TOP 40 DRUGS

A1. ACETAMINOPHEN (Tylenol)

EFFECTS: Analgesic (mild to moderate pain) Antipyretic

NO anti-inflammatory effectNO platelet effect

THERAPEUTIC LEVEL: 10 – 30 mg/dL ANTIDOTE: Acetylcysteine (Mucomyst) ADVERSE EFFECTS: hepatotoxic

2. AMINOGLYCOSIDES STREPTOMYCIN/ GENTAMYCIN Obtain Peak and trough level

o Peak level – 30 minutes after taking the drugo Trough level – 30 minutes before the next dose

Adverse effects: Neurotoxic Ototoxic therapeutic to Meniere’s disease to relieve from vertigo (but this is the last resort because it will lead to permanent

deafness) Nephrotoxic Monitor BUN

3. ANESTHESIA REGIONAL

Epidural anesthesiao Given in epidural spaceo side effect: Hypotension

Spinal anesthesia (Sub-Arachnoid Block/ intrathecal)o Given in subarachnoid spaceo side effect: Spinal headache

GENERAL Intravenous Inhalational

4. ANTICOAGULANTS AND THROMBOLYTICS WARFARIN SODIUM

(Coumadin)HEPARIN

(Hepalean)Action Blocks vitamin K and clotting factors synthesis

thus preventing prothrombin formation***Blocks conversion of prothrombin to thrombin

Onset 2 to 5 days 30 seconds to 1 minuteUse Thrombosis and embolism

Atrial fibrillation with embolization Adjunct treatment of coronary occlusion

Thrombosis and embolism Prevention of clotting in heparin lock sets, blood samples and

during dialysis Treatment of disseminated intravascular coagulation

Route Oral SQ, IV(DO NOT give IM, may lead to hematoma and pain)

Expressed in Milligrams UnitsAntidote Vitamin K/ Phytonadione (AquaMEPHYTON) Protamine sulfate

Laboratory test

Prothrombin time (PT) Normal value:11 to 15 seconds

Partial Thromboplastin Time (PTT) Normal value: 60 to 70 seconds; 2 to 2.5 times the controlActivated Partial thromboplastin time (APTT) Normal value: 30 to 45 seconds; 1.5 to 2 times the control

Usage Long term therapy Short term therapyEffect Slow Quick

Coumadin and Heparin CAN BE GIVEN together

Heparin-induced side effect: thrombocytopenia***

WHAT ARE THE DRUGS THAT ENHANCE THE EFFECTS OF ANTICOAGULANTS?4A – Aspirin, Antihistamines, Alcohol, Antibiotics5G – Ginseng, Garlic, Ginger, Ginko biloba, Guiafenesin

ANTICOGULANT – prevents clot formation THROMBOLYTICS – dissolves clot

USE: pulmonary embolism, coronary artery thrombosis, DVT, MI

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SIDE EFFECT: bleeding NURSING CONSIDERATIONS:

Start therapy as soon as possible after thrombus appears as thrombi older than 7 days react poorly to streptokinase*** Heparin is discontinued before streptokinase is started IM injections are contraindicated

ANTIDIOTE: aminocaproic acid (Amicar) Examples: streptokinase (Streptase) – PROTOTYPE; alteplase (Activase), urokinase (Abbokinase), reteplase (Retavase),

tenecteplase (TNKase), anistreplase (Eminase)

5. ANTI DEPRESSANTS 2 weeks interval in shifting from one type of anti-depressant to another Antidepressant effect: 2 – 4 weeks Problem in DEPRESSION:

Decrease norepinephrine Decrease serotonin

3 common groups:(1) TCA(2) SSRI(3) MAOI

Tricyclic Antidepressants (TCA) – increases norepinephrine and/or serotonin in CNS by blocking the reuptake of norepinephrine by presynaptic neurons1. Imipramine (Tofranil)2. Amitriptyline (Elavil)

SIDE EFFECTS: hypotension, arrhythmias, blurred vision, constipation, urinary retention, dry mouth NURSING CONSIDERATIONS:

Check BP and PR Give drug at BEDTIME Changing from TCA to MAOI, patient must discontinue TCA for 14 days 2 to 4 weeks needed before the full therapeutic effect happens TCA OVERDOSE (anticholinergic toxicity):

o Coma, convulsiono Ataxia, agitationo Stupor, sedation

Selective Serotonin Reuptake Inhibitor (SSRI) inhibits CNS neuron uptake of SEROTONIN*** (thus increasing the level of serotonin); DOES NOT AFFECT norepinephrine1. Fluoxetine (Prozac)2. Sertraline (Zoloft)

SIDE EFFECTS: hypotension, headaches, arrhythmias, insomnia, dry mouth, weight loss, sexual dysfunction NURSING CONSIDERATIONS:

o Give drug in the MORNINGo Takes 4 weeks for full effecto Changing from MAOI to SSRI, patient must discontinue MAOI for 2 weekso Changing from SSRI to MAOI, patient must discontinue SSRI for 5 weekso Monitor for weighto Provide oral hygiene

Monoamine Oxidase Inhibitor (MAOI) – acts as a psychomotor stimulator or psychic energizers; blocks oxidative deamination of naturally occurring monoamines (epinephrine, norepinephrine, serotonin) causing CNS stimulation1. tranylcypromine (Parnate)2. isocarboxazid (Marplan)3. phenelzine (Nardil)

SIDE EFFECTS: Hypertensive crisis – happens if the drug is taken with tyramine-containing foodso S - weating C - onstipationo H - eadache, HPN O - rthostatic hypotensiono U - rinary retention P - hotophobia, dilated pupilso N - ausea, Neck stiffness A - granulocytosiso T - achycardia

AVOID tyramine or tryptophan containing foods:o A ged meat, avocadoo B anana, beanso C hocolates, coffee, cheese (cheddar, aged, swiss), chicken and beef livero D rinks that are fermented (wine, beer)

o S moked fish, soy sauce, sour cream, sausageo P ickled foods (herring)o O verripe foods

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o R aisinso T eao Y ogurt, yeast

ALLOW: cottage and cream cheese*** Monitor BP Therapeutic effect are achieved within 10 days to 4 weeks

6. ANTI-GOUT C OLCHICINE (Novocolchine) NSAID anti-inflammatory

o SIDE EFFECTS: diarrhea, abdominal crampso NURSING CONSIDERATIONS:

DO NOT give IM or SQ, this may lead to irritation Administer drug after meals No more than 12 tablets should be given in a 24 hour period

A LLOPURINOL (Zyloprim) prevent production of uric acid by inhibiting the enzyme xanthine oxidoseo USE: prophylactic for attacks of gout; clients with calcium oxalate calculio SIDE EFFECTS: hepatotoxic

P ROBENECID (Benemid)/ SULFINPYRAZONE (Anturane) uricosuric agents o DRUGG OF CHOICE to reduce serum uric acid by increasing its renal excretion

7. ANTI-PARKINSONS Problem in PARKINSONS:

Decrease DOPAMINE Increase ACETYLCHOLINE

Dopaminergic Drugs (increase dopamine)1. Amantadine (Symmetrel)2. Levodopa (L-dopa)3. Levodopa-Carbidopa (Sinemet)

Anticholinergic Drugs (decrease Acetylcholine)1. Akineton2. Cogentin3. Artane4. Benadryl

8. ANTI-PSYCHOTIC (MAJOR TRANQUILIZERS) USE: Schizophrenia

1. Haloperidol (Haldol)2. Chlorpromazine (Thorazine)

NURSING CONSIDERATIONS: Take drug AFTER meals***

SIDE EFFECTS: HYPOtension Agranulocytosis/ leukopenia (sore throat) serious side effect*** NEUROLEPTIC MALIGNANT SYNDROME (HYPERthermia/ diaphoresis, HYPERtension) pink-red urine (normal: thorazine)

9. ASPIRIN/ SALICYLATES/ ACETYLSALICYLIC ACID 4 EFFECTS:

1) Anti platelet reduce risk of myocardial infarction and transient ischemic attack2) Anti-inflammatory rheumatic fever, Kawasaki disease, rheumatoid arthritis3) Antipyretic fever4) Analgesic mild to moderate pain

ASPIRIN TOXICITY Tinnitus – early sign of salicylism Metabolic acidosis – late sign of salicylism Epistaxis, nephrotoxic

