NCLEX Pharmacology LP

PHARMACOLOGY
ACE INHIBITORS [-PRIL]
Commonly Used: Captopril, Enalapril, Fosinopril, Moexipril, Perindopril

o Lisinopril
20-40 mg/day
Can cause HA, dizziness, fatigue, tachy
Notify if taking diuretic!!
Action: Any group of antihypertensive drugs that relax arteries and promote renal excretion of salt
and water by inhibiting the activity of an angiotensin converting enzyme.
Indications:
o Treat- HTN, CHF
o Lower risk of stroke and heart attack
Side Effects:
o Postural hypotension (head rush; dizzy spell)
o Fatigue
o Loss of appetite
o N/V; diarrhea
o HyperK
o Insomnia
o Could exacerbate non-productive cough
o Angioedema
o Difference between ACE inhibitors and ARBs cough and hyperkalemia are not S/Es of
ARBs
Nursing Considerations/Education:
o Meds cause retention of K+ Hence, monitor electrolytes (watch for K)
o Elderly clients at highest risk for postural hypotension
o DO NOT abruptly discontinue meds rebound hypertension can occur
o Monitor BP frequently
If take BP and is low, elevate pts legs by adjusting the bed and placing in
Trendelenburg position
o Notify MD if dizziness persists
Interactions/Contraindications
o Drug-Food
Absorption if taken with food: Wait at least one hour after taking meds before
eating
o Drug-Drug
If pt taking diuretics, notify MD if on Lisinopril

o Contraindications
If pt has impaired renal function be cautious

Desirable Outcomes
o BP WNL
o Improved survival rates for pts suffering from acute MI
o workload on cardiovascular system
o or absence of chest pain
ALPHA BLOCKERS [-ZOSIN]
Commonly Used: Alfuzosin, Prazosin, Tamsulosin, Doxazosin, Silodosin, Terazosin, Reserpine

(Serpasil)
Action: Help relax certain muscles and help small blood vessels remain open. Work by keeping
norepinephrine from tightening muscles in the walls of smaller arteries and veins.
Indications:
o
Treat- HTN, BPH, Raynauds Disease, Pheochromocytoma (Adrenal gland tumors)
Side Effects:
o
Expected: nausea, drowsiness, nasal congestion, wt. gain, edema
Orthostatic hypotension, and sodium & water retention may occur
o
Monitor: fluid retention, edema, BP
When rising from bed, breathe slowly for a few minutes and rise slowly to avoid OH
Typically NOT preferred as first tx option for high BP
o
Drug-Drug
Avoid OTC meds
Drug-Food
Prazosin (Minipress) best time to take initial dose @ bedtime
Decrease salt intake
+ foods include: banana, oatmeal
Contraindications
If BP difficult to control, alpha blockers may need to be combined with other drugs
like diuretics
Tamsulosin should not be prescribed to pts with coronary atherosclerosis
Desirable Outcomes
o
Renal blood flow of pt will be correctly maintained
Reduction in symptoms of BPH (noticeable)
BP will be decreased within 15 minutes following oral administration in hypertensive pts
ANGIOTENSION II INHIBITORS-ARBS [-SARTAN]

Commonly Used: Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan,
Telmisartan, Valsartan
o
Brand names include- Diovan, Micardis, Benicar, Cozaar, Avapro, Teveten,

Atacand
Action: Block action of angiotensin II, allowing the blood vessels to widen, thus making
it easier for the heart to pump blood
Indications: Treats- HTN, CHF, Kidney Failure in Diabetes, Chronic Kidney Diseases,
Scleroderma
Side Effects: Expected- HA, Dizziness, lightheadedness, nasal congestion, vomiting &
diarrhea, back & leg pain, Hyperkalemia, Angioedema, Dry Cough
Nursing Considerations/Education
o
Notify MD if edema occurs
Do not stop taking drugs until DR is consulted
Change positions slowly
Watch for hypotension (may be reduction in fluid volume through excessive

perspiration, dehydration, vomiting, & diarrhea)
Have blood drawn for potassium levels
o
Drug/Drug
Drug/Food
Contraindications
PREGNANCY CATEGORY D-not to be taken by preg moms or if

breastfeeding
Caution in pts with hypovolemia, hepatic, or renal dysfunction
Hold Telmisartan if menstruation delayed
Desirable Outcomes
o
Prevention and treatment of diabetic neuropathy
Decrease in sodium & potassium retention
Decrease in hearts workload
Improvement in pts unable to tolerate ACE inhibitors
ANTIANGINALS [-NITRATE]
Commonly Used: Erythrityl Tetranitrate (Cardilate); Isosorbide Mononitrate (Imdur, Monoket); Isosorbide
Dinitrate (Iso-Bid, Isordil, Isotrate, Sorbitrate); Nitroglycerine (NTG, Nitrostat, Nitrolingual); Nitroglycerine
ointment 2% (Nitro-Bid, Nitrol, Nitrodisc, Transderm-Nito)
Action: Relax smooth muscle, producing vasodilator effect on the peripheral veins and arteries with more
prominent effects on the veins.
Indications: Treats- Angina

o
Controls- Perioperative BP
Side Effects: HA, blurred vision & dry mouth; Postural hypotension; syncope; reflex tachycardia
o
Sublingual Nitroglycerine
Given for immediate response
Can give clients 3 doses in every five minute intervals
Avoid abrupt changes in posture
Nitroglycerine patch
Remove before defibrillation or cardioversion
Prevent tolerance to nitrates: 12 hour no nitrate period
Purpose of transdermal patch prevent chest pain, and allow pts to maintain ADLs
Topical application is used for sustained protection against angina attacks
Report to MD: continuous headaches, blurred vision, or dried mouth
Keep medicine a tightly closed, dark glass container to ensure potency
o
Drug/Drug
Drug/Food
Contraindications
Avoid contact with skin
Limit Alcohol: it will potentiate postural hypotension
Desirable Outcomes
o
Prevention of chest pains (d/t coronary artery disease)
Acute relief of an attack of angina pectoris
Decrease in demand of cardiac oxygen
ANTIDYSRHYTMICS
Commonly Used:
o
Class I: Na Channel Blockers: Procainamide, Disopyramide (Norpace), Amiodarone, Quinidine Sulfate

