Must Know Drugs:Psych, Complex, Peds/OB,

CommunityCompiled by Hannah Giboney

Psych

Valproic Acid (Depakote, Depakene)Ziprasidone (Geodon)Lithium carbonate

• Anticonvulsant• Uses: partial, generalized and absence seizures, bipolar d/o,

and migraine h/a• S/E: GI effects, hepatotoxicity, pancreatitis,

thrombocytopenia• Contraindications: liver d/o• Interactions: phenytoin and phenobarbital

Bupoprion (Wellbutrin, Zyban)

• Atypical antidepressant; smoking deterrant• S/E: h/a, dry mouth, constipation, increased HR, nausea,

restlessness, weight loss, seizures• Contraindications: seizure d/o, pts on MAOIs• Interventions: monitor for seizures, sip on fluids for dry

mouth, fiber for constipation; take daily, emphasize compliance (1-3 weeks before effects); don't d/c abruptly

Risperidone (Risperdal)Olanzapine (Zyprexa)• Atypical Antipsychotic• Uses: schizophrenia, levodopa-induced psychosis• S/E: agranulocytosis, seizures, DM, weight gain, heart

muscle inflammation• Contraindications: agranulocytosis,

immunosuppressive/anticancer meds, seizure d/o, DM• Interventions: signs of DM/weight gain, monitor for seizures,

CBC

Paroxetine (Paxil)

• SSRI• Uses: major depression, OCD, bulimia, PDD, panic d/o,

PTSD• S/E: sexual dysfunction, weight gain, Serotonin synd (2-

72hr--mental confusion, agitation, anxiety), w/d syndrome, hypoNa, rash, sleepiness, lightheadedness

• Contraindications: pts on MAOIs, Warfarin, TCAs, Lithium, NSAIDs, or anticoagulants

• Interventions: take w/ food, take daily, encourage compliance, no effects until 1-3 weeks

Benztropine mesylate (Cogentin)

• Anti-parkinson: Centrally-acting anticholinergic• Symptomatic relief from dyskenesias• S/E: NV, anticholinergic effects, antihistamine effects• Contraindications: pts w/ narrow-angle glaucoma• Interventions: warn about possible sudden loss of effects of

meds, may be weeks-months before noticeable effects

Haloperidol (Haldol) DecanoateFluphenazine (Prolixin-Decanoate)• Conventional Antipsychotic• Uses: schizophrenia, bipolar d/o, tourette's synd, delusional

d/o, schizoaffective d/o, dementia, huntington's chorea• s/e: seizures, EPS, anticholinergic effects, neuroleptic

malignant syndrome• contraindications: pts in a coma, severe depression,

parkinson's, prolactin-dependent breast cancer, severe hypotension; pts on anticholinergic agents, CNS depressants or levodopa

• Interventions: take on a regular schedule, 4-6 weeks before effects

Complex

Epinephrine (Adrenalin)

• Adrenergic Agonist• Used for cardiac stimulation in cardiac arrest; for

bronchodilation in asthma or allergic/anaphylactic reactions; produces mydriasis; produces local vasoconstriction when combined with local anesthetics and prolongs anesthetic action by decreasing blood blow to the site

• S/E: dysrhythmias, tachycardia, angina, restlessness, urgency or urinary incontinence

• Interventions: monitor VS, lung sounds, UOP & ECG; administer through a large vein

Norepinephrine (Levophed)

• Adrenergic Agonist• Stimulates the heart in cardiac arrest; vasoconstricts and

increases the BP in hypotension and shock• S/E: dysrhythmias, tachycardia, angina, restlessness,

urgency or urinary incontinence• Interventions: monitor VS, lung sounds, UOP & ECG;

administer through a large vein

Dopamine Hydrochloride (Intropin)

• Adrenergic Agonist• Increases BP and cardiac output through positive inotropic

action and increases renal blood flow through its action on alpha and beta receptors

• Used to treat mild renal failure caused by low cardiac output• S/E: dysrhythmias, tachycardia, angina, restlessness,

urgency or urinary incontinence• Interventions: monitor VS, lung sounds, UOP & ECG;

administer through a large vein

Lidocaine (Xylocaine)

• Class IB antidysrhythmic: sodium channel blocker. Local Anesthetic.

• suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heart; block conduction of pain impulses in certain area

• S/E: fluid retention; orthostatic hypotension, constipation; CNS excitation; spinal h/a, urinary retention

• Interventions: monitor HR, RR, BP, ECG; monitor serum drug levels; ensure administration of correct form; IV form must have an infusion pump; limit fluid & salt intake; monitor resp/thyroid/neruo functions; increase fiber

Adenosine (Adenocard)

• Antidysrhythmic• Restoration of normal sinus rhythm (SVT only)• S/E: orthostatic hypotension, constipation; fluid retention

(weight gain, peripheral edema, SOB)• Interventions: monitor HR, RR, BP, ECG; maintain

therapeutic serum drug levels; do not give w/ food that affects absorption; IV form must have an infusion pump; limit fluid & salt intake; monitor resp/thyroid/neruo functions; increase fiber intake

Eptifibatide (Integrillin) & Abciximab (ReoPro)• Antiplatelet: GPIIb/IIIa Inhibitor• Inhibit the aggregation of platelets in the clotting process,

prolonging the bleeding time• Used in the prophylaxis of long-tem conplications following

myocardial infarction, coronary revascularization, stents, and brain attacks (stroke)

• Contraindications: pts w/ bleeding d/o and known sensitivity• S/E: GI bleeding, bruising, hematuria, tarry stools• Interventions: determine sensitivity before administration,

monitor VS, give w/ food if GI bleeding occurs, monitor bleeding time & for S/E r/t bleeding; educate pt how to take & how to monitor for S/E

Tissue Plasminogen Activator (tPA)• Thrombolytic• Activate plasminogen which generates plasmin (an enzyme

that dissolves clots)• Uses: 4-6 hours onset of MI; arterial thrombosis, DVT,

occluded shunts or catheters & pulmonary emboli• Contraindications: internal bleeding; hx of stroke, intracranial

problems, recent surgery; hepatic/renal dz; uncontrolled HTN; recent CPR

• S/E: bleeding, dysrhythmias, fever, allergic rxns• Interventions: aPTT, PT, fibrinogen level, hematocrit, and

platelet count; monitor VS & pulses; monitor for bleeding, excretions for occult blood, for neruo changes, hypotension, tachycardia; avoid injection; direct pressure over puncture site 20-30min; electric razor & brush teeth gently

Nesiritide (Natrecor)

• Vasodilator,diuretic• recombinant version of human BNP that vasodilates arteries

and veins• used in treatment of decompensated HF• S/E: hypotension, confusion, dizziness, dysrhythmias• Interventions: give by continuous IF infusion via pump,

monitor BP, cardiac rhythm, urine output, body weight, monitor for signs of resolving HF

Propofol (Diprivan)

• IV General Anesthetic: loss of consciousness & eliminate response to painful stimuli

• Uses: adjunct to inhalation anesthetics, induction/maintenance of anesthesia, amnesia

• S/E: resp/CV depression, bacterial infection• Interventions: use open vial w/n 6hr; injected into a large

vein after IV lidocaine has been injected into the site to decrease pain

• Interactions: CNS depressants/stimulants, opioid analgesics\

• Implicated in Michael Jackson’s death

Midazolam Hydrochloride (Versed)

• Benzodiazepine: anxiolytic• Action: Depress CNS, muscle-relaxing, anticonvulsant • Contraindications: acute narrow-angle glaucoma; use

cautiously in children & adults; abrupt w/d can be life-threatening

• S/E: phlebitis at IV site, apnea, laryngospasm,resp depression, cardiac arrest

• Toxicity: somnolence, confusion, diminished reflexes, coma, agitation, restlessness, discomfort, anxiety

• Interventions: liver/renal function test results & CBC, reduced dose for elderly & impaired liver function; fall precautions; avoid alcohol, taper dose to stop

Mannitol (Osmitrol)

