TOP DRUGS

Normal value: 30 to 45
seconds; 1.5 to 2 times the
control
Usage Long term therapy Short term therapy

A
Effect Slow Quick

 Coumadin and Heparin CAN BE GIVEN together

 WHAT ARE THE DRUGS THAT ENHANCE THE EFFECTS OF

1. ACETAMINOPHEN (Tylenol) ANTICOAGULANTS?
 EFFECTS:
4A – Aspirin, Antihistamines, Alcohol, Antibiotics
 Analgesic (mild to moderate pain)
5G – Ginseng, Garlic, Ginger, Ginko biloba, Guiafenesin
 Antipyretic
 NO anti-inflammatory action
 ANTICOGULANT – prevents clot formation
NO platelet action
 THROMBOLYTICS – dissolves clot
 THERAPEUTIC LEVEL: 10 – 30 mg/dL
 USE: pulmonary embolism, coronary artery
 ANTIDOTE: Acetlycysteine (Mucomyst)
thrombosis, deep vein thrombosis, MI
 ADVERSE EFFECTS: hepatotoxic
 SIDE EFFECT: bleeding
 Start therapy as soon as possible after thrombus
appears as thrombi older than 7 days react poorly to
2. AMINOGLYCOSIDES streptokinase
 STREPTOMYCIN/ GENTAMYCIN  Heparin is discontinued before streptokinase is started
 Obtain Peak and trough level  IM injections are contraindicated
o Peak level – 30 minutes after taking the drug  ANTIDIOTE: aminocaproic acid (Amicar)
o Trough level – 30 minutes before the next  Examples: streptokinase (Streptase) – PROTOTYPE;
dose alteplase (Activase), urokinase (Abbokinase), reteplase
 Adverse effects: (Retavase), tenecteplase (TNKase), anistreplase
 Neurotoxic (Eminase)
 Ototoxic  therapeutic to Meniere’s disease to relieve
from vertigo (but this is the last resort because it will
lead to permanent deafness) 5. ANTIDEPRESSANTS
 Nephrotoxic  Monitor BUN  2 weeks interval in shifting from one type of anti-
depressant to another
 Antidepressant effect: 2 – 4 weeks
3. ANESTHESIA  Tricyclic Antidepressants (TCA) – increases norepinephrine
 Epidural anesthesia  Spinal headache and/or serotonin in CNS by blocking the reuptake of
 Spinal anesthesia  Hypotension norepinephrine by presynaptic neurons
1. Imipramine (Tofranil)
2. Amitriptyline (Elavil)
 SIDE EFFECTS: hypotension, arrhythmias, blurred
4. ANTICOAGULANTS AND THROMBOLYTICS vision, constipation, urinary retention, dry mouth
WARFARIN HEPARIN  NURSING CONSIDERATIONS:
SODIUM (Hepalean)  Check BP and PR
(Coumadin)  Give drug at BEDTIME
Action Blocks prothrombin Blocks conversionof prothrombin
 Changing from TCA to MAOI, patient must
synthesis to thrombin
Onset 2 to 5 days 30 seconds to 1 minute discontinue TCA for 14 days
Use  Thrombosis  Thrombosis and embolism  2 to 4 weeks needed before the full
and embolism  Prevention of clotting in therapeutic effect happens
 Atrial fibrillation heparin lock sets, blood  TCA OVERDOSE (anticholinergic toxicity):
with samples and during dialysis o Coma, convulsion
embolization  Treatment of disseminated
 Adjunct in intravascular coagulation o Ataxia, agitation
treatment of o Stupor, sedation
coronary
occlusion  Selective Serotonin Reuptake Inhibitor (SSRI)  inhibits
Route Oral SQ, IV CNS neuron uptake of serotonin, but not of norepinephrine
(DO NOT give IM, may lead to
hematoma and pain) 1. Fluoxetine (Prozac)
Expresse Milligrams Units 2. Sertraline (Zoloft)
d in  SIDE EFFECTS: hypotension, headaches, arrhythmias,
Antidote Vitamin K/ Protamine sulfate insomnia, dry mouth, weight loss, sexual dysfunction
Phytonadione  NURSING CONSIDERATIONS:
(AquaMEPHYTON)
o Give drug in the MORNING
Laborator Prothrombin time Partial Thromboplastin Time
y (PT) (PTT) o Takes 4 weeks for full effect
Test Normal value:11 Normal value: 60 to 70 o Changing from MAOI to SSRI, patient must
to 13 seconds seconds; 2 to 2.5 times the discontinue MAOI for 2 weeks
control Changing from SSRI to MAOI, patient must
Activated Partial thromboplastin
time (APTT) discontinue SSRI for 5 weeks
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 o Monitor for weight 7. ANTI-PARKINSONS
o Provide oral hygiene  Dopaminergic Drugs (increase dopamine)
1. Amantadine (Symmetrel)
 Monoamine Oxidase Inhibitor (MAOI) – acts as a 2. Levodopa (L-dopa)
psychomotor stimulator or psychic energizers; blocks 3. Levodopa-Carbidopa (Sinemet)
oxidative deamination of naturally occurring monoamines
(epinephrine, norepinephrine, serotonin) causing CNS  Anticholinergic Drugs (decrease Acetylcholine)
stimulation 1. Akineton
1. tranylcypromine (Parnate) 2. Cogentin
2. isocarboxazid (Marplan) 3. Artane
3. phenelzine (Nardil) 4. Benadryl