( Quinidex)
Uses: SVT, A. flutter, A. Fib, V tach
Class I B: Mexiletine, Lidocaine (Xylocaine), Tocainide
Class I C: Flecainide, Encainide, Propafenone
Class II: Beta Blockers: Metoprolol, Atenolol, Propranolol, Timolol, Esmolol
Short term use for ventricular dysrhythmias only
Class III: K Channel Blockers: Sotaolol, Amiodarone, Bretylium, Ibutilide
Uses: conversion of A. fib (oral), Recurrent V fib or V tach
CI: PREG D; AV block, bradycardia, infants
Class IV: Calcium Channel Blockers: Diltiazem, Verapamil
No grapefruit
Uses: A fib, A flutter, SVT
Others: Atropine Sulfate
Action: cardiac excitability and relay cardiac conduction in either the atrium or ventricle. Lastly, increase
rate of repolarization.
Indications: Treat- Ventricular dysrhythmia, Supraventricular dysrhythmia, Ventricular fibrillation, Atrial flutter,
Bradycardias or PVCs related to slow HR
Side Effects:
o
Monitor: for dysrhythmias precipitated by treatment
Hook pt up to cardiac monitor and assess for changes in rhythm
Avoid giving IV injections rapidly
Notify MD if joint pain and inflammation occur
Apical pulse then BP
If dry mouth can offer patients sugar free gum
o
Drug/Drug
DIG enhances cardiac depressant effects
NEVER administer Lidocaine that has epinephrine in it; loading dose followed by
maintenance dose of 1-4 mg/min
Drug/Food
Contraindications
Disopyramide (Norpace) contraindicated for pts with CHF
In patients with sinus or AV node blocks
Desirable Outcomes
o
Abnormal cardiac function will be corrected, and there will be a decrease in electrical conduction
Clients may either have a increase or decrease in automaticity
ANTIEMETICS [-SETRON]
Commonly Used: Chlorpromazine hydrochloride (Thorazine), Promethazine (Phnergan),
Prochlorperazine (Compazine), Thiethylperazine maleate (Toreacn), Hydroxyzine (Atarax,
Vistaril), Dimenhydrinate (Dramamine, Marmine), Metoclopramide (Reglan), Aprepitant
(Emend), Droperidol (Inapsine), Trimethbenzamide (Tigan), Dolasetron (Ansemet),
Granisetron (Kytril), Ondasetron (Zofran)
Action: Depress chemoreceptor trigger zone and vomiting center.
Indications: Pt experiencing motion sickness, intractable hiccups, gastro esophageal
reflux & gastroparesis (gastrointestinal hypomobility)
o
Also used to prevent and treat postoperative nausea and vomiting. Also may be
given as a prophylaxis of chemotherapy related emesis.
Choice of antiemetic is determined by the cause of N/V
Side Effects: expected- drowsiness or sedation, blurred vision, dry mouth, fatigue,
constipation, and difficulty urinating. Pt may also become photosensitive.
o
Limit odors in pts room
Protect pt from injury
SQ injections may cause tissue irritation & necrosis
Discontinue med if pt exhibits uncontrolled rhythmic movements of face or limbs

or blurred vision
o
Drug/Drug
Drug/Food
Limit oral intake to clear liquids when nauseated and or vomiting
Contraindications
Droperidol should be administered in extreme caution in presence of

prolonged QT syndrome
Desirable Outcomes
o
Pt will have control (& prevention) of vomiting, decrease in gastrointestinal

secretions and motility, and they may inhibit secretion of saliva and sweat.
ANTIFUNGALS [-NAZOLE]
Commonly Used: Amphotericin B (Fungizone), Clotrimazole (Lotrimin, Gyne-Lotrimin),

Fluconazole (Diflucan), Griseofulvin (Fulvicin), Ketoconazole (Nizoral), Terconazole (Terazol)
Metronidazole (Flagyl), Miconazole (Micatin, Monistat3), Nystatin (Mycolog), Oxiconazole (Oxistat)
Action: Usually destroy fungi and inhibit fungal growth
Indications: Treat- vaginal fungal infections, candidiasis, dermal infections, tinea infections,
diaper dermatitis, and scaling due to dandruff
o
Acyclovir- Herpes simplex type I
Side Effects: Nausea, vomiting, HA, vaginal irritation, erythema, peeling, pruritus & urticarial,
hepatotoxicity
Can be orally taken or topically applied
Urine may turn red/brown when taking Flagyl
Monitor Creatinine levels when administering Amphotericin B
Avoid exposure to sun med increases photosensitivity
Creams are not recommended to use with tampons or diaphragms
Avoid contact with eyes, nose, mouth, and do not swallow
Return to MD if no results are obtained after 4 weeks of tx
Monitor for hypersensitivity
o
Drug/Drug
Drug/Food
Take Griseofulvin with foods high in fat (ex. Milk or ice cream) to decrease GI
upset and assist in absorption
Contraindications
Avoid alcohol during tx
Desirable Outcomes
o
Disruption of fungal cell mitosis
Alteration of permeability of fungal cell membrane
Fungistatic and fungicidal in vitro against a wide variety of yeast and yeast like fungi
ANTIBIOTICS
Commonly Used: Penicillin V (PEN VEE K), Amoxicillin (amoxil), Clarithromycin (Biaxin) and
Azithromycin (Zithromax)
o
Gentamycin (Garamycin), Amikacin (amikin), Ceftazidime (Fortaz), Cefepime (Maxipime),

Ciprofloxacin (Cipro), Moxifloxacin (Avelox), Trtracycline (Achromycin), Doxycycline
(Vibramycin)
Prefixes:
Floroquinolones floxacin
Cephalosporins often start with cef or ceph
Action: Inhibit bacterial DNA, inhibit protein synthesis, interfere with formation of bacterial cell
wall
Indications: Treat- skin/skin structure infection, respiratory tract infections, gonococcal and
community or hospital acquired infections. Also in cases of meningitis, and as surgical prophylaxis
and inhalation of anthrax
Side Effects: HA, hypotension, and skin rash. Photosensitivity. May have signs of pain and
tenderness and injection site.
o
Hearing loss is irreversible. Assess peak and trough levels to determine toxic levels
o
It is better to start with first generation antibiotic classes as to prevent development of

resistance
Minimize using higher generation in less severe infections and in those in which
risk factors for multidrug resistance are not present
Take blood cultures BEFORE starting antibiotics
Assess for ototoxicity (change in hearing, ringing inears, dizziness, or unsteady gait)
Assess for nephrotoxicity (Monitor BUN and Creatinine)
Avoid direct or artificial sunlight
Drug/Drug
Dilute solution and administer slowly to decrease phlebitis on IV site
Drug/Food
Drink 2-3 L of fluid daily
Absorption is reduced by milk products and antacids
Take oral Doxycycline with food
Contraindications
If present, discontinue IV and put warm ice packs on IV site
Fluoroquinolones contraindicated with pt with epilepsy, QT prolongation,

pre-exisiting CNS lesions, CNS inflammation, or suffered a stroke
Desirable Outcomes
o
Negative bacterial result on culture and negative infection post-op
AMINOGLYCOSIDES
1.
Think A mean old mycin
2.
Powerful antibioticsto treat severe, life-threatening, resistant infections
3.
All aminoglycosides end in mycin, but not all drugs that end in mycin are aminoglycosides.
For example..
a. Azithromycin, clarithromycin, erythromycin thromycin NOT
4.
Examples of aminoglycosides: Streptomycin, Cleomycin, Tobramycin, Gentamicin, Vancomycin,

Clindamycin
5.
Toxic Effects:
a. The most famous feature of the worlds most famous mouse (ears)
i.
Toxic effect: ototoxicity
ii.
Must monitor hearing, balance, tinnitus
b. The human ear is shaped like a kidney
c.
i.
Toxic effect: nephrotoxicity
ii.
Monitor: creatinine
1.
Best indicator of kidney function
2.
0.6-1.2 mg/dL
The number 8 drawn inside the ear reminds you of:
6.
i.
Cranial nerve 8 (Drug toxic to)
ii.
Frequency of administration: Every 8 hours
Route of Administration
a. Give IM or IV
b. Do not give PO (not absorbed) except in these two cases:
i.
ii.
Hepatic encephalopathy
1.
Also called Liver Coma, Ammonia-Induced Encephalopathy
2.
When want a sterile bowel
3.
Due to a high ammonia level
Pre-op Bowel surgery

