Pharmacology Drugs

Urokinase

Uses: Tx pulmonary embolism. Decreases clotting, thrombosis, and embolism.

Contradictions: ulcerative colititis/enteritis. severe uncontrolled HTN, renal/hepatic disease, COPD, hypersensitivity to this product or other thrombolytic enzymes.

Signs of Toxicity: NA

Administration Guidelines: IV use

Precautions: pregnancy(b), aterial emboli, hepatic dise

Side Effects/Interactions: headache, nausea, vomiting, decreased hematocrit, bleeding, rash, urticaria, SOB, bronchospasm, retroperitoneal bleeding.

Vitamin K

Uses: antidote for warfarin overdose

Vitamin B12

Uses: vitamin b12, deficiency, pernicious anemia, malabsorption.
Contradictions: hypersensitivity, optic nerve atrophy.
Precautions: pregnancy(A), breastfeeding, children.
Interactions: increased absorption when taken with prednisone;
Side Effects: CHF, pulmonary edema, diarrhea, anaphlactic shock
Administration: keep away from light and heat. PO, IM, and IV

Folic Acid

Uses: megaloblastic or macrocytic anemia caused by folic acid deficency. alcoholism, pregnancy.
Contradictions: hypersensitivity, any anemia other than megaloblastic, vitamin b12 deficency.
Precautions: pregnancy A
Side Effects: bronchospasm, flushing.
Administration: PO, Im, Subcut, IV
* Store in a light resistant container.

Ferrous Sulfate- Iron

Uses: iron deficiency anemia, nutritional supplement.
Contradictions: hypersensitivity, ulcerative colitis/ enteritis, hemosiderosis, hemochromatosis, pepric ulcer disease, hemloytic anemia, cirrhosis.
Precautions: prenancy B
Side Effects: nausea, constipation, epigastric pain, black and tarry stools
Toxicity: nausea, vomitting, diarrhea, green then tarry stools, hematemsis, pallor, cyanosis, shock, and coma.
** Avoid reclining 30 minutes after taking iron(could cause esophagel erosion).

Iron Dextran

Uses: Iron Deficiency Anemia
Contradictions: hypersensitivity
Precautions: Pregnancy C, acute renal disease, asthma, lupus, hypotension,
Side Effects: seizure, shock, nausea, leukocytosis,
Toxicity: nausea, vomiting, diarrhea, fever, abdominal pain, cyanosis, CV collapse
Black Box: hypersensitivity, allergy, anaphylaxis, rash, purititis, fever, chills, wheezing
Overdose: Give Benadrayl or Epinephrine

Diphenydramine (Benadryl)

Uses: allergy symptoms, insomnia in children.
Contradictions: hypersensitivity to H-1 receptors. acute asthma attack, lower respiratory disease, neonates.
Precautions: IOP, cardiac/renal disorders, HTN, bronchial asthma, seizure disorder, peptic ulcers, hyperthyroidism
Side Effects: dizziness, drowisness, retention of urine. Avoid us in children.
Treatment of OD: Diazepam, vasopressor, phenytoin IV.

Promethazine (Phenergan)

Use: motion sickness, rhinitis, allergy symptoms, sedation, nausea, preoperative and postoperative sedation.
Contradictions: hypersensitivity, breastfeeding, agranulocytosis, bone marrow suppression, coma, jaundice, Reye's syndrome
Precautions: pregnancy C, cardiac/hepatic/renal, seizure disorder, glaucoma, COPD
Side Effects: dizziness, drowsiness, constipation, urinary retention
Black Box warning: infants, neonates, children, intraareterial/SUBcut administration, extravasatition.