 SIDE EFFECTS: Hypertensive crisis – happens if the

drug is taken with tyramine-containing foods 8. ANTI-PSYCHOTIC (MAJOR TRANQUILIZERS)
o Sweating  USE: Schizophrenia
Constipation 1. Haloperidol (Haldol)
o Headache, HPN 2. Chlorpromazine (Thorazine)
Orthostatic hypotension  SIDE EFFECTS:
o Urinary retention  HYPOtension
Photophobia, dilated pupils  leukopenia (sore throat)
o Nausea, Neck stiffness  NEUROLEPTIC MALIGNANT SYNDROME
Agranulocytosis (HYPERthermia/ diaphoresis, HYPERtension)
o Tachycardia  pink-red urine (normal: thorazine)

 AVOID tyramine or tryptophan containing foods:

o Aged meat, avocado 9. ASPIRIN/ SALICYLATES/ ACETYLSALICYLIC ACID
o Banana, beans  EFFECTS:
o Chocolates, coffee, cheese (cheddar,  Antiplatelets  reduce risk of myocardial infarction
aged, swiss), chicken and beef liver and transient ischemic attack
o Drinks that are fermented (wine, beer)  Anti-inflammatory  rheumatic fever, Kawasaki
o Smoked fish, soy sauce, sour cream, disease, rheumatoid arthritis
sausage  Antipyretic  fever
o Pickled foods (herring)  Analgesic  mild to moderate pain
o Overripe foods
o Raisins  Aspirin toxicity
o Tea  Tinnitus – early sign of salicylism
o Yogurt, yeast  Metabolic acidosis – late sign of salicylism
 Epistaxis, nephrotoxic
 ALLOW: cottage and cream cheese  ANTIDOTE: activated charcoal (can also give Ipecac syrup to
 Monitor BP induce vomiting of aspirin)
 Therapeutic effect are achieved within 10 days to  Give the drug with full stomach after meals
4 weeks  Aspirin is ulcerogenic
 Monitor CBC, Prothrombin time, renal and liver functions
 DO NOT give with any anticoagulant (Coumadin, Heparin). It
6. ANTI-GOUT may cause additive effect, high risk for bleeding
 COLCHICINE (Novocolchine)  anti-inflammatory  AVOID Aspirin in patients with viral infection to prevent
o SIDE EFFECTS; diarrhea, abdominal cramps Reye’s Syndrome
o NURSING CONSIDERATIONS:  AVOID Aspirin with OHA  causes hypoglycemia
 DO NOT give IM or SQ, this may
lead to irritation
 Administer drug after meals 10. ATROPINE SULFATE (Atropair, AtroPen)
 No more than 12 tablets should be  block neurotransmitter acetylcholine and inhibits
given in a 24 hour period parasympathetic actions
 USE: pre-op medication to reduce secretions and
 ALLOPURINOL (Zyloprim)  prevent production of uric bradycardia; produces mydriasis
acid by inhibiting the enzyme xanthine oxidose  CONTRAINDICATED in acute glaucoma, prostatic
o USE: prophylactic for attacks of gout; clients hypertrophy
with calcium oxalate calculi
o SIDE EFFECTS: hepatotoxic

