Pharmacology Hesi Drugs Study Guide for Surgical Nursing Development Course. The most examined Drugs

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Pharm Hesi Drugs Study Guide Surgical Nursing Development Course DRUG NTG Nitroglycerine

CLASS antianginals

MOA Acute ( translingual, SL, ointment ) and long-term prophylatic ( oral, transdermal ) management of angina pectoris. vasodilation

SIDE EFFECT/CONTRA SE: hypotension, tachycardia, syncope C: Severe anemia, pericarditis

NURSING ACTION -Acute Anginal Attacks: Relief usually occurs within 5 min. Dose may be repeated if pain is not relieved in 5–10 min. Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min.

SL—keep in dark containter away from moisture, may loose potency.

-Monitor behavior, may cause suicidal thoughts -For chronic asthma attack

montelukast (Singulair)

leukotriene receptor antagonist (antiinflammatory)

allergy, cold and cough remedies bronchodilators Decrease inflammatory response in chronic asthma

SE : Cough, rhinorrhea , suicidal thoughts, HA insomnia, tremors.

C: Acute asthma attack

Zileuton (Zyflo)

Leukotriene antagonist

Inhibits the enzyme 5lipoxygenase that catalyzes to formation of leukotrienes.

Suicidal thoughts, HA insomnia, tremors,

-Monitor behavior, may cause suicidal thoughts -For chronic asthma attack

arthralgia

Result is decreased inflammatory process that is part of asthma.

Oxycodone (Percocet)

Opioid

Binds to opiate receptors in the CNS

SE: RR depression, constipation, dizziness C: Hypersensitivity to acetaminophen/aspirin/ibuprofen

-Assess BP, RR, and HR. Hold if RR < 10 breath/min or bradycarida occus.

Ondansetron(Zofran)

Anti-emetic

N/V

headache, dizziness, drowsiness, TORSADE DE POINTE, constipation, diarrhea, abdominal pain, dry mouth, ↑ liver enzymes., extrapyramidal reactions.

Advise patient to notify health care professional immediately if symptoms of irregular heart beat or involuntary movement of eyes, face, or limbs occur.

Metoclopramide (Reglan)

antiemetics

Blocks dopamine receptors in chemoreceptor trigger zone of the CNS.

SE: constipation, diarrhea, drowsiness, extrapyramidal reactions, restlessness,

Stimulates motility of the upper GI tract and accelerates gastric emptying.

C: Pheochromocytoma

- Monitor for neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered consciousness, irregular pulse or BP,

Parkinson's disease

tachycardia, and diaphoresis).

- Assess (parkinsonian— difficulty speaking or swallowing, loss of balance control, pill rolling, mask-like face, shuffling gait, rigidity,

Tx N/V, Decreased symptoms of gastric stasis.

Isoniazid (INH-tyramine)

antituberculars

First-line therapy of active tuberculosis First-line therapy of active tuberculosis Bacteriostatic

SE: N+v, hepatitis, peripheral neuropathy, psychosis, fever, visual disturbances C: Liver disease , hepatitis induce from isoniazid

-Do not take with aluminum or antacid, decrease absorption -Check LFTs (AST, ALT, Alk phosphate) -Drug is hepatoxic

Linezolid (Zyvox)

anti-infectives

Inhibits bacterial protein synthesis Tx vancomycinresistant Enterococcus faecium

SE: teeth discoloration, tongue discoloration, bloody diarrhea , HA insomnia C: Uncontrolled HTN, pheochromocytoma, thyrotoxicosis, or concurrent use of sympathomimetic agents

-Take full course of therapy -May stain teeth -Report bloody diarrhea

Baclofen (Gablofen)

antispasticity agents

Treatment of reversible spasticity due to multiple sclerosis or spinal cord lesions

SE: Tinnitus, hypotension seizures C: Epilepsy MOA inhibitors, antihypertensive

- CNS depressant check BP and RR before meds.

-May cause hyperglycemia

Work by increasing the amount of water in the stool, making it softer and easier to pass.

Bloating, gas, or stomach cramps may occur.

Short-term management of duodenal ulcers.

Aluminum salt of sulfated

SE: constipation, diarrhea, dry mouth, hyperglycemia

Before using this medicine, consult your doctor or pharmacist if you have: sudden/unexplained abdomina l pain, nausea/vomiting, other symptoms of appendicitis (e.g., very tense abdomen, fever, chills), blockage in the intestines, hole in the intestines (perforation).

- Administer on an empty stomach, 1 hr before meals and at bedtime.

Bulk-forming laxative (Metamucil)

Sucralfate (Carafate)

antiulcer agents

sucrose reacts with gastric acid to form a thick paste, which selectively adheres to the ulcer surface.

