Medication Guide before starting to take an anticonvulsant and with each a refill

First generation 1.

Carbamazepine (Tegretol, Tegretol XR)

Carbamazepine:

2. Clonazepam (Klonopin)

Clonazepam, ethosuximide and valproic acid:

3. Fosphenytoin (Cerebyx) 4. Phenytoin (Dilantin) 5. Ethosuximide (Zarontin) 6. Valproic acid (Depakene, Depakote)

Generalized or mixed seizures

Risk for hyponatremia Cardiac, hematological, kidney, liver, and pancreas complications

Treatment of Rash; for example, absence seizures Stevens–Johnson (more likely to occur Phenytoin: in Asian patients who test positive for Prophylactic an inherited variant treatment of generalized and of an immune system gene HLA partial seizures B1502 allele, FDA Valproic acid: recommends genetic testing patients of “broadAsian descent prior spectrum” to starting therapy) anticonvulsant, useful for the management of many seizure types, including generalized tonic-clonic, absence, and myoclonic seizures

Drugs for absence epilepsy: Sedation, dizziness, headaches, aggression, or irritability GI distress including anorexia, nausea, vomiting, diarrhea Rash, blood dyscrasias Phenytoin:

Diabetes Pregnancy, breast feeding Hematological disease Drugs for absence epilepsy: Extreme caution: Hepatic or renal disease

Caution with driving or operating machinery until regulated with the medication Report side effects, Careful oral hygiene until tenderness of the gums subsides Always take medication on time Never omit dosage

Pregnancy, breast feeding

Do not discontinue medication abruptly

Phenytoin:

Wearing Medic-Alert tag or bracelet at all times in case of accident or injury

Kidney or liver disease Diabetes Heart failure, bradycardia, heart block, and hypotension Pregnancy, breast feeding Hematological disease Abrupt

Take medication with food or milk to lessen stomach upset Do not take medication with grapefruit juice Anticonvulsants are associated with numerous and potentially harmful drug interactions;

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Classifications and Drugs

Purpose

Side Effects

Contraindicatio ns or Cautions

Patient Education

Sedation

discontinuation

Ataxia

Valproic acid:

Dizziness

Extreme caution:

check with health care provider before initiating new treatments, including OTC and herbal products

Headache Blurred vision, nystagmus, and diplopia Gingivitis GI distress, including nausea, vomiting, anorexia, constipation, or diarrhea Rash, dermatitis, Stevens–Johnson, lupus-like symptoms Megaloblastic anemia Osteomalacia syncope, arrhythmias, and hypotension with IV use Valproic acid: Weight gain, dyspepsia Alopecia, rash, tremor Hepatotoxicity, lifethreatening pancreatitis (blackbox warning), blood dyscrasias

Hepatic or renal disease Pregnancy, breastfeeding

Parents and teachers should be cautioned to observe and report changes in cognitive function, mood, and behavior in children Some anticonvulsants cause an increased risk of birth defects if used during pregnancy; women of childbearing age should be educated on using proper contraception Increased risk of suicidal ideation and behavior in patients receiving anticonvulsants to treat epilepsy, psychiatric disorders, or other conditions All patients beginning treatment with anticonvulsants or currently receiving such treatment should be closely monitored for emerging or worsening suicidal thoughts/behavior, or depression, and/or unusual changes in

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Classifications and Drugs

Purpose

Side Effects

Contraindicatio ns or Cautions

Patient Education mood or behavior Phenytoin may decrease the effectiveness of oral contraceptives Dosage adjustments may be needed with valproic acid in hepatic and renal disease

Second generation 1. Gabapentin (Neurontin) 2. Lamotrigine (Lamictal) 3.

Levetiracetam (Keppra)

Adjuvant treatment of partial and generalized seizures

Use with caution in pregnancy, breast feeding Do not discontinue abruptly

See first-generation anticonvulsants Require a slow titration period to avoid CNS adverse effects and to minimize potential of a severe lifethreatening rash with lamotrigine

4.

Oxcarbazepine (Trileptal) 5. Topiramate (Topamax)

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Classifications and Drugs

Purpose

Side Effects

Contraindicatio ns or Cautions

Patient Education

Antiparkinsonian Drugs

Enhances the effects of levodopa, thereby increasing the therapeutic effect of dopamine in the CNS and reducing its adverse reactions

Numerous and frequent, can include:

Discontinuing abruptly

Administer on a regular schedule as prescribed, with food to lessen GI distress; give carbidopa/levodopa with a low-protein meal if food is necessary to offset nausea

Dopamine replacement agents 1. Carbidopa and levodopa (Sinemet, Parcopa, Sinemet CR)

Most often used for long-term treatment Recommended as initial drug treatment for patients with bradykinesia uncontrolled by other Parkinson’s disease (PD) medications

Dyskinesias Nausea, vomiting, anorexia Behavioral changes, Anxiety, agitation, confusion, sleep disturbances, depression, hallucinations, psychosis Hypotension, dizziness, syncope

Bronchial asthma or emphysema Cardiac disease or hypotension Active peptic ulcer Diabetes, Renal or hepatic disease Glaucoma Psychoses Pregnancy, postpartum or breastfeeding

Avoid abrupt withdrawal of medication—may greatly increase PD symptoms and risk of neuroleptic malignant syndrome Several weeks sometimes required before benefit is noted Caution with CNS drugs, alcohol, or antihypertensives Do not take other medicines including vitamins, without health care provider’s approval Report adverse side effects immediately to the health care provider Report any signs that the drug is no longer effective after prolonged use Avoid any dosage changes without medical supervision

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindicatio ns or Cautions

Patient Education Maintain physical activity, self-care, and social interaction, an essential part of therapy for PD Rise slowly to prevent falls Patients receiving Sinemet for prolonged periods of time (2–5 years) may develop a tolerance, resulting in ineffectiveness of the drug, called wearing off

Dopamine Agonists 1.

Bromocriptine (Parlodel) 2. Pramipexole (Mirapex) 3. Ropinirole (Requip) 4. Rotigotine

Commonly used in conjunction with levodopa to delay the onset of levodopacaused motor complications Used alone in early PD or in younger patients

Similar to Sinemet and can include: Psychosis, hallucinations, obsessive behavior, impulsivity, confusion, somnolence (higher risk compared to Sinemet) Excessive sedation leading to “sleep

See Dopamine Replacements Avoid abrupt withdrawal of medication There may be intense urges to gamble or spend money, increased sexual urges, bouts of binge eating, and other

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Classifications and Drugs (Neupro)

Purpose

Side Effects

Contraindicatio ns or Cautions

May reduce the required dose of levodopa for patients with advanced PD

attacks” during daily activities, including driving

intense urges

Hypotension, syncope; peripheral edema

Caution with driving or operation of machinery—there may be no warning signs before falling

Pramipexole:

Nausea and vomiting Pulmonary, renal, and cardiac valve fibrosis with bromocriptine

asleep while engaged in activities of daily living Rotigotine:

Neuroleptic malignant syndrome with abrupt discontinuation Anticholinergics for Parkinson’s 1. Benztropine (Cogentin) 2.