1.
7.
REMEMBER this military sound off:

a.
NEOmycin
b.
KANmycin
c.
WHO CAN STERILIZE MY BOWEL? NEO KAN
d.
^ PO, 2 bowel sterilizers
Trough and Peak Levels

a. Reason for drawing TAP levels: narrow therapeutic range
b. Time table:
ROUTE
TROUGH (lowest)
PEAK (highest)
Sublingual
30 min before next dose
5-10 mins after drug

dissolve
IV
15-30 min after drug

finished
IM
30-60 min after drug given
SQ
See diabetes lecture
PO
Forget about it.
Drugs
CIPROFLOXA
CIN
Use &
Dosage
Indication
ANTHRAX
Side
Effects/Adver
se
Teaching &
Labs
Contraindicat
ion
ANTICOAGULANTS [-PARIN]
Commonly Used: Heparin, Enoxaparin (Lovenox), Dalteparin sodium (Fragmin),
Warfarin sodium (Coumadin)
Action: Inactivate or decrease synthesis of clotting factors
Indications: Treat- thrombosis, pulmonary embolism, atrial fibrillation, MI
Side Effects: Bleeding gums, hypotension, hematuria, epistaxis, thrombocytopenia,
hemorrhagic tendency
o
Heparin
Antidote- Protamine sulfate
Warfarin
Antidote- Vitamin K
Consult with physician before taking vitamins
INR and protime monitored weekly
Dont take herbal meds
When administering med SQ NEVER rub injection site
Observe signs of bleeding, and instruct pt what not and what to do to prevent
bleeding
o
Drug/Drug
Women using oral contraceptives, anticoagulants may decrease

effectiveness if taken together
Drug/Food
Contraindications
NOT RECOMMENDED FOR PREGNANT AND LACTATING WOMEN
Desirable Outcomes
o
Prolonged PT time
Prevention of new thrombus formation
Reduction of risk of heart attack and stroke
ANTIDEPRESSANTS
Commonly Used:
o
MAOIs: Isocaraboxazid (Marplan), Phenelzine sulfate (Nardil), Tranylcypromine sulfate

(Parnate)
TCAs: [-tyline] [-pramine]; Notriptyline hydrochloride (Aventyl), Imipramine hydrochloride

(Toftranil), Amitriptyline hydrochloride (Elavil) Bupropion (Wellbutrin and Zyban), Doxepin
hydrochloride (Sinequan)
SSRIs: Fluoxetine (Prozac), Sertraline hydrochloride (Zoloft), Paroxetine hydrochloride

(Paxil), Fluvoxamine (Luvox), Venlafaxine (Effexor)
Action:
o
MAOIs:
TCAs:
SSRIs: increase extracellular level of serotonin
Indications: treat- Depression; also pts with OCD, Bulimia, and Enuresis (in children)
o
Tx enuresisTCA Imipramine hydricgkirude (Tofranil)
Side Effects: H/A, nausea, restlessness, photosensitivity, anticholinergic effects

o
Adverse: seizures
SSRIs & MAOIs huge tendency to develop insomnia
TCAs may have feelings of sedation
o
May take 2- weeks after start of tx for med to have response
SSRI & MAOI
Take in morning
TCA
Discontinuing:
No not abruptly discontinue
Before surgery bc may have adverse interactions with anesthetics
o
Drug/Drug
Drug/Food
No activities that require alertness
Avoid alcoholic beverages, foosd that require bacteria or molds for their prep, or
foods that contain tyramine
MAOIs
Avoid TYRAMINE! [aged cheeses, beer, avocados]
Could cause severe hypertensive crisis which will then cause BP as well
as PR and temperature and could cause tremors
Contraindications
Desirable Outcomes
o
Symptoms of depression being controlled
Reduction of seizure threshold
Obese clients appetite may be suppressed
ANTIHISTAMINES
Commonly Used: Benadryl (Diphenhydramine)

o
Promethazine hydrochloride (Phenergan), Hydroxyzine hydrochloride (Vistaril, Atarax),

Cetirizine (Zyrtec, Fexofenadine (Allegra), Fluticasone (Flonase, Flovent), Triamcinolone
(Nasacort)
Action: Block histamine receptor sites and control protein synthesis and prevent inflammation
Indications: Treat- allergy symptoms, cure congestion, otitis media, motion sickness, & urticarial
Should not be used in treatment of asthma
Benedryl topical- urticaria
Side Effects: Expected- drowsiness, dizziness

o
Watch for signs of urinary retention, constipation, & hypotension
blurred vision, dry mouth, & GI irritation
Children may exhibit paradoxical reaction
o
Always should be taken in moderation
Take 30 mins before an event that will trigger motion sickness
Candy or ice chips for dry mouth could also help with condition of pt
Avoid SC injection and administer IM meds in a large muscle to prevent tissue irritation
Monitor for signs of urinary dysfunction
Give IM Diphenhydramine for allergy using 1.4 mg using gauge 22 needle
o
Drug/Drug
Drug/Food
Contraindications
Administer one hour prior to eating (Benadryl)
DO NOT take with alcohol
Desirable Outcomes
o
Decrease in symptoms of histamine excess and decreas in post op nausea
Aid in sleeping
Potentiated effect of preop narcotics
BETA-ADRENERGIC BLOCKERS [-LOL]
Commonly Used: Metoprolol (Lopressor), Atenolol (Tenormin), Propranolol (Inderal), Nadolol

(Corgard), Carvedilol (Coreg), Esmolol (Brevibloc)
Action: Decreases cardiac workload, decrease myocardial o2 consumption
Indications: Treat- Angina, dysrhythmias, HTN, & migraine headaches

o
Also recommended for tx of glaucoma & acute MI
Side Effects:
o
Usual- N/V, hyperglycemia, hypotension, and depression. Bradycardia, bronchospasm
Agranulocytosis (Low WBC)
Propranolol diminished sexual function
Metoprolol frequent side effect: Impotence
o
Monitor for signs of CHF
If observed that pulse of BP is not WNL HOLD MEDS!
Monitor signs of hypotension if displaying orthostatic hypotension change their positions

slowly
Assess any respiratory distress and signs of wheezing & dyspnea
If patient on insulin, instruct pt to monitor BGM levels
DO NOT stop taking abruptly bc can cause rebound hypertension, rebound tachy, or an
angina attack can occur
Evidence of pt building drug tolerance gradual increase in BP
Drug/Drug
Drug/Food
Contraindications
Avoid grapefruit juice while on antihypertensives as it increases the level of the

medicine in the blood
COPD pts not advised to take beta blockers
Desirable Outcomes
o
Decrease in BP and HR
Decrease in occurrence of chest pain
CALCIUM CHANNEL BLOCKERS [DIPINE]

