Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Insulin lispro

(Humalog)

&

Insulin Aspart

(Novolog)

Rapid acting insulin

Onset: 5-15 min.

Peak: 1-2 hours

Duration: 4-6 hours

Mainly Type I Diabetes

~ take w/in 15 min. of meal

~ fast acting, short duration

~ should be clear

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

  Regular Insulin

(Humulin R,

Novolin R,

Velosulin BR)

Short- acting insulin

Onset: 30-60 min

Peak: 2-4 hours

Duration: 6-10 hours

Type I Diabetes

~ slower onset but longer duration than rapid

~ can have sliding scale

Can be given by IV

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Insulin Isophane Suspension

(NPH)

&

Insulin Zinc Suspension

(Lente)

Intermediate acting insulin

Onset: 1-2 hours

Peak: 4-8 hours

Duration: 10-18 hours

Type I Diabetes

Slower onset but more prolonged

Should appear cloudy

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Extended insulin zinc suspension

(Ultralente)

Long acting insulin

Onset: 2-4 hours

Peak: 8-14 hours

Duration: 18-24 hours

Is cloudy

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Glargine

(Lantus)

Long acting insulin

Onset: 1-2 hours

Peak: Flat

Duration: 24 hours

Is clear

Alcohol, anabolic steroids, MAOI’s, salicylates increase the hypoglycemic effects = lower blood sugar

Corticosteroids antagonize = increased blood sugar

Must give alone due to low pH of diluent

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Glipizide

(Glucatrol)

Oral antidiabetic-

Sulfonylureas ~ 2^nd gen.

Stimulates insulin secretion from the beta cells of the pancreas

~very rapid onset of action

~ give 30 min. before meals

Type II diabetes

Hematologic system- agranulocytosis, hemolytic anemia, jaundice, hypoglycemia, hemolytic anemia

Contra: not for Type I

Interactions: warfarin, aspirin, digoxin, insulin, diuretics, beta blockers, corticosteroids, MAOI’s, NSAID’s

Metformin

(Glucophage)

Oral antidiabetic-

Biguanides

Inhibits hepatic glucose production and increases the sensitivity of peripheral tissue to insulin

*does not cause hypoglycemia

Type II diabetes (Best type II med)

Helps decrease weight

Affects GI tract- bloating, nausea, cramps, diarrhea

Rare: lactic acidosis

Contra: preg., renal disease, HF, acidosis

Interaction: digoxin, diuretics, alcohol,

Rosiglitazone

(Avandia)

Oral antidiabetic-

Thiazolidenediones (TZD)

Decreases insulin resistance by enhancing the sensitivity to insulin

Type II diabetes

Hepatic toxicity might occur

Weight gain, edema, anemia

Measure ALT before treatment & every 2 mo for 1 year

Haloperidol

(Haldol)

Older antipsychotics

High potency

Blocks the receptors to which dopamine normally binds

Works best on “positive” symptoms (hallucinations, delusions)

High EPS (Extrapyramidal symptoms) due to dopamine blockage

~ less sedation, long duration

~ photosensitivity, sedation, constipation

~ use small doses, esp. w/ geriatrics

Contra: Not for pts w/ PD

Chlorpromazine

(Thorazine)

Older antipsychotics

Low potency

Blocks the receptors to which dopamine normally binds

For “positive” psychotic

Also for relief of N/V, hiccups, porhyria and preop sedation

Low EPS

~ High rate of sedative, anticholinergic and CV SE’s

Orthostatic hypotension, constipation

NMS- SE of antipsychotics – lead pipe rigidity

All antipsychotics: antacids reduce absorption

For side effects, take benzotropine (Cogentin) or Benadryl (neither work for TD because it is irreversible)

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Clozapine

(Clozaril)

Newer “atypical” antipsychotics

Selectively blocks the dopaminergic receptors in the mesolimbic system- so, minor or no EPS

For “positive” symptoms and “negative” symptoms- apathy, social withdrawal

~Lower risk of  EPS & TD & NMS

Causes weight gain -> diabetes

~Will not worsen motor sym. in PD

~SE: agranulocytosis, so monitor WBC weekly, hold if <3,000

~photosensitivity, sedation, anticholinergic effects (constipation)

Fluoxetine

Prozac

SSRI – antidepressant

Slows or inhibits the reuptake of serotonin into presynaptic terminals (increases its levels)

Depression

Has appetite-inhibiting action, so used for bulimia

~OCD, Premenstrual Dys.

