Summary of Pharmacological Agents:2015

Neurologic/Neuromuscular Agents

Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsSide Effects/Adverse EffectsNursing Considerations

Tetracycline

TetracyclineSumycin

> Bacteriostatic> Inhibits bacterial protein synthesis> Broad Spectrum

>Tx mycoplasma pneumonia>Tx H. Pylori when combined with other drugs>Tx severe acne vulgaris>Clostridium Difficile Bacteria Related Colitis> Teratogenic> Teeth discoloration if given to patients Avoid prolonged sun exposure (photosensitivity)> Dont take with dairy or antacids>Take on empty stomach

Macrolides

ErythromycinEry-tab

> Interferes with cell wall synthesis leading to cell death> Different structure from PCN, can give if allergic to PCN>Tx staphylococcus and other infections

>Torsades de Pointes> Prolonged Q-T interval on EKG> Hepatotoxicity>Ototoxicity

> Risk for sudden cardiac death with drug interactions

> Give w/ food if GI upset> Dont give w/ milk or acidic drinks> IV may irritate vein

Macrolides

AzithromycinZithromax

> Inhibits protein synthesis (bacteriostatic)>Bactericidal if given in large dose>Tx most gram positive, some gram negative>TxUTIs, Legionnaires

> Hypersensitivity to macrolides>Macrolides may prolong QT interval

> Reduced absorption if taken with antacids

Macrolides

ClarithromycinBiaxin

> Inhibits protein synthesis (bacteriostatic)>Bactericidal if given in large dose>Tx duodenal ulcers caused by H pylori>TxPharyngitis/ Tonsillitisdue toStreptococcus pyogenes> Hypersensitivity to macrolides> QT prolongation, ventricular arrhythmia> May affect prolong interval

> Tablets and oral suspension can be taken w/ or w/o food; can be taken with milk> BIAXIN XL tablets should be taken with food

Cephalos-porins

CefazolinAncef

> First Generation> Inhibits cell wall synthesis>Kills gram positive bacteria> Beta-lactam structure>Tx UTI, skin/joint/bone infection, septicemia, and genital infection

> Alcohol causes disulfiram reaction

> NephrotoxicityHypersensitivity/Anaphylaxis> Clotting issues with high dose

> IM or IV

Cephalos-porins

CefepimeMaxipime

> Fourth generation>Tx broad spectrum bacteria and pseudomonasCrosses blood brain barrier>Tx UTI, skin/joint/bone infection, and genital infection

> Alcohol causes disulfiram reaction> Hypersensitivity to beta-lactam antibiotics> Nephrotoxicity>Hypersensitivity/Anaphylaxis> Clotting issues with high dose> Neurotoxicity when renal insufficiency

> IM or IV

Glycopeptide

VancomycinVancocin

> Inhibits cell wall synthesis (gram positive bacteria)

>IV: Tx staphylococcus and streptococcus> Oral: Tx pseudomembranous colitis (C. Diff)>MRSA specifically, less efficacious than Oxacillin for regular staph> Condition of Increased Mast Cells> Decreased Neutrophils> Red Man Syndrome due to rapid IV push, extravasation> Anaphylaxis> Nephrotoxicity, neurotoxicity>Ototoxicity> Stevens Johnsons>Blood dyscrasias

> Assess VS and IV site before administering > Infuse over 60 minutes, no more than 5 mg/mL>Dilute 500 mg in 100 mL>Dilute 1000 mg in 250 mL

Lipopeptides

DaptomycinCubicin

> Bactericidal> Inhibits protein, DNA/RNA synthesis

>Tx G+ skin infections>Bacteremia r/tS. aureus> Infective endocarditis> Methicillin resistant S. aureus thats refractory to Vanco> Numbness, tingling or pain of hands or feet > Pneumonia with High amount of eosinophils>Rhabdomyolysis when given with statins> Myopathy> Peripheral neuropathy> K+ imbalance> Hyperglycemia> Pleural effusion

