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Packet 1- Review Not to work around machinery or drive long

SULFONAMIDES
“The Sulfa Drugs”
- Combat infection in the body by
checking the growth of the bacteria
and other microorganisms
distances after taking antihistamines
They potentiate the central depression of many
other agents such as alcohol, tranquilizer,
sedatives and hypnotics
DRUGS AFFECTING THE SKIN AND MUCOUS
MEMBRANES

Indications: Toxoplasmosis, Malaria, H. Soothing Substances

influenza of the middle ear, Urinary Tract - Emollients
Infections a. Petrolatum
b. Hydrous wool fat (Lanolin)
Examples: - Astringents

Sulfisoxazole (Gantrisin) - Irritants

Sulfamethizole
- Keratolytics
S/E: Crystalization of the drug in the kidneys, a. Lactic Acid
N/V, Rashes, Drug fever, Abdominal Distress
Antifungal Agents
Drug interactions: Coumadin - Common on the feet, underarms, under
the breast and perineal areas
Nursing Responsibilities:
Examples:
Increase oral fluid intake
Ketoconazole (Nizoral)
ANTIHISTAMINES Ciclopirox (Loprox)
Clotrimazole (Lotrimin)
- Counteracts the symptoms of allergic
reaction Local Anti-infectives
- OLDER adults
Ethyl Alcohol
Examples: Gentian Violet
Diphenhydramine Hydrochloride (Benadryl) Povidone Iodine
Chlorphenamine Maleate (ChlorTrimeton) Hydrogen Peroxide
Dimenhydramine (Dramamine)
Promethazine (Phenergan) DRUGS THAT AFFECT THE SIZE OF THE
Brompheniramine Maleate (Dimetapp) BRONCHIOLES
Certirizine (Zyrtec)
Loratadine (Claritin) Examples:

S/E: Drowsiness Epinephrine Injection

Nursing Responsibilities: Terbutaline Sulfate (Brethrine)

Theophylline (aminophylline)
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b. Quinidine Sulfate
Albuterol Sulfate (Proventil)

Montelukast Sodium (Singulair) c. Atropine Sulfate

- Prevention of asthma not as reversal of
bronchospasm
d. Lidocaine Hydrochloride
Zafirlukast (Accolate)

Cromolyn Sodium (Intal) e. Procainamide

Ipratropium Bromide (Atrovent)

f. Propanolol

DRUGS THAT AFFECT THE CIRCULATORY

g. Bretylium
SYSTEM
If lidocaine and procainamide is
I. INOTROPIC DRUG not effective

- Increase the contractility of the DRUGS THAT AFFECT THE BLOOD

myocardium. VESSELS

Examples: Vasoconstrictors
a. Digoxin (Lanoxin)

b. Digoxin Immune Fab (Digibind) Uses:

Antidote for 1. Stop superficial
digitalis toxicity hemorrhage
c. Dopamine hydrochloride 2. Relieve nasal
Increase renal congestion
blood flow and sodium 3. Increase the
excretion
force of heart
A/E: angina
pain, ectopic action
heartbeats, headache a. Epinephrine (Adrenalin)
and hypotension Local application- constrict
d. Dobutamine Hydrochloride peripheral blood vessels

II. ACE inhibitors

Parenterally- powerful
a. Isinopril (Zestril)
vasoconstrictor which causes a
b. Captopril (Capoten)
c. Enalapril (Vasotec) marked rise in BP

III. DRUGS USED TO TREAT Vasodilators

ARRHYTHMIAS
a. The Nitrates
a. Amiodarone (Cordarone)
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Relaxes the muscle fibers in the Atenolol (Tenormin)

walls of the blood vessels Nadolol (Corgard)
Major uses of nitrates is Timolol (Blocadren)
treatment of ANGINA PECTORIS
Asthma c. Calcium Channel Blockers
Relieve cramps Blocks the entry
Hypertension of extracellular
calcium ions into
b. Glyceryl Trinitrate (Nitroglycerine) the myocardial and
vascular smooth
ANTIHYPERTENSIVES muscle cells
Leads to
a. Central Alpha-Agonists reduced cardiac
Stimulate alpha output and reduced
adrenergic peripheral
receptors resulting resistance
in decreased Indications:
sympathetic ouflow Angina Pectoris
from the brain to Supraventricular arrhythmias
the peripheral Cardiomyopathy
circulation
Examples: Examples:
Clonidine Hydrochloride (Catapres)
Nifedipine (Procardia, Adalat)
b. Alpha Blockers - S/E- hypotension, dizziness, and nausea
Blocks
postsynaptic alpha Verapamil Hydrochloride (Calan,
adrenoreceptors- Isoptin)
vasodilator effect - Indications: hypertension, angina, and
and lowering the tachyarrhthmias
peripheral - S/E: Bradycardia, heart block,
resistance constipation
Examples:
Prazosin hydrochloride (Minipress) Diltiazem Hydrochloride (Cardizem)
- Indication: Hypertension and Angina
c. Beta Blockers Pectoris
S/E: Decreased - S/S: Nausea, dizziness andbradycardia
cardiac output and
cardiac failure may Amlodipine besylate (Norvasc, Lotrel)
occur Felodipine (Plendil)
Examples:
Metoprolol (Lopressor)
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Urokinase (Abbokinase)
Alteplase (Activase)
DRUGS THAT AFFECT THE BLOOD Antiplatelet Drugs