 PROBENECID (Benemid)/ SULFINPYRAZONE (Anturane)

– uricosuric agents: reduces uric acid in the blood by
increasing its renal excretion
B
11. BETABLOCKERS
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  Example: propanolol (Inderal), timolol (Blocadren), pinolol
(Visken), nadolol (Corgard), metoprolol (Lopressor), timolol  Digoxin toxicity – nausea, yellow color vision, arrhythmia,
maleate (Timoptic) sign of hypokalemia (weakness, muscle cramps)
 MODE OF ACTION: inhibit sympathetic stimulation of beta  Antidote: Digibind
receptors in the –
 HEART – decreasing myocardial oxygen consumption
and demand by: 15. DIURETICS
 decreases heart rate and *** CLASSIFICATIONS SITE OF EXAMPLES INDICATIONS SP
 decreases force of myocardial contraction ACTION I
 EYES – decreases intraocular pressure (IOP) by Anhydrase
Carbonic Proximal Acetazolamide (Diamox) Meniere’s disease,
 decreasing aqueous humor formation and tubule OPEN glaucoma
increases aqueous humor outflow Loop of Furosemide (Lasix) Potent diuretic
 Change of position gradually Henle Bumetanide (Bumex)
Glomerulus Mannitol Increased ICP Warm s
 Take pulse before taking drug***
Osmitrol crystalli
Glycerin
Urea
12. BRONCHODILATOR Distal Spironolactone (Aldactone) Mild diuretic, CHF, HPN Avoid p
 USE: bronchospasms, asthma tubule Amiloride (Modiuretic, Midamor) (banana
 EXAMPLES: Triamterene (Dyrenium) broccol
 BETA-ADRENERGIC: abuterol (Proventil, Ventolin), tomato
Thiazide and Thiazide- Proximal Hydrochlorothiazide HPN (Not effective for
metaproterenol (Alupent)
tubule Chlorothiazide (Diuril) immediate dieresis)
 XANTHINES: theophylline (Theo-Dur) – PROTOTYPE, Metolazone
aminophylline (Truphylline)
 THERAPEUTIC LEVEL OF THEOPHYLLINE: 10 – 20 mcg/ml  K-sparing: Spironolactone, Amiloride, Triamterene
(mg/dl)  K-wasting: CAI, Loop, Osmotic Thiazides
 SIGN OF THEOPHYLLINE TOXICITY:
 Tachycardia NURSING INTERVENTION
 nausea and vomiting 1. Monitor blood pressure (first/ before) and weight (second/
 FOODS TO BE AVOID after)
 ICE TEA – caffeine and caffeine containing foods 2. Administer in the MORNING
because Theophylline is a xanthine derivative which 3. Administer with FOOD
has same effect with caffeine
EVALUATION: for effectiveness of therapy
 Weight loss

D
 Increased urine output
 Resolution of edema
 Decreased congestion
 Normal BP

13. DIAZEPAM (Valium)



USE: Drug of choice for status epilepticus
EFFECTS:
H
 Anxiolytic 16. HERBAL DRUGS that causs BLEEDING
 Anti-convulsant
 GINKO BILOBA
 Muscle relaxant
 GINGER
 DO NOT MIX with other drugs
 GARLIC
 DO NOT withdraw abruptly
 GINSENG
 AVOID alcohol, smoking, activities that requires alertness
 May cause physical dependence
 Oral form should be given BEFORE MEALS
 Examples: alprazolam (Xanax), clorazepate (Tranxene),

I
flurazepam (Dalmane), midazolam (Versed), triazolam
(Halcion), chlordiazepoxide (Librium), clonazepam
(Klonopin), lorazepam (Ativan)