C: hypersensitivity Caution with renal failure increase aluminum Diabetes  hyperglycemia

- Assess patient routinely for abdominal pain and frank or occult blood in the stool.

Assess BP, pulse, and respirations before and periodically during admin. If RR is <10/min, assess level of sedation. Initial drowsiness will diminish with continued care; Assess type, location, and intensity of pain prior to and 1 hour following IM or PO and 5 minute (peak) following IV administration.

-May decrease ability to perspire—hyperthermia -This is a CNS depressant— check RR -May cause urinary retention / constipation—inform DR. -Drink with OJ with straw— stain teeth -Stool softer/increase water intake-fecal impaction/constipation -May cause dark (melena) stool-expected - Observe patient carefully for evidence of hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, and Chvostek's or Trousseau's sign). Protect symptomatic patient by raising and padding side rails; keep bed in low position.

- Toxicity is manifested as

Hydromorphone hydrochloride (Dilaudid)

Opioid agonist

Mu and Kappa stimulant.

Alters the perception of and response to painful stimuli while producing generalized CNS depression.

confusion, sedation, hypotension, constipation, respiratory depression

Oxybutynin (Ditropan)

anticholinergics

Tx bladder incontinence

SE: dizziness, drowsiness, urinary retention constipation, dry mouth

Ferrous Sulfate (Feosol)

antianemics iron supplements

prevention of iron deficiency anemia.

C: urinary retention , glaucoma, intestinal obstruction SE: temporary staining of teeth (liquid preparations) constipation, dark stools, C: Hemochromatosis

Vit D

vitamins

Requires activation in the liver and kidneys to create the active form of vitamin D3 (calcitriol).

Promotes the intestinal absorption of dietary calcium.

SE: anorexia, constipation, dry mouth somnolence, weakness bone pain, muscle pain C: Hypercalcemia

hypercalcemia, hypercalciuria, and hyperphosphatemia.

Assess patient for appearance of nausea, vomiting, anorexia, weakness, constipation, headache, bone pain, and metallic taste.

Isotretinoin (Accutane)teratogenesis

Warfarin (Coumadin)

Digoxin (Lanoxin)

retinoids antiacne agents

anticoagulants

antiarrhythmics inotropics

Management of severe nodular acne

DVT/ PE/ atrial fibrillation Interferes with hepatic synthesis of vitamin Kdependent clotting factors (II, VII, IX, and X).

Heart Failure, atrial flutter, paroxysmal atrial tachycardia Increases the force of myocardial contraction.

Prasugrel (Effient)

Succinylcholine

antiplatelet agents

neuromuscular blocking

Reduce thrombosis Acts by irreversibly binding its active metabolite to the P2Y12 class of ADP receptors on platelets; inhibiting platelet activation and aggregation.

Skeletal muscle paralysis

SE: cheilitis, dry mouth, nausea back pain, muscle/bone pain anemia SUICIDE ATTEMPT conjunctivitis, epistaxis, blurred vision, contact lens intolerance SEVERE BIRTH DEFECTS, ↑ thirst C: Hypersensitivity to retinoids, glycerin, soybean oil, or parabens -Pregnancy SE: BLEEDING. C: Uncontrolled HTN, IIOP-brain surgery

SE: ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block. thrombocytopenia.

Hyperkalemia C: AV block, pericardidits, Thiazides, loop diuretics SE: BLEEDING, THROMBOTIC THROMBOCYTOPENIC PURPURA hyperlipidemia cough, dyspnea

-Photosensitvity -May cause behavioral change (depression, psychosis) -Drys skin, drink water

-Given PO -Antidote: Vitamin K -Check PT/INR

C: Bleeding , hypotension

-Do not use with diuretics K+sparing—cause hyperkalemia -Monitor Apical pulse for full min-monitor EKG throughout therapy -Inform DR. if fever, weakness, skin paleness, purple skin patches, yellowing of skin or eyes, chills, sore throat occur

SE: ANAPHYLAXIS, MALIGNANT

-Assess RR rate—CNS

agents depolarizing

Insulin Methylrednisolone (Solu-Medrol)

corticosteroids

surgical procedures to produce skeletal muscle paralysis after induction of anesthesia and provision of opioid analgesics

HYPERTHERMIA, HYPERKALEMIA.

immunosuppressants Replacement therapy in adrenal insufficiency Suppresses inflammation

SE: depression, euphoria, headache, hypertension PEPTIC ULCERATION adrenal suppression, hyperglycemia ↓ wound healing, ecchymoses

C: Malignant hyperthermia

C: Active infection, live virus vaccine

Glucagon

hormones

Acute management of severe hypoglycemia Antidote to:

- May be given subcut, IM, or IV. Reconstitute with diluent supplied in kit by manufacturer. Inspect solution prior to use; use only clear, water-like solution. Solution is stable for 48 hr if refrigerated, 24 hr at room temperature.