NURSING CONSIDERATIONS: ANTIDOTE: activated charcoal (can also give Ipecac syrup to induce vomiting of aspirin) Give the drug with full stomach after meals Aspirin is ulcerogenic Monitor CBC, Prothrombin time, renal and liver functions If (+) ASA allergy, give other anti-platelet drug like Clopidogrel or Ticlopidine***

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AVOID Aspirin in patients with viral infection to prevent Reye’s Syndrome***AVOID Aspirin with OHA causes hypoglycemia***AVOID Aspirin with anticoagulant (Coumadin, Heparin) high risk for bleeding (additive effect)

10. ATROPINE SULFATE (Atropair, AtroPen) MODE OF ACTION:

block neurotransmitter acetylcholine inhibits parasympathetic actions

USES: pre-op medication to reduce secretions and bradycardia; produces mydriasis CONTRAINDICATED in acute glaucoma***, prostatic hypertrophy NURSING CONSIDERATION:

Check BP and PR

B11. BETA-BLOCKERS

2 TYPES:SELECTIVE NON-SELECTIVE

Beta 1 only Beta 1 and 2Atenolol, metoprolol (Lopressor) propanolol (Inderal), timolol (Blocadren),

MODE OF ACTION: inhibit or blocks sympathetic stimulation of beta receptors in the*** – HEART – decreasing myocardial oxygen consumption and demand by:

decreases heart rate*** decreases force of myocardial contraction

EYES – decreases intraocular pressure (IOP) by: decreasing aqueous humor formation and increases aqueous humor outflow (such as glaucoma)

Change of position gradually Take pulse before taking drug***

12. BRONCHODILATOR USE: bronchospasms, asthma EXAMPLES:

BETA-ADRENERGIC: abuterol (Proventil, Ventolin), metaproterenol (Alupent) XANTHINES: theophylline (Theo-Dur) – PROTOTYPE, aminophylline (Truphylline)

THERAPEUTIC LEVEL OF THEOPHYLLINE: 10 – 20 mcg/ml SIGN OF THEOPHYLLINE TOXICITY:

Tachycardia nausea and vomiting

FOODS TO BE AVOID: ICE TEA – caffeine and caffeine containing foods because Theophylline is a xanthine derivative which has same effect with

caffeine

C

13. CLOPIDOGREL (Plavix)/ Ticlopidine (Ticlid) – ANTIPLATELET *** USE: prevent blood clots by inhibiting platelets to coagulate*** INDICATION: heart attack, stroke, or vascular diseases NURSING CONSIDERATION:

Take with 1 full glass of water Can be take with or without food

AVOID: Alcohol Coumadin, Heparin

14. CHEMO DRUGS Methotrexate (folic acid antagonists) - inhibits DNA (protein) synthesis causing cell death

do not give together with Vitamin B9 Tamoxifen is the primary hormonal agent used in breast cancer treatment today.

NURSING INTERVENTIONS FOR CHEMOTHERAPEUTIC SIDE EFFECTSSIDE EFFECTS NURSING INTERVENTIONS

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Nausea and vomiting Administer antiemetics befoore chemotherapy;Withhold food and fluids for 4 to 6 hours before treatment

Constipation Increase fluids and fiber intakeDiarrhea Replace fluids, low fiber diet

Pruritus/ urticaria Provide good skin careStomatitis Provide good oral care (water/ NSS); avoid hot and spicy food

Alopecia Reassure that it is temporary; encourage to wear wigs, hats or head scarf

Skin pigmentation Reassure that it is temporaryNail changes Reassure that nails may grow normally after chemotherapy

Anemia Bed rest; provide frequent rest periods

Neutropenia Protect from infection; AVOID crowded places; fresh fruits and raw foods

ThrombocytopeniaBleeding precaution AVOID aspirin and anticoagulants, bruising, use of straight razors; USE a soft-bristle toothbrush

Hemorrhagic cystitis Provide 2 to 3 liters fluids per dayUrine color changes Reassure that it is harmless

D

15. DIAZEPAM (Valium) USE: Drug of choice for status epilepticus*** EFFECTS:

Anxiolytic Anti-convulsant Muscle relaxant

NURSING CONSIDERATIONS: DO NOT MIX with other drugs DO NOT withdraw abruptly AVOID alcohol, smoking, activities that requires alertness May cause physical dependence Oral form should be given BEFORE MEALS***

