PHARMACOLOGY

BUNDLE
by Nursing Bliss

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 Table of Contents
Administration Routes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Emergency Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Pharmacokinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Dosage Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Antidotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Cardiovascular . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Endocrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Respiratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Gastrointestinal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Neurologic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Immune . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Antibiotics 56
Antivirals 60
Antifungals 61
Antiretrovirals (HIV/AIDS) 63
Immunosuppressants 67
Immunomodulators 68
Antineoplastics (cancer) 69
Renal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Musculoskeletal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Maternity & Newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
IV Fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Abbreviations Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Top 100 Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Blank Drug Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
l3YVWMRK'PMWW
 PHARMACOLOGY

ADMINISTRATION ROUTES

Oral – absorbed in the GI tract

Intravenous – injection into vein
Intradermal – injection into the dermis
Intramuscular – injection deep into the muscle; large dosage absorbed quickly
Intrathecal – injection into spinal canal
Subcutaneous – injection into tissue below the dermis
Sublingual – absorbed under the tongue
Buccal – drugs held in the buccal area (cheek) and enter the bloodstream
Rectal or vaginal – transmucosal route, reduces GI side effects
Inhalation – absorbed in lungs; rapid onset of action, reduced risk of systemic side affects

RIGHTS OF MEDICATION EMERGENCY MEDS

ADMINISTRATION LEAN ON THESE
Lidocaine Ventricular Arrhythmias
Right Drug
Right Dose
Epinephrine Acute asthma attack, anaphylaxis
Right Patient
Right Route
Atropine bradycardia,
Right Time
to respiratory secretions
Right Documentation
Narcan Opioid overdose

MEASUREMENT ABBREVIATIONS
meter: m kilogram: kg
kiloliter: kl gram: g
liter: L milligram: mg
milliliter: mL microgram: write out microgram
microliter: mcl milliequivalents: mEq

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
3
 PHARMACOKINETICS

Pharmacokinetics - the absorption, distribution, metabolism, and excretion of drugs in the body.

(ADME)
Absorption – the process from administration of the drug until it reaches the systemic
circulation.

Distribution – how a drug is spread throughout the body.

Metabolism – the processing of the drug by the body. For example, a drug is converted
to a water-soluble form and can then be excreted by the kidneys.

Excretion – the process in which the drug is eliminated from the body. Most drugs are
excreted through the kidneys (renal function is extremely important!) but some are
excreted through the gastrointestinal tract, skin, or lungs.

Pharmacodynamics - the physiologic, biochemical, and molecular effects of drugs and the
mechanism of their action on the body. In other words it is what drugs do and how they do it.

Agonist - binds to and activates a receptor and produces a full, or partial response.

Antagonist - binds to and prevents receptor from producing its action.

Half-life - length of time for one half (50%) of the serum drug concentration to be eliminated.

Potency - amount of drug needed to produce the desired effect.

Efficacy - maximum response that can be produced by a drug.

Loading dose - an initial higher dose given to achieve a specific concentration level.

Onset of action - the time from administration to therapeutic effect response.

Toxic Concentration - serum level of drug that causes serious adverse effects.

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
4
 Dosage Calculation


Conversions
Conversion is the first step in the calculation of dosages. Convert the prescribed dose to the units of
the available drug.
To convert: Example:
mcg ĺ mgĺ g ĺ kg р ϭ͕ϬϬϬ ϭ͘ϰ g is prescribed Θ available dose is ϲϬϬ
mg convert gĺ mg: ϭ͘ϰŐпϭ͕ϬϬϬсϭ͕ϰϬϬmg
kg ĺ gĺ mgĺ mcg п ϭ͕ϬϬϬ
lb ĺkg ÷ Ϯ͘Ϯ Rounding
kg ĺlb × Ϯ͘Ϯ
Round up if number to right of decimal is шϱ
mcl ĺ ml ĺ L ĺ kl рϭ͕ϬϬϬ
Ϯ͘ϱсϯϬ͘ϱϯϳс͘ϱϰ
kl ĺ L ĺ ml ĺ mcl пϭ͕ϬϬϬ
Round down if number to right of decimal is чϰ
minĺ hour ÷ ϲϬ
Ϯ͘ϰсϮϬ͘ϱϯϭсϬ͘ϱϯ
hourĺ minute × ϲϬ
Always round to what you are asked – whole
Convert Cĺ F: C + ϰϬпϵрϱ and ͲϰϬ number, tenth, hundredth, etc.
Convert Fĺ C: F + ϰϬпϱрϵĂŶĚͲϰϬ

Basic Calculations
Equivalents
dose ordered
x volume = dose
ϭŵ>сϭĐĐ amount available
ϭŵ>сϭϱŐƚƚƐ
Tablet Dosage
ϭƚƐƉсϱŵ>
required dose
ϭdďƐƉсϭϱŵ>͕ϯƚƐƉ = # tablets
available
ϭŽnjсϯϬŵ>͕ϮƚďƐƉ
Drop Factor – number of
ϴŽnjсϭĐƵƉ IV Flow Rate
drops in one mL of solution

ϭϲŽnjсϭƉŝŶƚ
mL per hour volume (mL)
ϭŐƌĂŝŶ;ŐƌͿсϲϬŵŐ = mL per hour
time (hrs)
ϭŝŶсϮ͘ϱϰĐŵ volume (mL)
mL per minute x drop factor = flow rate gtt/min
time (min)
ϭŬŐсϮ͘Ϯůď

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE.

5
 Antidotes

Drug or Toxin Antidote

Acetaminophen Acetylcysteine
Poisons except cyanide, iron, lithium, caustics, alcohol Activated Charcoal
Alcohol withdrawal chlordiazepoxide
Anticholinergics Physostigmine
Aspirin Sodium bicarbonate
Benzodiazepines Flumazenil
Beta blockers Glucagon
Calcium channel blockers Glucagon, insulin, or calcium
Cholinergic toxicity Atropine
Cyanide Hydroxocobalamin
Digoxin Digibind, Digoxin immune Fab
Edrophonium Atropine
Heparin Protamine sulfate
Hypertensive Crisis Phentolamine injection
Insulin Glucose
Iron Deferoxamine
Lead Chelation agents – Dimercaprol (IM), Edetate
Lead (cont.) calcium disodium (IV or IM), Succimer (oral)

Magnesium sulfate Calcium gluconate

Opioids / narcotics Naloxone
Pyridoxine Deferoxamine
Thrombolytics Aminocaproic acid
Tricyclic antidepressants Sodium bicarbonate
Warfarin Vitamin K
Methanol Fomepizole, Folic acid
Ethylene glycol (Antifreeze) Fomepizole

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE.

6
 Cardiovascular Meds
Class
BETA BLOCKERS (ɴ-Adrenergic Blockers) SUFFIX: -lol P: Beta Blocker
T: Antihypertensive
Common Generics: atenolol, metoprolol, acebutolol (cardioselectives)
$QWLDUUK\WKPLF
Action: blocks the binding of beta receptors (epinephrine), Lowers HR/BP $QWLDQJLQDO
Uses: angina, tachycardia, hypertension, myocardial infarction, congestive heart failure, cardiac
arrhythmias, coronary artery disease migraine headaches, glaucoma

Serious Adverse Reactions: possible bronchospasm -Do not give to asthma/COPD patients,
bradycardia hypotension, weakness, fatigue, N/V, dizziness, hyperglycemia,
agranulocytosis, behavioral response, depression, nightmares

Considerations: Patient Education:

x May mask signs of hypoglycemia x ŽEŽƚƐƚŽƉĂďƌƵƉƚůLJ͊

x Check HR/BP BEFORE giving HOLD if BP <ϵϬ, HR <ϲϬ x avoid over-the-counter
x Monitor HR/BP cold meds Θ
x Watch for orthostatic hypotension, bradycardia, wheezing decongestants
x change positions slowly

SUFFIX: -pril
P: Ace Inhibitor
Common Generics: benazepril, captopril, enalapril
P: ARBs
SUFFIX: -sartan T: Antihypertensive
Common Generics: valsartan, olmesartin, irbesartan
Action: Both interfere with the renin-angiotensin-aldosterone system (RAAS)

Uses: HTN, HF, MI

er
Θ
Pregnancy: Teratogenic!

Considerations: Monitor Patient Education:

x
x
x
x
x renal function
x x
x
x x

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE.

7
 CARDIOVASCULAR MEDS

SUFFIX: -pine CALCIUM CHANNEL BLOCKERS CLASS

T: Antihypertensive,
Common generics: amlodipine (Norvasc), verapamil (Calan), Antianginal, Antiarythmic
diltiazem (Cardizem) P: Calcium Channel Blocker

Action: inhibits the movement of calcium into myocardial and vascular smooth muscle,
decreasing contraction relaxing smooth muscle
Indication: hypertension, angina, dysrhythmias

Serious Adverse Reactions: orthostatic hypertension, bradycardia, lightheadedness, headache,

peripheral edema, hyperglycemia, liver and kidney function changes

Contraindicated: hypersensitivity, heart failure, acute MI; caution in renal or hepatic impairment,
pregnancy and lactation
Nursing Considerations
Patient Education
check BP, HR before admin; Hold if HR <60;
Monitor Do not stop abruptly
report shortness of breath or chest pain;
EKG, I&O, daily weights
RFT, LFT, CBC, vitamin K and glucose level; immeditely
for s/s heart failure report dizziness, lightheadedness

SUFFIX: Digoxin DIGOXIN CLASS

Antidote is T: Cardiac Glycoside
Common generics: digoxin (Lanoxin)
Digibind P: Digitalis Glycoside

Action: calcium in the cells causing increased heart muscle contraction resulting in

increased cardiac output

Indication: Heart failure, AFib, atrial tachycardia, atrial flutter

Serious Adverse Reactions: anorexia, nausea, vomiting, diarrhea, arrhythmias, vision changes,;;;
dizziness, confusion GI s/s EarMy Sign of Toxicity
Contraindicated: ventricular dysrhythmias, heart blocks; caution in patients with renal;;
impairment, hypokalemia Therapeutic Range 0.5 - 2.0 ng/mL

Nursing Considerations Patient Education

Monitor
for GI symptoms (early toxicity)
increase potassium rich foods;
digoxin level
avoid OTC medications
RFT, creatinine,
notify PCHP if pulse is <60 or >100
assess apical pulse for one minute before;
admin; if <60 notify PHCP

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
8
 CARDIOVASCULAR MEDS

PREFIX: nitro- NITRATES CLASS

SUFFIX: -nitrate T: Antianginal
P: Nitrate

Common generics: isosorbide dinitrate (Isordil), isosorbide mononitrate (Monoket), nitroglycerin

(Nitrostat)
Action: nitrates cause vasodilation, decrease preload and afterload, BP, O2

Indication: angina, heart failure

Serious Adverse Reactions: orthostatic hypotension, dizziness, tachycardia, palpitations, flushing

Contraindicated: ICP, hypotension, use with sildenafil, tadalafil, vardenafil (erectile dysfunction),
renal & hepatic impairment
Nursing Considerations
Patient Education
Monitor
do not swallow sublingual
admin sublingual tablet every 5 minutes up
take one tablet for chest pain; if pain not
to 3 doses if pain not relieved.
relieved, take a second dose and call EMS;
if pain not relieved after 3rd dose contact; avoid alcohol with medication
PCHP
do not take Viagra or other erectile;
teach patient to store in a dark bottle, cool
dysfunction medications

CLASS
ANTIPLATELETS T: Antiplatelet
P: Antiplatelet

Common generics: aspirin (Bayer), clopidogrel (Plavix), prasugrel (Effient), ticagrelor

(Brilinta)
Action: inhibit clumping of platelets in the clotting process; prolong bleeding time.

Indication: myocardial infarction, acute coronary syndrome, stroke, stents, coronary artery bypass

Serious Adverse Reactions: GI bleeding, neutropenia, thrombotic thrombocytopenia

Contraindicated: active bleeding, history of stroke; caution in pregnancy

Nursing Considerations Patient Education

Monitor Report immediately
CBC w/differential, platelets; fever, chills, unusual bleeding, bruising;
s/s of TTP avoid OTC NSAIDs / aspirin
LFT, lipid panel, uric acid level

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
9
 ANTIHYPERLIPIDEMICS

Antihyperlipidemic medications will affect the liver and lipids. It is important to monitor the lipid
profile and liver function test.

They are contraindicated in pregnancy and lactation. If a patient becomes pregnant, discontinue
use immediately.

Lipid Panel Liver Function Test

Total Cholesterol <200 mg/dL ALT 7 – 56 U/L
LDL <100 mg/dL AST 10 40 U/L
HDL >60 mg/dL ALP 40 – 120 U/L
Triglycerides <150 mg/dL Bilirubin <1 mg/dL
Albumin 3.4 – 5.4 g/dL
Total protein 6.2 – 8.2 g/L

SUFFIX: -statin STATINS CLASS

T: Antihyperlipidemic
Common generics: atorvastatin (Lipitor), fluvastatin (Lescol XL),
P: HMG-CoA reductase
lovastatin (Altoprev), rosuvastatin (Crestor)
Inhibitor

Action: blocks the HMG-CoA reductase enzyme to reduce the production of cholesterol
Indication: reduce risk of MI, stroke, angina, in patients with hypercholesterolemia and CAD;
patients to slow progression
Serious Adverse Reactions: dizziness, headache, blurred vision, GI disturbance, liver toxicity,;
muscle pain, fatigue, rhabdomylosis which can lead to renal failure

Contraindicated: Teratogenic discontinue use if patient becomes pregnant; lactation

Nursing Considerations Patient Education

Monitor
Lipid profile
take exactly as directed
LFT
avoid grapefruit juice
if CPK and muscle pain during treatment avoid alcohol
- possible rhabdomylosis report unexplained muscle pain to HCP

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
10
 CARDIOVASCULAR MEDS

PREFIX col- BILE ACID SEQUESTRANTS CLASS

chol- T: Antihyperlipidemic
(RESINS) P: Bile Acid Sequestrant
Common generics: cholestyramine (Questran), colestipol (Cholestid), colesevelam (Welchol)

Action: reduces cholesterol by combining with intestinal bile acids and excreting through the
feces, preventing reabsorption
Indication: hypercholesterolemia
Serious Adverse Reactions: constipation, nausea, heartburn, hemorrhoid exacerbation,
interferes with fat-soluble vitamins A, D, E, K

Contraindicated: caution in patients with constipation

Nursing Considerations
Patient Education
assess for constipation & bowels sounds;
Monitor take with plenty of fluids;may
cause constipation;increase
for development of peptic ulcer;
fiber and fluids
lipid profile, LFT, electrolytes;PT
(prothrombin time) mix powdered form with juice

CHOLESTEROL ABSORPTION CLASS

T: Antihyperlipidemic
INHIBITORS
P: Cholesterol
Common generics: ezetimibe (Zetia) Absorption Inhibitor

Action: reduces total cholesterol by inhibiting absorption of cholesterol in the small intestine

Indication: hypercholesterolemia
Serious Adverse Reactions: liver toxicity, muscle pain & weakness rhabdomylosis (in;
combination with statins); Common: headache, runny nose, fatigue

Contraindicated: hypersensitivity, concurrent use with HMG-CoA reductase inhibitors in patients

with liver disease

Nursing Considerations Patient Education

Monitor
lipid profile, LFT baseline & monitor;
lifestyle changes - low-fat diet, exercise
creatinine kinase (CK)
if combination therapy with statins: report;
muscle pain or weakness

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
11
 CARDIOVASCULAR MEDS

SUFFIX: -fib- in the name FIBRATES CLASS

T: Antihyperlipidemic
Common generics: fenofibrate (Fenoglide), gemfibrozil (Lopid) P: Fibrate

Action: lowers LDL by lipoprotein lipolysis, decreases triglycerides, increases HDL

Indication: hypercholesterolemia to lower triglycerides, and increase HDL

Serious Adverse Reactions: liver toxicity, muscle pain or weakness, nausea, vomiting, diarrhea,;
gallstones, pancreatitis

Contraindicated: liver disease, renal impairment, gallbladder disease, lactation

Nursing Considerations
Patient Education
Baseline and Monitor
take exactly as directed
Lipid panel, LFT, RFT, CPK
lifestyle changes - low fat diet, exercise;
CBC, electrolytes
report abdominal pain/swelling,;
jaundice, fever, dark urine, muscle pain,;
administering with statins increases risk; chest pain immediately
of rhabdomylosis

NICOTINIC ACID/NIACIN CLASS

T: Antihyperlipidemic
(B3)
P: Vitamin B
Common generics: Niacin ER

Action: therapeutic dose reduces the release of fatty acids

Indication: hypercholesterolemia to lower total cholesterol

Serious Adverse Reactions: liver toxicity, peptic ulcer disease (PUD), muscle pain or weakness,;
hyperglycemia, gout, flushing of the skin (most common), nausea, vomiting

Contraindicated: hypersensitivity, PUD, liver disease,

Nursing Considerations Patient Education

Monitor
lipid panel, LFT, CPK,
take aspirin 30 minutes before niacin if;
blood glucose especially in diabetic or;
flushing occurs
prediabetic patients
uric acid take with meals to avoid GI symptoms

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
12
 Diuretics
SUFFIX: -ide

Common Generics: furosemide, bumetanide P: Loop Diuretics

T: Diuretics
Action: inhibits the reabsorption of sodium and chloride, depletes water
and electrolytes, Ĺ uric acid levels and excretes calcium
A potent diuretic causing rapid diuresis, ωfluid volume, CO and BP

Uses: HTN, edema associated with CHF, pulmonary edema, hypercalcemia, renaldisease

Considerations: Check K+ level (3.5 – 5 mEq/L) and BP before administering

furosemide - admin. too quickly can cause tinnitus, permanent hearing loss.

or ( <ϯ͘ϱ

x
Instruct patient:
x take in the morning to avoid nocturia, with food/GI upset
x rise slowly to avoid orthostatic hypotension, use sunscreen

SUFFIX: -thiazide
P: Thiazide Diuretics
Common Generics: hydrochlorothiazide, chlorothiazide T: Diuretics

Action: excretes sodium and water by inhibiting the reabsorption of sodium in the distal

renal tubules. Not as potent as loop diuretics.

Uses: HTN, peripheral edema, cirrhosis, estrogen therapy

to
dehydration, azotemia
Contraindicated
in patients with
Considerations: Check K+ level (3.5 – 5 mEq/L) and BP before administering renal failure.
Monitor: ĹBUN Ĺ CR ĻK+ ( replace K+ if <ϯ͘ϱmEq/L), uric acid levels

x
Patient Education:
x take in the morning to avoid nocturia, with food to avoid GI upset
x rise slowly to avoid orthostatic hypotension, use sunscreen

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE.

13
 Diuretics
SUFFIX: -actone, others

er to P: Na+ sparing diuretic Θ

aldosterone antagonist
T: Diuretics
Action: acts on distal tubule, promotes sodium and water excretion and reabsorption of potassium

Indication: edema, CHF, HTN, hypokalemia, hyperaldosteronism

primary concern is
di

Considerations: Use caution with patient with diabetes, taking lithium,

Monitor potassium supplements
x
x use heart monitor
x avoid potassium rich foods, salt substitutes
x blood glucose levels in patients with diabetes

x di
x take in the morning to avoid nocturia, with food, to prevent GI upset

P:

T:

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE.

14
 Anticoagulants
Class
ANTICOAGULANTS SUFFIX:-xaban, -arol, -irudin
P:AntiWKURPERWLF
Common generics: heparin, warfarin, dabigatran, rivaroxaban, apixaban
T: Anticoagulant
Parenteral – argatroban, bivalirudin, dalteparin
Action: inhibit factors in the clotting cascade and thrombin formation, thereby decreasing
coagulation
Uses: MI, unstable angina, AFib, deep vein thrombosis, pulmonary embolism, mechanical heart
valves

Serious Adverse Reactions: hemorrhage, blood in the urine, epistaxis (nosebleed), ecchymosis,
bleeding gums, thrombocytopenia (low platelet count), hypotension; nausea, GI
upset, diarrhea, and hepatic dysfunction indicates toxicity

Considerations for Heparin Antidote: protamine sulfate

x contraindicated in bleeding disorders, blood dyscrasias, ulcers, liver and kidney
disease, hemorrhagic brain injury
x therapeutic dose of heparin prevents new clots, does not dissolve
x continuous IV infusions on pump only to insure precise delivery rate

Monitor
x aPTT, (if aPTT is too long Ļ dosage, if aPTT is too short Ĺ dosage )
x Monitor platelet count
x Observe for side and adverse effects

Considerations for Warfarin (works by Ļvitamin K) Antidote: phytonadione YLWDPLQ.

x warfarin prolongs the prothrombin time (PT); the therapeutic range is ϭ͘ϱto Ϯtimes the
control value
x If the PT value is longer than 30 seconds and the INR is greater than 3.0 in a patient
receiving standard warfarin therapy, initiate bleeding precautions
x contraindicated in pregnancy, lactation
x nausea, GI upset, diarrhea, and hepatic dysfunction indicates toxicity

Monitor
x PT & INR
x Observe for side and adverse effects

Patient Education
x instruct patient adverse reactions
x measures to prevent bleeding
x avoid foods high in vitamin K

Bleeding is the primary concern with anticoagulant, thrombolytic, or antiplatelet medications

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE.