Coagulants Examples:
a. Calcium Salts Aspirin
Given before surgery - Prevents platelet aggregation
Dipyridamole (Persantine)
b. Vitamin K Ticlodipine (ticlid)
Phytonadione (Mephyton) Clopidogrel (Plavix)
Phytonadione Cilostazol (Pletal)
(Aquamephyton) - Intermittent claudication

Anticoagulants Antilipemic Drugs

PT range- 1.5-2.5 times the controlled value Examples:

INR- 2.5-3.5 Cholestyramine (Questran)
-S/E: Constipation
Examples: Colestipol (Colestid)
Sodium Heparin Prevastatin Sodium (Prevachol)
IV, SQ Lovastatin (Mevacor)
Indications: Simvastatin (Zocor)
Treatment of venous thrombosis Atorvastatin calcium (Lipitor)
Prevention and treatment of pulmonary
embolism
Prevention and treatment of arterial
emboli
Low Molecular Heparin
Tinzaparin (Innohep)
Enoxaparin (Lovenox)
Sodium Warfarin

Thrombolytic Therapy for Myocardial Infarction

Examples:
Streptokinase (Streptase)
- Protein produces by the group C beta
hemolytic streptococci
- Promotes thrombolysis or dissolution of
blood clots
- Used to lyse coronary artery thrombi
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Mephalan (Alkeran)

Implementation:
Packet #2- ANTINEOPLASTIC AGENTS
- Arrange blood test
- Ensure that patient is well hydrated
Types:
- Small frequent meals
a. Alkylating Agents
- Proper covering for alopecia
b. Antimetabolites
- Drugs that protect cells from these
c. Antineoplastic Antibiotics
drugs (Amifastine, Mesna)
d. Mitotic Inhibitors
e. Hormones and Hormone modulators
Antimetabolites
- Inhibit DNA production in cells that
Goal: Limit the offending cells enough so that
depend on certain natural metabolites
the immune system can control them without
to produce their DNA
causing too much toxicity to the host
- Affects rapidly multiplying cells
Indication: Leukemia, GI and basal cell
cancers
Alkylating Agents

C/I: allergy; pregnancy; bone marrow

Mechanism of action: Reacting chemically with
suppression, lactating, renal and hepatic
the portions of the RNA, DNA and cellular
dysfunction; GI ulceration
proteins
- Most useful in slow growing cancers
A/E: same
C/I: allergies to alkylating agents; pregnancy;
bone marrow suppression, suppressed renal
Examples:
and hepatic function
A/E: Bone marrow suppression; GI effects, Drug Special Notes
Hepatic toxicity, Alopecia
Cytarabine (Ara-C) Cytarabine syndrome;
Alopecia

Drug Special Notes Methotrexate (Folex, Hypersensitivity rxn, liver

Rhematrex) toxicity, GI complications
Busulfan (Myleran) Monitor Bone marrow;
Increase OFI; Alopecia Mercaptopurine
(Purinethol
Carboplatin (Paraplatin) Same S/E
Fludarabine (Fludara) Intraarterial line route
Chlorambucil (Leukeran) Toxic to liver and bone
only
marrow
Floxudirine (FUDR)
Cisplatin (Platinol)
Fluorouracil (Adrucil) Wash hands thoroughly
Cyclophosphamine HEMORRHAGIC CYSTITIS
after contact with drug
(Cytoxan)
Thioguanine
Mechlorethamine GI toxicity; impaired fertility
(mustargen) are common
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LEUCOVORIN (WELLCOVORIN)- rescue Mitotic Inhibitors

normal cells from adverse effects of
methotrexate therapy Mechanism of Action: Kills cells as
mitosis begins; Interferes with the
ability to divide, block or alter DNA
Implementation: synthesis
-Same
C/I: same
Antineoplastic Antibiotics
A/E: same plus necrosis and cellulitis if
Mechanism of Action: Cytotoxic and interfere extravasation occurs
with DNA synthesis Drug Special Notes
Etoposide (Toposar) Fatigue, GI toxicity;
C/I: Same Use protective
clothing and goggles

A/E: Toxic GI effects include nausea, vomiting, Teniposide (Vumon)

anorexia, diarrhea, and mucous membrane
Vinblastine (Velban)
deterioration
Extensive CNS effects,
Vincristine (Oncovin) GI toxicity, SIADH has
Drug Special Notes been reported