> Toxic with Tobramycin> Increased bleeding with Coumadin

Antiviral

Acyclovir SodiumZovirax

> Interferes with viral nucleic acid synthesis in cells (DNA/RNA)

>Herpes zoster

> Renal/Hepatic disease adjust dose

> Urticaria> Anemia> Nephrotoxicity>Anemia (lowers immune system)> Tell your doctor if you have any changes in weight (dose is affected)

Flouroquino-lones

LevoflaxicinLevaquin

> Interrupts DNA synthesis> Bactericidal> Absorbed by GI

>Tx gram positive and gram negative>Tx UTI, bone/joint infections, pneumonia, gonorrhea> Pregnancy (CategoryC(Risk cannot be ruled out)

> Stevens Johnsons> Encephalopathy>Seizures> Pseudo C. Diff>Dysrhythmias>Ruptured tendons

> Take at least 2 hours before or 2 hours after taking other products that may bind to it>Monitor for diarrhea

Anti-Fungal

MetronidazoleFlagyl

> Interferes with DNA function of bacteria

>Tx GI infections>Treatment for C.Diff infection>Prophylaxis in bowel surgery>Pregnancy (1st trimester)

> Peripheral neuropathy> Seizures> Encephalopathy> Do not drink alcohol

Aminoglyco-sides

GentamycinGaramycin

> Inhibits protein synthesis that's essential for bacterial growth

>Tx serious infections (sepsis)

> Loop diuretics = increased ototoxicity> With vancomycin = increased nephrotoxicity>Superinfections> Oliguria>Ototoxicity> Nephrotoxicity> Liver damage

> Check I/Os, creatinine clearance>Monitor for candidiasis, leukoplakia

Penicillin

AugmentinAmoxicillin-Clavulanate

> Combined with PCN-nase to intensify amoxicillin> Inhibits bacterial beta-lactamase enzyme>Tx gram positive and gram negative> Kills E. Coli, salmonella, influenza

> Liver disease>Kidney disease> Mononucleosis> Agitation> Confusion> Unusual thoughts or behavior> Seizure>Anaphylaxis

> Do not crush or chew the Augmentin XR (extended-release) tablet

Penicillin

PiperacillinPipracil

> Inhibits bacterial beta-lactamase enzyme> Extended spectrum (longer lasting!)

>Tx gram negative organisms>Tx bone/join, skin, soft tissue infections, UTI, respiratory infections> Anti-pseudomonal PCN

> Allergic reactions to any of the penicillin, cephalosporin, or -lactamase inhibitors> Hypoglycemia> Candidiasis>Arthralgia>Thrombo-phlebitis>thrombo-cytopenia

Antibiotics

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Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsSide Effects/Adverse effectsNursing Considerations

Cardiac Glycoside

DigoxinLanoxin

>Inhibits Na+ and K+ pump>Inotropic increase force and velocity of contractions>Increase Ca+ intracellular during depolarization>Tx CHF, A Fib, Paroxysmal Atrial Tachycardia

> Confusion>Delirium

> Toxicity! (Dig level =0.5 - 2.0 mg/mL)>Dysrhythmias> Visual Disturbances (halos around lights)

> Protein Binding 20-30%> Low K+ = Increased effects> Check BUN, creatinine, do not give if HR is Class 3> Prolongs repolarization (action potential)

>Tx of Atrial fibrillation, V-tach, V-Fib>Given in code> Cardiogenic shock> Symptomatic bradycardia (w/o pacer) >Hypotension> AV Block> Arrhythmia (PVCs, V-tach)> Peripheral neuropathy>IV site phlebitis>Pulmonary toxicity>Thyroid toxicity>Liver toxicity>Skin deposits