15
 Thrombolytics
Class
THROMBOLYTICS (FIBRINOLYTICS) SUFFIX: -teplase -ase
P: Plasminogen activator
Common generics: alteplase tenecteplase, retaplase, T: Thrombolytic

Action: thrombolytic medications activate plasminogen which generates plasmin. Plasmin is an

enzyme that dissolves clots.

Uses: acute MI to restore blood flow, arterial thrombosis, deep vein thrombosis, pulmonary
embolism, acute ischemic stroke, occluded catheters & shunts

Serious Adverse Reactions: bleeding, dysrhythmias, allergic reactions

Contraindicated in: Antidote: Aminocaproic acid

x active internal bleeding (excluding menses)

x history of hemorrhagic stroke
x recent intracranial hemorrhage
x recent head or facial trauma
x recent intracranial or intraspinal surgery
x thoracic, pelvic, or abdominal surgery in the previous 10 days
x history of hepatic or renal disease
x uncontrolled hypertension
x recent, prolonged cardiopulmonary resuscitation
x known allergy

Considerations

Monitor
x vitals, pulses
x for bleeding & check all excretions for occult blood
x for slurred speech, lethargy, confusion, and hemiparesis
x for hypotension and tachycardia
x withhold medication if bleeding develops and contact PHCP
x SDWLHQWQHHGVEHGUHVW

Bleeding is the primary concern with anticoagulant, thrombolytic, or antiplatelet medications

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE.

16
 Endocrine Meds

PREFIX: som- GROWTH HORMONE P: Growth Hormone

T: Hormone
Common Generics: somatropin

Action: promotes growth of bone primarily, also muscle, and organs

Uses: GH deficiency in adults and children

Adverse Reactions: hyperglycemia, hypothyroidism, hypersensitivity reaction, may develop antibodies

to GH

Route: Do not admin IV

Nursing Considerations Patient Education

x Monitor growth and bone age in children x Rotate injection site to prevent scar tissue
x Stop treatment before epiphyseal closure
x Teach s/s of hyperglycemia
x Monitor blood glucose, thyroid function test
x Monitor AST, ALT (liver function) x Report joint pain

SUFFIX: -pressin ANTIDIURETIC HORMONES P: Antidiuretic Hormone

T: Hormone
Common Generics: desmopressin, vasopressin

Action: causes kidneys to reabsorb water, which regulates fluid balance

Uses: Diabetes insipidus (desmopressin), hemophilia A, bedwetting, nocturia; vasopressin typical

treatment of septic shock

Adverse Reactions: flushing, headache, nausea, abdominal cramps, diarrhea, hypertension, water
intoxication, HYPONATREMIA, hypotension, tachycardia, nasal congestion with intranasal DDAVP

Nursing Considerations: Monitor Patient Education

x for s/s water intoxication (drowsiness, x Notify HCP if headache, SOB, s/s water

listlessness, SOB, headache) ωdosage intoxication, severe nasal congestion,

x for dehydration indicating χdosage χurine output

x weight, IΘO, urine osmolality x Avoid alcohol

x Medic-Alert bracelet
x BP Θ electrolyte levels

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 Endocrine Meds

SUFFIX: -thyro- THYROID HORMONES P: Thyroid Hormone

T: Hormone
Common Generics: levothyroxine, liothyronine, thyroid

Action: controls the metabolic rate of tissues, χO2 consumption, heart rate, respiration, growth rate

Uses: replace thyroid deficiency in hypothyroidism, goiters, myxedema coma, thyroid cancer

Adverse Reactions: GI upset, weight loss, nervousness, insomnia, headache, heat intolerance,
tachycardia, dysrhythmias, angina, HTN HYPERTHYROIDISM indicates TOXICITY

Contraindicated in MI, lactation, pregnancy

Patient Education
Nursing Considerations x Take in the AM with full glass of
water, without food
x Admin 4 hrs apart from other drugs – many drugs
x Report chest pain, tachycardia,
interfere
sweating ĺ toxicity
x Monitor for adverse effects
x Avoid OTC meds, wear medic alert

P: Antithyroid Agents
SUFFIX: varies ANTITHYROID HORMONES
T: Antithyroid Agents
Common Generics: propylthiouracil, methimazole, high doses iodine solution

Action: inhibit the production of thyroid hormone; high doses of iodine solution cause cell
oversaturation and stops thyroid production (risk of iodism)

Uses: hyperthyroidism, Graves’ disease

Adverse Reactions: nausea, vomiting, agranulocytosis, Ļplatelets, Ļwhite blood count,

HYPOTHYROIDISM indicates TOXICITY

IODISM s/s: metallic taste, sore mouth, vomiting, abdominal pain

Nursing Considerations: Monitor Patient Education

x Abruptly stopping meds could result
x T3, T4, TSH levels, vitals, weight in thyroid storm
x for thyroid storm s/s: fever, flushed, x Report fever; sore throat, mouth, or
tachycardia, sweating, HF signs gums; bruising, SOB
x methimazole can cause agranulocytosis, watch x Consult with HCP on iodine in the
for fever, sore throat diet Θ other medications

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE. 18
 Endocrine Meds

SUFFIX: -sone CORTICOSTEROIDS: MINERALOCORTICOIDS P: Mineralocorticoid

T: Corticosteroid
Common Generics: fludrocortisone

Action: promotes reabsorption of sodium and chloride and excretion of potassium from the renal
tubules. Results in fluid and electrolyte balance

Uses: replacement therapy in Addison’s Disease

Adverse Reactions: sodium and water retention, edema, HTN, HF, hypokalemia, hypocalcemia,
osteoporosis

Nursing Considerations: Monitor Patient Education

x for fluid retention, weight/lungs x Take with food to avoid GI upset
x Do Not stop meds abruptly
x electrolyte and calcium levels
x High K+ diet
x Report low BP, muscle weakness, mental
changes, illness

SUFFIX: -sone, -solone CORTICOSTEROIDS: GLUCOCORTICOIDS P: Glucocorticoid

T: Anti-inflammatory
Common Generics: cortisone, hydrocortisone, methylprednisolone,
prednisolone, prednisone
Action: suppress inflammation and alter the normal immune response
Uses: replacement therapy for adrenal insufficiency, as well as nonendocrine inflammatory conditions
and disorders
Adverse Reactions: hyperglycemia, adrenal insufficiency, hypokalemia, hypocalcemia, sodium Θ fluid
retention; Cushing syndrome; psychosis

Cautions Nursing Considerations: Monitor

x Contraindicated in patient w/hypersensitivity, x electrolytes, glucose
x IΘO, weight, BP
fungal infections, psychosis
x for hypokalemia, hyperglycemia
x Caution in patient w/diabetes, infection, cirrhosis x Teach patient report s/s Cushing’s, take
x Glucocorticoids increase or decrease potency of meds in AM, NO live virus vaccines, Do Not
many drugs! stop abruptly

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE. 19
 Endocrine Meds

SUFFIX: estra-, estro- ESTROGENS P: Estrogen Derivative

Common Generics: estradiol T: Steroid
Action: stimulate female reproductive tissue
Uses: metastatic breast cancer, osteoporosis, vulvar and vaginal atrophy in menopause, restore
endogenous hormonal balance
Adverse Reactions: HTN, MI, stoke, endometrial cancer, deep vein thrombosis, pulmonary embolism
breast tenderness, nausea, vomiting, diarrhea, edema
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Estrogens Contraindicated in patients with: Nursing Interventions

x Monitor vitals, for HTN
x Hx of breast cancer (except tx of metastatic
x Asses for edema, weight gain
breast cancer)
x DVT, pulmonary embolism, stroke, MI Patient Education
x endometrial hyperplasia, or cancer x Routine breast/pelvic exams needed
x liver dysfunction x No smoking
x pregnancy or lactation

PROGESTINS
P: Progestins
Common Generics: megestrol, norethindrone, levonorgestrel T: Antineoplastics
Action: specifically stimulate the uterine lining
Uses: (megestrol)AIDS related Cachexia, endometrial cancer, breast cancer
(norethindrone, levonorgestrel) birth control
Adverse Reactions: same as estrogens - HTN, MI, stoke, endometrial cancer, deep vein thrombosis,
pulmonary embolism; breast tenderness, nausea, vomiting, diarrhea, edema

3URJHVWLQV&RQWUDLQGLFDWHGLQSDWLHQWVZLWKWKURPERHPEROLFGLVRUGHUVDQGDYRLGHGLQEUHDVW
WXPRUVRUKHSDWLFGLVHDVH

Nursing Considerations (same as estrogens) Patient Education (same as estrogens)

x Monitor vitals x Routine breast/pelvic exams
x Monitor for HTN needed
x Asses for edema x No smoking
x Assess for weight gain

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE. 20
 Endocrine Meds

RAPID-ACTING INSULIN P: Rapid-Acting Insulins

(CLEAR) T: Antidiabetics
Common Generics: lispro, aspart, glulisine
Action: stimulates peripheral glucose absorption by skeletal muscle and fat; inhibits glucose
production in the liver
Uses: type 1 and type 2 diabetes mellitus
“Take with First Bite”
Onset: 10 – 30 min Peak: 30 min – 3 hours Duration: 3 – 6 hours

Adverse Reactions: hypoglycemia, hyperglycemia, hypokalemia, hives, anaphylaxis, lipodystrophy

Injection Sites Patient Education (see all Pt. Ed for insulins)

x abdomen x illness, trauma, infection require χinsulin
x back of upper arms x carry glucose, wear Medic Alert bracelet
x thighs
x teach patient/family s/s of hyper Θ
x rotate injection site daily
hypoglycemia Θantidote
x

SHORT-ACTING (REGULAR INSULIN) P: Short-Acting Insulins

(CLEAR) T: Antidiabetics
Common Generics: (currently none) Humulin R, Novolin R
Action: stimulates peripheral glucose absorption by skeletal muscle and fat; inhibits glucose
production in the liver
Uses: type 1 and type 2 diabetes mellitus; severe hyperglycemia (DKA)
Take 30 – 45 min before a meal
Onset: 30 – 60 min Peak: 1 – 4 hours Duration: 5 – 8 hours

Adverse Reactions: hypoglycemia, hyperglycemia, hypokalemia, anaphylaxis, lipodystrophy

Injection Sites Patient Education (see all Pt. Ed for insulins)

x abdomen x illness, trauma, infection require χinsulin
x back of upper arms x carry glucose, wear Medic Alert bracelet
x thighs x teach patient/family s/s of hyper Θ
x rotate injection site daily hypoglycemia Θantidote

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE. 21
 Endocrine Meds

INTERMEDIATE P: Intermediate-Acting Insulins

(CLOUDY) T: Antidiabetics
Common Generics: insulin NPH (brand names: Humulin N, Novolin N)
Action: stimulates peripheral glucose absorption by skeletal muscle and fat; inhibits glucose
production in the liver. 13+LVDQLQVXOLQVXVSHQVLRQDQGLVFORXG\²DOORWKHUW\SHVDUHFOHDU
Uses: type 1 and type 2 diabetes mellitus
Typical – 2X a Day – morning and evening before a meal
Onset: 1 -2 hours Peak: 4 - 14 hours Duration: 12 – 18 hours

Adverse Reactions: hypoglycemia, hyperglycemia, hypokalemia, anaphylaxis, lipodystrophy

Injection Sites same as above
Considerations Θ Patient Education Patient Education – same as above Θ͗
x DO NOT SHAKE x rubbing or exercise of injection site
x check for particles, discoloration, or clumpy causes χabsorption rate, possible
appearance
x gently roll in palms before admin hypoglycemia
x should have cloudy/milky appearance x injecting into scar tissue, ωabsorption

LONG-ACTING P: Long-Acting Insulins

(CLEAR) T: Antidiabetics
Common Generics: glargine, detemir
Action: stimulates peripheral glucose absorption by skeletal muscle and fat; inhibits glucose
production in the liver
Uses: type 1 and type 2 diabetes mellitus
Typical – Once daily
Onset: 1 -2 hours Peak: None Duration: 24 hours
Long-Acting insulins can be combined with other insulins but CANNOT be mixed!

Adverse Reactions: hypoglycemia, hyperglycemia, hypokalemia, anaphylaxis, lipodystrophy

Considerations Θ Patient Education Avoiding Dosage Errors

x check for particles or discoloration x Always use an insulin syringe with units
x do not inject cold insulin (painful) matching the insulin concentration on vial
x do not rub site after injection x follow the 6 Rights of Medication
x do not use same site more than once in 2-3 Administration
weeks x If unsure, have another nurse double-check

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE. 22
 Endocrine Meds

SUFFIX/PREFIX: metformin BIGUANIDES P: Biguanides

Common Generics: metformin T: Antidiabetics

Action: decreases glucose production in the liver, decreases intestinal absorption of glucose,
increases tissue response to insulin

Uses: type 2 diabetes mellitus

Adverse Reactions: GI symptoms: ωappetite, nausea/vomiting, diarrhea, metallic taste; lactic

acidosis (Ĺ risk with age and renal dysfunction), B12 deficiency

Discontinue before a NPO procedure or contrast dye imaging procedure and a period afterwards.
Contraindicated in patients with renal disease, metabolic acidosis

Nursing Considerations Patient Education

x Assess kidney, liver function before admin x report unusual weakness, tiredness,
x Monitor LFT, creatinine, B12 muscle pain, dizziness, irregular/slow HR
x B12 supplement if indicated x No alcohol
x do not break, crush, or chew tablet

SUFFIX: -ide SULFONYLUREAS P: Sulfonylureas

T: Antidiabetics
Common Generics: glimepiride, glipizide, glyburide

Action: stimulates insulin secretion in the pancreas; may also increase tissue response to insulin

Uses: treatment of type 2 diabetes mellitus

Adverse Reactions: hypoglycemia, hemolytic anemia, weight gain, photosensitivity, GI upset,

dizziness, headache

Contraindicated in type 1 diabetes, diabetic ketoacidosis Θ sulfa allergy

Nursing Considerations Patient Education

x NSAIDs χ hypoglycemic risk x NO alcohol w/ sulfonylureas
x assess patient’s knowledge of DM Θ oral meds x report fever, bruising/bleeding, SOB,
x obtain meds Hx yellowing eyes, dark urine right away
x Monitor blood glucose x take 30 minutes before meal, same
x Monitor kidney and liver function tests time each day
x Monitor urinalysis x wear Medic Alert bracelet, sunscreen

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE. 23
 Endocrine Meds

GLUCAGON P: Anti-Hypoglycemic
T: Hypoglycemia Antidote;
Common Generics: glucagon Also, Beta blocker ΘCCB Antidote

Action: treatment of severe hypoglycemia

 hypoglycemia in patients with diabetes

Uses: increase blood glucose during episode of severe
 vomiting
Adverse Reactions: hyperglycemia, GI upset, nausea,

Route: May be administered subcut, IM or IV. Peaks within 12 -20 minutes of subcut or IM admin

Contraindicated in pheochromocytoma, insulinoma (pancreatic tumor), hypersensitivity

Nursing Considerations: Monitor  Patient Education
x glucose level x carb should be eaten immediately after
x urinalysis subcut or IM admin
x A1C x seek medical attention after use
x kidney Θ liver function tests

P:
____________________
(drug class) T:

Common Generics:

Action:

Uses:

Adverse Reactions:

Considerations Θ Patient Education

Patient Education
x x

x x

x x

ALWAYS FOLLOW YOUR PROGRAM, FACILITY AND EMPLOYER POLICY AND PROCEDURE. 24
 RESPIRATORY MEDS

SUFFIX: -terol BETA2 AGONISTS CLASS

T: Bronchodilator
Common generics: albuterol, short acting for acute attacks P: Beta2-agonist

Common generics: salmeterol, long-acting for chronic conditions,

taken with corticosteroids
Action: binds to beta-2 receptors in lungs; relax bronchi smooth muscle and dilates airways

Indication: asthma, COPD, bronchitis (low air flow through lungs)

Serious Adverse Reactions: palpitations, dysrhythmias, HTN, nervousness, restless, tremors
Contraindicated in hypersensitivity, PUD, dysrhythmias; Use caution w/ HTN, DM, elderly, L&D
Nursing Considerations Patient Education
Assess wait 5 min to take #2 inhaled med
lung sounds wait 1-2 min to take 2nd dose of same med
for cough
wheezing (for paradoxical report SOB not relieved by med to PHCP immediately
bronchospasm)
Monitor
dysrhythmias intake & output
restlessness

SUFFIX: -phylline METHYLXANTHINES CLASS

Common generics: theophylline (oral), aminophylline T: Bronchodilator
P: Xanthine
Action: stimulates CNS, relaxes smooth muscle, dilates vessels, diuresis
Indication: long-term treatment of asthma, COPD (a last-line med)
Serious Adverse Reactions: restlessness, nervousness , palpitations, tachycardia, angina,
seizures, dysrhythmias
Adverse = early s/s of toxicity for theophylline

Nursing Considerations Patient Education

Assess & Monitor wait 5 min to take #2 inhaled med
lung sounds dysrhythmias
wait 1-2 min to take 2nd dose of;
for cough restlessness same med
wheezing (for paradoxical bronchospasm) report SOB not relieved by med to;
PHCP immediately
Monitor for avoid caffeine, alcohol
theophylline therapeutic level 10 – 20 mcg/mL; inhaler, spacer, nebulizer instruction
IV theophylline admin slowly w/infusion pump

theophylline increases risk of digoxin toxicity

theophylline decreases effectiveness of lithium, phenytoin;if
admin theophylline with beta2 agonist can dysrhythmias

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25
 RESPIRATORY MEDS

SUFFIX: -tropium, -clididiun INHALED ANTICHOLINERGICS CLASS

T: Bronchodilator
Common generics: tiotropium (long acting), ipratropium (short acting), P: Anticholinergic
& aclidinium
Action: blocks muscarinic receptors in the bronchi and inhibits parasympathetic response and;
bronchoconstriction

Indication: asthma, exercise-induced asthma, COPD

Serious Adverse Reactions: rare - blurred vision, palpitations, bronchospasm, urinary retention.;
Most common are dry mouth and irritation of the throat
ipratropium contraindicated in patients with peanut allergy, soy lecithin

Nursing Considerations Patient Education

Admin order of multiple meds: report SOB not relieved by med to PHCP
1)beta2-agonist immediately
2)anticholinergics inhaler, spacer, nebulizer instruction
3)steroids
order & timing of meds if multiple
asses lung sounds for cough, wheezing
monitor for dysrhythmias, restlessness suck on sugarless candy for dry mouth &
wait 5 min to admin #2 inhaled med throat irritation
wait 1-2 min to take 2nd dose of same inhaled med

SUFFIX: -asone, -onide, -olone GLUCOCORTICOIDS CLASS

(CORTICOSTEROIDS) T: Anti-inflammatory
Common generics: inhaled – budesonide, beclomethasone, fluticasone; P: Corticosteroid
oral – prednisone, prednisolone
Action: anti-inflammatory agents reduce edema in the airways and have an antistress,;
antiallergic affect. *affect glucose, protein, and bone; an immunosuppressant
masks s/s of infection
Indication: asthma, other inflammatory respiratory conditions

Serious Adverse Reactions: hyperglycemia, hypokalemia ( K), osteoporosis, PUD, GI

bleeding, pancreatitis, infections
Contraindicated w/hypersensitivity, fungal infections. Caution in patients with diabetes, infections

Nursing Considerations Patient Education

Monitor
for infection Do Not stop med abruptly – taper dose;
glucose level, electrolytes No NSAIDs
can be used alone or with beta2 agonist Not a rescue inhaler
No NSAIDs use spacer, rinse mouth after use





dose during increased stress, e.g., surgery

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 RESPIRATORY MEDS

SUFFIX: -lukast LEUKOTRIENE MODIFIERS CLASS

T: Anti-inflammatory
Common generics: montelukast, zafirlukast, zileuton P: Leukotriene receptor
(remember luk = affects leukotrienes) antagonist

Action: inhibits effects of leukotrienes, dilates smooth muscle, and reduces airway edema
*leukotrienes play key role in inflammation
Indication: treatment & prevention of chronic asthma, seasonal allergies Not for acute attack!