Bleomycin (Blenoxane) GI toxicity, severe skin

reactions, Pulmonary
problems Mechanism of Action: antineoplastics are
Dactonomycin (Cosmegan)
receptor site specific or hormone specific to
block the stimulation of growing cells that are
Doxorubicin ( Adriamycin) Alopecia, GI toxicity, BM sensitive to the presence of that hormones
suppression, local
extravasation C/I: Same
Idarubicin ( Idamycin)
A/E: Menopause like effects (hot flashes,
Mitomycin (Mutamycin) Severe pulmonary toxicity, vaginal spotting, vaginal dryness, moodiness,
alopecia, injection site and and depression; Hepatic dysfunction; GI toxicity;
toxicity Hepatic toxicity
Pentostatin
Drug Special Notes
Anastrazole (Arimidex) Antiestrogen drug that
Mitoxantrone
blocks estradiol prodiction;
Treatment of advanced
breast cancer
DEXRAZOXANE (Zinegard)- powerful
intracellular chelating agent, is a Tamoxifen (Nolvadex) Antiestrogen; For breast
cancer; S/E: Virilization
cardioprotective drug that interferes with
cardiotoxic effects of doxorubicin Estramustine (Emcyt) Prostate cancer
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Common Adverse Effects Of Antineoplastic PZI 4-8 H 8-20H 24-48H

Agents Humulin U

- Nausea and vomiting

- Loss of appetite Adverse Effects: hypoglycemia and ketoacidosis;
- Loss of hair local reactions at injection sites
- Mouth sores
- Fatigue, malaise Drug to drug interaction:
- Bleeding Decrease glucose- MAO inhibitors, beta
- Susceptibility to infection blockers, salicylates, alcohol

Implementation:

1. Ensure uniform suspension of insulin by

gently rotating vial
PACKET #3- ANTIDIABETIC AGENTS 2. Give maintenance doses SC only;
ROTATE injection sites
Replacement Insulin 3. Use caution when mixing types of
insulin; Use mixtures of regular and
Indication: Treat diabetes mellitus in adults who NPH or regular and lente insulins within
do not respond to diet, exercise, and oral 15 minutes of combining them
agents, and for type 1 diabetics 4. Store insulin in a cool place away from
Type 2 diabetes mellitus direct sunlight. Predrawn insulin- 1
Severe ketoacidosis or coma week
Hyperkalemia 5. Monitor patients during times of
Short courses for periodic stress-type 2 trauma
Gestational diabetes 6. Instruct patient also receiving beta
blockers to monitors glucose levels
C/I: No contraindications
Care- pregnancy and lactation
Allergic to beef or pork- use human insulin Oral Antidiabetic Agents

Type Onset Peak Duration Sulfonylureas

Insulin <15 min 1hour 3.5-4.5
Analogue - Bind to potassium channels on
Humalog pancreatic beta cells to increase insulin
Regular 30-60 2-4 hours 6-8 hours secretion
Humulin R mins - Effective only on patients with
Iletin functioning beta cells
Regular
Novolin R
NPH 1-2 H 6-12 H 18-24 H
Humulin N
Iletin NPH
Novolin N
Lente 4-8H 8-20H 18-24H
HumulinL
Iletin L
Novolin L
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Glucose Elevating Agents:

First Generation
Drug Indication Therapeutic Actions: Increase blood glucose
Chlorpropamide Adjunct diet for
level by decreasing insulin release and
(Diabenase) management of type 2
diabetes; Most accelerating the breakdown of glycogen in
frequently used the liver

Tolazamide (Tolinase) Type 2 C/I: Pregnancy and lactation

Tolbutamide (Orinase) Preferred with renal
Caution: Renal and hepatic dysfunction and
dysfunction cardiovascular disease

Acetohexamide A/E: GI upset, nausea, and vomiting

(Dymelor)
2nd Generation Safer for patients with
renal failure
Drug Special Notes
Diazoxide Oral management of
Glimepiride (Amary)l Less expensive (Proglycem, hypoglycemia
Hyperstat)
Glyburide (Diabeta,
Glucagon To counternact
Micronase, Glynase)
(Glucagen) hypoglycemic reactio
Glipizide (Glucotrol)
Implementation:

- Monitor blood glucose levels daily

C/I:Allergy; Major surgery, ketoacidosis; - Have insulin standby during emergency
severe renal failure, pregnancy and use
lactation - Monitor nutritional status

