HHHH

Proto: diazepam (Valium) Others: alprazolam (Xanax),
Expected Action:
lorazepam (Ativan), chlordiazepoxide (Librium)
Enhance the action of gamma-aminobutyric acid (GABA)

Anxiety
Seizures
Panic disorder
Therapeutic Uses:
Muscle spasms
Anesthesia
EtOH w/d
Insomnia
CNS depression
Anterograde amnesia
Adverse Effects:
Paradoxical response
Respiratory depression
Acute toxicity (treat oral charcoal, treat IV flumazenil)

Teratogenic
Contraindications/Precautions:
Interactions:
CNS depressants additive effects
Education:
Proto: zolpidem (Ambien) Others: zaleplon (Sonata),

Expected Action:
eszopiclone (Lunesta) , trazodone (Desyrel)
Enhance action of GABA in CNS leading to prolonged sleep duration. They do

not function as antianxiety, muscle relaxant, or antiepileptic agents.
Therapeutic Uses:
Management of insomnia
Adverse Effects:
Daytime sleepiness and lightheadedness
Interactions:

Food absorption when taken with food
Education:
Proto: Buspirone (BuSpar)
Expected Action:
Uncertain it does bind to serotonin and dopamine receptors.

Treatment of Generalized Anxiety Disorder
Therapeutic Uses:
Adverse Effects:
CNS effects
NO SEDATION
Erythromycin, ketoconazole, and grapefruit juice effects of buspirone

Does NOT potentiate CNS depressants
Interactions:
Education:
Take with meals to prevent gastric irritation

Proto: methylphenidate (Ritalin) Others: amphetamine,
Expected
Action:
dextroamphetamine (Dexedrine), Adderall, caffeine
Release norepinephrine and dopamine and prevent their reuptake in CNS.

ADHD
Obesity
Narcolepsy
CNS stimulation
Weight loss
Cardiovascular effects (dysrhythmias, chest pain, BP)
Therapeutic Uses:
Adverse Effects:
Interactions:
MAOIs hypertensive crisis

Caffeine CNS stimulant effects
Phenytoin, warfarin, phenobarbital Inhibited metabolism of these
levels
OTC cold & decongestants CNS stimulant effects
Education:
Caution: hyperthyroidism, heart disease, glaucoma, Hx of drug abuse, MAOIs
Expected Action:
-lactam destroys bacteria by weakening cell wall

Therapeutic Uses:
Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes)

Med of choice for syphilis
First choice for meningitis
Prophylaxis against bacterial endocarditis
Extended spectrum against Pseudomonas, Proteus, Klebsiella
Adverse Effects:
Anaphylaxis / Renal Impairment / Hyperkalemia (w doses)

Contraindications:
Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction

Interactions:
Aminoglycosides / Oral Contraceptives

Education:
Take orals H2O, food (some may be taken food)
Expected Action:
-lactam destroy bacteria by destroying cell wall

Four generations, each is: against G- and anaerobes more resistant to lactamas
more able to reach CSF
Therapeutic Uses:
Broad spectrum with TI for postop infections, meningitis, pelvic infections

Adverse Effects:
Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergies to

penicillins / AA-pseudomembranous colitis
Contraindications:
Allergies to Penicillin / Kidney Dysfunction

Caution with anticoagulants, antiplatelets, and thrombolytics
Interactions:
EtOH intolerance (disulfiram reaction) / Probenecid renal excretion

Education:
ExpectedTake
Action:
food
Bacteriostatic by preventing protein synthesis

Expected Action:
-lactam destroy bacteria by destroying cell wall

Therapeutic Uses:
MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile

Adverse Effects:
Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis

Caution with renal impairment

Infuse over 60 minutes
Very low therapeutic index
Interactions:
Education:
Therapeutic Uses:
Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus

fever / Rocky Mountain spotted fever / Lyme disease / UTI & VI
Adverse Effects:
GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity /

superinfection of bowel
Renal disease (except doxycycline) / Use during pregnancy will stain deciduous
teeth but not permanent teeth
Interactions:
Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to )

of oral contraceptives
Education:
Give with water on an empty stomach (except doxycycline & minocycline)

Expected Action:
Bacteriostatic by inhibiting protein synthesis Bactericidal at high doses

Therapeutic Uses:
Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires

Chlamydia, Mycoplasma pneumoniae, Streptococcus pyogenes
Adverse Effects:
GI discomfort / thrombophlebitis
Pre-existing liver disease

Interactions:
Toxic with: antihistamines, theophylline (asthma med), carbamazepine

(anticonvulsant), warfarin
Education:
Administer on empty stomach with water IV is rarely used
Expected Action:
Kill bacteria by disrupting protein synthesis

Therapeutic Uses:
Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P.

aeruginosa)
Oral paromomycin use for amebiasis and tapeworm
Adverse Effects:
Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity

Streptomycin: Neurologic disorders
Renal impairment reduced doses

Interactions:
Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) /

tubocurarine / penicillins ( AG)
Education:
Expected Action:
Bacteriostatic by inhibiting folate synthesis

Therapeutic Uses:
Med of choice for UTI by E. coli and Pneumocystis carinii.

Adverse Effects:
Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diuretics)

Blood dyscrasias / crystalluria / kernicterus ( bilirubin) / photosensitivity
Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min

Reduce dosages with renal dysfunction
Interactions:
Warfarin / phenytoin / tolbutamide ( effects of these)

Education:
Empty stomach with full glass of water
Expected Action:
Damages DNA
Prototype: Nitrofurantoin
Static a@ doses, Cidal @ doses

Therapeutic Uses:
Acute UTIs / Prophylaxis for recurrent lower UTI

Adverse Effects:
GI / hypersensitivity / blood dyscrasias / peripheral neuropathy

Renal dysfunction creatinine clearance < 40

Interactions:
Education:
Urine will be brown
Prototypes: isoniazid (INH), streptomycin, ethambutol,

pyrazinamide
Expected Action:
Prevents synthesis of mycolic acid

Therapeutic Uses:
Active and latent tuberculosis

Adverse Effects:
Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily)

Hepatotoxicity
Liver disease
Interactions:
Phenytoin (accumulates)
INH with EtOH, rifampin, pyrazinamide hepatotoxicity
Education:
Empty stomach but food if needed
Prototype: Dapsone Others: Clofazimine, Rifampin
Expected Action:
Prevents synthesis of folate which inhibits M. leprae.

Therapeutic Uses:
Used in combination therapy to treat leprosy

Adverse Effects:
Rifampin: Discoloration of body fluids / Hepatotoxicity

GI discomfort
Use caution with liver dysfunction

Interactions:
Rifampin warfarin / OC / protease inhibitors / NNRTIs (HIV)

Education:
Prototype: Acyclovir
Others: ganciclovir, interferon, ribavirin, amantadine
Expected Action:
Prevents reproduction of viral DNA

Therapeutic Uses:
Adverse Effects:
Acyclovir: Phlebitis, nephrotoxicity, nausea & headache

Ganciclovir: Granulocytopenia / thrombocytopenia / reproductive toxicity /
teratogenic
Pregnancy / neutrophil count (<500/cc)

Interactions:
Nursing Info:
Acyclovir: Never give IV bolus, Infuse over 1 hour min.
Prototype: Ciprofloxacin
Expected Action:
Bactericidal by inhibition of enzyme needed for DNA

Therapeutic Uses:
Broad spectrum / prevention of inhaled anthrax

Adverse Effects:
GI discomfort / Achilles tendon rupture / superinfection

Avoid use in children <18 d/t risk for tendon rupture

Interactions:
Cations ( Cipro absorption) / Theophylline & warfarin ( med plasma levels)

Education:
Infuse slowly over 60 minutes
Expected
Action:
Proto: Amphotericin
Others: flucytosine, miconazole, nystatin, griseofulvin, ketoconazole
permeability leakage of intracellular cations (static or cidal)

Therapeutic Uses:
Systemic or cutaneous fungal infections

Adverse Effects:
Amphotericin: Infusion rxn (1-3 hrs) / thrombophlebitis / nephrotoxicity /

hypokalemia / marrow suppression
Ketoconazole: Hepatotoxicity / Sex hormone effects
Contraindications/Precautions: Renal dysfunction
Interactions:
Aminoglycosides (streptomycin, cyclosporine) additive nephrotoxicity

Flucytosine antifungal effects are potentiated with amphotericin
Education: Highly toxic, infuse slowly (2-4 hr)
Renal damage limited by infusing 1 L NS on day of amphotericin infusion
Expected Action:
Proto: metronidazole (Flagyl)
Broad spectrum with anaerobic activity

Therapeutic Uses:
Protozoal infections / Bacterial infections against obligate anaerobes

Prophylaxis for surgical procedures at high risk for anaerobic infections (vaginal,
abdominal, colorectal)
H. pylori with tetracycline and bismuth salicylate
Adverse Effects:
GI discomfort / metallic taste / darkening of urine / CNS symptoms

Caution with renal dysfunction / avoid during 1 st trimester of pregnancy

Interactions:
Disulfiram-like reaction EtOH

Warfarin Flagyl inhibits inactivation of warfarin
Education:
Therapeutic Uses:
Diphtheria,
Hepatitis
A Tetanus,
& B viruses
Pertussis
Adverse Effects:
Local reaction (fever, persistent crying)

Encephalopathy
Seizures
Anaphylaxis
Local reaction at injection site
Hx of anaphylaxis
Severe febrile
Allergy
to Bakers
illness
yeast
Hx of anaphylaxis
Education:
Hx of encephalopathy 7 days after DTaP vaccination
Occurrence of seizures with 3 days of vaccination
Inconsolable crying (>3 hrs) within 48 hrs of vaccination
Education:
Proto: Gamma globulin (IgG)
Expected Action:
Passive immunity
Therapeutic Uses:
Immunodeficiency syndrome
Bone marrow transplantation
Measles, rubella, varicella exposure
Chronic lymphocytic leukemia

Hep A, Hep B exposure
Adverse Effects:
Local reaction / hypersensitivity

Interactions:
Live viruses can lead to disease avoid live viruses for 3 months following IgG
Education:
Administer in deep muscle / Date of exposure must be known (6 days measles, 7

days Hep B, 14 days Hep B)
Expected Action:
Proto: Interferon Alfa, Aldesleukin, Interleukin 2
Enhance immune response / reduce proliferation of cancer cells

Therapeutic Uses:
Leukemia / melanoma / Kaposis sarcoma

Adverse Effects:
Flu-like symptoms / Marrow suppression, alopecia, cardiotoxicity, neurotoxicity

Hypotension
Hypersensitivity / pregnancy and lactation (C)

Interactions:
Theophylline (toxicity)
Zidovudine or retrovir ( neutropenia)
Antihypertensives ( hypotensive effect)
Education:
Refrigerate / Do not shake vial
Therapeutic Uses:
Measles, Mumps, Rubella

Adverse Effects:
Local reactions (rash, fever, swollen glands)

Anaphylaxis
Allergies to eggs, gelatin, and neomycin

Hx of thrombocytopenia
Immunocompromised individuals
Recently received blood products or immunoglobulins
Education:
Adverse Effects:
Hepatotoxicity
Nephrotoxicity (BUN, Creatinine, I&O)
Pregnancy / Recent live virus vaccination / Recent contact chickenpox or herpes
Interactions:
Phenytoin, phenobarbital, rifampin, carbamazepine, TMP-SMZ ([cycl] )

Ketoconazole, erythromycin, amphotericin ([cycl] toxicity)
Amphotericin, aminoglycosides, NSAIDs (all nephrotoxic renal damage)
Grapefruit juice ( [cycl] by 50%)
Mix oral dose milk or OJ to palatability
Nursing
Therapeutic
Uses: dose over 2-6 hours
Admin initial
virus (chickenpox)
Varicella
Monitorzoster
for hypersensitivity,
stay pt. for 30 mins
Adverse Effects:
Varicella-like rash
Pregnancy
Cancer
Hx of allergy to neomycin or gelatin
Immunocompromised patients
Education:
Slight risk of virus being transmitted. If child develops rash after vaccination they
should be presumed to be infected and appropriate precautions taken.
Therapeutic Uses:
Immune response to poliovirus

Adverse Effects:
Vaccine-related paralytic poliomyelitis

Local reaction
None
Education:
Act on helper T lymphocytes to suppress proliferation of B cells and
cytotoxic T cells
For treatment of autoimmune disorders and to prevent organ rejection
Rheumatoid arthritis
Early type 1 diabetes
Lupus
Myasthenia gravis
Adverse Effects
risk of infection
Teratogenesis
Medications:
Cyclosporine (Gengraf, Neoral)
Tacrolimus
Glucocorticoids (prednisone)
Methotrexate
Cytotoxics (azathioprine)
Therapeutic Uses:
Immunity to influenza strains in the vaccine

Adverse Effects:
Guillain-Barr syndrome (ascending paralysis, weakness of BLE, dyspnea)

Local reaction
Fever
Acute febrile illness

Hypersensitivity to eggs
Education:
Nitrogen mustards .................................................... cyclophosphamide