Examples: alprazolam (Xanax), clorazepate (Tranxene), flurazepam (Dalmane), midazolam (Versed), triazolam (Halcion), chlordiazepoxide (Librium), clonazepam (Klonopin), lorazepam (Ativan)

16. DIGOXIN (Lanoxin) Effects:

o (+) inotropic – increases FORCE OF CONTRATION increase cardiac output increase kidney perfusion increase urine output

o (-) chronotropic – decreases HEART RATE decrease oxygen demand of the heart muscles***

Digoxin toxicity – nausea, yellow color vision, arrhythmia, sign of hypokalemia (weakness, muscle cramps)

3 parameters to check BEFORE giving Digoxin:1) Heart rate (apical pulse)*2) Serum potassium3) Serum Digoxin level

Urine output sign of drug effectivity***

Antidote: Digoxin immune Fab (Digibind)

17. DIURETICS CLASSIFICATIONS SITE OF

ACTION***EXAMPLES INDICATIONS SPECIAL NURSING

INTERVENTIONS

K-SPARING

Potassium Sparing Distal tubule

Spironolactone (Aldactone)Amiloride (Modiuretic, Midamor)Triamterene (Dyrenium)

Mild diuretic, CHF, HPN Avoid potassium-rich foods (banana***, potatoes, spinach, broccoli, nuts, prunes, tomatoes, oranges, peaches, papaya)

K-WASTING Carbonic Anhydrase Inhibitors (CAI)

Proximal tubule

Acetazolamide (Diamox) Meniere’s disease, OPEN glaucoma

Loop Diuretics Loop of Henle

Furosemide (Lasix)Bumetanide (Bumex)

Severe edema and HPN

Fastest diuretic to take effect

Osmotic Diuretics Glomerulus MannitolOsmitrolGlycerinUrea

Increased ICP Warm solution to avoid crystallization

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Thiazide and Thiazide-like

Distal tubule

Hydrochlorothiazide Chlorothiazide (Diuril)Metolazone

HPN (Not effective for immediate dieresis)

Electrolytes removed through diuretics: potassium, calcium, sodium***

NURSING CONSIDERATIONS:1. Monitor blood pressure (first/ before) and weight (second/ after)2. Administer in the MORNING3. Administer with FOOD

EVALUATION: for effectiveness of therapy Weight loss Increased urine output Resolution of edema Decreased congestion Normal BP

E18. EPINEPHRINE

Ideal drug for cardiac arrest Drug of choice for STATUS asthmaticus Therapeutic property for bronchial asthma and anaphylactic shock: bronchodilation effect Epinephrine + anesthesia – prolongs the function of anesthesia

G19. GASTRIC DRUGS

Classifications: Cytoprotective agents – coats/ cover the gastric lining (give BEFORE meals) Histamine2 blockers – decrease hydrochloric acid production (give WITH meals) Antacid – neutralize gastric acidity (give AFTER meals) Proton Pump Inhibitor – decrease hydrochloric acid production (give BEFORE meals)

Best time to give these drugs: at bedtime

H20. HERBAL DRUGS that cause BLEEDING

GINKO BILOBA GINGER GARLIC GINSENG

I21. IMCI DRUGS: IRON

1 dose daily x 14 daysAGE or WEIGHT TABLET

Ferrous sulphate 200mg + 250 mcg Folate(60 mg elemental iron)

SYRUPFerrous sulphate 150 mg per 5 ml

(6 mg elemental iron per ml)

DROPSFerrous sulphate 25

(25 mg elemental iron per ml)2 to 4 months(4 to <6 kg)

2.5 ml (1/2 tsp) 0.6 ml

4 to 12 months(6 to <10 kg)

4 ml (3/4 tsp) 1 ml

1 to 3 years(10 to <14 kg)

½ tablet 5 ml (1 tsp) 1.5 ml

3 to 5 years(14 to <19 kg)

1 tab 7.5 ml (1.5tsp) 2 ml

22. IMCI DRUG: VITAMIN AAGE

VITAMIN A CAPSULES100,000 IU 200,000 IU

6 months to 12 months 1 ½ capsule12 months to 5 years 2 capsules 1 capsules

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23. IMCI DRUG: MEBENDAZOLE/ ALBENDAZOLEAGE or WEIGHT Albendazole 400 mg tablet Mebendazole 500 mg tablet