Trihexyphenidyl (Artane)

Restore the cholinergicdopaminergic balance in PD

Dry mouth

Treatment of parkinson-like tremors associated with long-term use of major tranquilizers or for other forms of Parkinsonian syndrome

Blurred vision

Dizziness Drowsiness

Constipation or urinary retention Confusion Depression Nausea

Patient Education

A patch applied topically with once daily dosing Abrupt discontinuation, which leads to rebound symptoms Closed-angle glaucoma

See Dopamine Replacements Avoid abrupt withdrawal of medication

Use with caution in older patients Patients with BPH

Tachycardia

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Worksheet 2 for Chapter 22 Other Antiparkinsonian Drugs, and Alzheimer’s Drugs Classifications and Drugs

Purpose

Side Effects

COMT Inhibitors

Block the enzyme responsible for metabolizing peripheral levodopa, thereby increasing the peripheral and central plasma concentration of levodopa and dopamine

Orthostatic hypotension

1. Entacapone (Comtan) 2. With carbidopa/levodop a (Stalevo)

Contraindication s or Cautions

See Dopamine Replacements

Hallucinations

Avoid abrupt withdrawal of medication

Dyskinesia (levodopa dose may need to be decreased)

Treating health care provider must obtain patient’s signed consent form acknowledging risk of hepatic injury with tolcapone; Hepatic enzymes must be monitored throughout treatment with tolcapone

Nausea, vomiting Diarrhea (can be severe); abdominal pain Orange discoloration of the urine Hepatic injury with tolcapone (blackbox warning) Due to the severe nature of adverse effects associated with tolcapone and extensive monitoring, it is reserved for patients who do not respond to other therapies

MAO-B Inhibitors 1. Rasagiline (Azilect) 2. Selegiline (Eldepryl) 3. Safinamide (Xadago)

Patient Education

Break down dopamine and tyramine in the brain, thereby increasing levels of dopamine

Rasagiline:

Rasagiline:

See Dopamine

Headache, nausea

Similar to selegiline

Replacements

Sometimes prescribed as adjunctive monotherapy for

Hallucinations

Joint pain Hypotension

Dyskinesias Depression

Selegiline: Contraindicated with the following drugs, which can interact resulting

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Do not abruptly discontinue Rasagiline: Given only once daily

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Classifications and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

early PD or after levodopa has been used for several years and begins to “wear off”

Dyspepsia

Selegiline:

Rasagiline:

Confusion

in rare but severe CNS toxicity, hyperpyrexia, hypertensive crisis, and even death

Currently, the only MAO- B inhibitor approved as initial monotherapy for PD; it is also approved as an addition to levodopa later in the disease

Abdominal pain

Safinamide: newer MAO-B inhibitor that is commonly used as adjunct therapy to carbidopa–

Selegiline: Nausea Dizziness

Hallucinations Dry mouth Vivid dreams Dyskinesias Headache Anxiety and sleeplessness

levodopa when patients are experiencing wearing off episodes that are not resolved

1. Amantadine (Symmetrel)

Do not use selegiline with: meperidine (Demerol), methadone, tramadol Tricyclic antidepressants SSRIs; SNRIs Sympathomimeti cs (e.g., epinephrine, ephedrine, pseudoephedrin e isoproterenol) Dextromethorph an; St. John’s wort Abrupt discontinuation is contraindicated

by increasing dose and/or frequency.

Other Drugs for Parkinson’s

Should be given no later than early afternoon

Alters dopamine release and has anticholinergic properties

Usually dose related and reversible, can include:

Treatment of extrapyramidal reactions associated with prolonged use of phenothiazines,

CNS disturbances, including depression, confusion, hallucinations, anxiety, depression,

Abrupt discontinuation

See Dopamine Replacements

Liver and kidney disease (requires renal dose adjustment)

Avoid abrupt withdrawal of medication

Cardiac disorders Psychosis

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Classifications and Drugs

Purpose

Side Effects

Contraindication s or Cautions

carbon monoxide poisoning, or cerebral arteriosclerosis in older adults

irritability, nervousness, and dizziness

Neurosis

Headache, weakness, and insomnia Heart failure, edema, and hypotension

Patient Education

Mental depression Epilepsy Patients taking CNS drugs

GI distress, constipation Urinary retention Agents for Restless Legs Syndrome Dopamine agonists

Treatment of restless legs syndrome

Administer pramipexole and ropinirole 1–3 h before bedtime as a single daily dose. Apply the rotigotine patch at approximately the same time every day

1. Pramipexole (Mirapex) 2. Ropinirole (Requip) 3. Rotigotine (Neupro patch) Alzheimer’s Drugs Cholinesterase inhibitors 1. Donepezil (Aricept, Aricept ODT) 2. Rivastigmine (Exelon) 3. Galantamine (Razadyne, Razadyne ER)

Cholinesterase inhibitors:

Cholinesterase inhibitors:

Cholinesterase inhibitors:

Prevent the breakdown of acetylcholine in the synaptic cleft, thereby increasing acetycholine levels and improving cognitive function

GI upset (nausea, vomiting, diarrhea, abdominal cramps, anorexia, weight loss)

GI bleeding, peptic ulcer disease

NMDA receptor antagonist

Efficacious for symptom delay in mild-to-moderate AD

1. Memantine

NMDA receptor

NMDA receptor antagonist:

Cardiac disease (potential for bradycardia or syncope)

Involve the CNS, are dose dependent, and include:

COPD (exacerbates underlying disease)

Confusion, cerebrovascular

Jaundice, renal disease

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Require slow dose titration to improve patient tolerance Drugs may slow progression of the disease, but do not cure it Avoid abrupt withdrawal of medication Ultimately, the decision on whether to continue drug therapy in

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Classifications and Drugs

Purpose

Side Effects

Contraindication s or Cautions

Patient Education

(Namenda)

antagonist:

disorder, falls, agitation

Pregnancy, breast feeding

Dizziness, headache, constipation, cough

Abrupt discontinuation (limit sudden decline in cognitive function or increase in behavioral disturbances)

Alzheimer’s patients is based on quality of life, treatment goals, potential benefits, adverse effects, and costs

Thought to selectively block the excitotoxic effects with abnormal transmission of the neurotransmitter glutamate Treatment of moderate-tosevere dementia of the Alzheimer’s type Can be used as monotherapy or in combination therapy with cholinesterase inhibitors

NMDA receptor antagonist: Pregnancy, breast feeding, use with children Renal disease

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Worksheet 1 for Chapter 23 Endocrine System Drugs Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Corticosteroids

Used as supportive therapy with other medications in suppressing the body’s immune reaction to allergies, inflammation, acute skin or respiratory disorders, or with organ transplants or chemotherapy, or as replacement therapy

Adrenocortical insufficiency

Long-term use; avoid abrupt discontinuation

Follow exact dosage and take as prescribed (never taking longer than indicated)

Pituitary drugs 1. Corticotropin (ACTH) (H. P. Acthar Gel) 2. Cosyntropin (Cortrosyn) Adrenal corticosteroids 1. Cortisone 2. Dexamethasone (Decadron) 3. Fludrocortisone (Florinef) 4. Hydrocortisone (Cortef or SoluCortef) 5.