> Grapefruit = toxicity> Avoid citrus juices>Monitor peripheral IV site closely

HMG CoAReductase Inhibitors

AtorvastatinLipitor

> Inhibits HMG CoAreductase

> Lowers LDLs and triglycerides in blood> Increased HDLs> Seizure hx> Metabolic/Endocrine disorders>Rhabdomyolysis> Stevens Johnsons> Photosensitivity>Liver failure>Lactic acidosis>Rhabdomyolysis>Muscle pain (most common)> High Protein binding = toxicity> No citrus juices>Monitor for Myalgia

Anti-coagulants

ClopidogrelPlavix

> Prevents platelet aggregation by blocking adenosine diphosphate from binding to receptor>DVT, PE, post-bypass, post-thrombotic stroke, post-orthopedic Sx

> Active bleeding> Signs of heart attack/stroke

>Aplastic anemia> Stevens Johnsons> Given to patients allergic to aspirin>Monitor bleeding esp. when taken with other anticoagulants

Calcium Channel Blocker

NifedipineProcardia

> Inhibits Ca+ influx into smooth muscle (heart)

>Tx of angina and HTN

> Cardiogenic shock> May be contraindicated in STEMI>Angioedema>Heart block> Rebound tachycardia

> No citrus (grapefruit) juices> D/C slowly to prevent reflex tachycardia>Do not give if HR is Tx angina, HTN, arrhythmia >Sensitivity to amlodipine> Heart block>Angioedema

> No citrus (grapefruit) juices>Do not give if HR is Lowers HR/ BP> Prolongs PR interval> Reduces workload of heart>Tx angina and HTN>MI> Prevents heart attack>Portal HTN and varices

> Sinus brady, heart block (w/o pacer)> Cardiogenic shock> Uncompensated heart failure> Pulmonary edema> Pregnancy> Heart blocks> Ventricular arrhythmia> Sinus bradycardia>CHF

> D/C slowly to avoid MI>Do not give if HR is Lowers HR and BP>Tx tremors, angina, HTN, akathisia, hyperthyroidism>Anxiety (?)

> Uncompensated CHF> Cardiogenic shock> Severe sinus brady, heart block (w/o pacer)> Bronchial asthma> Heart blocks

> Monitor VS and assess lungs before administering>Do not give if HR is Lowers HR and BP> Lowers renin>Tx HTN>MI

> Severe sinus brady, heart block> Cardiogenic shock>Decompensated HF> Severe PAD> Systolic Prolongs PR interval> Heart blocks>Hypotension

> Monitor VS and assess lungs before administering>Do not give if HR is Antioxidant properties

> Slows progression of CHF (reduces free radicals linked to atherosclerosis)> Prolongs PR interval> Heart block

> Monitor VS and assess lungs before administering>Do not give if HR is Stimulates cGMP> Dilates blood vessels and causes vascular smooth muscle relaxation>Reduces afterload (only at doses>200mcg) and preload

>Tx for angina>MI>Acute heart failure

>Hypotension>Decreased effect of heparin

>Headache>Life-threatening (circulatory collapse)> Reflex tachycardia and lowers BP if given too fast

> SL (every 1-3 minutes for 10 total minutes = three doses)> IV (titrated and diluted in D5W)> Topical patch (remove in 12 hours)> Spray (3 sprays within 15 mins.)> D/C slowly to avoid rebound effect> Stored in brown bottle (no heat/sunlight)> Uses special IV glass bottles and tubing because adheres to plastic

Diuretics

FurosemideLasix

> Loop diuretic at Loop of Henle> Na+, Cl, H2O, K+ excreted

>Tx fluid retention and HTN>Tx heart failure> Anuria> Renal failure > Cirrhosis> Risk for nephrotoxicity> Severe hypokalemia>Metabolic acidosis

> Decreases insulin effect in DM>Monitor K, Mg

Diuretics

MannitolOsmitrol

> Osmotic Diuretic> Pulls fluid into urine >Tx cerebral edema and intracranial pressure

> Anuria, severe dehydration> Active intracranial bleeding> Severe pulmonary edema/congestion