Serious Adverse Reactions: headache, N/V, indigestion, diarrhea, back & generalized pain
Contraindicated in hypersensitivity, caution with impaired liver function
Only bet
a2-agon
for bron ists;
chospas
Nursing Considerations Patient Education m!
Assess not for acute attack!
treatment effectiveness use prescribed rescue inhaler
lung function Do Not discontinue med w/o PCHP
liver function tests take on empty stomach
renal function tests

SUFFIX: -ephrine, -zoline NASAL DECONGESTANTS CLASS

T: Nasal decongestant
Common generics: pseudoephedrine, oxymetazoline;
P: Nasal decongestant
includes adrenergic, anticholinergic, and corticosteroids

Action: shrinks respiratory mucosa and reduces fluid secretion ( inflammation),

relieves sinus pain & congestion
Indication: rhinitis, sinusitis, common cold

Serious Adverse Reactions: rebound congestion, palpitations, nervousness, HTN,

hyperglycemia w/corticosteroids
Contraindicated in HTN, heart disease, diabetes, hyperthyroidism

Nursing Considerations Patient Education

Monitor
for dysrhythmias; avoid caffeine, palpitations, nervousness
blood glucose >48-hour use can cause rebound;
if taking OTC meds congestion

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
27
 RESPIRATORY MEDS

EXPECTORANTS CLASS
T: Expectorant
Common generics: guaifenesin P: Expectorant

Action: reduces viscosity and loosens bronchial secretions to make cough more productive

Indication: unproductive cough

Serious Adverse Reactions: headache, nausea, vomiting, rash; prolonged use can mask serious
underlying cause of cough

Contraindicated in hypersensitivity, caution in pregnancy & lactation

Nursing Considerations Patient Education

Assess lung sounds fluid intake

secretions characteristics cough & deep breathe
admin with glass of water

MUCOLYTICS CLASS
T: Mucolytic agent
Common generics: acetylcysteine
P: Acetaminophen antidote

Action: breaks down mucus secretions making cough more productive

Indication: cystic fibrosis (CF), COPD or other with thick mucus (inhaled); an antidote for;
acetaminophen overdose (IV); protects kidneys prior to dx testing with contrast dye (IV)

Serious Adverse Reactions: possible anaphylaxis with IV admin; common - nausea, vomiting,;
stomatitis (inflammation, sores in mouth)
acetylcysteine contraindicated in patients with asthma; airway resistance;
dextromethorphan, a cough suppressant, is contraindicated in patients with COPD

Nursing Considerations Patient Education

monitor for side effects fluid intake
Do Not mix acetylcysteine admin via
cough & deep breathe
nebulizer with any other medication
if admin w/bronchodilator, admin;
1) bronchodilator
bronchodilator first, wait 5 minutes and then;
2) wait 5 minutes
admin acetylcysteine
3) acetylcysteine

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28
 RESPIRATORY MEDS

SUFFIX: -xone OPIOID ANTAGONISTS CLASS

T: Antidote for opioids
Common generics: naloxone, naltrexone, methylnaltrexone, P: Opioid antagonist
alvimopan (for opioid-induced constipation)

Action: blocks the effects of opioids

Indication: reverses respiratory depression & CNS depression in opioid overdose

Serious Adverse Reactions: ventricular fibrillation, tachycardia, hypotension, hypertension,;

flushing; more common - opioid withdrawal s/s: anxiety, N/V, diarrhea, abdominal pain

Contraindicated: not for use in nonopioid respiratory depression, pregnancy unknown, lactation

Nursing Considerations Opioid antagonists reverses effects of analgesics!

Monitor every few min. until stable:
BP; RR & rhythm, depth; pulse; EKG IV dose is titrated every 2 – 5 minutes as;
Do not leave unattended, monitor 3-5 hours; prescribed
watch for opioid overdose s/s to return O2 & resuscitative equipment available
RR <12, unarousable
give second dose if needed

SUFFIX:
CLASS
T:
Common generics: P:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

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29
 GI MEDS

SUFFIX: ANTACIDS CLASS

T: Antacids, mineral/electrolyte
Common generics: calcium carbonate, magnesium hydroxide, replacement
aluminum hydroxide, sodium bicarbonate P: Electrolytes

Action: neutralizes stomach acid, gastric pH; pH inhibits pepsin (>5 for effective benefit)

Indication: gastritis, electrolyte imbalance, osteoporosis, constipation

Serious Adverse Reactions: metabolic alkalosis (headache, confusion, weakness, N/V, tetany)
hypokalemia (dysrhythmias, ST depression, anxiety, N/V, bowel sounds, constipation)

Contraindicated lactation, hypersensitivity, electrolyte imbalance, bowel obstruction, renal

dysfunction, kidney stones, HF, Cirrhosis

Nursing Considerations
assess abdomen, auscultate bowel sounds
no Rx required
salt compounds – use caution in many conditions
adverse effects pronounced in infants & elderly
absorption of many drugs due to acidic GI environment

Nursing Considerations ANTACIDS CONTINUED

Aluminum hydroxide Calcium carbonate
constipation common side effect constipation common side effect
may cause hypophosphatemia may cause acid rebound
effects of tetracyclines, warfarin, digoxin causes flatulence
phosphate absorption avoid milk products & vitamin D (milk-alkali
syndrome)
contain sodium – caution w/HTN, HF
Magnesium hydroxide
a saline laxative, may cause diarrhea Sodium bicarbonate (aka baking soda)
admin w/aluminum hydroxide prevents rapid onset, abdominal pressure
diarrhea flatulence
contraindicated in intestinal obstruction,
appendicitis may cause hypophosphatemia
w/renal impairment magnesium effects of tetracyclines, warfarin, digoxin
toxicity
phosphate absorption
Patient Education
take antacids on a regular schedule contain sodium – caution w/HTN, HF
chew thoroughly, followed by glass of water
1 hour between admin of each type of antacid and other meds

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
30
 GI MEDS

SUFFIX: GASTRIC PROTECTANTS CLASS

misoprostol T: Gastric Protectant
Common generics: misoprostol, sucralfate P: Prostaglandin

Action: secretion of gastric acid; production of mucus

Indication: to prevent ulcers when using NSAIDs, aspirin in high-risk patients;

Serious Adverse Reactions: diarrhea, abdominal pain, nausea/vomiting, constipation

Contraindicated: in pregnancy. Causes uterine contractions = spontaneous abortion

Nursing Considerations Patient Education

assess childbearing age women for pregnancy take with evening meal
negative pregnancy test do not take with magnesium antacids,
start med during next menstrual cycle diarrhea

SUFFIX: GASTRIC PROTECTANTS CLASS

sucralfate T: Gastric Protectant
Common generics: sucralfate, misoprostol P: Prostaglandin

Action: creates a protective barrier against acid and pepsin

Indication: peptic ulcers, duodenal ulcers

Side Effects: constipation

Contraindicated: hypersensitivity

Nursing Considerations
Patient Education
Monitor
take on an empty stomach;
Monitor drug levels of:
take 2 hours before or after
warfarin, digoxin, phenytoin, theophylline
sucralfate may decrease absorption of these fluids, fiber
oral admin

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 GI MEDS

SUFFIX: -tidine HISTAMINE H2 RECEPTOR CLASS

T: Anti-ulcer
ANTAGONISTS (H2-BLOCKERS)
P: Histamine H2
Common generics: cimetidine, ranitidine, famotidine, nizatidine receptor antagonists

Action: inhibits action of histamine on H2 receptors = suppresses secretion of gastric acid;

Indication: heartburn, ulcers, GERD, PUD

Serious Adverse Reactions: cimetidine – confusion, psychosis; IV admin can dysrhythmias,;

hypotension

Contraindicated: caution in patients with impaired kidney or liver function

Nursing Considerations Patient Education

Monitor Depending on the drug, teach:
therapeutic drug levels take with or without food
renal function
signs & symptoms of adverse effects
CBC
occult blood w/GI bleeding avoid GI irritating foods, alcohol

H2-BLOCKERS CONTINUED
Nursing Considerations
cimetidine nizatidine
admin route – PO, IM, IV side effects less common
food rate of absorption of oral med
antacids absorption of oral med ranitidine, famotidine, nizatidine
admin 1 hour apart not affected by food

cimetidine, ranitidine, famotidine

interferes with metabolism and excretion of many drugs
such as warfarin, phenytoin, theophylline, beta blockers,;
benzodiazepines, others
lower dose for patients w/renal impairment

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32
 GI MEDS

SUFFIX: -prazole
PROTON PUMP INHIBITORS (PPIS) CLASS
T: Proton pump inhibitor
Common generics: omeprazole, esomeprazole, pantoprazole,
P: Anti-ulcer
lansoprazole, rabeprazole

Action: decreases gastric acid secretion (affect parietal cells in stomach)

Indication: ulcers, PUD, esophagitis, prevention of NSAID-induced ulcers

Serious Adverse Reactions: headache, abdominal pain, diarrhea, rash (indicates toxicity;
Contraindicated: hypersensitivity, severe liver disease

Nursing Considerations Patient Education

admin on empty stomach 1 hour before Avoid
food/drugs NSAIDs, alcohol, smoking
monitor prothrombin time (PT) if on warfarin caffeine & acid-producing foods
report abdominal pain, diarrhea, or black;
ok with antacids tarry stools to PCHP immediately
For Helicobacter pylori, PPIs are given in combination with antibiotics in a triple or quadruple;
therapy, e.g., lansoprazole, amoxicillin, and clarithromycin.

SUFFIX: - GASTRIC STIMULANTS CLASS

Common generics: metoclopramide T: Antiemetic
P: Gastric Simulant
Action: blocks dopamine receptors in the CNS, stimulates motility in
upper GI tract and increases rate of gastric emptying

Indication: nausea/vomiting with GERD, chemotherapy; & prophylaxis for post-op N/V
Serious Adverse Reactions: extrapyramidal symptoms - restlessness, Parkinson symptoms,;
dysrhythmias, neuroleptic malignant syndrome (NMS)
Contraindicated: hypersensitivity, GI bleeding, obstruction, perforation, pheochromocytoma

Nursing Considerations Patient Education

assess abdomen, bowel sounds may cause drowsiness, insomnia
assess nausea level report tremor, involuntary muscle contraction
monitor for extrapyramidal symptoms immediately
do not use alcohol, sedatives
monitor BP, EKG

admin 30 min before meals & bedtime

may cause HTN crisis in patient with pheochromocytoma
atropine, morphine
effects of metoclopramide, CNS depressants effects of
metoclopramide

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
33
 GI MEDS

PREFIX: chol-, cole- BILE ACID SEQUESTRANTS CLASS

T: Antihyperlipidemic
Common generics: cholestyramine, colesevelam, colestipol P: Bile acid sequestrant
Action: absorbs and combines with intestinal bile salts, then secretes in the feces, which prevents;
intestinal reabsorption. (Lowers cholesterol because the liver must use more cholesterol to make;
more bile acid.)
Indication: hypercholesterolemia, pruritus (itchy skin associated with biliary;
obstruction/disease), biliary obstruction, bile-acid diarrhea
Serious Adverse Reactions: indigestion, bloating, constipation, fecal impaction, bowel obstruction
Contraindicated: hypersensitivity, complete biliary obstruction

Nursing Considerations Patient Education

assess constipation, bowel sounds present Notify PCHP
monitor lipid panel, LFT, PT unusual bleeding or bruising
admin before meals w/juice or applesauce; black, tarry stools
severe constipation or GI upset
admin 1-2 hours before other medications -
mix powdered med w/juice or applesauce
risk of binding in the intestine w/others
fiber, use stool softeners for constipation

Caution in patients with severe constipation or possible bowel obstruction

SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

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34
 GI MEDS

SUFFIX: -ine ANTIEMETICS CLASS

Antihistamines T: Antiemetic
P: Antihistamine
Main antiemetic classes: antagonists of histamine, dopamine,
serotonin, peptide, muscarinic receptors in PNS, corticosteroids and benzodiazepines.
Choice of antiemetic is determined by the cause of the nausea/vomiting.
Common generics: meclizine, cyclizine, dimenhydrinate, diphenhydramine, hydroxyzine;
Action: meclizine blocks effects of histamine at H1 receptor sites; also has anticholinergic effects;
depressing CNS (1st generation antihistamine w/sedating effects)

Indication: nausea and vomiting in motion sickness and vertigo

Serious Adverse Reactions: drowsiness, headache, fatigue, dry mouth, urinary retention,;
vomiting. Rare – blurred vision, anaphylactic reaction
Caution in arrhythmias, renal or hepatic dysfunction

Nursing Considerations
Patient Education
determine cause of n/v
assess severity, hx, characteristics of n/v causes drowsiness
monitor I & Os avoid alcohol & other CNS depressants
monitor for fluid & electrolyte imbalance avoid OTC drugs
fluid intake take with or without food
sugarless candy for dry mouth

SUFFIX: -setron ANTIEMETICS CLASS

Serotonin receptor (5-HT3) antagonists T: Antiemetic
P: 5-HT3 antagonist
Common generics: ondansetron, dolasetron, granisetron;
palanosetron (2nd gen drug)
Action: blocks effects of serotonin on the vagal nerve and CNS

Indication: prevention of chemotherapy & radiation-induced nausea & vomiting and postop n/v
Serious Adverse Reactions: most common – headache, fatigue, dry mouth; drowsiness, QT;
elongation, arrhythmias, extrapyramidal symptoms (EPS)

Contraindicated: in patients taking apomorphine. Caution in pregnancy, PKU

Nursing Considerations Patient Education

admin prior to surgery/chemo/radiation therapy; Report to PHCP immediately:
asses for extrapyramidal symptoms (EPS) involuntary muscle contractions
if IM, IV, admin SLOWLY (see admin guidelines) involuntary movement of face,
Monitor arms, legs
EKG, LFTs, effectiveness of drug

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 GI MEDS

ROOT: -nab- ANTIEMETICS CLASS

Cannabinoids T: Antiemetic
Common generics: dronabinol, nabilone P: Cannabinoid

Action: inhibits area of brain that controls nausea, vomiting (medulla oblongata) and appetite

Indication: nausea/vomiting from chemotherapy when unresponsive to other antiemetics,

appetite stimulation in HIV/AIDS, epilepsy, chronic pain

Serious Adverse Reactions: tachycardia, syncope, seizure, n/v, psychosis, confusion,

hypertension
Contraindicated: caution in patients with depression/anxiety, psychiatric hx - can exacerbate
symptoms; cannabinoids cross the placenta/present in breast milk

Nursing Considerations Patient Education

Monitor take exactly as prescribed
vital signs, I & O avoid alcohol & other CNS depressants
mental status
dose can cause serious adverse –
CBC confusion, seizure, rapid heartbeat, n/v

SUFFIX: ANTIEMETICS CLASS

Anticholinergics T: Antiemetic
Common generics: scopolamine transdermal P: Anticholinergic agent

Action: inhibits acetylcholine at the muscarinic receptors; affects the CNS with a sedating effect
Indication: nausea/vomiting associated with motion sickness, post-op N/V
Serious Adverse Reactions: dry mouth, blurred vision, dilated pupils, flushed skin, tachycardia,;
confusion, agitation, urinary retention
Caution in patients with psychosis, glaucoma, hx of seizures, myasthenia gravis, arrhythmias,;
CAD, HTN, renal and hepatic impairment, UC, COPD, asthma

Patient Education Nursing Considerations

may cause drowsiness, blurred vision inform patient blurred vision possible
(from drug-contaminated fingers)
assess LOC after surgery
wash hands, don't rub eyes after applying patch
assess effectiveness of drug therapy
apply 4 hours or night before driving or motion
mouth rinses and/or sugarless candy for dry mouth
avoid alcohol, other CNS depressants

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
36
 GI MEDS

SUFFIX: LAXATIVES CLASS

Bulk-forming T: Laxative
P: Bulk-forming agent
Common generics: psyllium, methylcellulose

Action: absorbs water into the stool and increases bulk

Indication: treatment & prevention of constipation and straining

Serious Adverse Reactions: nausea/vomiting, bloating, diarrhea, dehydration, electrolyte;

imbalances, bowel obstruction w/ low water intake, dependency w/long-term use

Contraindicated: bowel obstruction

Nursing Considerations Patient Education

mixture gels quickly
drink as soon as mixing
gelled mixture is a choking risk!
drink additional 8 oz water after solution
fluid intake for all types of laxatives to

Do Not take a laxative if nausea, vomiting, or
avoid dehydration fever

SUFFIX: LAXATIVES CLASS

Stool softeners T: Laxative
P: Stool softener
Common generics: docusate sodium, docusate calcium

Action: allows water and lipids into the stool

Indication: prevention of straining, chronic constipation

Side Effects/Serious Adverse: mild cramping, throat irritation w/liquid;
dependence w/long-term use
Contraindicated: intestinal obstruction, acute abdominal pain, do not use with mineral oil

Nursing Considerations Patient Education

administered orally or rectally fluids & fiber-rich foods
admin with fluids exercise program
2 hours between other laxatives take as directed/ for short-term use
mix oral liquid with fruit juice Do Not take a laxative if nausea, vomiting, or fever
fluid intake for all types of laxatives
to avoid dehydration

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37
 GI MEDS

SUFFIX: LAXATIVES CLASS

Osmotics T: Laxative
Common generics: polyethylene glycol (PEG) and electrolytes, P: Osmotic
lactulose, magnesium hydroxide, magnesium citrate
Action: draws water into the large intestine
Indication: constipation;
PEG & electrolytes also for bowel prep before surgery or GI exams;
magnesium hydroxide & magnesium citrate also used as antacids
lactulose also used for hepatic encephalopathy – stimulates peristalsis, secreting ammonia

Serious Adverse Reactions: abdominal bloating, cramps; hypernatremia, hypokalemia possible

with lactulose
Contraindicated: (PEG) - caution in renal impairment & cardiac dysfunction,
lactulose – caution in hepatic impairment
Patient Education
Nursing Considerations
fluids & fiber-rich foods
monitor electrolytes exercise program
metabolic acidosis can occur with take as directed/ for short-term use
diarrhea PEG & electrolytes for bowel prep instructions
osmotics cause fluid shifts Do Not take a laxative if nausea, vomiting, or fever

SUFFIX: - LAXATIVES CLASS

Stimulants T: Laxative
Common generics: bisacodyl, senna P: Stimulant Laxative

Action: stimulates motility and secretions of large intestine; changes the movement of water
& electrolytes in the large intestine which results in water & motility

Indication: constipation, bowel prep for GI exams

Serious Adverse Reactions: abdominal cramps, diarrhea, fluid and electrolyte imbalance

Contraindicated: intestinal blockage, undiagnosed abdominal pain, pregnancy, lactation

Nursing Considerations Patient Education

Assess
fluids during therapy
bowel sounds
for abdominal distention take as ordered
Monitor short-term therapy only
fluid & electrolytes
Do Not take a laxative if nausea, vomiting, or fever

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
38
 GI MEDS

ANTIDIARRHEALS CLASS
Common generics:
Opioids T: Antidiarrheal
diphenoxylate with atropine, loperamide
P: Antidiarrheal
Action: inhibits excessive GI motility, peristalsis (GI contraction), and electrolyte loss
Indication: adjunct in management of diarrhea (adjunct - used in combo w/another primary;
treatment), chronic IBS
Serious Adverse Reactions: flushed, dry skin, hyperthermia, confusion, headache, tachycardia,;
respiratory depression indicates toxicity; common – drowsy, dizzy, constipation;diphenoxylate/
atropine can lead to toxic megacolon in patients with acute ulcerative colitis
Contraindicated: infectious diarrhea (; motility can increase bacterial growth)
Nursing Considerations Patient Education
treat the cause take only as directed
replace fluids, electrolytes before admin may cause drowsiness, dizziness, constipation
Monitor notify PCHP if diarrhea persists or if
I&O, stool frequency, consistency palpitations, other adverse reactions
bowel sounds
watch for distended abdomen - may indicate ileus
atropine has anticholinergic effects
opioids worsen infections and poisonings because they delay excretion

SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
39
 NEURO MEDS

SUFFIX: -profen ANALGESICS (NONOPIOID) CLASS

NSAIDs T: Analgesic, Anti-
inflammatory,
Common generics: naproxen, ibuprofen, diclofenac (topical),
Antipyretic
celecoxib (Cox-2 inhibitor)
P: NSAID
Action: inhibits synthesis of prostaglandins
Indication: treat pain and inflammation, rheumatoid and osteoarthritis, bursitis, tendinitis, gout,;
dysmenorrhea
Serious Adverse Reactions: tinnitus, GI symptoms & bleeding, liver toxicity, renal damage,;blood
clots, edema, electrolyte imbalance, dysrhythmias
Contraindicated: hypersensitivity, liver or kidney disease; patients taking anticoagulants (No;
aspirin or NSAIDs)

Nursing Considerations Patient Education

Monitor
take with food or milk
LFT, BUN, creatinine, CBC, electrolytes
No alcohol
bleeding time, and for edema
risk toxicity with CCBs Do not take with ibuprofen or other;
NSAIDs
Do not give aspirin and NSAIDs together report tinnitus to PCHP


bleeding risk

SUFFIX: Aspirin, ASA ANALGESICS (NONOPIOID) CLASS

T: Antiplatelet, Analgesic,
NSAIDs - Aspirin
Anti-inflammatory,
Common generics: acetylsalicylic acid (ASA) Antipyretic
Action: inhibits synthesis of prostaglandins and inhibits clotting P: Salicylate, NSAID
(platelet aggregation)
Indication: MI & angina prophylaxis, inflammatory disease, fever, pain
Serious Adverse Reactions: tinnitus = toxicity, anaphylaxis, laryngeal edema, bleeding, GI;
symptoms
Contraindicated: children & teens (Reye’s Syndrome),
Caution in asthma, ulcers, gastritis, bleeding disorders (e.g., hemophilia)