Codeine

Use: moderate to severe pain
Contradictions: breastfeeding, hypersensitivity to opiates, respiratory depression, increased ICP, severe respiratory disorders.
Precautions: pregnancy C, geriatric patients, cardiac dysrhythmias, prostatic hypertrophy, bowel impaction.
Side Effects: drowisness, sedation, nausea, vomiting, anorexia, constipation,
Treatment of OD: naloxone diuted with NaCl and given IV push
** can cause respiratory depression and dysfunction
Administration: PO/IM/Subcut

Dextromethorphan (Delsym)

Use: nonproductive cough caused by colds or inhaled irritants.
Contradictions: hypersensitivity
Precautions: pregnancy C, fever, hepatic disease, asthma, chronic cough
Side Effects: dizziness, nausea,
*Avoid smoking, alcohol, dust
Administration: PO, SUS

Aspirin

Use: mild to moderate pain, or fever including RA, osteoarthritis, thrombotic disorders.
Contradictions: Pregnancy D, breastfeeding, children with flu-like symptoms, hypersensitivity to salicylates.
Precautions: abrupt discontinuation, acetaminophen/NSAIDs hypersensitivity,
Side Effects: nausea, vomiting, rash. Toxicity: hepatotoxicity dark urine, clay colored stools, yellowing of the skin, sclera, itching, abdominal pain, fever diarrhea.-- Ototoxicity- may occur after long term therapy.

Naproxen (Aleve)

Use: osteoarthritis, RA, gouty arthritis, primary dysmenorrhea, anklylosing spondylitis, bursitis, tendinitis, myalgia,
Contradictions: pregnancy D, hypersensitivity to NSAIDs, asthma, severe renal/hepatic disease, ulcer disease
Precautions: pregnancy, geriatrics, children, other anti-inflammatory agents.
Side Effects: Mi, stroke, hepatitis, Gi ulceration, bleeding, perforation, blood dyscrasias,
Black Box Warning: cardiac status, thrombotic events, GI status, ulceration,

Ibuprofen (Advil)

Use: anti-inflammatory agents
Contradictions: pregnancy D, hypersensitivity to product.
Precautions: Pregnancy, breastfeeding, and children.
Side Effects: headache, anorexia
Black Box warning: GI bleeding, MI, stroke
Toxicity: blurred vision, ringing in ears.
Tx of OD: lavage,

Acetaminophen (Tylenol)

Uses: mild to moderate pain, fever reducers
Contradictions: hypersensitivity to yellow dye number 5, alcohol,
Precautions: pregnancy B, breastfeeding, geriatrics, and anemia.
** Very liver toxic. Tx: gastric lavage.
Administration: PO and rectal

Etanercept (Enbrel)

Uses: acute, chronic rheumatoid arthritis.
Contradictions: sepsis, active infections
Precautions: pregnancy B, breastfeeding, children
Side Effects: headache, injection site reactions, pharyngitis, cough, rhinitis
** Do not give concurrently with immunizations.

Infliximab (Remicade)

Use: absence of fever and mucous in stools. Tx of Chrons
Contradictions: hypersensitivity, moderate to severe CHF
Black Box: infection, neoplastic disease, TB
Side Effects: headache, dizziness, depression, vertigo, anxiety, fever, chills, flu-like symptoms, nausea, vomiting, abdominal pain, constipation, dyspepsia, flatulence. rash.
** DO not administer to patients with infections.

Indomethacin (Indocin)

use: decreased pain and stiffness in joints. Used to tx RA, osteoarthrisit, acute gouty arthrisis, patent ductus arterious.
Black Box Warning: perioperative pain in CABG, stroke, GI bleeding, and MI
Side Effects: headache, nausea, vomiting, constipation,
Toxicity: sx include blurred vision and tinitis,

Allopurinol (Zyloprim)

Uses: tx chronic gout, hyperurecemia.
Side Effects: headache, nausea, vomiting, anorexia, malaise,
Contradicitions: hypersensitivity
Uric Acid levels should be less than 6mg/dl- levels will need to be monitored q 2/weeks
Administer: PO and IV.

Alendronate (Fosamax)

Use: tx of osteoprosis, used to increase bone mass.
Side Effects: A-fib, esophagel perforation, angioedema.
Contradictions: hypersensitivity, esophageal delayed emptying,
Serious Reactions: angioedema, Stevens-Johnsons Syndrome, A-Fib.
* take with an 8oz glass of water and remain upright/no eating for 30 minutes.

Fluticasone (Flovent/Flonase)

Use: decreases severity of asthma- corticoidsteroid
Side Effects: pharyngitis, oral candidasis, upper respiratory infeciton.
Contradiction: hypersensitivity to this product or milk protein.
Not for use in acute asthma attacks.