> Fluid-electrolyte imbalance> Pulmonary edema>Hyperglycemia

> Irritating to veins; monitor for crystallization>Expect increase in urine output

Diuretics

SpironolactoneAldactone

> K-Sparing diuretic> Blocks production of aldosterone>Act son collecting and distal tubule to promote water and sodium excretions and potassium retention

>Tx CHF> promotes Na+/H2O secretion

> Anuria, acute renal insufficiency> Hyperkalemia> Addisons> Stevens Johnsons>Dysrhythmias

> No extra K+ in food>Monitor K in patients taking ACE inhibitors or with kidney failure>No K supplementation>Monitor urine output

Diuretics

HydrochlorothiazideAquazide H

> Thiazide diuretics> Inhibits Na+ and Ca+absorption in ascending loop of Henle>Tx CHF, edema, HTN, Kidney disorder

> Anuria> Anuria > Glaucoma>Arrhythmia> Photosensitivity

> Don't administer if BP is too low or if allergic to sulfonamides

Anti-coagulant

WarfarinCoumadin

> Inhibits hepatic synthesis of coagulation factors dependent on vitamin K

> Prevents thromboembolic conditions (embolism, A Fib, Stroke, CVA, DVT, PE)> Hemorrhagic tendency (e.g. aneurysm)> Eye/CNS ortraumatic surgery> Blood dyscrasias> Severe HTN>Pericarditis> Pregnancy> Increased AST/ALT> Bleeding (treat bleeding with fresh plasma or more effectively with PCC)

> Normal PT: 10-12 sec.> INR: 0.7-1.7> Antidote: Vitamin KINR Treatment goals:AF: 2-3Mech. Valves: 2.5 to 3.5PE: 2.5-3.5DVT: 2-3

Cardiovascular Agents

Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsAdverse EffectsSide EffectsNursing Considerations

Bronchodilators

AlbuterolProventil/Ventolin

> Rapid onset> Selective Beta 2 agonist>Maintenance treatment for COPD/broncho-spasm,asthma> Narrow angle glaucoma> Urinary retention> Angina> Hypokalemia>Arrhythmias>Tachycardia> Breathe in slowly and evenly until you have inhaled all of the medicine > Patients who use a beta-agonist inhalant should administer it 5 minutes before ipratropium

AnticholinergicTiotropium SpirivaIpratropium bromide Atrovent

>Antagonizes acetylcholine at the vagal-mediated receptor sites relaxes smooth muscle of bronchi (blocks parasympathetic response)>Maintenance treatment for COPD/bronchospasm,asthma>Narrow-angle glaucoma, urinary retention>dry mouth, constipation, vomiting, dyspepsia, abdominal pain, depression, insomnia, headache, joint pain, peripheral edema, and chest pain

Antihistamine

DiphenhydramineBenadryl

> H1 Blocker> Competes with histamine for receptors to prevent response

> First generation> Reduces itching, secretions, sneezing>Tx allergies and cough> Dilates eyes so avoid use on patients with narrow angle glaucoma

> Low BP> Risk for falls>Atropine-like effects> urinary retention)> Avoid use with MAOIs

Antihistamine

LoratadineClaritin

> Selectively antagonizes H1 receptors

> 2nd Generation> Non-sedating>Tx allergies (rhinitis)>hypersensitive tomedicationor to any of its ingredients

> Anaphylaxis>Jaundice>Seizures

> In adults,tachycardia, and headache have been reported with overdoses greater than 10 mg

Respiratory Agents

Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsAdverse EffectsSide EffectsNursingConsiderations

Benzodiazepines

LorazepamAtivan

> Potentiates GABA (inhibits rapid transmission)> Binds to benzodiazepine receptors

> Decreases signs of severe anxiety> Indirectly controls N/V that may occur with cancer chemotherapy> Provides sedation, anxiety reduction, & amnesia when used with a glucocorticoid & serotonin 5-HT3 receptor antagonist