Serotonin syndrome- involuntary muscle twitches, akathisia, tremor, seizure & coma

~insomnia, weight gain, sexual dysfunction

~Do not use for 2-5 wks after MAOIs

Aminotriptyline

(Elavil)

Tricyclic antidepressant (TCA)

Block the uptake of serotonergic, muscarinin, histaminergic, adrenergic, dopaminergic receptors in CNS

~balance of serotonin & NE

Depression and various pain disorders (ex: trigeminal neuralgia)

Potent anticholinergic -> dry mouth, constipation, blurred vision, dysrhythmias

~ sedation, impotence, orthostatic hypo, very lethal overdose, affects CNS & CV system- death from seizure (no antidote)

cardiac problems- dysrhythmias

Do not use w/in 14 days of MAOIs

Phenelzine

(Nardil)

MAOI antidepressant

Inhibits the MAO enzyme system in the CNS- amines (dopamine, serotonin..) are not broken down

Depression & panic disorders

Do not eat tyramine! Causes hypertensive crisis – nothing pickled, aged or fermented

Do not take with SSRI’s or sympathomimetics (hypertensive crisis)

Bupropion

(Wellbutrin)

(Zyban)

Other antidepressant

Has modest effect on the blockade of dopamine reuptake

Helps quit smoking

Not for pts w/ seizures, history of bulimia

Don’t mix with MAOI’s

All antidepressants have rebound depression if stop abruptly.

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Lithium Carbonate

(Lithobid)

Antimanics  - mood stabilizers

Exact MOA unknown

~lithium ions alter Na+ transport into nerve cells

Treatment of choice for mania & to prevent recurrent suicidal depression

*Serum level: .8-1.2 required

*decreased Na+ and fluid intake may lead to lithium toxicity (don’t take diuretic, and need Na+)

~Brain damage if mix w/ haloperidol

~increased thirst, urination, diarrhea, choreoathetotic movements (wavelike), weight gain

*Long term: hypothyroidism

Not for: renal/liver disease, schizo, under 12, diabetics

Take albumin, uric acid & glucose levels beforehand

~Don’t mix w/ NSAIDS- toxicity

Carbamazepine

(Tegretol)

Antimanics – mood stabilizers

*An antiepileptic agent

Decreases carbamazepine metabolism

Is similar to TCA’s

Mania, epilepsy

Bone marrow suppression, dysrhythmias, HF, vision & hearing disturbances, acute urinary retention, pneumonia

Lorazepam

(Ativan)

Antianxiety med.

~ Benzodiazepine

Depresses activity in the brainstem and limbic system

~increases the action of GABA (inhibitory neuroT)

IV or SL

Anxiety disorders

Insomnia

Preop med.

Prevents chemo- related N/V & symptoms of acute alcohol withdrawal

SE: drowsiness, ataxic gait, slurred speech

Addictive

Withdrawal: anxiety, insomnia

Severe withdrawal: seizures

Don’t mix w/ alcohol or sedatives

Aluminum antacids

(Mylanta)

Antacids

Promote gastric mucosal defensive mechanisms by stimulating secretion of:

Mucus (protective barrier against HCl)

PG (prevents histamine from binding to parietal cells) bicarb (helps buffer acidic properties of HCl)

Peptic ulcer disease

Hyperacidity disorders

Gastritis

Constipation

Not for renal disease or CV disease (high sodium causes increased BP)

Affects the absorption of meds given at the same time.

Calcium antacids

(Tums)

Antacids

See Aluminum

See Aluminum

Constipation, Rebound hyperacidity,

Gas, Affects the absorption of meds given at the same time.

OK for renal failure

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Magnesium antacids

(Phillips)

Antacids

See aluminum

See aluminum

Diarrhea

Can cause toxicity if used in pts w/ renal failure (Mg accumulates)

Not for renal / CV disease

Affects the absorption of meds given at the same time.

Sodium Bicarb

Antacids

See aluminum

See aluminum

Alkalosis

Electrolyte disturbances

*Monitor for metabolic alkalosis

Affects the absorption of meds given at the same time.