Methylprednisolone (Medrol) 6. Prednisone 7. Triamcinolone (Kenalog)

Adrenocortical atrophy Delayed wound healing Increased susceptibility to infection Fluid and electrolyte imbalance, possibly resulting in edema, potassium loss, hypertension, and heart failure Muscle pain or weakness Osteoporosis especially in older women Stunted growth in children

Viral or bacterial infections Fungal infections Hypothyroidism Cirrhosis Hypertension Heart failure Psychotic patients or emotional instability Diabetes Glaucoma Cataracts History of gastric or esophageal irritation

Increased intraocular pressure or cataracts

Use with children

Cushing’s syndrome

History of thromboembolic disorders, seizures

Endocrine disorders, including obesity of the trunk, “moon face,” acne, hirsutism amenorrhea, and

Pregnancy, breast feeding

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Do not stop medicine abruptly Notify health care provider of any signs of infection or trauma while taking corticosteroids or within 12 months after long-term therapy is discontinued and similarly notifying surgeon, dentist, or anesthesiologist if required Take oral corticosteroids during or immediately after meals or milk Take single daily or alternate-day doses prior to 9 A.M. Take multiple doses at evenly spaced intervals throughout the day, but not near bedtime Avoid using any

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Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

hyperglycemia

Patient Education other drugs (including OTC drugs) at the same time without health care provider’s approval

Nausea, vomiting, diarrhea, or constipation Gastric or esophageal irritation, ulceration, or hemorrhage

Side effects are expected with long-term therapy

CNS effects including headache, vertigo, insomnia, euphoria, psychosis, or anxiety

Danger of infection, delayed wound healing, osteoporosis, mental disorders Report any side effects to health care provider immediately

Petechiae, easy bruising Skin thinning and tearing Thyroid Agents 1. Levothyroxine (T4) (Synthroid, Levothroid) 2. Liothyronine (T3) (Cytomel) 3. Thyroid (T3 and T4) (Armour Thyroid)

Thyroid replacement therapy or treatment of hypothyroidism

Palpitations, chest Cardiovascular pain disease, including angina pectoris, Tachycardia myocardial infarction, and Cardiac hypertension arrhythmias Increased blood pressure Nervousness Difficulty concentrating

Older adults Adrenal insufficiency Diabetes

Tremor Muscle weakness Headache Insomnia Weight loss

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Take prescribed dosage of thyroid medication consistently every day on empty stomach 30–60 min prior to breakfast Medication usually has to be taken for life Report any symptoms of overdose Periodic lab test will be needed to determine effectiveness and proper dosage

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Diarrhea

Patient Education Not changing from one brand to another or to a generic without health care provider approval (if switched, TSH should be retested in six weeks)

Abdominal cramps Intolerance to heat Fever Excessive sweating Easy fatigability Menstrual irregularities Antithyroid Agents 1. Methimazole (Tapazole) 2. Propylthiouracil (PTU)

Oral Antidiabetic Agents First-generation sulfonylureas 1. Chlorpropamide 2. Tolbutamide Second-generation sulfonylureas 1. Glimepride (Amaryl) 2. Glipizide (Glucotrol, Glucotrol

Relieve symptoms of hyperthyroidis m while preparing for surgical or radioactive iodine therapy or for those who are not candidates for either procedure

Rare and may include:

Prolonged therapy

Take doses at regular intervals

Rash, urticaria, and pruritus

Age more than 40 years

Abnormal sense of taste, arthralgias

Pregnancy, breast feeding

Notify health care provider immediately if signs of illness occur

Blood dyscrasias (especially agranulocytosis)

Hepatic disorders (black-box warning with PTU)

Treatment of type II diabetes

Sulfonylureas:

Sulfonylureas:

GI distress

Debilitated or malnourished patients

Dermatological effects, including pruritus, rash, urticaria, or photosensitivity Hepatic dysfunction, including jaundice (rare) Weakness

Impaired liver or kidney function Unstable diabetes or type I diabetes Major surgery Severe infection Severe trauma

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Prevention of hypoglycemia— importance of good control through proper drug and diet therapy, never skipping meals Do not consume alcohol on an empty stomach Early symptoms and treatment of hypoglycemia—

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

XL)

Fatigue

3. Glyburide (Diabeta, Glynase)

Lethargy

Contraindicated with the older adults (refer to Beers List in Chapter 27)

always carry a ready source of carbohydrate

Vertigo

Alpha-glucosidase inhibitors

Headache

1. Acarbose (Precose)

Blood dyscrasias, including anemia

2. Miglitol (Glyset) Biguanides 1. Metformin (Glucophage, Glucophage XR) Incretin therapies GLP-1 receptor agonist 1. Exenatide (Byetta, Bydureon) DPP-4 inhibitors (gliptins) 1. Sitagliptin (Januvia) 2. Saxagliptin (Onglyza) Meglitinides 1. Nateglinide (Starlix) 2. Repaglinide (Prandin) Thiazolidinediones 1. Pioglitazone (Actos) 2. Rosiglitazone (Avandia)

Hypoglycemia, especially in older adults

Alpha-glucosidase inhibitors: Impaired liver and kidney function

Patients with inflammatory Possible increased bowel disease or risk of intestinal cardiovascular obstruction death— Pregnancy, breast controversial feeding, use in Weight gain, children water retention Biguanides: Alpha-glucosidase Impaired liver and inhibitors: kidney function High-rate GI Patients with effects heart failure (flatulence, requiring abdominal pharmacologic distention,pain, treatment loose stools) Elevated liver enzymes, which are dose related Biguanides: GI effects, metallic taste Lactic acidosis in patients with history of ketoacidosis, severe dehydration,

Follow a balanced diet using the Glycemic Index— substitute foods low on the Glycemic Index— reduce fats, increase fiber, and be sure to have an adequate fluid intake Regular exercise and maintenance of proper body weight; weight reduction if obese Immediately report nausea, vomiting, diarrhea, or infections to a health care provider

Good foot care to Administration of reduce chance of radiocontrast dye; infections withhold Carry metformin prior identification card to tests with and wear radioactive dye identification tag and for 48 h after Look-alike, soundcompletion of alike drugs: procedure Actos/Actonel, Pregnancy, breast glipizide/glyburid feeding e, insulin name Use with children pairs mentioned

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Classifications and Drugs Combinations 1.

Glyburide/metformin (Glucovance) 2.

Rosiglitazone/metfor min (Avandamet) 3.

Sitagliptin/metformin (Janumet)

Purpose

Side Effects

Contraindications or Cautions

Patient Education

cardiorespiratory insufficiency, renal dysfunction, and chronic alcoholism with liver damage

Older adults (especially those frail, anorexic, or underweight)

earlier

Vitamin B12 deficiency

Severe renal disease

Hypoglycemia

Meglitinides:

Exenatide:

Diabetic ketoacidosis

Nausea/vomiting, diarrhea, dyspepsia, gastroesophageal reflux Injection site reactions

Exenatide:

Impaired liver function Pregnancy, breastfeeding, use in children

Take medication (oral or insulin) at approximately the same time each day and in proper relation to meals Proper use of monitoring devices; check blood glucose as directed by the health care provider, especially with hypoglycemia or stress Take alphaglucosidase inhibitors at the start (with the first bite) of main meals

Hypoglycemia (when given in combination with sulfonylureas)

Thiazolidinedione s:

DPP-4 inhibitors:

Take meglitinides Heart failure; before each meal pulmonary edema When taking May cause thiazolidinediones resumption of , report weight ovulation in gain over 6.6 lb, premenopausal sudden onset of patients edema, or Pregnancy, breast shortness of breath to the feeding, use in health care children provider