A/E: Hypoglycemia; GI distress

Drug to drug interactions: Drug that

acidifies the urine- excretion of
sulfonylureas is decreased

Caution: Taking alcohol

Nonsulfonylureas

- Oral agents unrelated to the

sulfonylureas

Drug Special Notes

Acarbose (Precose) Alpha glucosidase
Metformin (Glucophage) Decrease the production
of and increase uptake of
glucose
Miglitol (Glyset) Delays digestion of
carbohydrates
Repaglinide (Prandin)
PACKET 4: HYPOTHALAMIC AND PITUITARY
Troglitazone (Rezulin)
AGENTS
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Contraindications/Cautions:
HYPOTHALAMIC RELEASING FACTORS - Contraindicated with any known allergy
to the drug or ingredients in the drug.
Drug Indications - Contraindicated in the presence of
closed epiphyses or with underlying
Generic (CRH) Diagnosis of Cushing’s cranial lesions.
Disease
Goserelin (Zoladex) Treatment of prostate Adverse Effects:
CA - The adverse effects that most often
Histrelin (Supprelin) Treatment of occur when using growth hormone
precocious puberty in include the development of antibodies
children to growth hormone and subsequent
Leuprolide (Lupron) Treatment of specific signs of inflammation and autoimmune-
CA, endometriosis, type reactions (more common in
precocious puberty somatrem).
Nafarelin (Synarel) Treatment of - Swelling and joint pain
endometriosis, - Endocrine reactions of hypothyroidism
precocious puberty and insulin resistance.
TRH (Protirelin) Diagnosis of thyroid Anterior pituitary hormones/Growth hormone
dysfunction; prevent drugs:
of respiratory distress Drug Indication
of prematurity
(orphan drug use) Chorionic Treatment of male
GHRH (Sermorelin) Diagnosis of gonadotropin (Chorex) hypogonadism,
hypothalamic or induction of ovulation,
pituitary dysfunction tx of prepubertal
in short children; cryptochirdism
evaluation of response Corticotrophin Diagnosis of adrenal
to surgery or (Acthar) function, treatment of
irradiation; ovulation various inflammatory
induction; AIDS- disorders
associated cachexia Cosyntropin Diagnosis of adrenal
(orphan drug use) (Cortrosyn) function
Menotropins Stimulation of
(Pergonal) ovulation and
ANTERIOR PITUITARY HORMONES spermatogenesis
Somatropin Treatment of children
- Agents that affect pituitary function are (Nutropin, Saizen) with growth failure
used mainly to mimic or antagonize the Somatrem (Protropin) Treatment of children
effect if specific pituitary hormones. with growth failure
- They may be used either as Thyrotropin Diagnosis of thyroid
replacement therapy for conditions (Thyropar) function
resulting from a hypoactive pituitary or
for diagnostic purposes.
GROWTH HORMONE ANTAGONIST
GROWTH HORMONES
Drug Indication
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exams
Bromocriptine Treatment of
(Parlodel) acromegaly in patients Contraindications/Cautions
who are not - Contraindicated with any known allergy
candidates for or who to the drug or its components or with
cannot tolerate other severe renal dysfunction.
therapy. - Use cautiously in patients with any
Octreotide Treatment of known vascular disease; epilepsy;
(Sandostatin) acromegaly in patients asthma; and pregnancy or lactation
who are not
candidates for or Adverse effects
cannot tolerate - Water intoxication related to shift of
therapy water retention; tremor, sweating,
vertigo and headache.
Contraindications/Cautions:
- Contraindicated in the presence of any
known allergy to the drug. PACKET 5: ADRENOCORTICAL AGENTS
- Use cautiously in the presence of any
other endocrine disorder and Drug Indication
pregnancy or lactation.
Beclomethasone Blocking inflammation
Adverse effects: (Beclovent) in the respiratory tract
Octeotide Betamethasone Management of
- Effects on the GI tract. Constipation, (Celestone) allergic intra-articular,
diarrhea, flatulence, and nausea are not topical and
common. inflammatory
- Development of acute cholecystitis, disorders
cholestatic jaundice, billiary tract Budenoside Relief of symptoms of
obstruction, and pancreatitis. (Rhinocort) seasonal and allergic
Bromocriptine rhinitis
- Postural hypotension Cortisone (Cortisone Replacement therapy
Acetate) in adrenal
insufficiency;
POSTERIOR PITUITARY HORMONES treatment of allergic
and inflammatory
Drug Indications disorders
Dexamethasone Management of
Desmopressin Diabetes insipidus, von (Decadron) allergic and
(DDAVP) Willebrand’s disease, inflammatory
hemophilia A, disorders, adrenal
treatment of nocturnal hypofunction
enuresis Flunisolide (Nasalide, Control of bronchial
Lypressin (Diapid) DI Aerobid) asthma; relief of
Vasopressin DI, prevention of post- symptoms of seasonal
(Pitressin) operative abdominal and allergic rhinitis
distension, to dispel Hydrocortisone Replacement therapy,
gas for abdominal (Cortef) treatment of allergic
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and inflammatory syndrome with a

disorder glucocorticoid
Methylprednisolone Treatment of allergic Hydrocortisone Replacement therapy,
(medrol) and inflammatory (Cortef) treatment of allergic
disorder and inflammatory
Prednisolone (Delta- Treatment of allergic disorders
Cortef) and inflammatory
disorder Contraindication/Caution
Prednisone Replacement therapy - Contraindicated in the presence of any
(Deltasone) for adrenal known allergy to the drug; with severe
insufficiency; hypertension, CHF, or cardiac disease
treatment of allergic - Use cautiously in women in pregnancy,
and inflammatory in the presence of any infection, and wit
disorder high sodium intake.

