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Pharmacclogy Lecture Must Knows Drugs * Aminoglycosides ~ Notable S/E : Ototoxicity & Nephrotoxicity * Cephalosporins ~ Ist Generation : Cefalixin ~ 2nd Generation : Cefuroxime ~ 3rd Generation : Ceftriaxone * Fluoroguinolones (-Floxacin) ~ Levofloxacin & Ofloxacin : DOC for UTI * Macrolides (-Tromycin) ~ Notable S/E : GI Disturbances like N&V and Diarrhea * Penicillin ~ Notable S/E : Allergic Reaction ~ DOC for syphilis & rheumatic heart disease * Sulfonamides ~ Cotrimoxazole (Septra, Bactrim) : DOC for Peunomonia w/ aids cause by pneumocystis carinii, ~ Cotrimoxazole : Can cause Steven Johnson's syndrome (Severe allergic reaction) * Tetracycline (Doxycycline) ~ DOC for chlamdiya ~ Use as prophylaxis for leptospirosis. * TB Drugs ~ Rifampicin : Red Orange Body Fluid Secretions ~ Isoniazid : Peripheral Neuritis (Need for Vit. B6) (Vit. B6 is not allowed to pt. w/ Parkinson Disease taking levodopa) ~ Pyrazinamide : Hyperuricemia (Gout / Joint Pain) ~ Ethambutol : Eye/Optic Neuritis Cinability to discriminate red and green) ~ Streptomycin ; Ototoxicity / Nephrotoxicity * Metronidazole ~ DOC for Amoebiasis * Praziquantel ~ DOC for Schistosomiasis (Snail Fever / Katayama Fever) * DEC / Diethylearbamazepine ~ DOC for Filariasis CElephantiasis) * Quinacrine ~ DOC for Gardia Lambia * lodoguinol ~ DOC for Blantidium Coli * Anti-Tumors Antibiotics (Anti-Neoplastic Medications) ~ Doxorubicin : Can cause arrhythmias because of its cardiac toxic. 4 Antidote ; Dexazoxane ~ Cyclophosphamide : Can cause hemorrhagic cystitis. a Antidote : MESNA ~ Tamoxifen ; DOC for breast cancer, but it can cause endometrial cancer. * Anti-Depressants (Depressed - EY Serotonin) (Schizo - Serotonin) ~ SSRI's : It blocks the re-uptake of serotonin; Prozac, Zoloft, Paxil. ~ TCA's : (Tryptiline) Increasing serotonin and norepinephrine in the brain which can help to improved mood. ~ MAOI's : (PaMaNa) Avoid foods rich in tyramine (cheese, milk, chianti wine, preserved meats, avocado) cause it can increase BP. * Anti-Manic Drugs (Bipolar Disorder) ~ Lithium CLithane) : N 0.5-1.5 mEg/liter * ADHD Drugs ~ Methylphenidate (Ritalin, Concerta) : CNS stimulant for children w/ ADHD its paradoxical. ¢ Anti-HPN Drugs ~ Beta-Blockers (-olol) : It slows down HR but it can cause bronchoconstriction, its not allowed for pt. w/ asthma. 4 Timolol : Reduces ICP, tx for Glaucoma ~ €CB / Calcium Channel Blockers : It blocks calcium to decreased contractility of the heart. * Direct Acting Anti-Cholinergic Agents ~ Carbacol & Pilocarpine : Used to induce miosis, DOC for Glaucoma. * Myasthenia Gravis Agents ~ Edrophonium CTensilon) : It is a drug for dx Myasthenia Gravis. Action is to increase the amount of acetylcholine at the receptor site. * Alzhiemers Disease Drugs ~ Tacrine (Cognex) It can cause accumulation of ~ Rivastigmine (Exelon) Acetylcholine at the receptor ~ Donepezil (Aricept) site in the Brain. + lodine Solutions ~ Radioactive lodine : Graves Disease ~ Potassium lodide (Thyro Block) : Administer after meals, use straw to prevent discoloration of teeth, 4 Pt. w/ Hypothyroidism should avoid foods that can inhibit thyroid secretion, * Anti-Diabetic Drugs ~ NPH : Only cloudy insulin ~ Regular, Lispro : Clear insulin ~ Principle for administration of insulin : Draw up the Clear before the cloudy insulin to prevent contaminating a short acting with a long acting insulin. * Cardiac Glycoside ~ Digoxin (Lanoxin) : DOC for CHF, C+) inotropic, (-) chronotropic, increased contractility; Slows down HR, N 0.3-2.0 ng/dl. Don't give to pt. HR of 60bpm. a Antidote : Digibind ¢ Angina Pectoris ~ Nitroglycerin CNitrostat) ; Its contraindicated w/ Viagra (sildenafil) it can cause hypotension leading to cardiac arrest. Sublingually every Smins max of 3x. * Anti-Hyperlipidemics ~ (Statin) : Inhibits the hmg coa, enzyme producing cholesterol. S/E: Myopathy, Hepatoxicity. * GI Drugs ~ H2 Antagonist (-dine) : Reduces gastric acid. 4 Cimetadine (Tagamet) : S/E Gyencomastia ~ Antacids : Use to neutralize stomach acid. A Magnesium : Magtatae / Diarrhea a Aluminum : Ayaw lumabas / Constipation ~ PP! (-Prazole) : Decreased/Suppressed production of hydrochloric acid by inhibiting potassium adenosine triphosplatase enzyme. ~ Emetic : Ipecac induce vomiting * Drugs for Erectile Dysfunction ~ Viagra (Sildenafil) : works on empty stomach, Its contraindicated w/ nitroglycerin, * Anti-Gout Drugs ~ Allopurinol : Decrease uric acid by cutting/interrupting production. ~ Probenecid : Blocks renal re-uptake uric acid. ~ Febuxostat CVloric) : Inhibits the formation of uric acid. * Other Drugs ~ Pantrolene ; DOC for Malignant hyperthermia ~ Diazepam : DOC for Status Epilepticus ~ Physostigmine : Antidote for Atropine toxicity. ~ Atropine Sulfate ; Antidote for Pt. who drunk malathione. ~ Furosemide : DOC for pulmonary edema, it is a potassium wasting diuretic that can cause hypokalemia, ~ Spyrolactone : Can cause hyperkalemia ~ Hyperkalemia : Peak/Tall T wave ~ Hypokalemia : U wave depressed T wave. Effects of Drugs Nephrotoxie Drugs (Kidney Injuries) Ciprofloxacin Acyclovir Contrast Medium Acetaminophen Sulfonamides Amphotericin B Rifampicin Aminoglycosides —_ Tetracycline Hepatotoxic Drugs (Liver Injuries) Ototoxic Drugs Acetaminophen (Ear Damage) Erythromycin lron Aminoglycosides Isoniazid Overdose Aspirin Sulfonamides Chloroguine Rifampicin Loop Diuretics Disulfiram Reaction (Flushing, N&V) | Can Cause Staining Metronidazole Macrodantin lron Cephalosporins Lugol's Solution Oral Hypoglycemic Agents Tetracycline Teratogenic (Birth Defects or Abnormalities) Fluoroguinolones Aminoglycosides Tetracycline Ace Inhibitor Lithium Oral Hypoglycemic Agents 2 Effects of Drugs 1, Stimulate -> Increases 2. Inhibits -> ("| Decreases Common Board Questions * Important Factors for Substance Abuse -> Accessibility of the drugs. -> Health professionals are the common addicts. * Substance Abuse -> Use of illegal drugs. -> Illegal use of drugs. Stimulants (Gjuppers) Depressants (E§Downers) ~ Cocaine ~ Alcohol ~ Coffee ~ Marijuana ~ Tea ~ Barbiturates ~ Shabu (Metamenthamine) ~ Opioids ~ LSD ~ Narcotics Drugs Acting on ANS/Autonomic Nervous System -> Controls the involuntary muscles. * 3 Types of Muscle 1, Skeletal Muscles : Voluntary 2. Cardiac Muscles : Involuntary, Found in the heart. 3. Smooth Muscles : Involuntary, Found in the Bronchus, Blood Vessels, Bladder, GI, Eyes. * 2 Divisions of ANS 1, Sympathetic -> [fl] Effects / Gi] vs -> Adrenergic / Fight or Flights -> Neurotransmitter : Epinephrine & Norepinephrine CAdrenaline/ Catecholamines) * 2 Divisions of ANS 1, Sympathetic -> [fl] Effects / Gi] vs -> Adrenergic / Fight or Flights -> Neurotransmitter : Epinephrine -> Stimulates when you are in stressful events. -> Constrict all (Sphincter, Blood Vessels BP) -> Dilates (Bronchus, Pupils) 2. Parasympathetic -> [i] Effects / (f) vs -> Cholinergic / Rest & Digest -> Neurotransmitter : Acetyl Choline -> Stimulates when you are in rest and digest. -> Dilates all (Sphincter, Blood Vessels BP) -> Constricts (Bronchus, Pupils) Terminologies 1, Stimulates (Agonist / Agent / Mimic or Mimetic) ~ Adrenergic Agent : Sympathetic ~ Sympathomimetic : Sympathetic ~ Parasympathomimetic : Parasympathetic 2. Inhibits CAntagonist / Anti / Lytic [Destroy] / Blocker) ~ Adrenergic Blockers :; Parasympathetic ~ Anti-Cholinergic : Sympathetic ~ Anti-Adrenergic : Parasympathetic ~ Sympatholytic : Parasympathetic ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATION Ss SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Heart Beta 1 SNS / Flight-or- Fight / Adrenergic Stimulate + t Heart rate + t Cardiac Output (Strength of contraction) + t Blood supply to vital organs + (N) Cardiac Output: > 5-7liters/min Beta-1 Adrenergic Agonists * Dobutamine (Commonly used B1 Agonists) * Dopamine (Acute Heart Failure) + Epinephrine (Cardiac Arrest / Anaphylaxix) * Norepinephrine + Isoproterenol + Denopamine + Xamoterol (Limited used / Experimental) Route: + IV (Mostly for emergencies) * IM, SC (Epinephrine) Indications: * Cardiac Arrest * Acute Heart Failure + Hypotension * Anaphylaxis (Epi) Contraindications: * Hypertension * Narrow-angle Glaucoma + Pheochromocytoma (for some) Side Effects: * Tachycardia + Palpatations + Hypertension * Chest Pain + Polyuria Adverse Effects: * Arrythmias + Hypertensive crisis + MI * Continous ECG monitoring + Assess BP/HR + Phentolamine mesylate = antidote for NE and dopamine overdose * Correct hypovolemia before vasopressors. PNS / Rest and Digest / Cholinergic Inhibit + | Heart rate * ¥ Cardiac Ouput (Strength of contraction) Beta-1 Adrenergic Antagonist / Beta Blockers (-OLOL) Selective B1B Indications: * Tachycardia + Palpatations * Hypertension * Chest Pain + Polyuria * Angina Side Effects: + Bradycardia + Hypotension » Fatigue + Dizziness + Cold extremities * Do not give drugs if the HR: <60 BP: <90 * Monitor HR and BP * Do not stop abruptly (Risk for recound + + Blood supply to * Metoprolol * Heart Failure Adverse Effects: hypertension) Vital organs + Atenolol + Arrythmias + Heart block + Use cardio-selective * Acebutolol + Post-MI + Bronchospasm in patients w/ lung * Betaxolol (Non-selective) issues * Esmolol Contraindications: * Depression Non-Selective B1B * Cardiac Arrest Il! Caution for Non- (P-Z) + Severe Heart Failure Selective B1 Blockers! + Propranolol (Acute Phase) + COPD * Nadolol * Bradycardia * Bronchial Asthma + Timolol * Heartblock -DM * Asthma (Non- Route: Selective) * Oral + IV (Metoprolol) PNS / Rest and Digest | Alpha Adrenergic Indications: Side Effects: * Monitor blood / Cholinergic Inhibit + Vasodilation by blocking alpha-1 receptors on blood vessels. + 4 Vascular resistance ++ BP + Improved urine flow in patients w/ BPH Blockers Non-selective Alpha Blockers (Al, A2) + Phentolamine + Phenyxybenzamine Selective Alpha Blockers (A1) * Doxazosin * Prazosin * Terazosin (Often used in BPH) * Tamsulosin (Prostate) + Hypertension * Benign Prostatic + Hyperplasia (BPH) + Pheochromocytoma * Raynaud's disease * Heart failure Contraindications: * Hypotension or orthostatic hypotension * Severe liver disease + Hypersensitivity to alpha blockers + Use with caution in elderly (risk of falls due to hypotension) + Dizziness + Headache » Fatigue + Nasal congestion * Orthostatic hypotension + Palpitations + Sexual dysfunction (e.g., retrograde ejaculation) Adverse Effects: + Severe hypotension * Syncope (especially with first dose - "first-dose phenomenon") pressure and heart rate regularly, especially after the first dose (watch for first-dose hypotension). + Instruct patient to change positions slowly to minimize dizziness and risk of falls. * Administer first dose at bedtime to reduce risk of syncope. * Monitor for signs of fluid retention or edema. + Teach patient to avoid alcohol and hot ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATION Ss SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Blood Vessel Alpha Receptor Constrict & Dilate Sympathomimetic Drugs Stimulate + Vasoconstriction + t Blood supply > Cells will shrink > Decongestion + t Systemic Vascular Resistance > t BP * Reduction in nasal mucosal edema + Improved nasal airflow + Temporary relief of nasal congestion (due to colds, allergies, sinusitis) Nasal Decongestants Topical (intranasal): * Oxymetazoline (Afrin) + Phenylephrine (Neo-Synephrine) + Xylometazoline Oral: + Pseudoephedrine (Sudafed) + Phenylephrine (less effective orally) Indications: * Common cold + Allergic rhinitis (hay fever) + Sinusitis + Upper respiratory tract infections + Before nasal examination or surgery (to reduce mucosal swelling) + Eustachian tube dysfunction (relieves ear pressure) Contraindications: + Hypertension * Severe coronary artery disease + Closed-angle glaucoma + Hyperthyroidism + Prostatic hypertrophy (BPH) » Use of MAO inhibitors (within last 14 days) + Chronic use of topical sprays (due to risk of rebound congestion) Side Effects: + Nasal dryness or irritation (especially with sprays) + Sneezing + Headache + Restlessness or nervousness + Mild hypertension + Palpitations Adverse Effects: + Rebound congestion (rhinitis medicamentosa) - with prolonged topical use (23-5 days) * Tachycardia + Insomnia + Elevated blood pressure + Systemic vasoconstriction (especially with oral forms) * CNS stimulation - anxiety, tremors + Limit use of nasal sprays to 3-5 days to prevent rebound congestion. + Check for hypertension, heart issues, diabetes, or thyroid problems before giving. * Monitor BP and heart rate, especially with oral decongestants. : Avoid caffeine and other stimulants when taking oral forms. * Teach correct nasal spray use: tilt head slightly, don't touch mucosa. + Don't share nasal sprays to avoid spreading infections. * Check if nasal breathing and congestion are improving. + Watch for systemic effects, especially in kids and elderly. Comprehensive List of Antihypertensive Drugs 1. Alpha-Adrenergic Blockers (Alpha-1 Blockers) + | Sympathetic tone > vasodilation Therapeutic Effects: * 4 BP via vasodilation Alpha Blockers (Alpha-1 Adrenergic Antagonists) (-ZOSIN) * Prazosin * Doxazosin * Terazosin + Tamsulosin (for BPH, not BP) Indications: + Hypertension + BPH Contraindications: + Hypotension + Liver disease Side Effects: + Dizziness * Headache * Drowsiness Adverse Effects: * Orthostatic hypotension + Syncope Nursing Considerations: * Administer at bedtime to reduce first-dose hypotension + Monitor BP & HR * Educate on slow position changes 2. Beta-Adrenergic Blockers (Beta- Blockers) + | Sympathetic activity > ) HR, ¥ contractility Therapeutic Effects: + | BP, HR, myocardial oxygen demand Beta Blockers (p- Adrenergic Antagonists) Cardioselective (p1): * Metoprolol + Atenolol + Bisoprolol Non-selective: + Propranolol * Nadolol With alpha-blocking activity: + Labetalol * Carvedilol Indications: + Hypertension + Angina * Heart failure + MI + Arrhythmias Contraindications: * Bradycardia + Asthma & COPD (non-selective) + Heart block Side Effects: + Fatigue + Bradycardia + Dizziness Adverse Effects: + Bronchospasm + Heart block + Depression + Sexual dysfunction Nursing Considerations: + Monitor HR and BP * Do not stop abruptly (risk of rebound HTN) » Use cardio-selective agents for asthmatics 2 ACE Tnhihitore ACE Tnhibitores Tndicatione: Side Fffecte: Nursing Considerationc: ORGANS SYSTEM / KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Blood Vessel Alpha Receptor Constrict & Dilate Important Notes: « Hyperkalemia 1s common with: ACE inhibitors, ARBs, potassium- sparing diuretics, and renin inhibitors - Bradycardia is seen with: Beta blockers, CCBs (non-DHP), central agents * Orthostatic hypotension: common in alpha blockers and qiuretics * Cough and angioedema are hallmark of ACE inhibitors 4. Angiotensin IT Receptor Blockers (ARBs) * Blocks RAAS > J sympathetic tone Therapeutic Effects: + ¥ BP without cough (vs. ACEIs) ARBs (Angiotensin II Receptor Blockers) + Losartan * Valsartan + Irbesartan * Olmesartan * Telmisartan * Candesartan Indications: + Hypertension * Heart failure + Kidney protection Contraindications: + Pregnancy + Renal impairment Side Effects: + Dizziness + Fatigue Adverse Effects: + Hyperkalemia + Renal failure + Rare angioedema Nursing Considerations: * Monitor BP, K*, kidney function + Avoid in pregnancy + Use as ACEI alternative if cough occurs 5. Calcium Channel Blockers (CCBs) + | Smooth muscle contraction > vasodilation (4 sympathetic effect) Therapeutic Effects: * 4 BP, J HR (non- DHP), antianginal Calcium Channel Blockers (CCBs) Dihydropyridines (vasoselective): + Amlodipine + Nifedipine + Felodipine Non-dihydropyridines (cardioselective): Indications: Hypertension, angina, arrhythmias (non-DHP) Contraindications: Bradycardia, heart block (non-DHP), heart failure Side Effects: * Headache + Constipation (verapamil) * Ankle edema Adverse Effects: * Bradycardia * AV block * CHF (non-DHP) Nursing Considerations: + Monitor BP and HR + Avoid grapefruit juice (1 drug level) + Assess for edema and constipation + Verapamil * Diltiazem 6. Diuretics (Thiazide, | Diuretics Indications: Side Effects: Nursing Considerations: Loop, K*-Sparing) + Hypertension ‘Indirect > 4 blood | Thiazide diuretics + Edema Thiazide: * Monitor volume > + BP (no direct ANS effect) Therapeutic