Famotidine

(Pepcid)

H2 Antagonist antacid

Competes w/ histamine for binding sites on parietal cells

*Causes decreased H+ ion production from parietal cells, which increases the stomach pH (more alkaline)

*Blocks 90%

GERD

PUD

Erosive esophagitis

GI bleed adjunct

Low incidence of SE (<3%)

May increase the secretion of prolactin

HA, lethargy, confusion

Diarrhea, cramps, jaundice

Increased BUN, liver tests

*smoking impairs absorption

Contra: Cimetidine, ketoconazole

Thrombocytopenia (low platelet)

Omeprazole

(Prilosec)

Proton Pump Inhibitor (PPI)- antacid

Irreversibly binds to H+/K+ ATPase. This prevents the movement of H+ ions out of the parietal cell into the stomach, thereby blocking ALL gastric acid secretion

Acute treatment of severe GERD unresponsive to conventional therapy

Only oral form

Treatment of H. Pylori

*require hepatic enzyme tests before & during treat.

Safe for short term, but may predispose pts to GI infections due to the reduction of the normal acid- mediated antimicrobial protection

Contra: warfarin, ketoconazole, ampicillin, digoxin

Pantoprazole

(Protonix)

Proton Pump Inhibitor (PPI)- antacid

Irreversibly binds to H+/K+ ATPase. This prevents the movement of H+ ions out of the parietal cell into the stomach, thereby blocking ALL gastric acid secretion

Short term treatment (up to 8 wks) of erosive esophagitis from GERD

H. pylori treatment

*Oral and IV form

Need hepatic enz. tests

Safe for short term, but may predispose pts to GI infections due to the reduction of the normal acid- mediated antimicrobial protection

Contra: warfarin, ketoconazole, ampicillin, digoxin

Sucralfate

(Carafate)

Mucosal Protectant

Acts locally, not systemically, binding directly to surface of ulcers

Active stress ulcers

PUD

Esophageal erosions

*Take 1hr after other meds, 2 hours before

Has little absorption into blood, so is void of systemic toxicity

Constipation, nausea, dry mouth

Take antacids .5hr  before, 1 hr after

Give on empty stomach, don’t crush

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Attapulgite

(Kaopectate)

Adsorbents-

Antidiarrheals

Coat the walls of the GI tract, bind the causative bacteria/toxin & eliminate it

Diarrhea

Can decrease the absorption of digoxin, quinidine, hypoglycemics

Oral anticoagulants (more bleeding)

Toxic w/ methotrexate

Bismuth Subsalicylate

(Pepto Bismol)

Adsorbent –

Antidiarrheal

Coat the walls of the GI tract, bind the causative bacteria/toxin & eliminate it

Diarrhea

A form of aspirin, so use w/ caution in children w/ chickenpox or flu

Temp. darkening of tongue or stool

SE: increased bleeding, constipation, confusion, tinnitus

Belladonna-alkaloid

Anticholinergic

Antidiarrheal

Decrease peristalsis & the muscular tone of the intestine, thus slowing the movement of substances through GI tract

Diarrhea

Not for pts w/ glaucoma, GI obstruction, Myastenia Gravis

~SE: urinary retention, impotence, HA, confusion, blurred vision, photophobia

It’s effects are lowered w/ antacids, MAOI’s, TCA’s and antihistamines

Diphenoxylate w/ atrophine

(Lomotil)

Opiate- antidiarrheal

Acts on smooth muscle of intestinal tract, inhibiting GI motility, decreased peristalsis in intestinal wall

Diarrhea- prescription

Drowsy, NV, constipation, resp. depression, bradycardia, palpitations, hypotension, urinary retention

Common: epigastric pain, dry mouth, anorexia

Contra: can cause additive CNS depressant effect w/ alcohol…

Don’t take if have E. Coli

Loperamide

(Imodium)

Opiate – antidiarrheal

Inhibits both peristalsis in the intestinal wall & intestinal secretion, decreasing the # of stools and water content

Diarrhea- only opiate OTC

Drowsy, NV, constipation, resp. depression, bradycardia, palpitations, hypotension, urinary retention

Common: epigastric pain, dry mouth,

Contra: can cause additive CNS depressant effect w/ alcohol…

Don’t take if have E. Coli

Psyllium

(Metamucil)

Bulk- forming laxative

Increases water absorption, resulting in greater total volume (bulk) of the intestinal contents – helps form formed stools, not liquid ones