Commonly Used: Amlodipine, Verapamil, Nifedipine, Diltiazem, Felosipine, &
Nicardipine
Action: blocks calcium channel receptors which causes decrease in cardiac contracility
Indications: Cure- HTN, Dysrhythmias, Chronic Stable Angina
Side Effects: Headache, Hypotension, Bradycardia
o
Monitor pt for signs of CHF, liver enzymes and kidney function tests
Monitor patient with cardiac monitor when administering med
Assess peripheral edema and weight gain
Teach pt to monitor pulse daily
DO NOT chew or crush sustained release tablets
Notify MD ASAP if dizziness or fainting occurs
Keep fast acting nitrateson in hand in case of acute attacks
o
Drug/Drug
Drug/Food
If taking antihypertensives DO NOT drink GRAPEFRUIT JUICE bc

increases level of medicine in blood
Contraindications
Desirable Outcomes
o
Correction of abnormal heart rhythm, decrease in occurrence of chest pain, HR, &
BP
ANTIPLATELETS
Commonly Used: Aspirin, Clopidogrel (Plavix), Pentoxifylline (Trental), Cilostazol (Pletal),
Ticlopidine (Ticlid)
Action: Inhibits the aggregation of platelets in the blotting process and prevents
thrombus formation. Therefore, they prolong the bleeding time of pts.
Indications: CVA, MI, RHD, Pericarditis, Pulmonary Embolism, Acute Coronary
Syndrome, and pts with DVT
Side Effects: Common- bruising, hematuria, GI bleeding & neutropenia. Some pts may
have tarry stools
o
Adverse- abdominal pain
o
Instruct to take measures to prevent bleeding, and if bleeding occurs, monitor the
time of occurrences.
Use of electric razor
If patient took entire aspirin bottle get ABG resultd
o
Drug/Drug
Do not take OTC meds containing aspirin or NSAIDS without consulting DR
Drug/Food
Always give with food or antacids to minimize GI upset
Contraindications
Pts with a history of peptic ulcers
Desirable Outcomes
o
Prevention of: Stroke, MI, and vascular death (after recent attack)
Relief of intermittent claudication in lower extremities (legs)
BENZODIAZEPINES [-ZOLAM] [-ZEPAM]
Commonly Used: Alprazolam (Xanax), Midazolam (Versed); Clonazepam (Klonopin), Diazepam

(Valium), Oxazepam (Serax) & Lorazepam (Ativan)
o
Others- chlordiazepoxide (Librium), Zolpidem (Ambien), Buspirone (Bu Spar), Eszopiclone

(Lunesta)
Action: Depress the CNS of a pt and produce relaxation with could cause depression of the limbic
system
Indications: Anxiety, tension, muscle spasms. May also be prescribed for acute alcohol
withdrawal and as preoperative med
Side Effects:
o
Hypotension, urinary incontinence, constipation, slurred speech, blurred or double vision.

Some pts could have amnesia, tremor, and ataxis. Most pts have signs of daytime sedation
Intoxication- somnolence, confusion, and diminished reflexes to coma
Flumazenil (Romazicon) IV reverses toxicity in 5 mins
o
Monitor liver and renal function tests and blood counts
Assess for symptoms of leukopenia (sore throat, fever, weakness)
Avoid tasks that require mental alertness
Physical dependency commonly develops
Tapered gradually over 2-6 weeks to lessen withdrawal symptoms
Med is anticonvulsant drug
o
Drug/Drug
Drug/Food
Zolpidem (Ambien) full glass of water on empty stomach
Contraindications
Do NOT mix Librium or Valium with any other drug or IV fluidinject directly
into a vein over a 1 minute period
Not meant to be taken if breast feeding
Desirable Outcomes
o
Anxiety level will be reduced
Muscles will be relaxed and could have a sedative-hypnotic feeling
CARDIAC GLYCOSIDES
Commonly Used: Digoxin (Lanoxin) & Digitoxin (Crystodigin)
Action: produce positive inotropic action that increases the force of myocardial contraction by
decreasing the conduction of the impulses through the AV node
Indications: Supraventricular tachy, CHF, A. Fib, A. Flutter
Side Effects: Anorexia, N/V, Visual Disturbances, Fatigue, Drug-indced dysrhythmias, photophobia
o
o
Monitor pt for cardiac abnormalities such as PVs.
Assess for an apical pulse greater than 60 before administering these meds
Dig Intoxication:
Contact physician immediately for apical pulses less than 60, signs of confusion, or
abnormal Dig levels
Hold med if apical HR is less than 60 for an adult and less than 90 for a child
Pt vomits more than twice, Hold next dose of Lanoxin and notify MD
o
Drug/Drug
Therapeutic Drug Levels: (0.8-2.0)
S/S Toxicity:
Antidote: Digoxin immune FAB (Digibind)
Quinidine & Verapamil both increase plasma levels of Digitalis
Drug/Food
Diet: low-salt diet & a potassium supplement
Dont mix meds with food or antacids
Contraindications
Desirable Outcomes
o
Decreased conduction of the heart cells
Increases cardiac output and blood flow to the kidneys
Change to normal sinus rhythm
DIURETICS: WATER PILLS

Commonly Used:
o
Loop Diuretics
Thiazide Diuretics [-thiazide]
Only should be used in pts with normal renal functions
Chlorothiazide (Diuri), Methylchothiazide (Aquatensen; Enduron), &

Hydrochlorothiazide (HydroDIURIL; Esidrix)
Osmotic Diuretics
Mannitol (Osmitrol) & Urea (Ureaohil)
Prolonged use of Mannitol can cause metabolic acidosis
Potassium Sparing Diuretics
Furosemide (Lasix), Torsemide (Demdex), & Bumetanid (Bumex)
Spirinolactone (Aldactone), Triamterene (Dyrenium), & Amiloride

(Midamor)
Carbonic Anhydrase Inhibitors
Action: Rid bodys water and sodium
Indications: HTN, Glaucoma, Edema, Hypercalcemia, Hepatic cirrhosis, Renal disease

Side Effects: Common- dehydration
o
Hypokalemia, orthostatic hypotension, hyponatremia, hyperglycemia
Mannitol- pulmonary edema
o
Always administer in the MORNING
Maintain rehydration efforts
Monitor potassium levels (hypokalemia)
Monitor for orthostatic hypotension
Monitor BP & Food intake and output
Daily weights
o
Drug/Drug
Cautious in pts taking Digoxin & Lithium
Drug/Food
Contraindications
Thiazide- Only to be used in pts with NORMAL KIDNEY FUNCTION
Prolonged use of Mannitol can cause metabolic acidosis
Desirable Outcomes
o
Relief of congestion
Maintenance of Acid Base imbalances
Restore volume status of pts
Pt will have diuresis
Prevention of sodium, K, or chloride reabsorption
HIV & ANTI AGENTS

Commonly Used:
o
Non-Nucleoside Reverse Transcriptase Inhibitors or NNRTIs
Nucleoside Reverse Transcriptase Inhibitors or NRTIs
Abacavir (Ziagen), Stavudine (Zerit) & Didanosine (Videx)
Protease Inhibitors
Nevirapine (Viramune), Delavirdine (Rescriptor) & Efavirenz (Sustiva)
Sawuinavir (Fortovase & Invirase), Indinavir (Crixivan) & Nelfinavir

(Viracept)
Fusion Inhibitors
Enfuvirtide (Fuzeon)
Action: see outcomes

Indications: Do not cure AIDS or reduce risk of transmission
Side Effects: rashes, diarrhea, V/
o
anemia, neutropenia, peripheral neuropathy, liver damage and lipodystrophy, GI

discomfort
o
When injecting Enfuvirtide pt should use insulin syringe to decrease the reaction
of this drug
CD4 count & viral load should be regularly tested
Avoid exposure to infection
Always wash hands on regular basis
Report any sore throat, fever, or other gins of infection directly to me or