Effects: + Reduce blood (first-line): *Hydrochlorothiazide (HCTZ) + Chlorthalidone + Indapamide + Heart failure Contraindications: * Dehydration + Electrolyte * Hypokalemia + Hyperuricemia Loop: * Hypokalemia electrolytes, weight, I&0 + Educate on potassium-rich foods volume, ¥ preload imbalance * Ototoxicity (unless K*-sparing) Loop diuretics: + Sulfa allergy + Furosemide (thiazides) K*-Sparing: + Give in morning to + Bumetanide + Hyperkalemia avoid nocturia * Torasemide Adverse Effects: Potassium-sparing + Severe electrolyte diuretics: imbalance * Spironolactone * Arrhythmias + Eplerenone + Amiloride + Triamterene 7. Central Alpha-2 Central Alpha-2 Indications: Side Effects: Nursing Considerations: Agonists + Agonists + Resistant * Dry mouth * 4 Sympathetic + Clonidine hypertension * Sedation * Do not discontinue outflow from CNS + Methyldopa + Pregnancy + Dizziness suddenly Therapeutic Effects: (preferred in pregnancy) (methyldopa) Adverse Effects: * Monitor liver + | HR and BP * Guanfacine Contraindications: * Rebound hypertension | function (methyldopa) + Liver disease if stopped abruptly + MAOT use + Use caution with CNS depressants 8. Vasodilators Direct Vasodilators Indications: Side Effects: Nursing Considerations: (Direct-Acting) * Hydralazine + Severe or * Headache * Direct smooth + Minoxidil (potent, | resistant + Reflex tachycardia + Monitor HR and BP muscle relaxation > afterload (not ANS- specific) — © + mrr.i.2.. for resistant HTN) hypertension Contraindications: * CAD mi... kt ll + Flushing Adverse Effects: + Lupus-like syndrome PT a a an ee * Often used with beta-blocker to prevent reflex en ee Pe ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Nervous System Neurologic Drugs Important Notes: * Many act on the central nervous system (CNS)—watch for sedation, dizziness, and CNS depression. * Never stop abruptly—risk of selzures, withdrawal, or rebound symptoms. * Monitor liver and kidney function—many are metabolized hepatically and excreted renally. * Fall precautions are crucial due to dizziness or ataxia. * Mood changes and suicidal ideation are possible, especially with antiepileptics. 5. Anti-Manic Agents / Mood Stabilizer ‘Indirect effect on neurotransmitters (dopamine, serotonin, norepinephrine) * No direct autonomic nervous system impact Therapeutic Effects: * Stabilizes mood swings + Reduces manic episodes Drug Examples + Lithium carbonate + Carbamazepine + Clonazepam + Valproate + Lamotrigine Indications + Bipolar disorder (mania/depression) * Schizoaf fective disorder * Mood instability, aggression (of f- label) Contraindications: * Renal or liver disease + Pregnancy (esp. valproate, carbamazepine) * Dehydration, low sodium (for lithium) Side Effects: * Lithium: tremor, thirst, nausea, weight gain + Valproate: GI upset, tremor, hair loss * Carbamazepine: drowsiness, vision changes + Lamotrigine: headache, rash Contraindications: + Lithium: toxicity, hypothyroidism, kidney issues + Valproate: liver failure, pancreatitis * Carbamazepine: blood disorders, severe rash (SJS) + Lamotrigine: serious skin reactions (SJS/TEN) Nursing Considerations: * Monitor levels (especially lithium: 0.6- 1.2 mEq/L) + Encourage fluids & stable salt intake with lithium * Monitor liver, renal function, CBC, and for rashes + Educate patient to report side effects/toxicity signs early 6. Anti-Psychotics / Neuroleptics + Block dopamine; some block acetylcholine, norepinephrine (may affect autonomic tone). Therapeutic Effects + Reduce hallucinations, delusions, agitation * Tourette's syndrome Drug Examples Typical: + Haloperidol (Haldol) + Chlorpromazine (Thorazine) + Thioridazine (Mellaril) + Fluphenazine (Prolixin) Atypical: + Risperidone (Risperdal) + Olanzapine (Zyprexa) * Quetiapine (Seroquel) + Clozapine (Clozaril) + Ziprasidone (Geodon) Indications: + Schizophrenia + Bipolar disorder (mania) + Psychosis Contraindications: + Parkinson's + CNS depression + Elderly with dementia (t death risk) * QT prolongation Side Effects: + Drowsiness + Weight gain + Dry mouth + Constipation Adverse Effects: + EPS / Extrapyramidal Side Effects + Tardive dyskinesia *NMS + Agranulocytosis (clozapine) * QT prolongation Nursing Considerations: * Monitor for EPS, NMS (fever, rigidity), WBC (clozapine) * Educate to avoid alcohol, report movement disorders 7. Hypnotics / Sedatives - Depress CNS; may reduce sympathetic outflow > 4 HR, BP Therapeutic Effects * Promote sleep, reduce anxiety, induce sedation Hypnotics / Sedatives Drug Examples: Barbiturates: + Phenobarbital + Pentobarbital * Secobarbital Indications: + Insomnia + Pre-op sedation + Anxiety + Seizure disorders Contraindications: + Respiratory depression + Severe liver/renal disease + Substance abuse history Side Effects: * Drowsiness + Dizziness * Confusion * Headache Adverse Effects: Barbiturate Toxicity + Hypertension + Pulmonary constriction * Cold & Clammy Skin + Cyanosis of lips + Insomia + Hallucination + Delirium Nursing Considerations: + Use short-term: avoid alcohol + Fall precautions; give before bedtime + Monitor respiration, especially in elderly 8. Anti-Anxiety / Anxiolytics * Reduce sympathetic overactivity () HR, muscle tension) Drug Examples Benzodiazepines: + Lorazepam + Alprazolam (Xanax + Diazepam (Valium) ¢ Chlordiazepoxide Indications: + Anxiety disorders * Panic attacks *GAD * PTSD Side Effects: + Drowsiness + Fatigue + Dizziness + GI upset (buspirone) Advereo Effoertea: Nursing Considerations * BZDs: short-term only; taper slowly + Buspirone: not for acitte anvietyv (takee ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Nervous System Neurologic Drugs Important Notes: + Many act on the central nervous system (CNS)—watch for sedation, dizziness, and CNS depression. + Never stop abruptly—risk of se/zures, withdrawal, or rebound symptoms. * Monitor liver and kidney function—many are metabolized hepatically and excreted renally. + Fall precautions are crucial due to dizziness or ataxia. * Mood changes and suicidal ideation are possible, especially with antiepileptics. 