Adrenergics 63: Used in Cardiac arrest and COPD Action: Stimulate Beta 2 receptors in lungs (increases peripheral resistance

and causes bronchodilation. Activation of cardiac beta 1 increases HR, force of contraction. Activation of Activation of alpha 1 causes vasoconstricition. They are sympathomimetrics. Indications: Hypovolemic shock, cardiac arrest, Anaphylaxis Side effects: Dysrhythmias, tremors, anticholinergic effects (Dry mouth, urinary retention) Nursing considerations: Monitor BP, peripheral pulses, check output (the patient becomes drowsy so safety is a concern), observe extremities for color and perfusion Meds: Norepinephrine (Levophed) Dopamine (Inotropin) Epinephrine (Adrenalin) Isoproterenol (Isuprel) Pseudoephedrine (Sudafed) Phenylephrine (Neo-Synephrine) Dobutamine hydrochloride (Dobutrex) Sodium Nitroprusside (Nitropress) Diphenhydramine HCL (Benadryl)

Antianxiety 64 Use: Manic episodes and panic attacks; CNS depression agent Action: Affects neurotransmitters Indications: Anxiety disorders, insomnia, petit mal sz, panic attacks, acute manic episodes. Side effects: Sedation, Bradycardia, Dry mouth, urinary retention, confusion and Hepatic dysfunction Nursing Considerations: Potential for addiction/overdose, Avoid alcohol, monitor liver function (AST/ALT and LDH) D/C meds slowly (cannot be on one day and off the next).

Meds may cause respiratory depression. Benzodiazepines are also used as muscle relaxants, sedatives, hypnotics and anticonvulsants. Meds: Chlordiazepoxide (Librium) Diazepam (Valium) Alprazolam (Xanax) Clonazepam (Klonopin) Lorazepam (Ativan) Oxazepam (Serax) Midazalam (Versed) Buspirone (BuSpar) Hydroxyzine (Vistaril) (Atarax) Herbals: Kava Melatonin Antacids 65 Uses: Peptic ulcer, Indigestion, Reflex esophagitis, Prevent stress ulcers Action: Neutralizes gastric acids; raises gastric pH, inactivates pepsin (when pH >5); does not coat stomach, it works systemically S/E: Constipation, Diarrhea, Acid rebound Nursing considerations: Interferes with absorption of antibiotics, Iron preps, INH, Oral contraceptives. Monitor bowel function (Remember we are giving GI med) TIMING: All antacids should be given 1-2 hours after eating (Antacids most effective after digestion has started, but prior to the emptying of the stomach) Maximum acid secretion occurs 1-3 hours after a meal. Interfere with ulcer meds such as famotidine (Pepcid) Meds: Aluminum hydroxide gel (Amphojel)

Calcium carbonate (Titralac) Aluminum hydroxide and magnesium trisilicate Magnesium hydroxide (Milk of Magnesia) Aluminum hydroxide and Magnesium hydroxide (Maalox)

Antidysrhythmics 66: Uses: Atrial Fibrillation, Premature Ventricular contractions Action: Interferes with excitability of heart Side effects: Bradycardia, lightheadedness, hypotension (were dampening the heart), urinary retention Nursing considerations: Monitor pulse and BP and cardiac rhythm, educate client about slowly sitting to stand for safety from falls. Class III lol drugs can cause bronchospasm (B for beta blocker and bronchospasm) airway is important to maintain. Class IA Procainamide (Protestyl) Disopyramide (Norpace) Amiodarone Quinidine Class IB Lidocaine (Xylocaine) Mexiletine hydrochloride (Mexitil) Tocainide hydrochloride (Tonocard) Class IC Flecainide (Tombocor) Encainide Propafenone hydrochloride (Rythmol) Antiarrhythmics (Beta blockers Class II) Metroprolol Atenolol Propranolol (Inderal) Acebutolol (Sectral)

Esmolol hydrochloride (Brevibloc) Timolol Sotalol hydrochloride (Betapace) Antiarrhythmics (K+Channel blockers Class III) Sotalol hydrochloride (Betapace) Amiodarone (Cordarone) Bretylium Ibutilide furmarate (Corvert) Dofertilide (Tikosyn) Antiarrhythmics (Ca2+ channel blockers) (Class IV): Diltiazem Verapamil Vasodilators: Verapamil Minoxidil Hydralazine Calcium Channel Blockers: Verapamil Diltiazem Nifedipine ACE Inhibitors: Lisinopril Enalapril Captopril Cardiac glycosides: Digoxin Dieuretics: Loop Dieuretics Hydrocholorothiazide K+ Sparing Dieuretics Spironolactone Triamterene Amiloride Sympathoplegics: Beta blockers Clonidine Reserpine Guanethidine Prazosin Antibiotics/Antiinfectives 67: General: allergies, Super infection, Organ toxicity (Liver and Kidney) Teach: Take until gone, do culture and sensitivity first; Encourage fluids, check expiration date. A lot have s/e of diarrhea, nausea, stomatitis, GI upset. AMINOGLYCOSIDES 67 -mycin Treatment for infection with Pseudomonus and Ecoli, anthrax Action: ihibit protein synthesis in gram negative bacteria S/E: diarrhea, Elevated Bun, AST.ALT, creatinine. *MYCIN are like mice: Mice have big ears (ototoxic) and their ears look like kidneys (Nephrotoxic), Check 8th cranial nerve (this is the hearing nerve), BUN and creatinine (1200/day is normal), Take for 7-10 days.