Unmixed medication should be stored at room temperature.

SE: MYOCARDIAL INFARCTION, edema, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS MYOCARDIAL INFARCTION oliguria, renal toxicity, urinary frequency prolonged bleeding time

-Assess bleeding (increased) - Caution with asthma pt. and nasal polyps—anaphylaxis

» Calcium channel blockers.

nonopioid analgesics

Short-term management of pain (not to exceed 5 days total for all routes combined).

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia.

- Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening.

SE: hypotension.

N/V, anaphylaxis C: Pheochromocytoma

» Beta blockers,

Ketorolac (Toradol)

depression -Assess for muscle pain -Malignant hyperthermia— increase temperature during procedure -Hyperkalemia with burns, trauma

Acetaminophen (Tylenol)

antipyretics

Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS

C; NSAIDs, Intracranial bleeding.

SE; HEPATOTOXICITY hypokalemia. muscle spasms, trismus.

-Do no exceed 4 g/day

C: Hepatic impairment

• Analgesia • Antipyresis Ribavirin

Filgrastim (Neupogen)

antivirals

colony stimulating factors

Inhibits viral DNA and RNA synthesis and subsequent replication.

A glycoprotein, filgrastim binds to and stimulates immature neutrophils to divide and differentiate.

SE: CARDIAC ARREST, hypotension hemolytic anemia dry mouth

-Assess patient for cardiovascular disorders (pulse, BP, chest pain).

C: Ventilator pts. Autoimmune disease SE: medullary bone pain. pain, redness at subcut site. excessive leukocytosis

- Monitor heart rate, BP, and respiratory status before and periodically during therapy.

C: Hypersensitivity to filgrastim or Escherichia coli -derived proteins.

Cyclosporine (Gengraf)

immunosuppressants

Prevention of rejection reactions.

SE: diarrhea, hepatotoxicity, nausea, vomiting, Hirsutism, hyperkalemia, hypomagnesemia C: Psoriasis Renal impairment

Calcitonin (Miacalcin)

hypocalcemics

Inhibits osteoclastic bone resorption and promotes

SE: rhinitis, epistaxis, nasal irritation arthralgia, back pain

- Monitor serum creatinine level, intake and output ratios, daily weight, and BP during therapy. Report significant changes.

- May cause ↑ serum potassium and uric acid levels and ↓ serum magnesium levels.

-Hepatotoxic

- Assess nasal mucosa,

Edrophonium (Tensilon)

antidotes anticholinesterases cholinergics

renal excretion of calcium.

urinary frequency , HA C: Hypersensitivity to calcitonin, salmon protein or gelatin diluent

Reversal of muscle paralysis Diagnosis of myasthenia gravis.

SE: SEIZURES, Diplopia, bradycardia, hypotension incontinence, urinary frequency

septum, turbinates, and mucosal blood vessels periodically during therapy.

If severe ulceration occurs, drug should be discontinued.

-Assess hypocalcemia -Overdose-atropine --Cause respitratory depression

C: obstruction of the GI or GU tract Fentanyl (Duragesic)transdermal

Phenytoin (Dilantin)

opioid analgesics

anticonvulsants

Binds to opiate receptors in the CNS, altering the response to and perception of pain.

Treatment/prevention of tonic-clonic (grand mal) seizures and complex partial seizures

SE: bradycardia. confusion, sedation confusion, sedation physical dependence, psychological dependence. bronchoconstriction, laryngospasm, respiratory depression.

C: Acute pain, post-op pain, alcohol intolerance MOA inhibitor SE: hypotension gingival hyperplasia, nausea, constipation SUICIDAL THOUGHTS C: Sinus bradycardia, sinoatrial block, 2nd- or 3rd-degree heart block, or Stokes-Adams syndrome

Ciprofloxacin

fluoroquinolones

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme.

SE: ELEVATED INTRACRANIAL PRESSURE hyperglycemia, hypoglycemia

-Wear gloves when handling -Remove existing patch, rotate site, place in hairless area

-Stop if rash develops (Steven Johnsons Syndrome) -Assess suicide/depression -Assess mental status - Assess patient for phenytoin hypersensitivity syndrome (fever, skin rash, lymphadenopathy) - Monitor levels- Have to have ther. Level to work- check labs q30days then q90days.

-Assess for gain-muscle paintendon rupture

photosensitivity tendinitis, tendon rupture.

C: myasthenia gravis Nitrofurantoin (Macrodantin)

anti-infectives

Prevention and treatment of urinary tract infections caused by susceptible organisms Bactericidal or bacteriostatic

SE: HEPATOTOXICITY, PSEUDOMEMBRANOUS COLITIS, anorexia, rust/brown discoloration of urine. dizziness, drowsiness, headache. hypersensitivity reactions.