MD
Take medication same time each day bc it will maintain consistency in

blood level
If pt taking Lopinavir (Kaletra) discontinue if serum amylase significantly elevated
o
Drug/Drug
Drug/Food
If pt taking Invirase & Crixivan instruct to eat foods high in fat
Take food when taking prescribed meds except in drugs like Videx and
Agenerase.
Contraindications
Desirable Outcomes
o
Prevent HIV from multiplying & destroying infection fighting CD4 cells
Prevention of infection
Prevention of HIV advancing to AIDS
INSULINS
Commonly Used:
o
Rapid Acting Insulin
Short Acting Insulin
Humulin NPH & Lente (Novolin L)
Long Acting Insulin
Regular insulins- Humulin R & Novolin R
Immediate Acting Insulin
Lispro (Humalog), Aspart (Novolog)
Ultralente (Humulin U)
Very Long Acting insulin
Glargine (Lantus)
Never mix Lantus with other insulins
Premixed Insulin
Primarily a combo of different categories
NPH 70% & Regular 30% (Humulin 70/30)
NPH 75% & Lispro 25% (Humalog Mix 75/25)
Action: facilitates transport of glucose, potassium, and magnesium into muscle and fat
cells
Indications: Prescribed to treat DM Type I and II
Side Effects: hypoglycemia, HA, blurred vision, wt. gain, skin reactions, lipodystrophy
o
Hypoglycemia: cold, clammy, sweating
o
When drawing upREGULAR before LONG-ACTING (Clear before Cloudy)
Administering insulin IV
Never cleanse skin with alcohol before injection
Rotate injection sites to prevent lipodystrophy
Regular insulin is the only type of insulin that can be administered IV
Do NOT shake insulin bottles before use
Do NOT administer cold insulin
o
Drug/Drug
Never mix Lantus with other Insulins
Drug/Food
Short Acting take 20-30 mins before eating meals
Rapid Acting advise client to eat immediately after administering med
Contraindications
Desirable Outcomes
Decrease in serum glucose
Diabetic condition maintained and controlled
ORAL HYPOGLYCEMIC
Commonly Used:
o
Sulfonylureas
Chlorpropamide (Diabinase)
Tolbutamide (Orinase)
Biguanide
Orinase can cause Disulfiram type of rx when alcohol is ingested
Metformin (Glucophage)
Alpha Glucosidase Inhibitor
Acarbase (Precose)
CI: IBS
Miglitol (Glyset)
Thiazolidinediones
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Meglitinides
Nateglinide (Starlix)
Repaglinide (Prandin)
Action: stimulate beta cells which help our body to secrete more insulin
Indications: Treat DM type II
Side Effects: jaundice, hypoglycemia, GI disturbance, & edema; skin reactions;
dizziness, nausea, wt. gain
o
Monitor: Liver function tests
**Compliance
Avoid OTCs unless prescribed by DR
o
Drug/Drug
Drug/Food
Interactions: CCB, OC, Glucocorticoids, Phenothiazines, & Thiazide

Diuretics
Take with meals; eat before taking
Contraindications
Desirable Outcomes
o
BGM will be WNL & Hyperglycemia will be controlled
NSAIDS
Commonly Used:
o
Acetylsalicylic acid (Aspirin, ASA)
Most common agent responsible for accidental poisoning in small children
Discontinue 3-7 days prior to surgery
Ibuprofen (Advil, Motrin)
Fenoprofen (Nalfron)
Naproxen (Naprosyn)
Acetaminophen (Tylenol, Tempra)
Overdose agent Acetylcysteine
Diclofenac (Voltaren)
Action: used as analgesic, antipyretic & anticoagulant drugs. Also inhibit prostaglandin
synthesis
Indications: Treat diseases like RA, bursitis, osteoarthritis, and tendinitis. Also used for
pain, fever, headaches
Side Effects: Salicylism, Tinnitus, Gastric irritation, Dizziness, Rash, Dermatitis, Erosive
gastritis with bleding, Hypotension, Blood dyscrasias, Sodium and water retention
o
Monitor bleeding tendencies of pts
Monitor for toxicity (especially if taking with CCB)
If overdose suspected contact poison control center (1-800-222-1222)
o
Drug/Drug
Do NOT give to pt on Anticoagulant
Monitor for toxicity (especially if taking with CCB)
Drug/Food
Take NSAID with water, milk or food.
Should not take on empty stomach
Contraindications
Do NOT give to pts with liver or renal diseases
Do NOT give to children with flu symptoms bc of risk of Reyes syndrome
Do NOT crush or cut enteric-coated forms
Desirable Outcomes
o
Relief of pain due to reduction in pain intensity
Fever reduction and swelling reduction
OPIOID
Commonly Used: Hydrocodone (Vicodin), Hydromorphone (Dilaudid), Oxycodone
(OxyContin, Percocet), Meperidine hydrochloride (Demerol), Methadone, Morphine sulfate
Action: reduces intensity of pain signals reaching the brain; block the action of opioids
assisting in withdrawal and also help suppress peristalsis
Indications: acute or chronic pain; sometimes diarrhea; withdrawal
Side Effects: itching, muscle rigidity, NV, euphoria, apathy and impaired judgement
o
Sedation, cough suppression, paralytic ileus, respiratory depression & constriction

of pupils
Overdose can lead to: coma, respiratory depression, and death
Methadone- watch for signs of respiratory depression & toxicity
o
OD antidote- Narcan (Demerol) 50 mg through IM
No activities that require mental alertness
Do not stop taking abruptly
Be aware of drug tolerance in pts
Increase fluid intake
o
Drug/Drug
Drug/Food
Contraindications
Do not use if pregnant
Desirable Outcomes
PROTON PUMP INHIBITORS [-PRAZOLE]

Commonly Used:
o
Omeprazole (Prilosec)
In combination with antibiotic (such as Clarithromycin- Biaxom)- treat pts

with Helicobacter pyori infection in duodenal ulcer
Lansoprazole (Prevacid)
Sprinkle granules over food. Do not chew granules
Esomeprazole (Nexium)-inhibits secretion of hydrochloric acid
Pantoprazole (Protonix)
Action: suppresses gastric acid secretion

Indications: Dyspepsia, Heart Burn
Side Effects: HA, dizziness, abdominal pain. Diarrhea, rashes.
o
Never crush or chew meds, never open capsules
o
Drug/Drug
Drug/Food
Take drugs before eating (30 mins)
Contraindications
Desirable Outcomes
o
Decrease in esophageal reflux
RESPIRATORY
Commonly Used:
o
Bronchodilators
Action: relax smooth muscles of the bronchi, reducing airway resistance
Indications: treat diseases like acute & chronic asthma, bronchitis, & COPD
Common:
Epinephrine (Adrenaline)
Theophylline (Theodur)
o
Increases risk of Dig Toxicity
Albuterol (Proventil & Ventolin)
Ipatropium bromid (Atrovent)
Side Effects:
Decreases effects of Lithium & Phenytoin
Drug/Drug
Drug/Food
Contraindications
Desirable Outcomes
Anti-Tubercular
Action: broad spectrum antibiotic, specific to TB Bacillii
Indications: treat Pulmonary Tuberculosis & Extrapulmonary Tuberculosis
Common:
Isoniazid (INH)
o
Combine with Vitamin B6 (Pyridoxine) to prevent peripheral

neuritis
S/E: peripheral neuritis
Rifampicin (Rifadin)
o
Orange body secretions
Ethambutol (EMG & Myambutol)
Pyrazinamide (PZA & Fibrazid)
Side Effects: Hepatotoxicity
Monitor Liver Function
Drug/Drug
Drug/Food
Contraindications
Desirable Outcomes
If drug has taken effect, pt will no longer be contagious when sputum
culture is negative
Decongestant
Action: produce constriction of dilated arterioles. Pts taking decongestants will

have short relief of nasal congestion
Indications: short relief of nasal congestion; treating allergic rhinitis, hay fever, &
acute coryza
Common:
Ephedrine HCL (Bronkotabs & Tedral)
Phenylephrine (Neo-Synephrine)
Oxymetazoline (Afrin)
Side Effects:
Drug/Drug
Drug/Food
Contraindications
Desirable Outcomes
Overall for Respiratory Meds