Constipation – OTC

Can lower hyperlipidemia

*Take other meds 1 hr before, 2 hours after Metamucil

Impaction, fluid overload, electrolyte imbalances, gas, Mg. toxicity, cramp

~nutrient malabsorption, rash

*Take with lots of water

*Don’t take if abd pain, N/V

Lowers absorption of some drugs

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Docusate Sodium

(Colace)

Emollient- laxative

Prescription

Directly lubricate the stool & the intestines, and acts as stool softener

Prevent water from leaking out of the intestines

Constipation – Rx

Skin rash, decreased absorption of vitamins (KADE), lipid pneumonia, electrolyte imbalances

Glycerin

Hyperosmotic laxative

Prescription

Increase the water content of feces by increasing the osmotic pressure in the intestine, which draws in fluid, resulting in distention, peristalsis, and evacuation

Chronic constipation

Used to evacuate bowels before doctor procedures

~ prescription

SE: abd bloating, rectal irritation, electrolyte imbalances

Contra: Can cause increased CNS depression if given w/ barbiturates, opioids, and antipsychotics

Magnesium Citrate

Saline laxative

Increases osmotic pressure & draws water into the colon, producing a watery stool usually w/ in 3-6 hrs

Constipation (Causes explosion)

Before endoscopic exams

Removal of parasites, helminthes

Mg. toxicity (w/ renal failure)

Electrolyte imbalances, cramping, diarrhea, increased thirst

Contra: Renal disease, abd pain, N/V, obstruction, rectal bleeding

Senna

(Senakot)

Stimulant laxative

Induces intestinal peristalsis

Site of action: entire GI tract

Most likely class to cause dependence

Stimulates the nerves that innervate the intestines

Acute constipation

Bowel surgery prep

SE: nutrient malabsorption, skin rash, gastric irritation, discolored urine

~Can decrease absorption of antibiotics, digoxin, tetracyclines, oral anticoagulants

Scopolamine

(Transderm-Scop)

Anticholinergic-

Antiemetic

Binds to & blocks ACh receptors in inner ear and reticular formation

~Corrects imbalance between ACh and NE

Motion sickness

SE: dizziness, disorientation, drowsy, blurred vision, dilated pupils, dry mouth, constipation, rash

Contra: glaucoma, additive drying effects when given w/ antihistamines and antidepressants

Meclizine

(Antivert)

Antihistamine

Antiemetic

Inhibits ACh by binding to H1 receptors, preventing cholinergic stim in both vestibular & reticular systems

Motion sickness

Dizziness

Vertigo

SE: drowsiness, confusion, blurred vision, dilated pupils, dry mouth, urinary retention

Increased CNS depression

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Prochlorperazine

(Compazine)

Neuroleptic antiemetic

Presctiption

Prevent N/V by blocking dopamine receptors in the CTZ

May also block ACh

Nausea, vomiting

Psychotic disorders

Hiccups

Rx

SE: ortho hypo, ECG changes, tachycardia, HA, extrapyramidal symptoms, pseudo PD, akathesia, TD

Dry mouth, constipation

May cancel benefits of Levadopa

Ondansetron
(Zofran)

Serotonin Blocker- antiemetic

Prescription

Blocks serotonin receptors in the GI tract, CTZ, VC

Prevention of V from chemotherapy

Radiation induced N/V

Oral/ IV Rx

Cause few adverse effects- have specific actions

SE: HA, diarrhea, transient increased AST/ALT, bronchospasm

Metoclopramide

(Reglan)

Prokinetic – antiemetic

(dopamine antagonist)

Prescription

Block dopamine in the CTZ

Stimulates peristalsis in GI tract, enhancing emptying of stomach contents into duodenum and enhancing intestinal movements

Treatment of delayed gastric emptying

GERD

Antiemetic

SE: hypotension, SV tachycardia, dry mouth, diarrhea, HA

~Additive CNS depression

Not for: seizures, breast cancer, GI obstruction

Somatropin

&

Somatrem

Pituitary hormones

Have effects equivalent to those of GH

Promote linear growth in children who lack normal amts of GH

Hypopituitary dwarfism (growth failure)

*can only use if bones have not stopped growing

*usually given SubQ, can be IM

SE: HA, hyperglycemia, ketosis, hypothyroidism, hypercalciuria, rash, antibodies to GH

Vasopressin

(Pitressin)