Nursing Considerations
Patient Education
Monitor
LFT, BUN, creatinine, electrolytes, edema; take with food or milk
s/s of bleeding (e.g., bl gums, petechiae) No alcohol
drug level at high doses report tinnitus to PCHP
Do not take with ibuprofen or other
tinnitus early s/s of toxicity
NSAIDs
do not use with warfarin
Do not give aspirin and NSAIDs together -
bleeding risk

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
40
 NEURO MEDS

SUFFIX: acetaminophen ANALGESICS (NONOPIOID) CLASS

Acetaminophen T: Analgesic, Antipyretic
P: Nonopioid analgesic
Common generics: acetaminophen

Action: inhibits prostaglandin synthesis

Indication: treat pain and fever

Serious Adverse Reactions: hepatotoxicity, hypoglycemia, oliguria, rash, nausea, vomiting;

Contraindicated: hypersensitivity, liver or kidney disease, alcoholism

Nursing Considerations Patient Education

Assess hx liver, kidney dysfunction, alcoholism; Do not use >10 days
Monitor No alcohol while taking medication
LFT, RFT, prothrombin time (PT); Do not exceed maximum dosage
s/s of liver damage
abdominal pain, n/v, diarrhea;

Antidote is acetylcysteine

SUFFIX: -ine, -one, -done ANALGESICS (OPIOID) CLASS

Common generics: morphine, codeine, fentanyl, hydrocodone, T: Opioid analgesic
meperidine, methadone, nalbuphine, oxycodone, tramadol P: Opioid agonists

Action: binds to opioid receptors in the CNS; suppress pain impulses and have a sedating effect;
on the body, depressing respiration rate, heart rate and coughing
Opioids - “low & slow” RR, HR, BP
Indication: mild to severe pain Potentially Fatal
Serious Adverse Reactions: respiratory depression, hypotension, bradycardia, sedation,;
confusion, hallucinations, dizziness, constipation, N/V, dependence, tolerance
Contraindicated: patients with pulmonary disorders (e.g., COPD, severe asthma), increased ICP,;
head injury, liver or kidney disease; meperidine - in patients taking MAOIs
Nursing Considerations Patient Education
Asses
breathing exercises/incentive spirometer
Hx of contraindications, pain level w/scale
take exactly as prescribed w/ food or milk;
Monitor
avoid CNS depressants
VS, respiratory rate, LOC, I&O;
alcohol, antihistamines, other OTC meds
bradycardia or RR <12 notify PCHP
IV admin – dilute and admin over 5 minutes;
naloxone (Narcan) is the antidote

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
41
 NEURO MEDS

SUFFIX: -xone OPIOID ANTAGONISTS CLASS

T: Opioid antidote
P: Opioid antagonist
Common generics: naloxone

Action: blocks the effects of opioids on the CNS and respiratory system

Indication: reverses CNS and respiratory depression in opioid overdose

Serious Adverse Reactions: ventricular fibrillation, tachycardia, hypotension, hypertension,;

flushing; more common - opioid withdrawal s/s: anxiety, N/V, diarrhea, abdominal pain
Contraindicated: hypersensitivity, not for use in nonopioid respiratory depression, pregnancy;
unknown, lactation

Nursing Considerations
Monitor every few min. until stable: Naloxone reverses effects of analgesics!
BP; RR & rhythm, depth; pulse; EKG
watch for opioid overdose s/s to return
RR <12, unarousable
give second dose if needed
Do not leave unattended, monitor 3-5 hours

SUFFIX: ANTIPARKINSONIAN CLASS

T: Anti-Parkinson
Common generics: amantadine (antiviral pharm class), apomorphine, P: Dopamine agonist
bromocriptine, pramipexole, ropinirole

Action: stimulates dopamine receptors in the CNS

Indication: Parkinson’s disease, parkinsonism; pramipexole & ropinirole also RLS (restless leg sy);
Serious Adverse Reactions: orthostatic hypotension, dizziness, falls, N/V, chest pain, urinary;
retention, insomnia, depression, hallucinations

Contraindicated: alcohol abuse, renal failure, cardiac disorders, psychiatric disorders

Nursing Considerations Patient Education

Fall Risk!
Monitor
VS, BP, I&O Do not stop med abruptly
LFT, RFT, creatine kinase (bromocriptine) No alcohol
assess for drowsiness stand/move slowly – hypotension;
DM urine glucose test inaccurate
assess for medication effectiveness

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
42
 NEURO MEDS

SUFFIX: -dopa ANTIPARKINSONIAN CLASS

T: Anti-Parkinson
Common generics: carbidopa/levodopa
P: Dopamine agonist
Action: levodopa is converted into dopamine in the CNS
carbidopa prevents levodopa from being metabolized (used up) in the body before it
reaches the CNS more dopamine w/lower dose when used in combo
carbidopa doesn't cross the blood-brain barrier
Indication: Parkinson’s disease
Serious Adverse Reactions: hepatotoxicity, orthostatic hypotension, drowsiness, dizziness,;
confusion, psychosis, dyskinesia (involuntary muscle movements)

Contraindicated: patients taking MAOIs within 14 days of C/L HTN crisis, renal failure,;
cardiac disorders, psychiatric disorders

Nursing Considerations Patient Education

Monitor SURWHLQPHDOLQWHUIHUHVZPHGLFDWLRQ
BP, LFT, RFT
%LQWHUIHUHVZPHGLFDWLRQ
for improvement of s/s dark urine/sweat harmless s/e
for signs of dyskinesia (toxicity) Do not stop taking med abruptly

SUFFIX: -capone ANTIPARKINSONIAN CLASS

T: Anti-Parkinson
Common generics: entacapone, tolcapone
P: COMT inhibitor

Action: inhibits catechol-O-methyltransferase (COMT) more levodopa reaching the brain

Indication: adjunct therapy for Parkinson’s patients taking carbidopa/levodopa that have motor
fluctuations to decrease the “off period” of C/L
Serious Adverse Reactions: hepatotoxicity, orthostatic hypotension, diarrhea, dyskinesia,
hallucinations, insomnia
Contraindicated: liver disease, nontraumatic rhabdomyolysis, psychotic disorders

Nursing Considerations Patient Education

Monitor LFTs Report to PCHP
jaundice, dark urine, prolonged diarrhea
Do Not Admin with:
insomnia, hallucinations
monoamine oxidase inhibitors (MAOIs)
No alcohol or other CNS depressants
tricyclic antidepressants (TCAs)
selective serotonin reuptake inhibitors (SSRIs)
serotonin and norepinephrine reuptake inhibitors (SNRIs)

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
43
 NEURO MEDS

SUFFIX: -giline ANTIPARKINSONIAN CLASS

T: Anti-Parkinson
Common generics: selegiline, rasagiline
P: Monoamine oxidase
Action: inhibits MAO-B, preventing reuptake of dopamine, serotonin, type B inhibitor
norepinephrine increased amounts available in the CNS
Indication: adjunct medication used to treat Parkinson’s disease with carbidopa/levodopa. Also
used in major depressive disorder (MDD)
Serious Adverse Reactions: HTN crisis when consuming foods w/tyramine (aged cheese,
processed meats, alcohol), orthostatic hypotension, arrhythmias, extrapyramidal symptoms,
hallucinations, dyskinesia. Common: headache, dizziness, insomnia, dry mouth
Contraindicated: Do Not use with meperidine or other opioid analgesics, TCAs, SSRIs, SRNIs,
pheochromocytoma (tumor in adrenal gland)
Nursing Considerations Patient Education
Monitor Do Not stop taking abruptly
RFT, LFT, sleep pattern, nightmares avoid foods w/tyramine
assess mood changes, suicidality monitor BP, rise slowly to avoid falls
Do Not Admin with: Report to PHCP immediately:
tricyclic antidepressants (TCAs) mental status changes
selective serotonin reuptake inhibitors (SSRIs) muscle twitching
serotonin and norepinephrine reuptake inhibitors (SNRIs)

SUFFIX: ANTIPARKINSONIAN CLASS

T: Anti-Parkinson
Common generics: benztropine, trihexyphenidyl P: Anticholinergic
Action: block cholinergic receptors in the CNS, acetylcholine

Indication: adjunct therapy for all forms of Parkinson’s disease

Serious Adverse Reactions: dry eyes, dry mouth, blurred vision, constipation, urinary retention,
tachycardia, dysrhythmias, confusion, hallucinations, photophobia (light sensitivity)

Contraindicated: patients with glaucoma

Nursing Considerations Patient Education

Assess
urinary function, bowel function Do Not stop med abruptly, symptoms
fluids, fiber
Monitor
No alcohol
VS, I&Os, improvement of s/s
for urinary retention, ileus sunglasses when going out
for involuntary muscle movement

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 NEURO MEDS

SUFFIX: ANTICONVULSANTS CLASS

AKA ANTISEIZURE T: Anticonvulsant
Common generics: phenytoin P: Hydantoin
Action: prevents the spread of the seizure focal point (alters sodium transport)
Indication: treat tonic-clonic seizures and complex partial seizures; used as an antiarrhythmic
Serious Adverse Reactions: headache, confusion, blurred vision, drowsiness, N/V, gingival
hyperplasia (bleeding, swollen gums), rash, Stevens Johnson Syndrome (rare, but life-
threatening) hirsutism, platelet & WBC
therapeutic range 10-20 mcg/mL
Contraindicated: hypersensitivity, pregnancy (teratogenic)
All Antiseizure Medications: Caution in patients on anticoagulants, antipsychotics, anti-infectives,
oral contraceptives, ASA (aspirin), cimetidine effectiveness oral contraceptives
Nursing Considerations
Patient Education
Monitor
Do Not take with antacids or dairy
EKG, LFT, RFT, CBC w/differential, rash
avoid alcohol, other CNS depressants
serum drug level
s/s toxicity - involuntary eye movement, report rash or Stevens Johnson
ataxia, slurred speech, vomiting Syndrome immediately
seizure precautions

absorption w/antacids, calcium supplements, cancer drugs

SUFFIX: -barbital, -ital ANTICONVULSANTS CLASS

Common generics: phenobarbital, amobarbital, methohexital T: Anticonvulsant,
Action: depresses the CNS by stimulating GABA (gamma- sedative-hypnotic
aminobutyric acid). GABA inhibits neurotransmitters excitability P: Barbiturates

Indication: seizures and status epilepticus; also used with anesthesia, ICP Toxicity
Serious Adverse Reactions: respiratory depression, ataxia, sedation, nausea, vomiting;
hypotension, tolerance, addiction, accidental overdose
Contraindicated: Caution in patients with COPD, asthma, cystic fibrosis (barbiturates are
respiratory depressants) All Antiseizure Medications: use caution in patients on anticoagulants,
antipsychotics, anti-infectives, oral contraceptives, ASA (aspirin), cimetidine
phenobarbital therapeutic range 15-40 mcg/mL No Antidote >40 mcg/mL
Nursing Considerations
Patient Education
Monitor
BP, respiratory status, LOC NO alcohol or other CNS depressant
EKG, LFT, RFT, CBC w/differential Do Not stop medication abruptly
serum drug level causes drowsiness – teach safety
seizure precautions precautions
s/s toxicity (respiratory depression, ataxia, take exactly as prescribed – accidental
slurred speech, N/V) overdose
absorption w/use of antacids, calcium supplements, cancer drugs

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
45
 NEURO MEDS

SUFFIX: -zepam, -zolam ANTICONVULSANTS CLASS

T: Anticonvulsant
Common generics: clonazepam, diazepam, lorazepam, alprazolam
P: Benzodiazepine
Action: depresses the CNS by stimulating GABA (gamma-aminobutyric acid). GABA inhibits
neurotransmitters decreased excitability in the brain
Indication: absence seizures, status epilepticus, anxiety disorders, sedation
Serious Adverse Reactions: respiratory depression, drowsiness, liver toxicity, platelet & WBC
count, medication tolerance, dependency
Contraindicated: hypersensitivity, patients with glaucoma; caution in children and elderly
Therapeutic range lorazepam 50-240 ng/mL, clonazepam 20-80 ng/mL
Antidote for benzodiazepines is flumazenil – CAUTION in patients with ICP or status epilepticus!
May cause s/s to reoccur.

Nursing Considerations Patient Education

Monitor No alcohol, opioids, other CNS
BP, RR depressants
LFT, RFT, CBC w/differential Do Not stop medication abruptly
IV admin slowly or oversedation, bradycardia take exactly as prescribed - OD
causes drowsiness – teach safety
precautions

SUFFIX: ANTICONVULSANTS CLASS

T: Anticonvulsant
Common generics: carbamazepine P: Anticonvulsant

Action: inhibits neuronal sodium channels, decreasing excitability

Indication: tonic-clonic and partial seizures, trigeminal neuralgia

Serious Adverse Reactions: Steven’s-Johnson syndrome, agranulocytosis, suicidal ideation,

dizziness, nausea, vomiting, ataxia, tremors
Contraindicated: MAOIs within 14 days, TCAs, myelosuppression (bone marrow depression)
Caution in pregnancy
carbamazepine therapeutic range 3-14 mcg/mL

Nursing Considerations Patient Education

Monitor Do Not stop abruptly
LFT, CBC, EKG, electrolytes take exactly as prescribed
depression, mood changes report a rash to PCHP
taper off drug – status epilepticus! No alcohol, opioids, other CNS
depressants

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
46
 NEURO MEDS

SUFFIX: - ANTICONVULSANTS CLASS

T: Anticonvulsant
Common generics: valproic acid, divalproex sodium
P: Anticonvulsant

Action: increases the inhibitory effects of GABA decreased excitability in the brain

Indication: many types of seizures, migraines, bipolar disorder, mood disorders

Serious Adverse Reactions: hepatotoxicity, platelet count, WBC, bleeding time,

pancreatitis, thrombocytopenia, nausea, vomiting, drowsiness

Contraindicated: liver disease, pregnancy

Caution in pediatric & elderly patients, depression, constipation, renal impairment
divalproex, valproic acid therapeutic range 50 – 100 mcg/mL

Nursing Considerations
Patient Education
Monitor
Do Not stop abruptly – status epilepticus!
CBC w/differential take exactly as prescribed
LFT & enzymes No alcohol, opioids, other CNS depressants
serum drug level

SUFFIX: - CNS STIMULANTS CLASS

T: CNS stimulant
Common generics: dexmethylphenidate, methylphenidate P: CNS stimulant

Action: stimulates the central nervous system (CNS) and respiration

Indication: attention-deficit hyperactivity disorder (ADHD), narcolepsy

Serious Adverse Reactions: insomnia, restlessness, tachycardia, HTN, diarrhea, appetite &
weight loss, blurred vision, dependence

Contraindicated: hypersensitivity, MAOI within 14 days (HTN crisis)

Nursing Considerations Patient Education

Monitor
CBC w/differential, BP, HR take in the morning to avoid insomnia
effectiveness of drug avoid caffeine, alcohol
weight, growth of child on long-term notify school nurse child on drug (ADHD)
report insomnia, palpitations
potential for abuse/dependence
Do Not stop abruptly – depression

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
47
 ANTIDEPRESSANTS

SUFFIX: -opram, SELECTIVE SEROTONIN REUPTAKE CLASS

-oxetine, -oxamine, T: Antidepressant
-zodone
INHIBITORS (SSRI)
P: SSRI
Common generics: citalopram, escitalopram, fluoxetine, fluvoxamine,
paroxetine, sertraline, vilazodone fewer side effects than TCAs & MAOIs

Action: inhibits reuptake of serotonin more serotonin in the brain an antidepressant effect
Indication: depressive disorders, anxiety disorders, OCD, PTSD, bulimia
Serious Adverse Reactions: insomnia, drowsiness, weight gain/loss, tremors, seizures, suicidality
Contraindicated: with use of MAOIs and any drug that serotonin levels (serotonin syndrome);
paroxetine is contraindicated in pregnancy (teratogenic)
S/s toxicity (serotonin syndrome) agitation, tachycardia, hypertension, hyperreflexia or
clonus, nausea, vomiting, diarrhea, fever
Nursing Considerations
Patient Education
Monitor
avoid alcohol, other CNS depressants
BP, CBC, LFT, RFT avoid St. John’s wort
do not stop medication abruptly (GI distress)
assess & monitor for suicidality
report suicidal thoughts, palpitations
4 – 6 weeks to feel full effect
risk of serotonin syndrome w/MAOIs, St. John’s wort

SUFFIX: -faxine, SEROTONIN-NOREPINEPHRINE CLASS

-oxetine
REUPTAKE INHIBITORS (SNRI) T: Antidepressant,
Common generics: desvenlafaxine, duloxetine, venlafaxine Antianxiety
Norepinephrine-dopamine reuptake inhibitors (NDRIs) aka atypicals: P: SNRI, NDRI
bupropion; method of action is not understood
Action: inhibits the reuptake of serotonin and norepinephrine more available in the brain
antidepressant effect
Indication: major depressive disorder, generalized anxiety
Serious Adverse Reactions: serotonin syndrome, hyponatremia , hepatotoxicity, urinary retention
Contraindicated: caution in patients taking warfarin, digoxin

Nursing Considerations Patient Education

Similar to SSRIs
Monitor BP, CBC, LFT, RFT, electrolytes avoid alcohol, other CNS depressants
assess & monitor for suicidality avoid St. John’s wort
risk of serotonin syndrome w/MAOIs, St. do not stop medication abruptly (GI distress)
John’s wort report suicidal thoughts immediately
take as prescribe, do not stop medication
abruptly
4 – 6 weeks to feel full effect

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
48
 ANTIDEPRESSANTS

SUFFIX: -pramine, -triptyline TRICYCLIC CLASS

ANTIDEPRESSANTS (TCA) T: Antidepressant
Common generics: amitriptyline, clomipramine, desipramine, P: Tricyclic
imipramine, nortriptyline, protriptyline Antidepressant

Action: inhibits reuptake of serotonin and norepinephrine increased serotonin and

norepinephrine in the brain. Inhibits receptors: alpha-adrenergic (orthostatic hypotension),
muscarinic (anticholinergic), and histamine (sedation)
Indication: depression TCAs have a narrow therapeutic range - prone to toxicity
Serious Adverse Reactions: anticholinergic side effects, serotonin syndrome, urinary retention,
dysrhythmias, hypotension, abnormal EKG, sedation
Contraindicated: use of SSRIs, SNRIs, MAOIs, CV problems, mania, renal or hepatic impaired,
glaucoma, urinary retention
EKG prior to treatment & periodically (cardiotoxicity possible)
Nursing Considerations Patient Education
Monitor may take several weeks for full effect
LFT, RFT, CBC No alcohol, OTC drugs, CNS depressants
suicidal ideation/attempt, risk early on report suicidal thoughts, palpitations immed
taper pt. off drug if discontinued use sunscreen; fiber, fluids (constipation)
overdose is life-threatening

SUFFIX: - CLASS
T:
Common generics: P:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

Monitor

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
49
 ANTIDEPRESSANTS

SUFFIX: multipe MONOAMINE OXIDASE CLASS

INHIBITORS (MAOI) T: Antidepressant
Common generics: phenelzine, selegiline, tranylcypromine P: MAOI

Action: Inhibits the enzyme monoamine oxidase which breaks down dopamine, tyramine,
serotonin, norepinephrine levels of these neurotransmitters antidepressant effect

Indication: depression, panic disorder not responsive to all other antidepressants

Serious Adverse Reactions: not a first line drug due to adverse effects, drug interactions, diet
restrictions; anticholinergic (muscarinic) side effects; dry mouth, GI effects, urinary hesitancy,
tachycardia/palpitations/dysrhythmias, restless, dizzy, insomnia, high fever, seizures, serotonin
syndrome, HTN crisis
Contraindicated: renal disease, hepatic disease, CV disease, pregnancy, lactation,
Interactions w/concurrent use of: amphetamines, stimulants, vasoconstrictors, SSRIs, SNRIs,
TCAs, dopamine, carbidopa/levodopa, epinephrine, norepinephrine, tyramine containing foods,
opioid analgesics, tramadol, St. John’s Wort and others.