Abdominal pain, diarrhea, nausea, vomiting Upper respiratory tract infection Nasopharyngitis Meglitinides: GI effects Abdominal cramps

Impaired liver function

Hypoglycemia, initial weight gain URIs Sinusitis

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Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Arthralgia Headache Thiazolidinedione s: Weight gain, fluid retention, edema URIs Sinusitis Pharyngitis Headache Myalgia; atypical bone fractures (upper arm, hand, foot) Anemia Hypoglycemia

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Worksheet 2 for Chapter 23 Insulins Action

Preparation

Onset (hours)

Peak (hours)

Duration (hours)

Rapid

10–30 min

1–2 h

3–8 h

Short

Aspart Glulisine Lispro Regular

30–60 min

1–5 h

6–10 h

Intermediate

Isophane (NPH)

1–3 h

6–12 h

18–24 h

Long

Glargine Detemir NPH/Reg 70/30, 50/50 NPH/Lispro 75/25 NPH/Aspart

1–2 h

No pronounced peak 1–4 h 1–6 h 1–4 h

Up to 24 h Dose dependent 16–24 h 12–24 h Up to 24 h

Mixtures

30–60 min 15–30 min 10–20 min

Hyperglycemia

Causes

Symptoms

Treatment

Elevated blood glucose

Undiagnosed diabetes

Dehydration and excessive thirst

IV fluids to correct electrolyte imbalance

Surgical or other trauma

Anorexia and unexplained weight loss in persons under 40 years of age

Regular insulin added to IV

Emotional stress

Polyuria

Other endocrine disorders

Fruity breath

Medications (e.g., glucocorticoids such as prednisone)

Weakness

Pregnancy

Vision problems

Insulin dose insufficient Infections

Lethargy Flu-like symptoms Coma if untreated Ketoacidosis

Lowered blood glucose

Overdose of insulin and/or other antidiabetic medications

Increased perspiration Pallor Hunger, nausea, and

If conscious, administer 4 oz orange juice, candy, honey, or syrup (sublingual is best)

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Hyperglycemia

Causes

Symptoms

Treatment

Delayed or insufficient food intake

vomiting

After initial treatment, provide a protein snack; for example, peanut butter, cheese, or glass of milk. Then recheck blood glucose

Excessive or unusual exercise Change in type of insulin

Irritability Confusion or sudden unexplained bizarre moodiness and/or behavior change Tremor Weakness Headache Hypothermia Tingling of fingers Blurred or double vision Loss of consciousness and convulsions if untreated Hypoglycemic reaction in older diabetics may mimic a CVA

If comatose, administer 10–30 mL of 50% dextrose solution IV or administer 0.5–1 unit (1 mg) glucagon SC, IM, or IV; follow with carbohydrate snack when patient awakens to prevent secondary hypoglycemia Avoid giving excessive amounts of sugar or frequent overdoses of insulin, which can result in rebound hyperglycemia

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Worksheet for Chapter 24 Reproductive System Drugs Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Androgens

Edema

Cardiac, renal, and liver dysfunction

Take only prescribed drugs according to directions

1.

Testosteronedanazol (Danocrine)

Replacement in cases of diminished testicular hormone

2.

Congenital Danazolmethyltestostero hypogonadism ne (Android, Testred) Acquired 3. Methyltestosterone hypogonadism with estrogen (Estratest Palliative Covaryx, Covaryx H.S.) treatment of 4. Oxandrolone females with (Oxandrin) advanced 5. Testosterone (Depo- metastatic carcinoma of the Testosterone, Striant, breast Androderm, AndroGel, Axiron)

Endometriosis and fibrocystic breast disease Treatment of cachexia

Hypertension Acne, increased oiliness of skin and hair, or alopecia Oligospermia Increased or decreased sexual stimulation or libido, impotence Gynecomastia in males Hirsutism, deepening of voice, and amenorrhea or other menstrual irregularities in females Jaundice and hepatitis Nausea and vomiting Premature closure of bone ends in adolescents

Men suspected of having carcinoma of the prostate or breast cancer Geriatric males Prepubertal males who have not reached their full growth potential Diabetes, obesity, or dyslipidemia Dangers of illegal use of anabolic steroids: Health care personnel have a responsibility to caution athletes, especially adolescents, regarding the hazards of taking illegal synthetic testosterone

Anxiety Depression Headache Increased lowdensity lipoprotein (LDL),

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Report side effects and sexual effects Skin irritation possible with transdermal formulations Possibility of stunted growth when administered to adolescent boys before puberty To avoid secondary exposure of children and partners, adults who use testosterone gels should target a discreet application site like the front and inner thighs or underarms, wash their hands with soap and warm water after every application, and cover the application site with clothing once the gel has

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

decreased highdensity lipoprotein (HDL), and insulin resistance Erectile Dysfunction Medications 1. Sildenafil (Viagra, Revatio)

Treatment of erectile dysfunction

Headache Flushing Vision abnormalities

2. Tadalafil (Cialis, Adcirca)

Dizziness Hearing loss, tinnitus

3. Vardenafil (Levitra) 4. Avanafi l (Stendra)

Dyspepsia, nasal congestion, rhinitis, diarrhea, rash, back pain Cardiovascular events, including angina, syncope, tachycardia, palpitation, and hypotension

Estrogens

Contraception

1. Estradiol (Estrace, Vagifem, Estrasorb, EstroGel)

Menstrual irregularities and dysmenorrhea

2. Conjugated estrogens (Premarin)

Menopausal vasomotor symptom relief Treatment of female hypogonadism Postmenopausal prevention of osteoporosis Atrophic vaginitis

Patient Education dried

Concurrent use of nitrates or alpha-blockers In the event of an erection persisting >4 h, advise patient to seek medical assistance immediately

Dangerous interactions: Do not take concurrently with nitrates or grapefruit juice

Older adults and patients with preexisting cardiovascular risk factors Hepatic and renal impairment

Increased risk of thromboembolic disorders, hypertension, myocardial infarction, and stroke

Hypertension, thromboembolic disorders

GI effects, including vomiting, abdominal cramps, bloating, diarrhea or constipation, and weight gain

Liver dysfunction

Skin

Visual

Stroke Myocardial infarction

Breast cancer (except for palliative treatment)

Before estrogen therapy is begun, a complete history and physical examination are essential, and yearly physicals, including Pap test and mammogram, during therapy are important

Undiagnosed vaginal bleeding

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Classifications and Drugs Purpose Postcoital use after rape or incest (within 24–48 h) a single large dose to prevent, not terminate, pregnancy Palliative treatment of males with inoperable prostate cancer

Side Effects

Contraindication s or Cautions

discolorations

disturbances

Fluid retention and edema

Severe headaches and migraine

Increased serum triglyceride levels Severe hypercalcemia in cancer patients with large doses Folic acid deficiency Liver function abnormalities, including jaundice, anorexia, and pruritus Breakthrough or irregular vaginal bleeding Increased risk of cervical erosion and Candida vaginitis

Patient Education

Shortness of breath Chest or calf pain Other cautions: Prolonged, continued use of high-dose estrogens in postmenopausal women Pregnancy breast feeding Diabetes Heavy smoking

Headache, especially migraine Depression Visual disturbances Breast tenderness, enlargement, and secretion Increased risk of gallbladder disease

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Cancer of the uterus with estrogen alone Progestins 1.