Platinum compounds ................................................................ cisplatin
Folic acid analog ............................................................... methotrexate
Pyrimidine analog .................................................................. cytarabine
Purine analogs ............................................................... mercaptopurine
Antitumor antibiotics ...........................................................doxorubicin
Mitotic inhibitors .................................................. vincristine, paclitaxel
Topoisomerase inhibitors ..................................... topotecan, irinotecan
Breast cancer ................................................... tamoxifen (antiestrogen)
Prostate cancer ........................................................................ leuprolide
Progestins ................................................................... megestrol acetate
Cytotoxic medications
Asparaginase
Hydroxyurea
Adverse Effects:
Prednisone,
Procarbazine
Proto:
prednisolone
2+
Osteoporosis (use Ca & vitamin D supplements

Renal insufficiency (stop drugs immediately)
Fluid retention
Systemic fungal infections
Recurring live virus vaccines
Interactions:
K+-depleting diuretics ( hypokalemia)

NSAIDs ( GI ulceration)
Glucocorticoids (Promote hyperglycemia)
Education:
Adverse Effects:
Bone marrow depression neutropenia & thrombocytopenia
None listed in ATI
Interactions:
Allopurinol (delays inactivation of azathioprine)
Education:
Action is on H1 receptors which blocks histamine release

Medications
1 Generation:
st
Diphenhydramine (Benadryl)
Promethazine (Phenergan)
Dimenhydrinate (Dramamine)
nd
Generation:
Loratadine (Claritin)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Desloratadine (Clarinex)
Therapeutic Uses:
Mild allergic reactions
Anaphylaxis
Motion sickness
Insomnia
Proto: Diphenhydramine, promethazine, dimenhydrinate

Block H1 receptors - prevent histamine release into small blood vessels & nerves
Expected Action:
Therapeutic Uses:
Mild allergic reactions

Motion sickness
Anaphylaxis
Insomnia
Adverse Effects:
Sedation
Anticholinergic effects (dry mouth,
GI discomfort
constipation)
Acute toxicity (flushed face, fever, tachycardia), children can have
hallucinations, incoordination and seizures Induce vomiting and give
activated charcoal.
3rd trimester, lactation, newborns / use cautiously in kids and elderly

Caution asthma, urinary retention, open angle glaucoma, & hypertension.
Interactions: CNS depressants
EtOH
Opioids
Barbiturates
Benzodiazepines
Expected Action:
Slows production of prostaglandins

Therapeutic Uses:
Analgesic and antipyretic

Max 4 g daily
Antidote: acetylcysteine (Mucomyst)
Adverse Effects:
Acute liver toxicity
Interactions:
EtOH risk to liver / Warfarin levels of warfarin

Education:
Bone marrow suppression

GI discomfort
Alopecia
Avoid crowds, check for bleeding gums
Give antiemetic (ondansetron) with dexamethasone,

metoclopramide or granisetron at outset
Occur 7-10 days after, persist max of 2 months after
Mucositis
Frequent oral care, soft toothbrush, EtOH mouthwash
Reproductive toxicity
Sperm banking, Avoid gravid on meds.
Hyperuricemia or uric acid
fluids, I&O
Give allopurinol if uric acid
Extravasation of vesicants such as carmustine, dactinomycin,
daunorubicin, and vincristine
Expected Action:
Proto: aspirin, ibuprofen, ketorolac, celecoxib
Cyclooxygenase inhibition COX 2 inflammation, COX 1 platelet agg.

Inflammation suppression / analgesia / fever
dysmenorrhea / suppression of platelet aggregation
Therapeutic Uses:
Adverse Effects:
GI discomfort, aspirin induced ulceration and bleeding (use misoprostol as

prophylaxis, and/or PPI and/or H2-receptor agonist risk of ulceration)
Renal dysfunction
Salicylism (tinnitus, resp.
Reye syndrome (in kids with viral illnesses)
alkalosis, dizziness)
Peptic ulcers / bleeding disorders / hypersensitivity / pregnancy / kids viral inf.

Glucocorticoids ( gastric bleeding) use antiulcer
prophylactic like misoprostol (Cytotec) to prevent
Warfarin ( bleeding)
EtOH ( bleeding)
Ibuprofen ( antiplatelet effects of low-dose aspirin)
Give with food or milk to reduce GI discomfort.
Education:
st
nd
If cant tolerate 1 generation, give 2 generation (celecoxib)
Interactions:
Expected Action:
Proto: ketorolac (Toradol) 1st generation NSAID
pain without anti-inflammatory effect
Therapeutic Uses:
Short-term treatment of moderate to severe pain (post-op)

Enhances opioid analgesia without opioid adverse effects
Adverse Effects:
Can occur when used with other NSAIDs.

GI bleeding / blood dyscrasias
Give no more than 5 days
Interactions:
Other NSAIDs / anticoagulants ( bleeding)
Education:
Usually started parenteral and then transition to oral dose
Tricyclic Antidepressants (TCA) ......................... Amitriptyline (Elavil)

Anticonvulsant .............................................. Carbamazepine (Tegretol)
...................................................................... Gabapentin (Neurontin)

........................................................................... Phenytoin (Dilantin)
CNS Stimulants ............................................ Methylphenidate (Ritalin)
....................................................... Dextroamphetamine (Dexedrine)
Antihistamines ....................................................Hydroxyzine (Vistaril)
Glucocorticoids ......................................... Dexamethasone (Decadron)
.......................................................................Prednisone (Deltasone)
Bisphosphonates .................................................. Etidronate (Didronel)
Proto: morphine, fentanyl, meperidine,
methadone,
codeine,
.........................................................................
Pamidronate
(Aredia)
oxycodone
Therapeutic Uses:
Moderate to severe pain / Sedation / bowel motility / Cough suppression
Respiratory
Sedation
Adverse Effects:
depression
Constipation
Orthostatic Hypotension
Urinary retention
Biliary colic
Cough suppression
Emesis
Increases cardiac workload
Meperidine metabolites are neurotoxic (< 600 mg/24hr, < 48 hours)
Interactions:
CNS depressants (barbiturates, phenobarbital, benzodiazepines, EtOH)

Anticholinergics, antihistamines, tricyclic antidepressant anticholinergic effects
MAOIs (hyperpyrexia, seizures)
Antihypertensives
Withhold if RR<12
Have naloxone (Narcan) and resuscitation
Education:
equipment available.
Infuse IV slowly over 4-5 minutes
Proto: naloxone (Narcan), naltrexone, nalmefene
Expected Action:
Competitively interfere with opioid actions
Therapeutic Uses:
OD treatment
Reversal of opioid effects
Adverse Effects:
Tachycardia / Tachypnea
Abstinence syndrome (cramping, hypertension)
Hypersensitivity
Dependency
Pregnancy: B
Interactions:
Education:
Naloxone has extensive first-pass modification

Observe for w/d symptoms or abrupt onset of pain
Expected Action:
Proto: ketorolac (Toradol) 1st generation NSAID
pain without anti-inflammatory effect
Therapeutic Uses:
Short-term treatment of moderate to severe pain (post-op)

Enhances opioid analgesia without opioid adverse effects
Adverse Effects:
Can occur when used with other NSAIDs.

GI bleeding / blood dyscrasias
Give no more than 5 days
Interactions:
Other NSAIDs / anticoagulants ( bleeding)
Education:
Usually started parenteral and then transition to oral dose
Proto: Ergotamine, ergotamine + caffeine
Expected Action:
Prevent inflammation and dilation of the intracranial blood vessels
Adverse Effects:
GI discomfort administer metoclopramide (Reglan)

Ergotism (muscle pain, paresthesia) stop medication
Physical dependence
Abortion
Renal or liver dysfunction / sepsis / CAD / pregnancy
Interactions:
Sumatriptan (Imitrex) can lead to spastic rxn of blood vessels
Education:
Therapeutic Uses:
Proto: TCAs, Anticonvulsants, CNS stimulants, Antihistamines,
Glucocorticoids, Bisphosphonates
Enhance opioid effects thereby permitting lower opioid doses
Alleviate other symptoms that aggravate pain
Treat neuropathic pain
Adverse Effects:
TCAs (neuropathic pain)
effects
Anticonvulsants (neuropathic pain)
Bone marrow suppression
CNS stimulants
Weight loss, insomnia
Antihistamines Sedation
Glucocorticoids ( ICP, Adrenal insufficiency Glucose intolerance
nerve compression)
Hypokalemia Osteoporosis GI Ulcers
Bisphosphonate (CA bone Flu-like symptoms Injection site irritation
pain)
Proto: Colchicine, indomethacin, allopurinol, probenecid
Expected Action:
Orthostatic hypotension, sedation, anticholinergic
Colchicine/Indomethacin: inflammation by preventing leukocyte infiltration

Allopurinol: Inhibits production of uric acid
Probenecid: Inhibits reabsorption of uric acid by renal tubules
Therapeutic Uses:
Colchicine/Indomethacin: Acute gout attacks

Allopurinol/Probenecid: Hyperuricemia
Probenecid: Prolongs effects of penicillins and cephalosporins
Others: GI discomfort
Adverse Effects:
Colchicine: GI toxicity
Probenecid: Renal injury (get 2-3L fluid/day)
Contraindications/Precautions: Colchicine: Pregnancy (C/D), renal, cardiac, elderly
Salicylates: probenecid
Warfarin: warfarin metabolism in liver bleeding risk
Interactions:
Education:
Avoid EtOH, purines. Adequate hydration.
Ergot Alkaloids ................................................... Ergotamine (Ergostat)

Serotonin Receptor Agonists ............................... Sumatriptan (Imitrex)
Beta-Blockers ....................................................... Propanolol, Atenolol
Anticonvulsants ................................................. Divalproex (Depakote)
Tricyclic Antidepressants .................................... Amitriptyline (Elavil)
Calcium Channel Blockers .................................................... Verapamil
Estrogens ........................................................................ Alora, Climara
Triptans..................................................... Almotriptan, Naratriptan, etc
Cytotoxics:
Gold salts:
Hepatic fibrosis / Marrow suppression / GI ulceration / fetal

death or abnormality
Toxicity, renal toxicity, blood dyscrasias, hepatitis, GI
Antimalarials:
discomfort
Retinal damage
Sulfasalazine: GI discomfort / hepatic dysfunction / marrow suppression

Bio Response Modifiers: Injection-site irritation
Penicillamine:
Marrow suppression
Glucocorticoids:
Osteoporosis (vit D, Ca2+, bisphosphonate)
Adrenal
Expected
Action:suppression
GIProto:
discomfort
Sumatriptan (Imitrex), almotriptan (Axert)
Adverse Effects:
Chest symptoms (not dangerous, self-resolving)

Coronary vasospasm/angina
Teratogenic
Pregnancy, hypertension, cardiac disease, CAD
Interactions:
Triptans & Ergot Alkaloids spastic reaction of blood vessels

MAOIs Concurrent use leads to MAOI toxicity (space 2 weeks apart)
Education:
Proto: Metoprolol, atenolol
Expected Action:
Adverse Effects:
Tiredness, fatigue
Asthma exacerbation
Depression
Interactions:
Education:
Expected Action:
Proto: Divalproex (Depakote)
Adverse Effects:
Neural tube defects
Interactions:
Education:
Expected Action:
Proto: Amitriptyline (Elavil)
Adverse Effects:
Anticholinergic effects: dry mouth, constipation, urinary retention, tachycardia
Interactions:
Education:
Proto: Pramipexole, ropinirole, bromocryptine
Expected Action:
Act directly on dopamine receptors
Therapeutic Uses:
Monotherapy early / combined with levodopa in later stages

Orthostatic hypotension
Psychosis
Sleep attacks
Daytime sleepiness
Dyskinesias
Pregnancy (C)
Caution liver & kidney impairment
Adverse Effects:
Nausea
Interactions:
Levodopa: Can motor-control fluctuations permitting lower dose

Levodopa: Also risk of orthostatic hypotension and dyskinesias
Education:
Expected Action:
Proto: Neostigmine, Physostigmine
Prevents ACh degradation transmission of nerve impulses by [ACh]
Therapeutic Uses:
muscle strength by [ACh] at neuromuscular junction in myasthenia gravis

Reversal of nondepolarizing neuromuscular blocking agents (tubocurarine)
Adverse Effects:
Excessive muscarinic stimulation: GI motility & secretions, bradycardia,

urinary urgency (side effect can be treated with atropine)
Cholinergic crisis: Above plus resp. depression from neuromuscular blockade.
Pregnancy (C)
CI in obstruction of GI/GU systems / caution with seizures, asthma, bradycardia,
hypotension, peptic ulcer disease
Interactions: Tubocurarine Neostigmine reverses blockade
Atropine counteracts
Succinylcholine - neuromuscular blockade
Wear medic-alert bracelet
Education:
Expected Action:
Proto: Nondepolarizing: tubocurarine, pancuronium
Depolarizing: succinylcholine
Block ACh at neuromuscular junction dont cross blood-brain barrier