12 months to 24 months ½ or 200 mg tablet 124 months to 59 months 1 1

24. INSULIN MODE OF ACTION: decreases blood sugar by –

Increasing glucose transport across cell membranes Enhancing conversion of glucose to glycogen

TYPE DESCRIPTION ONSET PEAK DURATIONULTRA RAPIDLispro (Humalog), Aspart (Novolog)

Route: SQ > 15minutes

30 – 60 minutes

3 – 4hours

RAPID-ACTING: Regular, Humulin R

Color: ClearRoute: IV, SQ

30 min – 1 hr

2 – 4 hrs 6 – 8 hrs

INTERMEDIATE-ACTING: NPH/ Neutral Protamine Hagedorn (Insulin Isophane Suspension), Humulin N

Color: CloudyRoute: SQ

1 – 2 hrs 6 – 8 hrs 18 – 24 hrs

LONG-ACTING: Ultralente (extended insulin zinc suspension)Humulin U

Color: CloudyRoute: SQ

3 – 4 hrs 16 – 20 hrs 30 to 36 hrs

PEAK TIME – time of hypoglycemic episodes 1 ml of insulin = 100 units of insulin U100 insulin syringe is – 100 units Administer insulin in room temperature ROUTE: SQ

45 degree (for skinny patient)*** 90 degrees (for fat patients)

Area: Abdomen – fastest absorption Deltoid thigh buttocks

AVOID: massage and apply compression (increase absorption) aspirate after injection shake. Gently roll vial in between palms Cold insulin lipodystrophy

STORAGE: In room temperature – last for 1 month Refrigerated once opened – last for 3 months

ADJUSMENT OF DOSE: increase insulin requirement Infection, Stress, Illness decrease insulin requirement Breast feeding (Antidiabetic effect)

Mixing of insulin: (Aspirate 1st – clear, Inject air 1st – cloudy)(1) Inject air to NPH(2) Inject air to Regular(3) Aspirate Regular(4) Aspirate NPH

Most common used: U100 (1)U40 (2)

25. IRON SUPPLEMENTS SIDE EFFECTS:

dark stools (tarry stool) constipation abdominal cramps

Tablet: give with citrus juice (orange, tomato)Liquid: give with citrus juice (orange, tomato) and strawIM: Z-track method (DO NOT massage)

BEST given with empty stomach (1 hour before meals*** or 2 hours after meals) Citrus juice is AVOIDED with iron elixir preparation

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L26. LACTULOSE (Duphalac, Cephulac)

Laxative SIDE EFFECT: ammonia binder (therapeutic to patient with hepatic encephalopathy)***

27. LITHIUM Anti-mania Therapeutic Level: 0.5 – 1.5 mEq/L*** Lithium toxicity (nausea and vomiting, anorexia, abdominal cramps, diarrhea) PREPARATIONS:

o Tablets: 300, and 450mg. o Capsules: 150, 300, and 600 mg. o Syrup: 300 mg/5 ml

(NO parenteral preparation)*** Maintain diet:***

o increase fluid (3L/day)o Increase Na (3 gm/day)

M28. MAGNESIUM SULFATE

tocolytic agent USE: premature labor, anticonvulsants in pregnancy induced hypertension (PIH) Check:

o deep tendon reflex (DTR) – FIRST reflex lost with CNS toxicityo Check RR (at least >12 breaths/ mino Check urine output (at least 30 mL/ hr)

Therapeutic level = 4 to 8 mg/dL ANTIDOTE: calcium gluconate

29. METRONIDAZOLE (Flagyl) Anti-amoeba AVOID alcohol (Metronidazole + Alcohol = Disulfiram-like effect)

30. MORPHINE SULFATE (Duramorph) INDICATION: moderate to severe pain, pain relief in myocardial infarction and burns EFFECT:

o induce sedation and euphoriao analgesia o anxiolytico DECREASES preload and afterloado DECREASES workloado DECREASES Peripheral vascular resistance

SIDE EFFECTS: Miosis Orthostatic hypotension Respiratory depression Produces tolerance and dependence Hyperglycemia

Increase urinary retention/ constipation Nausea and vomiting Euphoria Sedation/ dizziness