Nursing Considerations
Assess for contraindications/cautions admin medication early - insomnia
Monitor BP frequently, EKG, LFT, RFT taper pt. off drug if discontinued
hold med & contact PCHP if CNS or CV s/s

MAOIs CONTINUED
Patient Education two types of monoamine oxidase, A and B.
no tyramine containing foods MAO-A present in the placenta, liver, gut
report headache, sore/stiff neck immediately
MAO-B present in the brain, liver, platelets
no caffeine, OTC cold meds, “diet pills”
may take 2-3 weeks for full effects have a narrow therapeutic range

Hypertensive Crisis Toxicity Treatment

hypertension tyramine w/MAOIs IV fluids
headache = BP benzodiazepines for seizure, agitation
tightening chest pain
shortness of breat
Antidote: phentolamine
tachycardia or bradycardia
vertigo, nausea, vomiting
fever, chills
Tyramine-Containing Foods
aged cheese
processed meat (salami, pepperoni, bologna)
alcohol (beer, red wine)
caffeine (coffee, tea, chocolate)
chicken liver
fermented & pickled foods, meat tenderizer
avocados, bananas

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 MOOD STABILIZERS

SUFFIX: lithium MOOD STABILIZERS CLASS

T: Mood Stabilizer
Common generics: lithium carbonate
P: Mood Stabilizer
Action: unknown, lithium alters sodium transport in nerve and
muscles, and increases serotonin and/or GABA
Indication: manic episodes and prophylaxis in bipolar disorders
Serious Adverse Reactions: tremors, seizures, EKG changes, dysrhythmias, leukocytosis
( WBC), diabetes insipidus, hypothyroidism, polyuria

Contraindicated: CV & renal impairment/disease, lactation, pregnancy - teratogenic, children

toxicity risk when used with diuretics, NSAIDs, MAOIs
low sodium intake
fluid & electrolyte loss Patient Education
report palpitations, SOB immediately
Nursing Considerations Do not reduce/eliminate sodium – toxicity
Monitor report vomiting, diarrhea, fever immediately
I&Os, weight, electrolytes may take 2-3 weeks for full effects
LFT, RFT, CBC, thyroid tests limit coffee, tea, soda - have diuretic effect
serum drug level frequently when starting No alcohol, OTC meds,
assess for suicidality & monitor suicidal Do Not stop abruptly – take as prescribed
patient teach s/s toxicity

MOOD STABILIZERS CONT.

Narrow therapeutic range 0.6 – 1.2 mEq/L

Lithium Overdose

Toxicity Nursing Interventions

Serum lithium level: withhold medication & notify PHCP
Mild 1.5 mEq/L Monitor vital signs, LOC, EKG
Moderate 1.5 – 2.0 mEq/L institute suicide precautions
Severe >2.0 mEq/L

ADITIONAL NOTES

Atypical Mood Stabilizers - carbamazepine, clozapine, lamotrigine, olanzapine, valproate

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 SEDATIVE-HYPNOTICS

SUFFIX: -plon SEDATIVE-HYPNOTICS CLASS

T: Sedative-Hypnotic
Common generics: eszopiclone, meprobamate, suvorexant, zaleplon,
P:Sedative-Hypnotic
zolpidem, ramelteon, tasimelteon

Action: inhibit GABA receptors

Indication: anxiety, short-term treatment of insomnia

Serious Adverse Reactions: dizziness, confusion, allergic reaction, megaloblastic anemia,

agranulocytosis, thrombocytopenia, purpura
death can result from overdose
Contraindicated: hypersensitivity, taking other CNS medications; (all CNS depressants)
caution in patients with suicidal ideation, history of drug addiction
Nursing Considerations Signs & Symptoms of Overdose
Monitor
dilated pupils
older patient needs lower dose
clammy skin
supervise ambulation (dizziness)
BP
monitor for s/s overdose
tachycardia
Patient Education respiratory depression
No alcohol, other CNS depressants hyporeflexia (absent reflexes)
report sleepwalking immediately
Do Not stop med abruptly, take as directed

SUFFIX: -zine, -peridol, ANTIPSYCHOTICS CLASS

-peridone T: Antipsychotic
Common generics: chlorpromazine, fluphenazine, perphenazine P: 1st Gen. Antipsychotic
(antiemetic effects); haloperidol (Typical)
Action: blocks dopamine receptors in the brain, but is not “selective”
so also blocks histamine, and muscarinic receptors adverse reactions

Indication: positive symptoms of schizophrenia (e.g., hallucinations, aggression),

chlorpromazine – also nausea, vomiting, persistent hiccups; haloperidol – also Tourette’s

Serious Adverse Reactions: Neuroleptic malignant syndrome; extrapyramidal symptoms -

Parkinsonism, tremors, drooling; anticholinergic symptoms – hypotension, dry mouth, urinary
retention, constipation

Contraindicated: patients on SSRIs, dopamine agonists; Parkinson’s, glaucoma, hepatic & renal
disease, pregnancy; extreme caution in any condition or drug that causes CNS depression,
patients on BP meds

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
52
 ANTIPSYCHOTICS

ANTIPSYCHOTICS
CONTINUED

Nursing Considerations Patient Education

Assess for contraindications/cautions Do Not stop abruptly, take as directed
Monitor No alcohol or other CNS depressants
for adverse effects above full effect may take several weeks
vital signs, CBC, LFT urine discoloration may occur/normal
urine output

Neuroleptic Malignant Syndrome S/S Interventions for Neuroleptic Malignant Syndrome

LOC changes, confusion, seizures Notify PCHP
muscle rigidity seizure precautions
tachycardia, dysrhythmias admin antipyretics, muscle relaxants, IV
fluids as ordered
fever, diaphoresis
monitor electrolytes, vital signs
WBC, LFT

SUFFIX: -idone, -apine, -azole ANTIPSYCHOTICS CLASS

2ND GEN. ATYPICALS T: Antipsychotics
Common generics: aripiprazole, olanzapine, risperidone, ziprasidone P: 2nd Gen. Atypical
Antipsychotics
Action: block mostly dopamine and serotonin receptors so fewer side effects
Indication: + and - symptoms of schizophrenia, bipolar disorder, depressive disorder
Serious Adverse Reactions: somnolence, sedation, nausea, vomiting, dysrhythmias,
agranulocytosis, neutropenia, thrombocytopenia; weight gain, glucose, cholesterol;
hypotension, urinary retention, constipation. Similar to 1st gen. drugs, but risk of extrapyramidal
symptoms, neuroleptic malignant syndrome is lower in 2nd gen drugs (but still possible!)
Contraindicated: as with 1st gen. antipsychotics there are many drug interactions &
contraindications; including QT prolongation, any drug or condition that causes CNS depression;
Parkinson’s, dementia , glaucoma, pregnancy & lactation
Nursing Considerations Patient Education
Assess for contraindications/cautions Do Not stop abruptly, take as directed
Monitor No alcohol or other CNS depressants
for neuroleptic malignant syndrome full effect may take several weeks
EKG, CBC, LFT urine discoloration may occur/normal
electrolytes

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
53
 ANTIAXIETY

SUFFIX: -zepam, -zolam ANTIANXIETY CLASS

(ANXIOLYTIC) T: Antianxiety
P: Benzodiazepine
Common generics: clonazepam, diazepam, lorazepam, alprazolam
benzodiazepines are also muscle relaxant, anticonvulsive, sedative-hypnotic

Action: depresses the CNS by stimulating GABA (gamma-aminobutyric acid). GABA inhibits
neurotransmitters decreased excitability in the brain

Indication: anxiety disorders, absence seizures, status epilepticus, sedation

Serious Adverse Reactions: respiratory depression, drowsiness, liver toxicity, platelet & WBC
count, medication tolerance, dependency

Contraindicated: hypersensitivity, patients with glaucoma; caution in children and elderly

Therapeutic range lorazepam 50-240 ng/mL, clonazepam 20-80 ng/mL

Antidote for benzodiazepines is flumazenil - watch for withdrawal symptoms!

ANTIANXIETY
(ANXIOLYTIC) CONTINUED

Nursing Considerations Patient Education

Monitor No alcohol, opioids, other CNS
BP, RR depressants
LFT, RFT, CBC w/differential Do Not stop medication abruptly
IV admin slowly or oversedation, bradycardia take exactly as prescribed - OD
taper patient off med over several weeks causes drowsiness – teach safety
precautions
Monitor for withdrawal s/s
anxiety, irritability, disturbed sleep
muscle pain/cramps
nausea, vomiting
altered mental status
seizures

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 ANTI-ALZHEIMER

SUFFIX: ANTI-ALZHEIMER CLASS

T: Anti-Alzheimer
Common generics: donepezil, galantamine, rivastigmine P: Acetylcholinesterase
Inhibitor
Action: inhibits acetylcholinesterase an increase of acetylcholine improved
memory & other cognitive functions.

Indication: mild to moderate dementia in Alzheimer’s patients

Serious Adverse Reactions: nausea, vomiting, diarrhea, weight loss, peptic ulcer, bradycardia,
bronchospasm, sleep disturbance (increases parasympathetic activity)

Contraindicated: hypersensitivity, caution in patients with PUD, seizure disorder, asthma, COPD,
bradycardia, urinary obstruction (will increase symptoms

Nursing Considerations
Assess cognitive function & throughout Patient Education
therapy take with food to reduce GI effects
rivastigmine especially – monitor for take exactly as directed
adverse effects report vomit that looks like coffee grounds or
monitor weight worsening N/V

SUFFIX: - CLASS
T:
Common generics: P:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

Monitor

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 ANTIBIOTICS

NURSING CONSIDERATIONS FOR ANTIBIOTICS:

assess patient for contraindications and cautions

perform culture and sensitivity tests before administering
monitor the infection site
monitor for adverse effects Broad-Spectrum Antibiotics Risk:
long-term use can lead to superinfections diarrhea
antibiotics interact with many other drugs superinfections such as
antibiotics pose a risk for Clostridium difficile (C. diff) candidiasis
(To make space for other info these are not always pseudomembranous colitis
included in each medication.) (caused by C. diff)

EDUCATE PATIENT TO REPORT

fever, diarrhea, rash, bleeding DEFINITIONS
difficulty breathing bactericidal – kills the bacteria
difficulty urinating bacteriostatic – prevents the bacteria from growing
broad-spectrum - treat a variety of bacterial pathogens
severe headache
including gram-positive AND gram-negative infections
signs of infection narrow-spectrum - treat gram-positive OR gram-
negative infections

SUFFIX: sulfa- SULFONAMIDES CLASS

T: Antibiotic
Common generics: trimethoprim/sulfamethoxazole (Bactrim) also
P: Sulfonamide
known as cotrimoxazole
Action: inhibits the growth of folic acid in bacteria
Indication: bronchitis, UTI, otitis media, travelers’ diarrhea, pneumocystis pneumonia (PCP)
Serious Adverse Reactions: nausea/vomiting, severe rash, dizziness, hepatotoxicity, crystalluria,
bone marrow suppression

Contraindicated: hypersensitivity to sulfa drugs, pregnancy & lactation, renal or hepatic

impairment, hematological disorders, caution in elderly; interacts with many drugs

Nursing Considerations
Patient Education
Assess
for allergy to sulfonamides take medication as directed/finish all
other medications taken sunscreen for photosensitivity
Monitor increase fluids
I&O, encourage fluids report fever, rash, bleeding
RFT, LFT, CBC w/differential for baseline &
monitoring therapy

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
56
 ANTIBIOTICS

SUFFIX: -oxacin FLUOROQUINOLONES CLASS

T: Antibiotic
Common generics: ciprofloxacin (Cipro), gemifloxacin (Factive), P: Fluoroquinolone
levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin)

Action: inhibits DNA enzymes (bactericidal); broad-spectrum

Indication: UTI, skin, bone, and joint infections, respiratory infections, inhaled anthrax

Serious Adverse Reactions: N/V, diarrhea, photosensitivity, peripheral neuropathy, headache,

seizures, hyper/hypoglycemia, prolonged QT interval, tendonitis, tendon rupture, anaphylaxis

Contraindicated: hypersensitivity, pregnancy & lactation, seizures, prolonged QT interval

Nursing Considerations Patient Education

Monitor take with water – empty stomach, no food
for allergy/anaphylaxis finish all med as directed
for crystalluria, s/s tendonitis & infection protect skin from sun exposure
CBC w/diff, blood glucose, LFT, RFT report muscle/tendon pain, rash, blood in
admin w/water – no food stool

SUFFIX: -mycin MACROLIDES CLASS

Common generics: azithromycin (Zithromax Z-Pak), erythromycin T: Antibiotic
(Erythrocin, E-Mycin) P: Macrolide

Action: inhibits protein synthesis in the bacterial cell leading to death of the cell
Indication: upper/lower respiratory infections, sexually transmitted diseases, otitis media,
prevention of mycobacterium avium complex (MAC) in advanced HIV infection, Legionnaires
disease, prophylaxis for conjunctivitis in newborns
Serious Adverse Reactions: prolonged QT interval (erythromycin), pseudomembranous colitis,
hepatotoxicity, Stevens-Johnson syndrome
azithromycin is associated with less adverse effects than erythromycin

Contraindicated: erythromycin - prolonged QT interval or on drugs that prolong QT,

hypersensitivity, some antipsychotics and other drugs; caution in pregnancy with erythromycin

Nursing Considerations Patient Education

Monitor take with water on empty stomach
for allergy/anaphylaxis take medication as directed/finish all
LFT, EKG, CBC w/differential report rash, fever, abdominal pain, or
bloody diarrhea

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
57
 ANTIBIOTICS

SUFFIX: -cillin PENICILLINS CLASS

Common generics: amoxicillin (Amoxil, Trimox), ampicillin (no brand), T: Antibiotic
amoxicillin-clavulanate (Augmentin) beta-lactamase inhibitor P: Penicillin & Beta-
Action: interferes w/ bacterial cell by binding to the cell wall leading lactamase Inhibitors
to death of the bacterial cell
Indication: strep throat, scarlet fever, endocarditis, pneumonia, UTI, skin infections, GI infections
Serious Adverse Reactions: N/V, diarrhea, superinfection, crystalluria, pseudomembranous
colitis, bone marrow suppression, seizures (w/high dose)

Contraindicated: renal impairment, anaphylaxis (e.g. Stevens-Johnson syndrome); ampicillin is

contraindicated in infections caused by penicillinase-producing organisms

Nursing Considerations
Monitor Patient Education
for anaphylaxis (rash, pruritis, dyspnea, take medication as directed/finish all
wheezing,) increase fluids
for other adverse effects (bloody diarrhea) report rash, fever, abdominal pain, or
CBC w/differential, LFT, RFT
bloody diarrhea
Penicillinase-resistant antibiotics oral contraceptives less effective – use
are used for penicillin-resistant bacteria alternative
dicloxacillin, nafcillin, oxacillin are available

SUFFIX: cef- CEPHALOSPORINS CLASS

T: Antibiotic
Common generics: there are 4 generations: cephalexin (Keflex) (1st),
P: Cephalosporin
cefuroxime (2nd), ceftazidime, ceftriaxone (3rd), cefepime (4th)

Action: interferes with bacterial cell by binding to the cell wall leading to its death
Indication: respiratory infections, UTI, gonorrhea, bone infections, soft tissue & skin infections,
otitis media, surgery prophylaxis; 4th gen. effective against gram-positive & gram-negative
Serious Adverse Reactions: pseudomembranous colitis, bone marrow suppression, phlebitis at
IV site, superinfections, pruritis, Steven-Johnson syndrome

Contraindicated: hypersensitivity to cephalosporins, penicillin: renal & hepatic impairment;

caution in pregnancy & lactation

Nursing Considerations Patient Education

Monitor report diarrhea, fever, abdominal pain,
for allergy/anaphylaxis bloody stool
RFT, LFT, CBC w/differential report red, swollen or peeling skin, red
prothrombin time eyes, mouth
report vaginal discharge/itching
Hx of allergy to or taken penicillins?
oral contraceptives < effective

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 ANTIBIOTICS

SUFFIX: -cycline TETRACYCLINES CLASS

T: Antibiotic
Common generics: doxycycline (Vibramycin), minocycline (Minocin), P: Tetracycline
tetracycline (Sumycin)

Action: inhibits protein synthesis in the bacterial cell preventing it from multiplying

Indication: acne, skin infections, chlamydia, gonorrhea, syphilis, traveler’s diarrhea, periodontitis,
inhalation & cutaneous anthrax, legionnaire’s disease, Mycoplasma, Rickettsia
Serious Adverse Reactions: nausea, vomiting, diarrhea, photosensitivity, rash, bone marrow
suppression, superinfection, hepatotoxicity, anaphylaxis

Contraindicated: hypersensitivity, pregnancy, lactation, children <12 years (teeth & bones)
hepatic or renal disease, Myasthenia gravis; use with penicillins, isotretinoin (Accutane)

Nursing Considerations Patient Education

Monitor take medication as directed/finish all
RFT, LFT, CBC w/differential avoid milk, calcium, antacids
amylase and lipase take on empty stomach
report rash, fever, bloody diarrhea
oral contraceptives < effective

SUFFIX: -mycin, -micin AMINOGLYCOSIDES CLASS

Common generics: amikacin, gentamicin, neomycin, tobramycin T: Antibiotic
P: Aminoglycoside
(TOBI, Tobrex, Bethkis) streptomycin (highly toxic)
Action: inhibits protein synthesis in the bacterial cell leading to death of the cell
Indication: gram-negative aerobic bacterial infections, staphylococcus, and when penicillin is
contraindicated; (e.g., infections of blood, bone, skin, UTI, meningitis, pneumonia)
neomycin – bowel surgery prophylaxis

Serious Adverse Reactions: nephrotoxicity, ototoxicity, neuromuscular blockade, ALT, AST,

confusion, dizziness, ataxia, palpitations, hypo/hypertension, allergic reaction
Contraindicated: hypersensitivity, pregnancy & lactation, patients on neuromuscular blockers,
IBD, Parkinson’s, myasthenia gravis
Nursing Considerations Patient Education
Monitor drink plenty of fluids
RFT, LFT, CBC w/differential finish all medication as directed
peak and trough levels prior to next dose report tinnitus, vertigo, dizziness, rash
IV site every 30 minutes report palpitations, problems urinating
for s/s toxicity
I&O & nutrition

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 ANTIVIRALS

SUFFIX: -cyclovir, ANTIVIRALS CLASS

-ciclovir T: Antiviral
P: Purine Nucleoside
Common generics: acyclovir (Zovirax), famciclovir (Famvir),
Analogue
ganciclovir (Cytovene), valacyclovir (Valtrex)

Action: inhibits the herpes virus DNA from replicating

Indication: PO & IV: genital herpes, herpes zoster (shingles), varicella (chickenpox), encephalitis;
topical: cold sores; ganciclovir – used for prevention of cytomegalovirus (CMV) in transplant
recipients

Serious Adverse Reactions: (common - headache, dizziness, nausea); renal failure, Stevens-
Johnson syndrome, seizures, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic
syndrome (HUS); bone marrow suppression (ganciclovir, valacyclovir)
Contraindicated: hypersensitivity; caution in immunocompromised, HIV/AIDS, renal impairment,
pregnancy

ANTIVIRALS CONTINUED
Nursing Considerations Patient Education
Monitor condoms always during sexual contact
for phlebitis at IV site report infection, bleeding, bruising, fever
infection, bruising, bleeding, CNS changes bloody diarrhea, urinating changes, weight gain
I&O, BUN, creatinine (renal failure) wash hands thoroughly after touching
affected areas and after applying topical
baseline RFT
wear gloves when admin topical medication

HIGH DOSES CAN LEAD TO:

NEPHROTOXICITY
NEUROTOXICITY

Antivirals reduce replication of a virus - they do not kill it.