Examples:
Aminoglycosides: Amikacin Gentamicin Neomycin Tobramycin Streptomycin

CEPHALOSPORINS67 Uses: Tonsilitis, otitis media, perioperative prophylaxis, meningitis Action inhibits synthesis of cell wall. Side effects: Bone marrow depression, rash, superinfections Take with food can cause GI upset ONLY ONE GIVEN WITH FOOD Cross allergy with PENICILLIN!!!!!!!!!!!! Examples: Cefaclor (ceclor), Cefazolin (Ancef), Surax (Cefixime), Cephalexin (Keflex), Ceftriaxone (Rocephin), Cefoxitin (Mefoxin) FLuoroquinolones 68 Probenecid (gout medication) helps increase cipro effect Side effects: diarrhea Encourage fluids to help kindey (3000 ml/day) If needed administer antacids 2 hr after medication, do not give with iron.
Ciprofloxacin Sparfloxacin Enaxacin Nalidixic acid Norfloxacin Mortifloxacin

Glycopeptides68
Vancomycin (Vancocin) avoid extravasation may cause necrosis Give antihistamine if red man syndrome: decreased blood pressure, flushing of the face and neck Contact clinician if signs of superinfection: Sore throat, fever, fatigue.

Lycosamides 68 Clindamycin HCL Phosphate (Cleocin) -Administer oral med with full glass of water (prevents esophageal ulcers) Macrolide antibiotics 69 -used for ppl allergic to penicillin and cephalosporin UNIQUE S/E: Confusion Dont take with food wait 2-3 hr after food or give an hour

before you eat.

Carithormycin Erythromycin Azithromycin Aminoglycosides: Amikacin Gentamicin Neomycin Tobramycin Streptomycin

PENICILLIN 69 Pay attention to Mild reactions Multiple exposure and allergic reactions Decreases oral contraceptive effectiveness Potential cross allergy with cephalosporins It inhibits synthesis of cell wall (works differently than most) SULFONAMIDES Antagonize components of folic acid synthesis Side effects unique: peripheral neuropathy, crystalluria, proteinuria, photosensitivity. -give good mouth care for stomatitis
examples: Sulfadiazine Sulfisoxazole Sulfamethoxazole Malaria Treatment: Chlorquine Quinine Mefloquine

Tetracyclines indications: acne -If taken beyond its expiration date is toxic (Makes people sick!) -can cause esophageal irritation unique s/e: Discoloration and inadequate calcification of teeth of fetus if taken during pregnancy Phototoxic reactions (more severe than most) -donot take with antacids, milk , iron preps.
Tetracycline Doxycycline Minocycline Demeclocycline

Genitourinary medications Nitrofurantoin (Furadantin) side effect is asthma attacks; give with food or milk, monitor pulmonary status. Can be taken with cranberry juice Phenazopyridine (Pyridium)- turns urine orange ANTICHOLINERGICS- inhibit the action of acetylcholine; block parasympathetic nerve.

Anticonvulsant medication General: Depress bone marrow, respiratory depression, aplastic anemia, thrombocytopenia , leukopenia, gingival hypertrophy (overgrowth of gums), ataxia (dizziness/loss of control of body movement) Action: trying to decrease seizures so dampen CNS which leads to respiratory depression. It does this by decreasing the flow of calcium and sodium ions across neuronal membranes. Nursing considerations: do not discontinue abruptly (boomerang effects) -Caution with use of medications that lower seizure threshold (MAO inhibitors) and antipsycotics Meds: Phenytoin (Dilantin) NEVER be mixed with any other medication or dextrose IV, GIVE ALONE. Nursing considerations: If given fast may lead to cardiac arrest. Give with vit D, turn urine red-brown to pink (normal) Phenobarbital (luminal) Magnesium sulfate respiratory arrest is a side effect so monitor respirations Valporic acid (depakote) Do not take with carbonated beverage Antidepressants Action: increase concentration of neurotransmitters. Uses: Depression and treatment of chronic pain Maonoaminde oxidase (MAO) inhibitors difficult meds to take with; take good assessment history MAO plus TYRAMINE can lead to hypertensive crisis A hypertensive crisis is where one gets a sever headache, palpitations, diaphoresis, stiff neck, and it can even progress to intercranial hemorrhage. Nursing condierations- takes 4 weeks to be effective, Do not take with CNS stimulants or cold medications.