ADH pituitary hormone

Mimics actions of ADH (antidiuretic hormone)- increases water resorption, concentrates urine; directly stimulates capillary smooth muscle = vasoconstriction

To prevent or control polydipsia (excess thirst), polyuria, and dehydration in pts w/ diabetes insipidus caused by low ADH

Increased BP, drowsiness, HA, lethargy, nausea, cramps, heartburn, uterine cramping, tremor, sweating, vertigo

Desmopressin

(DDAVP)

ADH pituitary hormone

Like vasopressin-

Causes a dose=dependent increase in the plasma level of factor VIII, von Willlebrand’s factor, and tissue plasminogen activator

Hemophilia A

Type I von Willebrand’s disease

Nasal spray, parenteral injection, oral

Increased BP, drowsiness, HA, lethargy, nausea, cramps, heartburn, uterine cramping, tremor, sweating, vertigo

**Careful in pts w/ chronic migraines, seizures or asthma

*don’t take w/ OTC cold meds

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Levothyroxine

Hypothyroidism drug

T3

Causes an increase in the rate of protein, carb, and lipid metabolism

Has cardiostimulating effect- increases sensitivity of the heart to catecholamines

Increases CO, renal blood flow & GFR = diuretic

Hypothyroidism

*Preferred when a rapid effect is desired

*Its hormonal content is standardized and its effect is therefore predictable

SE: cardiac dysrhythmia, tachycardia, hypertension, tremors, HA, nausea, weight loss, insomnia, anxiety, diarrhea, menstrual irregularities, heat intolerance, fever, thyroid storm

*Geriatric dose is 25% less

Contra: increases activity of oral anticoagulants, so lower the anticoagulant’s dose

May decrease serum digitalis levels

Propylthiouracil

(PTU)

Hyperthyroid drug

Inhibits the incorporation of iodine molecules into the amino acid tyrosine- impedes the formation of thyroid hormone

Hyperthyroidism

Liver and bone marrow toxicity

Drowsiness, HA, vertigo, fever

N/V, diarrhea, jaundice, smoky colored urine, low urine output

Agranulocytosis, leucopenia, bleeding

*Increased BUN and Creatinine

*Don’t eat iodine

Hydrocortisone

(Solu-cortef)

Adrenocortical steroid

Short acting- has strong mineralocorticoid actions (K+ excretion and Na+ and water retention)

Weak anti-inflammatory

*Short half life

Replacement therapy in pts w/ adrenocortical insufficiency

~Oral, injectable, topical

SE: peptic ulcers, HF, hypertension, hyperglycemia, osteoporosis, weight gain, steroid psychosis

*decreased resistance to infection

*can produce Cushing’s syndrome

~ fat face, shoulders, trunk & abd (moon face)

*need baseline NA, K, BUN, HgB, Hct , blood glucose levels

Prednisone

(Deltasone)

Glucocorticoid

Intermediate acting

Longer half life and duration of action

Anti-inflammatory or immunosuppressant

Asthma, chronic bronchitis

*is NOT adequate alone to treat adrenocortical insufficiency (Addison’s)

~oral

SE: peptic ulcers, HF, hypertension, hyperglycemia, osteoporosis, weight gain, steroid psychosis

*decreased resistance to infection

*can produce Cushing’s syndrome

~ fat face, shoulders, trunk & abd (moon face)

*need baseline NA, K, BUN, HgB, Hct , blood glucose levels

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Digoxin

Positive Inotropic Agents

Cardiac Glycosides

Causes enhanced myocardial contractions.

+ inotropic effect

Increased SV

Heart failure and dysrhythmias, atrial flutter

SE: HA, halo vision, N/V, bradycardia

Contra: Low K+ increases toxicity

Antidote: Digibind

Other: Level: .5 – 2 ng/mL

Take pulse before (60-120)

Isorbide mononitrate

(Imdur)

Nitrate (Antianginal)

Dilates coronary arteries

Reduces preload & afterload

Chest pain, HF, edema

Has no active metabolites

SE: HA, tachycardia, postural hypotension

Tolerance can develop.

Contra: don’t take w/ Viagra, alcohol

Nitroglycerin

Nitrate (Antianginal)

Dilates coronary arteries

Reduces preload & afterload

~Sublingual: 1 every 5 min.

~Will burn, and cause HA

Available in IV form

Chest pain, coronary artery spasms, narrowed arteries, hypertensive emergencies, pulmonary edema from MI

SE: HA, tachycardia, postural hypotension

Tolerance can develop.