They alleviate symptoms by inhibiting reproduction of the virus.
Notes:

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 ANTIFUNGALS

SUFFIX: -conazole AZOLE ANTIFUNGALS CLASS

T: Antifungal
Common generics: fluconazole (Diflucan), itraconazole (Sporanox),
P: Azole Antifungal
ketoconazole (tablet & topical) (Nizoral), voriconazole (VFEND)

Action: decreases ergosterol production (ergosterol necessary for fungal growth)

Indication: treatment of systemic (e.g., candidiasis, UTI) and topical fungal infections

Serious Adverse Reactions: (GI symptoms common), headache, anemia, rash, photosensitivity,
prolonged QT interval, tinnitus, hearing loss, hepatotoxicity, cardiotoxicity, triglycerides

Contraindicated: itraconazole – HF, pregnancy; patients on drugs that prolong QT interval, liver,
or renal dysfunction, and MANY drugs, pregnancy (oral meds)

Nursing Considerations Patient Education

Monitor take with food; No alcohol
EKG changes protect skin with sunscreen, clothing
RFT, LFT, CBC w/differential report rash, dark urine, bruising, bleeding
jaundice, severe N/V, diarrhea immediately
obtain culture before starting medication no antacids within 2 hours of taking
medication
FOR ALL ANTIFUNGALS

POLYENE DERIVATIVES CLASS

Common generics: amphotericin B (Abelcet) Rapid Onset T: Antifungal
Highly Toxic P: Polyene Derivative
Action: decreases ergosterol production (ergosterol necessary for Antifungal
fungal growth) and stimulates phagocytic immune cells
Indication: IV: treatment of invasive/progressive systemic fungal infections

Serious Adverse Reactions: hypotension, arrhythmias, hypokalemia, peripheral neuropathy,

BUN and creatinine renal toxicity, liver toxicity, bone marrow suppression, rash

Contraindicated: patients on steroids, lactation; caution in pregnancy; do not combine

amphotericin with other nephrotoxic drugs (e.g. nephrotoxic antibiotics, corticosteroids, others)
Nursing Considerations
Monitor Infuse slowly over 3 hours (cardiotoxicity risk)
VS every few minutes until therapeutic
dosage reached obtain culture before starting medication
electrolytes (daily initially) asses respiratory status daily
EKG changes
RFT, LFT, CBC w/differential

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 ANTIFUNGAL

SUFFIX: -fungin ECHINOCANDINS CLASS

Common generics: anidulafungin (Eraxis), caspofungin (Cancidas), T: Antifungal
micafungin (Mycamine) P: Echinocandin

Action: inhibits the production of glucan in the fungal cell wall

Indication: candidemia, esophageal candidiasis, other candida infections, invasive aspergillosis,

neutropenia fever

Serious Adverse Reactions: injections site reactions, hypotension, tachycardia, headache, chills,
rash, N/V, diarrhea, creatinine, hepatic toxicity, bone marrow suppression, anaphylaxis
Contraindicated: concurrent use with cyclosporine, hypersensitivity, caution in hepatic
impairment. Pregnancy: caspofungin is contraindicated in pregnancy, caution with other
antifungals with pregnancy & lactation (amphotericin B is first choice)

Nursing Considerations Patient Education

Monitor Report immediately:
s/s anaphylaxis (rash, fever, edema, SOB) rash, low-grade fever, facial swelling
LFT, CBC w/differential shortness of breath
watch for Hgb, Hct dark urine, light-colored stools
nausea, vomiting, jaundice

SUFFIX: -
CLASS
T:
Common generics: P:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations
Patient Education

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
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 HIV/AIDS MEDS

NURSING CONSIDERATIONS FOR ANTIRETROVIRALS:

Highly active antiretroviral therapy (HAART) is the standard treatment for HIV and AIDS. It is
a drug therapy treatment of 3 to 4 medications. The combination helps to prevent drug
resistance. The HAART regimen does not cure HIV/AIDS but can improve immune function,
reduce risk of opportunistic infections, and prolong life.

Antiretrovirals inhibit the replication of human immunodeficiency virus (HIV)

Antibiotics, antivirals, antifungals, anti-inflammatory medications, and other drugs are used
to treat infections and complications of HIV/AIDS.

Monitor labs for baseline and throughout therapy (not noted on all meds to save space)

IMPORTANT PATIENT EDUCATION

Antiretrovirals do not decrease the risk of passing HIV on to others through sexual contact,
sharing needles, or donating blood.

Always use a condom Teach patient the timing of multiple

Do not share needles medications
Do not donate blood

SUFFIX: -vir, REVERSE TRANSCRIPTASE CLASS

-vudine T: Antiretroviral
INHIBITORS (NRTIs)
P: Nucleoside-nucleotide
Common generics: abacavir (Ziagen), didanosine (Videx), emtricitabine reverse transcriptase
(Emtriva), lamivudine (Epivir), stavudine (Zerit), zidovudine (Retrovir) inhibitors NRTI

Action: inhibits HIV reverse transcriptase which prevents viral replication

Indication: HIV infections in combination with other antiretrovirals; lamivudine for hepatitis B;
zidovudine first choice during pregnancy

Serious Adverse Reactions: headache, fatigue, sleep disturbance, rash, lactic acidosis,
hepatoxicity, hypersensitivity, pancreatitis (didanosine)
Contraindicated: hypersensitivity to any RTI, hepatic impairment

Nursing Considerations
Patient Education
Assess/Monitor
for s/s hypersensitivity report allergic reaction immediately
for decrease in infections timing of multiple medications important
viral load & CD4 count avoid people who are sick
LFT, RFT, CBC w/differential, lipids, glucose
for baseline & throughout treatment always use a condom, do not give blood,
or share needles

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 HIV/AIDS MEDS

SUFFIX: -virdine, REVERSE TRANSCRIPTASE CLASS

-virnez T: Antiretroviral
INHIBITORS (NNRTIs) P: Non-nucleoside-
nucleotide reverse
Common generics: delavirdine (Rescriptor), efavirenz (Sustiva), transcriptase inhibitors
etravirine (Intelence), nevirapine, rilpivirine (Edurant) (NNRTIs)

Action: inhibits HIV reverse transcriptase which inhibits viral replication

Indication: HIV infections in combination with other antiretrovirals

Serious Adverse Reactions: fewer adverse effects than NRTIs; diarrhea, cholesterol levels,
rash, insomnia, abnormal dreams, suicidal ideation

Contraindicated: hypersensitivity to any RTI, hepatic impairment

Nursing Considerations Patient Education
Monitor report allergic reaction immediately
for rash, CNS & mood changes, suicidal timing of multiple medications important
ideation avoid people who are sick
for decrease in infections always use a condom, do not give blood,
viral load & CD4 count or share needles
LFT, RFT, CBC w/differential, lipids, glucose
for baseline & throughout treatment

SUFFIX: -navir PROTEASE INHIBITORS CLASS

T: Antiretroviral
Common generics: atazanavir (Revataz), darunavir (Prezista), ritonavir
P: Protease Inhibitor (PI)
(Norvir), saquinavir (Invirase)

Action: inhibits HIV protease

Indication: treatment of HIV infection in combination with other antiretrovirals
Serious Adverse Reactions: (common) nausea, vomiting, diarrhea, malaise, muscle pain; renal
and hepatotoxicity, seizure, hyperglycemia, hyperlipidemia, fat redistribution, Stevens-Johnson
Syndrome, anaphylaxis, angioedema

Contraindicated: hypersensitivity; the drugs warfarin, diltiazem (CCB), lovastatin, sildenafil (PDE5
inhibitor), tenofovir and others

Nursing Considerations Patient Education

Monitor report allergic reaction, dark urine,
for decrease in infections jaundice
viral load & CD4 count timing of multiple medications is important
LFT, RFT, lipids, glucose for baseline & avoid people who are sick
throughout treatment always use a condom, do not give blood,
lipid lowering drug may be prescribed or share needles

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 HIV/AIDS MEDS

SUFFIX: -viritude FUSION INHIBITORS CLASS

T: Antiretroviral
Common generics: enfuvirtide (Fuzeon) P: Fusion Inhibitor

Action: inhibits the fusing of HIV cells with healthy cells

Indication: treatment of HIV in combination with other antiretrovirals when the virus is
replicating despite ongoing antiretroviral therapy

Serious Adverse Reactions: (common) diarrhea, muscle weakness, fatigue; hypersensitivity,

injections site reactions, pneumonia

Contraindicated: hypersensitivity, pregnancy & lactation

Nursing Considerations Patient Education

Monitor Report
allergic & injection site reactions severe redness, swelling at injection site
for pneumonia
rash, fever, trouble breathing, chest
viral load & CD4 count congestion
LFT, RFT, CBC w/diff, glucose, creatinine
phosphokinase

SUFFIX: -gravir INTEGRASE INHIBITORS (IIs) CLASS

T: Antiretroviral
Common generics: dolutegravir (Tivicay), elvitegravir (Vitekta),
P: Integrase Inhibitor
raltegravir (Isentress)

Action: inhibits HIV integrase and prevents it from getting into the healthy cell (HIV needs
integrase to replicate)

Indication: treatment of HIV in combination with other antiretrovirals

Serious Adverse Reactions: GI effects, headache, dizziness, ALT, glucose, lipase &
amylase, suicidal ideation (with elvitegravir)

Contraindicated: hypersensitivity, as initial treatment, lactation; caution in pregnancy

Nursing Considerations Patient Education

Monitor
report immediately if depression or
for suicidal ideation w/elvitegravir suicidal thoughts
viral load & CD4 count notify HCP if you are or become pregnant
do not breastfeed
LFT, RFT, CBC w/diff, glucose & A1C,
report signs of infection
creatinine phosphokinase

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 HIV/AIDS MEDS

SUFFIX: -viroc CHEMOKINE RECEPTOR 5 CLASS

T: Antiretroviral
(CCR5) ANTAGONIST P: CCR5 Antagonist
Common generics: maraviroc (Selzentry)
Action: blocks the receptor on T-cells and prevents attachment and entry into the healthy cell
Indication: treatment of HIV in combination with other antiretrovirals
Serious Adverse Reactions: dizziness, appetite, hepatotoxicity, rash, fever, infection,
bronchitis, URI, myocardial infarction, heart failure, immune reconstitution syndrome, Stevens-
Johnson syndrome
Contraindicated: hypersensitivity, renal impairment or ESRD, pregnancy & lactation; drug
interactions with protease inhibitors (PIs), antifungals, antivirals, NNRTIs (CYP3A inhibitory and
inducers)
Nursing Considerations Patient Education
Monitor
for rash/allergic reactions Notify HCP immediately if:
for cardiotoxicity, hepatotoxicity chest pain/pressure
for respiratory infections dark urine, light-colored stools, jaundice
viral load & CD4 count fever, chills, cough, mouth sores
LFT, RFT, CBC w/diff, glucose, amylase, No OTC meds or herbal supplements
lipase

SUFFIX: - CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

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 IMMUNOSUPPRESSANTS

SUFFIX: -trexate ANTI-METABOLITE CLASS

T: Immunosuppressant
Common generics: methotrexate (Otrexup)
P: Anti-metabolite
Action: inhibits folic acid metabolism decreased cell reproduction; different mechanism for
immunosuppression

Indication: chemotherapy in numerous cancers, severe psoriasis, RA, SLE, IBD

Serious Adverse Reactions: nausea, vomiting, anorexia (most common), hepatoxicity, bone
marrow suppression, renal failure, pancreatitis, mouth ulcers, respiratory toxicity
Contraindicated: pregnancy, lactation; caution in pts w/ blood disorder, renal impairment, ulcers

Teratogenic Interactions with NSAIDs, PPIs and many other drugs

Nursing Considerations
Patient Education
Monitor
use contraceptives, do not breastfeed
LFT, RFT, CBC w/differential
avoid alcohol
auscultate lungs
report fever, sore throat, chills, cough
dry cough may indicate pulmonary fibrosis
chest x-ray baseline may be needed

SUFFIX: -sporin IMMUNOSUPPRESSANT CLASS

T: Immunosuppressant
Common generics: cyclosporine (Sandimmune)
P: Immunosuppressant
Action: inhibits the cell-mediated immune response Agent

Indication: transplant rejection prophylaxis, admin w/ glucocorticoid & another immunosuppres

Serious Adverse Reactions: renal and hepatotoxicity, HTN, hirsutism, bone marrow
suppression, infection risk, pulmonary edema, headache, tremor, seizure, gingival hyperplasia,
n/v, diarrhea

Contraindicated: hypersensitivity, active infection, impaired renal function, use with other
immunosuppressants, blood disorders or cancers, uncontrolled HTN; caution hepatic impairm

Nursing Considerations cyclosporine interacts with statins and many

Assess medications & OTC taken by patient other hepatotoxic & nephrotoxic drugs
Monitor
BP, I&O, daily weight
RFT, LFT, glucose, electrolytes Patient Education
May Cause
serum drug levels
therap. level depends on many factors nausea, vomiting, diarrhea, abdominal pain
therapeutic range is narrow acne, hair growth, joint pain
if admin IV for s/s of hypersensitivity report weight gain, dark urine, jaundice

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 IMMUNOMODULATOR

ANTIINFLAMMATORY CLASS
T: Antiinflammatory
P: Immunomodulator
Common generics: pimecrolimus 1% cream (Elidel)

Action: inhibits activation of cytokines

Indication: atopic dermatitis (eczema) in patients 2 years or older

Adverse Reactions: redness, itching, burning, skin sensitivity to sunlight

Contraindicated: hypersensitivity, skin infections, immunocompromised, taking

immunosuppressive drugs, malignant lesions

Nursing Considerations
Patient Education
Assess
do not use occlusive (airtight) dressing on
for history of contraindications
treated area
do not let cream contact eyes

SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

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 CANCER MEDICATIONS

ANTINEOPLASTICS

Antineoplastic medications kill or inhibit cancer cells

Stimulate the vomiting center of the brain
IV route is the most common
Type of cancer and BSA determine dosing
Adverse effects are a result of antineoplastics effects on healthy cells
Rapid destruction of cells causes increased uric acid release

Also know as cytotoxic, chemotherapy, oncological medications

Cell Cycle Phase

Antineoplastics are cell cycle phase-specific or phase-nonspecific
Phase-specific affect the cell during a specific phase of the reproductive cycle
Phase-nonspecific affect the cell during any phase of the reproductive cycle

The Nursing Interventions/Considerations and Patient Education below are for

antineoplastics. To save space they are not always included on each drug sheet.

NURSING INTERVENTIONS & CONSIDERATIONS FOR ANTINEOPLASTIC MEDICATIONS

Assess
for contraindications, allergies, bone marrow suppression (BMS)
Monitor Wear indicated PPE to
CBC w/diff, electrolytes reduce exposure to
RFT, LFT, PFT, infusion site
antineoplastics!
for petechiae, ecchymoses, nosebleed, bleeding gums

IV fluids before and during therapy

provide calorie diet, protein supplements
antiemetics are administered before and after chemotherapy
initiate bleeding precautions if thrombocytopenia develops (<150,000)

Initiate Bleeding Precautions & Notify HCP According to Facility Policy

platelet count < 50,000/mm3 prolonged bleeding risk
platelet count < 20,000/mm3 spontaneous bleeding risk

Patient Education for Antineoplastic Medications

low purine foods
fluids to 2L/day
calorie diet, protein supplements
report adverse effects including s/s infection, fever, chills, pain urinating, jaundice

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 CANCER MEDICATIONS

SUFFIX: -mustine, -platin ANTINEOPLASTICS CLASS

T: Alkylating Medication
Cell Cycle Phase: Non-specific ALKYLATING
P: Antineoplastic Agent
Common generics: bendamustine (Treanda), cisplatin (generic),
chlorambucil (Leukeran), cyclophosphamide (generic), ifosfamide (Ifex)
Action: binds w/intracellular structures breaking the DNA strands prevents cell replication
Indication: used alone or in combo w/ others to treat variety – some testicular, ovarian, cervical,
breast, bladder cancers; malignant lymphomas, and others; used in slow-growing cancers
Adverse Reactions: nausea, vomiting, anorexia, alopecia, BMS, infection, nephrotoxicity,
hepatotoxicity, CNS toxicity, hyperuricemia, gonadal suppression (chlorambucil)
hemorrhagic cystitis (cyclophosphamide & ifosfamide)
Contraindicated: hypersensitivity, pregnancy, lactation, urinary flow obstruction

See Nursing Considerations Above Patient Education

report s/s infection, fever, chills, pain urinating
fluids to 2 – 3L/day w/ifosfamide &
cyclophosphamide
The nitrosoureas carmustine, lomustine, and streptozocin are alkylating agents that cross the
blood-brain barrier and are used to treat brain tumors.

SUFFIX: -arabine, -uracil ANTINEOPLASTICS CLASS

Cell Cycle Phase: Non-specific ANTIMETABOLITES T: Antimetabolite
P: Antimetabolite
Common generics: cladribine (no US brand), cytarabine, fludarabine,
fluorouracil (Carac), gemcitabine (Gemzar), mercaptopurine (Purinethol), methotrexate (Otrexup,
Trexall)
Action: interferes with DNA production; stops the production of protein. Antimetabolites
include folate, pyrimidine, and purine antagonists
Indication: used in combo w/others for leukemias, breast, colon, pancreatic, gastric cancers

Adverse Reactions: nausea, vomiting, anorexia, diarrhea, stomatitis, alopecia, bone marrow
suppression and...
Methotrexate Mercaptopurine Fluorouracil
hepatoxicity hepatoxicity fever, phototoxicity, ataxia, pulmonary embolism
respiratory toxicity pancreatitis Contraindications:
renal failure hyperuricemia hypersensitivity, pregnancy, lactation; pancreatitis
hyperuricemia w/mercaptopurine; renal and hepatic impairment,
photosensitivity GI ulcers
Nursing Considerations and Patient Education see first page of antineoplastics

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 CANCER MEDICATIONS

SUFFIX: -mycin, -rubicin, ANTINEOPLASTICS CLASS

-(x)antrone T: Antitumor Antibiotics
ANTITUMOR ANTIBIOTICS
Cell Cycle Phase: Non-specific P: Antitumor Agent, Anthracycline

Common generics: bleomycin (No US brand), dactinomycin (Cosmegen), mitomycin (Mutamycin,

Mitosol), doxorubicin (Adriamycin), daunorubicin (Cerubidine), mitoxantrone

Action: inhibits the synthesis of DNA and RNA

Indication: in combo w/ other antineoplastics for lymphomas, leukemias, bladder cancer,
metastatic breast and ovarian cancers, solid tumors; Mitosol for glaucoma
Serious Adverse Reactions: nausea, vomiting, anorexia, diarrhea, stomatitis, alopecia, BMS,
gonadal suppression, hyperuricemia; blistering, extravasation at IV site (esp. mitomycin)
bleomycin – pulmonary toxicity; daunorubicin – HF, arrythmias; doxorubicin – cardiotoxicity;
mitomycin – bone marrow toxicity
Contraindications & Cautions: hypersensitivity; pregnancy & lactation, pulmonary, cardiac, renal
& hepatic impairment/dysfunction; GI ulcers, bone marrow suppression

Nursing Considerations Patient Education

Monitor fluids to 2L/day
PFT, lung sounds, EKG for changes
report adverse effects
watch for s/s HF (SOB, weight gain)

SUFFIX: -taxel, -tecan, -vin, -vin- ANTINEOPLASTICS CLASS

MITOTIC INHIBITORS T: Mitotic Inhibitor
Cell Cycle Phase: Specific P: Taxane, Topoisomerase II
(affects M Phase) Inhibitor, Vinca Alkaloid

Common generics: cabazitaxel (Jevtana), docetaxel (Taxotere), paclitaxel, etoposide (Toposar),

teniposide, irinotecan, topotecan (Hycamptin), vinblastine, vincristine (Vincasar PFS), vinorelbine

Action: inhibits DNA synthesis preventing mitosis

Indication: various leukemias, lymphomas, tumors

Serious Adverse Reactions: renal, hepatic, pulmonary, & neuro (vincristine) toxicity, bone
marrow suppression, hyperuricemia, drooping eye lid, severe constipation/paralytic ileus;
cellulitis, phlebitis, necrosis at IV site
Contraindicated: hypersensitivity, pregnancy & lactation, renal, hepatic dysfunction/impairment,
and lung conditions (e.g., COPD)

Nursing Considerations
Patient Education
monitor CNS status, infusion site
report adverse effects
peripheral neuropathy esp. w/ vincristine
premedication w/antiemetic
prophylaxis for constipation see patient education above

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 CANCER MEDICATIONS

SUFFIX: -etsr ANTINEOPLASTICS CLASS

T: Hormone
HORMONES
Common generics: estradiol (systemic) (Estrace), estramustine (Emcyt) P: Estrogen
Estramustine is a combination of an antineoplastic and estrogen.
Action: blocks hormone receptors slower growth of cancer cells
Indication: estradiol - estrogen, vulvar & vaginal atrophy, hot flashes, (HRT), osteoporosis,
metastatic breast cancer, advanced prostate cancer;
estramustine – metastatic prostate cancer
Serious Adverse Reactions: estradiol – edema, HTN, breast tenderness, depression, weight
gain/loss, hirsutism (in women), triglycerides; estramustine – gynecomastia, impotence,
AST, SOB, edema

Contraindicated: estradiol – hypersensitivity, pregnancy & lactation, history of DVT or PE, breast
cancer, angioedema, CV disease, stroke; risk of breast or endometrial cancer
estramustine – hypersensitivity, history of DVT or PE

Nursing Considerations Patient Education

Monitor fluids, avoid alcohol
CBC w/differential, RFT, LFT estramustine – do not take with antacids,
for HTN, thromboembolism, edema dairy

SUFFIX: -ifene, -ifen ANTINEOPLASTICS CLASS

ANTIESTROGENS T: Antiestrogens
P: Selective Estrogen Receptor
Common generics: raloxifene (Evista), tamoxifen (Soltamox) Modulator (SERM)

Action: tamoxifen effects of estrogen; raloxifene has agonist effects on bone leading to
bone density, AND antagonist effects on breast and uterine tissues blocking estrogen effects

Indication: treat and reduce risk of breast cancer (tamoxifen); osteoporosis (raloxifene)

Serious Adverse Reactions: tamoxifen – edema, hypercholesterolemia, hypercalcemia,

flushing, endometrial cancer, stroke, PE; raloxifene – edema, hot flashes, infection, muscle
spasms, joint pain, flu-like symptoms

Contraindicated: hypersensitivity, pregnancy, history of DVT, PE; concurrent use with warfarin

Nursing Considerations
Patient Education
Assess/Monitor
bone density MAMMO & GYN exams baseline & annual
CBC w/diff (esp. platelet count) report leg pain, vision changes, weight gain
LFT, electrolytes, lipid panel
hormone levels