Example: Phenelzine sulfate (Nardil)

Selective serotonin reuptake inhibitors (SSRI) can turn urine pink. Nursing considerations suicide precautions, take in the morning AM. Decrease libidio. Example: Fluoxetine (Prozac), Paxil, Zoloft

Antidepressants: Tricyclics Inhibits reuptake of neurotransmitters. Side effects include photosensitivity, dry mouth (candy fix). Herterocyclics Bupropion (Wellbutrin, Zyban) side effect of agitation Trazodone (Desyrel) side effect of sedation INSULIN - peak action is the time of concern Anti gout Colchicine (Colsalide) acute. Probenecid (Benemid)- chronic Antihistamine- Brochospasm is a side effect Antilipemic agents -stran/sequestrants blocks Antihypertensives: Beta Adrenergic blockers Side effects: somnolence For diabetic patients it blocks hypoglycemia signs/symptoms (sweating , tachycardia), monitor bb glucose Antihypertensives: Calcium Channel blockers Indications: interstitial cystitis

Interacts with grapefruit juice Bipolar disorder medications Lithium- a salt (drink lots of fluid) 1-1.5 meq/L Dehydration -statins interfere with synthesis Antineoplastic agents: Hormonal agents Tamoxifen- blocks estrogen Side effects: Hypercalcemia, increased appetitie, retention Nursing considerations: check cbc, monitor serum calcium Antineoplastic agents: Vinca alkaloids Side effects: loss of reflexes Check reflexes, given with zyloprim to decrease uric acid and side effects Antipsychotic meds Nursing considerations: Check cbc, monitor v/s, avoid alcohol and caffeine (these decrease seizure threshold) Atypical: Clozaril and Risperdal. S/E: extrapyramidal Anticholinergic, sedative, orthostatic, hypotension Nurs cons: monitor BP, use sunscreen, slowly stand. Antipyretic: Acetaminophen (Tylenol) Side eff: Gi irritation, liver dysfunction (acetaminophen) Nursing consideration: Aspirin contraindicated for client less than 21 years old due to risk of reyes sybndrome. Antithyroid meds Stop taking 2 wks prior to any surgery Nurs consideration: may cause buring in mouth, give with

meals check cbc Thryroid replacements We are stimulating so you will see nervousness and tachycardia -enhances action of oral anticoagulants (Coumadin), antidepressants. -obtain baseline v/s : pulse and BP give in AM- can cause insomnia AntiTB Rifampin (rifadin) orange urine tears and saliva Antivirals Side eff: diarrhea, hypotension, agranulocytosis (infection), peripheral neuropathy, GI hemorrhage, MI, stroke. Meds to tx ATTENTION DEFICIT DISORDER Methylphenidate (Ritalin) Stimulant: appetite suppressant so kids dont eat. Give at least 6 hours before bedtime so able to sleep. Carbonic anhydrase inhibitors -evalate mental status before giving Cardiac glycosides Notify physician if AP less than 60bpm <90-110 (infants and young children), <70 (older children) -monitor k+ level -0.5 given 28 hr then .25 go on with the quarter as a running dose. -Antidote: Digibind CYtoprotective- coats lining of duodenum -give 2hr before or after meds to prevent decreased absorption (it lines the intestine) Glucocorticoids- increase risk for infection, insomnia, delay wound healing , hypokalemia and hypocalcemia Side effect: stunt growth

Mineralocorticoids,- give low sodium high protein high potassium diet Heavy metal antagonists- toxic to kidney Side effect: pain and induration at injection site -administer with anesthetic watch 4 sz bec rapid metabolism of lead increases or potentiate likelihood of sz. Immunosupressants -dont take with grapefruit -visitors wear masks, raw meats not allowed Laxatives Hypomagnesemia can decrease respiratory status which can decrease HR. Sode effects: abd cramps, hypermagnesemia (milk of magnesia) -nurs conside: encourage fluids 3000ml/day Miotic eye med -even if given for eyes it has a systemic eff on the body (H/A) -photophobia myopia-near sightedness. Avoid sun. Mydriatic and cyclopegic eye meds -Atrophine sulfate, cyclogyl -indic: wear dark glasses bec pupil wont constrict Narcotics Slows down the body Decrease bb return to hearts right side decrease perip resistance, decr preload and afterload pressures and cardiac workload, causes vasodilationand pooling of fluid in extremities, proides relief from anxiety Thrombolytics --have amino caproic acid available

-do neurockecks to check for bleeding into the brain 15 min x 1hr and 30 min x 2-8 hrs -Apply prolonged pressure to holes on skin s/e: bradycardia, bleeding, dyrhytmia mens hearlth meds: side eff: dizzy , h/a. ortho hypotension, decreased urinary uragency , hesitancy, nocturea, prostatic hyperplasia Herbal supplements THE 3 BiG Gs Garlic gincer ginko= affect anticoagulation Chondrotin for joint development Glucosamine screw up bb sugar lvl St. johns wart: Decreases effectiveness of dige, antineoplastic, antivirals, aids meds, antirejection meds, theophylline, Coumadin, oral contraceptives. Sulfanomides (Azulfidine)- used to treat inflammatory bowel dx; increase fluids to prevent crystallization in the kidney tubules. Take after food or with meals. Beta blocker and ACE inhib less effective in African americans.