> Wide-Angle Glaucoma> Closed Angle Glaucoma> Chronic Lung Disease> Liver Problems> Respiratory failure>Delirium in older adults> Blurred vision>Suicidality>Withdrawal symptoms>Dependency

> Protein binding 90%> No driving!> D/C slowly to prevent withdrawal symptoms

Dopamine Agonist

MetoclopramideReglan

> Blocks dopamine receptors in CTZ> Coordinated contractions to enhance GI contents (prokinetic)

> Post-op emesis> Cancer therapy

> Pts with GI obstructions, hemorrhage, or perforation

> Sedation as dose increases> EPS in children>tardivedyskinesia>Dystonic reactions

> High doses or long-term use of Reglan can cause a serious movement disorder that may not be reversible

Stimulant (Laxative)

BiscodylDulcolax

> Loosens stool and increases bowel movement

>Tx constipation

> Avoid if pt has colitis, GI obstruction, severe abdominal pain> Electrolyte disturbances>Hepatotoxicity> For rectal use only

H2 Blockers

RanitidineZantac

> H2 antagonist of histamine in parietal cells to decreased acid produced> Decreased PUD/prophylaxis

>Tx PUD, GERD, and prophylaxis> Prevents acid reflux (heartburn)> Hepatotoxicity> Blood dyscrasias

> Arrhythmias>Pancreatitis>Hepatitis> Long acting and more potent

Anti-Diarrheal

Diphenoxylate/AtropineLomotil

> Blocks nerve signals to intestinal muscles (relaxes muscle and slows peristalsis)> Prevents spasm and contractions>Tx diarrheal/traveler's diarrhea

>Diarrhea associated with pseudomembranousenterocolitis or enterotoxin-producing bacteria.> Potential for dependence>Monitor for tachycardia or chest pain>Anticholinergic effects

> No alcohol, sedatives, or tranquilizers to prevent CNS inhibition

Gastrointestinal Agents

Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsAdverse Effects/Side EffectsNursing Considerations

Phosphodieterase (PDE5 Inhibitor)

SildenafilViagra

> Selective inhibitor of cGMP> Increases vasodilation and blood flor

> Restores erectile response>Tx erectile dysfunction>Pulmonary hypertension

> Leads to too much vasodilation when taken with nitrates> CHF, CAD, Cardiomyopathy

> Diarrhea> Blurred vision> UTI symptoms> Photosensitivity>Unwanted prolonged erection>Hypotension>Syncope

> 30 min 4 hrs before sexual activity> Avoid grapefruit juice

Phosphodieterase (PDE5 Inhibitor)

TadalafilCialis

> Selective inhibitor of cGMP> Increases vasodilation and blood flow

> Restores erectile response>Tx erectile dysfunction

> Leads to too much vasodilation when taken with nitrates> CHF, CAD, Cardiomyopathy

> Sudden vision loss

> 30 min before sexual activity

Reproductive Agents

Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsAdverse Effects/Side EffectsNursingConsiderations

Uricosurics

ProbenecidSulfinpyrazone

> Decreases excretion of PCN> Increases serum level of PCN> Keeps PCN in body longer

> Uric acid kidney stones, acute gouty arthritis> Hypersensitivity

> Hemolytic anemia>Leukopenia> Renal calculi>Nephrotic syndrome (rare)

> Do NOT administer for acute gout attacks

NSAIDsCelecoxibCelebrex> 2nd generation NSAID> COX-2 inhibitor (selective)> Mild to moderate skeletal and joint pain

> Those who take ASA do not benefit from COX-2 inhibitors

> Bleeds (give Pepcid/Protonix to prevent bleeds)>Increases chance of acute coronary syndrome since its pro-thrombotic

>Monitor pain>Use with caution in patient with kidney failure

NSAIDsIbuprofenMotrin> 1st generation NSAID>Propionic acids> Inhibits prostaglandin synthesis> Non-addictive and less potent than opioids> Mild to moderate pain (anti-pyretic, anti-inflammatory, anti-platelet)