Adverse Effects
Contraindication/Caution - Associated with the use of
- Contraindicated in the presence of any mineralocorticoids are related to the
known allergy to any steroid increased fluid volume seen with
preparation; in the presence of acute sodium and water retention.
infection and lactation.
- Use cautiously in patients with
diabetes; acute peptic ulcer; other
endocrine disorders; and pregnancy

Adverse effects
- Adverse effects associated with the PACKET 6: THYROID AND PARATHYROID
glucocorticoids are related to the route AGENTS
administration that is used.
- Children at risk for growth retardation Thyroid Hormones
associated with suppression of the
hypothalamic-pituitary system. Drug Indication

MINERALOCORTICOIDS Levothyroxine Replacement therapy

(Synthroid) in hypothyroidism;
Drug Indication suppression of TSH
release; treatment of
Cortisone (Cortisone Replacement therapy myxedema coma and
Acetate) in adrenal thyrotoxicosis
insufficiency; Liothyronine Replacement in
treatment of allergic (Cytomel) hypothyroidism;
and inflammatory suppression of TSH
disorders release; treatment of
Fludrocortisones Replacement therapy thyrotoxicosis
(Florinef) and treatment of salt- synthetic hormone
losing adrenogenital used in patients
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allergic to dessicated - Contraindicated in the presence of any

thyroid – not for use known allergy to antithyriod drugs and
with cardiac or anxiety during pregnancy.
problems
Liotrix (Thyrolar) Replacement in A/E:
hypothyroidism; - Effects of thyroid suppression:
suppression of TSH drowsiness, lethargy, bradycardia,
release; treatment of nausea, skin rash.
thyrotoxicosis – not
for use with cardiac Iodine Solution:
dysfunction
C/I:
C/I: - Contraindicated in the presence of
- Should not be used with any known pregnancy and with pulmonary edema
allergy to the drugs or their binders, or pulmonary uberculosis
during acute thyrotoxicosis, or during
acute myocardial infarction. A/E:
- Hypothyroidism
A/E:
- Skin reactions and loss of hair are Antihypocalcemic Agents
sometimes seen reactions.
Drug Indication
Antithyroid Agents
Calcitrol (Calcijex) Management of
Drug Indication hypocalcemia and
reduction of PTH levels
THIOMIDES Dihydrotachyesterol Management of
Methimazole Treatment of (Hytakerol) hypocalcemia
(Tapazole) hyperthyroidism
Propylthiouracil (PTU) Treatment of C/I:
hyperthyroidism - Should n ot be usesd in the presence of
IODINES any known allergy to Vit. D;
Sodium iodide Treatment of hypercalcemia; Vit. D toxicity; or
(generic) hyperthyroidism, pregnancy.
destruction of thyroid
tissue in patients who A/E:
are not candidates for - Metallic taste, N/V
surgery and thyroid - CNS effects
destruction is needed
Strong iodide solution, Treatment of
potassium iodide hyperthyroidism, Antihypercalcemic Agents
(Thyro-Block) thyroid blocking in
radiation emergency Drug Indication

Thiomides: Biphosphonates

C/I: Alendronate Treatment of Paget’s

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(Fosamax) disease, post- - Should not be used during lactation

menopausal because the calcium-lowering effects
osteoporosis could cause problems for the baby.
Etidronate Treatment of Paget’s
disease, post- A/E:
menopausal - Flushing of the face and hands; skin
osteoporosis, rash; N/V; urinary frequency
hypercalcemia of
malignancy, osteolytic Other Antihypercalcemic Agents
bone lesions in cancer
patients C/I:
- Contraindicated in the presence of
Calcitonins severe renal dysfunction and lactation.

Calcitonin Inhibit bone A/E:

(Cibacalcin); Salmon resorption; lower - Hypocalcemia and decreased serum
Calcitonin (Calcimar) serum calcium levels bicarbonate which may lead to acidosis.
in children and
patients with Paget’s
disease. CHOLINERGIC AGENTS
Other
Antihypercalcemic DIRECT-ACTING ANTICHOLINERGIC
Agents
DRUG INDICATIONS
Gallium (Ganite) Inhibits calcium Bethanicol (Duvoid, Nonobstructive
resorption from bone Urecholine) urinary retention,
turnover, producing a neurogenic bladder
lowered serum Carbacol (Miostat) Glaucoma, miosis
calcium. Pilocarpine (Pilocar) Glaucoma, miosis

Bisphophanates
C/I:
- Drugs should not be used in the
presence of hypocalcemia, which could
be made worse by lowering calcium
levels.
C/I:
- Used sparingly because of the potential
undesirable systemic effects of
parasympathetic stimulation.
- Contraindicated in the presence of any
condition that would be exacerbated by
parasympathetic effects.

A/E: A/E:
- Headache, nausea, and diarrhea - N/V, vomiting, cramps, diarrhea,
increased salivation, involuntary
defecation, bradycardia, heart block,
and even cardiac arrest.