Control spontaneous respiration in ventilated pts.
Adjuncts to general anesthesia
Diagnose myasthenia gravis
Succinylcholine for: electroconvulsive therapy, intubation, endoscopy
Hypotension from histamine release & ganglionic blockade
Adverse Effects:
Respiratory arrest
Bradycardia, dysrhythmias
Succinylcholine: Low pseudocholinesterase activity apnea
Malignant hyperthermia (dantrolene)
Pain
Hyperkalemia
Pregnancy (C)
SCh: CI for hyperkalemia (trauma, burns)
General anesthetics
Interactions:
Aminoglycosides/tetracyclines - NM blockade
Neostigmine/ChE inhibitors: nondepolarizing / depolarizing
Therapeutic Uses:
Expected Action:
Proto: Levodopa, carbidopa, Sinemet
Levodopa taken up and converted to dopamine. Carbidopa augments levodopa by

preventing conversion to dopamine in intestine and periphery ([DA] in CNS).
Therapeutic Uses: Symptomatic relief from dyskinesias
Dyskinesias
Discoloration of sweat & urine
Adverse Effects:
Nausea / drowsiness
Psychosis (clozapine)
Activation of malignant melanoma
!! cardiac or psychiatric disorders
CI melanoma
2 weeks from MAOI
Pregnancy (C)
Proteins interfere with absorption and transport
Interactions:
Conventional antipsychotics (haldol, compazine)
Pyridoxine
MAOI hypertension
Carbidopa, dopamine agonists, anticholinergics, COMT inhibitors and dopamine
releasers therapeutic effects.
Proto: Phenobarbital (Luminal)
Therapeutic Uses:
Partial seizures and generalized tonic-clonic seizures

Not effective against absence seizures
Adverse Effects:
CNS effects: Adults as sedation and anxiety, kids as irritability and hyperactivity
Toxicity: Nystagmus, ataxia, respiratory depression, pinpoint pupils
Pregnancy (D)
CI intermittent porphyria
Interactions:
Education:
Proto: Benztropine (Cogentin), trihexyphenidyl (Artane)
Expected Action:
Block ACh at muscarinic receptors which helps maintain ACh, dopamine balance
Nausea (take food)
Atropine-like effects (dry mouth, blurred vision, mydriasis, constipation)

Antihistamine effects (sedation, drowsiness)
Adverse Effects:
CI in narrow-angle glaucoma
Interactions:
Education:
Proto: Amantadine
Expected Action:
Stimulate dopamine release, prevent dopamine reuptake, and may block

cholinergic and glutamate receptors
Parkinsons Disease
Therapeutic Uses:
CNS Effects
Discoloration of skin (temporary)
Adverse Effects:
Atropine-like effects
Interactions:
Education:
Barbiturates
phenobarbital (Luminal)
Hydantoins
phenytoin (Dilantin)
Benzodiazepines diazepam (Valium)
................................................................ Lorazepam (Ativan)
...................................................... Carbamazepine (Tegretol)
.........................................................Ethosuximide (Zarontin)
........................................................ Valproic acid (Depakote)
.......................................................... Gabapentin (Neurontin)
Other meds
lamotrigine (Lamictal)
........................................................ oxcarbazepine (Trileptal)
.......................................................... clonazepam (Klonopin)
Mechanisms:
Slow Ca2+ and Na+ reentry to neuron
Suppress neuron firing
Potentiating inhibitory effect of

(GABA)
Proto: Neurontin
Therapeutic Uses:
Single agent used for partial seizures
Neuropathic pain
Migraine prev.
Adverse Effects:
CNS effects (drowsiness, nystagmus)
Interactions:
Education:
Proto: Phenytoin (Dilantin)
Therapeutic Uses:
Effective against all major forms except absence seizures
Adverse Effects:
CNS effects
Cardiovascular
Skin rash
Teratogenic
Endocrine effects
Gingival hyperplasia
Vitamin D metabolism
CI: sinus bradycardia, SA blocks, 2nd & 3rd degree AV blocks

Oral contraceptives, warfarin, glucocorticoids: of these
Interactions:
EtOH, diazepam, cimetidine, valproic acid: phenytoin levels
Carbamazepine, phenobarbital, chronic EtOH: phenytoin levels
CNS depressants (e.g. barbiturates/EtOH): Additive effects with concurrent use
Use IV route for status epilepticus
Antidysrhythmics
Education:
Proto: Tegretol
Therapeutic Uses:
Partial seizures, tonic-clonic seizures, bipolar disorder, trigeminal neuralgia

Skin disorders
Cognitive function is minimally affected but CNS effects can occur
Blood dyscrasias
Teratogenic
Hypo-osmolarity ( ADH secretion)
Adverse Effects:
CI: marrow suppression / bleeding disorders

Grapefruit juice: inhibits metabolism [carbamazepine]
Phenytoin & phenobarbital: carbamazepine
Oral contraceptives and warfarin: Carbamazepine stimulates hepatic enzymes
which levels of these medications
Interactions:
Education:
Proto: Zarontin
Therapeutic Uses:
Indicated ONLY for absence seizures
Adverse Effects:
GI effects (take food)

CNS effects (fatigue, dizziness)
Interactions:
Education:
Proto: Depakote
Therapeutic Uses:
Partial, generalized, and absence seizures, bipolar disorder, and migraines
Adverse Effects:
GI effects (take food)

Hepatotoxicity
Thrombocytopenia
Pancreatitis as evidenced by nausea, vomiting, and abdominal pain
Avoid in children younger than 3 (hepatotoxicity)
Liver disorders
Interactions:
Phenytoin and phenobarbital: Concurrent use these medications
Education:
Name: Dantrolene
Expected Action:
(Dantrium)
Only peripherally acting muscle relaxant. Inhibits muscle contraction by

preventing release of calcium in skeletal muscles.
Therapeutic Uses:
Relief of spasticity d/t cerebral palsy or multiple sclerosis

Treatment of malignant hyperthermia
Adverse Effects:
CNS depression
Hepatic toxicity
Pregnancy (C)
Caution with impaired liver & renal

function
Interactions:
Therapeutic
Uses:
Proto: Diazepam (Valium)
Used in status epilepticus
Adverse Effects:
Respiratory depression
Anterograde amnesia
Teratogenic
Interactions:
Education:
Centrally Acting Muscle Relaxants

Diazepam (valium)
Baclofen (Lioresal)
Cyclobenzaprine (Flexeril)
Metaxalone (Skelaxin)
Peripherally Acting Muscle Relaxants

Dantrolene (Dantrium)
Proto: Diazepam (Valium)
Expected Action:
Acts in CNS to enhance GABA and produce sedation

Acts in CNS to depress spasticity of muscles
Relief of spasticity d/t Cerebral Palsy or MS
Therapeutic Uses:
Anxiety & panic disorders
EtOH withdrawal
Insomnia
Status epilepticus
Anesthesia induction
Relief of spasm d/t injury
Adverse Effects:
CNS depression
Physical dependence from long-term use
Pregnancy (D)
Caution impaired liver or renal function
Interactions:
CNS depressants (EtOH, opioids, antihistamines, barbiturates): Additive CNS

depressive effects with concurrent use.
Education:
Expected Action:
Proto: Baclofen, cyclobenzaprine, metaxalone
Acts in CNS to depress spasticity of muscles

Relief of muscle spasm d/t injury
Relief of spasticity r/t cerebral palsy or multiple sclerosis
Therapeutic Uses:
Adverse Effects:
CNS depression Physical dependence from long-term use

Metaxalone: hepatotoxicity Baclofen: nausea, urinary retention, constipation
Caution in patients with impaired liver or renal
function.
Baclofen: Pregnancy (C)
CNS depressants (EtOH, opioids, antihistamines) additive CNS
Interactions:
depressant effects with concurrent use.
Education:
Proto: : chlorpromazine (Thorazine), : haloperidol (Haldol)

Others: fluphenazine, molindone, perphenazine, thiothixene
Expected
Action:
Dopamine, acetylcholine, histamine, & norepinephrine receptors in brain and

periphery are blocked. Symptom inhibition d/t dopamine2 blockade in brain.
Delusional disorder
Bipolar disorder
Therapeutic Uses:
Tourettes Syndrome
Schizoaffective disorder
Dementia
Schizophrenia
Huntingtons chorea
Agranulocytosis
Sedation
Photosensitivity
Adverse Effects:
Anticholinergic effects
Ortho hypotension
Neuroendocrine effects
Seizures
Parkinsonism
Sexual dysfunction
Dysrhythmias
Dystonia
Akathisia
Tardive dyskinesia
Neuroleptic malignant syndrome

Anticholinergics:
CNS depressants: Additive effects
Interactions:
Levodopa: Counteracts antipsychotics by stimulating dopamine receptors
Consider depot preparations
Protect liquid prep from
Education:
Amide type: Lidocaine
Ester
type: tetracaine,
Early EPS symptoms with anticholinergics,
-blockers,
benzodiazepines
Expected Action:
procaine
pain by blocking local conduction of pain impulses

CNS excitation -- treat midazolam (Versed) or
Adverse Effects:
diazepam
Hypotension, bradycardia, heart block, cardiac arrest
Allergic reactions (more likely esters)
uterine contractility.
Freely cross placenta
Urinary retention (call after 8
Spinal headache (lay flat for 12 hrs)
hrs)
CI in dysrhythmias and/or heart block
Caution with liver/kidney dysfunction, heart failure, myasthenia gravis
Expected
Action:
Proto: Halothane (Fluothane), isoflurane (Forane), nitrous oxide
Loss of consciousness, loss of sensation, relaxation of muscles, amnesia

Hepatotoxicity
Gastric aspiration
Hypotension
Respiratory & cardiovascular depression
Malignant hyperthermia (d/c med, ice or ice saline infusion, dantrolene)
Adverse Effects:
Interactions:
CNS depressants: Additive effect
Opioids: constipation & urinary

retention
Succinylcholine used as a muscle relaxant

Encourage early ambulation
Assist with lung expansion
Education:
Barbiturates: Thiopental (Pentothal)
Ketamine (Ketalar)
Benzodiazepines: Diazepam (Valium), midazolam (Versed), lorazepam

(Ativan)
Propofol (Diprivan)
Therapeutic Uses:
Adjunct to inhalation anesthesia
Induction & maintenance of anesthesia
Midazolam & an opioid result in conscious sedation
Ketamine can be used with children
Adverse Effects:
Respiratory and cardiovascular depression

Propofol: Bacterial infection (use opened vial within 6 hrs)
Ketamine: Psychologic reaction (premedicate with diazepam to risk)
CNS depressants and stimulants: Additive effects

Opioid analgesics: Constipation and urinary retention
Education:
Ketamine should be avoided with psychiatric disorders
Interactions:
Amnesia
Thiopental, Diazepam, Ketamine, Propofol, Midazolam
Expected Action:
Midazolam (Versed): inject over >2 minutes

Propofol (Diprivan): inject into large vein; prep site with lidocaine.
Proto: bupropion (Wellbutrin) Others: mirtazapine (Remeron),
Expected
Action:
venlafaxine (Effexor), reboxetine (Vestra), trazodone
Inhibit dopamine uptake
Therapeutic Uses:
Adverse Effects:
Depression
Aid to quit smoking
Seizures
Headache, dry mouth, constipation, HR, restlessness, weight loss
Pregnancy B
CI: Seizure disorders, MAOIs
Interactions:
MAOIs (e.g. phenelzine) risk of toxicity
Proto: clozapine Others: risperidone, olanzapine, quetiapine
Expected
Action:
Action results from blocking serotonin and dopamine receptors (block other
receptors, too) -- Pr developing EPS or tardive dyskinesia
Severe schizophrenia
Therapeutic Uses:
Psychosis induced by levodopa therapy
Agranulocytosis (WBC<3000/cc, Neu<1500/cc)
Adverse Effects:
Weight gain
New onset diabetes
Seizures
Myocarditis (dyspnea, RR, lethargy, chest pain, palpitations)
Interactions:
Immunosuppressive medications: Avoid
Education:
Expected
Action:
Proto: fluoxetine (Prozac) Others: citalopram (Celexa),

escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
Block reuptake of serotonin in synaptic space

Major depression
Panic disorders
Bulimia
OCD
PTSD
PMDD
Sexual dysfunction
Weight gain
Rash
Adverse Effects:
Withdrawal syndrome
Sleepiness, faintness
Hyponatremia
Serotonin syndrome 2-72 hrs (confusion, anxiety, agitation, hallucinations)
Pregnancy (C)
CI: MAOIs
MAOIs risk of serotonin syndrome
Interactions:
Warfarin warfarin levels
TCA & Lithium levels of these
NSAIDs & anticoagulants fluoxetine suppresses platelets bleeding risk
Therapeutic Uses:
Expected
Action:
Proto: phenelzine (Nardil) Others: isocarboxazide
Block MAO in brain norepinephrine and serotonin available for impulses

Atypical depression
OCD
Bulimia nervosa
CNS stimulation
Hypertensive crisis from dietary tyramine (HR, BP): Induce vasodilation
with IV phentolamine (-blocker) or sublingual nifedipine.
Therapeutic Uses:
Adverse Effects:
CI: SSRIs, pheochromocytoma, cardiovascular disease & renal insufficiency

Indirect sympathomimetic release NE causing hypertensive
Interactions:
crisis
TCA hypertensive crisis
SSRIs serotonin syndrome
Meperidine
Antihypertensives additive hypotensive effect
hyperpyrexia
Tyramine-rich foods hypertensive crisis (aged cheese, salami, avocados,
bananas, protein, & red wine)
Vasopressors (phenylethylamine, caffeine) hypertension
Usually start within 12-72 hours / Persist 5-7 days