Contra: don’t take w/ Viagra, alcohol

Nifedipine

Calcium Channel Blockers

(Antianginals)

Peripheral artery vasodilation

Negative Inotropic effect (reduced contractility)

Reduce BP, slow HR

Angina, hypertension, SV tachycardia, migraines, Raynaud’s disease

SE: Hypotension, palpitations, heart failure, bradycardia, edema, constipation, wheezing

Clonidine

(Catapres)

Alpha 2 – Adrenergic receptor stimulator (Agonist)

~Antihypertensive agent

Reduces sympathetic outflow

Lowers BP

Works centrally on brain

Hypertension, opioid withdrawal

SE: hypotension, dry mouth, constipation, rebound hypertension, sedation

*Check BP before giving

Catopril

(Capoten)

Ace Inhibitor

(Antihypertensive)

Inhibits the angiotensin converting enzyme (inhibits aldosterone secretion & therefore, inhibits vasoconstriction).

Antihypertensive

Nephroprotective effect on kidney (good for diabetics)

Short half life

SE: Dry nonproductive cough

Loss of taste

Hyperkalemia

Rash, pruritis, anemia

Contra: Don’t take w/ NSAIDS or K+ sparing diuretics

*Monitor K+ levels

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Losartan

(Cozaar)

Angiotensin II Receptor Blockers

(Antihypertensive)

Dilates arteries

Blocks vasoconstriction and the secretion of aldosterone

Antihypertensive agent

Adjunct for heart failure

SE: Risk for URI

Insomnia, dyspnea, nasal congestion, back pain 

(Does not cause cough)

Hydralazine Hydrochloride

(Apresoline)

Vasodilator

(Antihypertensive)

Works directly on blood vessel to cause peripheral vasodilation

Antihypertensive agent

Antihypertensive emergencies

Restores hair growth

SE: dizziness, HA, tachycardia, nasal congestion, anorexia, dysrhythmia

Contra: Pts w/ impaired cerebral or cardiac circulation

Avoid OTC cold meds.

Furosemide

(Lasix)

Loop Diuretic

Blocks chloride & sodium resorption

Dilation of blood vessels of kidneys, lungs & body

Rapid onset of action

Edema associated w/ heart failure, renal disease

Hypertension

Ascites

SE: photosensitivity, aplastic anemia

Hypokalemia

Contra: NSAIDS, lithium

Spironolactone

(Aldactone)

Potassium Sparing Diuretic

Causes Na & H2O to be secreted, K+ retained

Competitively binds to aldosterone

Hypertension

Hyperaldosteronism

Ascites (high doses)

SE: Cramps, urinary frequency, weakness, gynecomastia, irregular menses

Hyperkalemia

Contra: can cause lithium toxicity, don’t take w/ NSAIDs, ACE inhibitors (Hyperkalemia), K+ supplements

Hydrochlorothiazice

(Hydrodiuril)

Thiazide Diuretic

Inhibits sodium, potassium and chloride resorption – results in osmotic water loss

Direct relaxation of arterioles, decreasing afterload

Adjunct for heart failure

Edema

Hypertension

~most common diuretic

~inexpensive

SE: Electrolyte disturbances

Hypokalemia (leg crams, weakness), hyperglycemia

Contra: Digoxin (increases dig. Tox, hypokalemia)

Warfarin Sodium

(Coumadin)

Anticoagulant

Interferes w/ proper production of Vit. K, prevents clots from forming.

PT range 2-3

IMR

Prevents formation of blood clots.

SE: Bleeding, N/V, abd cramps, ulcerations, osteoporosis, skin necrosis, allergic rxns.

Antidote: Vitamin K

Contra: Do not give IM – will bleed

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Heparin

Natural Anticoagulant

From tissues of sheeps & cows

Prevents clots from forming

APPT: 1.5-2x normal

(60-80 range)

Prevent clot formation

Rapid acting

Can give as IV

SE: Bleeding, N/V, abd cramps, ulcerations, osteoporosis, skin necrosis, allergic rxns.