9. General Anesthetics + CNS depression > v sympathetic tone > v BP, ) HR, 4 RR Therapeutic Effects * Induce unconsciousness + Amnesia + Immobility during surgery Drug Examples Inhalation Anesthetics + Cyclopropane * Enflurane + Ether + Nitrous oxide IV Barbiturates + Thiopental (Pentothal) + Methohexital sodium (Brevital) IV & IM Non- barbiturates + Midazolam (Versed) + Ketamine (Ketaject) + Propofol (Diprivan) Indications: + Surgical procedures * Sedation in ICU Contraindications: * Malignant hyperthermia history + Hemodynamic instability + Egg allergy (propofol) “CVA + Increased ICP + Severe hypertension Side Effects: + Nausea * Vomiting + Hypotension * Bradycardia Adverse Effects: * Malignant hyperthermia + Respiratory depression * Cardiac arrest Nursing Considerations + Monitor airway, VS, oxygenation closely + Have Dantrolene ready for malignant hyperthermia * Educate on NPO pre- op status 10. Local Anesthetics Block sensory nerves; minimal systemic ANS effect, unless absorbed in large amounts Therapeutic Effects Numb specific area without affecting consciousness Drug Examples Topical: + Benzocaine (Orajel) * Cocaine + Lidocaine (Xylocaine) Spinal * Dibucaine (Nupercaine) + Procaine (Novocaine) Nerve block + Bupivacaine (Marcaine) 5, * Mepivacaine (Carbocaine) Indications: + Minor surgical/dental procedures + Epidurals * Nerve blocks Contraindications: + Allergy to amide/ester anesthetics + Infection at site Side Effects: * Tingling + Numbness * Mild swelling or redness Adverse Effects: + Systemic toxicity (CNS: seizures, CV: arrhythmias) * Methemoglobinemia (rare) Nursing Considerations * Monitor for signs of toxicity (confusion, tinnitus, metallic taste) + Use smallest effective dose * Check for allergies before administration * Spinal Anesthesia: keep the client flat for 6-12 hours to prevent spinal headache. 11. Migraine Medications + Mild t sympathetic (cranial vasoconstriction) Therapeutic Effects: + Abort migraine attacks Migraine Medications * Sumatriptan + Rizatriptan + Ergotamine Indications: + Acute migraine/cluster headache Contraindications: * CAD + Uncontrolled HTN * pregnancy Side Effects: * Tingling + Flushing + Dizziness Adverse Effects: + MI * Stroke * Serotonin syndrome Nursing Considerations: + Administer at migraine onset + Monitor for chest pain + Avoid in CV risk patients + Use at migraine onset, not asa preventative. * Can cause chest tightness, tingling, dizziness. 12. Alzheimer's Disease Drugs * t parasympathetic tone (AChE inhibitors) Alzheimer's Disease Drug Examples * Donepezil * Rivastigmine Indications: + Alzheimer's + Dementia Contraindications: Side Effects: * Nausea * Diarrhea * Insomnia Nursing Considerations: * Give donepezil at bedtime ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Gastrointestinal System Drugs Important Notes: + Always assess for underlying cause before starting therapy (e.g., rule out infection before giving anti- diarrheals). + Many GI drugs affect electrolytes and fluid balance — monitor labs and hydration. * Watch for drug interactions, especially with antacids (can affect absorption of other meds). + Timing matters: some drugs must be taken before meals (€.9., PPIs) some after (é.g., antacids). * GI drugs often impact the autonomic nervous system (ANS)—monitor for systemic effects like drowsiness or CNS depression 1. Anti-Emetics + Some block dopamine/serotonin receptors, calming vomiting center (CNS effect) * May block parasympathetic activity (drying effect) Therapeutic Effects: + Prevent or reduce nausea and vomiting Antiemetics Drug Examples * Scopolamine (Anticholinergic) * Dronabinol (Cannabinoid) * Granisetron Ondansetron (Serotonin Receptor Antagonist) + Metoclopramide (Dopamine Antagonist) Antihistamines: * Diphenhydramine + Dramamine + Phenergen 5HT3 Blocker: * Ondansetron (Zofran) Phenothiazine: * Promethazine + Prochlorperazine Indications: + Motion sickness + Post-op N/V * Chemo-induced N/V + GI upset Contraindications: + GI obstruction + CNS depression + Seizure disorders (some drugs) * Glaucoma (anticholinergics like scopolamine) Side Effects: * Drowsiness + Dry mouth + Constipation + Blurred vision (anticholinergic) * Headache (Ondansetron) Adverse Effects: + Extrapyramidal symptoms (Metoclopramide) * QT prolongation (Ondansetron) * Sedation + Confusion (elderly) Nursing Considerations: + Use of non-pharma first like dry toast, tea, crackers. * Monitor LOC and vitals + Give before meals or motion exposure if needed + Caution in elderly and driving + Report involuntary movements (EPS) 2. Anti-Peptic Ulcer Disease / PUD * Indirect: Reduce parasympathetic gastric acid secretion Therapeutic Effects: + Reduce acid production, promote ulcer healing Drug Examples: Cytoprotective Agent * Sucralfate (Carafate) + Misoprostol (Cytotec) H2 blockers: * Ranitidine (Zantac) + Famotidine (Pepcid) * Cimetidine (Tagamet) PPIs: + Omeprazole (Prilosec) + Lansoprazole (Prevacid) + Pantoprazole Anti-cholinergics + Chlordiazepoxide (Librax) + Atropine Sulfate Antibiotics (for H. pylori): * Amoxicillin + Clarithromycin * Metronidazole Indications: + GERD * Gastric/duodenal ulcers + Zollinger-Ellison syndrome +H. pylori infection Contraindications: + Allergy + Pregnancy (Misoprostol) Side Effects: * H2 blockers: headache, constipation + PPIs: nausea, abdominal pain * Sucralfate: constipation + Misoprostol: diarrhea, cramping Adverse Effects: + PPI: osteoporosis, B12 deficiency, C. diff + H2 blockers: confusion in elderly + Misoprostol: uterine contractions Nursing Considerations: + Take PPIs before meals, sucralfate before meals and at bedtime * Monitor for GI bleeding signs + Avoid NSAIDs, caffeine, alcohol, spicy food ORGAN INDICATOON / SIDE EFFECTS / NURSING KEY CONCEPTS SYSTEM CONTRAINDICATIONS ADVERSE EFFECTS CONSIDERATIONS 3. Antacids Drug Examples Indications: Side Effects Nursing Considerations + Aluminum * GERD + Aluminum: + Neutralize gastric | hydroxide (AIOH) gel * Gastritis constipation + Give 1-2 hours before acid (Amphogel) + Peptic ulcers * Magnesium: diarrhea | or after other meds * Magnesium * Reflux Esophagus | + Calcium: gas, rebound Therapeutic Effects: | hydroxide (MgOH) + Hiatal Hernia acid + Avoid long-term use Covrcieesvinal | * Neutralize stomach | (Milk of Magnesia) without provider System Drugs | 2Cid > relieve + AIOH + MgOH Contraindications: | Adverse Effects consultation heartburn, indigestion | (Maalox / Magaldrate) | + Renal impairment | + Electrolyte imbalance * Calcium carbonate | (magnesium or * Renal stones + Monitor bowel * Sodium aluminum products) | (calcium) pattern and renal bicarbonate * Heart failure * Metabolic alkalosis function Important . HTN (sodium- (overuse) Neavex: containing) + Always assess for underlying | 4. Anti-Diarrheal Drug Examples: Indications: Side Effects: Nursing Considerations cause before - Acute diarrhea - Constipation starting therapy | + Slow peristalsis via | Fluid Absorbents - Traveler's > Dry mouth + Assess cause of (e.9., rule out parasympathetic (Decrease fluid diarrhea * Drowsiness diarrhea before giving infection before | inhibition content) - IBS-D giving anti- + Kaolin and Pectin Adverse Effects: + Encourage fluid & adiarrheals). Therapeutic Effects: Contraindications: * Toxic megacolon electrolyte replacement + Decrease stool Enteric Bacterium Infectious diarrhea | (especially with C. diff) * Many GI frequency, increase Replacement (C. diff), bloody * CNS depression (with | + Monitor bowel sounds drugs affect consistency + Lactobacillus diarrhea, overuse) & distention electrolytes and Acidophilus (Bacid) obstruction fluid balance — monitor labs and Motility Suppresants hydration, (Decrease GI motility) * Watch for - Loperamide drug hydrochloride interactions, (Imodium) especially with * Diphenoxylate antacids (can hydrochloride affect (Lomotil) absorption of + Bismuth other meds). subsalicylate + Timing 5. Laxatives Drug Examples Indications: Side Effects Nursing Considerations matters: some + Constipation * Cramping drugs must be + Stimulate or mimic + Bulk-forming: + Bowel prep * Gas + Encourage fluid taken before parasympathetic GI Psyllium + Hepatic + Diarrhea intake & fiber meals (2.9., motility + Stimulant: encephalopathy * Bloating PPIs), some Bisacodyl, Senna (Lactulose) + Administer bulk- after (é.g., Therapeutic Effects * Osmotic: Lactulose, Adverse Effects forming with water antacids). - Promote bowel Magnesium citrate Contraindications: * Electrolyte imbalance movement, relieve * Stool softener: * GI obstruction * Dehydration * Monitor bowel * GI drugs constipation Docusate sodium + Perforation + Dependence with patterns & electrolyte often impact the + Lubricant: Mineral * Nausea/Vomiting | overuse levels autonomic oil * Appendicitis nervous system + Use only short-term (ANS)—monitor unless prescribed for systemic effects like drowsiness or CNS depression ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Cardiovascular System Drugs 4. Anti-Anginals + Enhance parasympathetic-like response (J HR, ¥ workload) Therapeutic Effects: - Improve oxygen supply-demand balance in heart Examples: Nitrates: * Nitroglycerin + Isosorbide dinitrate (Isordil) + Isosorbide mononitrate Beta-blockers: + Metoprolol (Lopressor) + Propranolol (Inderal) Calcium channel Indications: + Angina + MI *HTN Contraindications: + Hypotension * ED drugs (with nitrates) + Bradycardia Side Effects: * Headache * Dizziness + Flushing Adverse Effects: + Severe hypotension * Syncope + Reflex tachycardia Nursing Considerations: * Monitor BP and HR before/after + Taper of f beta- blockers to prevent rebound HTN For nitrates: + Store nitrates ina dark, airtight container. + For chest pain, take one dose every 5 min (max 3) > call EMS if blockers: unresolved. + Amlodipine + Verapamil + Avoid ED meds (e.g., * Nicardipine sildenafil) with nitrates + Diltiazem > can cause fatal hypotension. 