Can be mild: nausea, anxiety, tremors
Can be life-threatening: hallucinations, cramps, tremors, seizures, HR, BP,
T
Withdrawal Symptoms
Support Meds:
Benzodiazepines (chlordiazepoxide, diazepam, lorazepam) DT and risk of

seizures, intensity of symptoms
Adjuncts (carbamazepine, clonidine, propanolol) seizure, craving,
depress autonomic response (HR, BP, T)
Maintenance Meds:
Disulfiram (Antabuse) EtOH, aldehyde syndrome occurs (nausea, extreme

vomiting, hypotension) Can progress to respiratory and cardiac depression,
seizures, and death.
Naltrexone (ReVia) Opioid antagonist that craving and pleasurable effects
Acamprosate (Campral) unpleasant effects of abstinence (anxiety, etc)
Proto: Lithium, mood-stabilizing anticonvulsants:

valproic acid (Depakote), carbamazepine (Tegretol)
Expected Action:
Lithium causes serotonin receptor blockade

Lithium use will evidence neuronal apathy and/or in neuronal growth.
Bipolar / alcoholism / bulimia / schizophrenia
Therapeutic Uses:
GI effects, usually transient (give milk)
Adverse Effects:
Tremors (give -blocker like propanolol)
Polyuria
Renal toxicity
Goiter/hypothyroidism
Teratogenic
Pregnancy - D
lactation
+
Caution renal dysfunction, heart disease, Na depletion & dehydration
Interactions:
Diuretics Na+ lithium excretion toxicity

NSAIDs renal absorption lithium toxicity (aspirin OK)
Anticholinergics abdominal discomfort from urinary retention & polyuria
Maintain adequate sodium intake and 8-12 glasses of H2O
Education:
Plasma lithium levels must be monitored (> 1.5 mEq/L is toxic)
RBC=4.7-6.1 x 1012/L
WBC = 5-10 x 109/L
PO2=75-100 mm Hg
Hgb=14-18 g/dL
PCO2=34-45 mm Hg
Hct=42-52%
PLT = 150-400 x 109/L

pH = 7.35-7.45
PT=11-12.5 s
PTT=60-70 s
Na =135-145 mEq/L
Cl =100-108 mEq/L
Ca =9-10.5 mEq/L
K+=3.5-5 mEq/L
PO43-=3-4.5 mg/dL
Mg2+=1.3-2.1 mEq/L
Prot=6-8 g/dL
BUN=8-25 mg/dL
Alb=3.5-5 g/dL
Neu=55-70%
(2,500-8,000)
2+
Osm=275-295 mOsm/kg
Lym=20-40%
(1,000-4,000)
Creatinine=0.6-1.5 mg/dL
Mon=2-8%
(100-700)
Eos=1-4%
(50-500)
Expected Action:
Proto: amitriptyline (Elavil)

Others: imipramine (Tofranil), doxepin (Sinequan)
Block reuptake of norepinephrine and serotonin in synaptic space

Depression & bipolar disorders
Therapeutic Uses:
Sedation
Adverse Effects:
Anticholinergic effects
Cardiac toxicity @ doses
Toxicity evidenced by dysrhythmias, confusion, & agitation followed by
seizures
Pregnancy (C)
MAOIs hypertension
Interactions:
Antihistamine & anticholinergicsadditive effects
Epi/Norepi amounts of adrenergics because reuptake is blocked by TCA
Ephedrine/amphetamine responses to these d/t uptake inhibition keeps
them from reaching site of action in nerve terminal
EtOH, benzodiazepines, opioids, antihistamines Additive CNS depression
Self-limiting in 7-10 days

Begins with sweating and rhinorrhea, progressing from tremors and irritability
to weakness, nausea, vomiting, muscle/bone pain, and spasticity.
NOT life-threatening.
Withdrawal Symptoms
Detox Meds:
Methadone substitution Prevents withdrawal syndrome.
Maintenance Meds:
Methadone Long-term maintenance. Dependence is transferred to

methadone.
Clonidine (Catapres) Control autonomic hyperactivity (nausea, vomiting)
Buprenorphine (Subutex) Opioid agonist/antagonist
Naloxone (Suboxone) Opioid agonist/antagonist
Withdrawal Symptoms
Abstinence syndrome is evidenced by irritability, nervousness, restlessness
Support Meds:
Bupropion (Zyban) craving and symptoms of withdrawal.

Nicotine Pharmaceutical replacement to alleviate symptoms
Education
Chew gum over 30 minutes; avoid eating and drinking within 15 minutes of
gum
Gum not recommended for use longer than 6 months
Avoid use of all nicotine products while pregnant or breastfeeding.
Expected Action:
Promote
Proto: vasopressin (Pitressin) Others: desmopressin (DDAVP)
H2O reabsorption in kidneys (desmopressin preferred)
Vasoconstriction
Therapeutic Uses:
Adverse Effects:
due to smooth muscle contraction (vasopressin)

Diabetes
Overhydration
insipidus
Cardiac
arrest
(sleepiness, pounding headache)
(X)
Pregnancy
CAD or peripheral circulation (risk for gangrene)
Education:
Monitor
site carefully; extravasation can cause gangrene.
ANS helps control pressure by adjusting cardiac output (HR x SV) and peripheral
resistance.
The renin-angiotensin-aldosterone system helps control arterial pressure by:
Releasing angiotensin II potent vasoconstrictor of arterioles

and veins
Releasing aldosterone promotes Na+ and H2O retention by
kidneys
Vasopressin (ADH) is a potent vasoconstrictor and water reabsorption.
Atrial natriuretic peptide (ANP) is a vasodilator and causes excretion of Na
and H2O by kidneys. It also inhibits renin secretion.

Decreasing blood volume and dilating arterioles and veins help control BP
Epinephrine (Adrenaline) Catecholamine
Adrenergic Agonist
Binds to: 1 vasoconstriction / 1 HR, contractility, & AV conduction
2 Bronchodilation
absorption of local anesthetics or extravasated meds
Therapeutic Uses:
Manage superficial bleeding
congestion of nasal mucosa
BP
Treatment of AV block and cardiac arrest
Asthma
Hypertensive crisis
Necrosis from extravasation
Adverse Effects:
Dysrhythmias / myocardial O2 demand angina
Pregnancy (C)
MAOIs effect and duration
TCAs block uptake of epi.
Interactions:
General anesthetics lead heart to be hypersensitive to epi dysrhythmias
-adrenergic blockers (phentolamine)
-adrenergic blockers (propanolol)
Expected Action:
Education:
Stop infusion with evidence of extravasation; treat with -blocker (phentolamine)

Dopamine (Intropin) Catecholamine
Adrenergic Agonist
Expected Action:
Low Dose (Dopamine receptors) Renal vasodilation

Mod Dose (Dopamine, 1) Above + HR, contractility, AV conduction
High Dose (Dopamine, 1, 1) Above + vasoconstriction
Shock
Heart failure
Therapeutic Uses:
Necrosis can occur from extravasation of high doses
Adverse Effects:
Dysrhythmias / myocardial O2 demand angina
Pregnancy (C)
CI: Pheochromocytoma
Interactions:
Education:
Stop infusion with evidence of extravasation; treat with -blocker (phentolamine)
Vasoconstriction of arterioles in skin, viscera, and
mucous membranes, and veins

HR, contractility, AV conduction
Release of renin in kidneys
Vasodilation of arterioles in heart, lungs, and
Dopamine
skeletal muscle
Bronchodilation
Relaxation of uterine smooth muscle
Glycogenolysis in liver
Skeletal muscle contraction
Vasodilation of renal blood vessels
Dobutamine (Dobutrex) -- Catecholamine
Expected Action:
Binds to: 1 vasoconstriction / 1 HR, contractility, & AV conduction

2 Bronchodilation
Therapeutic Uses:
Heart failure
Adverse Effects:
heart rate
Pregnancy (B)
Interactions:
Education:
Stop infusion evidence of extravasation; treat with -blocker (phentolamine)

Proto: Prazosin (Minipress) Others: doxazosin mesylate (Cardura),
Expected
Action:
Phentolamine (Regitine), ergotamine tartrate
Selective 1 blockade resulting in venous and arterial dilation

Hypertension
Phentolamine: Extravasation of adrenergic agonists
Doxazosin mesylate: symptoms of benign prostatic hypertrophy
Therapeutic Uses:
Adverse Effects:
First-dose orthostatic hypotension (monitor BP for 2 hrs post-treatment)

Pregnancy (C)
Interactions:

NSAIDs / clonidine antihypertensive effects of prazosin
Education:
Proto: clonidine (Catapres)

Others: guanfacine (Tenex), methyldopa (Aldomet)
Expected Action:
sympathetic outflow in CNS bradycardia, CO, vasodilation, BP

Hypertension
Severe cancer pain (epidural)
Investigational: Migraine, flushing from menopause, withdrawal management
Dry mouth (usually resolves in 2-4 weeks)
Adverse Effects:
Drowsiness & sedation
Rebound hypertension
Pregnancy (C)
Therapeutic Uses:
Antihypertensives: Additive hypotensive effect

Prazosin, MAOIs, TCAs: Counteract effects of clonidine.
CNS Depressants: Additive CNS depressant effect
Apply patch to hairless skin on torso or upper arm
Education:
Interactions:
Proto: Cardioselective: metoprolol (Lopressor), Nonselective: propanolol

(Inderal) - Others: Cardioselective: atenolol, Nonselective: nadolol (Corgard)
1-adrenergic blockade HR, contractility, AV conduction
Hypertension
Dysrhythmias (block SA/AV cond.)
Therapeutic Uses:
Angina/MI ( O2 demand - diastole time perfusion - BPO2)
Heart failure (mechanism unknown, probably related to above)
Hyperthyroidism, migraines, stage fright, pheochromocytoma, glaucoma
Expected
Action:
Adverse Effects:
1: Bradycardia CO AV block Orthostatic hypotension

Rebound myocardium excitation (d/c over 1-2 weeks)
2: Bronchoconstriction Glycogenolysis inhibited
CI: AV block, sinus bradycardia
Nonselectives are CI asthma, bronchospasms, heart failure
Interactions:
1: calcium-channel blockers verapamil (Calan) and diltiazem (Cardizem)

intensify effects of -blockers.
2: Insulin prevents glycogenolysis
Expected
Action:
Proto: captopril (Capoten) Others: enalapril (Vasotec), fosinopril
(Monopril), lisinopril (Prinivil), ramipril (Altace)

Block production of angiotensin II arteriole vasodilation, excretion of Na+
and H2O, retention of K+, and possible pathological changes to vessels and heart
Heart failure
Hypertension
Therapeutic Uses:
MI ( risk of HF and mortality)
Peripheral neuropathy
Ramipril can prevent MI, stroke, or death in high-risk patients
Hyperkalemia
Cough
Neutropenia
Adverse Effects:
Angioedema (swelling in tongue/oropharynx) treat with epinephrine
First-dose orthostatic hypotension
Rash & dysgeusia
Pregnancy (D)
CI: bilateral renal stenosis, history of angioedema
st
Diuretics1 -dose hypotension
Lithium [Lithium]
Interactions:
AntihypertensivesAdditive effects
NSAIDs antihypertensive eff.
+
+
K supplements/K sparing diuretics hyperkalemia
Captopril 1 hr ac / others or food
Education:
Should see renal function evidenced by proteinuria
Proto: Losartan (Cozaar) Others: valsartan (Diovan), irbesartan
Expected
Action:
(Avapro), candesartan (Atacand), olmesartan (Benicar)

Blocks action of angiotensin arteriole vasodilation, excretion of Na+ & H2O,
retention of K+
ACE and ARB is that cough and hyperkalemia are not side effects of ARB.
hypertension (all)
Stroke prevention (losartan)
Therapeutic Uses:
Mgt of heart failure / mortality prevention after MI (valsartan)
Delay progression of diabetic neuropathy (irbesartan, losartan)
Angioedema
Fetal injury
Adverse Effects:
Pregnancy (D)
CI: Renal stenosis
Caution Hx of angioedema
Antihypertensives Additive effect ARBs
Interactions:
ARBs can be taken with or without food

Should see renal function evidenced by proteinuria
Education:
Proto: nifedipine (Adalat) Others: amlodipine (Norvasc), felodipine

(Plendil), nicardipine (Cardene), verapamil (Calan), diltiazem (Cardizem)
2+
Nifedipine: vascular Ca channelsvasodilation peripheral & arterioles
Verapamil, Diltiazem: Above + contractility, HR, AV conduction
All: Hypertension
All but Felodipine: Angina
Therapeutic Uses:
Verapamil, Diltiazem: Hypertension, Angina, Dysrhythmias
Nifedipine: Tachycardia, peripheral edema, acute toxicity
Adverse Effects:
Verapamil, Diltiazem: Orthostatic hypotension, peripheral edema, constipation,
cardiac suppression, dysrhythmias, acute toxicity
Expected
Action:
CI: heart block, hypotension, bradycardia, aortic stenosis, severe heart failure
Digoxin[digoxin]
Interactions: Verapamil, Diltiazem: Grapefruittoxicity
-blockers: HF, AV block, bradycardia
Nifedipine: Grapefruittoxicity -blockers: Used to reflex tachycardia
Education:
Administer IV over 2-3 minutes
Proto: nitroprusside Others: labetalol (Trandate), diazoxide
Expected
Action:
(Hyperstat), fenoldopam (Corlopam), trimethaphan (Arfonad)