Montelukast (Singulair)

Use: Tx of chronic asthma in adults.
Side Effects: dizziness, fatigue, headache, abdominal pain, influenza cough, LFT increase
Contradictions: hypersensitivity
Assess to Chrug- Strauss Syndrome.
DOSE AT NIGHT TIME

Ipritropium (Atrovent)

Use: Blocks muscarinic cholinergic receptors; bronchospasm with COPD and asthma.
Side Effects: minimal systemic effects, dry mouth and throat irritation, peanut allergy
Administration: MDI or nebulizers four times a day.

Tiotropium Spireva)

Use: Very similar in all aspects to ipratropium. Blocks muscarinic cholinergic receptors, bronchospasm with COPD and asthma
Side Effects: systemic effects like constipation, and urinary retention. cough, sinusitis
Administration: DPI once daily

Cromolyn

Use: used for exercised induced asthma.
Administer: take 15 minutes before activity.
Side Effect: headache, dizziness,

Short Acting Beta 2 agonist

Use: used to prn to relieve attacks. Albuterol is the most common. Should still have a rescue inhaler available.
Side Effects: tachycardia, angina, jitterness, and tremor
Administration: MDIs, DPIs, Nebulizers--1-2 puffs or treatments ~ 3-4 times a day

Long Acting Beta 2 agonist

Use: Protect against bronchospasm over extended period. Not for treatment of acute attack
Most patients with persistent asthma should be on long-acting drugs. Preventative therapy.
Administration: Used for patients with frequent attacks. Fixed schedule dosing- not prn use. Not first choice agents for long-term control. Should not be used alone
Side Effects: May increase the risk of severe asthma and asthma-related death(they only tx the symptoms(bronchoconstriction) and not the cause(inflammation)

Theophylline (Theo-dur)

Use: bronchial astham, bronchospams of COPD. chronic bronchitis, emphysema. Makes it easier to breath.
Side Effects: anxiety, restless, insomnia, dizziness, palpatstations, sinus tachycardia, nausea, vomiting.
Administraiton: monitor levels, 10-20mg/dl.

Benzonottonate (Tessalon)

Use: nonproductive cough.
administered PO and very rarely used.

Pseudophedrine (Sudafed)

Use: nasal decongestant
Side Effects: tremor, anxiety, anorexia, vomiting,
WARNING: MAOIs or Tricyclic antidepressants can cause HTN crisis when used with this
Administer: take at bed time,

Sucralfate (Carafate)

Use: duodenal ulcer, oral mucositits, stomatitis.. Absorbs pepsin.
Side Effects: dry mouth, constipation
Administer: do not take 30 mins before or after taking an antacid. Take on an empty stomach.

Cimetidine (Tagamet)

Use: Gastric and duodenal ulcers. GERD. Zollinger-Ellison syndrome(produce too much acid). Aspiration pneumonitis. Heartburn, acid indigestion, and sour stomach
Side Effects: Antiandrogenic effects- risk of low libido, ED, and gyneomastia(breast tissue development). CNS effects. Pneumonia. IV bolus – can experience hypotension and dysrhythmias
** Gynomastia and Impotence may occur. Monitor for bleeding. Smoking decreases the effects.

Ranitidine (Zntac)

Uses: Shares many properties of cimetidine(tx ulcers, GERD and zollinger-ellison). More potent, fewer adverse effects, cause fewer drug interactions than cimetidine (and has less ability to cross CNS)
Side Effects: Significant ones uncommon. Does not bind to androgen receptors
Administer antacids one hour before and after. Do not take maxim OTC for more than two weeks.

Aluminum Hydroxide (Maalox)

Uses: antacid
Side Effects: constipation, hypophostamia, Stools may appear white or speckled.

Famotidine (Pepcid)

Use: Short-term treatment of gastric/duodenal ulcers. Prophylaxis of recurrent duodenal ulcers. Treatment of Zollinger-Ellison syndrome and hypersecretory states. Treatment of. GERD. OTC – to treat heartburn, acid indigestion, sour stomach
Side Effects: Does not bind to androgen receptors. Possible increased risk for pneumonia due to elevation of pH
Administer: 1 before or 2 hours after meals.