5. Anti-Coagulants Examples: Indications: Side Effects: Nursing Considerations: * DVT + Bruising + Disrupt the blood * Heparin = *PE + Bleeding gums * Monitor aPTT coagulation process, Protamine Sulfate * Stroke (heparin), INR Thereby suppressing + Warfarin = Vitamin | prevention in A-fib | Adverse Effects: (warfarin) the production of K + Post-op + Hemorrhage fibrin prophylaxis + Heparin-induced + Avoid giving aspirin Therapeutic Effects: + Prevent clot formation/extension DOACSs: * Apixaban + Rivaroxaban * Antidote: Adexanet Alfa Contraindications: + Active bleeding + Recent surgery * Hemorrhagic thrombocytopenia (HIT) » Use soft toothbrush, electric razor to reduce bleeding risk. conditions + Antidotes: Protamine LMWH: sulfate (heparin), + Enoxaparin Vitamin K (warfarin) + Educate about diet consistency (vitamin K) 6. Anti-Dysrhythmics | Examples: Indications: Side Effects: Nursing Considerations: + A-fib + Dizziness * Modulate Class I (Sodium + VT/VF + Fatigue * Monitor ECG, HR, BP sympathetic/parasymp | Channel Blockers): + SVT * Hypotension closely athetic influence on + Lidocaine cardiac conduction * Quinidine Contraindications: | Adverse Effects: + Teach patient to + Procainamide + Heart blocks Amiodarone: report palpitations, Therapeutic Effects: + Flecainide + Severe * Pulmonary toxicity SOB, visual changes + Normalize heart bradycardia * Thyroid dysfunction rhythm and rate Class II (Beta + Hypotension * Check pulmonary and Blockers): Propranolol: thyroid function + Propranolol * Bronchospasm (amiodarone) * Acebutol * Esmolol * Monitor for blood Class III (Conduction Delayers): + Amiodarone * Bretylium Class IV (Calcium- Channel Blocker): ¢ Verapamil dyscrasias + Beta-blockers may cause bronchospasm > avoid in asthma/COPD. ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Respiratory System Drugs 1. Bronchodilators * t Sympathetic stimulation (B2- agonists > bronchodilation) Inhibit parasympathetic activity (anticholinergics) Therapeutic Effects: + Relieve bronchospasm + Improve airflow and breathing Drug Examples: P2-Agonists: * Salbutamol / Albuterol * Salmeterol * Terbutaline + Epinephrine Anticholinergics: + Ipratropium + Tiotropium Methylxanthines: + Theophylline + Aminophylline Indications: + Asthma * COPD * Bronchitis Contraindications: * Cardiac arrhythmias + Uncontrolled HTN * Seizures (for theophylline) Side Effects: + Tremors + Nervousness * Headache * Dry mouth Adverse Effects: * Tachycardia + Palpitations * Paradoxical bronchospasm (rare) Nursing Considerations: + Monitor HR, RR, lung sounds + Use bronchodilator before corticosteroid inhaler + Rinse mouth after inhalation + Educate on proper inhaler technique 2. Mucolytics / Expectorants Drug Examples: Indications: + Productive cough Side Effects: * Nausea & Vomiting Nursing Considerations: Mucolytics: + Respiratory * Drowsiness + Encourage hydration + Mucolytics: act by * Acetylcysteine conditions with to aid mucus thinning dissolving chemical (Mucomyst) thick mucus (COPD, | Adverse Effects: bonds within the bronchitis) * Bronchospasm + Warn about mucus, causing it to Expectorants: (acetylcysteine) unpleasant odor of separate and liquefy, * Guaifenesin Contraindications: + Allergic reactions acetylcysteine thereby (Robitussin) + Asthma reducing viscosity (acetylcysteine may + Use with caution in Antidote for trigger asthma + Expectorants: acetaminophen: bronchospasm) stimulate a gastric + N-acetylcysteine + GI bleeding + Observe for mucosal production of effectiveness: t sputum lung mucous clearance Therapeutic Effects: + Thin and loosen mucus + Promote productive cough 3. Anti-Tussives Drug Examples: Indications: Side Effects: Nursing Considerations: + Some opioids suppress medullary cough center (CNS depression) Therapeutic Effects: + Suppress dry, nonproductive cough Narcotic/Opioid: + Codeine + Hydrocodone bitartrate Non-opioid/Non- narcotic: + Dextromethorphan + Benzonatate + Dry, irritating cough + Constipation (Codeine) Contraindications: + Productive cough + Asthma + Respiratory depression + Children <6 y/o (some agents) * Drowsiness * Dizziness + GI upset Adverse Effects: * Respiratory depression (opioids) + Abuse potential + Avoid in productive coughs unless prescribed + Monitor respiration (opioid-containing) + Educate about drowsiness, fall precautions ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Endocrine System Drugs 1. Anti-Diabetic Agents ‘Indirect: J Sympathetic overactivity due to improved glucose control + Parasympathetic stimulation can increase insulin secretion (vagal tone) Therapeutic Effects * Lower blood glucose levels * Prevent complications of diabetes (neuropathy, nephropathy, retinopathy) Drug Examples Insulin + Rapid + Short + Intermediate + Long-acting Oral hypoglycemics: + Metformin (Biguanide) + Acarbose (Alpha Glucosidase inhibitors) First-generation Sulfonylureas: + Acetohexamide + Chlorpropamide + Tolazamide + Tolbutamide Second-generation Sulfonylureas: + Glipizide + Glyburide + Glimepiride Thiazolidinediones: + Pioglitazone + Rosiglitazone Meglitinides: + Repaglinide + Nateglinide Indications: * Type 1DM (insulin only) * Type 2 DM (oral and injectable agents) Contraindications + Hypoglycemia + Renal or hepatic impairment (esp. with Metformin) * Type 1 DM (for most oral agents) Side Effects * Hypoglycemia * Weight gain (esp. sulfonylureas, insulin) + GI upset (Metformin) * UTI/genital infections (SGLT2 inhibitors) Adverse Effects + Lactic acidosis (Metformin) * Pancreatitis (GLP-1 agonists) * Severe hypoglycemia > coma Nursing Considerations * Monitor blood glucose & HbAic + Educate about hypoglycemia signs * Take Metformin with food * Avoid alcohol (risk of lactic acidosis) + Rotate insulin injection sites « Ensure renal function monitoring + Wear medic alert jewelry/ID 2. Anti-Hyperthyroid