Antidote: Protamine sulfate

Contra: Do not give IM – will bleed

Aspirin

Antiplatelet agent

(Coagulation agent)

Affects normal functioning of platelets- prevents formation of TX, which causes blood vessels to constrict & platelets to aggregate

Dilates vessels, lasts 7 days

Prevent blood clots

Analgesic

Anti-pyretic

SE: drowsiness, confusion, flushing, GI bleed, heart burn

Tinnitus = toxicity

Contra: K+ deficiency, GI bleed, peptic ulcer disease

Clipidogrel

(Plavix)

Antiplatelet agent

(Coagulation agent)

Affects normal functioning of platelets- alters platelet membrane so it can no longer receive signal to aggregate & form clot.

Takes 24-48 hours to work

Prevent blood clots

Reduction of MI, stroke

*Better than aspirin

SE: chest pain, hypertension, edema, flu-symptoms, rash, pruritis, diarrhea

Contra: Don’t mix with NSAIDS- increases bleeding

Streptokinase

(Streptase)

Thrombolytic agent

(Coagulation agent)

Dissolves clots

Digests fibrin

~Not from human source

Dissolves blood clots

Acute MI

DVT

PE

SE: Bleeding, hypotension, allergic reaction

*take baseline lab values

Contra~ Avoid K+ and antacids, do not give an IM injection (bleeding)

Don’t give w/ other drugs that affect platelet function

Lidocaine

(Xylocaine)

Antidysrhythmic

Class 1B

Raises the ventricular fibrillation threshold

Long half life

Can be administered by IV, topical, or Sub Cutaneous

For Ventricular tachycardia

Post MI

Rapid onset (2-15 min)

SE: Bradycardia, CNS toxicities (confusion, tremors), hypotension, blurred vision

*Use sunscreen

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Amiodarone

(Cordarone)

Antidysrhythmic

Class III

Prolongs repolarization

Blocks alpha & beta adrenergic receptors of the SNS

~ Long ½ life (15-100 days), slow onset

Supraventricular & ventricular tachycardia (SVT & VT)

~ Atrial dysrythmias

SE: this drug is fat loving- can store in adipose tissues of organs

~ Corneal microdeposits (halos, dry eyes)

Pulmonary fibrosis

Blue/grey skin

Hypothyroidism, photosensitivity

*use sunscreen

Atorvastatin

(Lipitor)

Statin

(Antilipemic)

Inhibits HMG-CoA reductase, the enzyme needed to make cholesterol

Lowers total LDL and triglycerides

Raises HDL levels

Hyperlipidemias

~Take before bed, once per day

SE: HA, dizziness, constipation, cramps, skin rashes

Myopathy / Myalgias – can lead to renal failure, so report any muscle pain

~Increases liver enzymes (AST, ALT)

Anticoagulants increase effects

Contra: Alcohol, anticoagulants

Cholestyramine (Questran)

Bile Acid Sequestrant

(Antilipemic)

Prevents resportion of bile acids from small intestine

Increases destruction of LDL

Does not decrease triglycerides

Hyperlipidemias

Pruritis

SE: GI – belch, bloat, heartburn

Decreased fat-soluble vit. Absorption (ADEK), burnt odor of urine

*Take 1 hr before or 4 hrs after ion-exhange resins

Niacin

(Nicobin, Vit. B3)

Niacin

(Antilipemic)

Inhibits lipolysis in adipose tissue

Decreases LDL, triglycerides

Increases HDL levels

Hyperlipidemias

SE: Abd. discomfort, hyperpigmentation, blurred vision, hepatotoxicity

Flushing, pruritis

Gemfibrozil

(Lopid)

Fibric Acid derivative

(Antilipemic)

Activates the enzyme responsible for breaking down cholesterol.

Reduces LDL concentrations

Good for mixed hyperlipidemias

SE: Gallstones

Impotence, decreased urine output, greasy stools, steatorrhea, risk for UTI

Contra: Caution w/ anticoagulants

Must monitor CBC & liver fx for 1 yr

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Codeine Sulfate

(Methylmorphine)

Opioid Analgesics

Beneficial effects from actions in CNS

Unwanted effects from actions outside the CNS

Antitussive agent for coughs

*Less effective analgesic than morphine

SE: CNS depression, N/V, constipation, urinary retention, euphoria

Contra: Bronchial asthma

Morphine Sulfate

(MS, MS Contin)

Opioid Analgesics

Beneficial effects from actions in CNS

Unwanted effects from actions outside the CNS

For severe pain

Variety of routes

SE: Highly constipating

Contra: Pts w/ head injuries, bronchial asthma

Fentanly

(Duragesic)