Esomeprazole (Nexium)

Uses: GERD,
Side Effect: headache, dizziness, diarrhea, flatulence, rash, cough,
Administer: same time daily, one hour before the meal.
Report: diarrhea, abdominal pain, tarry stools.

Pantoprazole (Protonix)

Use: GERD,
Side Effects: headache, abdominal pain, diarrhea, rash. Hyperglycemia can occur.
Report Severe Diarrhea, or Tarry Stools.

Rabeprazole (Acephex)

Use: tx GERD
Side Effects: headache, dizziness, asthenia, diarrhea, abdominal pain, vomiting, constipation, flatulence. Stevens-Johnsons syndrome can occur.
Contradicted: in Asain population.
Hypoglycemia can occur. Report black, tarry stools.

Lubiprostone (Amitiza)

Use: tx of chronic idopathic constipation and constipation in IBS.
Side Effects: nausea, abdominal pain, erucationg
Administer: with food BID.
Notify prescriber of GI symptoms, diarrhea, hypersensitivity reactions.

Docusate sodium (Colace)

Use: prevention of dry, hard stools
Side Effects: cramps, nausea,--no regular occurying side effects.
Administer: with milk or juice to decrease bitter taste. Take morning or night.

Magnesium citrate

Use: constipation
Side Effects: nausea, vomiting, anorexia, cramps.
Not to be used long term, can cause loss of bowel tone.
Warning: Eclampsia, seizure precautions.

Sulfasalazine (Azulfidine

Use: ulcerative colitis, RA,
Side Effects: nausea, vomiting, abdominal pain,
store in light resistance containers.
warning; blood dyscrasias and allergic reactions.

Infliximab (Remicade

Use: chron's disease, RA, ulcerative colitis.
Side Effects: headache, dizziness, depresison, vertigo, fatigue, anxiety, chills, flu-like symptoms. N/V, constipation, dyspepsia, rash, dermatitis.
Black Box Warnign: TB, Infection, neoplastic disease.

Misoprostol (Cytotec)

Use: Only approved GI indication is prevention of gastric ulcers caused by long-term NSAID therapy
Side Effects: Most common – dose-related diarrhea (13%-40%) and abdominal pain (7%-20%)
Contraindicated during pregnancy – category X**(can be used on the cervix when a woman is in labor. Causes effacement and dilation of the cervix)
Significant actions need to be taken to ensure that pregnancy does not occur after therapy starts and that patient is not pregnant at therapy initiation.

Digoxin

Uses:tx superventricular dysarythmias. It supresses conduction by decreasing conduction through the AV node and decreasing automaticity in the SA node.
Administeration: oral therapy is generally preferred. Initial dosage is 1-1.5 mg
Toxicity: hyper salivation, nausea or vomiting, loss of appetite or anorexia, changes in the rate and rhythm of the heart, visual disturbances just like yellowish tints, diarrhea, dizziness,
Normal Levels: should remain at 0.6-1.2.

Thiazide Diuretics ( Hydrochloraizide)

Use: anticoagulant. Used for long-term therapy of HF when edema is mild to moderate Limitations. Ineffective when GFR is low. Cannot be used if cardiac output is reduced. Hypokalemia /digoxin induced dysrhythmias

High Ceiling Loop Diuretics, Lasix

Use: Produce profound diuresis. Can be used even when GFR is low. Preferred to thiazides with C.O is greatly reduced. Drugs of choice for severe HF
Monitor K+

Potassium Sparing Diuretics, Spiralatone.

Uses: Promote only scant diuresis. Used to counteract potassium loss caused by thiazide and loop diuretics
monitor k+ levels.

Aldosterone Antagoinst

Use: Block harmful effects of aldosterone including: Myocardial remodeling. Promotion of myocardial fibrosis. Promotion of baroreceptor dysfunction. Essentially helps block all the pathology of heart failure.

Sodium Channel Blockers

Quinidine, procainamide, disopyramide, lidocaine, mexiletine, flecainide, moricizine) p. 538

Slow impulse conduction in the atria/ventricles, and HIS-Purkinje system.