17. IMCI DRUGS: IRON

 1 dose daily x 14 days
14. DIGOXIN (Lanoxin) TABLET SYRUP
 Effects: Ferrous sulphate 200mg + 250 mcg Folate Ferrous sulphate 150 mg per 5 ml Fer
o (+) inotropic – increases FORCE OF CONTRATION (60 mg elemental iron) (6 mg elemental iron per ml) (25 mg e
 increase cardiac output THY 2.5 ml (1/2 tsp) 0.6 ml
o (-) chronotropic – decreases HEART RATE 
decrease oxygen demand of the heart muscles 4 ml (3/4 tsp) 1 ml
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  aspirate after injection
½ tablet 5 ml (1 tsp) 1.5 ml  shake. Gently roll vial in between palms
 Cold insulin  lipodystrophy
1 tab 7.5 ml (1.5tsp) 2 ml  STORAGE:
 In room temperature – last for 1 month
 Refrigerated once opened – last for 3 months
 ADJUSMENT OF DOSE:
18. IMCI DRUG: VITAMIN A  increase insulin requirement  Infection, Stress,
VITAMIN A CAPSULES Illness
AGE
100,000 IU 200,000 IU  decrease insulin requirement  Breast feeding
6 months to 12 1 ½ capsule (Antidiabetic effect)
months  Mixing of insulin: (Aspirate 1st – clear, Inject air 1st –
12 months to 5 2 capsules 1 capsules cloudy)
years (1) Inject air to NPH
(2) Inject air to Regular
(3) Aspirate Regular
19. IMCI DRUG: MEBENDAZOLE/ ALBENDAZOLE (4) Aspirate NPH
AGE or WEIGHT Albendazole 400 Mebendazole 500
mg tablet mg tablet  Most common used: U100 (1)
12 months to 24 ½ or 200 mg tablet 1 U40 (2)
months
24 months to 59 1 1
months
21. IRON SUPPLEMENTS
 SIDE EFFECTS: dark stools (tarry stool), constipation,
abdominal cramps
 Tablet: give with citrus juice (orange, tomato)
20. INSULIN
Liquid: give with citrus juice (orange, tomato) and straw
 MODE OF ACTION: decreases blood sugar by –
IM: Z-track method; DO NOT massage
 Increasing glucose transport across cell membranes
 BEST given with empty stomach
 Enhancing conversion of glucose to glycogen
 Citrus juice is AVOIDED with iron elixir preparation
TYPE DESCRIPTI ONS PEA DURATI
ON ET K ON

L
RAPID- Color: Clear 30 2– 6 – 8 hrs
ACTING: Route: IV, min – 4
Regular, SQ 1 hr hrs
Humulin R
INTERMEDIA Color: 1–2 6– 18 – 24
TE-ACTING: Cloudy hrs 8 hrs
NPH/ Neutral Route: SQ hrs 22. LACTULOSE (DUPHALAC, CEPHULAC)
Protamine  Laxative
Hagedorn  SIDE EFFECT: ammonia binder (therapeutic to patient with
(Insulin hepatic encephalopathy)
Isophane
Suspension),
Humulin N
LONG- Color: 3–4 16 – 30 to 36
ACTING: Cloudy hrs 20 hrs 23. LITHIUM
Ultralente Route: SQ hrs
 Anti-mania
(extended
insulin zinc  Therapeutic Level: 0.5 – 1.5 mEq/L
suspension)  Lithium toxicity (n/c, anorexia, abdominal cramps, diarrhea)
Humulin U  PREPARATIONS:
o Tablets: 300, and 450mg.
 PEAK TIME – time of hypoglycemic episodes o Capsules: 150, 300, and 600 mg.
 1ml of tuberculin = 100 units of insulin o Syrup: 300 mg/5 ml
 U100 insulin syringe is – 100 units  Maintain:
 Administer insulin in room temperature o increase fluid (3L/day)
 ROUTE: SQ o Increase Na (3 gm/day)
 Administer insulin at either 45 degree (for skinny
patient) or 90 degrees (for fat patients)
 Area:
 Abdomen – fastest absorption
 Deltoid
 thigh
 buttocks
M
 AVOID: 24. MAGNESIUM SULFATE
 massage and apply compression (increase absorption)  tocolytic agent