Opioid Analgesics

Beneficial effects from actions in CNS

Unwanted effects from actions outside the CNS

For moderate to severe pain

Used as adjunct to general anesthetics

Very potent

Patch form

Contra: Pts with Myastenia Gravis, bronchial asthma

Meperidine (Demoril)

Opioid Analgesics

Beneficial effects from actions in CNS

Unwanted effects from actions outside the CNS

For pain

Random:

Mu: euphoria, 2+ sedation

Kappa: 4+ sedation

Delata: Analgesia

Very high potential for misuse/addiction

Use w/ caution in elderly, those w/ kidney dysfunction (a metabolite can accumulate and cause seizures)

Don’t use w/ MAOI’s – coma & death

Naloxone HCl

(Narcan)

Opioid Antagonist

(Blocks opioids)

Blocks opioid drugs

For acute opioid overdose

Injectable dose only

Reverses pain killer effects too.

Acetaminophen

(Tylenol)

All NSAIDS

Nonopioid Analgesics

Block pain impulses peripherally

Lower body temp (if have fever)

Weak anti-inflammatory

Mild to moderate pain & fever

SE: Rash, N/V, hepatic necrosis

Max dose: 4,000 mg/ day

Don’t use w/ alcohol

Not for pts w/ renal or hepatic disease

Antidote: Acetylcysteine

Drug

Drug Class

MOA / Drug effects

Used for

SE / Contraindications

Pilocarpine

(Isopto Carpine)

Direct – Acting parasympathomimetic

(Ophthalmic agent)

Directly stimulates PSNS receptors

Causes miosis (constriction), which leads to reduction of IOP from increased outflow of aqueous humor

Chronic open angle

Chronic angle-closure glaucoma

Can be given 1x/week

SE: Hypotension, bradycardia, HA, visual blurring

*Don’t drive at night

Dipivefrin

(Propine)

Sympathomimetic

(Ophthalmic agent)

Stimulates adrenergic receptors

Causes mydriasis (dilation)

Increase in aqueous humor outflow, decreases IOP

Penetrates into anterior chamber

Chronic open angle glaucoma

SE: Burning, eye pain & lacrimation

Tachycardia, hypertension

Contra: Not for narrow-angle glaucoma

Don’t mix w/ cardiac glycosides, thyroid hormones, or tricyclic antidepressants

Timolol

(Timoptic)

Beta – adrenergic blocker

(Ophthalmic agent)

Reduces aqueous humor formation, which reduces IOP

Open angle glaucoma

Ocular hypertension

1x/day dosing

SE: burning, discomfort, blurred vision, photophobia

Systemic: bradycardia, bronchospasm

Not for: bronchial asthma, cardiac failure

Contra: Beta blockers

*Don’t want systemic absorption, so apply pressure for 1 min.

Acetazolamide

(Diamox)

Carbonic anhydrase inhibitor

(ophthalmic agent)

Inhibits enzyme- results in reduced aqueous humor formation = reduced IOP

~ increased renal excretion of water, bicarb, K+

Chronic open- angle glaucoma

Acute angle- closure preop.

Edema from heart failure

Can be taken orally = systemic effects

*Drink 2L fluid/day

*Eat increased K+, low Na

SE: drowsiness, confusion, tinnitus, anorexia, hypokalemia, increased digitalis toxicity, photosensitivity, seizures

*Cross allergy w/ sulfonamides

Mannitol

(Osmitrol)

Osmotic diuretic

(Ophthalmic agent)

Produce an osmotic gradient, which forces water from aqueous & vitreous humors into the bloodstream, causing reduction in IOP

Acute angle closure

Lowering IOP before surgery

*Only by IV

SE: Tachycardia, angina, confusion, dehydration, urinary retention, edema, fever, chills, dry mouth

Contra: Increases lithium excretion

Toxicity: hypovolemia, cardiac dysrhythmias, hyperosmolar nonketotic coma

*Sudden volume shift is bad for cardiac, renal or hepatic diseases

Latanoprost

(Xalatan)

Prostaglandin Agonist

(Ophthalmic agent)

Increases outflow of aqueous fluid

* No effect on the production of aqueous humor

Open angle glaucoma

Ocular hypertension

May turn eyes brown permanently

SE: foreign body sensation, stinging, dotted appearance of cornea, blurred vision