o
Monitor patient for cardiac dysrhythmias and blood levels of meds
Provide client with adequate hydration
If using MDI gargle after each dose and use a spacer to decrease candidiasis
S/E for pt using MDI: oropharyngeal candidiasis
Instruct pt NOT TO TAKE OTC MEDS WHERE EPHEDRINE IS A COMMON INGREDIANT
Evaluate meds if using OTC drugs as home remedies
General side effects: Headache, HTN, Tremors, Dysrhythmias, Palpitation & tachycardia,
Gastric upset, Optic neuritis, Anxiety, Insomnia, Dry mouth (if using inhaler)
STATINS (HMG-COA REDUCTASE INHIBITORS) [-STATIN]
Commonly Used:
o
Atorvastatin (Lipitor)
Lovastatin (Mevacor)
Highly protein bound and should not be administered with anticoagulant
Need SGPT levels monitored regularly
Simvastatin (Zocor)
Inhibits hepatic synthesis of cholesterol
Pravastatin (Pravachol)
Fluvastatin (Lescol)
Rosuvastatin (Crestor)
Action: LDL cholesterol; usually do not LDL
Indications: Treat- hyperlipidemia, dyslipidemia, & hypercholesterolemia
Side Effects: nausea, HA, blurred vision, muscle pain
Rashing, flushing, GI disturbances
Elevated liver enzymes, hyperglycemia, hyperuricemia
o
Monitor liver enzymes, BGM, BUN
Assess and monitor for increase in muscle pain and liver enzyme
Annual eye exam should be facilitated as so to monitor the formation of cataract
o
Drug/Drug
Drug/Food
Contraindications
Take with evening meal
Never give to pt w preexisting gallbladder disease
Desirable Outcomes
o
Reduction of the risk of CAD
Reduction of risk (& reoccurrence) of stroke
THROMBOLYTICS
Commonly Used:
o
Alteplase (t-PA, Activase)
Streptokinase (Streptase, Kabikinase)
Reteplase (Retavase)
Urokinase (Abbokinase)
Action: converts plasminogen to plasmin to begin fibrinolysis. Used to bind fibrin in a thrombus
and initiate fibrinolysis
Indications: treat acute MI, central venous catheter clearance, acute pulmonary embolism, DVT
Side Effects:
o
Bleeding, dysrhythmias, fever, allergic reactions, and hypotension
o
Antidote for thrombolytic OD: Aminocaproic acid (Amicar)
Obtain baseline V/Ss & Coagulation studies
Meds must be infused through IV infusion pump
Monitor for neuro changes and all secretions for occult blood
Apply direct pressure over venipuncture site for 20-30 mins
Instruct pt to use electric razor for shaving and to brush teeth gently
o
Drug/Drug
Drug/Food
Contraindications
Used only in acute, life-threatening conditions
CI in patients with: active internal bleeding, uncontrolled HTN, hx of hepatic

disease, renal disease, CVA, intracranial problems, surgery or trauma
Desirable Outcomes
o
Blood flow will be restored and emboli will be dissolved
VASOPRESSORS
Commonly Used:
o
Dopamine (Intropin)
Dobutamine (Dobutrex)
Inamrinone (Inocor)
Epinephrine hydrochloride (Adrenalin)
Norepinephrine (Levophed)
Isoproterenol (Isuprel)
Action: cause vasoconstriction of the blood vessels so as to increase BP & myocardial

contractility, stroke volume, and cardiac output. Also used to enhance renal blood flow.
Indications: Anaphylactic shock & cardiac arrest. Some pts with asthma
Side Effects: angina, restlessness, tachy, dysrhythmias
o
Urgency, urinary incontinence
o
Monitor pts UO
Normal urine output 30-40 ml/hr
Monitor V/S, lung sounds, ECG
Must administer these drugs through a large vein
If extravasation occurs STOP infusion immediately and infuse area with

alpha adrenergic antagonist Phentolamine (Regitine)
o
Drug/Drug
Drug/Food
Contraindications
Do not give to pts with tachydysrhythmias or ventricular fibrillation
Desirable Outcomes
OPHTHALMIC
o
Mydriatics
Common
Atropine (Isopto Atropine)
o
Toxicity can produce dry mouth, hallucinations, HA, fever,

and urinary retention or constipation which can worsen
narrow-angle glaucoma
Homatropine (Isopto Homatropine)
Tropicamide (Mydriacyl)
Cyclopentolate (Cyclogyl)
Phenylephrine (Mydfrin)
Action: Block response of sphincter muscle of iris, causing pupillary dilatation
Indication: Preoperative for eye surgeries and during eye exams
Side Effects: tachy, dermatitis, conjunctivitis. Photosensitivity.
Drug/Drug
Drug/Food
Contraindications: Patients with glaucoma, cardiac dysrhythmias, and
cerebral atherosclerosis. Caution in elerly pts and those with prostatic
hypertrophy, DM, and Parkinsonism
Desired Outcomes:
Mydriasis (pupillary dilatation)
Cylopegia (relaxation of ciliary muscles)
Miotics
Common
Pilocarpine hydrochloride (IsoptoCarpine, Pilocar)
Carbachol (Miostat, Isoptocarbachol)
Acetylcholine chloride (Miochol)
Pilocarpine nitrate (Pilofrin, Pilagan)
Isoflurophate (Floropryl)
Action: contract ciliary muscle, causing pupillary constriction.
Indications: Used to treat chronic open-angle and closed-angle glaucoma and

miosis during eye surgeries.
Side Effects: HA, decreased vision in poor lighting, local irritation, and eye pain.
Some pts also may develop myopia
Miotic toxicity can produce vertigo and syncope, cardiac

dysrhythmias, hypotension, tremors, or seizures
Drug/Drug
Drug/Food
Contraindications: Pts with retinal detachment, adhesions between the iris
and lens, or inflammatory diseases.
o
Use in caution in pts with asthma, HTN, corneal abrasion,

hyperthyroidism, coronary vascular disease, UTI, GI
obstruction, ulcer diseases, Parkinsonism, and bradycardia
Desirable Outcomes
Reduction in intraocular pressure and increase in the outflow of

aqueous humor
Overall Nursing Considerations/Education:
In administering eye drops:

o OS: Left Eye
o OU: Both Eyes
o OD: Right Eye
Monitor for toxic/side effects and allergic response and report eye pain to DR
Instruct pt to apply punctual occlusion to the lacrimal duct during and
immediately after instillation of drops to decrease systemic absorption
Tell pts to avoid driving or operating heavy machinery 24 hours after instillation of
meds, unless otherwise allowed by DR
OTC REMEDIES
Commonly Used:
o
Ibuprofen (Advil, Midol, Motrin) Pain and Fever
Loratadine (Claritin) Runny nose and itchiness
Bisacodyl (Dulcolax) commonly used for constipation
Ranitidine (Zantac) Heartburn
Drug taken best at night to suppress acid reduction
Bismuth Subsalicylate (Pepto-Bismol) most pts use for diarrhea, nausea, and
upset stomach
Aluminum Hydroxide (Gaviscon, Maalox) heartburn and upset stomach
Benzocaine (Orajel) toothache
Acetaminophen (Tylenol) pain or fever
Watch out for Reyes Syndrome if changes in behavior with N/V occur, and
immediately consult with DR
Bilirubin labs
Side Effects: rashes and itchiness, dizziness, N/V, diarrhea, constipation, drowsiness
(especially with cold medicines), heart burn, and respiratory depression
o
Drug/Drug
Drug/Food
Contraindications
Desirable Outcomes
HERBAL REMEDIES
Action: alternative plant derived meds to provide relief of symptoms of diseases
Commonly Used:
o
Aloe
Indications: topical skin ailment; constipation
Side Effects: abdominal pain, diarrhea
Black Cohosh
Indications: Premenstrual syndrome (PMS); Acne; Osteoporosis
Side Effects: Upset stomach, HA, Vaginal spotting or bleeding, Wt. gain
Echinacea
Indications: Suppresses inflammation
Side Effects: Fever, N/V
Feverfew
Indications: Migraine, fever, suppresses inflammation
Side Effects: nervousness and insomnia, heartburn, diarrhea or