Direct vasodilation of veins and arteries causing rapid BP (preload/afterload)
Hypertensive emergencies
Therapeutic Uses:
bleeding during surgery by producing controlled hypotension
Excessive hypotension
Adverse Effects:
Cyanide poisoning: risk liver dysfunction; Give slowly (5 mcg/kg/min)
along with thiosulfate to deactivate cyanide.
Thiocyanate poisoning: Can manifest as altered mental state/psychosis. Avoid
prolonged use (>3 d). Plasma thiocyanate should be <0.1 mg/mL
Pregnancy (C)
Discard solutions that are blue, red, or green

Protect solutions from light Do not mix other meds nitroprusside.
Education:
Proto: nitroglycerine Others: isosorbide dinitrate (Imdur)

cardiac O2 demand by dilating veins and decreasing venous return (preload)
Relaxes or prevents spasms in coronary arteries thus O2 supply
Treatment of angina (acute, variant, and prophylaxis)
Therapeutic Uses:
IV perioperative BP control, HF d/t acute MI
Headache
Tolerance
Adverse Effects:
Reflex tachycardia - give metoprolol (Lopressor)
CI: traumatic head injury ICP
Sildenafil (Viagra)Acute or fatal hypotension
Interactions:
EtOH, -blockers, Ca-blockers, diuretics additive hypotensive effects
Sublingual tab/translingual spray: R onset, S duration
Education:
Transmucosal: R onset, L duration
SR caps: S onset, L duration
Transdermal: S onset, L duration (hairless area, min 8 hr/day without med to
lower risk of developing tolerance.
Topical: S onset, L duration
IV: Use glass bottle & mfrs tubing; Start at slow rate (5 mcg/min)
Expected Action:
Proto: digoxin
Expected Action:
(+) inotropicSV, CO (-) chronotropic > fill time SV, CO

Tx of HF
Dysrhythmias, A-Fib
Therapeutic Uses:
GI effects
CNS effects (fatigue, vision changes)
Adverse Effects:
+
Dysrhythmias, cardiotoxicity: risk fromK , [digoxin], disease
CI: v-fib, v-tach, 2/3 blocks
Quinidine dig toxicity
Verapamil [digoxin]
Interactions:
Sympathomimetics add to inotropic effect
+
Loop & thiazide diuretics K risk of digoxin dysrhythmia
+
ACE inhibitors / ARBs risk K therapeutic digoxin effects
Check apical pulse: hold < 60 (adults), < 70 (kids), < 90 (infants)
Education:
Therapeutic levels = 0.5-2 ng/mL
Treat bradycardia atropine
Treat dysrhythmias phenytoin or lidocaine
Activated charcoal or cholestyramine can bind digoxin to prevent absorption.
Sodium channel blockers: procainamide (Pronestyl),
quinidine, disopyramide, tocainide, propafenone
Expected Action:
conduction / automaticity / repolarization rate
Therapeutic Uses:
Ventricular tachycardia
Adverse Effects:
Supraventricular tachycardia
Blood dyscrasias
Atrial fibrillation
Cardiotoxicity (QRS, QT)
CI: Sens. to quinidine, complete block, lupus
Anticholinergics anticholinergic effects

Antidysrhythmics in therapeutic effects / toxicity potential
Education:
Atrial flutter
Systemic lupus syndrome (resolve with d/c medication)
Interactions:
Proto: atorvastatin (Lipitor)

Others
: simvastatin
(Zocor),(Xylocaine)
lovastatin
Sodium
channel
blockers: lidocaine
Expected
Expected Action:
(Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor)
Action:
conduction
/ receptors
automaticity
/ repolarization
rate
LDL
by LDL
in liver
VLDL
HDL
Therapeutic
Promote vasodilation
plaque-site
/ thromboembolism
/Short-term
use inflammation
only for ventricular
dysrhythmias risk
Uses:
hypercholesterolemia
HDL
Therapeutic
Uses: 1
Respiratory
arrest
Adverse Effects:
Prevention of stroke and coronary events.
CNS effects (fatigue, paresthesias, seizures)Tx seizures phenytoin (Dilantin)
Myopathy (monitor CK)
Peripheral neuropathy
Adverse Effects:
CI: Stokes-Adams,
Hepatotoxicity evidenced by serum
transaminase Complete block
Pregnancy (B)
rosuvastatin in Asians
Pregnancy (X)
Interactions:
CI: Pregnant / viral or EtOH hepatitis
Caution ketoconazole
Fibrates -Blockers
risk of myopathy
Cimetidine, phenytoin,
effects of lidocaine.
Interactions:
Med that suppress CYP3A4 (ketoconazole, erythromycin) statin levels
Never administer lidocaine that has epinephrine in it.
Education:
Grapefruit juice and (lovastatin or simvastatin) Toxicity
Loading dose followed by maintenance dose of 1-4 mg/min.
Lovastatin evening meal (others OK food)
Education:
Atorvastatin or fluvastatin should be used with renal insufficiency
Calcium-channel blockers: verapamil (Calan),
diltiazem (Cardizem)
Expected Action:
force / HR / AV node conduction
Therapeutic Uses:
Atrial flutter
CI: heart block, hypotension, bradycardia, aortic stenosis, severe heart failure
Interactions:
SVT
Orthostatic hypotension, peripheral edema, constipation, cardiac suppression,

dysrhythmias, acute toxicity
Adverse Effects:
Atrial fibrillation
Digoxin[digoxin]
Grapefruittoxicity
-blockers: HF, AV block, bradycardia
Education:
Potassium channel blockers: amiodarone (Cordarone),
bretylium, sotalol, dofetilide
Expected Action:
conduction / automaticity / repolarization rate / contractility
Conversion of A-fib (oral)

Recurrent V-tach
Pulmonary toxicity
Visual disturbances (can blind)
Adverse Effects:
Cardiac effects sinus bradycardia & AV block / may cause HF / Hypotension
Liver/thyroid dysfunction
CNS effects
GI effects
Phlebitis: Central venous line is indicated
Pregnancy (D)
CI: AV block, bradycardia, newborns, infants
Grapefruit toxicity
Cholestyramine [amiodarone]
Interactions:
Quinidine, procainamide, digoxin, diltiazem, warfarin levels of these
-blockers, verapamil, diltiazem bradycardia
Diuretics, antidysrhythmics, macrolide antibiotics risk dysrhythmias
Therapeutic Uses:
Recurrent V-fib
Expected Action:
Endogenous Glucoside: adenosine (Adenocard), ibutilide (Corvert)
conduction through AV node
Therapeutic Uses:
Adverse Effects:
Paroxysmal SVT
Wolff-Parkinson Syndrome
Sinus bradycardia, dyspnea, flushed face (usually < 1 min)
Pregnancy (C)
CI: 2/3 block, AV block, atrial flutter, atrial fibrillation
Interactions:
Methylxanthines (theophylline, caffeine) Adenosine receptors are blocked
Dipyridamole (Persantine) Uptake is blocked leading to effects
Education:
Very short life (< 1 min)
Administer by IV bolus, flushed with NS
Proto: Heparin Others: enoxaparin, tinzaparin (Innohep)
Expected Action:
Intrinsic factors and thrombin conversion are inhibited by heparin

Evolving stroke, PE, MI, DVT
During pregnancy
Adjunct during surgery, dialysis, abdominal surgery, or joint replacement
Disseminated intravascular coagulation
Hypersensitivity reaction (chills, fever, urticaria)
Adverse Effects:
Hemorrhage 2 heparin OD (treat protamine sulfate)
Heparin-induced thrombocytopenia (stop if PLT < 100,000/cc)
CI: PLT or uncontrollable bleeding
CI: Surgery of eye, brain, spinal cord; regional anesthesia; lumbar puncture
Anti-platelet agent additive risk of bleeding
Interactions:
Therapeutic Uses:
Education:
Monitor aPTT levels Q4-6h and then QD (60-80 sec)
Proto: gemfibrozil (Lopid) Others: fenofibrate (Tricor)
Expected Action:
TG by VLDL excretion
Therapeutic Uses:
Adverse Effects:
Gall stones
Hepatotoxicity
Pregnancy (C)
Statins myopathy
Warfarin risk of bleeding (monitor PT and INR)
Proto: ezetimibe (Zetia)
Inhibit absorption of cholesterol secreted in the bile and from food.
Therapeutic Uses:
Adverse Effects:
Adjunct to modified diet to help LDL (alone or statin)
Well-tolerated no adverse effects
Caution statins
Cholestyramine absorption
Expected Action:
Myopathy
CI: liver disorders / severe renal dysfunction / gallbladder disease
Interactions:
Promote HDL precursor production
plasma VLDL, plasma HDL
Pregnancy (X)
Caution breastfeeding
CI: Renal dysfunction
Interactions:
Bile acid sequestrants (cholestyramine) absorption
Use with fibrates (gemfibrozil) risk of gall stones and myopathy
Cyclosporine levels of ezetimibe
Education:
Taken once per day without regard to food
Expected Action:
LDL receptors in liver promotes uptake of serum cholesterol LDL
Therapeutic Uses:
Proto: cholestyramine (Questran) Others: colestipol (Colestid)
Adjunct with HMG CoA reductase inhibitor (eg atorvastatin) & diet LDL
Adverse Effects:
No systemic effects (not absorbed in GI tract)
CI: biliary disease or VLDL
Digoxin, warfarin, thiazides, tetracyclines form complexes absorption
Education:
Constipation
Interactions:
Dissolve in water or applesauce to prevent esophageal irritation or impaction.
Proto: Aspirin Others: ticlopidine (Ticlid), clopidogrel (Plavix),
Expected
Action:
dipyridamole (Persantine), abciximab (Reo Pro)

Prevent platelet clumping by inhibiting arterial clotting enzymes and factors
Primary prevention of acute MI
Prevention of stroke
Therapeutic Uses:
Prevention of reinfarction
Acute coronary syndromes (abciximab and tirofiban {Aggrastat})
GI effects (concurrent PPI / enteric-coated / take food)
Adverse
Hemorrhagic stroke
Effects:
Pregnancy (D)
Interactions:
Medications that enhance bleeding additive risk for bleeding
Education:
ASA (81 mg) for prevention / ASA (325 mg) during initial acute MI episode
Proto: Protamine sulfate
Expected Action:
Binds with heparin and forms a non-coagulating complex

Antidote to severe heparin overdose
Therapeutic Uses:
Reversal of heparin administered during procedures
Adverse Effects:
Interactions:
Administer slowly (20 mg/min or 50 mg in 10 min)

aPTT levels of 60-80 sec
Education:
Proto: warfarin (Coumadin)

Antagonizes vitamin K / prevents synthesis of 4 intrinsic factors & prothrombin
Prevention of venous thrombosis
Therapeutic Uses:
Prevention of thrombi in A-fib and with prosthetic heart valves
Hemorrhage (Tx with vitamin K)
Adverse Effects:
Expected Action:
Pregnancy (X)
CI: Surgery of eye, brain, spinal cord; regional anesthesia; lumbar puncture
CI: PLT counts, uncontrolled bleeding, vit. K , liver problems, alcoholism
Heparin, aspirin, glucocorticoids bleeding
Interactions:
Acetaminophen, sulfonamides, parenteral cephalosporins, ASA [warfarin]
Phenobarbital, carbamazepine, phenytoin, OC, vitamin K warfarin effects
PT therapeutic level = 18-24 sec (normal = 11-12.5 sec)
Education:
Onset takes 8-12 hrs, full effect takes 3-5 days
Proto: Vitamin K (Phytonadione)
Expected Action:
Promote synthesis of intrinsic factors and prothrombin

Vitamin K deficiency
Reversal of hypoprothrombinemia and bleeding d/t warfarin OD
Anaphylactoid reaction (infuse slowly in diluted solution)
Adverse Effects:
Therapeutic Uses:
Interactions:
Education:
Administer small doses (2.5 mg PO / 0.5-1 mg IV) of vitamin K to

prevent development of resistance to warfarin.
Proto: Folic Acid
Expected Action:
Folic acid is essential in DNA production & erythropoiesis (RBC, WBC, PLT)
Therapeutic Uses:
Tx of macrocytic anemia
Prevention of neural tube defects in pregnancy

None
Adverse Effects:
Interactions:
Sulfonamides, sulfasalazine, methotrexate folate levels concurrent use
Education:
Proto: streptokinase
Others: alteplase (tPA), tenecteplase, reteplase
Expected Action:
Clot dissolution by plasminogenplasmin which destroys fibrinogen
Therapeutic Uses:
Acute MI / DVT / Massive PE / Ischemic stroke (alteplase)
Adverse Effects:
Serious risk of bleeding from different sites

Streptokinase Hypotension (infuse slowly)
Allergic reaction or anaphylaxis
Hx of intracranial hemorrhage
Brain tumors / pericarditis / Recent head or facial trauma / internal bleeding
Interactions:
Meds that enhance bleeding have additive risk for bleeding