C: Oliguria, anuria, or significant renal impairment jaundice or hepatic impairment

Metronidazole (Flaygl)

anti-infectives

Disrupts DNA and protein synthesis Disrupts DNA and protein synthesis

SE: STEVENS-JOHNSON SYNDROME optic neuropathy, abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, Diarrhea

- Assess for signs and symptoms of urinary tract infection - Monitor bowel function.

Diarrhea, abdominal cramping, fever, and bloody stools - Administer with food or milk to minimize GI irritation,

- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome.

Discontinue therapy

C: Hypersensitivity Antihistamine Glaucoma meds PCN

anti-infectives penicillins

Bactericidal action against susceptible bacteria.

S.E: diarrhea, epigastric distress, nausea, vomiting, pseudomembranous colitis.

ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS AND SERUM SICKNESS , superinfection C: hypersensitivity to penicillins (crosssensitivity exists with cephalosporins and

- Observe patient for signs and symptoms of anaphylaxis - Obtain a history to determine previous use of and reactions to penicillins, cephalosporins, or other beta-lactam antibiotics. Persons with a negative history of penicillin sensitivity may still have an

Mannitol

osmotic diuretics

Increases osmotic pressure of the glomerular filtrate, inhibiting reabsorption of water and electrolytes.

other beta-lactam antibiotics) Hypersensitivity to procaine or benzathine (procaine and benzathine preparations only)

allergic response

SE: transient volume expansion, chest pain, HF, pulmonary edema, tachycardia dehydration, hyperkalemia, hypernatremia, hypokalemia, hyponatremia confusion, headache

- Assess patient for anorexia, muscle weakness, numbness, tingling, paresthesia, confusion, and excessive thirst. Report signs of electrolyte imbalance.

-Assess fluid and electrolytes-LOC

C: Anuria; Dehydration; Active intracranial bleeding; Severe pulmonary edema or congestion

Anabolic steroids Levalbuterol

bronchodilators

Bronchospasm Relaxation of airway smooth muscle

SE: PARADOXICAL BRONCHOSPASM (EXCESSIVE USE OF INHALERS) , increased cough hyperglycemia. hypokalemia. tachycardia.

C: Hypersensitivity

Duloxetine (Cymbalta)

antidepressants SSRI

Inhibits serotonin and norepinephrine reuptake in the CNS. Major depressive disorder

SE: HEPATOTOXICITY, ↓ appetite, constipation, dry mouth, dysuria, SUICIDAL THOUGHTS, fatigue, drowsiness, insomnia , C: MAO inhibitor therapy End-stage renal disease

- Advise patients to use levalbuterol first if using other inhalation medications, and allow 5 min to elapse before administering other inhalant medications unless otherwise directed.

-rinse mouth with water after each inhalation dose to minimize dry mouth -Assess BP- cause HTN - Asses for rash -Monitor change in behavior

Concurrent use with MAO inhibitors may result in serious potentially fatal reactions Lithium

mood stabilizers

Alters cation transport in nerve and muscle.

Manic episodes of manic depressive illness

Rivastigmine (Exelon)

anti-Alzheimers's agents cholinergics

Enhances cholinergic function by reversible inhibition of cholinesterase.

SE: Severe cardiovascular or renal disease aphasia, blurred vision, dysarthria, tinnitus.

Muscle weakness C: Dehydrated or debilitated patients Brugada syndrome Severe cardiovascular or renal disease SE: anorexia, dyspepsia, nausea, vomiting, abdominal pain, diarrhea, flatulence, weight gain weakness

-Assess hearing loss - fluid intake of at least 2000–3000 mL/day should be maintained. Weight should also be monitored at least every 3 mo.

Weight gain -Cause dizziness -PO by syringe -Assess LOC

Tx Alzheimer's disease.

terbinafine (Lamisil)

antifungals

Affects the synthesis of the fungal cell wall.

C: Asthma, GI beeding SE: burning, itching, local hypersensitivity reactions, redness, stinging.

C: hypersensitivity Donepezil (Aricept)

anti-Alzheimers's agents

Inhibits acetylcholinesterase thus improving cholinergic function by making more acetylcholine available. v Mild, moderate, or severe dementia associated with Alzheimer's disease.

SE: syncope, diarrhea, frequent urination, muscle cramps, weight loss, hot flash depression C: Hypersensitivity

Inspect involved areas of skin and mucous membranes before and frequently during therapy.

Increased skin irritation may indicate need to discontinue medication.

- Administer in bedtime - Advise patient and caregiver to notify health care professional if nausea, vomiting, diarrhea, or changes in color of stool occur