• Osmotic diuretic• increase osmotic pressure of glomerular filtrate• used for oliguria, prevent RF, decrease ICP, decrease IOP;

used with chemotherapy to induce diuresis• S/E: F&E imbalance, pulmonary edema, NV, H/A,

tachycardia, hypoNa, dehydration• Interventions: monitor VS, weight, UOP, electrolyte levels,

lungs & heart sounds, dehydration, neuro status, IOP, ICP; change position slowly, do not give if med has crystallized in vial

Naloxone Hydrochloride (Narcan)

• Opioid Antagonist• Treat resp depression from opioid OD• Interventions: monitor BP, HR, RR Q 5min, then Q 15min,

then Q 30min until pt is stable• Place pt on cardiac monitor to monitor rhythm, auscultate

breath sounds, have resuscitation equipment available; don't leave unattended, monitor pt for several hours

Sodium bicarbonate (bicarb)

• Orally: Antacids• Action: Reacts w/ gastric acid to produce neutral salts or

salts of low acidity; inactivate pepsin and enhance mucosal protection but don't coat the ulcer crater to protect it from the acid and pepsin; elevates gastric pH above 5

• Uses: PUD and GERD • take on a schedule; chew thoroughly and follow w/ water or

milk; shake liquid prep before administration; allow 1 hour between antacid  and other meds

• S/E: rapid onset, liberating carbon dioxide, increasing intraABD pressure, and promotes flatulence; used w/ caution w/ HTN and HF; can cause systemic alkalosis in pts w/ Renal Impairment

Sodium bicarbonate (bicarb)

• IV: Weak alkaline; used to treat acidosis (esp metabolic), • Action: Shifts carbonic acid/carbon dioxide equilibrium

toward base raising blood pH• Uses: acidosis, hyperkalemia, cardiac arrest

Peds/OB

Mg sulfate

• CNS depressant• Produce uterine relaxation & suppress uterine activity in order

to prevent preterm birth. Used for preeclamptic pts to prevent seizures.

• S/E: depress resp, depress DTRs, hypotension, extreme muscle weakness, flushing, decreased UOP, pulmonary edema, serum Mg levels >9 mg/dL

• Contraindications: Mother: severe (pre)eclampsia, vaginal bleeding, intrauterine infection, cardiac dz.                    Fetus: gestational age >37wks, cervical dilation >4cm, fetal demise, lethal fetal anomaly, chorioamnionitis, acute fetal distress, and chronic intrauterine growth restriction

• Interventions: use controller pump; monitor DTRs, resp & UOP; Mg levels, keep Ca gluconate at bedside (antidote)

Oxytocin (Pitocin)

• stimulates smooth muscle of the uterus & induces contraction of the myocardium; intranasal/IM/IV

• Uses: induce/augment labor, control postpartum bleeding, promote milk letdown; induce/complete abortion

• S/E: rare; allergies, dysrhythmias, BP changes, uterine rupture, water intoxication; nasal vasoconstriction (intranasal); uterine hypertonicity; hypotension/rebound HTN; postpartum hemorrhage

• Interventions: monitor VS/weight/I&O/LOC/lung sounds, the freq, duration, force of contractions & resting uterine tone, fetal HR Q 15min; give IV via infusion monitoring device; don't leave unattended; monitor for hypertonic contractions, uterine hyperstimulation or nonreassuring fetal HR, signs of water intoxication; document. If necessary, turn on her side, increase IV NS rate, & give O2 via face mask

Betamethasone

• Corticosteroid that increases the production of surfactant• Use: pt in preterm labor 28-32 wks gestation whose labor

can be safely inhibited for 48 hours• S/E: decreased resistance to infection; pulmonary edema

secondary to Na and fluid retention; elevated blood glucose levels in pt w/ DM

• Interventions: monitor maternal VS, lung sounds, for edema, signs of infection, WBC, blood glucose levels

Concerta, Adderall, Ritalin

• CNS Stimulant: amphetamines• stimulate the cerebral cortex of the brain; increase alertness &

sensitivity to stimuli• Uses: narcolepsy and ADHD; adjunctive therapy for exogenous

obesity• S/E: irritability, restlessness, tremors, tachycardia,

dysrhythmias, HTN, dry mouth, anorexia/weight loss, ABD cramping, diarrhea/constipation, hepatic failure, psychoses, impotence, dependence and tolerance, high potential for abuse