Admin within 4-6 hours of onset
Education:
IV aminocaproic acid for excessive fibrinolysis
Administer H2 antagonists such as ranitidine (Zantec) or PPI such as
omeprazole (Prilosec) to prevent GI bleeding.
Proto: Ferrous sulfate Others: Iron Dextran
Expected Action:
Increase iron level for RBC development and oxygen transport capacity
Therapeutic Uses:
Adverse Effects:
Treat and prevent iron-deficiency anemia
Teeth staining (liquid) {Dilute / Drink straw / Rinse}
GI distress: {take food if necessary but absorption}

Anaphylaxis (parenteral): IV is safer / Deep IM Z-track / Infuse slowly
Interactions:
Education:
Vitamin C absorption but side effects
Antacids or tetracyclines absorption

Take on empty stomach to absorption
Anticipate dark green or black stool
Proto: Vitamin B12 (cyanocobalamin)
Expected Action:
Necessary to convert folate (required for DNA production) from inactive form
Treatment of B12 deficiency
Megaloblastic (macrocytic) anemia related to B12 deficiency
Therapeutic Uses:
Adverse Effects:
Hypokalemia 2 RBC production
Interactions:
Folic acid supplements mask signs of B12 deficiency
Intranasal spray / oral / IM / SC

Injections are painful; reserved for reduced ability to absorb.
Education:
Proto: oprelvekin (Interleukin 11, Neumega)
Expected Action:
Increases production of platelets.
Therapeutic Uses:
Adverse Effects:
Fluid retention (peripheral edema, dyspnea on exertion)
Dysrhythmias
thrombocytopenia myelosuppressive chemotherapy

Conjunctival injection, transient blurring, and papilledema
Interactions:
Education:
Treat for 21 days or until PLT > 50,000
Expected Action:
Proto: Epoetin alfa (Epogen, Procrit) Others: darbepoetin alfa
Act on bone marrow to RBC production

Anemia of chronic renal failure or chemotherapy
HIV patients taking zidovudine
Anemia in patients schedule for
(Retrovir)
elective surgery
Hypertension 2 Hct
Adverse Effects:
risk for CV event (MI, stroke, arrest) Hgb > 12 g/dL or > 1 g in 2 weeks
CI: uncontrolled hypertension
Therapeutic Uses:
Interactions:
RBC production requires iron, folate, and vitamin B12

Monitor Hgb and Hct 2x per week until target range is reached
Education:
Expected Action:
Proto: filgrastim (Neupogen) Others: pegfilgrastim (Neulasta)
Medications stimulate bone marrow to production of neutrophils.

infection risk with neutropenia (e.g. cancer)
Bone pain
Adverse Effects:
Leukocytosis: dose / interrupt treatment if WBC > 50,000/cc, ANC >
20,000/cc, or platelets > 500,000/cc.
CI: Sensitive to E. coli proteins
Therapeutic Uses:
Interactions:
Filgrastim should not be agitated nor mixed

Monitor CBC 2x per week
Education:
Proto: Sargramostim (Leukine)
Expected Action:
production of WBCs in bone marrow
Therapeutic Uses:
Facilitates recovery of bone marrow after marrow transplant.
Adverse Effects:
Diarrhea, weakness, rash, malaise, and bone pain (call)
Leukocytosis, thrombocytosis: if WBC>50,000, ANC>20,000, PLT>500,000
CI: Allergic to yeast products
Caution disease, hypoxia, peripheral edema, pleural/pericardial effusion.
Interactions:
Education:
Sargramostim should not be agitated nor mixed with other meds.
Expected Action:
Massive hemorrhage
Extensive burns
Shock
Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids)
Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m

Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m
Anaphylaxis: VS Q5m for 15m IM or IV epinephrine
Mild allergy: If respiration uncompromised, antihistamines and restart
Circulatory overload: Place upright / O2 and diuretics / slower rate
Requires countersign
Assess site & patency
Education:
Disseminated intravascular coagulation

Antithrombin III deficiency
Thrombotic thrombocytopenic purpura
Reverse warfarin effects
Replacement therapy for factors II, V, VII, IX, X, & XI
Adverse Effects:
Replaces coagulation factors
Therapeutic Uses:
Expected Action:
Adverse Effects:
Increases circulating blood volume
Acute blood loss, extensive burns, dehydration, shock
Therapeutic Uses:
Assess before, during, & after

No Mix
Education:
Complete in 2-4 hours
Expected Action:
Use 19 ga, filter, Y-tubing
No Mix
Hgb 1-2 g/dL per unit
Erythroblastosis fetalis
Severe symptomatic anemia (Hgb<6 g/dL)
Adverse Effects:
# of RBCs
Therapeutic Uses:
Hemoglobinopathies
Med-induced hemolytic anemia
Education:
Complete in 2-4 hours
Expected Action:
Use 19 ga, filter, Y-tubing
No Mix
Hgb 1-2 g/dL per unit
platelet count
Therapeutic Uses:
Thrombocytopenia (< 20,000/cc)
Active bleeding (platelets < 80,000/cc)
Adverse Effects:
Education:
Use special platelet kit (smaller filter, shorter tube
Bronchodilators
Anti-inflammatory
2-adrenergic agonists
Glucocorticoids
Inhaled, short-acting
Inhaled medications
Albuterol (Proventil, Ventolin)
Inhaled, long-acting
Formoterol, salmeterol
Oral, long-acting
Beclomethasone (QVAR)
Budesonide (Pulmicort)
Fluticasone (Flovent)
Triamcinolone (Azmacort)
Oral medications
Albuterol, terbutaline
Prednisone, prednisolone
Cromolyn & nedocromil (inhaled)
Leukotriene modifiers (Oral)
Methylxanthines
Oral, long-acting
Theophylline
Anti-cholinergics
Montelukast (Singulair)
Zafirlukast (Accolate)
Maintenance therapy
Ipratropium, inhaled (Atrovent)
Bronchodilators are oral or inhaled, for acute relief, short-term
prophylaxis and long-term control. Anti-inflammatory are for long-acting

prophylaxis.
Neonatal sepsis
Therapeutic Uses:
Replace neutrophils / granulocytes
Expected Action:
Neutrophil dysfunction
Severe neutropenia (ANC < 500)
Nonresponsive life-threatening infection
Adverse Effects:
Education:
Hypovolemia
Therapeutic Uses:
Hypoalbuminemia
Hemolytic disease of the newborn
Burns
Adult respiratory distress
Cardiopulmonary bypass surgery
Risk for fluid volume excess such as pulmonary edema
CHF or renal insufficiency
Contraindications:
Education:
Adverse Effects:
No Mix
Expands circulating blood volume by oncotic pressure
Expected Action:
Must administer IV: Slowly using an infusion pump
Can be administered whole blood, plasma, saline, or glucose.

Proto: albuterol (Proventil) Others: formoterol (Foradil),
Expected Action:
salmeterol (Serevent), terbutaline (Brethine)
Selectively activate 2 receptors resulting in bronchodilation: bronchospasm is

relieved, histamine release is inhibited, and ciliary motility is
Therapeutic Uses:
Adverse Effects:
Albuterol: Inhaled, short-acting and oral, long-acting
Formoterol, salmeterol: Inhaled, long-acting
Inhaled: Minimal adverse effects
CI: tachydysrhythmias
-blockers like propanolol negate effects of both

TCAs and MAOIs risk of tachycardia and angina
Education:
(C)
Interactions:
Terbutaline: Oral, L-A
Oral: Tachycardia/angina d/t 1 in / tremors d/t 2 in skeletal muscle
Inhale 3-5 sec, hold 10 sec, wait 60 sec for next dose
Use inhaled 2-agonist before using inhaled glucocorticoid
Proto: Theophylline (Theolair)
Expected Action:
Theophylline relaxes bronchial smooth muscle bronchodilation
Adverse Effects:
Long-term control of asthma
Therapeutic Uses:
Mild toxicityGI distress & restlessness. Severe reactions
Severe reactions can occur at therapeutic levels and include dysrhythmias and
seizures. Effects unlikely @ <20 mcg/mL. Activated charcoal absorption,
lidocaine for dysrhythmias and diazepam for seizures.
Interactions:
(C)
Caffeine: CNS/ effects of theophylline. Also [theophylline]
Phenobarbital, phenytoin: [theophylline]
Cimetidine, ciprofloxacin: [theophylline]

Proto: ipratropium (Atrovent) Others: tiotropium (Spiriva)
Expected Action:
Block muscarinic receptors on bronchi bronchodilation
Therapeutic Uses:
Relief of bronchospasms associated with COPD
Relief of allergen-induced and exercise-induced asthma.
Adverse Effects:
Local anticholinergic effects
CI: Peanut allergy
Caution in narrow-angle glaucoma
Education:
(B)
Usual adult dose is 2 puffs (1 minute apart)
If taking two inhaled medications, separate by at least 5 minutes.
Proto: beclomethasone (QVAR) Others: budesonide (Pulmicort),

fluticasone (Flovent), triamcinolone (Azmacort), prednisone (Deltasone)
Prevent inflammation, suppress airway mucous production, and promote
responsiveness of 2-receptors in bronchial tree.
Inhaled: Long-term asthma prophylaxis
Therapeutic Uses:
S-T, oral: Treat symptoms following acute asthma.
L-T, oral: Treat chronic asthma
1 adrenocortical insufficiency
Promote lung maturity and RDS in fetuses at risk for preterm birth.
Inhaled: Dysphasia, candidiasis, bone loss
Adverse Effects:
Oral (10d): adrenal gland function / bone loss / hyperglycemia / glucosuria /
/ infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances.
(?) CI: Live virus / systemic fungal infect.
Diuretics: hypokalemia
NSAIDs: GI ulceration
Interactions:
Glucocorticoids counteract effects of insulin and oral hypoglycemics.
Oral are for short-term use, 3-10 days following acute attack
Education:
Expected
Action:
Proto: Cromolyn (Intal) Others: nedocromil (Tilade)
Expected Action:
Anti-inflammatory: Stabilize mast cells, inhibiting histamine release.

Suppress inflammatory cells (e.g. eosinophils, macrophages)
Therapeutic Uses:
Management of chronic asthma
Prophylaxis of exercise-induced and allergen-induced asthma attacks
Allergic rhinitis by intranasal route
Adverse Effects:
Safest of all asthma meds / safe for kids
(B)
Propellant CI: CAD, dysrhythmias, and status asthmaticus
Education:
Take 15 min before exercise
Long-term prophylaxis may take several weeks
Proto: montelukast (Singulair) Others: zileuton (Zyflo),
zafirlukast (Accolate)
Expected Action:
Prevent effects of leukotrienes thus suppressing inflammation, airway edema,

bronchoconstriction, and mucus production.
Therapeutic Uses:
Liver injury zileuton and zafirlukast. (nausea, anorexia,

abdominal pain)
Adverse Effects:
Long-term asthma therapy in folks 12 YO
(?)
Interactions:
Zileuton / zafirlukast inhibit warfarin metabolism [warfarin]
Zileuton / zafirlukast inhibit theophylline metabolism theophylline toxicity
Education:
Zileuton given without regard to food. Zafirlukast taken food

Proto: codeine Others: hydrocodone
Expected Action:
Suppresses cough center in the medulla oblongata.

Chronic, non-productive cough
Therapeutic Uses:
Adverse Effects:
GI distress (nausea, constipation) take food, fluid/fiber
CNS sedation effects: Respiratory depression (<12/min) naloxone
Potential for abuse, schedule II.
Proto: Phenylephrine
Others: Ephedrine, naphazoline, phenylpropanolamine
Stimulate 1-adrenergic receptors inflammation of nasal membranes
Therapeutic Uses:
Adverse Effects:
Allergic rhinitis, sinusitis, and common cold
Rebound congestion (Max 3-5 days, taper down use)
CNS stimulation (rare topical)
CI: acute asthma, head trauma, liver/renal dysfunction, acute alcoholism
Expected Action:
(C)
(?)
Vasoconstriction
CI: Chronic rhinitis
Caution: CAD and hypertension
Education:
Oral do not lead to rebound congestion
Proto: omeprazole (Prilosec) Others: pantoprazole (Protonix),
lansoprazole (Prevacid), esomeprazole (Nexium)

gastric acid secretion by irreversible inhibition of enzyme that produces it.
Reduce basal and stimulated acid production
Expected Action:
Therapeutic Uses:
Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome)

Adverse Effects: Insignificant short-term treatment
(C)
risk pneumonia d/t pH promoting bacterial colonization

Interactions:
Delayed absorption of Ampicillin, digoxin, iron, ketoconazole if concurrent

Education:
IV pantoprazole may cause thrombophlebitis, headache, or diarrhea.
Proto: Phenylephrine
Others: Ephedrine, naphazoline, phenylpropanolamine
Expected Action:
Stimulate 1-adrenergic receptors inflammation of nasal membranes
Therapeutic Uses:
Adverse Effects:
Allergic rhinitis, sinusitis, and common cold
Rebound congestion (Max 3-5 days, taper down use)
CNS stimulation (rare topical)
(?)
Vasoconstriction
CI: Chronic rhinitis
Caution: CAD and hypertension
Education:
Oral do not lead to rebound congestion
Proto: acetylcysteine (Mucomyst) Others: hypertonic saline
Expected Action:
Enhance flow of secretions in the respiratory passages
Therapeutic Uses:
Cystic fibrosis
Adverse Effects:
Acute & chronic pulmonary disease secretions
Acetylcysteine is the antidote for acetaminophen poisoning
Aspiration and bronchospasm
CI: GI bleeding
Caution: Peptic ulcers / esophageal varices / severe liver disease
Education:
(B)
Has smell of rotten eggs
Dilute in fruit juice
IV: Loading dose, next dose over 4h, last dose over 16h.
Proto: ranitidine (Zantec) Others: cimetidine (Tagamet),
nizatidine (Axid), famotidine (Pepcid)