>Pregnancy risk:CategoryC>Acute Thromboembolic Stroke> Ulcer (COX-1)

> High protein binding = toxicity> Max = 1st generation NSAID>Salicylate> Inhibits prostaglandin synthesis and hypothalamic heat regulatory center> Blocks thromboxane A2> Analgesia> Anti-inflammatory> Anti-pyretic> Anti-platelet> Prophylaxis for stroke and MI (81 mg daily)

> Reye's Syndrome> Thrombotic Thrombocytopenic Purpura> Reye's syndrome in children>Ulceration> Anaphylaxis

> Crosses placenta> Watch salicylate in other meds> Take with food> Max = 4g/day>Chew ASA in acute MI

NSAIDs

Paracetamol/AcetaminophenTylenol

> Inhibits prostaglandin synthesis and hypothalamic regulatory center> Anti-gout> Mild to moderate pain> Sedative

> Liver Disease> Severe skin reaction> Overdose>Liver failure

> Max = 4g/day

Opioid

KadianMorphine Sulfate

> CNS depression (lowers impulses by binding with opiate CNS receptors)> Relieves severe pain/MI (vasodilator)> Small dose relieves dyspnea> Decreases preload> Bowel Obstruction> Severe asthma> Loss of consciousness> Hypotension>Myoclonic spasms> GOLD STANDARD!> Dilute and inject over 5 minutes> Crosses placenta

Opioid

FentanylSublimaze

> Lipid soluble> CNS depression (sedation)

> Pre-anesthesia> Continuous chronic pain control (end of life)>History of head injury or brain tumor> Somnolence, dizziness> Hyperesthesia> 100x more potent than morphine!

Opioid

NalbuphineNubain

> Relieves moderate to severe pain> Labor pain> Moderate to severe pain> Labor delivery or surgery>History of alcoholism or substance abuse, depression or other mental or mood problems, suicidal thoughts

>Miosis (constricts pupils)> Resp. depression> Inhibited cough reflex> Postural hypotension> Withdrawal symptoms

Opioid Antagonist

NaloxoneNarcan

> Pulls opioid off receptor (prevents opioid from attaching to CNS receptors)

>Tx opioid overdose> Restores breathing

>Head injury or brain tumor; or>Drug or alcohol addiction.

>Lacrimation>Rhinorrhea> Hypotension>Acute withdrawal> Can trigger acute rebound effect= pain)> 0.4-2 mg every 2 minutes

Anti-Gout

AllopurinolZyloprim

> Uric acid inhibitor (lowers serum uric acid)> Prevents gout attack/prophylaxis against gout>Pregnancy category C> Stevens-Johnson syndrome> Nephrotoxicity

> Take fluids!

Analgesics/Anti-Inflammatory

Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsAdverse Effects/Side EffectsNursingConsiderations

Glucocorticoids

PrednisoneDeltasone

>Suppresses inflammation and adrenal function

>Tx of Addisons disease, MS, gout> Lowers inflammation

> Systemic fungal infections>known hypersensitivity

>Immuno-suppressant> Increased GI bleeds

> D/C Slowly> Lowers effect of anti-diabetics> Increased K+ loss when taken with Lasix

Anti-Thyroid

LevothyroxineSynthroid

> Increases metabolic rate, O2 consumption, and body growth> Increased T3/T4>Tx hypothyroidism, myxedema>Dx for hypothyroidism

>Thyrotoxicosis>Acute myocardialinfarction.> Tachycardia> HTN> PalpitationsThyroid Crisis

> Lifelong therapy> Given on empty stomach> Lowers effect of anti-diabetics

Polypeptide Tropic Hormone

Corticotropin (ACTH)HP Acthar

> Stimulates adrenal gland-cortisol

> Used to diagnose adrenocortical disorders> Anti-inflammatory agent>Tx MS

>Myasthenia Gravis> CHF> Diverticulitis>Petechiae> H2O/Na+ retention> Lowers K+ and Ca+