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 CANCER MEDICATIONS

SUFFIX: -utamide ANTINEOPLASTICS CLASS

T: Antiandrogens
ANTIANDROGENS
P: Antiandrogens
Common generics: bicalutamide (Casodex), flutamide (Eulexin)
Action: binds to androgen receptors and inhibits testosterone’s stimulating effect, reducing
prostate cancer cell growth

Indication: prostate cancer

Adverse Reactions: edema, pain, hot flashes, gynecomastia, constipation, back pain, impotence;
flutamide – hepatic failure

Contraindicated: hypersensitivity, severe hepatic impairment w/flutamide

Nursing Considerations Patient Education

Assess/Monitor
LFT, PSA, CBC, testosterone level take medication exactly as prescribed
adherence to drug therapy report jaundice, dark urine,
nausea/vomiting, light-colored stools

SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

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 RENAL & URINARY MEDS

URINARY CLASS
ANTISEPTIC/ANTIBACTERIAL T: Antiseptic/Antibacterial
P: Urinary Anti-infective
Common generics: methenamine (Hiprex, Urex)
Action: inhibits growth of bacteria in the urine (breaks down into ammonia and formaldehyde)
Indication: chronic UTIs (not for acute)
Serious Adverse Reactions: nausea, vomiting, diarrhea, anorexia (most common); bladder
irritation, crystalluria

Contraindicated: renal impairment, liver disease, gout, pregnancy near term

Do not combine with sulfonamides, OTC antacids

Nursing Considerations Patient Education

take after meals or at bedtime
monitor urine pH do not take OTC antacids
needs acidic urine of pH 5.5 or <
fluids = pH drug less effective
monitor BUN, creatinine, WBC count
admin after meals or bedtime to reduce GI
effects

URINARY CLASS
ANTISEPTIC/ANTIBACTERIAL T: Antiseptic/Antibacterial
Common generics: nitrofurantoin (Macrodantin, Macrobid) P: Urinary Anti-infective

Action: inhibits growth of bacteria in the urine

Indication: treatment and prophylaxis of lower UTIs

Serious Adverse Reactions: nausea, vomiting, diarrhea, anorexia (most common); jaundice,
hepatitis, peripheral neuropathy, pulmonary toxicity: fever, chills, cough, shortness of breath,
chest pain; anaphylaxis

Contraindicated: hypersensitivity, renal impairment; not for use in upper UTIs, pregnancy near
term or patients >65 years old
Nursing Considerations Patient Education
Monitor urine may turn brown (harmless)
BUN, creatinine, WBC count do not take OTC antacids
admin after meals or bedtime to reduce GI report rash, itching, tingling to HCP
effects take after meals or at bedtime
teach patient s/s of adverse effects

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 RENAL & URINARY MEDS

ANTISPASMODICS CLASS
T: Antispasmodic
Common generics: darifenacin (Enablex), mirabegron (Myrbetriq),
P: Anticholinergic
oxybutynin (Ditropan), solifenacin (VESIcare)

Action: inhibits muscarinic (cholinergic) receptors which results in bladder smooth muscle
relaxing
Indication: treatment of overactive bladder (urge incontinence, frequency, urgency)

Serious Adverse Reactions: nausea, vomiting, anorexia, constipation, dry mouth, dry eyes,
blurred vision, tachycardia, dizziness, drowsiness, urinary retention, agitation/confusion in older
adults, angioedema

Contraindicated: glaucoma ( intraocular pressure), urinary retention; bowel or urinary

obstruction; caution in lactation

Anticholinergic Side Effects

HOT, DRY, RED

ANTISPASMODICS
Nursing Considerations CONTINUED
Monitor
for s/s toxicity & allergic reaction – confusion, agitation, restlessness, hallucinations,
tachycardia, red face, hyper/hypotension; angioedema
I&O
tablets must be swallowed whole not chewed
give hard candy for dry mouth

Patient Education
teach anticholinergic effects – report urinary retention
avoid driving until effects known
discontinue medication & report swelling of face, lips, tongue, or trouble breathing

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 RENAL & URINARY MEDS

SUFFIX: -osin, -zosin

BPH ALPHA BLOCKERS CLASS
T: BPH Alpha Blocker;
Common generics: alfuzosin (Uroxatrol), doxazosin (Cardura), Antihypertensive
Tamsulosin (Flomax), terazosin (No US brand) P: Alpha 1A Blocker

Action: acts on the sympathetic nervous system, relaxing the prostate and bladder neck muscles,
which allows urine to flow more easily

Indication: management of benign prostatic hyperplasia (BPH)

Serious Adverse Reactions: dizziness, nausea, diarrhea, libido, sexual dysfunction, diminished
ejaculation, first-dose hypotension, syncope, palpitations especially in elderly
Contraindicated: hypersensitivity, caution in elderly

Nursing Considerations Patient Education

first-dose fall risk take medication at night to avoid falling
toxicity common in elderly men
avoid driving until effects known
fall precautions for nursing facility
residents avoid alcohol

SUFFIX: -steride 5-ALPHA REDUCTASE INHIBITORS CLASS

(ANDROGEN INHIBITORS) T: BPH Agent
P: 5-alpha-reductase-
Common generics: dutasteride (Avodart), finasteride (Propecia) inhibitor

Action: inhibits 5-alpha-reductase preventing testosterone conversion to DHT, size of prostate

Indication: management of BPH symptoms in men; finasteride is also used to treat male pattern
baldness (androgenic alopecia)

Serious Adverse Reactions: libido, sexual dysfunction, diminished ejaculation

Contraindicated: hypersensitivity, pregnant women, and of childbearing age, lactation, children

Nursing Considerations Patient Education

obtain baseline PSA before starting therapy may take up to 6 months for full effect
Asses exposure to finasteride in pregnancy can
starting of urinary stream, cause birth defects
hesitancy, frequency, urgency, nocturia
tablets can be absorbed by the skin
Pregnancy semen of a partner taking finasteride
Category X
sexual s/e decrease with continued use

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 RENAL & URINARY MEDS

Suffix -afil PHOSPHODIESTERASE TYPE 5 INHIBITORS CLASS

T: Anti-Impotence Agent
Common generics: sildenafil (Viagra), tadalafil (Cialis), vardenafil P: PDE5 Inhibitor
(Levitra)

Action: causes smooth muscle to relax and increases blood flow

Indication: treatment of erectile dysfunction; sildenafil (Revatio) treats pulmonary arterial

hypertension (PAH)

Serious Adverse Reactions: headache, dizziness, flushing, ototoxicity, UTI

Contraindicated: taken with nitrates (vasodilators) causes life-threatening hypotension,

hypersensitivity, hypotension, optic neuropathy, CV disease

Caution when combining with antihypertensives

PHOSPHODIESTERASE TYPE 5 INHIBITORS

CONTINUED

Nursing Considerations
PDE5 inhibitors cause systemic vasodilation and should not be taken with any
other vasodilators!

Interactions
AZOLE ANTIFUNGALS
ERYTHROMYCIN
sildenafil levels

Patient Education
Report Immediately
erection lasting longer than 4 hours
sudden vision loss
sudden or any hearing loss

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 RENAL & URINARY MEDS

Suffix -poetin ANTIANEMIC CLASS

T: Antianemic
P: Hormone
Common generics: epoetin alfa (Epogen)

Action: stimulates red blood cell production (erythropoiesis)

Indication: treatment of anemia caused by chronic kidney disease, chemotherapy, zidovudine

Serious Adverse Reactions: hypertension, headache, seizures, heart failure; blood clots
stroke, myocardial infarction, cardiac arrest

Contraindicated: hypersensitivity, uncontrolled hypertension

ANTIANEMIC
CONTINUED

Nursing Considerations Patient Education

Monitor do not drive during therapy
BP, CBC w/differential iron containing foods – eggs, meat
ferritin, transferrin, iron levels monitor blood pressure at home
aPTT, INR
dialysis shunt (thrill & bruit)

dialysis patient may need heparin

initiate seizure precautions
as Hct increases BP rises
Hct increase of >4 pts in 2 weeks = risk of seizure

Do not shake vial – makes it inactive

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 MUSCULOSKELETAL MEDS

DMARDs: Disease-modifying anti- ANTIARTHRITICS CLASS

rheumatic drugs T: DMARDs
TNF: Tumor Necrosis Factor P: TNF Blocker
Common generics: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade)

Action: inhibits tumor necrosis factor (TNF) by binding to it; (TNF regulates immune cells and is
responsible for the inflammatory response)
Indication: RA, ankylosing spondylitis, juvenile arthritis, plaque psoriasis, Crohn’s disease, UC
Serious Adverse Reactions: common-injection site reactions, headache, rash; serious infections,
increase risk of cancers, antibody development, bone marrow suppression (pancytopenia)
Contraindicated: hypersensitivity, active infections (e.g., active & latent TB), herpes zoster, sepsis

Nursing Considerations
Patient Education
Monitor
avoid people who are sick
s/s infection (e.g., resp. fungal)
notify HCP immediately if you get an
CBC w/differential, LFT, antinuclear
infection
antibody (ANA)

TB test before starting medication

effectiveness of therapy

ANTIARTHRITICS CLASS
T: DMARDs
Common generics: methotrexate (Otrexup), sulfasalazine,
P: Antiarthritic
(Azulfadine), hydroxychloroquine (Plaquenil), leflunomide (Arava)

Action: DMARDs act via different mechanisms to suppress immune and inflammatory response

Indication: RA, systemic lupus erythematosus (SLE), juvenile arthritis, Sjogren’s syndrome,
ulcerative colitis

Serious Adverse Reactions: nausea, vomiting, diarrhea, dyspepsia, liver enzymes (hepatotoxic),
alopecia (reversable), dizziness

Contraindicated: hypersensitivity to sulfonamides (for sulfasalazine); pregnancy, liver

impairment, blood dyscrasias (disorders)
Patient Education
Nursing Considerations
increase fluids w/sulfasalazine
Monitor
use contraceptives, do not breastfeed
for pregnancy
CBC, LFT, BUN, blood pressure avoid alcohol
report fever, sore throat, chills, cough, s/s
for dry cough (pneumonitis) infection
report vision changes (hydroxychloroquine)

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 MUSCULOSKELETAL MEDS

Muscle relaxants are centrally acting MUSCLE RELAXANTS CLASS

(act on CNS neuron activity) OR T: Skeletal Muscle Relaxant
CENTRALLY ACTING
direct acting (act on skeletal P: Skeletal Muscle Relaxant
muscles)
Common generics: baclofen (Gablofen), cyclobenzaprine (Amrix), metaxalone (Skelaxin),
methocarbamol (Robaxin), tizanidine (Zanaflex)
Action: relaxes skeletal muscles through CNS depression
Indication: acute, painful musculoskeletal conditions, spasticity (clonus, multiple sclerosis,
spinal cord lesions)

Serious Adverse Reactions: drowsiness, muscle weakness, hepatoxicity, dry mouth, nausea,
dyspepsia, constipation, hypotension, withdrawal symptoms if abrupt cessation
Contraindicated: heart, liver or renal disease, other CNS depressants (e.g., opioids, TCAs,
barbiturates, sedatives); No cyclobenzaprine if MAOIs within 14 days; No IV methocarbamol in
renal impairment
Patient Education
Nursing Considerations
avoid alcohol & other CNS depressants
Monitor Do not stop
take with food, fluids, fiber
LFT, RFT medication
for CNS effects report urinary retention
abruptly
report blurred vision, hives, nasal
congestion

MUSCLE RELAXANTS CLASS

DIRECT ACTING T: Skeletal Muscle Relaxant
P: Skeletal Muscle Relaxant
Common generic: dantrolene (Dantrium)
Action: acts directly on skeletal muscle by inhibiting the release of calcium decreased
muscle contraction
Indication: life-threatening malignant hyperthermia (a reaction to general anesthesia), chronic
spasticity w/spinal cord injury, multiple sclerosis, cerebral palsy, stroke

Serious Adverse Reactions: hepatotoxicity, GI bleeding, urinary bleeding, incontinence,

impotence, muscle weakness (myalgia), photosensitivity

Contraindicated: liver disease, cardiovascular disease, respiratory depression, lactation; caution

in pregnancy
Nursing Considerations Patient Education
Monitor
LFT baseline and during therapy
avoid alcohol & other CNS depressants
IV site for irritation
report yellow skin or eyes immediately
discontinue if s/s of liver injury
bloody or tarry stools
assess neuromuscular status for baseline
use sunscreen/wear protective clothing

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 MUSCULOSKELETAL MEDS

ANTIGOUT CLASS
T: Antigout Agent
Common generics: allopurinol (Zyloprim) P: Xanthine Oxidase Inhibitor
Action: inhibits xanthine oxidase which decreases uric acid production
Indication: treatment and prevention of gouty arthritis attacks, manage hyperuricemia

Adverse Reactions: nausea, vomiting, diarrhea, hypersensitivity, bone marrow suppression

Contraindicated: caution in patients with hepatic, renal, cardiovascular and GI disease

Increases effects of anticoagulants (warfarin), immunosuppressants (azathioprine), oral

hypoglycemics (metformin)

Given with an NSAID or colchicine can help prevent acute attacks during initiation of therapy

Nursing Considerations Patient Education

Monitor
assess uric acid level report flu-like symptoms, rash, or fever
report urinary changes, jaundice
I&O, CBC w/diff, LFT, RFT, glucose no aspirin - can cause flare up
fluid intake of 2000-3000 mL/day (kidney avoid high purine foods – red meat, organ
stones) meat, sardines, alcohol, caffeine

CLASS
ANTIGOUT T: Antigout Agent
Common generics: colchicine (Colcrys) P: Antigout Agent

Action: disrupts leukocytes (WBC) reducing the inflammatory response uric acid

Indication: treatment and prevention of acute gouty arthritis flare ups

Serious Adverse Reactions: nausea, vomiting, diarrhea, headache, alopecia, bone marrow
suppression, AST and ALT, rhabdomyolysis

Contraindicated: renal and hepatic impairment; caution in renal impairment, alcoholism, GI

disease, older patients

Nursing Considerations
Patient Education
Monitor
avoid high purine foods
LFT, RFT, CBC w/differential
avoid grapefruit juice
I&O, respiratory status
no aspirin - can cause flare up
report nausea, vomiting, diarrhea, bruising,
if GI s/s withhold med & notify PHCP
bleeding, rash
report dark or urine, muscle
pain/weakness (rhabdo)

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 MUSCULOSKELETAL MEDS

ANTIGOUT CLASS
T: Antigout
Common generics: probenecid (generic only) P: Uricosuric

Action: probenecid – inhibits the reabsorption of uric acid in the tubules more excretion and
lower serum uric acid levels

Indication: treats hyperuricemia associated with gout

Adverse Reactions: nausea, vomiting, GERD, dizziness, headache, flushing

Contraindicated: hypersensitivity, aspirin therapy (salicylates), uric acid kidney stones, not for
initiation during an acute gout attack
aspirin uric acid levels
Nursing Considerations
Monitor Patient Education
assess uric acid level
I&O, CBC w/differential take with food to avoid mild GI s/s
LFT, RFT, glucose no aspirin - can cause flare up
fluid intake of 2000-3000 mL/day (kidney
stones)

CLASS
OSTEOPOROSIS MEDICATIONS T: Antihypercalcemic
medications that decrease bone resorption P: Hormone
(breakdown) and promote bone formation
Common generics: calcitonin-salmon (Miacalcin)

Action: inhibits osteoclastic bone resorption and promotes renal excretion decrease in serum
calcium
Indication: treat postmenopausal osteoporosis, hypercalcemia, Paget’s disease of bone

Serious Adverse Reactions: hypersensitivity, anaphylaxis, nausea, vomiting, diarrhea, flushing of

face, itching, tingling palms

Contraindicated: hypersensitivity, allergy to fish Calcitonin tones it down!

Nursing Considerations
Assess Patient Education
for fish allergies
take medication exactly as directed
for tetany (Trousseau’s & Chvostek’s signs)
diet - calcium & vitamin D
Monitor report rash, hives, wheezing, swelling of
EKG, calcium levels (9-11 mg/dL) face, lips, tongue
check nostrils for irritation w/intranasal rt

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 MUSCULOSKELETAL MEDS

OSTEOPOROSIS MEDICATIONS CLASS

T: Antihypercalcemic
Common generics: alendronate (Fosamax), ibandronate (Boniva), P: Biphosphonate
pamidronate (Aredia), risedronate (Actonel), zoledronic acid (Zometa)
Action: inhibits osteoclastic bone resorption decreased serum calcium and increased total
bone mass
Indication: postmenopausal osteoporosis, male osteoporosis, Paget’s disease of bone,
hypercalcemia associated with cancer
Adverse Reactions: esophagitis, acid reflux, muscle pain, eye inflammation;
hypo- calcemia, -phosphatemia, -kalemia, -magnesia

Contraindicated: esophageal disorders, unable sit upright for 30 minutes

Nursing Considerations
Patient Education
Monitor
take in morning w/full glass of water,
electrolyte levels, vit D - baseline & therapy
before any food, beverage
CBC w/differential
sit upright for 30 minutes – no food,
admin on empty stomach w/water
beverage
teach patient – adequate fluids, dental care
report side effects
Raloxifene is a bone resorption inhibitor AND antineoplastic and is included in the Immune Medications section.

CLASS
OSTEOPOROSIS MEDICATIONS T: Antihypercalcemic
P: Monoclonal Antibody,
Common generics: denosumab (Prolia and Xgeva)
RANKL inhibitor

Action: binds to RANKL and inhibits osteoclast formation leading to bone resorption & bone
density; RANKL (receptor activator of nuclear factor kappa-B ligand)
Indication: osteoporosis, cancer-related hypercalcemia, bone cancer
Serious Adverse Reactions: fatigue, rash, hypocalcemia, hypophosphatemia,
hypercholesterolemia, SOB, peripheral edema, weakness, back pain, musculoskeletal pain,
osteonecrosis of the jaw

Contraindicated: hypersensitivity, hypocalcemia, pregnancy

Nursing Considerations Patient Education

Assess
for pregnancy, breastfeeding
have dental check-ups regularly
Ca+, vit D, K+, phosphorous levels before
notify HCP if pregnancy possible
administration notify HCP of muscle cramps, numbness,
monitor creatinine, Ca+ and vit D tingling, fever, red or swollen skin, jaw pain,
SOB, severe stomach or back pain

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 MATERNITY & NEWBORN MEDICATIONS

TOCOLYTICS CLASS
T: Tocolytic
Common generics: magnesium sulfate (magnesium salt) P: Magnesium Salt,
Action: relaxes smooth muscle; a CNS depressant Antiseizure Agent

Indication: stops preterm uterine contractions; prevention of seizures in preeclampsia and

eclampsia (also may be prescribed for 12-24 hrs postpartum) use IV infusion pump
Serious Adverse: maternal – respirations, deep tendon reflexes; pulmonary edema,
hypotension; fetal – muscle tone (hypotonia), drowsiness

Contraindicated: MI, heart block, renal failure; caution in patients with renal impairment

High doses can cause cardiac arrest! Antidote - calcium gluconate

Therapeutic range 4 to 7.5 mEq/L
Nursing Considerations when used as a tocolytic
every 30 - 60
Monitor
vital signs, O2 sat, respirations minutes minimum
magnesium sulfate is stopped
EKG, DTR (hourly), LOC, renal function for delivery only if patient
I &O hourly, uterine activity, fetal heart rate having a C-section
IV admin closely for s/s toxicity - check knee reflex & respiration
call OB if respirations <12 per min, other adverse rate before administering a
for risk of magnesium toxicity in newborn repeat parenteral dose

TOCOLYTICS CLASS
T: Tocolytics
Common generic: nifedipine (Adalat CC) P: Calcium Channel Blocker

Action: relaxes smooth muscle

Indication: stops preterm uterine contractions; severe HTN during pregnancy & post-partum
nifedipine is for SHORT TERM use – up to 48 hours
Serious Adverse Reactions: maternal – tachycardia, hypotension, dizziness, nausea, anxiety,
flushing; fetal – vascular dilation
Contraindicated: maternal – uncontrolled diabetes, vaginal bleeding, preeclampsia, placental
abruption (detached), uterine infection; fetal – cervix dilated >4cm, >37 weeks gestational age,
fatal fetal anomaly (FFA), non-reassuring fetal status

Nursing Considerations
patient on side
Monitor
vital signs, fetal and labor status frequently placental perfusion &
for adverse effects cervical pressure
I&O, daily weight concurrent use with magnesium
provide comfort & support sulfate can cause severe
hypotension

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 MATERNITY & NEWBORN MEDICATIONS

CORTICOSTEROIDS CLASS
T: Corticosteroid
P: Corticosteroid (Systemic)
Common generics: betamethasone, dexamethasone (Ozurdex)
Action: accelerates fetal lung development (increases production of surfactant)

Indication: patients at risk of preterm delivery at 28 – 32 weeks to decrease risk of or severity of

respiratory distress syndrome in the newborn; a total of two doses given to mother every 24
hours (max 48 hour tx) by IM injection No IV or Subcut!
Serious Adverse Reactions: risk of infections, hyperglycemia, fluid and sodium retention,
pulmonary edema
Contraindicated: hypersensitivity, systemic infection, benefit must outweigh risks

Nursing Considerations
Monitor
vital signs, lung sounds
blood glucose (esp. patients with DM)
WBC, electrolytes, infection

LUNG SURFACTANTS CLASS

T: Lung Surfactant
P: Lung Surfactant
Common generics: beractant (Survanta), calfactant (Infasurf),
poractant (Curosuf); *notice generics have -actant in the name; brand names have sur or surf in
the name
Action: replaces deficient lung surfactant reducing surface tension and preventing alveoli
from collapsing upon expiration
Indication: prophylaxis and rescue of respiratory distress syndrome (RDS) in the preterm newborn
Serious Adverse Reactions: transient bradycardia and oxygen desaturation; hypotension,
mucus plugging, sepsis
Contraindicated: none if it is an emergency rescue treatment (all risks are outweighed by the
benefit of saving the infants life);
Nursing Considerations
instill medication through the catheter in the endotracheal tube
avoid suctioning for 2 hours after admin to allow drug time to work
Monitor
provide support to parent(s) of
for bradycardia, O2 saturation during administration
respiratory status, lung sounds the newborn; explain use of
adverse effects medication

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 MATERNITY & NEWBORN MEDICATIONS

PROSTAGLANDINS CLASS
T: Oxytocic
SUFFIX: -prost-
P: Prostaglandin

Common generics: Prostalandin E1 (PGE1): misprostol intravaginal tablet;

Prostaglandin E2 (PGE2): dinoprostone (Cervidil) vaginal gel, or insert (cervical ripening),
suppository (abortion)
Action: stimulates the myometrium, ripening and dilating the cervix
Indication:VMTIRMRKXLIGIVZM\FIJSVIMRHYGMRKPEFSVMJ'MWLSTWGSVIMWǷ4
Adverse Reactions: nausea, vomiting, diarrhea, stomach cramps (effects on GI smooth muscle),
fever, headache, uterine tachysystole, fetus passing meconium

Contraindicated: hypersensitivity, contraindicated vaginal delivery (e.g., active genital herpes,

complete placenta previa), unexplained vaginal bleeding, acute pelvic inflammatory disease,
active cardiac, pulmonary, renal, or hepatic disease, asthma, glaucoma, history of C-section,
major uterine surgery, cephalopelvic disproportion, maternal infection, non-reassuring fetal heart
rate

PROSTAGLANDINS
CONTINUED

Nursing Considerations
Monitor
maternal vital signs, fetal heart rate (FHR) pattern
for adverse effects esp. maternal fever
signs of labor

patient on her side (left lateral tilt) takes pressure off inferior vena cava
discontinue if adverse effects (e.g., uterine hyperstimulation, fetal distress)
HMWGSRXMRYI[LIR'MWLSTWGSVIMWǸ47ǸGSRXVEGXMSRWMRQMnutes
remove prostaglandin 6 – 12 hours if administering oxytocin

*Opioids are used to relieve pain during labor.