• Interventions: monitor VS, mental status, CBC, WBC, platelet; degree of inattention, impulsivity, hyperactivity, sleepiness; height/weight/growth of child; take before food; avoid caffeine/alcohol; take >6hrs before bed

Atomoxetine (Strattera)

• CNS stimulant• S/E: tachycardia, anorexia/weight loss, elevated BP,

dizziness, agitation• Interventions: monitor CNS s/e, BP; obtain baseline ECG;

avoid OTC; take last dose >6hr before bed (>14hr if XR); monitor height/weight in children; several weeks before therapeutic effect

Fluticasone/Salmeterol (Advair)

• Corticosteroid + long acting bronchodilator• Uses: prevent asthma attacks or flare-ups of COPD (not for

acute attacks or dyspnea)• S/E: h/a, churg-strauss syndrome• Caution: DM, glaucoma, seizure d/o, pheochromocytoma• Interactions: beta-blockers, ketoconazole, MAOIs• Interventions: assess VS, resp status; allow 1-2min between

inhalations; take regardless of symptoms; do not use as rescue inhaler

Montelukast (Singulair)• Leukotriene modifier• Action: inhibit bronchoconstriction caused by specific

antigens & reduce airway edema and smooth muscle contraction

• Use: prophylaxis/treatment of chronic bronchial sthma• Contraindication: pts w/ hypersensitivity & breast-feeding

mothers; use w/ caution w/ impaired hepatic function• Interaction: inhaled glucocorticoids increase risk of upper

resp infection• S/E: H/A, NV, dyspepsia, diarrhea, generalized pain,

myalgia, fever, dizziness• Intervention: monitor VS, lung sounds (rhonchi/wheezing),

liver function lab values, for cyanosis; take 1hr before or 2 hr after meals; increase fluid intake; don't self-d/c

Terbutaline (Brethine)

• beta-adrenergic agonist• Used to stop preterm labor by relaxing smooth muscles,

inhibiting uterine activity & causing bronchodilation• s/e: SOB, coughing, tachypnea, pulmonary edema,

tachycardia, palpitations, chest pain, hypotension, fluid retention, decreased urine production, tremors, dizziness, muslce cramps, weakness, h/a, hypokalemia, hyperglycemia, hypocalcemia

• interventions: monitor for s/e; put pt on her side; monitor VS, weight, I&O, fluid restriction, comfort measures

dinoprostone (Cervidil)

• prostaglandin E2• “ripen” the cervix (dilation and effacement), stimulate uterine

contractions, given vaginally• Uses: preinduction cervical ripening, induction of labor,

induction of abortion• S/E: diarrhea, NV, stomach cramps, fever, chills, fllushing,

h/a, hypotension, tachysystole (>12 contractions in 20min w/o alteration in fetal HR pattern), hyperstimulation of uterus, fetal passage of meconium

• Contraindications:• Interventions: monitor VS, cervical ripening, Bishop score,

s/e; void before administration, maintain supine position w/ lateral tilt or side-lying for 30-40min

Erythromycin

• Opthalmic ointment or drops are bacteriostatic & bactericidal• Use: prophylactic measure to protect against N. gonorrhoeae & C.

trachomatis• Interventions: cleanse neonate's eyes before instilling drops or

ointment, instill into conjunctival sacs w/n 1hr after delivery; don't flush eyes after instillation

– Oral• Various bacterial infections; otitis media, bronchitits• Adverse effect: GI UPSET; DIARRHEA

Ferrous Fumarate (Hemocyte F)

• Antianemic: iron supplement (same as ferrous sulfate, but different concentration of iron)

• Uses: treat/prevent Fe-def anemia• Contraindications: non-Fe-def anemia• S/E: NV, constipation, dark stools, epigastric pain, teeth

staining (liquid)• Interactions: tetracyclines, ascrobic acid, antiulcer meds• Intervention: assess nutritional status, bowel function;

monitor CBC/BMP; monitor for toxicity/OD (stomach pain, fever, NV); warn about stools; instruct to take 1hr before/after food (unless GI discomfort)

Rhogam

• Uses: prevent anti-Rh (D) antibody formation in Rh-neg pts exposed to Rh-positive blood (from baby)