Largest group of anti-dysrhythmic drugs

Beta blockers

Propranolol, acebutolol, esmolol
Effects in the heart
SA node: they reduce automaticility
AV node: they slow conduction velocity
In the atria and ventricles: they reduce contractility

Potassium Channel blocker

Amiodarone, bretylium, sotalol
Delay repolarization of fast action potentials
Prolong action potential duration and refractory period

Calcium Channel Blocker

Only 2 are used as dysrhythmics (Non-dihydroperidines)
Verapamil
Diltiazem

Digoxin and Adenosine

Digoxin
Adenosine
Both drugs suppress dysrhythmias by decreasing conduction through the AV node and refractory automaticity in the SA node

Atrial Fib Treatment

Pharmacologic Treatment
Long-term beta or calcium channel blocker therapy to slow ventricular rate
PRN flecainide or propafenone (class Ic dysthrythmics)
Warfarin for clot prevention
Non-Pharmacologic Treatment, DC cardioversion, Short treatment drugs (amiodarone), Radiofrequency ablation of of the dysrhythmia source

Sustained Supraventricular Tachycardia (SSVT)

Circuit issue in the AV node causing rapid re-firing
HR is 150-250 beats/minute
Treatment
Carotid sinus massage
Valsalva maneuver
IV beta blockers or calcium channel blockers emergently, then orally when stable

Ventricular Dysrhythmias

Sustained Vetricular Tachycardia
Arises from a single, rapidly firing ventricular ectopic foci
Rate in the 150-250 beats/minute
Treatment
Cardioversion is treatment of choice
IV meds: amioadorone, lidocaine, procainamide
Oral sotalol for long-term control if needed
Implantable cardiac defibrillator (ICD)

Ventricular Premature Beats (VPBs)

Occur before they should in cardiac cycle
Caused by 1 or more ectopic foci
Treatment
Don’t treat unless additional signs of heart disease
Generally benign
Treat in acute MI because they may be precursor to VT or VF
Beta blockers are the drugs of choice

Paroxysmal sustained ventricular tachycardia (PSVT)

Drug of choice: adenosine
Short half-life (1.5-10 seonds)
Give IV
Not effective for atrial dysrhythmias

Coronary atherosclerosis

Thickening of coronary arteries
Moderate disease = angina pain
Severe disease = acute myocardial infarction (MI/heart attack)
Pathology of athersclerosis
Fatty streak in the arterial wall
Deposition of fibrous plaque
Atherosclerotic plaque grows and impedes blood flow
Plaque cap encourages the formation of thrombi (clots)

Very-Low Density Lipoproteins: VLDL

Contain mainly triglycerides and some cholesterol
Role
Deliver triglycerides to nonhepatic tissues
Influence on athersclerosis
Probably contribute to athersclerosis

Low-Density Lipoproteins: LDL

Contain cholesterol as their primary lipid core
Account for the majority (60-70%) of all cholesterol in the blood
Role
Delivery of cholesterol to non-hepatic tissues
Influence on atherosclerosis
Definitely contributes to athersclerosis
Direct relationship between higher LDL levels and CHD

High-Density Lipoproteins (HDL)

HDLs contain cholesterol as their primary core lipid
Account for 20-30% of all cholesterol in the blood
Role
Carries cholesterol from peripheral tissue back to the liver
They promote cholesterol removal
Protect against athersclerosis

Cholesterol Levels

Total < 200 mg/dL
LDL < 100 mg/dL
HDL > 40 mg/dL (men) >45 mg/dL (women)
Triglycerides < 150 mg/dL

Positive Risk Factors

Age
Men >45 years
Women >55 years
Family history of CHD in 1st degree relative
Males <55 years
Females A<65 years
Hypertension
Current cigarette smoking
Low HDL cholesterol <40 mg/dL

Drug therapy for cholesterol

When TLCs are not enough or are not effective
HMG-CoA reductase inhibitors (statins)
Atorvastatin, simvistatin, resuvastatin, others…
Bile acid sequestrants
Cholestyramine
Nicotinic acid
Niacin
Fenofibrates
Tricor

Pharmacology Drugs

Nursing Pharmacology with Burnitt at Goldfarb School of Nursing

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