NURING CONSIDERATIONS: Assess client’s pain before giving medication Check before and after the respiration May lead to tolerance

FIRST SIGN of tolerance is decrease duration of effect of the analgesic AVOID activities that require alertness, alcoholic beverages, smoking, CNS depressants, sedatives, muscle relaxants Change position gradually

N

31. NITRATES AND NITROGLYCERINE (Nitro-bid, Nitrodur, Nitrostat IV) MODE OF ACTION: vasodilator USE: angina pectoris and hypertension

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SIDE EFFECTS OF NITRATES: headache, flushing, orthostatic hypotension, dizziness Other Related drugs: isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur) SUBLINGUAL form: 0.15 – 0.6 mg

No more than 3 tablets should be taken in a 15 minute period (one tablet every 5 minutes); if pain not relieved after 15 minutes and 3 tablets, notify physician immediately

SIGN OF POTENCY: burning sensation under tongue Drink water first BEFORE taking drug

OINTMENT applied to a hairless or clipped/ shaved area new site should be used with each new dose use ruled applicator paper that comes with ointment to measure dose wear gloves during application leave applicator on site and cover it with plastic wrap and secure it with tape

TRANSDERMAL PATCH Apply a patch once a day only Rotate site Place patch in non-hairy area Determine a base region and remove the old patch Wear gloves during application

IV form: 5 mcg/ min dilute IV nitroglycerine in 5% dextrose or 0.9% sodium chloride and titrate every 3 to 5 minutes

STORAGE: store in original dark glass container in a cool, dry place. date bottle when opening discard after 6 months

NURSING CONSIDERATIONS: Change position gradually to prevent dizziness HEADACHE is a sign that the drug is taking effect. It will discontinue with long term use. AVOID alcohol, hot baths Carry drug at all times DO NOT administer nitrates with sildenafil (Viagra), both drugs are vasodilator which may lead to HYPOTENSON

32. NONI JUICE Scientific name: Morinda citrifolia High in fiber Use for diabetes clients

O33. OCTREOTIDE (SANDOSTATIN)***

Inhibits GROWTH HORMONE, GLUCAGON, INSULIN 2 formulations:

Sandostatin®is a short acting version Sandostatin LAR®is a long acting version.

Sandostatin® Sandostatin LAR®subcutaneous injection*** intramuscular injection It may be necessary to take the shot several times a day. This medication is generally given once every 4 weeks

Sandostatin LAR® should NOT be given by S.C. or IV routes.The injection sites should be rotated regularly The preferred site for injection is the hip, because it is painful given

into the arm.

COMMON SIDE EFFECT: constipation***

34. OXYTOCIN (Pitocin) stimulate uterine contraction USE: postpartum bleeding, labor induction ADVERSE EFFECTS: uterine hyperstimulation, arrhythmias, tachycardia, hypertension Given IM or IV (IV via piggyback and delivered with an infusion pump) Observe fetal hypoxia or distress

P35. PANCREATIC ENZYMES

USE: aid in digestion; cystic fibrosis Give WITH MEALS***

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Expected outcome of the drug is absence of steatorrhea*** EXAMPLES: pancreatin (Dizymes), pancrelipase (Cotazym)

36. PHENYTOIN (Dilantin) USE: seizure SIDE EFFECT: gingival hyperplasia, may turn urine pink, red, or red-brown ADVERSE EFFECTS: hepatotoxic, Steven-Johnson’s syndrome DO NOT administer IM Give drug with NSS BEFORE AND AFTER (flushing) drug administration Provide oral hygiene, Use soft, bristled toothbrush Takes 7 to 10 days to achieve therapeutic serum level Therapeutic level: 10 – 20 mg/ dl

37. PRE-OPERATIVE MEDICATIONS PURPOSE: to facilitate anesthesia induction***

PRE-OP DRUGS MODEOF ACTION Examples WATCH OUTMUSCLE RELAXANT Relaxes smooth and

skeletal musclesMidazolamDiazepamLorazepamAlprazolam

BP Avoid rapid injection to prevent shock

OPIATE AGONISTS(Narcotic analgesic)

Increases pain threshold thus needing lesser amount of anesthesia

Morphine sulfateFentanyl citrateCodeine

RR Antidote: naloxone (narcan)