• S/E: elevated temp, site tenderness• contraindications: Rh-positive women, hx of systemic

allergic rxn to preps containing human immunoglobulins; not for newborn infant

• Intervention: IM injection at 28 wks gestation & w/n 72hr after delivery; not IV; monitor for temp elevation

Vitamin K (AquaMEPHYTON)

• necessary to assist in production of active prothrombin• Use: prophylaxis & tx of hemorrhagic dz of the newborn• S/E: hyperbilirubinemia in newborn• Interventions: protect med from light; give during early

neonatal period, in lateral aspect of mid-3rd of the vastus lateralis muscle of thigh; monitor for bruising at injection site and for bleeding from cord; monitor for jaundice and bilirubin level

Amoxicillin, Amoxicillin-clavunalate (Augmentin)• Broad-Spectrum Penicillin; clavunalate helps make it

penicillinase resistant• Action: inhibit growth of bacteria; beta-lactamase resistant• Uses: prophylaxis bacterial endocarditis; 1st choice for

meningitis• S/E: GI effects (upset stomach, sore mouth, furry tongue);

superinfections; hypersenxitivity rxns (anaphylaxis)• Interventions: assess for allergies, monitor lab values,

monitor I&O, encourage fluid intake, initiate safety precautions (CNS effects); IV, IM

• Educate: importance of compliance

Zidovudine (AZT)

• NRTI• Uses: tx HIV and AIDS; prophylaxis in exposed healthcare

workers, HIV+ mothers, HIV+ sexual partners• Action: inhibit the activity of reverse transcriptase• S/E: NV, anemia, leukopenia, myopathy, fatigue, h/a• use 3 or 4 meds (highly active antiretroviral therapy:

HAART) to delay or reverse loss of immune function, preserve health, and prolong life

Community

Rifampin• 1st-line TB agent to inhibit bacterial RNA synth; used with at

least one other anti-TB med• Contraindication: pts w/ hypersensitivity• Interactions: decreases effects of oral anticoagulants, oral

hypoglycemics, Chloromycetin, Lanoxin, Norpace, Mexitil, Diflucan, Dolophine, Dilantin, Calan, and others.

• S/E: hypersensitivity rxn, heartburn, NVD, red-orange body secretions, vision changes, hepatotoxicity, hepatitis, increased uric acid levels, blood dyscrasias, colitis

• Intervention: CBC, uric acid, LFT; monitor stools (colitis); mental status

• Education: warn about s/e; take as prescribed; avoid alcohol

Isoniazid (INH)

• 1st-line med for TB• bactericidal; used in combo w/ other anti-TB meds• Contraindications: pts w/ hypersensitivity or w/ acute liver dz• Interactions: increase risk of toxicity or Tegretol & Dilantin; may

decrease ketoconazole concentrations; tyramine foiods• S/E: hypersensitivity rxns, peripheral neuritis, neurotoxicity,

hepatotoxicity, pyridoxine (vit B6) deficiency, irritation at inj site w/ IM, NV, dry mouth, dizziness, hyperglycemia, vision changes, hepatitis

• Interventions: monitor LFT, CBC, blood glucose levels; give 1hr before or 2hr after food & 1hr before Al antacids; pyridoxine reduces risk of neurotoxicity; total compliance

lamivudine (Epivir)

• NNRTIs• Uses: HIV and AIDS• Action: inhibit the activity of reverse transcriptase• S/E: nausea, nasal congestion• use 3 or 4 meds (highly active antiretroviral therapy:

HAART) to delay or reverse loss of immune function, preserve health, and prolong life

Bicillin

• PCN G• Action: inhibit growth of bacteria (gram positive narrow

spectrum: S. pneumo, S. pyogenes, syphillis); • Uses: prophylaxis becterial endocarditis; 1st choice for

meningitis; • S/E: GI effects (sore mouth, furry tongue); superinfections;

hypersenxitivity rxns (anaphylaxis)• Interventions: assess for allergies, monitor lab values,

monitor I&O, encourage fluid intake, initiate safety precautions (CNS effects); IV, IM

• Educate: importance of compliance