Selectively block H2 receptors in parietal cells to suppress gastric acid secretion
OTC for heartburn, sour stomach, and indigestion
Therapeutic Uses:
Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome)
In conjunction with antibiotics to treat ulcers caused by H. pylori.
Adverse Effects: libido / impotence
CNS effects (lethargy, depression, confusion) - frequent in elderly renal or
liver dysfunction.
Expected Action:
(B)
risk of bacterial colonization of stomach and respiratory tract

Interactions:
Warfarin, phenytoin metabolizing enzymes inhibited by cimetidine levels

Concurrent use of antacids absorption H2-receptor antagonists
Stop drinking, stop smoking, eat smaller, more frequent meals
Education:
Ranitidine can be taken without regard to food
Proto: Sucralfate (Carafate)
Expected Action:
Acidic conditions sucralfate to viscous gel that adheres to and protects ulcers.
Therapeutic Uses:
Acute duodenal ulcers
Investigational use for gastric ulcers and GERD

Adverse Effects:
No systemic effects
Avoid constipation by > 1500 cc and fiber

Interactions:
(B)
Antacids interfere with absorption of sucralfate.
absorption of phenytoin, digoxin, warfarin, ciprofloxacin

Education:
Take on empty stomach, 4x per day
Proto: Al(OH)3 gel (Amphojel), Others: AlCO3,

Mg(OH)2 (Milk of Magnesia), NaHCO3
Expected Action:
Neutralize gastric acid and inactivate pepsin

Mucosal protection through stimulation of prostaglandin production
Peptic ulcer disease and GERD
Therapeutic Uses:
Adverse Effects: Al/Ca compounds constipation, Mg compounds diarrhea
Na+-containing fluid retention
Al(OH)3hypophosphatemia
Mg2+ compounds toxicity with renal impairment.
Contraindications/Precautions: (C) GI perforation or obstruction
Interactions:
Aluminum-compounds bind to warfarin, tetracycline and their absorption

Chew tablets thoroughly then take with 8 oz water or milk
Frequency of administration makes compliance difficult
Education:
Proto: misoprostol (Cytotec)
Expected Action:
acid secretion / secretion of HCO3- and mucus / submucosal vasodilation.

Therapeutic Uses:
Long-term NSAID therapy
Induce labor by causing cervical ripening.

Adverse Effects:
Diarrhea and abdominal pain
(X)
Dysmenorrhea and spotting
Potential to become pregnant
Agent:
Action
Ondansetron
Prochlorperazine
Dexamethasone
Dronabinol
Scopolamine
Dimenhydrinate
Use
SERR in CTZ & vagal nerve

DOPR in CTZ
Unknown
Unknown
impulses: inner ear VC
HISR MUSR inner ear VC
Agent
Chemo, radiation, postop

Chemo, opioids, postop
Combo for chemotherapy
Chemotherapy (CINV)
Motion sickness
Motion sickness
Adverse Effect
Ondansetron
Headache, diarrhea, dizziness

EPS (Tx Benadryl or Ativan), hypotension, sedation, and
Prochlorperazine
anticholinergic effects.
Dronabinol
Dissociation, dysphoria, hypotension, tachycardia
AntiCh, AntiHis Sedation, anticholinergic effects
Interactions
CTZ = chemoreceptor trigger zone
CNS depressants / Antihypertensives / Anticholinergics Additive Effects
Antagonists urinary retention, asthma, and narrow-angle glaucoma
Combo therapy allows lower doses of each side effects
Proto: metoclopramide (Reglan)
Expected Action:
dopamine and serotonin receptors in CTZ emesis

Augments action of acetylcholine to upper GI motility
Therapeutic Uses:
Postop and chemo-induced nausea and vomiting
GERD
Diabetic gastroparesis
EPS: Restlessness, spasms of face & neck. Minimize
EPS with benzodiazepine like lorazepam (Ativan).
Adverse Effects:
Sedation
(?)
Diarrhea
Seizure disorder ( seizure risk)
GI perforation or bleeding, bowel obstruction, and hemorrhage

Kids and older adults due to risk of EPS
Interactions:
Concurrent EtOH or CNS depressant: seizure / sedation risks
Opioids and anticholinergics effects of metoclopramide.

Education:
Dose 10 mg dilute in 50 mL D5W or Ringers; Infuse over 15m

Agent
Adverse Effect
Sulfonylureas
1st generation
Tolbutamide (Orinase)
Chlorpropamide (Diabinese)
2nd generation ( duration)
Glipizide (Glucotrol) 30 min ac 1st meal
Glyburide (DiaBeta) QD with 1st meal
Glimepiride (Amaryl) QD with 1st meal
Thiazolidinediones
Rosiglitazone (Avandia)
(Given regard to food, usually 1x/day)
Type
Duration
Route
Peak
15 m ac
15 30 m
2 hr
5-10 m ac
10 20 m
1 3 hr
30 m ac
30 60 m
1 5 hr
SC
2x/day
(same time)
1 2 hr
6 14 hr
SC
1x/day
(same time)
70 min
None
Short, Slower SC / Pump /

Regular
(Humulin R) (6 10 h) IH / IM / IV
Glargine
(Lantus)
Long
(24 h)
-Glucosidase Inhibitor
Acarbose (Precose)
(With 1st bit at 3 meals/day)
Onset
Short, Quick
SC / Pump
(3 5 h)
NPH
Intermediate
(Humulin N) (16 24 h)
Biguanides (take food)

Metformin (Glucophage)
(Dont promote insulin release
dont hypoglycemia)
Time
Lispro
Short, Quick
SC / Pump
(Humalog)
(3 - 6 h)
Aspart
(Novolog)
Meglitinides (fast, short-lived)

Repaglinide (Prandin)
(30m ac 1st meal) ( risk hypo)
Insulin: promotes cellular GLC uptake // GLCGLYC // moves K+ into cells

Type 2 may need insulin: severe renal/liver disease // neuropathy // Severe stress
Insulin also used: Tx of hyperkalemia // Tx of DKA and HHNS.
Adverse Effects:
Hypoglycemia
Lipohypertrophy
(?)
Only regular insulin by IV
Interactions:
Additive GLC effect with sulfonylurea, meglitinides, -blocker, EtOH

Thiazide diuretics, glucocorticoids glucose-reducing effects
Education:
When mixing short-acting and long-acting draw short-acting first and then
longer-acting in order to keep longer-acting from contaminating shorter-acting.
Disperse particles in suspension before drawing insulin.
Glargine is never IV and should not be mixed
Use one general area to produce consistent results (rate thigharmabdomen)
GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%
Proto: 1st tolbutamide / 2nd glipizide
Others: 1st chlorpropamide, 2nd glyburide
Expected Action:
Promote insulin release from the pancreas

With diet/exercise, control blood GLC in type 2 diabetes
Therapeutic Uses:
Adverse Effects:
Hypoglycemia (abruptSNS / slowCNS symptoms)
(C) Pregnancy/lactation
Diabetic ketoacidosis
Renal/liver dysfunction
Interactions: EtOH: disulfiram-like reaction
EtOH, NSAIDs, sulfonamides, ranitidine, cimetidine additive hypoglycemic
Concurrent use of -blockers may mask awareness of hypoglycemic, specifically
SNS symptoms of tachycardia, palpitations, and diaphoresis.
Education:
Proto: repaglinide (Prandin) Others: nateglinide (Starlix)
Expected Action:
Promote insulin release from pancreas

Therapeutic Uses:
Type 2 diabetes, with diet and exercise
Often use with metformin

Adverse Effects:
Hypoglycemia
(C)
Hepatic dysfunction
Interactions:
Gemfibrozil (Lopid) inhibition of repaglinide metabolism

Education:
Proto: Metformin (Glucophage)
Expected Action:
muscular uptake and use of glucose
Inhibit gluconeogenesis in liver

Therapeutic Uses:
Type 2 diabetes
Polycystic ovarian syndrome (PCOS)

Adverse Effects:
GI effects (nausea, vomiting, weight loss 6-8 lb)
Vitamin B12 and folate deficiency d/t altered absorption

Lactic acidosis (hyperventilation, myalgia, sluggishness) 50% mortality
(B)
Renal, hepatic, cardiac failure
Interactions:
Severe infection, shock, hypoxia
EtOH - risk lactic acidosis with concurrent use
Education:
Expected Action:
Proto: rosiglitazone (Avandia) Others: pioglitazone (Actos)
Increased cellular response to insulin by insulin resistance

Therapeutic Uses:
Adverse Effects:
Type 2 diabetes with diet and exercise

Fluid retention
(C)
LDL
Hepatotoxicity
DKA & heart failure
Mild heart failure d/t fluid retention effects

Interactions:
Insulin risk for hypoglycemia
Gemfibrozil (Lopid) metabolism of rosiglitazone hypoglycemia

Education:
Proto: acarbose (Precose) Others: miglitol (Glyset)
Expected Action:
Slow carbohydrate absorption and digestion

Therapeutic Uses:
Adverse Effects:
Control postprandial blood sugar in type 2 diabetes

Risk for anemia d/t iron absorption
Hepatotoxicity with long-term use

Intestinal effects (abdominal distention, cramping, hyperactive bowel sounds,
diarrhea, flatulence)
(B)
GI disorders (inflammatory disease, ulceration, obstruction)
Interactions:
Insulin, sulfonylureas risk of hypoglycemia
Metformin Additive GI effects and risk for hypoglycemia with concurrent use.
Education:
Take medication with first bite.
Postprandial blood glucose < 180 mg/dL
HgA1c < 7%
Proto: Glucagon
Expected Action:
glycogenolysis
Therapeutic Uses:
glycogenesis
gluconeogenesis
Hypoglycemia 2 insulin overdose
GI motility while undergoing radiological procedures of stomach / intestines

Adverse Effects:
GI distress (turn on left side to risk of aspiration)
(?)
Pheochromocytoma d/t catecholamine stimulating effects
Ineffective for starvation-related hypoglycemia because depleted glycogen stores.

Education:
Provide food as soon as patient is able to eat.
Expected Action:
Proto: levothyroxine (Synthroid) Others: liothyronine, liotrix
Synthetic thyroxine metabolic rate, protein synthesis, cardiac output, renal

perfusion, oxygen use, body temperature, blood volume, and growth processes.
Hypothyroidism (all forms)
Therapeutic Uses:
Emergency treatment of myxedema coma by IV
Adverse Effects:
Hyperthyroidism (anxiety, tachycardia, palpitations, appetite, heat intolerance,

fever, diaphoresis, and weight loss)
Contraindications/Precautions: (A) Thyrotoxicosis and MI
Cardiovascular problems and pregnancy
Interactions: Levothyroxine breaks down vitamin K Warfarin effects
Many antiseizure and antidepressant meds like carbamazepine, phenytoin,
phenobarbital, sertraline levothyroxine metabolism
Binding agents (iron, calcium, antacids, cholestyramine)and sucralfate
levothyroxine absorption
Expected Action:
Proto: propylthiouracil Others: methimazole (Tapazole)
Block thyroid hormone synthesis // Prevent oxidation of Iodine // T4 T3

Therapeutic Uses:
Graves disease
Adjunct to thyroid irradiation
Produce euthyroid state prior to thyroid removal
Emergency thyrotoxicosis
treatment
Overmedication hypothyroidism (drowsiness, weight gain,

edema, bradycardia, cold intolerance, dry skin)
Agranulocytosis Monitor for early signs (fever, pharyngitis) Tx: Neupogen
Adverse Effects:
(D)
Pregnancy
Marrow depression or immunosuppression

Interactions:
Education:
anticoagulant effects
Take at consistent time and with meals ( GI distress)
Hyperthyroidism may get -adrenergic blocker (propranolol) to tremors
Proto: Radioactive iodine
Expected Action:
Destroys thyroid cells at high doses

Therapeutic Uses:
Hyperthyroidism ( dose)
Thyroid cancer ( dose)
doses: Thyroid function studies

Adverse Effects:
Marrow suppression (anemia, leukopenia, thrombocytopenia)
Radiation sickness: Hematemesis, epistaxis, intense nausea, vomiting

Interactions:
Education:
(X)
Pregnancy, childbearing age, lactation
Reduced uptake with antithyroid meds

Take on empty stomach
Void frequently // Limit contact to hr/day/person // fluids

Dispose of body wastes per protocol
Avoid coughing and expectorating
Proto: strong iodine solution (Lugols solution) Others:
sodium iodide, potassium iodide
Expected Action:
iodide levels uptake (by thyroid), thyroid hormone production, and

block release of thyroid hormones into blood stream.
Therapeutic Uses:
Development of euthyroid state and size prior to removal
Emergency treatment of thyrotoxicosis

Adverse Effects:
Iodism symptoms d/t corrosive property (metallic taste, stomatitis, sore teeth and
gums, gastric distress). drink through straw // take food // OD prevention
Interactions:
Education:
(D)
Pregnancy
Foods high in iodine (fish, salt) Risk for iodism

Dilute Lugols solution with juice to improve taste.
Proto: Somatropin Others: Somatrem (Protropin)
Expected Action:
Stimulate overall growth, production of proteins, and use of glucose

Therapeutic Uses:
Growth hormone deficiencies
Bulking up so you can hit the long ball...