Calcitonins
INDIRECT-ACTING CHOLINERGIC AGONISTS
C/I: DRUG INDICATION
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Ambenonium Myasthenia gravis neuromuscular

(Mytelase) blockers
Donepezil (Aricept) Alzheimer’s disease Propantheline Adjunctive therapy for
Endophonium Myasthenia gravis (ProBanthine) ulcers
(Tensilon, Enlon) diagnosis, antidote
NMJ blockers C/I:
Neostigmine Myasthenia gravis - Contraindicated in the presence of
(Prostigmine) diagnosis, antidote known allergy to any of these drugs.
NMJ blockers - Also contraindicated with any condition
Physostigmine Miosis, glaucoma that could be exacerbated by a blocking
(Eserine) of the parasympathetic nervous system.
Pyridostigmine Myasthenia gravis
(Reganol, Mestinol) A/E:
Tacrine (Cognex) Alzheimer’s disease - Blurred vision, pupil dilation and
resultant photophobia, cycloplegia, and
C/I: increased intraocular pressure.
- Contraindicated in the presesnce of
allergy to any of these drugs; ANTIARRHYTHMIC AGENTS
bradycardia or intestinal or urinary tract
obstruction. CLASS I ANTIARRHYTHMICS

A/E: DRUGS INDICATIONS

- Adverse effects associated with these Class Ia
drugs are related to the stimulation of disopyramide Treatment of life-
the parasympathetic nervous system. (Norpace) threathening
- N/V, cramps, diarrhea, increased ventricular
salivation and involuntary defecation. arrhythmias
- Bradycardia, heart block, hypotension Moricizine Treatment of life-
and even cardiac arrest. (Ethmozine) threathening
ventricular
ANTICHOLINERGIC AGENTS arrhythmias
Procainamide Treatment of life-
ANTICHOLINERGIC DRUGS (Pronestyl) threathening
DRUGS INDICATIONS ventricular
Atropine (generic) Decrease secretions, arrhythmias
bradycardia, Quinidine Treatment of atrial
pylorospams, uteral (Quinaglute, arrhythmias
colic, relaxing of Cardioquin)
bladder, emotional Class Ib
lability with head Lidocaine (Xylocaine) Treatment of life-
injuries, antidote for threathening
cholinergic drugs, ventricular
pupil dilation arrhythmias during MI
Dicyclomine (Antispas, Irritable or hyperactive or cardiac surgery;
Dibent) bowel emergency treatment
Glycopyrrolate Decrease secretions, of ventricular
(Robinul) antidote for arrhythmias when
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diagnostic tests are

not available A/E:
Mexiletine (Mexitil) Treatment of life- - Adverse effects are associated with
threathening their membrane-stabilizing effects and
ventricular effects on action potential.
arrhythmias - Dizziness, drowsiness, fatigue,
Tocainide (Tonocard) Treatment of life- twitching, mouth numbness, slurred
threathening speech, vision changes, and tremors
ventricular that can progress to convulsions, N/V,
arrhythmias; studied development of arrhythmias, heart
for the treatment of block, hypotension, vasodilation, and
myotonic dystrophy, the potential for cardiac arrest,
trigeminal neuralgia respiratory depression, rash,
Class Ic hypersensitivity reaction, loss of hair,
Flecainide (Tambocor) Treatment of life- and potential bone marrow depression.
threathening
ventricular CLASS II ANTIARRHYTHMICS
arrhythmias;
prevention of PAT in DRUGS INDICATIONS
symptomatic patients Acebutolol (Secretal) Management of PVCs
with no structural Esmolol (Brevibloc) Short-term
heart defect management of
Propafenone Treatment of life- supraventricular
(Rhythmol) threathening tachycardia
ventricular Propanolol (Inderal) Treatment of
arrhythmias; supraventricular
prevention of PAT in tachycardias caused
symptomatic patients by digoxin toxicity or
with no structural catecholamines;
heart defect treatment of
hyopertension,
C/I: angina, migrane,
- Contraindicated in the presence of situational anxiety
allergy to any of these drugs; with
bradycardia or heart block unless an C/I:
artificial pacemakers is in place, as - Contraindicated in the presence of sinus
changes in conduction could lead to bradycardia (rate <45) and AV block,
complete heart block. which could be exacerbated by the
- Congestive heart failure (CHF), effects of these drugs; with cardiogenic
hypotension, or shock, which could be shock, CHF, asthma, or respiratory
exacerbated by effects on the action depression which could be made worse
potential. by the blocking of beta receptors.
- Pregnancy and lactation because of - Contraindicated in pregnant and
potential adverse effects on fetus or lactating women because of the
neonate. potential for adverse effects on the
- Electrolyte disturbances, which could neonate.
alter the effectiveness of this drug. A/E:
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- Dizziness, insomnia, dreams, and CLASS IV ANTIARRHYTHMICS

fatigue, hypotension, bradycardia, AV
block, arrhythmias, and alterations in DRUGS INDICATIONS
peripheral perfusion. Diltiazem (Cardizem) IV to treat paroxysmal
supraventricular
CLASS III ANTIARRHYTMICS tachycardia
Verapamil (Calan, IV to treat paryxysmal
DRUGS INDICATIONS Covera) supraventricular
Amiodarone Treatment of life- tachycardia; slow
(Cordarone) threathening ventricular response
ventricular to rapid atrial rates
arrhythmias not
responding to any C/I:
other drug - Contraindicated with known allergy to
Bretylium (generic) Treatment of any calcium channel blocker; with sick
ventricular fibrillation sinus syndrome or heart block.
and ventricular
tachycardias not A/E:
responsive to other - Adverse effects associated with these
drugs drugs are related to their vasodilation
Ibutilide (Corvert) conversion of recent of blood vessel throughout the body.
onset atrial fibrillation
or atrial flutter
Sotalol (Betapace) Treatment of life-
threathening
ventricular
arrhythmias not
responding to any
other drug

C/I:
- When these drugs are used to treat life-
threatening arrhythmias for which no
other drug has been effective, there are
no contraindications.