Medroxyprogesterone (Provera, Depo-Provera) 2. Megestrol acetate (Megace, Megace ES) Estrogen–Progestin Combination 1. Conjugated estrogens/medroxy progesterone (Premphase, Prempro) 2.

Estradiol/norethindrone (CombiPatch, Activella)

Treatment of amenorrhea and abnormal uterine bleeding Contraception Postmenopausal —sometimes combined with estrogen in replacement cyclical therapy Adjunctive and palliative therapy for advanced and metastatic endometrial or breast cancer Megace also used for anorexia, weight loss, and cachexia associated with AIDS

Menstrual irregularity and amenorrhea, breakthrough bleeding, and spotting Edema, weight gain Nausea Breast tenderness, enlargement, and secretion Jaundice, rash, and pruritus Headache and migraine Mental depression

Any condition that might be aggravated by fluid retention History of mental depression History of cerebrovascular accident Liver disorders Undiagnosed vaginal bleeding Pregnancy Breast, cervical, uterine, vaginal cancers (except for palliative treatment)

Thromboembolyt ic disorders Vision disorders Possible decrease in bone density with prolonged use

Contraceptives Monophasic preparations 1. 50 mcg estrogen (Necon 1/50, Ovcon-50) 2. 35 mcg estrogen (Norinyl 1/35, Ortho-

Prevention of pregnancy Treatment and/or improvement of other medical conditions, such as fibroids and

Minor: Nausea Increased breast size, breast tenderness Fluid retention

Thrombophlebiti s or history of thromboembolyt ic disorder History of CVA History of chest pain or MI

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Use of backup contraception for the first month on oral contraceptives, and for the first two weeks with Depo-Provera

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Novum 1/35, Brevicon)

Weight gain or loss

Known or suspected history of breast cancer, cervical cancer, or other estrogendependent malignancy

3. 30 mcg estrogen (Lo/-Ovral, Seasonale, Yasmin) 4. 20 mcg estrogen (YAZ, Lybrel, Ortho Evra) Biphasic preparation 1. Seasonique 2. Mircette Triphasic preparation 1. Trivora 2. Ortho-Novum 3. Ortho-Tri-Cyclen Four-phasic preparation 1. Natazia Progestin-only preparations 1. Ortho Micronor 2. Depo-Provera IM 3. Mirena IUD

endometriosis; premenstrual dysphoric disorder; painful, heavy periods; irregular cycles; and acne Decreased incidence of ovarian cysts, ovarian or endometrial cancer, improve bone density during perimenopause, benign breast disease, and ectopic pregnancy. Also protective effect against pelvic inflammatory disease (PID)

Bleeding between periods Scanty menstrual flow (considered a benefit) Changes in libido Mood changes Facial discoloration Serious: Migraine headaches Severe depression Blurred vision or loss of vision

Patient Education

Take the contraceptive at the same time every day. Follow specific package directions if a dose is missed— general instruction: pill Pregnancy, should be breast feeding doubled up until the patient has Major surgery caught up, using with prolonged a backup method immobilization until period History of liver begins. If three disease or pills or more are impaired liver missed, the function patient is instructed to Smoking throw away the Caution: pack until she starts her period, Women over age and then begin a 35 and currently new pack of pills smoking 15 or more cigarettes Stop oral a day contraceptives if pregnancy is Migraine suspected and headaches that stop smoking start after initiating oral Use backup contraceptives contraception when taking Perimenopausal other medicines women that may alter Seizure disorder effectiveness— check with your Hypertension pharmacist when with resting obtaining a new diastolic above medication 90 or systolic including OTC above 140 and herbal High cholesterol; medications

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education

dyslipidemia

Report the following symptoms to your health care provider should they occur while on oral contraceptives: chest pain, shortness of breath, severe headache, dizziness, weakness, numbness, eye problems, breast lumps, or severe leg pains in the calf or thigh

Obesity Diabetes mellitus Undiagnosed vaginal bleeding Confirmed sickle cell disease Breast feeding Oral contraceptives may accelerate development of gallbladder disease in women already susceptible

Oral contraceptives do not protect against HIV, AIDS, or other sexually transmitted diseases Follow prescribed schedule with contraceptives Take with evening meal or at the same time every day Report side effects Increased risk of stroke or myocardial infarction for

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education smokers Do not take if pregnant, breastfeeding Mifepristone Medication Guide must be followed completely and carefully and drug administered only by trained health care providers

Postcoital Contraceptives 1. Lo/Ovral 2. Seasonale 3. Levonorgestrel (Next Choice, Plan B, One Step) 3. Ulipristal (Ella)

Prevention of pregnancy

Side effects, which include nausea, vomiting, headache, and breast tenderness, usually subside within 1–2 days after treatment

There is no medical condition for which the risks of emergency contraception use outweigh the benefits; therefore, emergency contraception can be taken by women with contraindication s to conventional oral contraceptives

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Emergency contraception should NOT be used as a regular method of birth control and is not as effective as other forms of contraception Women already on certain estrogen/progest in combination oral contraceptives can take a higher dose of their regular pill for use as emergency contraception if It must be administered within 72 h of unprotected intercourse with the exception of uliprisal that is

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education effective if taken up to five days after the event

Agents for Labor and Delivery Oxytocics 1. Methylergonovine (Methergine) 2. Oxytocin (Pitocin) Prostaglandins 1. Dinoprostone (Prostin E2 Cervidil Prepidil) 2. Misoprostol (Cytotec) 3. Carboprost (Hemabate) 4. Tocolyt 5. Terbutaline Antiprogesterone drug 1. Mifepristone (Mifeprex) Semisynthetic ergot alkaloid 1. Methylergonovine

Oxytocins:

Oxytocin:

Induction of labor

Dose related— can be serious, resulting in maternal or fetal death

Stimulation of uterine contractions with uterine inertia Prostaglandins: Cervical ripening Therapeutic abortion Uterine evacuation with fetal death in late pregnancy, benign hydatidiform mole,or fetuses with abnormalities incompatible with life Uses of carboprost for treatment of postpartum bleeding due to uterine atony Terbutaline: Off label use with careful monitoring in the management of

Titanic contractions with risk of uterine rupture Abruptio placenta Impaired uterine blood flow Amniotic fluid embolism Fetal trauma, including intracranial hemorrhage or brain damage Fetal cardiac arrhythmias, including bradycardia, tachycardia, and premature Ventricular contractions Fetal death due to asphyxia With large amounts of oxytocin: Severe

Elective induction for convenience Cephalopelvic disproportion Unfavorable fetal position or presentation Uterine or cervical scarring

Mifepristone: Patient education (Mifepristone Medication Guide) is very important for the proper administration for this drug treatment

Fetal distress when delivery is not imminent Placenta previa Prolapsed cord Multiparity Prolonged use with eclampsia Prostaglandins: Used only by trained health care providers in a hospital Contraindicated with history of pelvic surgery, uterine fibroids, cervical stenosis, acute PID Caution with asthma, hypertension, cardiovascular, or renal disease

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

preterm labor

hypotension

Mifepristone:

Tachycardia and arrhythmias

Previous history of C-section

Termination of an unwanted pregnancy (in conjunction with misoprostol) Only for use very early in pregnancy— within 49 days from the beginning of a woman’s last menstrual period Methylergonovin e: Prevention and treatment of postpartum and postabortion hemorrhage

Postpartum hemorrhage Subarachnoid hemorrhage Hypertensive episodes Prostaglandins: GI hypermotility: nausea, vomiting, diarrhea Bradycardia, hypotension, hypertension, arrhythmias Dizziness, syncope, flushing, fever Bronchospasm, including wheezing, dyspnea, chest constriction, chest pain Cervical laceration Retained placenta or uterine rupture (less common)

Patient Education

Terbutaline: Caution: Watch patient closely for signs of pulmonary edema Should not be used in patients with hypertension, cardiac disease, hyperthyroidism, diabetes, or history of seizures Contraindication s with terbutaline (black-box warning): Prolonged tocolysis (use beyond 48–72 h), for terbutaline administered by injection or by continuous infusion pump due to the potential for serious maternal cardiovascular events and death

Retained placenta

Mifepristone:

Hypotension

Ectopic pregnancy

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Hypertension

Any time after 49 days from the beginning of the woman’s last menstrual period

Arrythmias Dizziness, syncope Bronchospasm, chest pain Andrenergic: Nervousness Tremors Increased heart rate Headache Nausea, vomiting Heart palpitations Terbutaline: Maternal nervousness, tremors, increased heart rate Headache Nausea, vomiting, hypotension, heart palpitations, cardiac arrhythmias, myocardial ischemia, metabolic abnormalities (hyperglycemia, hypokalemia)

Patient Education

Current longterm corticosteroid therapy Bleeding disorders Current anticoagulant therapy Methylergonovin e: When administered during third stage of labor, may lead to retained placenta Contraindicated with cardiovascular disease, especially hypertension, and with hepatic and renal impairment Patients with preeclampsia or eclampsia

Palpitations

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Fetal tachycardia, hypotension, hyperbilirubinemi a, hypoglycemia, hypocalcemia, intraventricular hemorrhage Mifepristone: Diarrhea, nausea Uterine hemorrhage in about 5% of patients Infection—if the embryo is not completely expelled A malformed child if the second and third steps are not completed Methylergonovin e: Most common when administered IV undiluted or too rapidly, or in conjunction with regional anesthesia or vasoconstrictors, and can include: Nausea, vomiting, dizziness, headache, diaphoresis, palpitation,

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education

Magnesium sulfate:

Magnesium sulfate:

Flaccid paralysis

Impaired renal function

Monitor patient closely for vital signs and reflexes

dyspnea, arrhythmias Hypertension or hypotension Numbness, coldness of extremities with overdose (peripheral vasoconstriction) Seizures with overdose Treatment for Preeclampsia or Eclampsia 1. Magnesium sulfate

Treatment of preeclampsia or eclampsia Also used in the management of uterine tetany associated with the use of oxytocic agents

CNS depression Circulatory collapse Cardiac depression

Heart block or myocardial damage Prolonged use

Cardiac arrest

Antidote for overdose of magnesium sulfate is IV administration of calcium gluconate

Pulmonary edema, fatal respiratory paralysis Flushing and sweating, hypotension Fetal toxicity at high doses Other Gonadotropics: GnRH Analogs

Management of endometriosis

Hot flashes, diaphoresis

Not effective contraceptives

1. Lupron nafarelin acetate (Synarel)

Lupron:

Vaginal dryness, vaginitis

Not safe during pregnancy, breast feeding

2. Leuprolide acetate

Also used to inhibit the growth of

Headache

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Administer Lupron IM monthly or trimonthly Administer Synarel as a nasal spray. Treatment

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Classifications and Drugs Purpose

Side Effects

Contraindication s or Cautions

Patient Education

(Lupron) Synarel

Insomnia

Diabetes

Emotional or mood swings, reduced libido

Prolonged use creates a hypoestrogenic state that may increase the risk of bone density loss

with either is limited to six months

hormonedependent tumors; prostate and breast cancer

Weight gain or loss, peripheral edema Nasal congestion, irritation with Synarel

Use a backup barrier method of contraception Must be informed of the benefits and risks of the use of GnHR

Acne

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Worksheet for Chapter 25 Anti-Infective Drugs Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

Aminoglycosides

For gram-negative and gram-positive bacterial infections

Especially in older adults, dehydrated patients, or those with renal or hearing impairment include:

Tinnitus

Close medical supervision during therapy is very important

1. Amikacin 2. Gentamicin 3. Tobramycin

Used for shortterm treatment of many serious infections such as septicemia only when other less toxic anti-infective drugs are ineffective or contraindicated

Nephrotoxicity, generally reversible upon discontinuation Ototoxicity, both auditory (hearing loss) and vestibular (vertigo), may be permanent

Vertigo High-frequency hearing loss Reduced renal function Dehydration Pregnancy, breast feeding Infants

Careful observation of intake and urinary output Promptly report side effects, especially kidney or hearing problems

Older adults

Neuromuscular blocking, including respiratory paralysis CNS symptoms including headache, tremor, lethargy, numbness, and seizures Blurred vision Rash Urticaria Cephalosporins First generation 1. Cephalexin (Keflex) 2. Cefazolin Second generation

Used to treat many grampositive and gram-negative bacterial infections

Hypersensitivity, including rash, edema, or anaphylaxis (especially in those allergic to penicillin)

Third generation:

Blood dyscrasias

Especially for

Renal toxicity,

Known allergies, especially to penicillin

Possible allergic reactions

Avoid alcohol Prolonged use possibly leading to Report any side superinfections or effects to health care provider severe colitis Take without regard to meals,

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Classifications and Drugs

Purpose

Side Effects

1. Cefaclor (Ceclor)

gram-negative bacteria and some STDs (e.g., gonorrhea)

especially in older patients

2. Cefuroxime (Ceftin, Zinacef) Third generation 1. Cefdinir (Omnicef) 2. Ceftazidime (Fortaz)

Fourth generation: Stronger for both gram-positive and gram-negative bacteria

3. Ceftriaxone (Rocephin)

Contraindications or Cautions

Patient Education unless stomach upset occurs; then take with food

Mild hepatic dysfunction

Attention to signs of abnormal bleeding (checking stools and urine for blood)

Nausea, vomiting Diarrhea Phlebitis with IV administration Pain at site of IM injection Respiratory distress

Fourth generation

Seizures

1. Cefepime (Maxipime) Fifth generation 1. Ceftaroline (Teflaro) Macrolides 1. Erythromycin (EES) 2.

Clarithromycin (Biaxin) 3. Azithromycin (Zithromax)

For infections of the respiratory tract For skin conditions (e.g., acne) For some STDs, especially when patient is allergic to penicillin

Serious, are rare, and mild side effects, usually dose related Anorexia Nausea, vomiting Diarrhea, cramps Urticaria Rash Superinfections Serious side effects can occur with some interactions

Liver dysfunction GI disease Electrolyte imbalance

Common GI side effects to be expected Take with food or use smaller, more frequent doses Report side effects to health care provider for possible dosage adjustment or prescription of medication for symptomatic relief Take medication with full glass of water 1 h before or 2 h after meals,

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Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education unless stomach upset Do not take with other medications (see Interactions)