Adverse Effects:
Hyperglycemia (polyphagia, polydipsia, polyuria)
(C)
Diabetes Risk for hyperglycemia

Interactions:
Education:
Obese or respiratory impairment

D/c Tx before epiphyseal closure
Glucocorticoids can counteract growth-promoting effects

IM or SC (less painful)
Expected Action:
Proto: vasopressin (Pitressin) Others: desmopressin (DDAVP)
Promote H2O reabsorption in kidneys (desmopressin preferred)

Vasoconstriction due to smooth muscle contraction (vasopressin)
Therapeutic Uses:
Adverse Effects:
Diabetes insipidus
Overhydration (sleepiness, pounding headache)
Cardiac arrest
(X)
Pregnancy
CAD or peripheral circulation (risk for gangrene)
Education:
Monitor site carefully; extravasation can cause gangrene.
Testosterone produced by testes, ovaries, and adrenal cortex. Primary
androgen in both genders.

: Primary estrogen and progestional are estradiol and progesterone.
Both made in ovaries maturation of reproductive organs & 2 sex

characteristics.
Menstruation results from progesterone toward end of cycle
Menopausal symptoms result from estrogen levels.
Clinical uses of hormone preparations: Hormone deficiencies and
oppositional treatment of hormone-dependent cancers.

Postmenopausal HRT: Benefits include vasomotor symptom relief and
prevention of osteoporosis. Risks include embolic events and cancers.

Oral contraceptives suppress ovulation using ethinyl, estradiol, and
norethindrone
OC risks are minimal except in smokers and those with Hx of embolic
events.
Oxytocics are uterine stimulants used to induce or assist labor; Tocolytics
are used to delay preterm labor.

Expected Action:
Proto: oxytocin (Pitocin)

Others: methylergonovine (Methergine)
strength, frequency, and duration of uterine contractions

Therapeutic Uses:
Methergine: Emergency intervention for serious postpartum hemorrhage

Oxytocin: Labor induction or enhancement // Delivery of afterbirth // Control of
postpartum bleeding // Fetal stress testing // Milk letdown (intranasal)
Adverse Effects:
Methergine: Hypertensive crisis (IV): Headache, nausea, BP

Oxytocin: Uterine rupture {Relax myometrium Mg(SO4)}
Contraindications/Precautions: (?) Methergine: Hypertension
Methergine: Cardiovascular, renal, or hepatic failure.
Oxytocin: unripened cervix, Hx of multiples, uterine surgery // immature lungs,
cephalopelvic disproportion, prolapsed umbilical cord, fetal distress.
Interactions: Vasopressors hypertension
Use infusion pump and gradually rate
Education:
contractions longer than 60 sec, freq > q 2-3 min infusion
Proto: Terbutaline sulfate (Brethine)
Others: magnesium sulfate, ritodrine
Expected Action:
Selectively activates 2-adrenergic receptors uterine smooth muscle relaxation

Therapeutic Uses:
Adverse Effects:
Delay of preterm labor

Tremors, anxiety, headache (2 skeletal muscle side effects)
Tachycardia, palpitations, chest pain (1 side effects)

Interactions:
(?)
Pregnancy // lactation
Concurrent use of -blockers blunt effects
Concurrent use of adrenergic agonists additive effects

Concurrent use of MAOIs Hypertension
Proto: testosterone (Delatestryl) Others: fluoxymesterone

(Halotestin), methyl testosterone (Oreton), danazol (Danocrine)
Growth and maturation of sex organs and 2 sex characteristics. Promotes
skeletal muscle growth.
Hypogonadism in androgen-deficient men
Therapeutic Uses:
Delayed puberty
Palliative treatment of androgen-responsive breast cancer
Adverse Effects: Hypercalcemia ( breast cancer treatment)
CV risks: LDL, HDL, edema
Hepatotoxicity
: Acne, facial hair, gynecomastia, impotence, priapism
: Deeper voice, unusual hirsutism, clitoral enlargement, menstrual irregularities
Prostate cancer
Contraindications/Precautions: (X) Pregnancy
Liver, heart, or renal failure
Interactions: Hepatotoxic drugs: risk of liver damage
Warfarin, oral hypoglycemics, and glucocorticoids androgen effects on
metabolism can levels of these.
Report weight gain > 2 lb/week.
Education:
Expected Action:
Expected Action:
Proto: conjugated equine estrogens (Premarin)

Others: estradiol (Estrace), estradiol hemihydrate (Vagifem)
Growth and maturation of reproductive tract and 2 sex characteristics. They

bone resorption and LDL. At high levels they suppress release of FSH.
Therapeutic Uses:
Dysfunctional uterine bleeding & endometriosis
Postmenopausal symptoms & osteoporosis

Adverse Effects:
Prostate cancer
Contraception
Risk for estrogen-dependent breast cancer
Prolonged estrogen endometrial / ovarian cancers (Give progestins, too)

Emboli ( risk from smoking)
Feminization, impotence, libido in
(X)
Risk of thromboembolic disease
Interactions:
Education:
Pregnancy
Estrogens of warfarin
IM deep into large muscle mass
Expected
Action:
Breast cancer
Pt. or family Hx of heart disease

Phenytoin toxicity
Apply patches to trunk
Proto: medroxyprogesterone (Provera)

Others: norethindrone (Micronor), megestrol acetate (Megace)
Induce favorable conditions for fetal development and maintain pregnancy. in

progesterone levels menstruation.
Therapeutic Uses:
Counter adverse effects of estrogen in HRT for treatment of dysfunctional uterine

bleeding, amenorrhea, endometriosis, and endometrial cancer.
Edema
Thromboembolic events
Adverse Effects: Breast cancer
Breakthrough bleeding, amenorrhea, breast tenderness
Contraindications/Precautions: (X) Breast cancer

Hx of thromboembolic, cardiovascular, cerebrovascular disease.
Undiagnosed vaginal bleeding
Interactions:
Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin,

tetracycline, penicillin all of oral contraceptives.
Anticipate withdrawal bleeding for 3-7 days
Education:
Expected Action:
Proto: Ovcon 35 Others: Necon, ortho-novum
fertility by inhibiting ovulation, thickening cervical mucous, and making lining

of endometrium less favorable to implantation.
Prevent pregnancy
Therapeutic Uses:
Hypertension Thromboembolic events
Breakthrough or abnormal uterine bleeding
Cervical cancer
Contraindications/Precautions: (X) Pregnancy
Hx of thrombophlebitis and cardiovascular events
Smoker > 35
Family history or risk factors for breast cancer
Interactions: OC of warfarin and oral hypoglycemics
Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin,
tetracycline, penicillin all of oral contraceptives.
Take for 21 days followed by 7 days with no drug
Education:
1 missed dose: Take 2 next time / 2 missed doses: double-up x 2 days
Adverse Effects:
Proto: leuprolide (Lupron)
Expected Action:
Synthetic luteinizing hormone testosterone levels and uterine fibroid growth

Therapeutic Uses:
Palliative treatment of advanced prostate cancer
Uterine fibroids and endometriosis

Adverse Effects:
Hot flashes
Bone pain
Thromboembolic events ( risk with smoking)

Education:
(X)
Pregnancy and lactation
Administer leuprolide immediately upon reconstitution
Administer leuprolide depot preparations deep IM
Proto: tamoxifen (Nolvadex), Selective Estrogen
Receptor Modulators (SERMs)

Tamoxifen competes estrogen estrogen effects
Breast cancer
Breast cancer prevention
Therapeutic Uses:
Bone pain
Hyperlipidemia
Adverse Effects: Hot flashes
Hypercalcemia: Patients with bone metastases risk for hypercalcemia
Contraindications/Precautions: (X) Pregnancy and lactation
History of DVT
Interactions: Warfarin: anticoagulant effect
Antineoplastic agents: antineoplastic effects (nausea, vomiting, neutropenia)
Give with food or fluid if gastric upset occurs
Education:
Omit missed doses
Monitor for weight gain and peripheral edema
Expected Action:
Proto: sildenafil (Viagra) Others: tadalafil
(Cialis), vardenafil (Levitra)
Expected Action:
Augments effects of nitric oxide released during stimulation blood to corpus

cavernosum penile erection.
Therapeutic Uses:
Adverse Effects:
Erectile dysfunction
Priapism: if longer than 4 hours
MI, sudden death: Evaluate and monitor cardiovascular history and health
(?)
Cardiovascular disease
Taking medications in nitrate family including nitroglycerin
Interactions:
Organic nitrates (nitroglycerin) fatal hypotension
Ketoconazole, erythromycin, cimetidine, ritonavir, grapefruit: Inhibit sildenafil

metabolism plasma level of sildenafil.
Education:
Take 1 hour before sex; limit to 1x/day.

HHHH

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

HHHH

Uploaded by

Copyright:

Available Formats

Proto: diazepam (Valium) Others: alprazolam (Xanax),

lorazepam (Ativan), chlordiazepoxide (Librium)

Enhance the action of gamma-aminobutyric acid (GABA)

Acute toxicity (treat oral charcoal, treat IV flumazenil)

CNS depressants additive effects

Proto: zolpidem (Ambien) Others: zaleplon (Sonata),

eszopiclone (Lunesta) , trazodone (Desyrel)

Enhance action of GABA in CNS leading to prolonged sleep duration. They do

Daytime sleepiness and lightheadedness

CNS depressants additive effects

Proto: Buspirone (BuSpar)

Uncertain it does bind to serotonin and dopamine receptors.

Erythromycin, ketoconazole, and grapefruit juice effects of buspirone

Take with meals to prevent gastric irritation

dextroamphetamine (Dexedrine), Adderall, caffeine

Release norepinephrine and dopamine and prevent their reuptake in CNS.

MAOIs hypertensive crisis

Caution: hyperthyroidism, heart disease, glaucoma, Hx of drug abuse, MAOIs

-lactam destroys bacteria by weakening cell wall

Med of choice for G+ cocci (Strep pneumoniae, S. viridans, S. pyogenes)

Anaphylaxis / Renal Impairment / Hyperkalemia (w doses)

Allergies to Penicillin, Cephalosporin, or Imipenem / Kidney Dysfunction

Aminoglycosides / Oral Contraceptives

Take orals H2O, food (some may be taken food)

-lactam destroy bacteria by destroying cell wall

Broad spectrum with TI for postop infections, meningitis, pelvic infections

Anaphylaxis / Bleeding / Thrombophlebitis / Pain IM / cross allergies to

Allergies to Penicillin / Kidney Dysfunction

EtOH intolerance (disulfiram reaction) / Probenecid renal excretion

Bacteriostatic by preventing protein synthesis

-lactam destroy bacteria by destroying cell wall

MRSA / Antibiotic-associated pseudomembranous colitis by C. difficile

Ototoxicity / Infusion Rxn (red man syndrome) / Thrombophlebitis

Caution with renal impairment

Acne / rickettsia / Chlamydia / Helicobacter pylori / periodontal disease / typhus

GI symptoms / tooth discoloration / hepatotoxicity / photosensitivity /

Milk / Ca2+, Fe3+ supplements / Mg2+ laxatives / antacids (chelates to )

Give with water on an empty stomach (except doxycycline & minocycline)

Bacteriostatic by inhibiting protein synthesis Bactericidal at high doses

Use for pts with penicillin allergies / pertussis / diphtheria / Legionnaires

Pre-existing liver disease

Toxic with: antihistamines, theophylline (asthma med), carbamazepine

Administer on empty stomach with water IV is rarely used

Kill bacteria by disrupting protein synthesis

Med of choice against aerobic G- bacilli (E. coli, K. pneumoniae, P. mirabilis, P.

Ototoxicity ()/ nephrotoxicity / neuromuscular blockade / hypersensitivity

Renal impairment reduced doses

Ethacrynic acid (oto-tox) / amphotericin, cephalosporins, vanco (neph-tox) /

Bacteriostatic by inhibiting folate synthesis

Med of choice for UTI by E. coli and Pneumocystis carinii.

Hypersensitivity (sulfonamides, thiazide diuretics, tolbutamide, loop diuretics)

Avoid in: folate deficiency / pregnancy / creatinine clearance < 15 mL/min

Warfarin / phenytoin / tolbutamide ( effects of these)

Empty stomach with full glass of water

Static a@ doses, Cidal @ doses

Acute UTIs / Prophylaxis for recurrent lower UTI

GI / hypersensitivity / blood dyscrasias / peripheral neuropathy

Renal dysfunction creatinine clearance < 40

Urine will be brown

Prototypes: isoniazid (INH), streptomycin, ethambutol,

Prevents synthesis of mycolic acid

Active and latent tuberculosis

Peripheral neuropathy (administer 50-200 mg of vitamin B6 daily)