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  USE: premature labor, anticonvulsants in pregnancy  use ruled applicator paper that comes with ointment
induced hypertension (PIH) to measure dose
 Check:  wear gloves during application
o deep tendon reflex (DTR) – FIRST reflex lost with  leave applicator on site and cover it with plastic wrap
CNS toxicity and secure it with tape
o Check RR (at least >12 breaths/ min  TRANSDERMAL PATCH
o Check urine output (at least 30 mL/ hr)  Apply a patch once a day only
 ANTIDOTE: calcium gluconate  Rotate site
 Place patch in non-hairy area
 Determine a base region and remove the old patch
25. METRONIDAZOLE (FLAGYL)  Wear gloves during application
 Anti-amoeba  IV form: 5 mcg/ min
 AVOID alcohol (Metronidazole + Alcohol = Disulfiram-like  dilute IV nitroglycerine in 5% dextrose or 0.9% sodium
effect) chloride and titrate every 3 to 5 minutes
 STORAGE:
 store in original dark glass container in a cool, dry
place.
26. MORPHINE SULFATE (Duramorph)  date bottle when opening
 EFFECT: induce sedation, analgesia and euphoria
 discard after 6 months
 INDICATION: moderate to severe pain, pain relief in
 NURSING CONSIDERATIONS:
myocardial infarction
 Change position gradually to prevent dizziness
 DECREASES preload and afterload
 HEADACHE is a sign that the drug is taking effect. It will
 DECREASES workload
discontinue with long term use.
 SIDE EFFECTS of Morphine SO4
 AVOID alcohol, hot baths
 Miosis
 Carry drug at all times
 Orthostatic hypotension
 DO NOT administer nitrates with sildenafil (Viagra),
 Respiratory depression
both drugs are vosadilator which may lead to
 Produces tolerance and dependence
HYPOTENSON
 Hyperglycemia
 Increase urinary retention/ constipation,
 Nausea and vomiting 28. NONI JUICE
 Euphoria  Morinda citrifolia
 Sedation/ dizziness  High in fibers
 Assess client’s pain before giving medication
 Check before and after the respiration

O
 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
29. OCTREOTIDE (SANDOSTATIN)
 Inhibits GROWTH HORMONE, GLUCAGON, INSULIN
 2 formulations
 Sandostatin®is a short acting version

N
 Sandostatin LAR®is a long acting version.
 Sandostatin® is given by subcutaneous injection  It may
be necessary to take the shot several times a day. The
27. NITRATES AND NITROGLYCERINE (Nitro-bid, injection sites should be rotated regularly. This medication
may also be given intravenously.
Nitrodur, Nitrostat IV)  Sandostatin LAR® is given by intramuscular injection. This
 MODE OF ACTION: vasodilator medication is generally given once every 4 weeks. The
 USE: angina pectoris and hypertension preferred site for injection is the hip, because it is painful
 SIDE EFFECTS OF NITRATES: headache, flushing, orthostatic given into the arm.
hypotension, dizziness  Sandostatin LAR® should NOT be given by S.C. or IV routes.
 Other Related drugs: isosorbide dinitrate (Isordil),  COMMON SIDE EFFECT: constipation
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
30. OXYTOCIN (Pitocin)
relieved after 15 minutes and 3 tablets, notify  stimulate uterine contraction
physician immediately  USE: postpartum bleeding, labor induction
 SIGN OF POTENCY: burning sensation under tongue  ADVERSE EFFECTS: uterine hyperstimulation, arrhythmias,
 Drink water first BEFORE taking drug tachycardia, hypertension
 OINTMENT  Given IM or IV; IV via piggyback and delivered with an
 applied to a hairless or clipped/ shaved area infusion pump
 new site should be used with each new dose  Observe fetal hypoxia or distress

5 | TOP DRUGS
  DIET: Restrict sodium, alcohol and caffeine; high potassium
foods