Agents * ¥ Sympathetic overactivity by reducing thyroid hormone levels Therapeutic Effects + Inhibit thyroid hormone synthesis * Control symptoms of thyrotoxicosis Drug Examples + Methimazole (Tapazole) + Propylthiouracil (PTU) + Iodine (Lugol's solutions) * Radioactive iodine (RAI) Beta-blockers (adjunct for symptoms): + Propranolol Indications + Hyperthyroidism (e.g., Graves’ disease) + Thyroid storm + Pre-op thyroidectomy Contraindications + Pregnancy (avoid Methimazole in 1st trimester; avoid RAT) + Liver disease (PTU) + Iodine hypersensitivity Side Effects * Rash + Mild GI upset * Metallic taste (iodine) * Hair loss Adverse Effects + Agranulocytosis (PTU, Methimazole) * Hepatotoxicity (PTU) * Hypothyroidism Nursing Considerations * Monitor CBC & liver function * Educate on signs of infection (fever, sore throat) + Report jaundice or dark urine * Take medications at same time daily + Avoid foods high in iodine 3. Anterior Pituitary: Growth Hormone - No direct effect, but GH influences metabolic activity, mimicking sympathetic effects (* glucose, growth, etc.) Therapeutic Effects + Stimulate linear growth in children * Promote protein synthesis & fat metabolism Drug Examples * Somatropin (Humatrope) + Somatrem (Protropin) (synthetic GH) + Sandostatin (Octreotide) Indications: * GH deficiency (children, adults) + Turner syndrome * Chronic kidney disease (pediatric growth failure) Contraindications: + Closed epiphyseal plates + Active malignancy * Diabetic retinopathy Side Effects: * Injection site pain * Edema, joint pain + Hyperglycemia Adverse Effects: + Intracranial hypertension + Slipped capital femoral epiphysis in children * Hypothyroidism Nursing Considerations + Monitor growth rate, glucose levels + Administer at bedtime to mimic natural GH surge + Rotate injection sites + Report limping or headaches 4. Anti-Diuretic Hormone (ADH) * Mimics Drug Examples + Desmopressin (DDAVP) Indications + Diabetes insipidus + Nocturnal enuresis (Desmopressin) « Bleeding disorders Side Effects * Headache * Nasal irritation (nasal spray) Nursing Considerations + Monitor 1&0, daily weights, electrolytes (Na+) ORGAN SYSTEM KEY CONCEPTS INDICATOON / CONTRAINDICATIONS SIDE EFFECTS / ADVERSE EFFECTS NURSING CONSIDERATIONS Genitourinary System Drugs 1. Diuretics * Indirect: J sympathetic tone via + blood volume & RAAS suppression Therapeutic Effects + Promote urine Examples * Mannitol Urea (Osmotic) + Acetazolamide (Carbonic Anhydrase) Loop: + Furosemide (Lasix) Indications + Hypertension + Heart failure * Renal/liver edema * Cerebral edema Contraindications * Anuria + Dehydration Side Effects + Polyuria + Dizziness + Electrolyte loss (K*, Na*) + GI upset Adverse Effects * Hypokalemia Nursing Considerations * Monitor I&0 * Electrolytes + BP * Give in AM * Teach K* diet (increase for loop/ thiazide, avoid for K*- output, reduce BP & + Bumetanide (Bumex) + Severe /hyperkalemia sparing) edema electrolyte * Dehydration Thiazide: imbalances * Ototoxicity * Hydrochlorothiazide | + Sulfaallergy (Furosemide) + Chlorothiazide (thiazide/loop) * Gynecomastia (Spironolactone) K*-Sparing: * Spironolactone * Triamterene 2. Sulfonamides Examples Indications: Side Effects: Nursing Considerations + Sulfamethoxazole- + UTIs + GI upset Therapeutic Effects | trimethoprim (SMX- + Bronchitis * Rash * Encourage ft fluid * Inhibit bacterial TMP) (Bactrim) + Otitis media + Photosensitivity intake folic acid synthesis > bacteriostatic * Succinylsulfathiazole (Sulfasuxidine) + Sulfisoxazole (Gantrisin) * Sulfadiazine + Silver sulfadiazine (topical) + Burns (topical) + Pneumocystis jirovecii Contraindications: + Sulfa allergy * Pregnancy (near * Crystalluria Adverse Effects: * Stevens-Johnson syndrome * Blood dyscrasias + Hepatotoxicity + Avoid sun exposure * Monitor CBC, renal/liver function + Educate on allergy term) * Kernicterus in symptoms + Infants <2 newborns months 3. Immunosuppresants | Examples Indications: Side Effects: Nursing Considerations Calcineurin inhibitors: * Organ transplant | + GI upset * Can reduce immune- | + Cyclosporine rejection prevention | + Hypertension * Monitor for infection related inflammatory | (Sandimmune) + Autoimmune * Acne signs (fever, sore autonomic reactions * Tacrolimus diseases (RA, SLE, * Tremor throat) Therapeutic Effects + Suppress immune response, reduce inflammation Corticosteroids: + Prednisone Antiproliferative agents: * Azathioprine * Mycophenolate IBD) Contraindications: + Active infection * Malignancy + Hypersensitivity Adverse Effects: + Infections * Nephrotoxicity + Hepatotoxicity * Malignancies * Bone marrow suppression + Educate on lifelong adherence (transplant) * Monitor CBC, renal & liver labs + Avoid live vaccines Biologics: + Infliximab + Adalimumab 4. Anti-Infectives Examples: Indications Side Effects Nursing Considerations + Pyelonephritis + GI upset * No direct effect: * Nitrofurantoin + Pyelitis + Diarrhea * Check culture & reduce ANS-mediated | (Furadantin) + Cyctitis * Rash sensitivity before fever and inflammation | + Methenamine + Bacterial Methenamine: starting due to infection Therapeutic Effects * Kill or inhibit growth of pathogens (Hiprex) infections (based on organism & site) Contraindications * Allergy to specific drug class «| iver/kidnev * Crystalluria * Bladder irritation Nitrofurantoin: * Exfoliative dermatitis + Interstitial nenhritiec * Monitor for allergic reaction * Complete full course « Watch for 