constipation, N/V
Garlic
Indications: HTN, Hyperlipidemia, Atherosclerosis
Side Effects: Heartburn, N/V, Diarrhea
Ginger
Indications: Motion sickness, diarrhea, osteoarthritis
Side Effects: Heartburn, stomach upset
Ginkgo Biloba
Indications: Impotence, Impaired circulation, Weak memory
Side Effects: stomach upset, HA, bleeding
Goldenseal
Indications: Bacterial, fungal, and protozoal infections
Side Effects: Ureterotonic
Kava
Indications: Anxiety, insomnia, muscle relaxant
Side Effects: CNS damage, liver damage, skin problems
Can exacerbate Parkinsons disease
CI: patients taking antipsychotics, benzodiazepines, and barbiturates
Ma huang/Ephedra
Indications: bronchospasms, obesity
Side Effects: agitation and palpitations, HTN, insomnia
St. Johns Wort
Indications: Depression
Side Effects: GI disturbance, fatigue, dizziness, dry mouth, photosensitivity
CI: patients taking antidepressants
Saw palmetto
Indications: BPH, cough, asthma
Side Effects: Mild GI upset, HA
Valerian
Indications: Insomnia
Side Effects: HA, daytime drowsiness, palpitations, GI upset, cardiac

abnormality
o
Inappropriate use may lead to adverse effects and even death
Avoid consuming alcohol while into these meds
These alternatives may have certain interaction with some drugs
o
Drug/Drug
Warfarin is most often potentiated with herbal medicines
Drug/Food
Contraindications
Desirable Outcomes
BIOTERRORISM
Category A (Most Serious)
Small pox
o Inhaled transmission
o Dies from septicemia (Blood infection-only one from this group that dies from this)
o Rash starts around mouth first (early ID & isolation is crucial to contain)
Tularemia
o Inhaled
o Chest symptoms (coughing, chest pain, sputum)
o Dies from respiratory failure
o Treat with Streptomycin (watch hearing and creatinine)

Anthrax
o Spread by inhalation
o Looks like flu (chest symptoms and achy muscles)
o Treat with Cipro, PCN, and streptomycin
Plague
o Spread by inhalation
o Has the 3 Hs:
Hemoptysis (coughing up blood)
Hematemesis (vomiting blood)
Hematochezia (bloody diarrhea)

o Dies from respiratory failure and DIC
o Treat with Doxycycline and Mycins
o No longer communicable after 24 hours of treatment
Hemorrhagic fever [Ebola]
o 21 day time frame
Primary symptoms are
petechair and ecchymosis
o High % fatal
o Die of DIC
Botolism
o Ingested (drink/eat)
o Has 3 major symptoms:
o Descending paralysis (starts at head-goes down to diaphragm)
o Fever
o But is alert
Category B: All others. A long list.

Category C
Hanta virus
Nipeh virus
Chemical Agents
Mustard Gas Blisters (Vesicant, eventually cover airway)
Cyanide Respiratory arrest. Treat with Sodium Thiosulfate IV
Phosgine chloride Choking
Sarin Nerve agent.
Symptoms (Cholinergic Effects)
o Bronchorrhea
o Bronchoconstriction
o Salivation
o Lacrimating
o Urination
o Diaphoresis/diarrhea
o GI upset
o Emesis
i. Symptoms (Cholinergic Effects)
1. Bronchorrhea
2. Bronchoconstriction
3. Salivation
4. Lacrimating
5. Urination
6. Diaphoresis/diarrhea
7. GI upset
8. Emesis
All chemical agents require only soap and water cleansing except for Sarin, which requires a
bleach
a. Nursing Actions: Bioterrorism- Isolation, Antibiotics
b. Chemical: Decontamination
i. Send all suspected cases to decontamination center
ii. Remove all clothing
iii. Chemical hazard double bag
iv. Incinerated
v. Shower in soap and water (bleach- sarin)
vi. Discharged in government clothes
PSYCHOTROPIC DRUGS
Note: All psych drugs cause a decrease in BP and weight change
1. Phenothiazines
a. All end in zine
b. Very potent
c. Immediate onset
d. Ex. Thorazine, Compazine
e. Actions:
i. Does not cure disease. Reduces symptoms
ii. Large doses: Psychotic symptoms (Hallucinations
iii. Small doses: Nausea/Vomiting
iv. Major: Tranquilizers
f.
Side Effects: (remember ABCDEFG)
i. Anticholinergic Effects
ii. Blurred vision and Bladder retention
iii. Constipation
iv. Drowsiness
v. Extra Pyramidal Syndrome (EPS)
vi. FPhotosensitivity
vii. AGranulocytosis (low WBC count-immunosuppression)
viii. Teach patient to report sore throat and any S/S of infection to DR
g. Nursing Care: treat side effects. Number one nursing diagnosis is safety.
h. Deconate after name of drug means it is long acting (at least 2 weeks to
month) IM form given to non-compliant patients
2. Tricyclic Antidepressants
a. Antidepressant
b. mood elevators to treat depression
c. Ex. Elavil, Tofranil, Aventyl, Desyrel
d. pram, -trip
e. Side Effects: (Elavil starts with E so this group goes through E)
iii. Constipation
iv. Drowsiness
v. Euphoria
f.
Must take meds for 2-4 weeks before beneficial effects
3. Benzodiazepines
a. Antianxiety meds (considered minor tranquilizers)
b. Always have pam, -lam in the name
c. Prototype: Diazepam (Valium)
d. Indications:
i. Induction of anesthetic
ii. Muscle relaxant
iii. Alcohol withdrawal
iv. Seizuresespecially status epilepticus
v. Facilitates mechanical ventilation
e. Tranquilizers work quickly
i. Must not take for more than 90 days/3 weeks-3 mos
ii. Keep on Valium until Elavil kicks in
f.
Side Effects:
iii. Constipation
iv. Drowsiness
g. #1 Nursing DX: Safety