A/E:
- N/V, dizziness, CHF, hypotension and GI
distress and arrhythmia.
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Extrapyramidal Side Effects
Antipsychotic drugs
- Neuroleptics
- Antipsychotic’s work by blocking
receptors of the neurotransmitter,
dopamine.
- Dopamine receptors are classified into
subcategories (D1, D2, D3, D4, and D5)
and D2, D3, and D4 have been
associated with mental illness.
- The typical antipsychotic drugs are
potent antagonists (blockers) of D2, D3,
and D4. This makes them effective in
treating target symptoms but also
produces many extrapyramidal side
effects because of the blocking of the
D2 receptors.
- Newer, atypical antipsychotic drugs
such as clozapine (Clozaril) are relatively
weak blockers of D2, which may
account for the lower incidence of
extrapyramidal side effects.
- The newer antipsychotics also inhibit
the reuptake of serotonin, increasing
their effectiveness in treating the
depressive aspects of schizophrenia.
Typical Antipsychotics
Chlopromazine (Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Laxapine (Loxitane)
Mesoridazine (Serentil)
Prochlorperazine (Compazine)
Atypical Antipsychotics
Clozapine (Clozaril)
Olanzapine (Zypreza, Sparine)
Quetiapine (Seroquel)
Risperidone (Risperdal)
 (EPS) are the major side effects of
antipsychotic drugs. They include acute
dystonia (prolonged involuntary
muscular contractions that may cause
twisting of the body parts, repetitive
movements, and increased muscular
tone), pseudoparkinsonism, and
akathisia (intense need to move about).
Blockage of the D2 receptors in the
midbrain region of the brain stem is
responsible for the development of EPS.
Included in the EPS are:
o Torticollis: twisted head and
neck
o Opisthotonus: tightness of the
entire body with head back and
an arched neck.
o Oculogyric crisis: eyes rolled
back in a locked position.
 Immediate treatment with
anticholinergic drugs usually brings
rapid relief.
 Pseudoparkinsonism, or drug-induced
Parkinsonism if often referred to by the
generic label of EPS. Symptoms include
a stiff, stooped posture; mask-like
facies; decreased arm swing; a shuffling.
festinating gait; drooling; tremor;
bradycardia; and coarse pill rolling
movements of the thumb and fingers
while at rest.
 Treatment of these symptoms can
include adding an anticholinergic agent
or amantadine, which is a dopamine
agonist that increases transmission of
dopamine blocked by the antipsychotic
drug.
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Neuroleptic Malignant syndrome
 (NMS) is a potentially fatal idiosyncratic
reaction to an antipsychotic. Death
rates have been reported at 10% to
20%.
 Symptoms include rigidity, high fever;
autonomic instability such as unstable
blood pressure, diaphoresis, and pallor;
delirium; and elevated levels of
enzymes, particularly creatine and
phosphokinase.
 Clients with NMS are confused and
often mute; they may fluctuate from
agitation to stupor.
 Dehydration, poor nutrition, and
concurrent medical illness all increase
the risk of NMS.
 Treatment includes immediate
discontinuation of the antipsychotic and
the institution of supportive medical
care to treat dehydration and
hyperthermia.
Tardive Dyskinesia
 (TD) is a syndrome of permanent
involuntary movements. This is most
commonly caused by the long-term use
of antipsychotic drugs.
 There is no treatment available.
 The symptoms of TD include
involuntary movements of the tongue,
facial, and neck muscles, upper and
lower extremities, and truncal
musculature. Tongue thrusting and
protruding, lip smacking, blinking,
grimacing, and other excessive
unnecessary facial movements are
characteristic.
 One TD has developed, it is irreversible.
Agranulocytosis
 Some antipsychotics produces
agranulocytosis. This develops suddenly
and is characterized by:
o Fever
o Malaise
o Ulcerative sore throat
o Leucopenia
 The drug must be discontinued
immediately if the WBC drops by 50%
or to less that 3,000.
Antidepressant drugs
 Although the mechanism of action is
not completely understood,
antidepressants somehow interact with
the two neurotransmitters,
norepinephrine and serotonin.
 Antidepressants are divided into four
groups:
o Tricyclic and the related cyclic
antidepressants
- Inhibit the presynaptic reuptake of
neurotransmitters norepinephrine and
serotonin, which leads to an
accumulation of these
neurotransmitters
Examples:
Amitryptyline (Elavil)
Amoxapine (Ascendin)
Clomipramine (Anafranil)
Doxepin (Sinequan)
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Imipramine (Tofranil) the client ingests food