Naloxone is the antidote for opioids.
See the Neurologic System Medications for information on opioids.

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 MATERNITY & NEWBORN MEDICATIONS

UTERINE STIMULANTS CLASS

T: Hormone
OXYTOCIN P: Oxytocic
SUFFIX: -tocin
Common generics: oxytocin (Pitocin)

Action: stimulates smooth muscle of the uterus and mammary glands; increases the strength and
frequency of contractions, promotes lactation

Indication: to induce or enhance labor, to control postpartum bleeding and hemorrhage; can be
used to manage or induce abortion (abortifacient)

Serious Adverse Reactions: N/V common effects, arrhythmias, anaphylaxis,

hypo/hypertension, water intoxication, postpartum hemorrhage, uterine rupture

Contraindicated: hypersensitivity, contraindicated vaginal delivery (e.g., active genital herpes,

complete placenta previa), cephalopelvic disproportion, fetus in abnormal position,
hypertonic/hyperactive uterus

OXYTOCIN
CONTINUED

Nursing Considerations
Establish baseline & then:
Monitor Every 15 Minutes:
maternal BP, HR, I&O, lung sounds, LOC
frequency and duration of contractions
resting uterine tone

fetal heart rate - notify OB if non-reassuring

Stop Medication:
if hypertonic contractions (longer than 60 seconds)
or a non-reassuring fetal heart rate occurs
turn patient on her side
Have magnesium sulfate on hand
Stay with patient while oxytocin is infusing

Usually piggybacked into main IV fluids at

port nearest patient

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 MATERNITY & NEWBORN MEDICATIONS

POSTPARTUM HEMORRHAGE

Medications Used to Manage Postpartum Hemorrhage:

tƲƳƍŗüĮŎͩ͒àŎͩŗƲƳƍŗüĮü͕ͩͩƄĉĉͩàûŗƬĉ͓ͩ͒–ĮƍŗüĮŎ͓

àżûŗŹżŗƄƍͩƍżŗŌĉƍĩàŌĮŎĉͩ͒ŹżŗƄƍàĢńàŎăĮŎͩA˷à͓ͩ͒IĉŌàûàƍĉ͓
Contraindicated: pulmonary (asthma), CV, renal, or hepatic disease; pelvic inflammatory disease
Adverse effects: nausea, vomiting, diarrhea, headache, fever, hypertension
Monitor: vital signs, vaginal bleeding, uterine tone

iĉƍĩƳńĉżĢŗŎŗƬĮŎĉͩ͒àŎͩĉżĢŗƍͩàńŁàńŗĮă͓ͩ͒iĉƍĩĉżĢĮŎĉ͓
stimulates uterine smooth muscle
administered AFTER birth of the placenta
Adverse effects: vasoconstriction, vasospasm of coronary arteries, painful uterine cramping,
dysrhythmias, MI, HTN crisis, stroke (CVA)
Contraindicated: pregnancy, hypertension, preeclampsia, CV disease, PVD

POSTPARTUM HEMORRHAGE
CONTINUED

Nursing Considerations
Assess BP before administering
Monitor
vital signs esp. BP – if BP notify OB
I&O, weight, lung sounds, LOC, EKG
uterine contractions and tone, vaginal bleeding
watch for adverse effects – notify OB if chest pain, SOB, other adverse

An analgesic for painful uterine contractions and an antiemetic for nausea may be
prescribed with these medications.

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 MATERNITY & NEWBORN MEDICATIONS

Rho(D) Immune Globulin CLASS

T: Immune Globulin
P: Immune Globulin
Common generics: Rho(D) immune globulin (HyperRHO SD)
Action: suppresses the immune response and antibody formation prevents isoimmunization

Indication: (derived from human plasma), given to prevent anti-Rho(D) antibody formation in Rh-
negative patients who are exposed/potentially exposed to Rh-positive blood by childbirth,
amniocentesis, transfusion, etc. and immune thrombocytopenia
Serious Adverse Reactions: fever, chills, headache, injection site reactions, antibody
development

Contraindicated: hypersensitivity to human immunoglobulins, Rh-positive patients

Nursing Considerations
administered at 28 weeks gestation and 72 hours after delivery
IM only – never IV for pregnancy!
maternal - Not given to the newborn
monitor for fever, injection site & allergic reactions

RUBELLA VACCINE CLASS

T: Vaccine
P: Vaccine, Live Viral

Common generics: rubella virus vaccine live (Meruvax)

Action: a live vaccine producing a humoral as well as a cell-mediated immune response

Indication: a postpartum patient with a rubella titer <1:8 is given via subcut prior to discharge to
avoid congenital rubella syndrome with any future children

Adverse Reactions: hypersensitivity, fever, transient rash, joint tenderness

Contraindicated: allergy to gelatin, pregnancy, lactation; caution in immunocompromised

Nursing Considerations Patient Education

monitor for 15 minutes after administration use birth control for 3 months after
vaccination

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 MATERNITY & NEWBORN MEDICATIONS

EYE PROPHYLAXIS CLASS

T: Antibiotic
P: Ophthalmic Antibiotic

Common generic: erythromycin

Action: erythromycin is both bacteriostatic and bactericidal

Indication: prevention of Neisseria gonorrhoeae and Chlamydia trachomatis in the newborn

(required in the United States)

Nursing Considerations
After allowing mother-baby eye contact/bonding:
clean the newborn’s eyes before instilling medication
do not clean the eyes after instillation

VITAMIN K CLASS
T: Vitamin
(PHYTONADIONE)
P: Vitamin, Fat-soluble

Common generics: phytonadione (Mephyton)

Action: Vitamin K is essential for coagulation, but it is not produced until intestinal bacteria
are present. Newborns lack intestinal bacteria for up to 8 days so are therefore vitamin K
deficient which makes them susceptible to bleeding.
Indication: treatment and prevention of vitamin K deficiency bleeding in newborns

Serious Adverse Reactions: rare hyperbilirubinemia

Nursing Considerations
After allowing mother-baby eye contact/bonding:
administer within 1 hour
IM in the vastus lateralis muscle of the thigh
Monitor
for bleeding from the umbilical cord
injection site
for jaundice, bilirubin level

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 MATERNITY & NEWBORN MEDICATIONS

HEPATITIS B VACCINE CLASS

T: Vaccine
P: Vaccine, Inactivated Viral

Indication: given to the newborn before discharge to prevent hepatitis B; within 48 hours of birth

Adverse Reactions: fever, rash, redness, and pain at the injection site

Nursing Considerations
Give IM before discharging
IM in the vastus lateralis muscle of the thigh
fill out record of administration on a vaccine card
if mother positive for Hepatitis B surface antigen give hep B
immune globulin to newborn within 12 hours of birth
must obtain parental consent

CONTRACEPTIVES CLASS
T: Contraceptives
P: Estrogen, Progestin

Common generics: Oral: ethinyl estradiol and desogestrel (Apri),

ethinylestradiol and norethindrone (Brevicon), ethinylestradiol and drospirenone (Yaz)

Available: oral, IM injection, implants, IUD, patch, vaginal ring,

Oral contraception is the most common

Action: progesterone prevents ovulation

Indication: prevention of pregnancy - estrogens combined with progestins or progestins alone;

combinations are more effective

Adverse Reactions: breakthrough bleeding, nausea, headache, breast tenderness

smoking, diabetes, hypertension risk of complications

avoid use with hepatotoxic drugs

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 MATERNITY & NEWBORN MEDICATIONS

CONTRACEPTIVES
CONTINUED

Contraindicated: smoking, hypertension, cardiovascular disease, obesity, breast & endometrial

cancers (any estrogen dependent), stoke, VTE (venous thromboembolism), pregnancy

Nursing Considerations
Monitor weight & vital signs

Patient Education
take oral contraceptives 21 days, 7 days off (placebo pill)
takes up to 7 days for full effect
if trying to become pregnant, use other birth control for 2 mos
if diabetic monitor glucose more closely
breast self-exam, and annual physical important
antibiotics reduce effectiveness of hormonal contraceptives
Patches Off For:
<24 hours stick back on or replace w/new
>24 hours must start a new 4-week cycle

CLASS
FERTILITY MEDICATIONS T: Fertility Medication
P: Gonadotropin

Common generics: chorionic gonadotropin (Chorex), clomiphene citrate (Clomid), follitropin alfa
(Gonal-F), follitropin beta (Follistim), menotropins (Pergonal), ganirelix (Antagon)

Action: stimulates follicles and ovulation in functioning ovaries

Indication: infertility in women with functioning ovaries whose partners are fertile
Serious Adverse Reactions: risk of multiple births and birth defects, ovarian
hyperstimulation syndrome (abdominal pain, distention, pleural effusion, ascites), nausea,
vomiting, fluid retention, orthostatic hypotension

Contraindicated: ovarian failure, thyroid or adrenal dysfunction, ovarian cysts, idiopathic uterine
bleeding, pregnancy, thromboembolic disease, respiratory disease

Nursing Considerations Patient Education

Monitor how to administer medication
assess for contraindications, cautions when intercourse should occur
monitor hormone levels, LFT, RFT risk of multiple births
report adverse effects to OB

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 IV FLUIDS

ISOTONIC
same osmolality as body fluids
does not enter the cell because there is no osmotic force to shift fluids
so, isotonic solutions increase extracellular fluid volume

TYPE USE
0.9% saline (NS) extracellular fluid, burns, with blood products, low serum sodium
Not used in patients with heart failure, renal impairment, pulmonary edema because the
sodium solution will cause more fluid retention

Lactated Ringers extracellular fluid, burns, dehydration from diarrhea, bleeding

Not given to hyperkalemic, liver disease, renal impaired
Contains water, sodium, potassium, chloride, calcium, lactate

5% dextrose in water (D5W) to replace total body water, treat hypernatremia

5%dextrose in 0.225% saline (5% D/1/4 NS) as initial fluid hydration >water than sodium
D5W is initially isotonic, but when dextrose is metabolized it becomes hypotonic

Pediatric, elderly, and patients with cardiac, respiratory, or liver disease have an increased risk
for circulatory overload (fluid overload).

hypo = low
HYPOTONIC concentration of solutes
more dilute solution ( concentration of solutes)
lower osmolality than body fluids, water enters cells by osmosis
increases cellular fluid volume

causes cells to swell infuse slowly can cause cell rupture

TYPE USE
0.45% saline (1/2 NS) to replace water in hypovolemia w/hypernatremia, DKA/HHS (no
0.33% saline (1/3 NS) glucose)
0.225% saline (1/4 NS)
Do not use with blood products
Increases risk of ICP
not for burns, trauma, liver disease
monitor for cell lysis, hypovolemia, BP

Pediatric, elderly, and patients with cardiac, respiratory, or liver disease have an increased risk
for circulatory overload (fluid overload).

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 IV FLUIDS

hyper = high
HYPERTONIC concentration of solutes

more concentrated solutions ( concentration of solutes)

higher osmolality than body fluids
cause water to move from cells into the extracellular fluid causes cells to shrink
decrease cellular fluid volume
administer via a central line, not peripherally
risk of hypervolemia,
monitor for pulmonary edema, BP, JVD

TYPE USE
5% dextrose in 0.9% saline extracellular fluid in hypovolemia, hyponatremia

5% dextrose in 0.45% saline common for maintenance fluids providing water, electrolytes,
and calories, contains more water than sodium

5% dextrose in Lactated Ringer’s extracellular fluid in burns, dehydration from vomiting or

diarrhea, hemorrhage

Pediatric, elderly, and patients with cardiac, respiratory, or liver disease have an increased risk
for circulatory overload (fluid overload).

IV GAUGE

16 surgery, trauma, multiple large volume infusions

18 large volume/rapid infusions in critical situations (e.g., burns, MI)

20 multi-purpose, works for most adults - not for fluid resuscitation

22 children, adults with small veins

24 infants and elderly patients with very fragile veins

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 ABBREVIATIONS

increased, high
decreased, low
ABGs arterial blood gases
ACE angiotensin-converting enzyme
ADH antidiuretic hormone
ALT alanine aminotransferase
aPTT activated partial thromboplastin time
ARDS adult respiratory distress syndrome
ASA acetylsalicylic acid
bid two times a day
BMS bone marrow suppression
BNP brain natriuretic peptide
BP blood pressure
BPH benign prostatic hyperplasia
BUN blood urea nitrogen
CBC complete blood count
CNS central nervous system
CO cardiac output
COPD chronic obstructive pulmonary disease
CPK creatine phosphokinase

CSF cerebrospinal fluid

CT computerized tomography
CV cardiovascular
CVA cerebrovascular accident
CXR chest x-ray
DKA diabetic ketoacidosis
dL deciliter
DM diabetes mellitus
DMARD disease-modulating antirheumatic drug
DVT deep vein thrombosis
ECG/EKG electrocardiogram
EEG electroencephalogram
EENT eye, ear, nose, and throat
EPS extrapyramidal symptoms
ESRD end-stage renal disease
GABA gamma-aminobutyric acid
GERD gastroesophageal reflux
GFR glomerular filtration rate
GI gastrointestinal
GTT glucose tolerance test

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 ABBREVIATIONS

GU genitourinary
HbA1c hemoglobin A1c
HCO3 bicarbonate
HCP healthcare provider
Hct hematocrit
HDL high-density lipoprotein
HF heart failure
Hgb hemoglobin
HIV human immunodeficiency virus
HTN hypertension
I&O intake and output
IBS irritable bowel syndrome
ICP intracranial pressure
IM intramuscular
IOP intraocular pressure
IV intravenous
kg kilogram
L liter
LDL low-density lipoprotein
LFT liver function test

LR lactated Ringer's solution

MAO monoamine oxidase
MAOIs monoamine oxidase inhibitors
mcg microgram
MDI metered dose inhaler
mEq milliequivalent
mg milligram
MI myocardial infarction
mL milliliter
MRI magnetic resonance imaging
MS musculoskeletal
NG nasogastric
NPO nothing by mouth
NRTI nucleoside reverse transcriptase inhibitor
NS normal saline
NSAIDs nonsteroidal antiinflammatory drugs
pc after meals
PCA patient controlled analgesia
PDE5 phosphodiesterase type 5 inhibitor
PE pulmonary embolism

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96
 ABBREVIATIONS

PO by mouth
PRN as needed
PSA prostate-specific antigen
PT prothrombin time
PUD peptic ulcer disease
qid four times a day
RA rheumatoid arthritis
RAAS renin-angiotensin-aldosterone system
RBC red blood cell
RFT renal function test
SA sinoatrial
SL sublingual
SNRIs serotonin and norepinephrine reuptake inhibitors
SOB shortness of breath
SSRIs selective serotonin reuptake inhibitors
subcut subcutaneously
TB tuberculosis
TCAs tricyclic antidepressants
tid three times a day
VFib ventricular fibrillation

VS vital signs
VT ventricular tachycardia
WBC white blood cell

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 TOP 100 PRESCRIBED DRUGS IN THE US

ALPHABETICAL BY GENERIC NAME

Acetaminophen; Hydrocodone
Acetaminophen; Oxycodone
Albuterol
Alendronate
Allopurinol
Alprazolam
Amitriptyline
Amlodipine
Amoxicillin
Amoxicillin; Clavulanate
Apixaban
Aspirin
Atenolol
Atorvastatin
Azithromycin
Budesonide; Formoterol
Bupropion
Buspirone
Carvedilol
Cephalexin
Cetirizine
Cholecalciferol
Citalopram
Clonazepam
Clonidine
Clopidogrel
Cyclobenzaprine
Dextroamphetamine
Diclofenac
Diltiazem
Doxycycline
Duloxetine
Ergocalciferol
Escitalopram
Estradiol
Ethinyl Estradiol; Norethindrone
Ethinyl Estradiol; Norgestimate
Fenofibrate
Finasteride
Fluoxetine

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 TOP 100 PRESCRIBED DRUGS IN THE US

Fluticasone
Fluticasone; Salmeterol
Folic Acid
Furosemide
Gabapentin
Glimepiride
Glipizide
Hydralazine
Hydrochlorothiazide
Hydrochlorothiazide; Lisinopril
Hydrochlorothiazide; Losartan
Hydroxyzine
Ibuprofen
Insulin Aspart
Insulin Glargine
Insulin Lispro
Lamotrigine
Latanoprost
Levetiracetam
Levothyroxine
Lisdexamfetamine
Lisinopril
Loratadine
Lorazepam
Losartan
Lovastatin
Meloxicam
Metformin
Methylphenidate
Metoprolol
Montelukast
Naproxen
Omeprazole
Ondansetron
Oxycodone
Pantoprazole
Paroxetine
Potassium
Pravastatin
Prednisone
Pregabalin

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
99
 TOP 100 PRESCRIBED DRUGS IN THE US

Propranolol
Quetiapine
Ranitidine
Rivaroxaban
Rosuvastatin
Sertraline
Simvastatin
Sitagliptin
Spironolactone
Sulfamethoxazole; Trimethoprim
Sumatriptan
Tamsulosin
Tizanidine
Topiramate
Tramadol
Trazodone
Venlafaxine
Warfarin
Zolpidem

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100
 PHARMACOLOGY

SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE
101
SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE

SUFFIX: CLASS
T:
P:
Common generics:

Action:

Indication:

Serious Adverse Reactions:

Contraindicated:

Nursing Considerations Patient Education

ALWAYS FOLLOW YOUR PROGRGAM, FACILITY, AND EMPLOYER POLICY & PROCEDURE

102



PHARMACOLOGY


Drug Class: . ............................................................

Generic Name: ..........................................................
Trade Name: ...........................................................

Therapeutic Use Route

Contraindications
Mechanism of Action

Nursing Considerations
Adverse Effects

Patient Education


103



PHARMACOLOGY


Drug Class: . ............................................................

Generic Name: ..........................................................
Trade Name: ...........................................................

Therapeutic Use Route

Contraindications
Mechanism of Action

Nursing Considerations
Adverse Effects

Patient Education


104