4. Monoamine Oxidase (MAO) Inhibitors
a. Antidepressants
b. Depression is thought to be caused by a deficiency of norepinephrine,
dopamine, and serotonin in the brain. Monoamine oxidase is the enzyme
responsible for breaking down norepinephrine, dopamine, and serotonin. MAO
inhibitors prevent the breakdown of these neurotransmitters and thus restore
more normal levels and decrease depression.
c. 2-4 weeks
d. Drug Names:
i. Mar-plan
ii. Nar-dil
iii. Par-nate
e. Side Effects
iii. Constipation
iv. Drowsiness
f.
Interactions: (Patient Teaching)

i. To prevent severe, acute, sometimes fatal hypertensive (stroke)
crisis, the patient MUST avoid all foods containing TYRAMINE.
1. Foods containing TYRAMINE:
a. Fruits and veggies(remember salad BAR)
i. AVOID:
1. Bananas
2. Avocados
3. Raisins (any dried fruits)
b. Grains: all okay except things made from active yeast
c. Meats
i. No organ meats: liver, kidney, tripe, heart, etc
ii. No preserved meats: smoked, dried, cured,
pickled, hot dogs
d. Dairy
i. No aged cheese
ii. No yogurt
iii. Cannot eat brick cheese
e. Other
i. No alcohol, elixirs, tinctures, caffeine, chocolate,
licorice, soy sauce
ii. Drug Interactions:
1. Teach patient not to take OTC meds unless they are prescribed
5. Lithium
a. An electrolytenotice ium ending as in potassium, etc
b. Used for treating BPD (manic depression)it decreases mania
c. Side Effects: (The 3 Ps)
i. Peeing (Polyuria)
ii. Pooping (Diarrhea)
iii. Paresthesia (First sign of electrolyte imbalance)
d. Toxic:
i. Tremors, metallic taste, severe diarrhea or any other neuro signs
besides paresthesia
ii. #1 intervention: keep hydrated
iii. If sweating, give electrolyte drink as well as fluids
e. Note: Closely linked to sodium. Monitor sodium levels. Low sodium levels
prolong lithiums half-life, causing lithium toxicity. High sodium levels decrease
the effectiveness of Lithium.
i. Will only work as prescribed if Sodium normal!!
6. Prozac (Fluoxetine)
a. Prozac is a SSRI (Antidepressant)
b. Similar to Elavil (A tri-cyclic antidepressant)same info
c. Side Effects:
iii. Constipation
iv. Drowsiness
v. Euphoria
d. Prozac causes insomnia, so give before 12 noon
i. If BID give at 6A & 12 N
e. When changing the dose of Prozac for a adolescent or young adult watch for
suicidal ideation
7. Haldol (Haloperidol)
a. Also has deconate form [IM, long acting, given to pts who wont take pills
b. Same info as Thorazine
c. Very potent
d. Immediate onset
e. Actions:
i. Does not cure disease. Reduces symptoms
ii. Large doses: Psychotic symptoms (Hallucinations
iii. Small doses: Nausea/Vomiting
iv. Major: Tranquilizers
f.
Side Effects: (remember ABCDEFG)

iii. Constipation
iv. Drowsiness
v. Extra Pyramidal Syndrome (EPS)
vi. FPhotosensitivity
vii. AGranulocytosis (low WBC count-immunosuppression)
viii. Teach patient to report sore throat and any S/S of infection to DR
g. Nursing Care: treat side effects. Number one nursing diagnosis is safety.
h. **Elderly patients may develop Neuroleptic Malignant Syndrome
(NMS), a potentially fatal hyperpyrexia (fever) with a temp of >104 F
from overdose. Dose for elderly patient should be HALF of usual
adult dose.
8. Clozaril (Clozapine)
a. Second generation atypical antipsychotic
b. Used to treat severe schizophrenia
c. Advantage: it does not have side effects A, B, C, D, E, or F (much less)
d. Disadvantage: it DOES have side effect: Agranulocytosis (worse than cancer
drug in susceptible patients)
e. For first month need WBC counts weekly. If WBC LOW STOP!
f.
Do not confuse with Klonopin (Clonazepam)
9. Zoloft (Sertraline)
a. Another SSRI like Prozac

b. S/E ABCDE
c. 2-4 weeks to work
d. Also causes insomnia but CAN be given in evenings
e. Watch for interaction with:
i. St. Johns wort- serotonin syndrome *deadly
1. Sweating
2. Apprehension impending sense of doom
3. Dizziness
4. HEAD-ache
ii. Warfarin (Coumadin)- watch for bleeding (may need to lower warfarin
dose)
1. When take Zoloft- warfarin and INR stays UP

NCLEX Pharmacology LP

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NCLEX Pharmacology LP

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PHARMACOLOGY

ACE INHIBITORS [-PRIL]

Commonly Used: Captopril, Enalapril, Fosinopril, Moexipril, Perindopril

If pt taking diuretics, notify MD if on Lisinopril

If pt has impaired renal function be cautious

ALPHA BLOCKERS [-ZOSIN]

Commonly Used: Alfuzosin, Prazosin, Tamsulosin, Doxazosin, Silodosin, Terazosin, Reserpine

Treat- HTN, BPH, Raynauds Disease, Pheochromocytoma (Adrenal gland tumors)

Expected: nausea, drowsiness, nasal congestion, wt. gain, edema

Orthostatic hypotension, and sodium & water retention may occur

Monitor: fluid retention, edema, BP

Typically NOT preferred as first tx option for high BP

Avoid OTC meds

Prazosin (Minipress) best time to take initial dose @ bedtime

Decrease salt intake

+ foods include: banana, oatmeal

Tamsulosin should not be prescribed to pts with coronary atherosclerosis

Renal blood flow of pt will be correctly maintained

Reduction in symptoms of BPH (noticeable)

BP will be decreased within 15 minutes following oral administration in hypertensive pts

ANGIOTENSION II INHIBITORS-ARBS [-SARTAN]

Brand names include- Diovan, Micardis, Benicar, Cozaar, Avapro, Teveten,

Notify MD if edema occurs

Do not stop taking drugs until DR is consulted

Change positions slowly

Watch for hypotension (may be reduction in fluid volume through excessive

Have blood drawn for potassium levels

PREGNANCY CATEGORY D-not to be taken by preg moms or if

Caution in pts with hypovolemia, hepatic, or renal dysfunction

Hold Telmisartan if menstruation delayed

Prevention and treatment of diabetic neuropathy

Decrease in sodium & potassium retention

Decrease in hearts workload

Improvement in pts unable to tolerate ACE inhibitors

Indications: Treats- Angina

Given for immediate response

Can give clients 3 doses in every five minute intervals

Avoid abrupt changes in posture

Remove before defibrillation or cardioversion

Prevent tolerance to nitrates: 12 hour no nitrate period

Topical application is used for sustained protection against angina attacks

Report to MD: continuous headaches, blurred vision, or dried mouth

Keep medicine a tightly closed, dark glass container to ensure potency

Avoid contact with skin

Limit Alcohol: it will potentiate postural hypotension

Prevention of chest pains (d/t coronary artery disease)

Acute relief of an attack of angina pectoris

Decrease in demand of cardiac oxygen

Class I: Na Channel Blockers: Procainamide, Disopyramide (Norpace), Amiodarone, Quinidine Sulfate

Uses: SVT, A. flutter, A. Fib, V tach

Class I B: Mexiletine, Lidocaine (Xylocaine), Tocainide

Class I C: Flecainide, Encainide, Propafenone

Class II: Beta Blockers: Metoprolol, Atenolol, Propranolol, Timolol, Esmolol

Short term use for ventricular dysrhythmias only

Class III: K Channel Blockers: Sotaolol, Amiodarone, Bretylium, Ibutilide

Uses: conversion of A. fib (oral), Recurrent V fib or V tach

CI: PREG D; AV block, bradycardia, infants

Class IV: Calcium Channel Blockers: Diltiazem, Verapamil

Uses: A fib, A flutter, SVT

Others: Atropine Sulfate

Monitor: for dysrhythmias precipitated by treatment

Hook pt up to cardiac monitor and assess for changes in rhythm

Avoid giving IV injections rapidly

Notify MD if joint pain and inflammation occur