P 

Carry extra medication during travel.
Adjust medications during periods of acute or chronic stress
such as pregnancy or infections; contact health care
provider.
31. PANCREATIC ENZYMES
 USE: aid in digestion; cystic fibrosis
 Give WITH MEALS*** 34. SYMPATHETIC AND PARSYMPATHETIC
 Expected outcome of the drug is absence of steatorrhea
 EXAMPLES: pancreatin (Dizymes), pancrelipase (Cotazym) SYMPATHETIC PARASYMPATHETIC
SNS (Adrenergic) PNS (Cholinergic)
Dumping Syndrome, MG Glaucoma, GERD
32. PHENYTOIN (Dilantin) Atropine Prostigmine
 USE: seizure Cholinesterase Anticholinesterase
 SIDE EFFECT: gingival hyperplasia, may turn urine pink, red, “fight or flight” response “Sleep and digest” response
or red-brown (BIOAMINE THEORY) Acetylcholine – slowly release
 ADVERSE EFFECTS: hepatotoxic, Steven-Johnson’s Epinephrine (Adrenaline) – faster but long acting
syndrome release but short acting
 DO NOT administer IM Norepinephrine
 Give drug with NSS BEFORE AND AFTER (flushing) drug Dopamine
administration Serotonin
 Provide oral hygiene, Use soft, bristled toothbrush (Increase) HR, RR, BP (Decrease) HR, RR, BP
 Takes 7 to 10 days to achieve therapeutic serum level (Decrease) peristalsis, UO, secretions (Increase) peristalsis, UO,
 Therapeutic level: 10 – 20 mg/ dl Pupil dilation (mydriasis) secretions
Bronchodilation Pupil constriction (miosis)
Hyperglycemia Bronchoconstriction

S
Diarrhea
Urinary frequency
Miosis (constriction)
Bradycardia
33. STEROIDS Bronchoconstriction
 EFFECTS: Erection/ emesis
 Anti-inflammatory L
 Hormonal replacement Salivation
 USE: USE: bronchial asthma, Addison’s disease, allergies
 Examples: hydrocortisone (Cortisol), prednisone (Strap red),
dexamethasone (Decadron), methylprednisone (Solu-


medrol), betamethasone (Celestone)
SIDE EFFECTS:
 Cushing’s syndrome
 Immunosuppression  therapeutic to AUTOIMMUNE
T
DISEASES 9 like nephrotic syndrome, SLE, multiple 35. THYROID AND ANTI-THYROID DRUGS
sclerosis, Rheumatoid arthritis, for organ transplant,  THYROID AGONISTS – used to increase blood thyroid
hyperthyroidism, allergies) hormones
 causes GI irritation and ulceration  LEVOTHYROXINE (Synthroid)
 Long term: Adrenal insufficiency***, osteoporosis  USE: hypothyroidism (myxedema), cretinism
 Short term: Immunosuppresant, hypokalemia, (congenital hypothyroidism)
hypocalcemia, edema  SIDE EFFECTS: insomnia, tachycardia, diarrhea
 Give with food  Taper the dose
 Watch out for infection  Monitor vital signs (temperature, BP, PR)
 Taper the dose (abrupt withdrawal may lead to acute  Give the drug in the morning (due to insomnia side
adrenal crisis) effect)
 Parenteral form: Give IM avoid SQ  CONTRAINDICATIONS:
Oral form: Give it WITH food or milk, may cause gastric  Cabbage, Cauliflower
irritation  Peaches, Peas, Pears
Topical creams: DO NOT apply in broken skin and near eyes  Raddish, turnips
 Administer in the morning (before 9 am); Take medication  Spinach
with breakfast (corresponds to biorhythms and reduces
gastric irritation)  THYROID ANTAGONISTS – used to decrease blood thyroid
 Wear medic alert bracelet hormones
 Isolation precaution A. ANTITHYROID DRUGS – inhibit synthesis of thyroid
 AVOID sunlight, people with infections or crowded place hormones
AVOID immobility to prevent osteoporosis Examples: propylthiouracil (PTU, Propacil, Propyl-
AVOID crowd Thyracil), methimazole (Tapazole)

6 | TOP DRUGS
 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:
o agranulocytosis (sore throat)
o paresthesias
o 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)

7 | TOP DRUGS