Penicillins 1. Penicillin G (Bicillin L-A) 2. Penicillin VK 3. Amoxicillin 4. Ampicillin Extended spectrum 1. Amoxicillin– clavulanate (Augmentin) 2. Piperacillin– tazobactam (Zosyn)

For the treatment of streptococcal, staphylococcal, and meningococcal infections, including respiratory and intestinal infections Treatment of choice for syphilis Also used prophylactically to prevent recurrences of rheumatic fever

Hypersensitivity reactions ranging from rash to fatal anaphylaxis Superinfections, especially with oral ampicillin

History of serious allergy to penicillins or other betalactams (e.g., anaphylaxis, hives)

Nausea, vomiting Diarrhea

Stop taking and report reaction immediately Take medication as prescribed on time, on an empty stomach, 1 h before or 2 h after meals, with full glass of water Avoid antacids and alcohol

Blood dyscrasias, which are reversible with discontinuance of drug

Effectiveness of estrogen contraceptives may be affected

Renal and hepatic disorders (rare) CNS effects: for example, confusion, anxiety, seizures (especially with penicillin G)

Carbapenems 1. Meropenem (Merrem)

Quinolones 1. Ciprofloxacin (Cipro) 2. Levofloxacin

Used to treat gram-negative and gram-positive organisms, including anaerobes and many multidrugresistant pathogens

See Penicillins

Use with caution in patients with documented penicillin allergies because of the potential for cross-reaction

See Penicillins

For infections of the urinary tract, sinuses, lower respiratory tract, GI tract, skin,

Nausea, vomiting

Older adults, especially with GI disease or arteriosclerosis

Do not take other medications without health care provider’s approval (many

Diarrhea, abdominal pain, colitis (especially older

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

(Levaquin)

bones, and joints, and in treating gonorrhea

adult patients)

Use with children or adolescents— potential for cartilage damage

interactions)

CNS effects, headache, dizziness, confusion, irritability, seizures, anxiety Crystalluria Superinfection Phototoxicity Possible cartilage or tendon damage

Strenuous exercise during and several weeks after therapy— potential for tendon rupture Pregnancy, breast feeding Seizure disorders Cardiac disease (may cause or contribute to cardiac arrhythmias)

Tetracyclines 1. Tetracycline HCl (Sumycin) 2. Doxycycline (Vibramycin) 3. Tigecycline (Tygacil)

For rickettsia, some STDs, chlamydia, acne, or some uncommon bacteria

Nausea, vomiting, and diarrhea (frequently dose related) Superinfection such as vaginitis and stomatitis Photosensitivity, with exaggerated sunburn Discolored teeth in fetus or young children Retarded bone growth in fetus or young children

Drinking liberal quantities of fluids Restrict caffeine intake Avoid excessive sun exposure Report any side effects, especially rash or hypersensitivity signs to health care provider Older patients should follow preceding instructions, especially reporting GI or CNS effects (see Side Effects)

Pregnancy, breast feeding

Avoid exposure to sunlight

Use with children under eight years of age

Avoid this medication if pregnant, breastfeeding, or a child under eight years of age

Patients exposed to direct sunlight Caution in patients with liver or GI disease Patients with renal disease (doxycycline preferred)

Take preferably on an empty stomach with full glass of water, 1 h before or 2 h after meals, unless there is gastric distress Avoid iron, calcium,

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Hepatic or renal toxicity (rare)

magnesium, antidiarrheals, and dairy foods within 2 h of taking tetracyclines

CNS symptoms such as vertigo and cerebral edema Thrombophlebitis possible with IV therapy

Do not take at bedtime to prevent irritation from esophageal reflux

Allergic hypersensitivity reactions rare

Antifungals 1. Amphotericin B (Abelcet, AmBisome) 2. Fluconazole (Diflucan) 3. Micafungin (Mycamine) 4. Nystatin

Treatment of specific susceptible fungial disease Fluconazole: Appropriate for patients requiring prolonged antifungal therapy

Discard any expired drug— nephrotoxicity can result from taking outdated drug

Amphotericin B:

Fluconazole:

Headache, chills, fever, hypotension, tachypnea

Pregnancy, breast feeding

Infusion-related reactions Malaise, muscle and joint pain, and weakness Anorexia, nausea, vomiting, and cramps Nephrotoxicity— occurs to some degree in most patients

Hepatic or renal disease Micafungin: Use with children under age 18 Pregnancy, breast feeding—or women who may become pregnant while taking the drug Liver dysfunction

Anemia

Renal disease Porphyria

Hypokalemia, hypomagnesemia

Nystatin:

Fluconazole: Moderate nausea,

Patient Education

Caution should be taken in the use with pregnancy,

Take the medication for prolonged periods as prescribed, even after symptoms have subsided Report relapses promptly to health care provider Report side effects immediately to the health care provider for possible dosage adjustment or symptomatic treatment Do not take any other medications at the same time without health

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

vomiting, abdominal pain, diarrhea

breastfeeding

care provider’s approval (see Interactions)

Ethambutol:

Ethambutol:

Optic neuritis—with visual problems (reversible if discontinued early)

Visual testing should be performed before and during therapy

Take prescribed medication for lengthy required period of time even though asymptomatic

Rash Hepatic abnormalities Dizziness and headache Micafungin: Headache, fever— frequent initially Thirst, nausea, vomiting, and diarrhea Infusion hypersensitivity reactions—rash, urticaria Neutropenia Photosensitivity Hypokalemia, hypomagnesemia Nystatin: Rare but may include nausea, vomiting, and diarrhea with high oral doses occasionally Antituberculars 1. Ethambutol (Myambutol) 2. Isoniazid (INH) 3. Pyrazinamide (PZA)

Used in the treatment of latent or asymptomatic tuberculosis infection and in treatment of active clinical tuberculosis and

Dermatitis, pruritus Headache, malaise,

Impaired renal function—

Report side effects for

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Patient Education

4. Rifampin (Rifadin)

prevention of relapses

fever, confusion, joint pain

reduced doses indicated

GI symptoms

Diabetes, especially diabetic retinopathy

possible dosage adjustment or prescription of other palliative medications to relieve discomfort

5. Streptomycin (Streptomycin)

Peripheral neuritis rare INH and rifampin: Usually more pronounced in the first few weeks of therapy and can be treated symptomatically Nausea, vomiting Diarrhea Dizziness Blurred vision Headache Fatigue Numbness, weakness of extremities Hepatic toxicity especially those over age 35 and children Body fluids colored red-orange with rifampin Hypersensitivity, with flu-like symptoms (sometimes with rifampin) Pyrazinamide: Hepatic toxicity

Ocular defects Use with children under age 13— and only in children whose visual acuity can accurately be determined and monitored

Importance of frequent medical and laboratory checks Interactions with other drugs (e.g., birth control pills may be ineffective)

Pregnancy— caution

Avoidance of alcohol

Patients with gout (ethambutol can cause hyperuricemia)

Take rifampin on empty stomach for maximum absorption or with food if nauseated

INH and rifampin: Chronic liver disease or alcoholics, periodic laboratory tests required Impaired renal function Children’s dose should be limited to 10 and 15 mg/kg, respectively, to decrease likelihood of hepatic toxicity

Red-orange color of urine, feces, sputum, sweat, and tears with use of rifampin Not wearing contact lens with rifampin Importance of visual testing periodically with ethambutol

Pyrazinamide:

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

Gout—increased uric acid

History of gout

Hypersensitivity GI disturbances Streptomycin: Ototoxicity Nephrotoxicity

Patient Education

Diabetes Severe hepatic disease or alcoholism Use with children— potential toxicity Pregnancy, breastfeeding

Miscellaneous 1. Clindamycin (Cleocin) 2.