> Warm gel to room temp before injection

Insulin

Lispro ("Aspart")Humalog

> Rapid acting

>Tx of DM, hyperglycemia

>Hypoglycemia>Lipodystrophy> Onset: 5 minutes> Peak: 30 min-1hr> Duration: 2-4 hrs> Give right before meal to prevent hypoglycemia> Uses sliding scale

Insulin

Humulin 70/30

> Pre-mixed (70/30)> 70% NPH> 30% regular

>Tx of DM, hyperglycemia

>Hypoglycemia>Lipodystrophy> Mix regular insulin first> No Need to mix if combo iseffective

Insulin

RegularHumulin R> Short acting

>Tx of DM, hyperglycemia>Tx DKA, HHS

> Hypoglycemia> Hypoglycemia> Hypokalemia> Onset: 30min-1hr> Peak: 2-3 hrs> Duration: 4-8 hrs> Give before meal

Insulin

Insulin NPHHumulin N

> Intermediate acting> Added "P" protamine zinc>Tx hyperglycemia

> Hypoglycemia> Hypoglycemia> Hypokalemia> Onset: 2-4 hrs> Peak: 4-12 hrs> Duration: 18-24 hrs

Insulin

GlargineLantus

> Clear insulin> Continuous insulin

>Tx hyperglycemia

> Hypoglycemia> Hypoglycemia> Hypokalemia> Onset: 1 hr> Peak: None> Duration: 24 hrs> Give snack at bedtime if given at night

Biguanides

MetforminGlucophage

> Non-sulfonylurease affect hepatic/GI production of glucose

> Increases insulin binding for people with Type 2 diabetes

> Renal disease> Acute MI> Diabetic acidosis >Myalgia> Hypoglycemia>Dyspnea> Take with meal to decrease GI upset

Endocrine Agents

Drug ClassPrototype/Drug NameMechanism of ActionIndicationsContraindicationsAdverse Effects/Side EffectsNursing Considerations

Dopaminergic Drug

Carbidopa-LevadopaSinemet

> Carbidopa and levodopa converted to dopamine> Inhibits enzyme dopa-decarboxylase to reduce metabolism of levodopa in GI(higher levodopa in blood brain barrier, so more dopamine)

>Tx Parkinson's Disease

> Recent MAOI use> Discolored urine and sweat

> D/C Slowly

Stimulant (amphetamine)

Methylpheni-dateRitalin

> Acts on cerebral cortex, reticular activity system> Excites arousal stimuli in reticular activating system

>Tx ADHD, narcolepsy

> Recent MAOI use> Anxiety>Tourette syndrome/ tics> Severe HTN, recent MI/angina> Dependence> Altered insulin effects>Thrombocytopenia

> Toxicity if taken with MAO> No caffeine!

Serotonin 1 (5HT) Receptor agonist

SumatriptanImitrex

> Causes cranial vasoconstriction> Binds to selective serotonin receptor sites to cause vasoconstriction

>Tx acute migraine headaches (not used for prevention)

> Not given to pts with CAD or Vascular disease (b/c want them to vasodilate!)

> Heart block> Angina>Seizures/embolism

> If using patch, apply to skin without hair, scars, tattoos, lesions> If using intranasal, dont inhale deeply

Hydantoins (anti-convulsants)

PhenytoinDilantin

> Suppresses sodium influx to decreased rapid neuron firing

>Tx of Seizures

> Sinus bradycardia> Heart block> Teratogenic during pregnancy> Inhibits insulin release> Narrow therapeutic Index (High PB)> Free Dilantin (1.0-2.0 mcg/mL)

> Monitor use> Take extra contraceptives in women> Pink/Red/Brown urine> D/C slowly

SSRIs

FluoxetineProzac

> Selectively inhibits serotonin reuptake

>Tx migraines and MDD

>Torsades de Pointes

> Prolongs QT wave

> Check EKG before administering