ANTICHOLINERGIC Decrease mucus and saliva production

DiphenhydramineAtropine sufateScopolamineHydrobromide

HR Causes constipation

S38. STEROIDS

USE: bronchial asthma, Addison’s disease, allergies Examples: hydrocortisone (Cortisol), prednisone (Strap red), dexamethasone (Decadron), methylprednisone (Solu- medrol),

betamethasone (Celestone)

THERAPEUTIC EFFECTS: Anti-inflammatory Hormonal replacement

SIDE EFFECTS: Long term use: Adrenal insufficiency***, osteoporosis Short term use:

Cushing’s syndrome: Immunosuppressant, hypokalemia, edema Immunosuppression therapeutic to AUTOIMMUNE DISEASES like nephrotic syndrome, SLE, multiple

sclerosis, Rheumatoid arthritis, for organ transplant, hyperthyroidism, allergies) hypocalcemia, GI ulcer

NURSING CONSIDERATIONS: Give with food Give in the morning (before 9 am)

Take medication with breakfast (corresponds to biorhythms and reduces gastric irritation) Watch out for infection Taper the dose (abrupt withdrawal may lead to acute adrenal crisis) Parenteral form: Give IM avoid SQ

Oral form: Give it WITH food or milk, may cause gastric irritation Topical creams: DO NOT apply in broken skin and near eyes

Wear medic alert bracelet Isolation precaution AVOID:

AVOID immobility to prevent osteoporosis AVOID crowd to prevent infection AVOID sunlight

DIET: Restrict sodium, alcohol and caffeine; high potassium foods Carry extra medication during travel. Adjust medications during periods of acute or chronic stress such as pregnancy or infections; contact health care provider.

39. SYMPATHETIC AND PARSYMPATHETIC

SYMPATHETIC PARASYMPATHETICSNS (Adrenergic) PNS (Cholinergic)

Dumping Syndrome, MG Glaucoma, GERD

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AtropineCholinesterase

ProstigmineAnticholinesterase

“fight or flight” response “Sleep and digest” response(BIOAMINE THEORY)Epinephrine (Adrenaline) – faster release but short actingNorepinephrineDopamineSerotonin

Acetylcholine – slowly release but long acting

(Increase) HR, RR, BP(Decrease) peristalsis, UO, secretionsPupil dilation (mydriasis)BronchodilationHyperglycemia

(Decrease) HR, RR, BP(Increase) peristalsis, UO, secretionsPupil constriction (miosis)Bronchoconstriction

DiarrheaUrinary frequencyMiosis (constriction)BradycardiaBronchoconstrictionErection/ emesisLSalivation

T40. THYROID AND ANTI-THYROID DRUGS

THYROID AGONISTS – used to increase blood thyroid hormones

LEVOTHYROXINE (Synthroid) USE: hypothyroidism (myxedema), cretinism (congenital hypothyroidism) SIDE EFFECTS: insomnia, tachycardia, diarrhea NURING CONSIDERATIONS:

Taper the dose Monitor vital signs (temperature, BP, PR) Give the drug in the morning (due to insomnia side effect)

CONTRAINDICATIONS: Cabbage, Cauliflower Peaches, Peas, Pears Raddish, turnips Spinach

The normal maintenance dose of levothyroxine: adult is 0.1 to 0.2 mg daily infants 0 to 6 months of age is 0.025 to 0.05 mg daily children 1 to 5 years of age, 0.075 to 0.1 mg daily children 6 to 12 months of age, 0.05 to 0.075 mg daily.

THYROID ANTAGONISTS – used to decrease blood thyroid hormones

A. ANTITHYROID DRUGS – inhibit synthesis/production of thyroid hormones***Examples: propylthiouracil (PTU, Propacil, Propyl-Thyracil), methimazole (Tapazole)

B. IODIDES – inhibit secretion/ release of thyroid hormone; _ decrease vascularity of the thyroid gland (for thyroidectomy preparation)

Examples: Potassium Iodide Saturated Solution (Lugol’s solution) Give at least 10 day before surgery

SIDE EFFECTS: agranulocytosis (sore throat) paresthesias bleeding (inhibits vitamin K)

Taper the dose Monitor vital signs (temperature, BP, PR) AVOID iodine, iodine containing foods and sea foods ORAL form: dilute with water or juice (to improve taste) and use straw (to prevent discoloration)

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