Metronidazole (Flagyl) 3. Vancomycin (Vancocin)

Used in the treatment of potentially lifethreatening infections caused by susceptible organisms that cannot be treated with other less toxic anti-infective agents

Clindamycin:

Clindamycin:

Metronidazole:

Nausea, vomiting, diarrhea (drug should be discontinued if this develops), colitis

History of GI, hepatic, or renal disease

Rash, pruritus, fever, and occasionally anaphylaxis

Use with children

Clindamycin:

Local effects— minimize by deep IM or frequent IV catheter change

Avoid alcohol during and 48 h after treatment (disulfiram-like reaction with symptoms of flushing, nausea, vomiting, thirst, chest pain, vertigo, and hypotension)

May be a viable therapeutic option for communityacquired MRSA Metronidazole: One of the most effective drugs available against anaerobic bacterial infections

Metronidazole: Abdominal pain, Nausea/vomiting Anorexia, metallic taste, Xerostomia (dry mouth)

Vancomycin:

Headache, dizziness, Ataxia (defective muscle coordination)

Drug of choice for MRSA

Flushing, rash, urticaria Peripheral

Older adults

Metronidazole: History of blood dyscrasias Pregnancy (especially during first trimester), breast feeding Use in children (except for treatment of amebiasis) CNS disease Hepatic disease Vancomycin: Older adults Hearing impairment Renal impairment

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

neuropathy (rare) and seizures

Pregnancy and breast feeding

Patient Education

Dark urine (common) Vancomycin: Ototoxicity or nephrotoxicity with IV Local effects; give only IV with care, can cause necrosis or thrombophlebitis Rash (Red man syndrome), anaphylaxis, vascular collapse Pseudomembranous colitis due to Clostridium difficile infection (rare) Agents for VRE 1. Daptomycin (Cubicin) 2. Linezolid (Zyvox)

Used in the treatment of vancomycinresistant staphylococci (VRSA) and vancomycinresistant enterococci (VRE) infections

Daptomycin:

Daptomycin:

Linezolid:

Constipation, nausea, injectionsite reactions, Headache

Renal impairment— dosage adjustments required in severe disease

Stop medication and contact health care provider with blood in stool or abdominal pain

Elevated levels of creatinine phosphokinase (CPK), leading to myopathy (monitor CPK levels weekly) Linezolid: Nausea, headache, Diarrhea Myelosuppression (including anemia and

Pneumonia— daptomycin is inactivated by pulmonary surfactant and, therefore, is ineffective Linezolid: Blood dyscrasias Cardiac disease,

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

Contraindications or Cautions

thrombocytopenia)

Hypertension

Lactic acidosis

GI disease, Hyperthyroidism

Patient Education

Pseudomembranous colitis Pregnancy, breast feeding, infants Sulfonamides 1.

Sulfamethoxazole (SMX) and trimethoprim (TMP) (Bactrim, Bactrim DS)

Used in combination with other drugs for urinary tract infections, enteritis, otitis media, Pneumocystis carinii pneumonia

Numerous and sometimes serious, especially with AIDS patients and can include:

Also may be considered as an oral alternative to vancomycin when treating certain MRSA infections and used in the prevention treatment of toxoplasmosis in HIV-infected AIDS patients

Nausea, vomiting

Rash, pruritus, dermatitis Photosensitivity

Impaired hepatic or renal function or urinary obstruction

Drink large amounts of fluid to prevent crystalluria

Blood dyscrasias

Discontinue sulfa at first sign of rash

Severe allergies or asthma Pregnancy, breast feeding

Diarrhea

Report any side effects immediately to health care provider Avoid exposure to sunlight

High fever, headache, stomatitis, and conjunctivitis

Ingestion of sulfa with food delays but does not reduce, absorption of the drug

Blood dyscrasias Hepatic toxicity with jaundice Renal damage with crystalluria and hematuria Hypersensitivity reactions that can be fatal

Urinary AntiInfective Drugs 1.

Nitrofurantoin (Macrodantin, Furadantin) 2. Trimethoprim

Used for initial or recurrent urinary tract infections

Nitrofurantoin:

Nitrofurantoin:

Nitrofurantoin:

Nausea and vomiting

Renal or hepatic impairment

Numbness and weakness of lower extremities

Anemia

Take medication for required number of days

Headache, dizziness,

Electrolyte abnormalities

Report side effects to health care provider

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

(Macrobid)

Side Effects

Contraindications or Cautions

Patient Education

and weakness of muscles

Asthma Pregnancy, breast feeding

Take medication with milk or food to reduce nausea and vomiting

Use with children under one month of age

Discoloration of urine can stain underpants

Acyclovir:

Acyclovir:

Acyclovir:

Not common but can include:

Use with children, breast feeding

Report side effects

Impaired renal function, especially with rapid IV infusion

Renal disease (adjust dosage)

Take medication only as prescribed

Dehydration

Lethargy, tremors, confusion, and headache, especially with older adults

Neurological abnormalities with high doses

Do not share drug with others

Rash, urticaria, pruritus, and photosensitivity

Pregnancy, breast feeding. Health care practitioners and visitors who are pregnant, breastfeeding should be warned about the serious risk of close contact with patients receiving ribavirin inhalation therapy

Cough; respiratory distress with prolonged use Dark yellow or brown-colored urine Hemolytic anemia Antivirals For herpes infections 1. Acyclovir (Zovirax) 2. Famciclovir (Famvir) 3. Valacyclovir (Valtrex) For influenza Neuraminidase inhibitors 1. Oseltamivir (Tamiflu) 2. Zanamivir (Relenza) Other Drugs for Influenza 1. Baloxavir marboxil (Xofluza) For RSV 1. Ribavirin (Virazole)

Acyclovir: Treatment of herpes simplex, herpes zoster, and varicella zoster Neuraminidase inhibitors: Treatment of uncomplicated acute illness due to influenza types A and B

Baloxavir marboxil: Works differently than neuraminidase inhibitors in that it inhibits viral RNA synthesis

Nausea, vomiting, abdominal pain, and diarrhea Neuraminidase inhibitors: Oseltamivir:

Ribavirin: Treatment of infants and young children with respiratory syncytial virus (RSV) infections.

Also treatment of other severe viral infections in

Nausea, vomiting, and diarrhea in one out of four patients; can be lessened by taking the medication with food

Ribavirin:

Finish full course prescribed, even if feeling better Avoidance of sexual intercourse when visible genital herpes lesions are present and using protection at other times

Zanamivir: Airway irritation and

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Instructor Manual: Colbert, Essentials of Pharmacology for Health Professions, 9e, 2023, ISBN 9780357618301; Worksheets for Textbook Part II

Classifications and Drugs

Purpose

Side Effects

adults

bronchospasm, especially in patients with asthma and chronic obstructive pulmonary disease (COPD)

Contraindications or Cautions

Patient Education

Ribavirin: Respiratory complications Hypotension, cardiac arrest Anemia Rash, conjunctivitis

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