Nortiptyline (Aventyl) containing tyramine (an amino
acid) while taking MAOIs.
o Selective serotonin reuptake
inhibitors (SSRIs)  Mature or aged cheeses

- SSRI’s specifically block the reuptake of  Aged meats (sausage,

serotonin, with little effect on NE pepperoni)

- Increases the levels of serotonin  Tofu

Examples:  ALL tap beers and

Citalopram (Celexa) microbrewery beer.
Fluoxetine (Prozac)
Fluvoxamine (Luvox)  Sauerkraut, soy sauce,
Paroxetine (Paxil) or soybean condiments
Setraline (Zoloft)
 Yogurt, sour cream,
peanuts, MSG

o MAOIs cannot be given in

o MAO inhibitors (MAOIs)
- Irreversibly inhibit MAO, an enzyme
found in the nerves and other tissues,
including liver, which breaks down
Examples:
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
oOther antidepressants such as
venlafaxine (Effexor),
bupropion (Wellbutrin),
duloxetine (Cymbalta),
trazodone (Desyrel), and
nefazodone (Serzone).
 MAOIs have a low incidence of sedation
and anticholinergic effects, they must
be used with extreme caution for
several reasons:
o A life-threatening side effect,
hypertensive crisis, may occur if
combination with other MAOIs,
tricyclic antidepressants,
Demerol, CNS depressants, and
hypertensives, or general
anesthetics.
o MAOIs are potentially lethal in
overdose and pose a potential
risk for clients with depression
who may be considering
suicide.
 SSRIs, venlafaxine, nefazodone, and
bupropion are often better choices for
those who are potentially suicidal or
highly impulsive because they carry no
risk of lethal overdose in contrast to the
cyclic compounds and the MAOIs.
However, SSRIs are only effective for
mild to moderate depression.
 The major actions of antidepressants
are with the monoamine
neurotransmitter systems in the brain,
particularly norepinephrine and
serotonin.
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o Norepinephrine, serotonin, and
dopamine are removed from
the synapses after release by
reuptake into presynaptic
neurons. After reuptake, these
three neurotransmitters are
reloaded for subsequent
release or metabolized by the
enzyme MAO.
o The SSRIs block the reuptake of
serotonin; the cyclic
antidepressants and
venlafaxine block the reuptake
of norepinephrine primarily and
block serotonin to some
degree; and the MAOIs
interfere with enzyme
metabolism.
Mood stabilizing drugs
 Mood stabilizing drugs are used to treat
bipolar disorder by stabilizing the
client’s mood, preventing or minimizing
the highs and lows that characterize
bipolar illness, and treating acute
episodes of mania.
 Lithium is considered the first-line agent
in the treatment of bipolar disorder.
o Lithium normalizes the
reuptake of certain
neurotransmitters such as
serotonin, norepinephrine,
acetylcholine, and dopamine. It
also reduces the release of
norepinephrine through
competition with calcium.
o Lithium produces its effects
intracellularly rather than
within neuronal synapses.
o Lithium serum levels should be
about 1.0 mEq/L. Levels less
than 0.5 mEq/L are rarely
therapeutic, and levels of more
than 1.5 mEq/L are usually
considered toxic.
o If Lithium levels exceed 3.0
mEq/L, dialysis may be
indicated.
 The mechanism of action for
anticonvulsants is not clear as it relates
to their off-label use as mood
stabilizers.
o Valproic acid and topiramate
are known to increase the
levels on the inhibitatory
neurotransmitter, GABA. Both
are thought to stabilize mood
by inhibiting the kindling
process.
 The kindling process
can be described as the
snowball-like effect
seen when minor
seizure activity seems
to build up into more
frequent and severe
seizures. In seizure
management,
anticonvulsants raise
the level of the
threshold to prevent
these minor seizures. It
is suspected that this
same kindling process
may occur in the
development of full-
blown mania with
stimulation by more
frequent, minor
episodes.
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Modafinil (ProVigil)
Pemoline (Cylert)
Antianxiety drugs (Anxiolytics)

 Benzodiazepines mediate the actions of

the amino acid GABA, the major
inhibitory neurotransmitter in the brain.
Because GABA receptor channels
selectively admit the anion chloride into
neurons, activation of GABA receptors
hyperpolarizes neurons and thus is
inhibitory.
 Benzodiazepines produce their effects
by binding to a specific site on the
GABA receptor.

CNS Stimulants

 Today, the primary use of stimulants is

for ADHD in children and adolescents,
residual attention deficit disorder in
adults, and narcolepsy.
 Stimulants are often termed indirectly
acting amines because they act by
causing release of the
neurotransmitters (norepinephrine,
dopamine, and serotonin) from
presynaptic nerve terminals as opposed
to having direct agonist effects on the
postsynaptic receptors. They also block
the reuptake of these
neurotransmitters.

 By blocking the reuptake of these

neurotransmitters into neurons, they
leave more of the neurotransmitter in
the synapse to help convey electrical
impulses in the brain.

Examples:

Methylphenidate (Ritalin)
Dextroamphetamine (Dexedrine)